In a manner of speaking

I never thought I'd embrace dictation.

For emergency physicians, dictation varies department to department. Some require it, some make it an option, and for others it's an exotic luxury. For my part, I'd seen too many errors in transcription and watched too many colleagues struggle with a phrase over and over to get enthusiastic about it. I never considered investing in dictation software for my own workflow, since I'm not a bad typist and it wasn't something my department was offering to us.

Along came iOS 5 for the new iPad, and suddenly I found myself dictating emails and short messages. Dictation seems like a natural fit for the iPad, since I can't type particularly quickly on it, and I'm not writing or editing long pieces on it.

Plus, I enjoy Apple's style of dictation, where my phrase or sentence remains invisible as it's transported to their servers for transcription. This process has been derided as a step backward, by folks who are used to desktop dictation software showing your transcription word-by-word, on screen. But mentally checking each word can be its own distraction, and disrupts flow. Plus, Apple's way of doing dictation seems more like a fun gamble to see if they got the whole sentence correct. 

So, when OS X Mountain Lion came out this week, with its Siri-like dictation feature, I finally gave computerized dictation a chance to help with my charting. 

First, a couple of concessions: 

HIPAA -- Mountain Lion, like iOS 5 before it, sends your voice to Apple servers via the internet. Unlike other web-based dictation services that ensure and advertise HIPAA compliance, Apple offers no such guarantees. At least one iPad-based EHR vendor is recommending to exclude PHI (protected health information) in any dictated charts, and that seems like a wise course at this time. 
Citrix -- I access my hospital's health records via a Citrix virtual desktop inside my browser. While Citrix can handle my trackpad movements and keyboard input, invoking dictation leaves it confused (nothing happens in Safari; in Chrome, the dictation icon appears on the edge of the window and fails to put text in the patient's chart). I'm forced to dictate onto a scratchpad and paste it into the chart. 

So, no, it's not ideal. But after a dozen or so attempts, I have to say, it's not bad, either. My biggest concern going into this - that medical terms would go unrecognized or mis-transcribed - has not been borne out (or at least, I haven't minded the corrections). 

Still, I'm finding some chart elements are more suited for typing than dictating: 

Easier to just type: "Complains of URI sx, sore throat and rhinorrhea, denies rash, no ear pain, no neck stiffness, no f/c no cough no SOB no CP no abd pain no dysuria no pedal edema."  
Easier to dictate: "I discussed my differential and diagnostic plan with the patient, answered questions, and agreed to share her results with her primary care doctor when available." (Then again, some of the paragraphs or templates that I repeatedly use in charting are already encoded in my EHR's system for frequently regurgitating blocks of text.)

So, if the point of this is efficiency, I don't think OS X dictation can save me time - yet. Maybe with a bit of practice and some more judicious use, it can. But I think dictation's real value to me will be breaking up the monotony of typing up an inbox full of charts. And that's something worth talking about.