Abstract
Objective To conduct a replication study to validate previously identified significant risks
and inefficiencies associated with the use of speech recognition (SR) for documentation
within an electronic health record (EHR) system.
Methods Thirty-five emergency department clinicians undertook randomly allocated clinical
documentation tasks using keyboard and mouse (KBM) or SR using a commercial EHR system.
The experiment design, setting, and tasks (E2) replicated an earlier study (E1), while
technical integration issues that may have led to poorer SR performance were addressed.
Results Complex tasks were significantly slower to complete using SR (16.94%) than KBM (KBM:
191.9 s, SR: 224.4 s; p = 0.009; CI, 11.9–48.3), replicating task completion times observed in the earlier
experiment. Errors (non-typographical) were significantly higher with SR compared
with KBM for both simple (KBM: 3, SR: 84; p < 0.001; CI, 1.5–2.5) and complex tasks (KBM: 23, SR: 53; p = 0.001; CI, 0.5–1.0), again replicating earlier results (E1: 170, E2: 163; p = 0.660; CI, 0.0–0.0). Typographical errors were reduced significantly in the new
study (E1: 465, E2: 150; p < 0.001; CI, 2.0–3.0).
Discussion The results of this study replicate those reported earlier. The use of SR for clinical
documentation within an EHR system appears to be consistently associated with decreased
time efficiencies and increased errors. Modifications implemented to optimize SR integration
in the EHR seem to have resulted in minor improvements that did not fundamentally
change overall results.
Conclusion This replication study adds further evidence for the poor performance of SR-assisted
clinical documentation within an EHR. Replication studies remain rare in informatics
literature, especially where study results are unexpected or have significant implication;
such studies are clearly needed to avoid overdependence on the results of a single
study.
Keywords
electronic health record - speech recognition - integration - medical errors - patient
safety
