In this article, JAMES KIPPENBERGER, managing director of UK healthcare at BigHand, outlines how digitising and connecting clinical correspondence can not only deliver productivity gains and improve patient outcomes, it can also help healthcare trusts to manage the transition towards new models of electronic healthcare. The NHS is at the start of a journey, but he argues, that to progress the clinical community must find – and use – its voice.
As organisations battle to meet QIPP targets, digital dictation has rightly been identified as a ‘quick win’ that can improve back office efficiencies and curb wastage
Much has been made of the efficiency benefits of deploying digital dictation solutions within NHS trusts. As organisations battle to meet QIPP targets, digital dictation has rightly been identified as a ‘quick win’ that can improve back office efficiencies and curb wastage. In turn, hospitals are increasingly implementing basic technologies to improve dictation processes and deliver cost efficiencies. But digital dictation provides much more than a short-term opportunity to save money.
Enhanced digital dictation software, powered by speech recognition and used as part of a workflow solution, can deliver major productivity gains, improve the patient experience and, ultimately, drive better health outcomes. Moreover, it can provide a platform to shape long-term strategy, helping trusts prepare for the introduction of EPR and the development of sustainable models of electronic healthcare beyond it.
The focus on cost savings as the driver for digital dictation is therefore too narrow. There are real clinical benefits to taking a more digitised approach to clinical correspondence, for clinicians and patients alike.
In recent years, a high number of trusts have made the transition from analogue to digital dictation. But the move is actually only the first tentative step of a longer journey that can drive demonstrable improvements in productivity and efficiency. Hospitals can do much more to ensure that clinicians realise the holistic benefits of digitised clinical correspondence.
Liberating clinicians
Naturally, clinicians’ priority is patient care. But, in reality, many still spend a disproportionate amount of time away from patients, performing administrative tasks. In mental health trusts, where consultations are often conducted in the community, clinicians can spend a hugely disproportionate amount of their time doing administration. In the acute trusts the ratio is more favourable, but correspondence methodologies mean clinicians continue to lose valuable patient-facing time to the onerous process of creating, disseminating, checking and signing discharge summaries and clinic letters.
Some hospital departments are forced to function without administrative support and there are still high numbers of clinical staff producing handwritten notes, all of which eventually need typing. It’s a busy environment, plagued by inefficiency and too often patient care becomes a casualty of that inefficiency, with important correspondence held up in the system and unavailable to GPs at the point of clinical need. Despite clinicians’ best efforts, the impact on patient outcomes is real. The challenge is to liberate clinicians from unwieldy administration, enabling them to focus on treating patients.
With national targets putting hospitals under renewed pressure to speed up the delivery of clinical correspondence to GPs, workflow solutions provide cumulative benefits of exploiting small pockets of resource capacity, ultimately accelerating turnaround time
Although many trusts now use digital dictation, lots only implemented standalone systems that work on the same peer-to-peer basis that characterised the old analogue approach - the clinician dictates the notes, passes the dictation device to the medical secretary, who transcribes the notes and returns printed versions back to the clinician for signature. The audio files are digital, but the processes remain the same and yield no additional productivity gains. In many respects, standalone means standing still. There are, in addition, about 15% of acute trusts and nearly 70% of mental health trusts still using analogue machines.
The real benefits of digital dictation begin with the migration to a ‘workflow solution’ which gives clinicians the ability to track clinical correspondence, prioritise individual items, and accurately report trustwide activity. Using this approach, hospitals are able to identify bottlenecks and disseminate work to available resources.
With national targets putting hospitals under renewed pressure to speed up the delivery of clinical correspondence to GPs, workflow solutions provide cumulative benefits of exploiting small pockets of resource capacity, ultimately accelerating turnaround time. This helps hospitals meet targets and reap financial CQUIN benefits. Moreover, it frees clinicians to spend more time with patients, expedites clinical communication to support continuity of care, and brings increased back office efficiency. Digital dictation is also being used to improve the delegation of tasks, enabling clinicians to dictate administrative duties into centrally-managed teams, with tasks prioritised and scheduled into workflow accordingly.
Speaking volumes
The greatest benefits will come through a pragmatic adoption of speech recognition technologies. Speech recognition engines commonly return dictated copy within minutes – leaving secretaries with the important, but significantly reduced, task of proofreading documents for accuracy and clinical correctness. Dictated information is subsequently electronic throughout its lifecycle, from the clinic to the GP surgery. The productivity gains are huge.
There is incremental uptake of speech recognition technology across the NHS, but evidence shows the approach is able to produce high-quality documents in a timely and accurate fashion.
With obvious advantages to patient care, improved efficiencies and heightened productivity, it’s clear that digital clinical correspondence – powered by voice-enabled technologies – is something worth talking about
Some pro-active trusts that have deployed speech recognition are restructuring their administrative workforce, reducing temporary staff and overtime and rebranding secretaries so that some concentrate on document production while others support patient liaison. The clinical benefits, as well as the inherent cost savings, are clear.
Downstream benefits
Speech recognition also promises significant downstream benefits. Some of the more sophisticated engines are now able to return dictations as machine-readable data, as well as standard text, turning speech recognition into speech understanding. In the future this data can be coded and uploaded into third party systems, opening hospitals up to the possibility of a range of value-added informatics tools in the long-term. In addition, ‘voice-enabled’ systems will allow clinicians to dictate directly into an EPR, enabling them to populate the system and generate clinical correspondence simultaneously. Moreover, machine-readable data can also be ‘mined’ to monitor correspondence activity in costly outpatient clinics, where hospitals currently have no way of measuring output; identify appropriate patients for clinical trials; and to audit clinical correspondence in order to improve back office efficiencies and patient communications.
In the medium-term, hospitals will need to exploit the opportunities presented by mobile technologies. Smartphones can provide clinicians with efficient means of uploading dictations while on the move. Whether they are between ward rounds, seeing a patient at home, or driving between sites at a multi-hospital trust, these current periods of downtime can become more productive and dictations can be wirelessly transmitted to secretaries and actioned immediately, freeing clinicians to see more patients.
The decision to implement digital systems should not be left to IT and procurement alone – clinicians must make sure their voices are heard
The NHS is currently suffering a collective paralysis around the use of smartphone technology, despite widespread personal use among clinicians, with historically-justifiable concerns around data security. But the growing uptake of mobile device management platforms that centrally lock down information could pacify those fears. Certainly, trusts must determine the real and perceived risks of mobile technology, and investigate ways of securely optimising it. It also offers immediate tangible cost savings, as hospitals do not need to spend thousands of pounds purchasing remote dictation devices if they already use smartphone technology.
Making your voice heard
Clinicians are increasingly recognising the important role that digital dictation can play in helping them focus on patient care by reducing the burden of administration. Yet the journey towards digitised clinical correspondence will not be completed overnight. In a healthcare environment where clinicians are battling to spend more time with patients, the increased use of tools that can improve the efficiency and productivity of care can only benefit patients.
But the decision to implement digital systems should not be left to IT and procurement alone – clinicians must make sure their voices are heard. As the old saying goes, it’s good to talk. With obvious advantages to patient care, improved efficiencies and heightened productivity, it’s clear that digital clinical correspondence – powered by voice-enabled technologies – is something worth talking about.
