Zolnoori Maryam, Vergez Sasha, Kostic Zoran, Jonnalagadda Siddhartha Reddy, V McDonald Margaret, Bowles Kathryn K H, Topaz Maxim
School of Nursing, Columbia University, New York, NY, United States.
Center for Home Care Policy & Research, Visiting Nurse Service of New York, New York, NY, United States.
JMIR Hum Factors. 2022 May 11;9(2):e35325. doi: 10.2196/35325.
Patients' spontaneous speech can act as a biomarker for identifying pathological entities, such as mental illness. Despite this potential, audio recording patients' spontaneous speech is not part of clinical workflows, and health care organizations often do not have dedicated policies regarding the audio recording of clinical encounters. No previous studies have investigated the best practical approach for integrating audio recording of patient-clinician encounters into clinical workflows, particularly in the home health care (HHC) setting.
This study aimed to evaluate the functionality and usability of several audio-recording devices for the audio recording of patient-nurse verbal communications in the HHC settings and elicit HHC stakeholder (patients and nurses) perspectives about the facilitators of and barriers to integrating audio recordings into clinical workflows.
This study was conducted at a large urban HHC agency located in New York, United States. We evaluated the usability and functionality of 7 audio-recording devices in a laboratory (controlled) setting. A total of 3 devices-Saramonic Blink500, Sony ICD-TX6, and Black Vox 365-were further evaluated in a clinical setting (patients' homes) by HHC nurses who completed the System Usability Scale questionnaire and participated in a short, structured interview to elicit feedback about each device. We also evaluated the accuracy of the automatic transcription of audio-recorded encounters for the 3 devices using the Amazon Web Service Transcribe. Word error rate was used to measure the accuracy of automated speech transcription. To understand the facilitators of and barriers to integrating audio recording of encounters into clinical workflows, we conducted semistructured interviews with 3 HHC nurses and 10 HHC patients. Thematic analysis was used to analyze the transcribed interviews.
Saramonic Blink500 received the best overall evaluation score. The System Usability Scale score and word error rate for Saramonic Blink500 were 65% and 26%, respectively, and nurses found it easier to approach patients using this device than with the other 2 devices. Overall, patients found the process of audio recording to be satisfactory and convenient, with minimal impact on their communication with nurses. Although, in general, nurses also found the process easy to learn and satisfactory, they suggested that the audio recording of HHC encounters can affect their communication patterns. In addition, nurses were not aware of the potential to use audio-recorded encounters to improve health care services. Nurses also indicated that they would need to involve their managers to determine how audio recordings could be integrated into their clinical workflows and for any ongoing use of audio recordings during patient care management.
This study established the feasibility of audio recording HHC patient-nurse encounters. Training HHC nurses about the importance of the audio-recording process and the support of clinical managers are essential factors for successful implementation.
患者的自发言语可作为识别病理实体（如精神疾病）的生物标志物。尽管有此潜力，但录制患者的自发言语并非临床工作流程的一部分，而且医疗保健机构通常没有关于临床会诊录音的专门政策。以前没有研究调查过将患者与临床医生会诊的录音整合到临床工作流程中的最佳实用方法，特别是在家庭医疗保健（HHC）环境中。
本研究旨在评估几种录音设备在家庭医疗保健环境中录制患者与护士言语交流的功能和可用性，并了解家庭医疗保健利益相关者（患者和护士）对将录音整合到临床工作流程的促进因素和障碍的看法。
本研究在美国纽约一家大型城市家庭医疗保健机构进行。我们在实验室（受控）环境中评估了7种录音设备的可用性和功能。HHC护士在临床环境（患者家中）对总共3种设备——Saramonic Blink500、索尼ICD-TX6和Black Vox 365进行了进一步评估，这些护士完成了系统可用性量表问卷，并参加了简短的结构化访谈，以获取关于每种设备的反馈。我们还使用亚马逊网络服务转录工具评估了这3种设备录制会诊的自动转录准确性。单词错误率用于衡量自动语音转录的准确性。为了了解将会诊录音整合到临床工作流程的促进因素和障碍，我们对3名HHC护士和10名HHC患者进行了半结构化访谈。采用主题分析法对转录的访谈进行分析。
Saramonic Blink500获得了最佳总体评估分数。Saramonic Blink500的系统可用性量表分数和单词错误率分别为65%和26%，护士发现使用该设备比使用其他两种设备更容易接近患者。总体而言，患者认为录音过程令人满意且方便，对他们与护士的交流影响最小。虽然一般来说，护士也觉得这个过程容易学习且令人满意，但他们表示家庭医疗保健会诊的录音可能会影响他们的交流模式。此外，护士没有意识到利用录音会诊来改善医疗服务的潜力。护士还表示，他们需要让管理人员参与进来，以确定如何将会诊录音整合到他们的临床工作流程中，以及在患者护理管理期间如何持续使用录音。
本研究确定了录制家庭医疗保健患者与护士会诊的可行性。对HHC护士进行录音过程重要性的培训以及临床管理人员的支持是成功实施的关键因素。
