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We have used a system called "MedWare" in one of our EDs for about two
years. When logging on, the user can input a code which tells the
transcriptionist when the user's shift ends. The company guarantees some
percentage (let's say 75%) of all dictations will be back by the end of
the shift. Stat dictations can be back in under two hours but are more
expensive. The system provides multiple copies automatically so there is
no need to copy dictated reports.
 
The company provides "prompter" cards to use as templates for dictation,
I think that this insures better documentation. Mistakes are uncommon.
 
There are downsides. It still takes a while to get dictations back and
some will not be back by the end of the shift. This means that charts
have to be held in some location until the responsible resident/attending
returns. The ED business office keeps track of this for us, thank God.
Each time that a resident or attending works, they are handed a folder of
incomplete charts to sign/finish.
 The situation becomes more cumbersome when
visiting residents are
involved because they may be unable to return to complete charts. The
other big problem is that charts and dictations sometimes never find each
other. So you can end up with an ED chart that says "see dictation".
 
Overall, I like the system and if it were not so expensive, I think that
we would use it a bit more widely.
 
Brent King
 
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