interviews

Coordinating communications

New technology is transforming the ways doctors work. Dr Justin Whatling, vice chair of strategy & policy at BCS Health and BT Health’s chief clinical officer, explains the key trends and outlines the next steps trusts can take.

Dictation and transcription have long been used in the health service, but now sophisticated technological developments are taking this practice to a whole new level. Advances in natural language processing in transcription systems mean that voice recognition is starting to be used, increasing efficiency savings for the NHS.

Dr Justin Whatling, vice chair of Strategy & Policy at BCS Health and a former hospital physician working in neurology, spoke to NHE about the latest progress in this field.

Intelligent technology

Some of these newer technologies include learning systems, so the programme can use examples of secretaries correcting certain errors to increase its own accuracy levels.

Dr Whatling explained: “The more data they have, the easier it is to do, and they learn quickly so the secretary needs to correct less and less over time.”

He said that the accuracy of these kinds of systems increases with use, due to these learning capabilities and pre-embedded terminology to recognise certain medical terms.

“They’re generally very accurate, and the learning makes them even more so. It’s amazingly clever, it deals with all your ‘ums’ and ‘urrs’,” Dr Whatling added.

Another intelligent development is the option to create structured outputs, formatting text into the template of a letter or medical report. This maps specific text into the slots, such as patient name and blood pressure.

Dr Whatling suggested this would be very helpful and “quite powerful” in discharge summaries or referrals as it reduces the amount of work for secretaries.

“You can also use some of these solutions to control your interface. This is suitable for professionals and staff such as radiologists who generally report sitting at a station, being very dynamic, so you can imagine how they can quickly get used to using structured commands. Most applications are built on Windowslike environments, so the software programmes have been able to couple in operating systems commands.”

Adapting to technology

Commenting on the modification needed to transform natural speech into coherent text, Dr Whatling said: “It does require a lot of grammatical correction and re-constructing sentences to compensate for how people talk versus how things should be written. There must be quite a lot of intelligence and understanding of language and how to construct it.”

The potential to increase system integration means transcriptions can be uploaded into an electronic document management system or patient record system, thus increasing efficiency.

“Moving to electronic discharge summaries rather than paper ones means you don’t have all the packaging up of post, and they’re all on patient record systems. It’s easier to find a record because it’s all online, and secretaries and doctors will save a lot of time by not running around everywhere wondering where their notes were,” Dr Whatling added.

So what?

Discussing the benefits of these advances, Dr Whatling said he applies the ‘so what?’ factor, to consider how the time freed up by digital dictation or voice recognition can be best put to use.

“You’re effectively trying to increase the efficiency of your processors and improve accuracy. A lot of this is actually orchestrated around productivity. What do you do with the time you’ve got back? You can make the process more efficient but does that mean that some people then just twiddle their thumbs or do you get them doing other things? If you make the process more efficient, do you cut back on your workforce because you don’t need so many people?” he said.

Dr Whatling recommended that Trusts consider this aspect in their business cases, as they must have plans for their productivity enhancement. Some options include using natural attrition, an active plan to diminish that part of your workforce or redistributing work, he suggested.

This could raise concerns with the workforce and brings up the old debate of technology replacing humans in certain roles, but Dr Whatling believes the third option could be the best solution.

He said: “What you’ll see is an increasing diversification of staff, and people morphing into different roles. In general practice there’s been quite a lot of response to getting practice managers and nursing staff and others to do different types of jobs. Clinicians can give those duties to others and it’s not necessarily clinical work – they’re just conforming to a process which takes a burden off clinical staff to get on with other things.”

As well as saving time and allowing staff to work on different tasks, Dr Whatling explains how the elimination of human error can radically increase accuracy, and therefore safety.

He said: “Having been a practitioner, you can dictate a note and then go and review the letter itself – it’s Chinese whispers. By the time you’ve dictated it and someone has listened to it and laid their interpretation over it there’s plenty of room for error to creep in and that could actually be quite dangerous. Some medical terms are similar to each other – you can imagine how easily that might come up.”

Pay-as-you-go

In terms of return on investment, whether the savings are financial or not, Whatling suggests that digital dictation is “a no-brainer”.

But with some services requiring specific devices and others compatible with a range of different technologies, including smartphones, which to buy and how to buy it is a key question for Trusts looking to implement digital dictation and speech recognition.

Dr Whatling explained some of the cost-cutting benefits of different business models.

“If you don’t need to spend capital money on equipment, then that could be advantageous. On the other hand, doctors have had devices for years so keeping that might manage the change process better. Some of that technology can be put through a secure network so that it’s all checked with confidentiality– that’s an important factor.

“One of the interesting things for other business models, like pay as you go, is that organisations who don’t have that much money to spend can get going quite quickly; they can also terminate quite quickly and move on to someone else if they don’t like it or can get a better offer. It helps them spread their costs and enables them to do it within an affordability envelope so they can get to their cashable benefits, or even non-cashable, within their time limit and this is something we are looking into at BT.

“You can scale it up and down the organisation depending on size, which is another benefit. If you’re a small clinical commissioning group, a small health provider or even an individual practitioner, you might not have that scale. With all the other demands on your budget, you can’t afford that investment and it might be better just to rent the service. There are choices available to people now,” he said. With more doctors owning personal smartphones, individual devices can be integrated with Trusts’ software. While the IT department may be unwilling to buy such expensive equipment that carries a high risk of theft, Dr Whatling noted: “If the individual’s bought it, that’s at their own risk, not the Trust’s risk.

“Also they haven’t had to spend the money on that equipment, and the clinicians have the technology to change their work. There are obviously some things to work through with that. Part of the power of these conversions is getting the tools into the clinicians’ hands.”

Orchestrating the workflow

Coordinating workflow is another service that some solution providers now offer, incorporating clinicians using dictation and transcription teams to manage work effectively.

Dr Whatling said: “It has been the case that you have medical secretaries who are mapped almost one-to-one, or one-to-two, with consultants, or one medical secretary to a clinical team.

“If they can work more efficiently, you might want to balance workload when those team members are around more dynamically. Some of these providers can help with the orchestration of work flow as well.

“On the conversion side, you’re not only making the best use of the equipment that’s out there, you’re starting to give one stop shop solutions.

“That’s the power of smartphones and tablets these days – you can start bringing new things together – a lot of the work we do is unifying communications together much more seamlessly.”

Dr Justin Whatling, vice chair of Strategy & Policy at BCS Health, is Chief Clinical Officer at BT Health and a visiting professor at UCL’s Centre for Health Informatics and Multiprofessional Education (CHIME).

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