how to achieve speed, volume and physician satisfaction in clinical documentation

© 2014 Nuance Communications, Inc. All rights reserved. 1

SPEED + VOLUME = SATISFACTION


“The way medical documentation influences treatment quality needs to be understood better to choose the right mode of documentation and to help both the doctor and the patient.”

Analysis of Documentation Speed Using Web-Based Medical Speech Recognition Technology: Randomized Controlled Trial http://www.jmir.org/2015/11/e247

http://www.jmir.org/2015/11/e247


Digital communication and electronic information exchange have become a part of everyday communication.


CLINICAL DOCUMENTATION is a core aspect of the clinical profession and is more than a tool for efficient, maximized billing.

Still, the emphasis lies on PAPER-BASED documentation, being only assisted by electronic documentation.

The reasons for this are the deficient quality and usability of electronic clinical documentation TOOLS.

Quite a situation….




To enter information into the EHR…CLINICIANS need to rely• on their ability to type• on the assistance of transcriptionists

TRANSCRIPTIONISTS are• a limited resource• usually not available at the point of care or outside

office hours

ALTERNATIVES for clinicians are• pen-and-paper documentation,• self-typing• avoidance of documentation.


“As hospitals continue to digitise and electronic patient records proliferate, the laborious task of creating, reviewing and updating those records will not go away.”

Alan FowlesNuance CommunicationsSenior Vice PresidentHealthcare International Sales and Operations


“Tools for efficient capturing of patient data and clinical observations are still under represented in clinical practice.

Clinical documentation in the 21st century: Executive summary of a policy position paper from the American College of Physicians http://annals.org/article.aspx?articleid=2089368

http://annals.org/article.aspx?articleid=2089368

http://annals.org/article.aspx?articleid=2089368


So, what can you do to put a halt to tedious data capture processes?

© 2015 Nuance Communications, Inc. All r ights reserved.

Voice input and speech recognition.


A study describing the effects of Automatic Speech Recognition (ASR) availability on the clinical documentation process based on detailed data recorded by a computer program.




University Clinic of Duesseldorf, Germany

28 participants 1455 clinical reports

727,865 characters

120 days Randomized controlled trial

Study structure and flow




So what happened using voice?

INCREASED DOCUMENTATION

SPEED

INCREASED DOCUMENTATION

AMOUNT

HIGHER PHYSICIAN

SATISFACTION

Demonstrated outcome of using medical speech recognition




1455 Clinical reports eligible

for analysis

50.65%Clinician typing

49.35% Speech-to-text

recognition

26%Documentation speed

increase

23%User satisfaction

increase

82%More data captured

The impact by the numbers


Together, all participants documented 727,865 characters (total documentation volume).

Documenting this amount by the study group using the keyboard alone would have taken 104 hours.

By adding speech to the documentation process, this time decreased to 87 hours.

Therefore, the gain on the total documentation time would have been 17 hours.

A different view


Reality check: timeProfessional profile

# Individual time spent on clinical documentation 1)

Annual time spent by role2)

Daily individual savings potential in hours 3)

Annual time savings potential by role

Chief Physicians 12 5:28 hours per day 14,432 hours 00:55 hours per day 2,453 hours

Senior Physicians 15 3:08 hours per day 10,340 hours 00:31 hours per day 1,757 hours

Medical Specialists 20 3:42 hours per day 16,280 hours 00:37 hours per day 2,767 hours

Residents 93 3:50 hours per day 78,430 hours 00:39 hours per day 13,333 hours

Head Nurses 10 2:59 hours per day 6,563 hours 00:30 hours per day 1,115 hours

Nurses 170 2:42 hours per day 100,980 hours 00:27 hours per day 17,166 hours

TOTAL STAFF 320 227,025 HOURS 38,594 HOURS

+ =An example of a 450 beds average public hospital

1)ClinDoc studies HIMSS Germany and Ignetica UK 20152)Xxxxx3)17% time savings by an 26% increase in documentation of SR over self typing on 68% of narrative reportin g


What would you do with 38,594 hours available?

Take a breakDedicate to patientsGo home on timeLearn and train


*Applying speech-to-text systems in documentation

‘In this implementation, speech-to-text technology brought advantages both in the level of detail captured in our nursing records and the readability of the records.’White P., Scott E. (2015) Nursing Times 111(15)p15-17

6x faster than typing* Alder Hey Children’s Hospital Paediatric Intensive Care Unit23 bed, 160 nurses, 40 doctors and over 1000 admissions per year make it one of the largest PICUs in Europe

OUTCOME

Time freed up to care for patients

Faster more effective communication Reduced risk Increased confidence in

clinical decision support

CHALLENGEImprove quality of patient care record Relieve administration burden Information sharing across multi-

disciplinary team


Global experience, local delivery„Vor fünf Jahren haben wir jährlich gerade knapp 33.000 Patienten behandelt, heute sind es 37.000. Diese Steigerung können wir nur bewältigen, wenn auch die begleitenden Prozesse angepasst werden.“ Inga Romer, Malteser Rhein-Ruhr gGmbH

„Jeder der sich auf Spracherkennung einmal eingelassen hat, möchte nicht mehr ohne Arbeiten. Das ist vielleicht so wie beim Autofahren. Wer einmal Auto gefahren ist, möchte auch nicht mehr zurück aufs Fahrrad.“ Augusta-Kranken-Anstalt, Bochum

„Alle Radiologen diktieren bereits seit 2003 ausschließlich mit der Online-Spracherkennung. Klinikumsweit sind 114 Spracherkennungslizenzen im Einsatz, lediglich 20 davon in Radiologie.“Prof. Dr. Ulrich Fink, Ärztlicher Direktor, Schwarzwald-Baar Klinikum Villingen-Schwenningen

„Unsere Ärzte sind begeistert – mit Hilfe der Spracherkennung lassen sich ganze Textbausteine einfach in ein Word-Dokument einfügen. So können sie Arztbriefe und Befunde wesentlich schneller und viel effizienter erstellen.“ Marius Nehling, Dermatologikum Hamburg


La communication au cœur de la médecine

« La qualité de la reconnaissance vocale est bluffante, quels que soient les accents parfois prononcés et les débits de diction souvent très rapides. Je suis impressionnée par le niveau de précision ! » Corinne Casoli, DSI, Cadre supérieure de santé, responsable du DPI et des processus de soins

« Globalement, les médecins sont satisfaits parce que les comptes rendus sont finalisés beaucoup plus rapidement. L’outil leur permet également de travailler en mode totalement autonome sur les plages horaires où les secrétaires ne sont pas présentes. De plus, en apposant l’image de leur signature sur le document directement lors de la validation du compte rendu, ils évitent la fastidieuse étape de signature manuscrite. » Frédérique Ferrant et Peggy Pellegrinelli, responsables des secrétariats médicaux de l’HNFC.

Hôpital Nord Franche Comté


Speech-enabling EMR in the Middle East

Prestigious King Fahd Hospital of the Damman University• Dragon Medical to aid Physicians in Care Delivery and Students in their Training• Part of a drive to link all aspects of hospital IT with their electronic medical records

UAE’s national healthcare IT Wareed programme• Dragon Medical to cut time and effort in medical reporting and to improve processes

Prince Hamzeh Hospital in Amman, Jordan• Nuance PowerScribe 360 | Reporting and Dragon Medical• Accompanying a national move to integrated computerized hospital systems


Lean workflow in the Nordics“With speech recognition doctors finalize documents immediately. The availability of documents creates a lean workflow with a number of benefits, especially a reduction in bottlenecks that again and again had previously led to delays in patient care.” Kenneth Jørgensen, Facility manager, Sygehus Lillebælt

“Speech recognition is the only IT solution I have introduced in the course of 20 years which has resulted in measurable cost savings. This is the first time we can say that a new technology generates savings in terms of employees and costs.“ Per Urdahl, Manager of the Medical Department. STHF/Telemark Hospital

“The introduction of speech recognition has revolutionised my day-to-day work as a GP in many ways. I have all my documentation and paperwork finished by the end of the day.” Marius Christensen, local doctor in the municipality of Tjeldsund

“Speech recognition has made the updating of patient information much faster. In the past, we had hundreds of unwritten outpatient notes; now there are none.” Dr. Aud E. Stenehjem at Ullevål University Hospital

“Personnel impacts and faster treatment processes, for example, are among the positive effects. All in all, speech recognition is an economical way of producing statements.” Tomi Kauppinen, during his research at HUS Medical Imaging Center.


We can help you put a halt to tedious clinical documentation processes and win back valuable time, quality and work-life balance!

© 2015 Nuance Communications, Inc. All r ights reserved.

www.nuance.co.uk/healthcare

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