Be Kind, Unwind

April 14, 2009 - The days of the vital test report or patient letter being dictated onto a crackling cassette for typing are numbered. More and more acute trusts are moving to digital dictation systems; and now primary care organisations are joining them. Daloni Carlisle reports.

Have you tried to buy cassettes for a dictaphone recently? If you have, you will know that supplies are in danger of drying up as manufacturers stop making them. The days of consultants dropping off a crackling tape with three hours of dictation and a scrappy note to say there is an urgent letter about half way through are numbered.

Major contract wins coming thick and fast The replacement is digital dictation, which can come with or without voice recognition. It is not new technology, but the software and its application in the NHS are moving on rapidly, leading to an acceleration in uptake. In just the first four months of 2009, suppliers have announced several major contracts including:

  • Scotland (where a £2m national framework contract with Voice Technologies will make Winscribe available to every NHS hospital that wants to purchase it)
  • Sheffield Teaching Hospitals NHS Foundation Trust (which has done a deal with BigHand to roll out a digital dictation workflow system to 1,000 users in five hospitals on two campuses)
  • University Hospitals Birmingham NHS Foundation Trust (where SRC is to roll out Winscribe to 750 users )
  • HCA International (which has bought SpeechMagic from Nuance Communications and is rolling it out over 12 sites).

Suppliers are also moving beyond big contacts with hospital trusts and into primary care. Winscribe, for example, has just signed its first contract with a primary care trust to provide services for its GP practices.

“Digital dictation as a technology has crossed the cavern,” says SRC’s chief executive Chris Hart. “It is now seen as a key technology to aid NHS trusts in meeting some of their key targets and improving efficiency. We are now deploying systems in 14 trusts in the UK and have signed an additional four in the last few months.”

The driving force behind this upswing in interest is not just the death of analogue tape technology. The 18 week referral to treatment time target and the requirement for hospitals to provide discharge summaries to GPs within 72 hours by April 2009 and 24 hours by 2011 are also playing a part.

Managing workflow

Digital dictation can be stand alone - that is, doctors can just be given digital recorders to replace their analogue versions. This alone cuts the cost of consumables and makes secretaries’ lives easier, say suppliers.

More usually, though, trusts are taking up integrated workflow systems, sometimes with speech recognition bolted on. This is where the real gains are to be made. Demonstrations by any one of a number of suppliers run through very similar features. In essence, systems work like this. A doctor dictates his or her notes into a recorder, marking them as urgent or routine, and hits a send button.

This takes the transcript to a workflow system that automatically distributes the recordings for typing by secretaries. It is up to trusts how they manage that workflow - for example, urgent work might be pooled. Trusts can even use the system to manage out-sourced transcriptions.

Once transcribed, the workflow system handles distribution - sending letters back to the consultant for sign-off and printing, for example.

If voice recognition is included, a doctor might either dictate and then correct his or her report or dictate and then use the workflow system to manage the report electronically.

Some systems integrate with the hospital’s patient administration system so that dictations can be linked to individual patients and letters automatically populated with the NHS number and demographic details.

In some places, the workflow system integrates report writing and imaging so that a patient’s notes and images stay linked (this happens at Great Ormond Street Hospital for Children NHS Trust, which has invested in a SpeechMagic solution from Nuance Communications).

“We call this a manageable process,” says Tom Rothwell, managing director of Medisec Software, which is now working with Countess of Chester Hospital and more than 30 GPs practices whose patients regularly use it. “Our system is semi-automated, allowing electronic signatures and the distribution of letters electronically to GPs. Because the system is integrated to the PAS, all the secretaries in the hospital can use the system to generate their correspondence. It is integrated with Microsoft Word so generates Word documents.”

Slashing reporting times

The benefits of this type of system are manifold. Suppliers’ case studies are full of trusts that have slashed their reporting backlogs and can now turn around reports in two to three days.

HCA International, for example, says it has reduced the average radiology report creation time from 24 hours (dictate, type, correct and sign off) to two minutes and 40 seconds by deploying speech recognition and an integrated workflow system.

This has already been adopted by 96% of HCA’s160 radiologists, who are obtaining 95-99% accuracy from the speech recognition software. Sheffield Teaching Hospitals is now achieving same day discharge summaries in some specialties, and real time typing of clinics.

Trusts have also rationalised their secretarial workforce and reduced error rates in transcription.

“All the trusts we work with are looking at efficiency,” says Hart. “They are not making redundancies, but in some cases they have stopped using agency secretaries who are anyway the most expensive and sometimes the least efficient.”

Out into the community

Suppliers are now investing in R&D to make sure their products meet NHS trust requirements. Medisec Software and SRC are looking into how to work with primary care IT systems to enable the electronic distribution of discharge summaries, the use of electronic signatures and to integrate workflow with document storage systems. Winscribe has gone a step further and teamed up with HOIP, a healthcare intelligence social enterprise. The two are now exploring how voice recognition can be used to capture data.

The idea is this: by making Winscribe’s technology available through mobile telephones or PDAs, fieldworkers such as social workers or community nurses could dictate their notes directly to voice forms. They would dictate in a name, demographic details and notes, then send everything to the transcription centre as normal.

So far, so routine. Now the clever bit. HOIP’s Anoop Singh, explains:

“If the form also allows some sort of ranking for severity, this granular data can be captured, put into a database which can then automatically flag up any anomalies or urgent cases within a management system.” Because voice data is captured digitally, it makes it much faster and easier to analyse. “The applications are huge, for example in supporting healthcare in the developing world, care closer to home and epidemic monitoring, and it uses cost effective, ubiquitous mobile technology.” Says Singh. The technology is already being used by the police force in the UK.

For the NHS and care services it is very early days, stresses Carine Russias, Winscribe’s marketing executive in Europe.

“But we are now opening our eyes to the possibilities that the technology offers.”

For more information contact Winscribe Marketing:

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