Dr. Bob, a prominent cardiologist, tells Susan, his transcriptionist of 10 years, that he has purchased an EMR package and will no longer need her assistance.  He will miss her, but looks forward to the elimination of transcription as a sure way to save money for his practice, as his EMR vendor promised him would be the case.

Dr. Bob's EMR package has a front-end voice recognition system that he plans to train and utilize for charting his patient encounters.  Initially, he decreases his patient load by 10 patients per day, about two hours, so that he can spend that two hours training the voice rec engine.  The engine requires that he dictate slowly and with punctuation, and often the time needed exceeds the two hours he allowed.  He also assumes the responsibility of editing his own reports and typing his corrections.  Dr. Bob, while an excellent cardiologist, types a mere 30 words per minute, so this task proves slow and painful for him.

After two weeks, Dr. Bob has made some progress in the training of his engine, but does not realize that some of the abbreviations he likes to use are supposed to be typed out long-hand, per national guidelines.  He adds an hour to his day for a week, so that he can re-train the engine to type out these abbreviations the way his transcriptionist always just did for him.

Another two weeks goes by, and Dr. Bob seems to be on-course for reaching his goals of saving money by eliminating his transcriptionist.  Dictating into his computer ties him to his desk, but this seems a small price to pay for improving his bottom line.  While he still stays late at the office every night to complete the training process, he feels he is getting home a little earlier every night, so stays the course.  

Thirty days has passed and Dr. Bob feels his voice recognition documents are accurate enough that he does not have to continue the training process.  He's confident that simple review of his documents is all that is needed now, and he's sure that eliminating 12 cent per line transcription was a good decision.  It is time to ramp back up to his usual capacity of 40 patients per day.

Dr. Bob begins the task of dictating and editing notes for the 40 patients he sees each day.  At the end of another month, he throws his hands up in frustration and calls Susan to please take over the documentation task for him once again.