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 Hospital Information Systems

Transcription makeover

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   By Mike Rozmus, August 2010

Virginia's Rockingham Memorial Hospital improves its clinical documentation process by implementing advanced speech-recognition technologies.

rozmusChanges put in place to improve clinical documentation
As part of a two-phased project in 2009, Harrisonburg, Virginia-based Rockingham Memorial Hospital (RMH) set out to improve its clinical documentation process, implementing advanced speech-recognition technologies. Even though speech-recognition technology was not new to RMH, the hospital sought to find a new solution that would improve medical-transcription (MT) and clinical-documentation processes. The primary improvement objectives were to increase the quality and accuracy of transcribed documents, reduce the turnaround time for clinical notes to be created and finalized in the EMR and reduce the overall costs associated with transcription.

To execute plans, staff members knew they had to move away from their mix of legacy transcription solutions, which included both in-house dictation and transcription technology, as well as outsourced services from a major transcription company, which provided the majority of transcription services. After reviewing options, staff decided to move toward the background and real-time (front-end) speech-recognition solutions from Nuance, which included eScription and Dragon Medical.

To kick off the project, in January of 2009, RMH piloted a program whereby three doctors were provided with Dragon Medical for use over an eight-week test trial in the emergency department. Not only did RMH receive positive feedback from its physicians, the facility was able to cover the entire cost of the Dragon software through the savings in outsourced transcription realized as part of the two-month pilot. According to Robert Underwood, M.D., emergency department physician and chief medical information officer at RMH, the productivity gains were substantial. "It was instantly recognizable that even if we had some physicians use it, it would more than pay for itself," he says.

memorialToday at RMH, nearly 40 percent of the emergency department clinicians are now using Dragon Medical. With it, doctors are able to dictate directly into a MEDITECH electronic health record (EHR) system, creating clinical documentation in real time. The power of real-time document completion is the immediate access that the clinician team has to these documents, allowing them to quickly evaluate patients and create treatment plans. Because there is no reliance or support necessary from the medical-transcription service, Dragon Medical has helped eliminate nearly 40 percent of RMH's outsourced medical-transcription costs in the emergency department. Beyond measurable cost savings, physicians have provided feedback that Dragon Medical is helping them create documents in a personally preferred format in which they can easily document the unique patient story; for some, this allows faster review and comprehension of their own and other clinicians' notes. Additionally, individual clinicians who use the hospital's EHR system are finding it faster to document directly into the EHR with Dragon Medical versus having to rely on the keyboard and mouse alone.

Eight months later, September 2009
RMH also deployed the eScription background speech-recognition platform in September 2009, replacing its current medical transcription solutions and services. The transition from a technical, and most importantly, a physician-user standpoint, was relatively seamless. Since the switch, clinicians have noted improved quality in their documentation, as well as faster turnaround times (TAT). While many reports are available in less than 20 minutes, overall, the average TAT for all volume processed through background speech recognition is typically less than one hour. As part of this work flow, clinicians' dictations and edited notes are also made available within the EHR system, where physicians can review and sign their notes shortly after seeing the patient.

Since deployment last September, RMH's small internal medical-transcription department has seen overall productivity gains of 91 percent. Because of such high productivity gains, the hospital has been able to turn around diagnostic imaging reports faster than outlined in original goals and absorb peak volumes without additional resources.

At the onset of this project, the desired final TAT was: emergency radiology report, less than one hour; inpatient radiology report, less than three hours; and outpatient radiology report, less than eight hours.

Today, however, average TAT is far exceeding these goals: emergency radiology report, eight minutes; inpatient radiology report, 11 minutes; and outpatient radiology report, 13 minutes.

Dr. Underwood offers a positive review of his experience with the speech-recognition technology: "With background speech recognition, there is zero disruption to physician's work flow, yet we see efficiency gains in the background speed with which patient reports become final in the EHR; whereas with front-end, Dragon Medical provides the option for real-time documentation. Depending on physician work-flow preference, as well as on the priority of the information being documented, I believe both scenarios of speech recognition are helping our team work more efficiently. This, in turn, allows us to create and share patient information faster than ever before."

Currently, 100 percent of the doctors at RMH are using speech-recognition software as part of their clinical documentation work flow. Using the software has shown a proven return on investment and enabled RMH to reduce administrative costs of the transcription process by 40 percent — money the hospital can now re-allocate for clinical uses.

Speech recognition software making a difference
Currently, 100 percent of the doctors at RMH are using speech-recognition software as part of their clinical documentation work flow. Using the software has shown a proven return on investment and enabled RMH to reduce administrative costs of the transcription process by 40 percent — money the hospital can now re-allocate for clinical uses.

Speech-recognition technology, along with the supporting IT infrastructure, has finally reached a maturity stage that is viable for healthcare. For any healthcare organization that has not tried speech recognition, or has not tried it in recent years, now is the time. Physicians need a variety of documentation tools, including speech recognition, to enable them to work efficiently and to support the creation of high-quality, electronic health records. By deploying speech recognition tools, RMH has realized improved patient documentation, which in turn facilitates improved patient care.

With the use of speech-recognition technology, RMH has found that physician satisfaction has improved, efficiency has increased and the hospital will save a projected $600,000 in 2010 alone.

Mike Rozmus is vice president of information services and chief information officer at Rockingham Memorial Hospital.
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