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Test Drive the Kurzweil Clinical Reporter

Reprinted from the February 1997 issue of "PaACEP News", the newsletter of the Pennsylvania Chapter American College of Emergency Physicians.

To generate emergency medical charts, you have three choices: the pen, the transcriptionist, or the computer.

Over the past six months, I have had the opportunity to test a new computer dictation system, the Kurzweil Clinical Reporter. The system is a standard personal computer (I use a Pentium 133 with 32 mg RAM) with a headset microphone. I am using the system as a stand-alone unit. Thus, I must input basic data, like patient name and medical record number myself. With practice, and that is the key word, this is easy and swift. Ideally, one would interface the Kurzweil unit with the registration desk and have basic patient information on your screen automatically.

The next step is to verbalize a chief complaint, and the computer will put your spoken words right on the report screen. You then choose a clinical template and simply fill in the blanks, verbally. I use the generic "illness" template most of the time because it opens you back up to free-text verbalization. I then speak and thus record an entire chart word by word. It was a struggle at first, but I soon learned to speak in a telegraphic and distinct way so that the system would pick up my personal preferences in recording observations about any given complaint.

There are, of course, a multitude of fill-in-the-blank templates for common ED complaints. They are extensive and very complete. They serve as good reminders for the busy physician and are likely to improve documentation. Also, besides your voice, you can type in information, and since the product is Windows based, you have a mouse to easily execute commands like, "new report", and so forth. The system works well right out of the box with anyone's voice; with time it improves greatly. You can customize the system for each individual user and have one key word generate an entire sentence (your standard abdominal exam for example), without "spoiling" that word for any of your associates.

The Kurweil Clinical reporter is an ED problem solver. It is up and running 24-hours a day. It produces reports immediately, which can be faxed to family doctors before the patient gets home, or sent to the floor as the patient is settled into a hospital bed. Consultants and nurses caring for inpatients really appreciate a perfectly legible report on the chart right away. Then, there is reimbursement. If you are interested in justifying level "5" visits, you must generate a detailed review of systems. I cannot imagine doing this by hand in a busy ED. Kurzweil has a wonderful template that allows me to document a head-to-toe systems review in under one minute. Finally, the torment of proofreading is just easier on the fly with a computer screen than after the fact reading a stack of charts.

So, is there a down side? Perhaps, cost. You do have to price the various alternatives for dictation and do what is justifiable. Also, the technology is not as seamless nor as portable as a pocket-sized cassette recorder, but it is light years ahead of the voice activation of only two years ago.

The greatest concern I had (and you should have too) about this computer system is the learning curve. Make no mistake about it, becoming accomplished at voice activation takes dedication, time, and effort. The learning is a mountain, but well worth climbing. Realistic goals must be set such that voice activation must be "required" for most charts after a couple of months. My experience with training and back-up from the folks at Kurzweil AI (Applied Intelligence) was first class. Within six months, the Kurzweil system has become as useful to me as my prescription pad. If you are highly motivated and interested, take this system for a test drive.