interviews

Easing the bottleneck

Claire Wells, performance manager at Barnet, Enfield and Haringey Mental Health Trust, talks to NHE about the integration of digital dictation and overcoming the teething problems that all trials experience. 

Savings on admin costs, redistributing transcription into a more regular workflow and speeding up both turnaround times and clinical time spent moving from site to site are all benefits of digital dictation.

At Barnet, Enfield and Haringey Mental Health Trust, one of the country’s largest, with more than 3,000 staff serving a population of more than 800,000 people, a project incorporating both digital transcription and voice recognition elements is set to bring these improvements and more into the workplace.

However, they’re not quite there yet, as Claire Wells, performance manager in the forensics department, explains.

Wells said: “There were a few technical problems at the beginning, but as improvements have been made to it and people have got used to it, they do really like it.

“It was difficult to start with; you always end up ironing out all the teething problems when you pilot things, as with any sort of change in management, especially when you’re involving senior clinical staff and getting them to change their practices. That’s been the biggest hurdle really.”

The pilot, which began in spring 2011, was confined initially to 34 medical staff, before being expanded to more clinical staff and administrators. The work is not outsourced at the moment, although this has not been ruled out in the future.

Timesaver

Digital dictation does still offer great improvements to the Trust though, as community staff are currently using a BlackBerry app for dictation, enabling them to send files from wherever they are, straight into the workflow.

She explained: “That’s been a huge timesaver for them. It also stops bottlenecks in admin, because you would find that consultants who were based in the community would come back to base on a Friday and dump a big pile of paper on the desk and everything’s ‘urgent’; so this allows the workflow to flow a bit more smoothly. We don’t get the peaks and troughs we used to get.

“The Trust works across all three boroughs, so in terms of management, it’s much easier. If we’ve got a shortage in Haringey, to send the work up to Barnet, it’s just a click of a button and it’s moved into the Barnet workflow.”

Voice recognition

The next step for efficient transcription is voice recognition, which can again reduce the workload for admin staff and speed up turnaround times.

Wells said: “We’re just starting to launch the voice recognition component. We’ve targeted five of our more prolific authors, because they are the ones who are generating a predominant amount of the work.”

Once the training for this is complete, this will increase the savings on admin time, Wells suggested, although while these innovations can cut costs, “that doesn’t necessarily mean a loss of jobs”, she said. “It just means that their time can be spent doing the 101 other things they have to do as well.

“The system we bought from BigHand allows staff to dictate a job into a voice recorder and submit that into a transcription server. That then gets converted into a document, goes to an administrator to proofread and comes back to doctors for sign off.”

The benefits this can bring depend on the reliability of the voice recognition software, Wells said, but she added: “Once accuracy levels are up to about 98% then they will just submit the jobs and get those straight back, sign them off and send to dispatch.

“We’ve got five doctors using it at the moment. We’ve been trying to train it through the back end of the system so what’s been happening is the secretaries have been typing the dictation, giving me the voice file and the paper file and then I can match them together in the back end as a training tool.”

Obstacles

She continued: “The problem is nobody actually dictates what eventually gets typed. You get doctors saying ‘Oh hi Sue, this is Tim and I’m doing a report on…’ and that’s not what the secretary then types, so that’s been a bit painful.”

These details are included when the job is submitted to the workflow, so it is unnecessary information to include, she notes, adding: “We’re trying to get them to do things the  way the system needs them to do it.

“When we went with RiO (electronic patient record system) it took them ages to get used to doing things that way and now people just do it.”

Challenges with voice recognition also include modifying natural speech in order to fit the technology’s requirements to work at its greatest potential, the length of time spent checking and length of transcriptions.

Wells said: “Forensic documents tend to be very lengthy; the average report is about eight to ten pages, so it’s not just short letters that they are just checking.

“Initially the checking time will probably not be much less than what it would take them to type it, but once you start seeing the accuracy levels improve, there will be less time spent proofing.

“Voice recognition requires the doctors to alter their style of dictation a bit – if they’re doing a date, for example, they’ll say ‘14th of July’ but you have to say it in a specific way for the software to pick it up. You have to say ‘full stop’, you have to punctuate your dictation, which a lot of them don’t.”

She said that most of the doctors were getting used to it and seeing the benefits, but admitted it was a struggle for some.

Consequences

The future of voice recognition and digital dictation in general may involve unlocking further potential in savings, but there can still be a disinclination for staff to participate in new ways of working that they fear could eventually cost their jobs.

Wells said: “I do think it will work, but there’s a little bit of reluctance in people to actually train it, both from the clinical and the admin point of view. I think administrators are worried they’re going to lose their jobs if they do too good a job of training it, and clinicians are worried they’re going to lose their secretaries if they have voice recognition.

“That’s not really going to happen, but they may have a slightly different support structure in future.”

This redistribution of the workload could free up admin time to be spent on other activities, thus creating more efficiencies.

When the trial has reached a point where the Trust can demonstrate the benefits of the technology, Wells believes there will be further takeup, due to its ability to speed up turnaround times.

She said: “Once we get to a point where we can say doctors X, Y and Z are using it, and that it’s working well – that there are a couple of typos that come back on difficult words but mostly it’s fine – then hopefully people will take it up.” 

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