Medical transcription is an integral component of providing healthcare, as all patient encounters need to be documented as required by respective governing bodies. As we talk faster than we can write or type, many physicians dictate their patient notes, letters and reports. Physician have two choices, handheld recorders or telephone dictation systems.
In the past, options for dictation were all tape based. The old Dictaphone machines were large and stationary. In the 1960’s came handheld tape recorders, followed by micro and mini-cassette tape recorders. However, tapes stretch and the recorded quality degrades with time and use, they can’t be indexed or searched easily, and they can easily be lost or misplaced. The advent of digital recorders brought many advantages over tape recorders, including having different folders for different types of dictations, such as patient notes, urgent notes and medical-legal reports, so a transcriptionist would know which ones need to be transcribed first. And a new file could be started for each report, making it easy to search to find a particular dictation.
The major advantage of a hand-held recorder, be it tape or digital, was that it was portable. As long as the physician had their notes with them, they could dictate in the car (as a passenger!), at the cottage, in their office or at home. Unfortunately, the challenge to it being portable was that the recorder could also be misplaced or stolen. And the recorder had to be connected to a computer to download the files to be transcribed. It isn’t as easy as just popping out a tape, putting in a new one, and continuing recording. Unless of course you purchased a digital recorder with a removable memory card and have a memory card reader attached to your computer.
Telephone dictation systems were first used in hospitals, primarily for physicians to report surgical notes. With the advent of digital storage media, usage spread.
Today, physicians need to choose between using a digital handheld voice recorder (distinct from digital note takers which are not suitable for dictation) and a telephone dictation system. Both systems require several factors for optimal usage – low ambient or background noise, clear dictation and knowledge of how to use them.
Top end digital recorders have functions very similar to the older tape models, with slide switches for pausing, rewinding and fast forwarding. It makes the transition from tape to digital very easy. Less expensive models have buttons instead of the slide switch, and it can take longer to get use to using them effectively. Handheld recorders are portable; they can be kept with the physician and notes dictated ‘on the fly’, immediately after a patient has been seen, or at any time and place later. However, the dictation has to be downloaded to a computer – either through a USB cable or a removable storage disk reader – and uploaded to the transcriptionist’s computer. And the digital recorder needs to record in a format that is playable in transcription software. Different manufacturer’s use different file formats (most are a version of .wav file), some of which are highly compressed and are easily downloaded by the transcriptionist. There is also the issue of security in transferring the files to the transcriptionist, if they are not on-site.
Telephone dictation systems must be accessed from a telephone – and preferably a land-line and not a cell phone for better voice quality. It restricts their use to when the physician has access to a telephone, so they can’t be used for dictating in a patient examination room (unless of course there’s a telephone). But it can be any telephone, anywhere – physician’s office or home, cottage, hotel room, or even the physician’s lounge at the hospital. Once the file is dictated, it is automatically saved. It does not have to be uploaded to a computer and sent to the transcriptionist. All file movement is within the dictation system and is done securely. There’s no delay in uploading files to the computer, as they are automatically saved with the system.
To summarize:
| Feature | Digital Recorder | Telephone Dictation System |
| Cost | $400 – $650 | n/a |
| Security | None – if recorder is lost anyone can play the files – files must be protected before they can be sent to a transcriptionist if using Internet | Professional systems are PIPEDA/HIPAA compliant |
| Portability | Excellent | Limited to any landline |
| Challenges | Recorder can be lost or stolen
Delay in transcription until files loaded to computer User responsible for ensuring compliance with applicable security legislation |
Restricted to landline |
| Benefits | Portable | File saved automatically and sent immediately for transcription
Professional systems have security embedded |
| Timeliness | File has to be uploaded to a computer before it can be sent for transcription | Immediately in system to be transcribed |
| File size | Depends on manufacturer – large .wav files are difficult to send over the Internet | Doesn’t matter |
| Ease of use | Depends on digital recorder model and features | Same keypad commands for any telephone |
Ultimately, the choice is usually physician preference. Physicians who used tape recorders often prefer to continue to use a similar style of recorder, albeit digital. Physicians who learned to dictate using a hospital telephone-based dictation system, often prefer the telephone. Other physicians make the decision based on which system is more automated, where there is less for them to do. Telephone dictation systems automatically save your dictation, provide embedded security, and queue your dictation for transcription as soon as you finish dictating.
2Ascribe Medical Transcription is a Toronto based medical transcription company, offering medical transcription services across Canada. For more information, please contact 2Ascribe Inc. at www.2ascribe.com or 416/866-503-4003.
