Health Service Focus


Digitally speaking

Source: NHE Sep/Oct 15

2gether NHS FT, the mental health and learning disabilities foundation trust for Gloucestershire and Herefordshire, is overhauling its clinical IT systems to implement modern digital dictation and speech recognition, as well as new clinical practices. NHE’s Adam Hewitt spoke to the trust’s IT director, Ryan Lewis.

The cessation of the National Programme for IT has prompted many trusts to strike out in new directions, enthused by the personalised possibilities of bespoke contracts, instead of the sometimes one-size-fits-all approach they were limited to under the old contracts. 

2gether NHS FT, whose 2,300 staff work across four hospital sites but also out in the community and at other bases, is in the middle of a transformative programme called Improving Care with Technology. 

It has stuck with the RiO system for its care records and notes – though it now has a version with much more functionality provided directly by Servelec, replacing the more basic version it has used over the past five years via the old National Programme for IT / Connecting for Health. Trust IT director Ryan Lewis said the old iteration it has been working with “was really limiting because we couldn’t develop it in the way we wanted to”, and there was an extensive change control process in requesting even basic changes. 

But the new version “really opens doors for us”, he said. “Now, we’re masters of our own destiny. That brings massive benefits, but also some risks. We have been very much in a learning process since May, when we deployed the new system.” 

On the move 

The trust has chosen to put a far bigger focus on mobile working, digital dictation and speech recognition, with the core aim of reducing the admin burden for clinicians, allowing them more time with patients and reducing travel time between bases. 

Before picking its preferred supplier, the trust worked with NHS Shared Business Services and carefully investigated the digital dictation options on offer, how they integrate with RiO, and visited other trusts – including Northumberland, Tyne & Wear NHS FT, Oxleas NHS FT, Cambridgeshire & Peterborough NHS FT, and Southern Health NHS FT – to see the technology in action. From six suppliers that were initially interested, it picked three to go forward with, before eventually deciding to go with BigHand after it concluded its procurement and pilot phase. 

Lewis says the new technology infrastructure, software and working practices at the trust will also reduce delay in data entry, leading to improved risk management, flexibility for staff, and more effective use of team bases.

Until recently, the trust’s core EPR was only available at those team bases, forcing clinicians to travel ‘back to base’ to input their progress notes into the system, usually directly via keyboards, which proved very time-consuming. 

Lewis said: “Making a clinical system available wherever you are is one thing, but that would still leave our clinicians having to input data through the keyboard, and none of them are qualified secretaries.” 

Instead, it is hoped the new system, based around digital transcription, will transform all that – though Lewis acknowledges that lots of training and behaviour change will be required, and it has been important not to assume all clinicians are familiar with smart devices and similar technology. “It’s about much more than just giving them new devices and saying, ‘get on with it’,” he said. 

Clinicians won’t see the background technical infrastructure of the trust’s upgraded wi-fi, VPN (virtual private network) and so on, but hopefully they will benefit. “Mobile working is really core,” Lewis explained. That is because the trust serves a combined population of nearly 800,000 people across 1,900 square miles of rural and urban landscape. 2gether provides 96% of its services within the community and as close to people’s family and friends as possible, it says. 

No option to ‘do nothing’ 

The trust’s Strategic Plan 2014-19 is emphatic on the need for change: “The ‘do nothing’ scenario has been ruled out as we believe that unless the transformation of services is achieved, then the future viability of the trust is in question.” 

The changes as regards IT span the infrastructure, software, clinical systems, digital dictation, clinical practice development and changing operational policies. 

That latter leg of the strategy is especially important, as the trust gives clinicians permission to work in new ways and encourages working from home, while ensuring they do not expose themselves or the trust to risk. 

“We wouldn’t want staff dictating progress notes in a coffee shop, or anything like that,” Lewis said. “But you have to explicitly develop those policies and permissions with the staff, that’s fundamental. If you haven’t got that framework – we’ve learnt this through the pilots we’ve been doing – it can introduce such a level of uncertainty for staff that you can get into real problems.” 

As well as its four hospital sites, the trust also has many other buildings and facilities across its patch, making for a large estate and thus high operating costs. Its transformation strategy is explicitly intended to help rationalise that estate. 

A clear communications plan has been important to stop rumours spreading, along the lines of the trust wanting to shut every team base, or force people to work from their cars. The trust realises that there is a clinical and operational benefit in having staff being able to easily meet and talk and discuss what they’re working on, and for more experienced staff to offer informal guidance to those newly qualified. “It’s also important to not forget we’re all social creatures, and it’s an important part of both work life and quality of care,” Lewis added. 


Something of a split has emerged in terms of hardware preferences for digital dictation, with those who have never done it before wanting to record their notes using smart devices, but those with long experience keen to use bespoke dictation devices, such as those made by Olympus. Those are being trialled at the moment, some tethered to desks and some not.  

It is using Nuance’s Dragon speech recognition software, and Lewis says it is definitely a new departure and will be a learning experience. 

“Speech recognition is at the heart of it,” Lewis said, “because we are expecting to take that administrative burden off not just the clinicians. We are starting from a position where medical secretaries are still getting audiotapes. So, there are going to be real benefits for the medical secretaries themselves, because all of the dictations are managed through the speech recognition [tool] and then through a workflow piece of software. That effectively opens up resource and flexibility, so the workflow can be managed, so that hopefully secretaries don’t get, say, a five-hour tape at 4pm on a Friday afternoon.” 

BigHand’s tools will be integrated with patient administration system, RiO, allowing for the fully automated production of patient progress notes, requiring little to no manual intervention.

Support from the Nursing Technology Fund 

The trust now has 2,500 licences with BigHand, funded via the Nursing Technology Fund (NTF). It won a substantial £1m grant from the second round (2014-15 and 2015-16) of the Fund to buy and deploy the digital transcription and speech recognition software and associated hardware across its nursing workforce. 

The trust had already been successful in the first round of the Fund, for 2013-14, when it won £50,000 to trial and develop the ‘Store & Forward’ functionality of the RiO EPR system, which supports mobile working without needing a network connection.

Lewis said: “That was one of the reasons we were successful [in the second round]. The NTF people could see we had a clear vision and logical five-year process. We’re very grateful to the NTF for supporting the capital investment.” 

In the longer term, the trust also hopes to develop social media tools to provide its service users with more peer-group support, and to use digital technologies to enable some consultations to be carried out online rather than face-to-face. The trust is still at the ‘research stage’ there, though, Lewis said.



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