St. James's Hospital digitally transforms documentation in Cerner Millennium using speech technology

St. James's Hospital digitally transforms documentation in Cerner Millennium using T-Pro's speech technology

Background

St James’s Hospital is Ireland’s largest acute academic teaching hospital and is based in Dublin’s south inner city. By international standards, St James’s Hospital is a substantial acute hospital service provider. They occupy a prominent position in the public eye and are recognised as prioritising innovation and excellence of delivery. They provide acute, emergency, specialist services and residential care, including mental health services, and place a high emphasis on excellence of delivery, research, innovation and education.

Prior to the implementation of T-Pro, all dictations were recorded using a mix of dictation methods including analogue tapes, standalone devices, and other dictation systems. They had a very siloed approach to documentation with limited visibility, poor turnaround and very low user satisfaction. 

The hospital evaluated all market-leading speech recognition suppliers in line with both their documentation requirements as well as their ongoing Electronic Patient Record (EPR) rollout strategy - and chose T-Pro as their preferred supplier of digital dictation and speech recognition to improve the experience of patients, clinical staff, and lower healthcare costs.

Solution

T-Pro provides the hospital with an affordable, scalable, and securely robust central speech recognition platform to improve the speed, accuracy and quality of clinical documentation.

T-Pro’s digital transformation team worked closely with the hospital’s project team to co-design an enterprise-wide solution for clinical documentation workflow improvement. After further assessing the hospital’s workflow requirements, the transformation team relayed relevant feedback and recommendations to management, ensuring that current and future performance indicators were met and that the new solution would deliver the desired improvements.

T-Pro complements PAS and Cerner Millennium’s EPR workflows through an intuitive and easy-to-use interface with secure data transmission, that incorporates functionality to boost clinician productivity and work more flexibly. Clinicians can manage dictations, prioritise their work, and access and report on patient information. T-Pro's integration with PAS allows clinicians to select from a live patient list on their laptop/PC, smartphone or tablet device. Dictations can be uploaded anywhere, anytime, with patients identified and demographics attached, ensuring document accuracy and accelerating the transcription process. With options to create, edit and approve correspondence independently, or send to a secretary for review, clinicians have the power of choice in their hands.

• Supports dictation through multiple devices - using a USB microphone, digital recorder, mobile device or telephony, clinicians record their dictation while at their desk or on the move.
• Allow patients to be selected from a pre-generated clinic list, which automatically populates templates, ensuring document accuracy, and accelerating the transcription process.
• Clinicians have the power of choice - they can use front-end speech recognition (real time, text to cursor) to create, self-edit and sign documents, or use back-end speech recognition which converts speech to text (server-side) and sent to a secretary for editing.
• Additional features include customisable voice commands and auto-texts, navigation and voice-based correction, as well as ability to add vocabulary/jargon/medication/terminology.
• This text editor has a feature set designed to maximise the efficiency of document creation and editing; words are highlighted as the playback is controlled with the microphone or foot pedal and the auto-text function speeds up any required changes.
• All urgent documents are automatically placed at the top of the worklist, in red and in bold text, and therefore, clearly visible.
• On completion of the proof-reading stage, the work is submitted back to the clinician who can rapidly check and approve documents via web or mobile app.
• The final step then includes some intelligent routing and interfacing with the hospital EPR and subsequent electronic transmission of letters to the patients GP.
• Comprehensive analytics and reporting tools allow management to collect, track and analyse their documentation processes, turnaround times and staff productivity.

Benefits

T-Pro’s market-leading, cloud-based AI-powered solution has brought greater efficiency and reduced the workload for all staff involved in the production of medical letters, without compromising on quality and accuracy. There was no voice profile training requirement, meaning clinicians could begin using and realising the benefits of the solution immediately, with little to no change management. Clinicians also now have the flexibility to create, edit and approve correspondence independently, or send to an admin-supported transcription workflow - allowing them to focus more time on patient care.

Professor David Bradley, Consultant Neurologist, commented: “I would say that it has transformed correspondence in Neurology. The speech recognition is markedly better than the prior system, consolidation of correspondence from multiple sources into one system, letters can’t get lost and are immediately available if needed even prior to transcription, convenience of PC or phone dictation allows time efficiency. All in all, a great advancement!”

While accent adjustment is automatic based on initial few utterances, T-Pro’s acoustic model is trained on a large corpus of medical dictation, which includes a significant subset of multi-accented speakers from all over the world, meaning the hospital was able to provide advanced accuracy for non-native English speaking clinicians.

Since the introduction of T-Pro, clinicians have the flexibility to produce clinic letters using T-Pro’s web or mobile app which acts as an integrated extension of the EPR - or dictate progress notes directly to the patient record. This has resulted in an increase in the overall quality and quantity of data being captured. There has been a significant increase in clinician engagement and satisfaction, as clinicians can capture the patient's story away from their desk and at the point of care. Clinicians are notified when the transcription is complete and can review and approve the document on their mobile device, which is then automatically saved to the EPR.

Mr Prakash Madhavan, Consultant in Vascular Surgery, added: “There has been a quantum leap in how letters are processed which has resulted in an enormous amount of time being saved. It is quicker, more efficient and seamless in the way letters are processed. Further efficiencies will be made by sending letters electronically to GPs - resulting in a lot of time and money being saved for postage. I cannot recommend T-Pro enough, and quite frankly is the only way to go.”

Time spent on documentation by admin staff was reduced immediately, saving an estimated 152 minutes per day. The number of letters that secretaries are able to process per month has doubled and significant improvements in turnaround time have been felt across all departments.

T-Pro’s e-correspondence distribution solution has also delivered significant cost savings for and support the hospital’s paperless agenda, by enabling 2,000 letters per day to be sent electronically from the platform to GPs, reducing paper, printing and postage costs.

T-Pro’s reporting dashboard gives management visibility of letter status for each speciality in real-time. Additionally, T-Pro’s dedicated project manager also provided reports on the utilisation and performance of the solution, focusing on the areas the hospital was trying to improve, and highlighting areas that required additional training and/or were struggling to realise the full benefits of the solution. The reports also highlighted those departments/users that were excelling in the use of the T-Pro platform and were able to assist others.