Comment: Talk/Don’t talk

Published: 27-Feb-2014

James Kippenberger, managing director at BigHand, argues how digital dictation technology should be the cornerstone of the NHS\'s drive to become a paperless organisation

The iconic US signpost may read ‘Walk/Don’t Walk’, but as NHS England prepares to welcome its next chief executive fresh from the American healthcare market, there can be no more waiting on the sidewalk for electronic healthcare. The transition towards electronic patient records has been a more-than-pedestrian crossing for the NHS, but could digital dictation solutions help accelerate its journey to the other side of the digital road? JAMES KIPPENBERGER, managing director of BigHand digital dictation specialist, separates the hope from the hyperbole and explains how progress could depend upon some straight talking - literally

If digital technology is to fulfil its promise and help the NHS address some of its biggest priorities, trusts can no longer afford to watch and wait. It’s less about first steps, and more about next steps

When it comes to ensuring the NHS makes best use of technology to drive service improvements, we all know that it’s time for the talking to stop. But, paradoxically, for a journey that’s so far been dominated by rhetoric, but stifled by cultural inertia, perhaps it’s time for the talking to begin.

Confused? Don’t be – it’s really not that complicated. In fact, plain speaking could turn out to be the NHS’s best chance of a digital revolution. Digital dictation solutions can, and should, sit at the heart of the NHS’s digital roadmap – helping healthcare professionals, quite literally, dictate real change in service provision. But it’s time to walk the talk.

Major roadworks

The recent launch of the Clinical Digital maturity Index (CDMI), which has been developed by EHI Intelligence in partnership with NHS England,once again underlines the role that technology is expected to play in transforming NHS services. Introduced in the slipstream of the £260m technology fund for Safer Hospitals, Safer Wards, the CDMI sets out to help trusts benchmark their digital capabilities and better understand how investing in IT can improve patient outcomes, reduce bureaucracy and increase efficiencies.

The DH hopes the tool will act as a catalyst for behavioural change across the NHS – reducing digital variability and encouraging healthcare organisations to work together and share best practice. It’s been hailed as an important first step in realising the NHS’s digital vision. But with full EPR functionality just a few years away, it seems a little late in the day to be talking about ‘first steps’.

Waiting prohibited

If digital technology is to fulfil its promise and help the NHS address some of its biggest priorities, trusts can no longer afford to watch and wait. It’s less about first steps, and more about next steps.

While organisations accept that EPR could transform NHS services, implementation is still perceived as a major headache, and a widespread resistance to change has perpetuated

So what are they? The best advice is to keep it simple; to focus on the aggregation of marginal gains rather than attempting ambitious giant leaps. The pragmatic approach will undoubtedly help trusts to overcome the historical scourge of digital advancement: the fear-factor.

Policymakers’ tendency to ‘talk big’ and over-hype their digital utopia has, for NHS professionals on the ground, made the size of the task appear monumental. While organisations accept that EPR could transform NHS services, implementation is still perceived as a major headache, and a widespread resistance to change has perpetuated.

But the journey towards electronic healthcare need not be so daunting. With the DH investing heavily in infrastructure to support the digitisation of the NHS, the quickest, simplest and most cost-effective way to achieve this is through digital dictation. Indeed, renewed – but not significant – investment in integrated digital dictation solutions can help trusts go beyond the rhetoric and put their money, quite literally, where their mouth is.

Works traffic

– It’s really not that complicated. In fact, plain speaking could turn out to be the NHS’s best chance of a digital revolution

Much of the health service’s valuable resources are, effectively, lost in transcription. With more than £1.3 billion of the NHS budget spent on medical secretaries, processing clinical correspondence comes at a great cost – in both time and money. The implications for patient care are significant; patient communications – and pathways – are slowed down, clinical response times suffer and, worst of all, health outcomes are put at risk. Any attempt to maximise that £1.3 billion investment – and optimise the undoubted value that medical secretaries provide – can only be welcomed.

Far from being a replacement for administrative staff, digital dictation solutions are designed to strengthen the work of medical secretaries, supporting them in their ongoing efforts to expedite clinical correspondence and maintain patient flow. Evidence shows that dictation solutions can transform working practices. They can help trusts redefine administrative resources, allowing typing enthusiasts to focus on clerical duties, while freeing secretaries that favour patient liaison to devote more time to patient-facing activities. In both cases, the impact on patient pathways is hugely positive.

One-way system

But integrated digital dictation solutions go beyond transcription and the shift from old analogue processes; they have a broader utility and are steadily advancing higher up the NHS value chain. Trusts know that digital dictation can accelerate the creation of clinical correspondence – but increasingly, many are also recognising how digital dictation workflow software can provide additional value in terms of the approval, storage and transmission of clinical documentation.

By joining up the component parts in a seemingly-unwieldy process, a digital file generated from a dictation system can easily be profiled with all the relevant metadata to ensure its communication to relevant stakeholders is quick, reliable and efficient. With the secure and rapid sharing of patient information between primary, secondary and community care a key strategic priority, digital dictation tools provide the perfect platform to drive this through one integrated solution.

Bridge ahead

The most-effective plans are led by internal advocates, who champion the cause to win employees’ hearts and minds – supported by technology partners that can design, implement and develop solutions that align with identified organisational needs

In the longer term, the use of client-side speech recognition tools to capture information can provide trusts with an effective bridge to EPR. Data being dictated directly into the system during clinical correspondence can be used to fuel future EPR systems, and assist the incremental development of EPR in time for full implementation by 2018.

Certainly, the current communications model is archaic. In the absence of an effective EPR, the clinic letter – often a lengthy document – has become the patient record. This not only takes a proportionately lengthy time to transcribe and process, its distribution through the system is equally slow and vulnerable. Dictation solutions can improve and replace this model at a stroke – harnessing the power of information, improving efficiencies and creating a dynamic platform for EPR.

Get in lane

To optimise the scalable benefits of integrated dictation solutions, trusts should consider creating a cross-functional team to explore strategic objectives, and – like the CDMI – develop a shared understanding of how IT can help to meet them.

The most pro-active organisations are those that have recognised digital dictation as a central component in their strategy, and have developed a robust implementation plan – based on clinical engagement – that outlines agreed objectives to all stakeholders. The most-effective plans are led by internal advocates, who champion the cause to win employees’ hearts and minds – supported by technology partners that can design, implement and develop solutions that align with identified organisational needs.

Signpost for success

NHS policymakers have talked a good game for many years – and the buzz-phrases are all familiar; workforce planning, integrated care, patient-centricity and electronic healthcare are just some of the usual suspects. Digital dictation can help with them all. What’s more, while talk is cheap, digital dictation tools are affordable and high-value.

So the major talking point is clear: integrated digital dictations solutions can become a real (and ready-made) enabler for EPR, powered by the voices at the heart of the NHS.

It’s a beautiful paradox. The time for talking is over, but with digital dictation at the heart of the UK’s vision for electronic healthcare, it could be time for the talking to begin.

Talk/Don’t Talk: it’s the NHS’ signpost for success.

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