Homerton University Hospital
re‑imagines clinical documentation in outpatient services
Dragon Medical One secure, cloud‑based speech recognition reduces transcription costs, speeding up clinical correspondence and freeing up time to care.
Transforming care through speech recognition
Homerton University Hospital set out to realise its mission of ‘Safe, compassionate, effective care provided to our communities with a transparent, open approach.’ Two transformation initiatives focused on how the Trust organises and delivers administrative support and outpatient services. They turned to Nuance Dragon Medical One speech recognition.
Challenge
- Redesign outpatient services to deliver greater value
- Boost admin support
- Reduce clinic letter turnaround time
Solution
- Nuance Dragon Medical One
- Nuance PowerMic Mobile
- Nuance Professional Services
- Customer Success Organisation
Results
- Clinic letter turnaround times reduced from weeks to days and meeting CCG targets
- >£150,000 saved annually in outsourced transcription costs
- Costs of medical secretariat reduced by one third
- Turnaround times on target and improved patient experience
Based in the East London Borough of Hackney, Homerton provides a wide range of health services in a hospital and community setting with staff working out of 75 different sites. The hospital has almost 500 beds spread across 11 wards, a nine‑bed intensive care unit and maternity, paediatric and neonatal wards.
Homerton is deeply embedded in its local community and is recognised as an innovator in embracing methods and systems that promise better and safer patient care. It is continuing to pursue that reputation with its ongoing program of investing and adopting digital technologies that enhance its services and the way it delivers them to its community. ‘Achieving Together’ is the blueprint for how Homerton will deliver new services up to 2020 and realise its mission of ‘Safe, compassionate, effective care provided to our communities with a transparent, open approach.’ It is the context within which a series of transformation initiatives across the Trust are being delivered.
Two initiatives have been focused on how the Trust organises and delivers administrative support and outpatient services.
Clinicians in outpatients were still creating handwritten notes and using their medical secretaries to type and edit. As the workload of clinics increased, worklists were getting longer and backlogs were building up. Clinicians were staying late at work to catch up on admin. Outpatients were also experiencing slow clinic letter turnaround times of 17 working days despite large outsourced transcription costs. Working within tight budget controls, the option to recruit more medical secretaries or contract in temporary administrators was not an option.
Investments in new technology have enabled the transformation team, working closely with clinicians and medical secretaries, to re‑visit outpatient workflows and processes. Together they have re‑designed them for longterm efficiency and to free up precious administration resources and refocus them on patient‑centred activities.
The team implemented Nuance Dragon Medical One speech recognition, which was integrated into the Cerner Millennium electronic patient record (EPR). Clinicians now use their voice to capture the patient consultation more naturally, efficiently and on their own terms.
The transformation team brought their experience and success in introducing technology elsewhere at Homerton to create an efficient, paper‑light service. They engaged early to identify enthusiastic clinicians and medical secretaries who would champion the change.
The project was led by clinicians and their teams with all of them having opportunity at every stage to input to the process. Clinicians, their medical secretaries and operations colleagues re‑imagined the entire outpatient clinic process and the clinical documentation flow that accompanies it. Together they re‑designed their ideal workflows focused on the desired communication with patients, GPs and other colleagues.
Having designed the ideal workflow, the team started rolling the technology out. Understanding the time pressured, high‑throughput environment of outpatient clinics it was clear that formal classroom training just wasn’t going to work. Clinicians and secretaries could not free up half days to work through workflows, templates, macros etc. Instead, Nuance Professional Services and Homerton’s in‑house training team offered a one‑hour introductory course. This included the basics of using speech recognition with the EPR and the creation of a few key templates and macros. Once back in the outpatient clinic and in the 4‑5 weeks post‑implementation of the Dragon Medical One software, floor‑walkers and ‘super‑user’ clinicians and medical secretaries provided peer to peer support and ‘on‑the‑job’ training in the use of standard templates and macros. This further sped up and smoothed the workflows.
The team were supported by Nuance Professional Services throughout the scoping, design, workflow mapping and implementation of the project. Once deployed, the day‑to‑day monitoring of key performance targets such as the continued uptake of speech recognition by users, optimisation of the use of standardised outpatient templates and macros etc. are carried out by Nuance Customer Success Organisation (CSO). Reporting on a weekly then monthly basis as the operation settles into the day‑to‑day, the CSO also highlights early and up‑front any user training or support issues. Working closely with the Homerton transformation team, this approach enables speedy remediation, avoids any interruption to services and supports clinician usability and satisfaction.
2 days
Turnaround time of clinic letters has reduced from 17 days to just 2 days.
In terms of hard targets and cost savings, turnaround time of clinic letters has reduced from 17 days to just 2. This is well within CCG targets. The trust is also saving in excess of £150,000 a year on outsourced transcription costs. Staff costs too have been reduced. Medical secretaries who have left are not replaced and bank and agency costs have been reduced, culminating in a one third reduction in spend on the medical secretariat.
The softer benefits are just as impressive. Now, during outpatient clinics, clinicians are entering their own notes into the electronic patient record at the point of care and creating clinic letters they can give to their patients and send electronically to the GP before the patient leaves the clinic.
Patients benefit from faster, personalised communication and there are few lost or missed appointments. Medical secretaries can now focus on patient contact rather than having to try to get on top of typing a backlog of handwritten notes. The clinicians themselves benefit from knowing they are providing a better level of care to patients and no longer have to spend extra time after clinics catching up on paperwork.
Paul Adams, Head of Clinical Information Systems explains why Homerton opted for a managed software service solution delivered via secure cloud rather than one which the Homerton team runs from their own data centre.
“We’ve invested in the latest proven technology. The Dragon Medical One speech recognition engine, utilising artificial intelligence, is super‑fast and accurate, making life for our clinicians easier.
We had questions about patient data privacy and security and 24x7 availability of the application for our clinicians for software delivered from a hosted cloud. Once these questions had been answered, a cloud solution enabled Homerton to focus on delivering new workflows and continuous improvement for users rather than the day‑to‑day operation of the software.
Dragon Medical One directly integrated into the EPR system supports our paper‑lite and transformation strategies. The roll‑out of Dragon Medical One to our clinicians is quick and simple and limited only to the speed at which we can introduce clinicians and their teams to the new ways of paperless working. Because Dragon Medical One is delivered via the cloud it offers much more flexibility. The voice profile for each user follows them wherever they work using any desktop or laptop PC. This means that we do not need to worry about any changes we want to make to the location of our clinicians and services.
We’ve seen considerable month‑on‑month cost savings as we replace our transcription services with real‑time speech recognition. We have also saved expenditure by not having to invest in additional hardware or recruit scarce and expensive technical resources to run the software day to day.
We want to ensure that our investment is for the long term and remains current. Via the cloud we will get continuous updates and our clinicians will have instant access to and can take advantage of new features and enhancements as soon as they are released.”
—Paul Adams
Head of Clinical Information Systems
In their own words
The transformation team have been posting blogs from those experiencing the transformation to keep everyone at Homerton up to date with the progress of outpatient projects. The following are a few extracts from the blogs as the outpatient transformation has progressed.
