EHR Deficiencies in HIMSS Survey and the Need for Medical Transcriptionists

02-March-2015 Julie Clements EHR Transcription

Medical Transcriptionists Most providers are transitioning to EHR technology owing to the EHR incentive program, and they must be sure of their clinical documentation integrity. A 2014 survey by the Healthcare Information and Management Systems Society (HIMSS) found severe deficiencies with EHR technology that disrupt physician workflow, increase the difficulty of clinical decision making and delay the accomplishment of vital clinical tasks. These challenges make one think about the need of human intervention – medical transcriptionists in a new role – as healthcare documentation specialists or HDS.

The survey identified plenty of vulnerabilities in multiple categories. Some of them are:

Clinical Data Review – There were too many clicks with confusing data placement and organization. Hidden information, lack of customization and difficulty in seeing trends were other deficiencies.
Physician Documentation – Too many clicks required while templates impair data quality. Structured documents conflict with the thought process, context and reasoning hard to communicate.
Medication Reconciliation and Prescribing – Inability to e-prescribe controlled substances, inaccurate prescription data and difficulty in entering or reconciling combination medications.
Provider to Patient Communication – Diverting attention from the patient interferes with face to face care, loss of nonverbal cues as well as emotional connection with the patient, increased work and regulatory burden owing to required secure electronic communication.

How an HDS (Healthcare Documentation Specialist) Can Be of Assistance

The umbrella term "healthcare documentation specialist" includes medical transcriptionists, speech recognition editors, QA reviewers etc. Working as a human interface, this specialist maximizes the quality of data and narrative necessary for optimal performance of EHR technology. HDS also support physician choice of document creation methodology according to the workflow and environmental needs.

Healthcare documentation specialists provide front-line document risk management and monitor documents for:

Wrong patient/demographic mismatches
Wrong provider name
Incorrect dates of service
Incorrect work types
Errors in medication dosage
Right/left, male/female inconsistencies
Medical contradictions
Other missing elements and speech recognition errors

In this way, they will ensure documentation integrity and save a significant amount of time for physicians so that they can focus more on patient care. This will also improve the ability to prescribe medications. With discrete reportable transcription (DRT) technology, physicians can avoid the problem with templates and too many clicks. Once the HDS edits your documents, they can be populated into relevant EHR fields through this technology.

Overall, HDS facilitate successful transition to EHR and the speech recognition technology. Reliable transcription companies offer the service of medical transcriptionists along with three-level quality assurance ensured by editors and proofreaders. With such a service, you can effectively address EHR vulnerabilities without compromising the data quality.

How to Convert Old Paper Charts to Your EHR

26-February-2015 Rajeev Rajagopal EHR Transcription

Convert Old Paper Charts to EHR As many healthcare providers are relying upon electronic health record (EHR) systems for more efficient clinical documentation and on account of the incentive program for meaningful use, there is growing concern about migration of old paper charts into EHR. Information such as problem list, family history, social history, past medical history, allergies and medication are discrete data that must be entered from paper charts into the electronic record system in order to produce a useful record for the present and future. Providers can use either of the following methods for data migration.

Scan Paper Chart into EHR

Certain data including immunization history, EKG, recent CAT scans or MRI scans and possibly recent important consultation reports can be scanned into EHR. The provider can flag these items before, during or just after the first or second visit. Even though one may stop using the paper charts gradually, they can be stored off-site for retrieval, if necessary. The main advantages of this option are all data is in the EHR and it is possible to store old paper charts securely off-site. The disadvantages are:

Since the data is stored in a graphical format (PDF), it can’t be searched using keywords in times of need.
The files will have to be sorted after scanning and placed in the appropriate areas within the electronic record system.

Enter Data Manually into EHR

Data can be manually entered into appropriate fields within the EHR. Both nurses and physicians enter data from paper-based charts into electronic records. However, nurses only enter medications and allergies while physicians enter their own data. The nurses are usually fairly straightforward if the information is up to date in the chart. The disadvantages are:

Nurses may not accurately enter the correct information
Cost for nurses to perform this action
Medical problems won’t be entered, which are required to be added by the physicians later

If physicians are entering the data, it is possible to have accurate data in the EHR. Phrasing and diagnosis are entered according to the individual doctor’s preference. However, this option also has the following disadvantages.

Physicians will have to spend their valuable time for data entry
It won’t generate any revenue

Providers using electronic records must make sure that the data within the system is accurate since a minor error can be populated very easily and malign the entire system. A professional medical transcription company can help in creating accurate reports from physician dictations and populate the appropriate EHR fields with transcribed reports. Outsourcing the task of transferring data from old paper charts to the EHR will prove cost-effective as well as save valuable time and effort for providers.

Importance of Incorporating SOGI Information within EHR

23-February-2015 MTS TEAM EHR Transcription

Incorporating SOGI Information within EHR Expanding Electronic Health Records (EHRs) data collection to include sexual orientation and gender identity (SOGI) information is critical to eliminate the invisibility of LGBT (lesbian, gay, bisexual and transgender) people in the healthcare system. The Institute of Medicine (IOM) has also recommended that it is the only way to end this disparity. Efforts to implement this solution are in progress. Entering SOGI related information into EHR fields that support documentation of such details will ensure that clinicians have the necessary medical data at the right time to address and screen for health conditions disproportionately affecting LGBT people and have frank discussions with their patients. Many physicians still prefer dictating patient details and in such cases, a medical transcription company can be of assistance in that their transcriptionists will take care of the transcription process and entering the required details into the EHR.

According to an article published in LGBT Health Journal in 2013 by a group of scientists, recording SOGI information of patients in EHRs can help clinicians to identify the unique health needs of LGBT people. For instance, transgender women need regular prostate exams. Many transgender men retain their natal anatomy and therefore require pap smears. If the doctor is handling the case of a transgender person, EHR that has SOGI fields can help the doctor to quickly determine whether there is a need to assess current anatomy. In an EHR without such fields, sexual orientation and gender identity information are often included in a non-standardized way that prevents correlation with preventive procedures, medical or behavioral symptoms or illness.

The researchers also explain that recording SOGI information on EHRs can facilitate better conversation between doctors and patients regarding the specific risk factors LGBT individuals may have for certain conditions. According to the U.S. Centers for Disease Control and Prevention, there is an increased risk for gay and bisexual men to contract HIV and other sexually transmitted diseases than other individuals. With SOGI information and a clear record of all the medications patients may be on and any tests they have received, physicians can determine whether their patients are at risk and provide appropriate advice as early as possible.

The scientists also emphasize that if SOGI data were available to the physicians at the right time, care disparities could be reduced significantly. For example, both lesbian and bisexual women experience cervical cancer at the same rate as that of heterosexual women, but they are much less likely to get routine pap tests to screen for cervical cancer. EHRs with decision support system related to SOGI data can prompt the doctor conducting an annual exam for a woman to take a pap smear to check for cervical cancer and conduct a breast exam.

Implementing EHRs with decision support system related to sexual orientation and gender identity requires clinicians to become better informed and aware of the needs of LGBT people. This will require time, continued education, advocacy and collaboration across the continuum of care. The U.S. government is already contemplating on whether to include SOGI data collection in the Stage 3 guidelines for the incentive program that promotes meaningful use of EHR. However, it is up to the providers to ensure the accuracy of SOGI information within their EHR, once such a system is established. They can utilize the latest technologies and obtain the help of a professional medical transcription company.

Study Says Diabetes Drugs Have Different Effects on the Male and Female Heart

16-February-2015 Rajeev Rajagopal Medical Transcription

According to a study published in the December issue of American Journal of Physiology – Heart and Circulatory Physiology, widely used diabetes drugs affects men’s and women’s hearts differently. The researchers studied the effect of three commonly prescribed medications metformin, rosiglitazone (sold under the brand name Avandia) and Lovaza (omega-3 fish oil medication) on 78 type 2 diabetes affected patients comprised 43 women and 35 men. They were divided into three groups – one group was given metformin alone, the next group was given metformin, plus rosiglitazone, and the last group was given metformin plus Lovaza. The researchers found even though the drugs controlled blood sugar levels in both genders equally well, but had different and sometimes opposite effects on the male and female heart.

The major findings of this study are as follows:

Metaformin lowers fat metabolism in women and increases glucose uptake by their hearts and thereby brings about positive effects on women’s hearts. The heart metabolism will further improve in women while taking rosiglitazone with metformin rather than taking metformin alone.
In men, metaformin causes the heart metabolism to burn less sugar and more fat. As per the researchers, chronic burn of fat by the heart can cause harmful changes that may result in heart failure. In the opinion of senior author of the study, Dr. Robert Gropler, metformine alone can worsen heart metabolism in men instead of making it more normal. The study found either taking rosiglitazone or lovaza in addition to metformine can reduce the negative effects of metaformin alone in men.
The addition of lovaza to metformin can’t cause a strong effect on both men and women.

Though the study did not prove a cause-and-effect for drug combinations and heart changes, it stressed the need to define diabetes therapies optimal for men and women. However, the findings of this study give us a hint about the risk of medication errors. We saw in the study that metaformine alone can have positive effects in women but negative effects in men. Family practice physicians need to be aware of the effects that a particular drug can have on a patient. Diabetes requires focused ongoing medical management and use of monitoring tests.

It is expected that electronic health records (EHRs) will help physicians improve the coordination and quality of care. However, a report published by the American Medical Association (AMA) in October 2013, says that while physicians note the benefits of EHR, some complained that the systems are burdensome to operate and are an important contributor to their dissatisfaction. The study found that EHR technology interferes with patient interactions, requires physicians to spend too much time on data entry, and detracts from the accuracy of medical records with template-generated notes.

Physician frustration and workload can be reduced in many ways. In addition to medical scribes to help with the tasks involved in data entry in electronic records, primary care physicians can rely on family practice medical transcription services for comprehensive clinical documentation. Support services such as these can go a long way in improving primary care physicians’ management of diabetes and other conditions.

Patients Prefer Online EHR Access, Protect Your Data from Errors and Breach

12-February-2015 MTS TEAM EHR Transcription

Patients Prefer Online EHR Access According to a study released by the Washington, D.C.-based National Partnership for Women & Families, a significant boost in online access to health information is increasing patient engagement. As more patients use online EHR, healthcare providers should ensure the security of their patient data regardless of whether they are transcribing their patient records, editing the speech recognition data or using front-end speech recognition (real-time transcription) while entering data into the EHR.

When the ‘Meaningful Use’ Incentive Program began, the National Partnership for Women and Families conducted a groundbreaking survey in 2011 to assess patients’ expectations and needs regarding EHRs and health IT. In 2014, they conducted a follow-up survey to measure the impact of this evolution and these initiatives under the perspective of patients and families. The major findings of the study are as follows.

In 2014, more than four in five patients (86 percent) having online access to their health records used their online record once while more than half (55 percent) used them three or more times a year. Online access to electronic health record system has increased since 2011 from 26 percent to 50 percent in 2014.
It was reported that the more frequently individuals access their health information online, the more it motivates them to take some actions to improve their health. Around 71 percent of those who used online access three or more times a year report this compared to 39 percent of those who used online access less often.
Consumers want even more robust functionality as well as features of online access than are available today such as the ability to email providers (56 percent), review treatment plans (56 percent), doctors’ notes (58 percent) and test results (75 percent), schedule appointments (64 percent) and submit medical refill requests (59 percent).
Regarding privacy and security of health data, it was found that the patients’ trust in the privacy and security of EHRs has increased since 2011. Patients having online access to their health information have a much higher level of trust in their doctor and medical staff (77 percent) compared to those with EHRs that don’t support online access (67 percent).

Crucial Risks with Online EHR

The study findings clearly show that patients are increasingly relying upon online EHR systems than before. However, there are several challenges with online or cloud-based record systems. Here are the critical ones.

In the case of cloud-based system, EHR vulnerabilities (faulty data entry, unexpected conversion, selection of wrong file or field and more), if they exist, will spread to all other documents in no time. It will become quite difficult for you to track the errors afterwards and the entire system will be corrupted quickly.
Since the data is controlled by a third party vendor in the case of a web-based system, there is a big chance for data breach. As your data stays on the same database servers being used by thousands of others, patient information may be compromised. Even cloud vendors may mine your data and sell them to other companies.

It is a practical option to outsource your transcription or data editing work to ensure that the data sent to EHR is free from errors. Healthcare documentation specialists will thoroughly check for discrepancies before sending them to your electronic health record system. Reliable transcription companies provide three-level quality check by experienced proofreaders and editors. In order to ensure data security, establish an HIPAA-compliant contract with the company that clearly explains about accessibility time, requirements, security measures taken, data backups, offshore data storage, upgrade and downtime.

When it comes to front-end speech recognition, there is no way left for physicians, but to remain alert to each and every word transcribed in their computer screen. So, it is better to use such kind of EHR system for accomplishing simple tasks.

Recent Trends in Telemedicine

09-February-2015 Julie Clements Healthcare News

Telemedicine, the actual delivery of remote clinical services using technology, is growing rapidly. According to a report by Research and Markets, the global telemedicine market is expected to increase by a compound annual growth rate of 18.5% through 2018. The highest growth will be in the U.S. During the past five decades, the use of medical information exchanged from one site to another via electronic communications helped save time and money and, most importantly, saved lives. Today, telemedicine is not just about extending care to patients in remote areas. It is being integrated into the everyday operations of hospitals, home health agencies, private physician offices, specialty departments, and also homes and offices. The benefits that telemedicine offers can be listed as follows:

Timely provision of appropriate treatment
Minimize travel expenses
Physicians could cover more patients in less time
Patients living in remote areas could experience quality treatment
Lesser number of hospital visits needed for patients
Improved monitoring and management of diseases
Timely response to emergency
Convenient patient counseling
Continuity of care
Saves costs to patient, provider & system

Let’s take a look at the latest trends in telemedicine.

The focus is on home-based healthcare solutions, which would give patients more control over their care. New tools and products are allowing for physicians to retrieve patient data quickly and more efficiently.
Physicians can use smartphones, laptops, and tablets to sync to the facility’s network. Patients can monitor vital signs and transmit it to their physician when needed.
The cloud storage solutions are widely being used with the rise in requirement of storage of large amount of data. This is helping to avoid excessive hardware costs.
Telemedicine is being used to implement health and wellness programs, which helps to reduce health complications and hospital readmissions.
Many private insurers cover telehealth in the same way they cover in-person services. Medicare and Medicaid plans also cover many telehealth services.

However, the introduction of advanced systems for transfer and storage of patient information could compromise the safety and security of patient data. Medical networks need to integrate appropriate privacy and security measures in the telehealth systems they use.

One of the areas of focus of the mHealth + Telehealth World 2014 to be held in Boston, MA, during July 22-24 is how real life uses of digital health programs provide tools and methods to promote hospital and provider buy-in and prove ROI of using mHealth and Telehealth as part of normal delivery of care. Timely and accurate documentation of telemedicine care reports is crucial to ensure hassle-free and maximum reimbursement for healthcare providers. Professional medical transcription services are available to make this possible.

A More Comprehensive Approach to Address SRT Challenges

05-February-2015 MTS TEAM Medical Transcription

Speech recognition technology (SRT) is being increasingly adopted in clinical documentation. While only a small percentage of providers use this technology in self-editing (front-end) mode, the use of back-end SRT system is growing rapidly within the healthcare field. Though many providers claim greater efficiencies with back-end system by reducing turnaround times for completing reports, they require the service of medical record editors to accomplish this. There are several challenges with this technology, especially inadvertent errors, which can be addressed effectively by blending speech recognition editing and good dictation habits.

A Reality Check on SRT

According to the E2364: Standard Guide for Speech Recognition Products in Health Care approved by the ASTM E31.22 subcommittee on Health Information Transcription and Documentation to assist those considering speech recognition technology for healthcare documentation, here are some real facts about SRT.

Clinicians with good dictation habits are more likely to be successful in using SRT.
Clinicians having exceptionally rough accents may find this system challenging as it may not generate texts according to what they intended while dictating.
Depending upon the SRT context, it may not distinguish homonyms. Homonyms are words that are pronounced alike, but have different meanings (for example, Ileum (Intestine) Vs Ilium (Hip Bone)).
SRT systems can’t overcome dictation errors, improper grammar, incomplete or disorganized dictation or wrong punctuation.
Excessive background noise in the environment may hamper recognition accuracy. However, it may be possible to overcome this by using noise-canceling SRT microphones and proper microphone position and placement.
Appropriate training can facilitate better results with the SRT system.
In certain environments, SRT may not be the best method for data entry.

Speech Recognition Edition with Better Dictation Techniques

With the help of experienced speech recognition editors, clinicians can eliminate dictation errors, grammar mistakes and punctuation errors, differentiate homonyms and identify missing elements. At the same time, they can flag doubts for physicians to review. However, a highly problematic dictation often results in blanks within reports, and may require additional reviews by medical transcriptionists and editors. This will delay the report completion. Identifying errors in SRT-draft document is really challenging as it requires different eye/ear/brain coordination dynamics. A clear, concise and complete dictation can produce quality documentation. In order to get the best results from SRT technology, speech recognition editing is not enough, but better dictation habits. Some of the effective dictation techniques given in the Standard Guide are as follows.

Identifying suitable dictation environments free from background noises, distractions, interruptions and confidentiality issues
Providing formal orientation and training for all dictators, which should include equipment functionality, dictation processes, regulatory requirements, institutional policies and guidelines for report formats and organization of content
Appropriate use of facility-approved abbreviations within dictated reports
Establishing a feedback system regarding any mechanical, technical, or other problems that may hamper a clear, complete, and accurate document

Applying these techniques and ensuring proper speech recognition editing with the help of experts can significantly reduce the turnaround time for completion of reports. Partnering with a reliable medical transcription company that provides three-level quality assurance would be an effective option.

How Death Summary is Different from Discharge Summary

Rajeev Rajagopal Medical Transcription

Hospital Discharge Summary

Discharge summary is among the four types of reports that comprise the core of medical transcription work and is required whenever a patient is discharged from the hospital. This report is critical for further consultation and promoting patient safety while they transfer from care settings. If a patient dies instead of being discharged, the discharge summary becomes the death summary. Accurate death reports are crucial to receive social security benefits and reimbursements.

The accuracy of death summary is very important since the relatives of the patient who had died in the hospital can sue the hospital for wrongful death/negligence if they find the death report is incomplete and comprised of critical errors. According to a news report, a hospital had to pay more than $9 million to a family in wrongful death lawsuit. The victim had a history of bleeding problem and there was no documentation regarding what blood would be needed or when. The correctness of death summary is critical for patients too as the Social Security Administration (SSA) creates a set of death records by collecting death reports from multiple sources (family members, state vital records agencies) and ensures the accuracy of those documents before paying federally-funded benefits.

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In order to generate accurate and complete reports, the medical transcriptionist should understand how death summary differs from discharge summary. Even though death summary comprises a subset of the typical discharge summary, it is different discharge summary in the following ways:

‘Discharge Date’ will be changed to ‘Date Expired’ or ‘Date of Death’
Discharge Diagnoses will become Final Diagnoses
Cause of Death may be dictated as an explicit heading depending on whether the cause is known or not during the dictation of death summary (sometimes, a pending surgical pathology report or autopsy record is needed to confirm the cause of death)

The death summary should also include the information on whether the patient’s family had already agreed to an autopsy and whether there is a living will of patient that calls for no aggressive therapy. In case, the patient does not have a living will, the family or next kin of the patient can make this decision and this information should be also included in the death summary. Usually, the death summary would comprise only Final Diagnoses and Hospital Course sections.

The dictator may sometimes give a narrative description with no headings and it is the job medical transcriptionists to arrange the information under proper headings. Hospitals can seeking the help of a medical transcription company to transcribe death summaries along with discharge summaries should take time to provide good documentation on expectations so as to ensure a smooth flow of information to generate good documentation.

Read our blog on What are the Key Components Included in a Hospital Discharge Summary?

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Predicted Rise in Healthcare Data Breaches in 2015 and Transcription Outsourcing

02-February-2015 MTS TEAM Medical Transcription

Healthcare Data Breaches Research studies say that there will be more data breaches in healthcare in the year 2015. In this scenario, you need to be very careful when outsourcing transcription tasks. As EHR is now widely adopted, most of the providers are rather concerned about the quality of data within the electronic system. Entering data into EHR through transcription technology is a good option to ensure the accuracy of data, since professional transcriptionists thoroughly check the transcribed data before submission. Though it will ensure data accuracy, the security of your data is at risk if the concerned outsourcing company does not have proper security measures in place.

As per Experian’s 2015 Second Annual Data Breach Industry Forecast, data breaches in the healthcare field are expected to increase in 2015 owing to the potential economic gain and digitization of patient records. Some of the top data breach trends for 2015 are:

The increasing number of access points to Protected Health Information (PHI) and other sensitive data through electronic medical records and the growing popularity of wearable technology would make healthcare data a vulnerable target for cyber criminals.
As more businesses adopt interconnected systems and products (for example, cloud EHR systems), cyber attacks are likely to increase through data accessed from third-party vendors. The challenge of securing a considerable amount of sensitive information stored on the network combined with the value of a medical identity make many healthcare organizations attractive targets for cyber attacks.
Many businesses will overlook protecting their data against security breach by employees within the organization though they will increase focus on security protocols against external hackers. Employees and negligence will continue to be a leading cause for security breach over the next year.

A 2014 report from EMC Corporation says that healthcare data forms the largest percentage of digital universe and it is growing at 48 percent per year. A great deal of this data is not adequately protected. Around 93% of the healthcare digital universe requires protection. The report suggests several security measures to protect digital data such as locking down all devices, adopting control over all devices, embracing an enterprise mobile/BYOD (Bring Your Own Device) data management strategy and more.

We have already seen how the Federal Trade Commission (FTC) charge settlement by a transcription company highlighted the importance of securing your data when outsourcing. The risk is virtually doubled now, going by these studies. There is greater risk when sending your data to a transcription company as well as receiving the processed data from the same. So, be careful when choosing a third party service for your transcription work. Here are some of the important considerations:

Ensure that the company is HIPAA compliant
A non-disclosure agreement drawn up with the employees
Use secure space for keeping your data
Employs strong encryption for data transfer

A reliable transcription company would offer no BYOD policies and provide password protection for downloadable files so that these sensitive documents can be accessed only with your password.

EHR for Reducing Hospital-acquired Infections in Pediatric Care

29-January-2015 Julie Clements Pediatrics Transcription

A complete and accurate reporting of all hospital-acquired infections (HAIs) is critical in pediatric care as HAIs are associated with longer hospital stays, longer ventilation times, increased cost and adverse neuro-developmental outcomes in children. Electronic health records or EHRs are quite effective for reporting HAIs as they provide complete and easily accessible data. Many hospitals have leveraged EHR enabled workflows to reduce hospital acquired infections. Physician dictations still play an important role in the medical documentation process and these must be transcribed accurately. Providers can utilize medical transcription services that transcribe physician dictations, interface with the provider’s EHR system and post the transcripts onto the EHR. In this way clinicians can save the time wasted on transcribing and data entry tasks. There needn’t be any concern about security since the transcription and EHR integration is done via HIPAA-compliant portals.

Now let’s take a look at some research studies on utilizing EHR for the most common HAIs among children such as central line-associated blood stream infection (CLABSI), ventilator-associated pneumonia (VAP) and catheter-associated urinary tract infection (CAUTI).

A study conducted in the pediatric intensive care unit of the Lucile Packard Children’s Hospital Stanford found that a computerized safety checklist that can automatically pull information from patients’ electronic health records was effective in reducing the rates of central line-associated blood stream infection (CLABSI). A dashboard-style interface was used to interact with the automated checklist so that caregivers were able to easily and quickly follow the national guidelines for keeping patients’ central lines infection-free. This system explored the data within the EHR and prompted alerts to the physicians and nurses when a patient’s central line was due for care. It was found during the study that the rate of CLABSI in the pediatric ICU dropped from 2.6 to 0.7 per 1,000 days of central line use.

A program that uses the EHR was used in UC Davis Health System pediatric ICU to reduce VAP. It was found that this system reduced the rate of VAP from an average of 5.34 per 1000 patient days in CY 2010 to 0.60 in CY 2012 (82%). New clinical workflows were defined and embedded into the EHR before using it in the pediatric ICU. The creation of best practice online clinical knowledge in the EHR has contributed much to the effectiveness of the system.

CAUTI has not received that much attention as CLABSIs and ventilator-related pneumonia have. Still, a research study at Penn Medicine found targeted automated alerts in the EHR system significantly reduced urinary tract infections in patients with urinary catheters. In patients’ EHR, doctors were impelled to specify the reason for which they were inserting a urinary catheter. Based on their choice, they were alerted to reassess the need for the catheter if it had not been removed within the stipulated time specified. This pattern of creating alerts within the EHR can be used in the pediatric ICU as well.

From these three cases, it is evident that EHRs are effective in reducing HAI in pediatric care when the data within the system is complete and accurate. Keeping data accurate within EHR is challenging even with effective speech recognition systems since errors may occur due to temporary changes in the dictator’s sound (for example, due to cold) or noise from the environment. Most of the physicians overlook the data errors within the electronic record system while providing care to their patients. The service of health documentation specialists is very important for ensuring the accuracy of data including laboratory and clinical reports within the EHR.