Medication Errors in Nursing Homes – Part 2

  • Estimated one adverse drug event occurs per patient per day
  • Treating avoidable events conservatively cost $billions annually
  • Information technology plays a key role in improving resident medication safety

Nursing home residents take an average of eight medications per month. One-third of them take nine or more. Despite the excellent care provided to these residents, one avoidable adverse drug related event is estimated to occur per resident per day at an annual healthcare cost of billions. Many events are caused by inefficient information systems offering incomplete or inaccurate information to the clinician. Increasing access to accurate resident specific information empowers physicians in perhaps their most important role in long-term care facilities; that of monitoring for inevitable drug interactions between diseases, symptoms and other drugs in the medication use process. Three emerging technologies (EMRs, CPOE and CDSS) actively enlist clinician participation in this ongoing process.

Information Technology (IT) Opportunities

Electronic medical records (EMRs) store resident specific information electronically thus centralizing information and enhancing operational efficiencies for clinicians and the interdisciplinary team. Other benefits include:

  • Increased accessibility to and sharing of information
  • Ongoing clinician maintenance and review of the resident specific medication list
  • Legible clinician documentation consistently compliant with regulatory language
  • Enhanced systematic surveillance of disease/symptom/drug monitoring
  • Updated drug information resources

Computerized Physician Order Entry (CPOE)

CPOE enables electronic entry of clinician orders. Prescribing medications electronically with an EMR is safer and more reliable than paper based prescribing and reduces medication error rates.

Clinical Decision Support Systems (CDSS)

Clinical decision support systems provide care guidelines to clinicians and promotes resident safety, education and communication. Diagnosis specific treatment guidelines (e.g., myocardial infarction plus aspirin or atrial fibrillation plus warfarin) support optimal health through proactive disease management. Automated resident-specific reminders for drug allergies, interactions, dosing adjustments and evidence-based interventions prevent errors of omission. The reminders become a reliably consistent surrogate for resources inefficiently spent in retrospective, individual chart reviews. When combined with clinical decision support systems CPOE reduce medication errors by 80 percent. Benefits of CPOE and CDSS include:

  • Better documentation for drug usage indications, allergies and interactions
  • Warning messages triggered by incomplete, incorrect or excessive dosing orders
  • Improvements in therapeutic drug dosing adjustments
  • Avoidance of preventable pharmacotherapeutic organ toxicity
  • Improved clinician adherence to guideline-based care
  • Positive influence on provider prescribing behavior
  • Increased adherence to corollary orders

Cultural Changes

Residents and families, institutional partners and third party payers now expect system approaches to ensure policies and procedures follow evolving standards of care. Cost related quicker and sicker hospital discharges into nursing facilities and lawsuits involving adverse drug events are a few of the change drivers for using these integrated information systems to improve communication efficiency and quality of care. Despite demonstrated improvements using an EMR, CPOE and CDSS, the long term care industry has been slow to voluntarily adopt these technologies. The government is considering mandating e-prescribing as requisite for physician Medicare participation with all prescriptions being written electronically by 2010.

Raise the Bar

Specialty EMR, CPOE and CDSS give institutions and clinicians the ability to revolutionize healthcare quality with accurate, comprehensive information systems. The time has come for us to use electronic medical records and embrace a higher standard of resident safety and advocacy in long term care by integrating these systems into the disease and medication monitoring process. This ensures clinicians and facilities deliver the best care they are capable of and that residents receive the excellent care they deserve.

Speech Recognition Technology and Medical Transcription Services

:An Overview:

Speech is now not confined solely to the human race, or even living beings on a broader perspective. It has extended to the World of Technology; specifically Computers and Software. Speech Recognition Technology [SRT], little known until recent times, is an area that has been constantly growing over the years. SRT has opened new windows of panoramic dimensions to human kind.

Speech Recognition Technology – Defined:

A technology wherein a machine or program identifies spoken words and phrases and converts them to readable format. In more simpler terms, voice/speech is converted to text format.

The Beginning:

Speech Recognition Technology, as we know it today, did not just bloom overnight. It is the work of over 30 years. The very first implementation of Speech Recognition was designed and displayed by IBM during the 1964 New York World’s Fair. It was called the IBM Shoebox; and typically sized too. This device only recognized spoken digits from 0 to 9. Over the years, Software companies have delved upon the benefits and the profits that can be reaped from developing SRT, and they have come a long way since. Now many noted companies have come up with different versions of this technology, offering various features.
While Speech Recognition has progressed vastly, the downside is that it has been a long and laborious road this far. It calls for training and updating of Software to work flawlessly; and it is currently far from perfect. There is so much more to go before it can be said that SRT is without any imperfections.

Speech Recognition Technology – In Health Care and Medical Transcription:

An area where this technology has caught on to a great extent is the Medical Transcription Industry. Speech Recognition is of two types: Front End and Back End.

  • Front End: As the doctor dictates into the machine, the words are automatically generated and displayed. This text can be edited directly, the report finalized, and signed by the doctor immediately. But there are few Front end users due to time constraints faced by doctors and practitioners.
  • Back End: Also called Delayed or Deferred Speech Recognition. The written draft is generated by the Software and sent to the Medical Transcriptionists for editing and proof reading. This is more convenient for doctors as it requires less time spent reading the proofs.
  • EMR: Speech Recognition can be applied in Electronic Medical Record systems of hospitals, clinics, etc. Searches, queries, and even filling up of forms can be made simpler and faster with voice rather than using the keyboard.


Speech Recognition Technology can be advantageous to both Medical Transcriptionists as well as doctors in a number of ways. A few advantages are:

  • There is not much typing involved as the first draft is generated by the software
  • Requires only editing of the machine-generated text
  • Faster turnaround of reports
  • Saves time in completion of reports
  • Stat reports can be completed and returned quicker than by using the conventional method of typing


Being a technology that has not entirely been perfected, SRT has a few drawbacks.

  • It cannot fully distinguish words spoken with heavy accents
  • Homophones (words which sound the same but may have different spellings and meanings) can cause spelling errors
  • Incorrect grammar is bound to occur in the generated texts
  • Punctuation rules are not likely to be followed at all times
  • Multiple speakers cannot be clearly differentiated
  • Background noise and disturbances may cause misspellings

Question of the Hour:

A niggling thought in the minds of many Medical Transcriptionists is whether Speech Recognition Technology poses a threat to their livelihood. This is a baseless fear, keeping in mind the drawbacks of SRT. No report will be complete until a human eye has scanned it. Machine-generated documents can only be 60%-70% error-free. It demands well-trained and professional Medical Transcriptionists to read through and edit the reports. A mistake, even a tiny one, can result in unpleasant situations for many. And one cannot rely on mere machines to do the job 100% without errors. In conclusion, Speech Recognition Technology is certainly one of a kind. While it has not yet reached the peak of perfection, it is still quite an aid to the healthcare industry, specifically Medical Transcription. And there is certainly no danger of software or machines or even technology entirely taking over man’s work; technology is just merely helping out!

Electronic Medical Records – Challenging the Medical Transcription Industry

Recently, the healthcare industry has been benefiting from the use of electronic medical records. Contrary to misconception, medical transcription is not leading to extinction yet because of EMR and other advanced technology in Toronto. Its benefits to the medical society still outweigh that of electronic medical records and voice recognition technology. That sparks hope from groups of medical transcriptionists and transcription agencies. Let’s find out the reasons why.

Why Medical Transcription?

One of the practical reasons why medical transcription flourished in the healthcare industry is convenience. Most health care provider and agencies prefer this method over handwritten notes and electronic documentation. Thus, it remains as the standard form of patient collaboration documentation.

Here are the top reasons:

Time efficient- it is highly preferred because it allows physicians to save time specifically through dictation. Writing notes is painstaking at times especially during peak hours when each doctor is on call.

Accessibility- since most doctors are using PDA, it makes it easier for them because it allows them to dictate anytime. Other means of dictation are through telephone and Dictaphone.

More Descriptive-it enables doctors to appropriately describe a patient’s condition including relevant details. Thus, it enables them to go on with conventional practice and need not to adjust to the use of EMR.

Why Not EMR?

Utilizing point and click templates, EMR systems enable healthcare providers to produce clinical documents.By simply pointing and clicking corresponding choices from a list, patient encounter can be recorded. The finished document is closely similar to notes generated from transcription.

Time Delays- the standard point and click templates present a problem to some doctors in terms navigation. It prevents them to pay attention to some data presented to them.

Template Issues- since physicians’ preferences and requirements vary; the use of standard template presents an issue specifically to their flexibility in customizing such templates.

Usability- Needless to elaborate; not all doctor are tech savvy.

The battle continues between technological advancement such as EMR and conventional medical transcription. It is important to highlight that as the medical industry leans towards technological advancement, medical transcription is adopting new technologies.