Seventy per cent of people believe that improved information technology in NHS Trusts contributes towards better care for patients, according to new research commissioned by Dictate It, a provider of digital dictation, speech recognition and transcription software and hardware to the NHS. The poll of over 1,200 people from across Britain also revealed that 89% think that it is possible to increase efficiency within the NHS, but only 25% believed that this could be achieved by increased spending. There has been growing public anxiety over the effect on patient care since the previous Health Secretary Andy Burnham’s admission last September that the NHS needs to save between £15 billion and £20 billion. However, former head of strategy at the Department of Health, Penny Dash, recently claimed that spending cuts within the NHS need not necessarily affect quality of care, and that existing funds should be directed to efficiency-driven initiatives such as increased utilisation of information technology. Mark Miller, managing director of Dictate It, commented: “We already work with 27 NHS Trusts across the country, and are expecting to see this expand, as more Trusts recognise the value of IT in making their budgets go even further, while also improving performance.” Further reinforcing a widespread desire for improved efficiency, the research also revealed that 65% of the public would vote for outsourcing of NHS administration, if the result was extra funding for patient care. Mark Miller continued: “From both a clinical and an administrative point of view, NHS Trusts that invest in digital dictation and transcription systems are seeing rapid returns. They are more efficient without compromising on security, resulting in better frontline care for patients, and, as this research proves, efficiencies using IT are being driven from the patient side as well.” Dictate It’s patient data management platform integrates dictation, speech recognition and transcription of doctor’s notes, delivering a hybrid solution that is bespoke to the Trust and can be assimilated into existing systems. With workflow securely managed online, the NHS is able to provide better patient safety, comply with legal requirements for document turnaround times and reduce backlogs. One of the early adopters of the technology has been the Derby Hospitals NHS Foundation Trust, which comprises two hospitals – the London Road Community Hospital and the recently opened £334 m Royal Derby Hospital. Together they provide planned and emergency healthcare to a population of over 600,000 from Southern Derbyshire. The Trust also provides more specialist services which attract patients from both neighbouring counties and further afield. The hospital’s IT systems, both clinical and non-clinical, are some of the most advanced within the NHS. Derby uses the McKesson Totalcare PAS and some of the iCM suite of products for the provision of Electronic Patient Records (EPR). IT services are managed through three key areas: EPR and IT projects, patient administration and the IT operational support. At present, there are 50 major IT projects being managed through the team.
Challenges
At the beginning of 2009, the Trust recognised the need to review administration and secretarial workflows. It was decided that Derby needed a system that would enable the most efficient ways of working, in order to support and realise Trust and national targets. In terms of patient data recording and management, the Trust required a solution that included audit and activity reporting to support workstream programmes and care pathways. In terms of dictation and transcription, this required replacing outdated analogue tape devices with solid state digital recorders to improve user functionality.
Solution
Dictate It won the tender with a system that is able to deliver differing configurations to departments and individuals. “We analysed Derby’s specific requirements and created a bespoke solution to suit the Trust’s needs. Our system automatically assigns dictation to speech recognition, depending on the type of text and the turnaround time required, so high priority records are processed first. This was a key feature in this contract win,” explained Mark Miller. Derby started the implementation programme in February 2009, with a nine month roll out to approximately 300 secretaries and over 1,000 clinicians. The Trust operates a multidisciplinary project team approach with training for administration managers from five clinical directorates, IT technical services and IT systems management, coordinated by a project coordinator and a project manager. To date, the Trust has implemented the system in the following directorates:
• Surgery.
• Medicine – except renal and cardiology, where local system integration is pending address.
• Rehabilitation and cancer.
• Paediatrics element of women and children.
Result
The Trust has reported very positive results with a high level of commitment from staff to using the system and the hardware. The speech microphones have proved to be very popular in the outpatient clinic rooms, day case unit and theatres. Commenting on the implementation of the solution, Kathy Kelly, project coordinator at Derby, said: “We originally looked at the system to improve our communication with GPs as we had previously conducted an audit on how quickly we were processing dictations and the time it was taking to send out letters. We wanted to improve the speed and efficiency of our processes by moving from an analogue system to digital technology. “With the analogue system, secretaries would have to take tapes down to the consultant in the outpatient area, wait until the end of clinic, then collect them and return to their offices, rewind the tape, then process the information. Digital dictation speeds up this process by being routed directly to the secretary.” The system first went live in the urology department, followed by roll out across the Trust. “Super users” were brought in from each specialty and trained by the supplier, then these returned to their areas to cascade this knowledge down to their peer groups. “Before going live, the urology department was six weeks behind on analogue tapes. Currently they are typing live – which means that the letter is typed as soon as the patient leaves the room and is often completed before they have even left the building. Our long-term plan is for these letters to be sent out electronically to GPs,” Kathy Kelly continued. Previously, when tapes were used, it was only possible to have one secretary at a time writing up dictation. However, the software allows the data to be routed to enable five letters at a time to be written up by five different people. In essence, this means letters for a clinic can be typed up in one fifth of the time, while this work may also be routed to a typing pool if preferred. “My advice to others seeking to roll out this technology is to ensure they have good clinical engagement,” added Kathy Kelly. “The challenge for implementation across UK Trusts is to encourage consultants to get behind the technology and recognise this as an important tool, in the same way as they recognise the importance of clinical tools, to improving the delivery of patient care. “Proof of concept and an initial pilot, we have learned, are crucial to getting staff on board and we would recommend other Trusts considering this technology adopt this approach. There is always resistance to change, but once the system went live and the consultants could see the value of the technology, they were very supportive. “In addition, although many liked the familiarity of using a handheld dictation device, the more efficient and cost effective approach proved to be the option of a speech microphone – since the handheld hardware still requires a memory card to be physically taken to the secretary and is therefore more time consuming. Not only is the speech microphone a better use of resources, therefore, but it is also cheaper in terms of capital outlay. Dr Probi Chakraborti, consultant oncologist at Derby Hospitals, commented: “Dictate It provided us with a fully integrated digital dictation solution, which has resulted in increased efficiencies in delivering dictation in real time and increased the turnaround time of the correspondence to GPs within our department. The system is easy to use and delivers excellent sound quality to our secretaries while also providing an efficient workflow management system for them. The digitalisation of patient correspondence is linked to the EPR system and we need to be employing the most advanced optimisation techniques to deliver this.”
The future
In conclusion, Mark Miller pointed out that IT projects, such as the one undertaken at the Derby Hospitals NHS Foundation Trust, will have an increasing role to play in the future of healthcare delivery – whatever the new Government decides to do with respect to the NHS National Programme for IT: “It was reported, prior to the election, that the Conservative party might decide to dismantle the national spine of patient records, but it is important to remember that localised versions of EPRs and Patient Administration Systems (PASs) have existed since the 1990s and have been highly successful in many regional Trusts. The question should not be ‘when can we scrap it?’, but ‘how can we increase the efficiency of the system already in use?’ We find that technologies that complement and increase overall efficiency are very popular at the Trusts we work with,” he commented, adding: “The NHS will always be presented with funding conundrums and every area of healthcare needs its own debate as it puts forward a case for increased support. One thing that will remain constant is a need for additional finance, and one method to tackle this is to undertake localised IT projects that are quickly implemented and measurably increase efficiency. Often, the only way to paint a bigger picture is one part at a time.”