Going Digital
Oxford University Hospital NHS Foundation Trust’ (OUH) ‘Go Digital’ health digitisation programme is a journey, not a ‘big bang’. Key to ‘Go Digital’ is the rollout and adoption by clinicians of the ‘Go Digital’ platform – the Cerner Millennium electronic patient record (EPR). OUH’ aim is to deliver information to clinical teams based on real-time data and enable them to share that information with colleagues across different record-keeping systems and to underpin high quality care and improve communication with patients.
How clinical speech recognition found its voice
Amidst the ambitious aims of ‘Go Digital’ are the day to day challenges of delivering health services in response to growing demand and constrained budgets. In 2017, one well-performing department at the OUH was averaging a 12 day turnaround of clinic letters to General Practitioners (GPs) and struggling to meet the clinical commissioning group (CCG) target which as of April 2018 is 5 days. The root cause was a combination of a chronic shortage of administration staff and the complex, costly workflow of in-house and outsourced transcription used to produce the outpatient clinic letters. Printing and mailing of letters added to delay and cost.
Consultant nephrologist and OUH’s Chief Clinical Information Officer (CCIO), Dr Paul Altmann, piloted and championed the use of Nuance Dragon Medical front-end clinical speech recognition in nephrology within the Cerner Millennium EPR. Using a structured clinic letter template mirroring their legacy system workflow he then shared this with a handful of co-piloteers and quickly realised the potential of Dragon Medical integrated into the EPR to simplify workflow, save clinician time and cut costs associated with clinic letter production.
Building the business case
OUH initiated a 3-month pilot of Dragon Medical One; secure, clinical speech recognition in the cloud. The pilot was across a range of specialties and with a focus on the whole of the nephrology department. The success criteria for the pilot were set out from the start:
- Achieve adoption of speech recognition by at least 80% of designated users
- Reduce clinic letter turnaround times
- Reduce outsourced transcription costs
- Ensure complete integration with EPR
- Drive the Go-Digital and paperless strategy
Services speed the change
Throughout the pilot Nuance Professional Services (PS) delivered workflow analysis and one to one training for Dragon Medical One for the nephrology team and the Trust’s own EPR trainers. Once Dragon Medical One licenses were enabled and actively in use by the clinicians, Nuance Client Success Organisation (CSO)constantly monitored the progress of uptake and adoption of the licenses by the clinicians. To support the pilot effort Nuance PS and CSO and OUH project team worked closely. Together they carried out weekly project reviews to quickly identify and fix any training or process issues. The lessons learned from these weekly meetings further hastened rollout.
Successful pilot and lasting benefits for health digitisation
The success criteria of the pilot were fully achieved including:
- 100% adoption of Dragon Medical One speech recognition
- Clinic letter turnaround times reduced from 12 to 3 days
- Outsourced transcription no longer used i.e. zero cost
Having proven that the transition from transcription and digital dictation workflow to front-end speech recognition is feasible and cost effective, the roll out of Dragon Medical One continues apace and is due to complete in November 2019. OUH investment in secure, cloud-based clinical speech recognition will continue to accelerate health digitisation and deliver long lasting benefits to clinicians, patients and the organisation as it continues to roll out across the whole of the Trust’s 8000 clinicians.
