Implementation of Enterprise Wide Speech Recognition, Text-based

Documentation and Automated Document

Distribution

May 27, 2013Michelle Leafloor

Faculty/Presenter Disclosure

No conflict of interest to declare

• >$1.2 B Operating budget• >1100 Inpatient Beds • >12,000 Employees• > 1,250 Physicians• 2,020 Volunteers• > 3,600 Residents / Students• 47,000 Admissions• 60,000 Surgical Cases• 138,000 ED Visits• +$60M research grants• Active regional partner

TOH Today

Opportunity • Organizational imbalance with transcription service

presented unique opportunity– “Have not’s” pressing for a solution beyond handwriting– Why not address those that had centralized services as

well

• Dragon roaming profile capability

• Funding opportunity with Canada Health Infoway’s Ambulatory EMR and HIS Connect programs

Driving Objectives

There were two primary objectives relative to the strategic focus areas of Quality and Finance

Quality: Improve patient safety and quality of care through immediate access to patient electronic records

Finance: Be a responsible and accountable steward of health care resources

Driving Factors

Quality: 14 Day average turn around time on transcribed documents

Finance: $3M annual budget for Central Transcription

GOAL: Ensure timely access to patient information for all involved in the circle of care

Evolution of Tools for Clinicians

TOH has a proven track record of successful implementation of voice and self-editing technologies

Extend the past experience and leverage the technology far more broadly in the organization

Well understood that the broad move to voice and text-enabled self-editing would come with challenges

Project Overview

Identify physicians with central transcription access, train them on our clinical document manager tool within our EHR and the use of dragon, support them with template development and measure success

Scope : • All medical divisions (22 Divisions in 15 months)• All physicians/residents & medical students as appropriate• Measure achievements

Mandate:

Timelines – 15 Months January 2012 - March 31, 2013

Two offerings: Use of tool set or Opt to pay for central services

Approach18 week transition period emphasized gradual transition

Personalized training in Voice Recognition

Option for Fee for Service Transcription

Workflow Analysis

Customize Templates

Install Hardware

Train Support

18 Weeks

Build Generic Templates

Workflow Considerations

PC to MD

Patient Homogeneity

Clinic Volume

Dictation Length

Case Complexity

EnvironmentNoise

LEGENDRisks: High, Medium, Moderate, Low

CriteriaIdeal for

Voice Recognition

Not Ideal for Voice

RecognitionPoints

Computers to Physician

Ratio1 to 1

2 + users share 1 computer

1 to 5

Clinic Volume

(dictations required)

>30mins between patients

<15mins between patients

1 to 5

Length of Dictation

Short notesLong narratives

1 to 5

Patient Homogeneity

Surgery follow-up

General Medicine clinic

1 to 5

Patient Complexity

SimpleComplex with many problems

1 to 5

Environmental Noise

Private Office

Small clinic with many health providers

1 to 5

Below 15, significant issues faced Max = 30

Six factors affect adoption rates of physician self-edit dictation

PC to MD

Patient Homogeneity

Clinic Volume

Dictation Length

Case Complexity

EnvironmentNoise

UROLOGYScore: 21.5 / 30Difficulty: Moderate

Clinic volume can beMitigated by one-to-onePC to MD ratio

Project Status

• Well over 1500 physicians and residents trained

• Over 350 word and dragon templates created

• Very Positive Feedback from our referring physicians

• Allied Health Care Professionals transitioned

• Over the first six months, the number of documents authored by physicians using this technology increased 1000%

Growth Self-edited/authored Documents

260K documents were created over the past 12 months by services across the hospital

Transcription Contract Status

Approximately 130 physicians signed ongoing contracts for centralized transcription services

However – they are only using it for about 35% of their previous activities and leverage the new technologies for the remainder.

Covered by 3 FTE’s

We Knew You Would Ask?

OutcomesQuality: • Immediate availability in hospital electronic medical record

• Immediate e-distribution to Family and Referring physicians

• No more 14-21 day turn around for documents

• Breadth of documents continues to grow

Finance:$4M to implement

$11 M in savings after 5 years

Keys to Success

• Unwavering leadership support

• Ability to address many workflows

• Training & Support – project and ongoing

Thank you to Canada Health Infoway for supporting this initiative under their Ambulatory EMR and HIS Connect Funding Programs, without such support the immense positive patient impact would not have been realized.

Mission Accomplished

The original mission scope has been completed!

Contact Information:Michelle LeafloorDirector, Solutions Delivery Information Services, Admitting & Health Recordsmleafloor@toh.on.ca

Questions ?