Roger,
I am working for a doctor who does a majority of his notes by dictation. Your questions are the very same I have been wrestling with for the past 3 months.
Right NOW, the transcription comes back in a Word doc batch, I use a microsoft word macro to 'split' the batch into individual files, scrub the files for blanks/errors, and drag+drop into Updox (where a staff member assigns it to the correct patient and it goes to live in the imported items tab).
The original idea was to setup an account for the typist in AC, forward the typist all the day's notes, the typist would 'remote in' to our server, listen to the dictations, and type into the corresponding fields. Then, forward the note to the Doc to be signed.
The typists had some pushback because they like to use their macros and formatting, which would be gone if typing straight into AC. My issue was that they couldn't remote in without 'occupying' a computer (we don't have a terminal server), AND that the typists may not be able to use their foot pedals. (Local Hardware on a remote system doesn't always play).
Our current plan for the immediate future is this: For routine care, use templates. When we need to dictate, Certain things will be filled into that patients encounter in the room by the nurses(vitals, and the 'left side' of the AC note). From the exam room the note is forwarded to a staff member. When the transcription comes back, the staff member copy-pastes it into the corresponding sections in the AC note, and forwards on to the doc to be signed.
Some considerations:
For my doc, dictating a full note using Dragon is not feasible. It can't keep up with how low and fast he dictates. We are looking into using it for voice Macros.
Having a company like John suggested (or like MModal) is a good idea. They are big enough to get your transcription back within 24 hours, and have some pretty sweet web software. We did a test with MModal and the accuracy was pretty good for their first time.
