User Guide — Encounter Dictation

athenaClinicals

With the Encounter Dictation feature, providers using athenaClinicals can dictate directly into encounter sections and send the audio files to their transcription vendor via an automated interface. When transcription results are received, they are inserted into the Notes field in each section, and the provider is notified to review and close the encounter. athenaOne automatically transfers the audio files and the transcription results to and from the transcription vendor.

 

You must have the Clinicals: Encounter Dictation permission to create and delete audio recordings for an encounter. All practice users (with appropriate Clinicals permissions) can listen to existing encounter dictations without this additional permission.

 

 

 

 

Encounter dictation is available for these encounter sections:

 

Physical Exam

Physical Exam: Grid

Review of Systems

Well Child ROS

History of Present Illness: Templated

Assessment / Plan — Assessment field and Discussion field

 

Although many of these sections can be configured to appear in an order group, dictation is available only through an encounter.

 

 

 

You must have the Clinicals: Encounter Dictation permission to create and delete audio recordings for an encounter. All practice users (with appropriate Clinicals permissions) can listen to existing encounter dictations without this additional permission.

 

If you are responsible for monitoring transcriptions, you must have the Clinicals Admin permission.

 

 

 

Click Start dictation next to a section title to initiate dictation. The only exception to this is the Assessment / Plan section, where the Start dictation links are next to each subtitle within the section, since both the Assessment and Discussion fields are available for dictation. After the recording starts, the dictation controls appear at the bottom left side of the page. Depending on what action you take, the status bar appears differently:

  • Not Recording or Playing — The status bar indicates how many dictations exist for encounters that are open. If there is one or more, an arrow expands into a pop-up menu, displaying details about each saved dictation. You can also select a file to play back. Additionally, if there are saved audio files that have not yet been sent to the transcription vendor, Send All appears; otherwise, Sent indicates that there are no unsent files.
  • Recording — The left side of the status bar now displays the name of the section being dictated. The next button is a Record / Pause toggle button. If you're recording, a gain meter displays the audio level being captured and the current length of the recording. If you have paused recording, you can play back the recording; there's a Play / Stop toggle button, a Seek button so you can move around the recording, and an indicator that shows your location in the recording. Finally, at the right of the status bar are links to Save the recording or to Cancel, which discards the recording.
  • Playing — When playing a previously saved file, the status bar appears similar to playback in the Recording stage with a few differences: there is no Record / Pause toggle button, and the links are Send, Delete, and Close. If the file has already been sent for transcription, Sent appears instead, and you can no longer Delete the file. Click Close to clear the status bar.

 

  1. Open an encounter and in either the Intake or Exam stage, display an encounter section.
  2. Click Start dictation.

    Recording starts immediately. Several visual indicators on the encounter show this: the current encounter tab has a red circle, Recording appears where the Start dictation link appeared, and the microphone status bar is in the Recording state.

    Note: You can move around the encounter or bring up other parts of the patient's chart without disrupting the recording. You cannot leave the patient's chart with a recording in progress.

  3. Recording options:
    • Pause — Click if you are interrupted or need to pause the recording for any reason, including if you want to play back.
    • Play — Click to listen to your recording so far. Clicking Play after pausing a recording starts playback from the beginning of the file. If you want to play back from somewhere other than the beginning, click to the desired position on the slider and then click Play. You can play files both while you are recording and at a later time when reviewing the encounter.
    • Save — If you are satisfied with the recording, click Save to save the audio file to an athenahealth server.
    • Cancel — To discard the recording, click Cancel.

    After you Save your recording, you can move on to dictate other sections of the encounter.

    Note: For each saved dictation, a status message appears below that section's Notes field, indicating that an audio file is attached to the section and its current status.

  4. When you're finished documenting the encounter, click Send all from the dictation status bar to send all recordings to the transcription vendor.
    Clicking Send all (or Send at the individual recording level) starts the automated interface process. If you have access, you can view these messages using the Interface Message Queue Manager page; search for messages sent to your transcription vendor.
  5. When you're finished with the exam, click Done with Exam. athenaOne saves changes to the encounter and displays the Sign-Off stage tabs.
  6. Review the encounter summary information in the Sign-Off stage.

    Close Encounter — The checkbox is disabled and the field displays, "(Transcription pending)" until all audio files have received a transcription result.


    The "Move to REVIEW, assigned to" option defaults to the practice role you selected on the User Dictation Preferences page. Check the box to remove the encounter from your Inbox while you are waiting for the transcription vendor to return the transcribed results.

  7. If appropriate, click Ready for Checkout; otherwise click Save to save your selection in the Sign-Off stage.

 

 

While waiting for transcription results to be returned, you can see the status of the files in several places:

  1. Display the Clinical Inbox.
  2. Select the row for the practice role to which you assign your dictated encounters.
  3. In the Description column, TRANSCRIPT PEND appears after Encounter. This indicates that the encounter includes files that are still waiting for transcription results.
  4. For additional details, open the encounter.
  5. The dictation status bar shows a count of dictations. Click the arrow to the left of the count.
    A pop-up box displays the section name and the status for each dictation.
  6. You can see this same status below the Notes field in each encounter section that includes a dictation.
  7. A dictation file can have one of these statuses:
    • Recorded — The file has been saved but not sent to the transcription vendor.
    • Sent / Submitted — The file has been sent to the transcription vendor.
    • Received / Transcribed — The transcription results have been received.

 

 

If an encounter is assigned to a transcription practice role while awaiting transcription results, athenaOne assigns it back to the original provider when all transcription results for the encounter arrive.
Note: If the encounter is assigned to another practice user while awaiting transcription results, it is not reassigned to the original provider.

  1. Display the Clinical Inbox and select your row.
  2. Transcribed encounters are in REVIEW status; TRANSCRIPT COMPLETE now appears in the Description column.
  3. Open the encounter.
    The Sign-Off stage appears.
  4. Follow your normal sign-off process, reviewing the entire encounter (both dictated and non-dictated sections) for completeness and accuracy.

    All text in the Notes section is editable, including the transcribed text.

  5. The dictation files are still available for playback for a limited time (in case, for instance, you want to check the transcription accuracy). Click Play next to the dictation status note in the encounter section or select the dictation via the pop-up menu in the dictation status bar. Click the arrow in the dictation status bar.
    The dictated files appear.
  6. Select a dictation from the list and it will automatically begin playing.
    Note: Dictation files are available for 30 days after athenaOne sends them to the transcription vendor. After that time, they are deleted and are no longer available for playback.
  7. Check the Close Encounter box in the Sign-Off stage.

 

 

To track transcriptions across all providers and to easily focus on transcriptions that may have issues, use the Dictation Queue page. This page includes several filters to help you find dictations that have not yet received transcription results. You can listen to dictations, review other dictations that may exist on the same encounter, and, if necessary, mark a dictation as deleted or manually resolved.

 

Note: You must have Clinicals Admin permission to access and use this page.

 

  1. Display the Dictation Queue page: On the Main Menu, click Patients. Under RESOURCES, click Dictation Queue.
  2. Department — Select the encounter department. The default is your current department.
  3. Appointment type — Select the encounter appointment type. This list changes depending on the department you selected.
  4. Date of service — Enter a range of dates.
  5. Patient ID — Enter the patient ID.
  6. Encounter status — Select an encounter status. The list defaults to show only encounters that are still open. Select Closed or All if you are using this list for reporting purposes.
  7. Dictated by — Select the provider who performed the dictation. Only users with dictation permissions appear.
  8. Assigned to — Select the user to whom the encounter is currently assigned.
  9. Exam section — Select the encounter section, such as Discussion or HPI, in which the provider recorded the dictation.
  10. Dictation status — Select the status of the dictation.
  11. Dictation status date — Enter a range of dates during which the dictation's status changed.
  12. Click Search.
    The search results appear below.
  13. The status of the dictation and when the provider recorded it determine which actions are available. Click a link in the left column.
    • play — Click to listen to the dictation if the provider recorded it in the past 30 days. After 30 days, audio files are no longer available for playback.
      When you click play, the dictation controls appears above the Save and Cancel buttons, and the audio starts playing automatically.
    • update — Click to edit a dictation if it has not yet been transcribed. Select an action in the Update dictation status menu.
      • Manually resolve — Select this option if you received the transcription through means other than the automated interface.
      • Delete — Select this option if the dictation is silent or is an erroneous dictation that you would not have transcribed.
    • view — Click to view the results of the transcription.
      The transcription appears in a new window.

 

 

 

Your practice is responsible for reviewing any messages that your transcription vendor sends to athenaOne that it cannot process. This is usually due to incorrect formatting or missing content, and it usually requires that the vendor re-send a corrected file. If a dictation is missing a transcription, review the Interface Message Queue Manager page to see whether the missing transcription is in the ERROR queue.

 

 

Your practice is responsible for reviewing any messages that your transcription vendor sends to athenaOne that it cannot process. This is usually due to incorrect formatting or missing content, and it usually requires that the vendor re-send a corrected file. If a dictation is missing a transcription, review the Interface Message Queue Manager page to see whether the missing transcription is in the ERROR queue.

  1. Display the Interface Message Queue Manager page: On the Main Menu, click Settings > Practice Manager. In the left menu, under Practice Links — Interfaces, click Interface Message Queue Manager.
  2. Message status — Accept the default message status, ERROR.
  3. Interface Vendor — Select your transcription vendor.
    The problem is stated in the rightmost column, Errors.
  4. Click view in the leftmost column to view the message content.
  5. You can expect to see one of the following error messages:

    6. INVALID RULE: Encounter ID has already received Y dictations where Y is a total number of transcriptions.

    -OR-

    INVALID RULE: The dictation (Encounter ID, Encounter Section, Section Note, Count) has already been transcribed.

     

    These messages indicate that the vendor sent more transcriptions than indicated.

    1. Click view to see the message contents and find the patient ID in the line that starts with PID.
    2. Search for that patient on the Dictation Queue page and compare the results of the transcriptions you already received.
      • If the message contents are a duplicate of a message you already reviewed, delete the message on the Interface Message Queue Manager page (delete this message link in the Errors column).
      • If the message contents appear different, contact your transcription vendor to determine why the vendor sent more transcriptions for this patient than expected.

     

    INVALID RULE: Encounter X cannot have a transcription added because it is already closed or deleted.

     

    This message indicates that the encounter was closed before the transcription was received.

    1. Click view to see the message contents and find the patient ID in the line that starts with PID.
    2. Display that patient's chart and re-open the encounter in question.
    3. Return to the list of errors on the Interface Message Queue Manager page and click Reprocess Selected Messages to reprocess the message now that the encounter is open.

     

    INVALID RULE: DBD::Oracle::st execute failed... (or other error messages).

     

    This message indicates that the vendor sent a message with a serious formatting error, so athenaOne cannot process the message.

    Click view to see the message contents and contact your transcription vendor to see whether the vendor can identify the issue and resend the message correctly formatted.

    Note: If assistance is needed from athenahealth, contact the CSC to create a case for our Interface Operations team to review.

 

 

 

 

You can use a third-party application to dictate notes and receive the transcribed text directly into the Notes fields of the athenaClinicals encounter sections. Please visit the athenahealth Marketplace for a list of our technology partners.

 

 

Providers who will be dictating in another application must have the Clinicals: Encounter Dictation permission turned on in athenaOne. Additionally, users who will be responsible for monitoring transcriptions must have the Clinicals Admin permission.

 

 

 

After a dictation is submitted to the transcription vendor, it usually takes the vendor at least several hours to return the transcription result. If providers do not want these encounters in their Inbox while they are waiting for transcription results, they can assign the encounter to a practice role. On the User Dictation Preferences page, you can set this assignment as the default option.

 

  1. Display the User Dictation Preferences page: On the Main Menu, click Settings > Clinicals. In the left menu, under Practice Links — Chart/Encounter, click Encounter Dictation Preferences.
  2. Click Add new.
    Additional fields appear.
  3. User — Select the user who uses dictation to document encounters.
    Note: This field lists only users in your practice who have permission to dictate and do not already have a preference set, as well as a default option that applies to any users without their own preference.
  4. Assign to this role while waiting for transcription — Select the practice role to assign the encounters that are pending transcription.
    Note: This menu lists all existing practice roles. You can create a new practice role dedicated to transcription using the Practice Roles page.
  5. Click Save.
    The "Move to REVIEW, assigned to" option at encounter sign-off now defaults to the selected role for any encounters that are pending transcription.

 

 

 

If you use an MDP external dictation partner, you can dictate the result note for in-house orders into the MDP partner's mobile application. The partner transcribes the dictated audio file and sends the transcribed text to athenaOne. athenaOne matches the incoming text to the order document's Results Notes text field.

Note: If you send an order to an external lab, you cannot dictate into the Results Notes field.

 

In rare instances, the outbound interface between athenaOne and the MDP partner does not receive an order ID, which is required to map the incoming order text to the correct patient order in athenaOne. In this case, the dictation partner sends the transcribed text as a clinical document, which athenaOne attaches to the patient chart.

 

 

You must have the dictation partner's application installed on your mobile device.

  1. During an encounter or from the patient's chart (On the Patient Actions Bar, click Clinicals, and then click New Order Group), add an order for an in-house order type as you normally would.
    Note: For more information about in-house labs, please see In-House Labs for athenaClinicals).
  2. Sign the order. If you created the order from the patient chart, you must also assign an ordering physician.
    When you click Save, the dictation partner is notified that you placed a new order.
  3. Open the mobile application:
    1. Select the patient's order in your worklist.
    2. Dictate the patient's order results note.
    3. Upload the audio file from your mobile device to the partner's service.
  4. When the partner sends the note's text to athenaOne, the text appears in the Result Notes field of the order's Results/Interpretation template.

 

 

 

When athenaOne receives a notification from the vendor that a transcription job has started, you can no longer close the encounter. You can view this status from the Clinical Inbox: "TRANSCRIPT PEND" appears in the Description column for encounters. Within an individual encounter, in the Encounter Sign-Off stage, the status appears next to the "Close Encounter" checkbox (which is grayed out) with (Transcription pending).

 

 

 

If an encounter is assigned to a transcription practice role while awaiting transcription results, athenaOne assigns it back to the original provider automatically when all transcription results for the encounter arrive. If the encounter is assigned to another practice user while awaiting transcription results, it is not reassigned to the original provider automatically.

 

 

When a transcribed result is received from a third-party vendor, the result is routed to the dictating provider in REVIEW status. The dictating provider must use athenaClinicals and be listed on the transcription result itself.

Note: If no dictating provider is listed on the result, the result is routed to the first provider listed in the CC line of the result.

 

After the dictating provider reviews and confirms the transcription, the result can be routed to the ordering provider as follows:

  • The dictating provider can reassign the document in REVIEW status to the ordering provider.
  • The result can be attached as a consult note to the encounter and sent in REVIEW status to the ordering provider. (For more information about consult notes, see "Intra-office letters" on the Letters Section page.)
  • The result can be printed and then faxed to the ordering provider in REVIEW status.

 

  1. Display the Clinical Inbox and select your row.
  2. TRANSCRIPT COMPLETE appears in the Description column for transcribed encounters.
  3. Open the encounter.
    The Sign-Off stage appears.
  4. Follow your normal sign-off process, reviewing the entire encounter (both dictated and non-dictated sections) for completeness and accuracy.

    All text in the Notes field for the Encounter Reasons/ Chief Complaint section is editable, including the transcribed text.

  5. Check the Close Encounter box in the Sign-Off stage.

 

 

 

Practice managers can use the Dictation Queue page to track transcriptions across all their providers and to easily focus on transcriptions that may have issues. The Dictation Queue page provides all the necessary information to track down a transcription in one place. You can review other transcriptions that may exist on the same encounter, view any transcribed text, and if needed, mark a dictation as manually resolved or delete a dictation placeholder.

Note: You must have Clinicals Admin permission to access and use this page.

 

  1. Display the Dictation Queue page: On the Main Menu, click Patients. Under RESOURCES, click Dictation Queue.
  2. You can filter the results.
    Note: All search fields are optional.
    • Department — Select the encounter department. Defaults to your current department.
    • Appointment type — Select the encounter appointment type. This list changes depending on the department you selected.
    • Date of service — Enter a range of dates.
    • Patient ID — Enter the patient ID.
    • Encounter status — Select an encounter status. Defaults to show only encounters that are still open. Select Closed or All if you are using this page for reporting purposes.
    • Dictated by — Select the provider who performed the dictation. Only users with dictation permissions appear.
    • Assigned to — Select the user to whom the encounter is currently assigned.
    • Exam section — Select the encounter section, such as Discussion or HPI.
    • Dictation status — Select the status of the dictation.
    • Dictation status date — Enter a range of dates during which the dictation's status changed.
  3. Click Search.

  4. Look at the Exam section column.

    • If the name of a section (for example, Discussion or Assessment) appears, athenaOne has received a transcription corresponding to that section.

    • If no section name appears, the transcription vendor has sent athenaOne a notification that a transcription job has started, but athenaOne has not yet received the corresponding transcription. You cannot close these encounters.

    • Encounters that have multiple rows — some with named sections and others with blank sections — indicate that athenaOne has received some but not all transcriptions from the transcription vendor. The transcription vendor indicates the total number of transcriptions to be sent when they send the first file, so athenaOne knows to expect the correct number of transcriptions per encounter.

  5. Select an action in the left column.
    • view — Click this option to view the results of the transcription.
      The transcription text appears in a new window.

    • update — Click this option to edit a dictation if it has not yet been transcribed. Select an action in the Update dictation status menu:

      • Manually resolve — Select this option if you received the transcription through means other than the automated interface and have inserted the text into the encounter yourself. The status note indicating the field was transcribed will remain below the Notes field on the encounter if this option is selected.
      • Delete — Select this option if the dictation marker is erroneous and you are not expecting an inbound transcription, or if you have contacted the vendor and the vendor will be resending the inbound transcription. This action also deletes the transcription status note from the encounter section.

 

 

 

Your practice is responsible for reviewing any messages that your transcription vendor sends to athenaOne that it cannot process. This is usually due to incorrect formatting or missing content, and it usually requires that the vendor re-send a corrected file. If a dictation is missing a transcription, review the Interface Message Queue Manager page to see whether the missing transcription is in the ERROR queue.

  1. Display the Interface Message Queue Manager page: On the Main Menu, click Settings > Practice Manager. In the left menu, under Practice Links — Interfaces, click Interface Message Queue Manager.
  2. Message status — Accept the default message status, ERROR.
  3. Interface Vendor — Select your transcription vendor.
    The problem is stated in the rightmost column, Errors.
  4. Click view in the leftmost column to view the message content.
  5. You can expect to see one of the following error messages:

    6. INVALID RULE: Encounter ID has already received Y dictations where Y is a total number of transcriptions.

    -OR-

    INVALID RULE: The dictation (Encounter ID, Encounter Section, Section Note, Count) has already been transcribed.

     

    These messages indicate that the vendor sent more transcriptions than indicated.

    1. Click view to see the message contents and find the patient ID in the line that starts with PID.
    2. Search for that patient on the Dictation Queue page and compare the results of the transcriptions you already received.
      • If the message contents are a duplicate of a message you already reviewed, delete the message on the Interface Message Queue Manager page (delete this message link in the Errors column).
      • If the message contents appear different, contact your transcription vendor to determine why the vendor sent more transcriptions for this patient than expected.

     

    INVALID RULE: Encounter X cannot have a transcription added because it is already closed or deleted.

     

    This message indicates that the encounter was closed before the transcription was received.

    1. Click view to see the message contents and find the patient ID in the line that starts with PID.
    2. Display that patient's chart and re-open the encounter in question.
    3. Return to the list of errors on the Interface Message Queue Manager page and click Reprocess Selected Messages to reprocess the message now that the encounter is open.

     

    INVALID RULE: DBD::Oracle::st execute failed... (or other error messages).

     

    This message indicates that the vendor sent a message with a serious formatting error, so athenaOne cannot process the message.

    Click view to see the message contents and contact your transcription vendor to see whether the vendor can identify the issue and resend the message correctly formatted.

    Note: If assistance is needed from athenahealth, contact the CSC to create a case for our Interface Operations team to review.

 

 

 

 

 

Note: If you use the Encounter Dictation feature with a third-party vendor, you should check the Interface Message Queue Manager page daily to monitor any error messages you may receive from your transcription vendor.

  1. Display the Interface Message Queue Manager page: On the Main Menu, click Settings > Practice Manager. In the left menu, under Practice Links — Interfaces, click Interface Message Queue Manager.
    The filter fields appear at the top of the page, with the Message status filter set to ERROR. Filter the list of messages.
  2. Message status — Set to blank to see messages in all statuses, or select a status to display only messages in that status. This option defaults to ERROR.
  3. Interface Vendor — Select your transcription vendor to display only messages from the selected vendor. This option defaults to blank.
  4. Created between — Leave this field blank to see messages created at any time, or enter dates to see messages created between (and including) the selected dates.
  5. Processed between — Leave this field blank to see messages processed at any time, or enter dates to see messages processed between (and including) the selected dates.
  6. Message destination — Leave this field blank to see all messages. Select IN to see only messages inbound to athenahealth, or select OUT to see only messages outbound from athenahealth.
  7. Max Messages to Show — Enter the number of messages to display per page.
  8. Click Advanced Search for additional search options. Additional search fields appear.
  9. Click Filter Messages.
  10. Resolve the error messages for the selected vendor as you normally would.
    Tip: Resolve errors in the order that they appear in the message. Some errors may be caused by a previous error in the same message; when you fix the first error, it may fix the errors that follow.
    For example, if the error is, "Encounter closed or deleted" and the encounter should not have been closed and the provider dictated multiple sections, when you reopen the encounter and then click Reprocess Selected Messages on the Interface Message Queue Manager page, any appropriate message is applied and multiple errors are then resolved.

 

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