Oxford University Hospitals boost digitisation and accelerate uptake of the EPR
Dragon Medical One secure cloud‑based clinical speech recognition supports the Trust ‘Go Digital’ framework.
Accelerating clinician uptake of the EPR
Consultant nephrologist and OUH’s CCIO, Dr Paul Altmann, piloted and championed the use of Nuance Dragon Medical One 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 One integrated into the EPR to simplify workflow, save clinician time and cut costs associated with clinic letter production.
Oxford University Hospitals NHS Foundation Trust (OUH) is a world‑renowned centre of clinical excellence and one of the largest National Health Service (NHS) teaching trusts in the UK. With an annual turnover of more than £1 billion, 4 hospital sites and numerous remote clinics, 13,000 staff, and with 1.4 million outpatient contacts per annum it is leading the way in health technology. OUH is already acknowledged to be one of the most advanced NHS trusts for implementing the Cerner Millennium electronic patient record (EPR) system. It is also one of 16 acute trusts selected by NHS England as a Global Digital Exemplar (GDE) based upon its digital maturity and involvement in innovative digital healthcare initiatives.
OUH’s ongoing programme of investment in digital services and infrastructure is ‘Go Digital’. It has ambitious plans to accelerate the opportunities that digital technology offers. This is in line with the vision of the NHS to be ‘paper‑free’ and for patient records to be held electronically and accessible across different systems.
The 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 EPR. Clinical staff routinely document patient notes, order diagnostic tests, view the results electronically and carry out ePrescribing. Nurses document care and when ward clerks are not available also record patient admissions, discharges and transfers. Therapists also document care electronically.
OUH’s 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.
The EPR is used at scale across the whole Trust and as an example of its ubiquity and importance is a snapshot of its use in just one day in August 2019. The platform supported 2.2M user triggered transactions and this will continue to grow as ‘Go Digital’ rolls out across the Trust, inpatients, outpatients and satellite clinics.
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 GPs and struggling to meet the 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. Hardcopy printing and mailing of letters added to delay and cost.
Consultant nephrologist and OUH’s 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.
The introduction of Dragon Medical One into nephrology has resulted in a dramatic change in clinic letter turnaround times. As a result of time being freed up from letter reviewing, this has also permitted the nephrology secretaries to expand the variety of their tasks and work on their continued professional development (CPD).
Nephrology Consultant and CCIO
Training of the individual’s Dragon Medical One voice profile—available from the cloud, wherever they are working in the hospital—was quick and easy.
OUH found that focusing-in on one specialty, in this case nephrology, benefited faster uptake and adoption of new ways of working enabled by Dragon Medical One. Training of the individual’s Dragon Medical One voice profile—available from the cloud, wherever they are working in the hospital—was quick and easy. The effort and the focus of the change was in familiarity with the EPR templates and smoothing the workflows within the department using the peer to peer support of the doctors, nurses and administration team who were ‘in‑it‑together’ to share knowledge, experience problem solve and re‑design the end to end workflows.
Throughout the pilot Nuance 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 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 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.
adoption of front‑end speech recognition
outsourced transcription costs in renal
turnaround of clinic letters, reduced from 12 days
Why OUH opted for clinical speech recognition in the cloud
Having proven that the transition from transcription and digital dictation workflow to front‑end speech recognition is feasible and cost effective, the rollout of Dragon Medical One continues apace and is due to complete in November 2019. Rolling out across the whole of the Trust’s 8000 clinicians, outsourced transcription services are being switched off department by department.
As workflows are simplified, so too are the PowerNote templates within the Cerner Millennium EPR used to capture patient notes. Considering the necessary differences between specialties there is an ongoing process of standardisation and quality improvement and automated routing.
Clinicians are saving hours per week writing patient notes within the EPR and generating clinical correspondence. The quality and speed of clinician communication continues to improve with a reduction in duplication of their effort, the need for data re‑entry and delay and frustration caused by ’finger‑trouble’. For example, drug and problem lists do not have to be re‑entered each time and letters to one patient cannot accidentally be placed in an envelope to another.