Worcestershire Health and Care NHS Trust are leading by example
Global Digital Exemplar funding for Nuance Dragon Medical One enhances workforce mobility, reduces paperwork and improves the clinician‑patient relationship.
Equipping the healthcare workforce
Recently Worcester applied for and won funding to equip the healthcare workforce with an easy‑to‑use tool to support remote working, reduce clinical documentation workload, eliminate the backlog of reporting associated with detailed patient records and replace legacy, slow analogue dictation workflows with the goal of freeing up healthcare workers to focus on patient care. To achieve this, they invested in Dragon Medical One.
- Huge administration backlog
- Individuals overwhelmed with paperwork
- Weak mobile working practices
- Nuance Dragon Medical One
- Bluetooth/tethered headsets
- Nuance Professional Services
- Enhanced workforce mobility and adoption of the EPR
- Zero backlog, patient records updated within work hours
- More time to care, improved patient experience
Worcestershire Health and Care NHS Trust (Worcester) is the main provider of community and mental health services across Worcestershire employing more than 3500 clinical and non‑ clinical staff. It delivers a diverse range of services from over 100 sites and in a variety of settings: people’s homes, schools, community centres, and in-patient facilities and five community hospitals. With 26,000 recorded patient contacts per week Worcester provides services for people across all age groups from Health Visitor services for newborn babies and their families through to services which support older people with complex health and social care needs.
Global Digital Exemplar
Worcester is also one of seven mental health trusts chosen as a Global Digital Exemplar (GDE); NHS England’s flagship digital initiative, prioritising funding for the most digitally advanced trusts. A GDE is an internationally recognised NHS provider delivering exceptional care, efficiently, through the use of world‑class digital technology and information. Exemplars will share their learning and experiences to enable other trusts to follow in their footsteps as quickly and effectively as possible. NHS England is currently supporting GDE’s through funding and international partnership opportunities to establish proven models that can be rolled out across the NHS more broadly. In some cases, this will be sharing software or a common IT team. Others will adopt standard methodologies and processes.
Enhancing mobile working
Worcester’s GDE digital and technology investments will improve working practices for staff and front‑line care for patients. These investments have focused on better access to patient records by enabling mobile access to the patient record system so that community and mental health teams can update patient records and other clinical documentation on‑the‑go and without needing to return to the office.
Recently Worcester applied for and won funding to equip the healthcare workforce with an easy‑to‑use tool to support remote working, reduce clinical documentation workload, eliminate the backlog of reporting associated with detailed patient records and replace legacy, slow analogue dictation workflows with the goal of freeing up healthcare workers to focus on patient care.
To achieve this, Worcester have invested in 200 licenses of Dragon Medical One and Bluetooth/tethered headsets. For the benefit of the community and mental health team including paediatricians, mental health nurses and other allied health professionals (AHPs), the speech recognition software works with the workflow of the OneAdvanced electronic patient record (EPR) used by the Trust and other office productivity tools used to create, for instance, emails and GP letters.
Worcester’s project team prioritised the rollout of speech recognition amongst the specialties suffering from the greatest burden of paperwork and backlog of administration. Amongst these were the paediatricians, psychiatrists, community and mental health nurses and AHPs working in Child and Adolescent Mental Health Services and Community Assessment and Recovery Services and Speech and Language Therapy.
Necessarily these teams make extensive notes to capture the patient story and the context of their clients’/patients’ care. These notes are vital in communication with colleagues in multi‑disciplinary health and care teams to ensure continuity of care and to meet child protection, medico‑legal and other social care requirements. With no back‑office administration support, many of the team were spending long hours capturing patient records, writing GP letters and other clinical documentation. The results of this were people going home late or producing abbreviated notes which in turn were difficult for others to interpret or caused duplication of effort.
To speed up adoption and uptake of speech recognition and ensure a fast return on the GDE funded investment, Worcester also invested in Nuance professional services to work alongside their in‑house project management team and trainers. Nuance professional services team delivered project management, configuration and installation services, workflow analysis, training and optimisation services.
Having identified specialties with the greatest burden of paperwork and therefore those most likely to quickly benefit from speech recognition integrated into the clinical documentation workflow, Nuance professional services scheduled train the trainer and onsite training with individuals at their places of work and satellite clinics. After deploying the software, optimisation services to ensure learnings particular to Worcester and their implementation of the EPR and the experience of best practice passed on by Nuance of other clinical documentation workflows were shared and transferred to everyone. This included the development of bespoke templates and forms unique to each specialty, speeding up note capture, reducing repetition and supporting standardisation.
Karen Edwards is an occupational therapist (OT) at the trust working with her patients and clients taking a ‘whole‑person’ approach to their mental and physical health and well‑being to enable them to achieve their goals. Karen’s role involves assessing patients and clients within their homes and then providing practical support to help clients to help themselves to recover and to overcome barriers preventing them from doing the activities (or occupations) that matter to them. Karen remarks “OT’s are unusual amongst therapists in that we look at the full picture beyond just the clinical diagnosis. In our practice and our record keeping we need to capture the full ‘back‑story’ of our clients.” Over time, Karen’s workload of administration and paperwork was such that she was spending a lot of time outside working hours trying to catch up. Eventually, the inability to keep on top of the documentation burden was becoming oppressive and affecting her to the extent that she was at the point of resigning.
It was at this point that she heard about Worcester’s speech recognition project, and she contacted the Worcester project team asking that she be among the first to try out the technology. “Over the years, my pen and I had come to an arrangement, and I was pretty efficient at capturing patient records. Then, with the move to an electronic patient record, I just couldn’t input the information via a keyboard quickly enough. The mountain of admin became oppressive to the point I just didn’t want to do the job anymore. Then Dragon Medical speech recognition came along and I caught up with a backlog of 2 years work in just 3 weeks.“
Up to that point Karen had been a self‑confessed technophobe but the boost that Dragon Medical One gave to her mobile working and to help her get on top of her paperwork allowing her to get back to focusing on her patients and clients had a positive impact on her patients too. Enthused by the power of technology, Karen relates the story of one patient that stands out. Karen sourced a voice‑controlled digital assistant for a tetraplegic man who was slowly losing even the movement in his hand to control things like the radio and television, lighting and heating in his home. He was becoming depressed at not being able to do even these smallest of things for himself. Now, with a voice command, his control over these small things was re‑instated and his depression was eased.
The success of this project has been as a result of top‑level sponsorship and leadership within the trust and in the close working of the Worcester team with our healthcare team stakeholders and with Nuance professional services.
Nuance involvement with Worcester does not finish with the roll out. Nuance Customer Success Organisation (CSO) will remain involved. Regular account meetings between the CSO and Worcester’s project and management team will include the review of utilisation reports from Dragon Medical One's central management server. In this way any reduction in use of the software can be identified early and up front and the reasons for this investigated e.g.software, hardware or training and functionality issues technical and version support for the Dragon Medical One software or access, functionality or training issues for users. In this way the Worcester technology investment is protected and enhanced for the long term.
Leading from the front
The success of Worcester’s technology investments for its mobile workforce has come under the scrutiny of NHS England and NHS Digital and the lessons learned from use of Dragon Medical One speech recognition within the clinical documentation workflow will be communicated to and showcased for other community and mental health trusts. Worcester’s IT Director, David Brown, who sponsored and applied for the GDE funding for the roll out of speech recognition says, “The success of this project has been as a result of top‑level sponsorship and leadership within the trust and in the close working of the Worcester team with our healthcare team stakeholders and with Nuance professional services team. We had a carefully worked out and controlled schedule of work but along the way sought and listened to feedback from our healthcare team, adapting as we went along. We hope that other trusts will learn from us—the things that have gone well and also those things that could have gone better—speeding the benefits of digitisation and technology and in doing so, meeting our goals and those of the GDE funding programme.”
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