Physicians weigh in on meaningful use.

With so much speculation about the definition of "meaningful use," Nuance asked more than 15,000 of its physician customers what the term means to them. "Not only did we seek to learn what physicians consider essential elements of the definition," says Keith Belton, senior director of product marketing at Nuance, "we wanted to get their views on how, if at all, speech recognition plays a part in physicians achieving true meaningful use of electronic health records (EHR)." According to the survey:

Ninety-three percent disagree or strongly disagree that using an EHR has reduced time spent documenting care. EHRs are considered by most doctors to potentially "dumb down" the quality of patient documentation; 74 percent of the doctors surveyed said EHR cookie-cutter templates and patient notes with no uniqueness are challenges to realizing the full value of EHRs.

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When asked about qualifications that the federal government should measure as part of payouts associated with EHR meaningful use, physicians cited the following: 90 percent said access to medical records faster without waiting for records to come out of transcription was important or very important; 83 percent said more complete patient reports, with higher levels or detail on the patient's condition and visit were important or very important; 83 percent said better caregiver-to-caregiver communication based on improved reporting that is more accessible and easily shareable was important or very important; 79 percent said improved documentation by pairing the EHR point-and-click template with physician narrative was important or very important.

When asked about the importance of various EHR components, physicians identified the following as the five most important: lab test results reporting and review; tools that allow doctors to dictate a physician narrative into the EHR; e-prescribing; secure health messaging between caregivers; and keyboard support via speech recognition for data entry into the EHR.

In an era when the availability of transcription services has been sharply reduced to pay for many organizations' EHR purchases, and physicians have only the keyboard and mouse to rely on, EHR adoption has proven a struggle, according to the survey. Sixty-seven percent of the doctors surveyed cited "time associated with reliance on keyboard and mouse to document within an EHR," as a concern.

"If doctors rely solely on manual methods, they may not succeed in capturing all the necessary data within the EHR," explains Belton, "which is a priority, given the fact that 93 percent of doctors surveyed either agree or strongly agree with the statement,

"Capturing physician narrative as part of the documentation process is necessary for complete and quality patient notes."

Productivity tools that help doctors to document better care within an EHR (beyond the keyboard and mouse) were cited by 75 percent of the doctors surveyed as an incentive to EHR adoption; whereas 69 percent cited "stimulus money," showing the concern doctors have with not only getting the EHR system in the door, but effectively using it.