interviews

Visible benefits

Danny Roberts, associate director of IT at University Hospitals Coventry and Warwickshire NHS Trust, talks to NHE about increasing visibility throughout the workflow.

Digital dictation is allowing trusts to integrate workflows, supporting clinicians and secretaries to work more effectively whilst reducing the amount of typing and delays in verification.

University Hospitals Coventry and Warwickshire Trust piloted the technology in 2011, between May and July, across its haematology, paediatric orthopaedics, breast surgery and respiratory units. Danny Roberts, associate director of IT at the trust, said that different devices were trialled, including smartphones and laptops, to remotely access the system from wherever clinicians are.

The pilot sites have now switched to digital dictation, while the rest of the trust is still using traditional methods, including outsourced transcription and tape recordings. In the future, digital dictation will be rolled out throughout the trust, to enable all to benefit from the significant time and accuracy savings.

Roberts said: “We’re quite happy with the solution. The issue is the capacity to deploy that alongside a number of other projects that we’re working on.

“The trust has an in-house electronic patient record (EPR) for clinicians to access letters, results, patients’ tests, discharge summaries and basic assessments. A clinician will work from a clinic list of all the patients expected. The beauty of that is opening the dictation system with the entire patient context: demographics, consultant’s specialty, clinic and so on.

“Previously that would have had to be dictated onto the tape or added later by a secretary. All that detail is now transferred in context electronically. That’s the real hub of the integration.”

Dictation files are then typed up by secretaries, predominantly in-house, although Roberts added: “There’s another stream of the digital dictation project which is looking at outsourcing services.”

No resistance

A status field in the clinical correspondence area of the EPR allows users to log in and see if a letter has been typed. Authors also have their own to-do lists within the system, which flag up letters ready for online verification, such as checking errors and editing the text.

Roberts said: “That speeds up the end-to-end process; they don’t have to scribble on a piece of paper that a secretary then retypes and they have to check.

“They can re-dictate the letter, or if it’s just minor changes, they’ll go in and tweak it themselves. We expected a bit of resistance to that from clinicians, but it’s been very enthusiastically taken up because of the flexibility. They’re not waiting to do a batch of letters for next Thursday, or in the office with letters stuck in the post to get to their outworking in the community. They can log on from wherever they are and verify the letters straight away.

“Letters can be typed during clinic, directly into the system. Effectively a clinician could dictate, with his secretary in another part of hospital typing up all the letters. Then he can verify all the letters and by the end of the morning, potentially have all the clinic letters done for that day. Full end-to-end is achieved because we have an electronic document interface to transmit those letters directly out to connected GPs.”

Roberts explained that some of the trusts’ consultants do remote clinics, and operating on two principle sites means that secretaries can often be in a different location to the clinician. The ability to dictate and verify from anywhere therefore simplifies the whole process of record keeping.

Topping and tailing

Voice recognition has already been used for several years in radiology, but while Roberts said the technology had been considered, he added: “At the moment we don’t have any immediate plans to move to voice recognition.

“Once we have the platform deployed – the mics – what we do with that voice file, and whether we use voice recognition or outsourced transcription or in-house, are options open to us.”

Roberts suggested that apart from the controlled, quiet environment of radiology, where the language used tends to be very formulaic, there haven’t been many examples of trusts rolling it out into other areas. However, he believes this is more to do with the necessary formatting and processing of files, rather than inadequacies with the technology.

“It’s not just a voice file; it’s the processing of that voice file that needs to occur. Recipient addressees and distribution lists are the real administration tasks that are best done by the administrator.

“You still need to do the topping and tailing. Asking a clinician to dictate a diagnosis on an eye cancer; yes he’ll do that. But asking him to look up a GP and a couple of colleagues and transmitting it to so-and-so specialist, their processes and habits are that they’ll say ‘copy it to Fred, John and Tim’ and the secretaries will do that. Even if you’re using voice recognition, they’ve still got to work out how to do the physical distribution that’s required.

“I think there are process issues. Fundamentally, if you’re still going to have someone doing the topping and tailing then you might as well have them doing the typing. The majority of secretaries are performing that kind of clinical coordinator/personal assistant role and typing is a proportion of that time rather than the whole of that time,” he said.

Visibility

Roberts said the main benefit that digitisation has brought to the trust is greater visibility throughout the process of creating, transcribing and filing records.

He said: “You can see the order of patients in a clinic list, and you can see very quickly that every patient has had a dictation completed. On a tape you might miss one out.

“It’s also easier to see divisions of work. If a registrar is working in one room and a consultant is working in another after a joint consultation, they can see when the dictation is completed.

“We can now look at performance associated with letter production; how effective our secretaries and doctors are, which historically was completely invisible as there was no way of seeing how quickly letters were produced.

“It’s visibility and that’s the key thing for us: the end-to-end process.” 

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