• SEPTEMBER 2007 FEATURE ARTICLES •
Voice Recognition
and Transcription
Something to Talk About
A Philadelphia healthcare enterprise lowers costs, eliminates paper and raises efficiency by integrating its Web-based voice technology, PACS and clinical system.
By Sharon Schildt
When speech recognition technology first appeared in the
toolbox of tech-savvy radiologists, Main Line Health (MLH) Radiology was at the
forefront. When its existing digital dictation solution needed upgrading and
integration with the PACS infrastructure, MLH was prepared for the challenge of
taking speech recognition to the next level.
Located in Philadelphia'
s western suburbs, MLH, which
consists of Lankenau, Bryn Mawr, Bryn Mawr Rehab, and Paoli hospitals, performs
between 400,000 and 500,000 diagnostic and treatment procedures annually,
including breast imaging, interventional radiology, neuroradiology,
musculoskeletal imaging, abdominal and pelvic imaging, ultrasound, pediatric
imaging, nuclear medicine, CT, PET and MRI.
To deliver on our goal of providing high quality patient
care, MLH needed to pair its radiologists'
clinical experience with
state-of-the-art technology. By finding, deploying and using the right
technology, MLH would be well positioned to carry out its groupwide hallmarks of
quality imaging, friendly care, and fast and accurate interpretation of
radiologic studies.
Revamping Radiology
As MLH sought to create a completely digital, filmless and
paperless environment, speech recognition was a major component of the strategy.
We began by identifying specific vendor and product selection criteria. This
included ensuring compatibility with an extensive list of PACS integration
providers, demonstrating a track record of cost savings and fast implementation,
and verifying improvement capabilities surrounding workflow efficiencies by
eliminating radiology paperwork and film. "We needed an application that could
integrate seamlessly with our PACS system, so it was critical to find a vendor
with an extensive list of PACS integration partners that could provide a system
with proven ROI," says Enterprise Imaging System Administrator Ken Olbrish.
A project selection committee consisting of radiologists, a
lead transcriptionist, system administrators and radiology and information
services management identified the scope and business requirements for a speech
recognition solution. RFPs were developed and distributed to vendors, which then
were evaluated using a predefined metric to quantify and qualify responses to
identify two final vendors.
The project selection committee participated in scripted
vendor demonstrations and went on multiple site visits. The site visits proved
very valuable in finalizing and validating new workflow changes. The final
vendor selection was made after about six months of very intensive evaluation of
available systems that provided integration options with our existing systems
and workflow redesign. After a thorough review of available speech recognition
systems, MLH ultimately implemented the Dictaphone PowerScribe solution from
Nuance.
PowerScribe was installed and integrated with MLH'
s PACS and
clinical systems, enabling clinicians to view radiology reports and images
digitally through a Web
interface across all four MLH hospitals and seven outpatient centers.
MLH'
s IT and radiology resources worked with Nuance and
McKesson to configure PowerScribe to run directly on the McKesson PACS
workstation and to allow the radiologists to have full PowerScribe functionality
on the PACS workstations. As both vendors already had a strong relationship,
this integration was very easy to set up and was done in less than a week'
s
time. MLH'
s IT staff installed the PowerScribe client and microphone on each
diagnostic PACS workstation in a single evening and the integrated system was
ready to go.
Training
To secure immediate buy-in from our radiology community that
would be the actual users of this technology, MLH instituted a 7-week training
period and developed a one-on-one vendor interaction program to teach
radiologists best practices from day one.
This included the use of MLH-specific training guides and
daily conference calls to review issues and training progress (i.e., site
radiology chairmen called-in to report on their site'
s progress and issues).
Also, two-on-one training took place consisting of a radiologist coached by a
vendor trainer and PowerScribe super-user. The training period was broken down
into multiple sessions instead of one long session, consisting of an initial
2-hour session for voice adaptation and basic system functionality with a
follow-up 90-minute session for advanced functions and training. Radiologists
were also encouraged to self-edit and sign off during the initial training
sessions, and editor reviews for accuracy and content of completed reports were
followed up by one-on-one evaluations with radiologists.
Although use of the speech solution was not mandated, and
physicians did have the choice to self-edit their patient reports or to use
transcriptionists, more than 80 percent began self-editing immediately following
implementation. This exceptionally high rate is attributed to the method in
which MLH introduced the new system to its users. By training the radiologist
team to use the PowerScribe system and by demonstrating the value that speech
capabilities can bring to radiologic operational efficiency, MLH kicked off its
new speech initiative with a high adoption rate. Since then, the bar was raised
even higher to an 89 percent self-editing rate across the facility'
s 39
radiologists and 18 residents.
Today'
s Image of MLH
In addition to a very high self-edit rate, we improved
clinical image and information distribution throughout our multiple locations
and reduced transcription time and the subsequent enhanced report turnaround
time from nearly 23 hours in 2004 to just 3.5 hours in 2007. Additionally, the
number of transcriptionists has decreased from 12 full-time and five part-time
onsite manual transcriptionists to just five.
While the total number of MLH onsite transcriptionists
decreased, the remaining five have expanded their responsibilities and operation
workload beyond transcribing to include a variety of tasks from basic clerical
duties to assisting radiologists with any reporting issues they may
encounter. They also provide assistance to many of the supervisors in their
daily duties and have cross-trained to provide backup for various other
positions in radiology, including reading room coordinator, front desk reception
and nuclear medicine department secretary. The transcriptionists provide
continuous monitoring to ensure that all studies are reported on and any Q & A
issues are resolved in a timely fashion.
Even though reducing the number of transcriptionists that
were required to be onsite was part of this project'
s goals, one of the primary
objectives of expanding our use of speech recognition technology was to make
report turnaround time as short as possible, which pleases both referring
physicians and patients. "Rather than have our team of radiologists dependant on
transcriptionists, we wanted the radiologists to have the control," says
PowerScribe system administrator Ann Marie Gravelle.
By integrating PowerScribe with our McKesson PACS, our
radiologists are empowered to do everything they need to do on one computer. Our
team can dictate right into the PACS system, review the report, make edits as
needed, and avoid any paper build up, thereby making the process paperless.
With speech integrated into PACS, our radiologists can
immediately access images via the PACS system and dictate into the speech
recognition system. Having the information and image simultaneously available
allows reports to be generated at high speeds. Subsequently, radiologists can
view an image, dictate their diagnosis, sign-off on the report and have it
automatically faxed to the referring physician within minutes. The benefit is
not only in a shortened report process turnaround time, but also in improved
patient care due to that shortened turnaround time. Patient care has been
improved with speech recognition since in many cases the ordering physicians
have the actual reports before the patients reach their offices or homes.
Value Revealed
Staff physicians love the addition and use of
PowerScribe because they get reports back much faster
and can give results to their patients sooner than ever before. In addition to
speedy delivery and overall improved efficiency, our radiologists are receiving
positive feedback from staff physicians. The majority of radiologists like the
new systems because reports can be created, edited, and sent in one fell swoop
with no waiting or having to be available later to complete a report.
"
We needed an application that could integrate seamlessly with our PACS system, so it was critical to find a vendor with an extensive list of PACS integration partners that could provide a system with proven ROI."
—Ken Olbrish
Main Line Health
In addition to improving the efficiency of the radiology
team, speech recognition is far less expensive than traditional transcription.
Outside of the initial upfront expense, voice recognition dramatically reduces
the cost of off-site transcription. In total, MLH has saved on average more than
$500,000 per year since its implementation. This cost includes money saved on
resources needed for onsite manual transcriptionists, decreased outsourced
transcription services for report completion and savings associated with a
streamlined employee base.
Because PowerScribe is Web-based, its architecture enables radiologists
and referring physicians to have immediate access to images and reports from any
location via Internet. For the MLH community, this means radiologists and
editors can go home and sleep well at night knowing their job is completed.
Referring clinicians make an important impact on radiology business and speech
recognition has dramatically improved the time in which radiologists can
turnaround high-quality, accurate reports to referring physicians.
Because of the success in Radiology, we'
re looking at expanding speech
recognition technology to other areas of the enterprise. MLH'
s future plans are
to establish its Health Information Management (HIM) department as
voice-enabled. This progression is a direct result of the operational and
quantifiable benefits that MLH has already experienced. Within a few months, MLH
will launch a speech recognition initiative by integrating iChart within its HIM
department. The ultimate goal in all of this is to continue to deliver on our
hallmarks of quality imaging, friendly care and fast, accurate interpretation of
radiologic studies.
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Sharon Schildt is applications manager
for Main Line Health,
contact her at
SchildtS@mlhs.org.
|