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Transcript of Implementation of Enterprise Wide Speech Recognition, Text-based Documentation and Automated...
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 [email protected]
Questions ?