Comment: Bridging the NHS efficiency gap - a strategic approach to unleashing the power of digital dictation

Published: 8-Nov-2013

Tom Rothwell of Medisec Software on the role of digital dictation in the drive for a paperless NHS

In this article, TOM ROTHWELL of Medisec Software reflects on the introduction of digital dictation and the steps that trusts should consider to improve workflow efficiency and increase cost benefits

To reduce transcription costs and speed up letter delivery times, trusts need to examine the potential of ‘paperless’ workflows from the point of patient contact to electronic delivery of the final letter

Digital dictation technology has been readily adopted by NHS trusts in a bid to address workflow and administrative efficiencies and few would deny that it marks an improvement on the use of analogue tapes.

However, trusts introducing digital dictation in isolation are failing to realise full cost benefits that could be gained by integrating the technology with the letter generation processes. To reduce transcription costs and speed up letter delivery times, trusts need to examine the potential of ‘paperless’ workflows from the point of patient contact to electronic delivery of the final letter.

The tagging solution

Left to their own devices authors will typically provide little information about the nature of saved audio files, which leaves the secretary with little clue about their content until the files are opened. Demanding more information from the author, however, would inevitably lead to a greater burden on precious clinical resources and compromise user buy-in.

A system that automatically tags audio files with key data like author, patient demographics, activity details, letter type in the context of the patient visit maximises the potential for automation. This can be achieved and merely requires the author to select the correct patient activity entry; the system then connects (tags) the audio file with the key data items.

To reduce transcription costs and speed up letter delivery times, trusts need to examine the potential of ‘paperless’ workflows from the point of patient contact to electronic delivery of the final letter

The approach has been successfully adopted by forward-thinking trusts such as Alder Hey and Doncaster and Bassetlaw. Both have integrated systems capable of creating clinical letters at the touch of a button.

Tagging enables the system to create the letter template automatically, including letter headings, addresses, patient demographics, activity data and author. This leaves the transcription of the voice file as the only input required. Minimal transcription means that improved quality of output and time savings in production can be significant.

Workflow efficiency and cost savings realised

Hospital consultants can see their patients, dictate their correspondence online and have letters typed and available for them to sign off by the end of their clinics; it is a streamlined paperless process.

Additionally, consultants can create customised workflows of outstanding dictations, so that the work automatically appears in the transcriber’s inbox removing any need to search for specific pieces of work.

Tagging voice files in this way enables a trust’s dictation and transcription procedures to be reorganised to improve efficiencies using for example outsourcing and centralised transcription services.

In cases where a trust has decided to outsource transcription, core letter content can be transcribed by third parties without them having access to patient-identifiable information. This can be made visible, within letter templates, to hospital staff only – consigning the process of cutting and pasting letter content from one document to another to the history books. Not only is this more efficient, but it reduces the opportunity for error.

The paperless Holy Grail

Health Secretary, Jeremy Hunt, has thrown his weight behind proposals to make the NHS fully paperless by 2018. From a clinical correspondence perspective, this is digital dictation’s Holy Grail – and the technology is available to make this a reality now.

Intelligent coupling of technological developments can result in real and significant benefits – it is now up to NHS trusts to unleash these capabilities to help meet increasing standards of patient care and attract necessary cost savings

By using a fully-integrated system, letters such as clinic attendance or discharge summaries can be checked and delivered electronically.

Doncaster and Bassetlaw Hospitals NHS Foundation Trust, for example, has halved the average time taken for providing clinical correspondence to GPs, from eight days to four. Nearly a third are being delivered within its 24 hour target and it is confident it can improve yet further on this.

Once transcriptions are completed, documents are forwarded to hospital consultants for review and electronic sign off, before being delivered electronically to the relevant GP at the practice in a seamless paperless process.

More than 100 clinicians are now using the system to create around 11,000 pieces of digitally-dictated clinical correspondence each month.

Adapting to smart new technology

It is clear that there are considerable opportunities for integrating digital dictation systems to improve service levels and reduce transcription costs, but trusts must be mindful how such digital dictation systems are implemented if these opportunities are to generate most benefit.

Clinical and secretarial engagement in the development of reliable, simple-to-use solutions is vital if these key user groups are to have sufficient confidence to use them effectively.

Hospital trusts need to ensure that both training in and support of equipment and system is effectively delivered; users become readily ‘fed up’ if support responses are poor.

Authors must have ready access to the appropriate digital dictation equipment and workstation. Remote digital dictation can be used with hand-held devices where the clinical setting demands it or where they are working offsite and don’t have access to a connection to the hospital system network. Naturally, remote handheld dictation does not tag voice files and this is less efficient than the tagged solution. Hospital trusts should restrict the issue of hand held devices in order to encourage the ‘tagged’ solution.

At both Alder Hey and Doncaster and Bassetlaw, use of tagged dictation was introduced first to maximise its usage; the provision of hand-held devices could then be better controlled and used only out of necessity. It has helped the trusts to make meaningful decisions for instance on the potential time and cost savings that might result from restructuring staff resources.

Intelligent coupling of technological developments can result in real and significant benefits – it is now up to NHS trusts to unleash these capabilities to help meet increasing standards of patient care and attract necessary cost savings.

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