With the Recovery Act and HITECH Act of 2009 reimbursing clinicians for purchasing and implementing an EHR and the Patient Accountability Act (aka Obamacare) requiring an EHR for meaningful use, EHR's have become more common throughout the medical community.  Unfortunately one of the side effects of this was that EHR vendors, as part of their sales pitch, were telling Clinicians that with the new EHR systems they would no longer need Transcription; just use the template system or the built in voice recognition system.  The clinician gets a check from the government, meets meaningful use and cuts out the costs of Transcription.  As the old saying goes "If it sounds too good to be true......".


    The reality is that template only systems take up to 6 times longer to document an encounter and have an average of 7.8 critical errors per encounter.  Voice recognition averages 1.48 errors per encounter.  Template only and voice recognition systems are actually costing more than they are saving.  The costs lie in reduced productivity, increased patient care issues and increased kickbacks on claims.

    CMS has recognized the increase in errors in these systems and has stated that use of a templated only system does not meet meaningful use requirements.  This was mentioned several times and then finally clarified in the December 10, 2012 CMS Manual System Change Request 8033, Transmittal 438, section 8033.3 "Review contractors shall remember that progress notes created with limited space templates in the absence of other acceptable medical record entries do not constitute sufficient documentation of a face-to-face visit and medical examination."


    The Hybrid Solution consists of Templates and Human Based Transcription with Intelligent Interface.  In a Hybrid Solution part of the encounter is documented using templates (most commonly done by Medical Assistants) while the interpretive part is dictated by the clinician.  The encounter documentation is then transcribed, quality assured, and delivered via Intelligent Interface to the EHR.  The EHR then splits the  encounter documentation and populates it into the appropriate sections of the EHR.  Example S.O.A.P. note, Subjective is populated in the Subjective section of the EHR, the Objective is populated into the Objective section of the EHR, etc.