Relativity in Reporting

How long does it take a surgeon to complete a postoperative report?

It seems like a straightforward question and it’s been one of our main focuses as we’ve developed the OpNote, our electronic postoperative reporting product.  In order to ensure adoption by users, we know that we can’t tax the user’s (in this case, a physician’s) time any more than they already spend on reporting.  So we had to determine how much time physicians spend generating their own postoperative reports.  This was mainly done through anecdotal means – speaking with various surgeons and asking them how long it takes for them to complete a report.

And that’s when we learned something interesting.  Surgeons would tell us it would only take 30 seconds to 5 minutes to complete their report, depending on the level of complexity of the procedure.  But is that accurate?  As we gathered information and stories of postoperative reporting – we noticed that the way physicians think about report completion may not be as correct as they think.

image via Doncaster & Bassetlaw Hospitals

We can all agree that it only takes a few minutes to dictate a report for most surgical procedures.  But that doesn’t mean it takes that long to complete a full postoperative report.  Dictation is a part of the reporting process – but it’s not the entirety of the process.

After the report is dictated, it has to be transcribed, then sent back to the physician for his approval and any revisions that he wishes to make.  If there are revisions, those have to be sent back and incorporated into the report before it’s sent back to the physician again for final approval/sign out.  Then this report has to be entered into the facility’s medical records and medical billing departments – where codes will be extrapolated by medical coders.  This process to complete one report takes more than just a few minutes.

I’m sure there will be those that object to how this argument is laid out.  What about physicians who use report templates in their dictation? Or voice recognition software? And most facilities use electronic sign out – having done away with the tedious hours spent signing hard copies many years ago.  Each of these are helpful tools that cut down the time spent dictating reports – but it still takes longer than most people realize.

Templates (if facilities allow the physician to use them) are good ways to cover the redundant descriptions of common procedures.  If you have a fairly standard procedure that is done the same way 95% of the time with little or no complications, then a template is a great solution to cut down on time spent dictating your report.  Templates accelerate the dictating process, but they aren’t the easiest to correct.  Most templates are blocks of free text either hosted on the physician’s computer or the transcription service has a copy.

This means that any time a correction has to be made, or if the procedure was different in any way than described in the template, a physician has to either specify in his dictation exactly where the changes need to be inserted in his report or else go into his word document, read through it and find the place where he wishes to note the deviation from the normal technique.  Such deviations and alterations might make up a small portion of the reports that a physician dictates, but it is still not as rapid as people think when they speak of the speed of dictation.  Most of the time the surgeon does not have the template when he dictates, so it’s up to the transcriptionist to interpret any special instructions as deviations from the standard template.

Voice recognition software is another boon in dictating reports – but it’s a tool with some severe limits.  Firstly, users can’t speak too fast or else the software won’t recognize what the person is saying and therefore won’t transcribe it.  Or it may mistake what the physician is saying – and so she must take the time to revise it either by hand or vocal instruction.  Voice recognition has come along way but still requires a lot of training to the individual’s voice, and it does not eliminate the need for “correctionists” — a new word for transcriptionists.

We know that speed of completion isn’t the most important part of the postoperative report.  Surgeons could be done with reporting in less than 10 seconds if it was just a matter of time.  But it’s important that the information provided accurately and comprehensively details the procedure and all of its components.  Obviously, we don’t believe that such vital information should be sacrificed for the sake of time or convenience.  However, we do believe that there are better ways of capturing the same information and to do so with a faster method that provides many benefits to the physician, the facility and, ultimately, the patient.

So, again the question must be asked: How long does it take a surgeon to complete a postoperative report?