Effect of Speech Recognition Software on Provider Documentation Characteristics Within an Electronic Health Record...

This study evaluates the effect of speech recognition software Dragon Medical One (DMO) on physician documentation burden and EHR workflows using Epic Signal usage metrics.

We conducted a longitudinal cohort study of physicians at a single academic medical center between December 2019 and November 2023. We compared 291 DMO adopters with 2,828 non-adopters using a staggered-adoption difference-in-differences design with two-way fixed effects and standard errors clustered at the physician level. We analyzed 23 Epic Signal metrics spanning documentation methods, time metrics, and workflow efficiency. We applied Benjamini-Hochberg correction for multiple comparisons and validated parallel trends assumptions through event study analysis. Heterogeneous effects were assessed through interaction models with demeaned baseline physician characteristics.

Among 3,119 physicians (291 adopters, 2,828 non-adopters), DMO adoption shifted documentation composition from manual typing to voice recognition (+2.67 percentage points; q < 0.001) with corresponding decreases in manual (-1.98 percentage points; q = 0.002) and SmartTool-based documentation (-1.89 percentage points; q = 0.004). Time in notes per appointment decreased by 0.50 minutes (q = 0.004) and time outside scheduled hours decreased by 2.74 minutes per day (q = 0.009). Of 23 outcomes 6 survived false discovery rate correction at q < 0.05. Event study analyses confirmed parallel pre-treatment trends for 22 of 23 outcomes. Physicians with higher baseline documentation time experienced larger reductions in time in notes per day and time in system per day following DMO adoption (interaction q < 0.01).

Adoption of speech recognition software was associated with a shift from manual to voice-based documentation, reduced time in notes per appointment, and reduced time outside scheduled hours. Effects were most pronounced among physicians with the highest baseline documentation burden, suggesting that those with the greatest room for improvement benefit most from this technology.