Study shows dictation with EHR means worse care

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A recent study from the Journal of the American Medical Informatics Association (JAMIA) indicates that physicians who rely on dictation to interact with their electronic health record systems apparently provide a lower quality of care than physicians who interact with their EHRs more directly. “EHR-assessed quality is necessarily documentation-dependent, but physicians who dictated their notes appeared to have worse quality of care than physicians who used structured EHR documentation,” conclude the authors.


In “Method of electronic health record documentation and quality of primary care,” Linder et al. (2012) posit that a greater attention to structured fields and clinical decision support (CDS) results in a significantly improved level of patient care. The breakdown of respondents was disproportionate: 20 (9%) dictated notes, 68 (29%) used structured documentation, and 146 (62%) typed free text notes. However, in no area of the study did dictating physicians outperform their free text or structure documentation counterparts: ”There was no measure for which dictators had higher quality of care than physicians using the other two documentation styles.”

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