Since March 2008, all 14 secondary and tertiary care centers have access to the EHR, which means that they can store clinical documents like radiology, pathology, surgery reports and issue electronic prescriptions. Since 2006, primary care centers have also been involved. More than 470 out of 493 primary care institutions are now connected to the network. All primary care institutions are using the EHR-network, mainly for electronic prescriptions.
EHR and speech recognition benefits
The broad benefits of the regional EHR include better availability and access of documents when patients are referred from one doctor to another and a reduction in administrative workload through the digitization of prescriptions. Since a patient's medical history tends to be less patchy in electronic environments, patient safety increases because the probability of being misinformed decreases. Speech recognition, on the other hand, reduces the workload for medical staff and helps making patient data available immediately. If integrated deeply into the RIS as in Galicia, it does also have an impact on patient safety, since it guarantees that the DICOM images are intrinsically tied to the radiological reports, making mistakes in names etc. technically impossible.
Acceptance of EHR
Usage of the Galician EHR system is quite high, indicating that doctors perceive the theoretical benefits of an EHR as really coming into place. In 2008, there were 23.8 million contacts between patients and pharmacies based on electronic prescriptions. This is a share of 54% of all prescriptions that are being issued in primary care. As for the number of users, there are 5088 professional users in secondary care and 3331 in primary care. 2.6 million citizens of Galicia have an EHR already. In secondary care, the EHRs of 343 260 patients were accessed in 2008 monthly, making up for a total of more than 4.1 million in the whole year. In primary care, the numbers are 58 .621 and nearly 7 million respectively. When it comes to clinical reports, 545 821 were elaborated on the EHR in 2008 excluding radiology, and another 897 958 reports in radiology alone.
Acceptance of speech recognition
Speech recognition was introduced in the radiological departments of all 14 secondary and tertiary care centers in April and May 2008. It is currently being implemented in pathology as well, with five centers being equipped in March 2009. This adds up to a total of 350 users at the moment. If implementation continues as planned, a threshold of 1 000 users of speech recognition will be reached early in 2010. In March 2009, 80% of all radiologists are using speech recognition regularly.
Influence of SR on EHR usage
Speech recognition clearly led to an increase in the total number of radiological examinations that were made available in the EHR, indicating that it can increase digitalization because it is a quick and easy way to generate and finish an electronic document. In one tertiary care center with more than 1 200 beds and more than 350 000 radiological examinations per year, for example, the total number of radiological reports that were made available in the EHR was 7 520 in November 2007. After the introduction of speech recognition in May 2008, this number increased to 11 824 in November 2008. The average time between transcription and final availability of the report in the EHR decreased from 1.7 days to 0.5 days in this hospital. In conclusion, speech recognition did not only (as could be expected) lead to acceleration of medical document production, but also to an increase in the use of the EHR system as a whole.
Among the benefits of using speech recognition for creating electronic medical documents is an increase in technical and semantic standardization. In the long run, this can be of considerable benefit both for a medical institution and in the context of cross-regional or even cross-border care. Bringing together speech recognition with coding software, for example,Â reduces administrative activities for health professionals and thus brings benefits for the medical institution. It also provides a platform for communication in cross-border healthcare scenarios, since codes offer a degree of semantic interoperability that text only documents are lacking.