Children s Hospital Boston redefines workflow with consultancy from Philips Speech Recognition Systems Six Sigma: Expert team vastly improves transcription productivity Customer Story Following the implementation of an encounter-based transcription system in March of 2007, 83% of reports at Children s Hospital Boston exceeded the desired turnaround time of 48 hours. Workflow changes and loss of a previously used overflow vendor were exacerbated by high dictation volume. Turnaround times mounted to five or more days. Children s Hospital Boston created a cross-functional project team, including Philips experts, and examined the root causes using the Six Sigma methodology. When the expert team implemented several changes, the productivity of transcriptionists improved dramatically: today, up to 90% of all reports are produced within less than a day. For 18 years straight, U.S. News & World Report has ranked Children s Hospital Boston as one of the USA s top two pediatric hospitals. Based in Boston, MA, the hospital takes care of 17,000 inpatients and performs 20,000 operating room procedures per year.
At Children s Hospital Boston (Children s), clinicians dictate 330,000 reports annually. Transcription service providers work remotely to transcribe a volume of more than 14 million lines every year. To improve availability of information and promote patient safety, the hospital implemented Cerner s electronic health record, which matches every document to a patient s visit. In addition, Children s was interested in piloting speech recognition for dictation transcription. The Dolbey transcription platform Fusion Text was installed to streamline report creation and facilitate the linking of reports to the patient s registered visit; Dolbey s Fusion Speech was planned to follow five months later in phase two. Before the installation of our new encounter-based system, we produced our medical records within 48 hours, recalls Mary Radley, Director of Medical Record Services. We were surprised to see the turnaround time increase so dramatically after the installation. Several workflow changes were needed to bring the process up to speed again. We decided to determine the best sustainable solutions in a collaborative approach with both hospital staff and outside experts, says Mary Radley. In order to analyze which processes were negatively impacting the report turnaround times, the primary objective was to identify root causes for problems using Six Sigma methodology and to resolve those problems. The project was done post installation of a new transcription system and in conjunction with implementation of speech recognition technology. We were aiming for a turnaround time of less than 24 hours for 85% of all reports, says Mary Radley. We were also striving to increase the transcriptionists productivity by a third and to decrease the volume of work to the outsource vendors.
Determining hospital needs Children s Hospital Boston decided to apply Lean Six Sigma and change management techniques within one pilot project to achieve efficient and timely report creation a challenge common to all healthcare providers. The multidisciplinary project team included staff from the medical record department, a transcription coordinator and technicians from the technology vendors. Rupinder Hargun, Professional Services Manager and an expert in the field of Six Sigma, at Philips Speech Recognition Systems headed the project. Lean Six Sigma methodology focuses on optimizing flow, increasing speed and reducing waste using Six Sigma statistical tools to identify root causes. explains Rupinder Hargun. As a first step, the productivity improvement team determined the hospital s needs. Apart from reducing the turnaround time, we realized that we had to increase physician satisfaction and improve our services to referring physicians, says Mary Radley. One option was to exploit the full benefits of speech recognition and deploy it in high-volume areas. The team dove into an analysis of the process, established a baseline of the existing workflow and looked at possible root causes of the issues at hand. We found that sometimes invalid data would be dictated and some jobs were completed incorrectly by the transcriptionists. The voice quality was often poor because physicians would use a cell phone or a speaker phone, says Tammy Seithel, Director Training and Speech Recognition at Dolbey. Sometimes physicians would not dictate the date of a visit which could be a huge issue for the encounterbased health record system. In total, the project team determined 46 potential causes and decided to focus on three major root causes. We wanted to improve the quality of the dictation, increase the transcriptionists productivity and change the workflow and information process, says Mary Radley. Six Sigma Steps to Success: Measure Deploy Measure Six Sigma is a rigorous, measurement-based approach with a toolset for eliminating defects and reducing variation. Lean Six Sigma addresses the rework and efforts used to become defect-free. The Six Sigma methodology is based on the following steps: 1. Determine customer needs 2. Analyze current process 3. Establish baseline of existing process 4. Determine potential root causes 5. Implement the changes 6. Measure the results, establish monitoring and controls
Improving communications Together, we redesigned the hospital s workflow, establishing separate work queues for efficient workflows. We also balanced the workload to include weekend and evening coverage, says Rupinder Hargun. The hospital also introduced SpeechMagic speech recognition and established standard operating procedures. In addition, they initiated a daily status report and improved communication methods among the departments involved. A major focus was communication and managing transcriptionists and physicians expectations. Our transcriptionists were concerned that their learning curve could have a negative impact on their payment, says Mary Radley. We decided to pay them at the regular rate while they were training to ease the pressure. In the end, they were pleasantly surprised at how quickly they adapted to the new editing skills. Throughout the project, Mary Radley also did presentations at management meetings to provide information and answer questions. The benefits of the project continue to be seen in ongoing department operations. Gary DePaolo, Supervisor of Transcriptions & Record Completion at Children s feels The data analysis helped us streamline and fine-tune our workflows. The metrics we developed in the project are still used for monitoring and continue to help us manage our resources more effectively. While Six Sigma methodology has helped in discovering new areas for process improvements, Mary Radley is convinced that the combined knowledge of the experts involved has been the key to achieving the desired results. The benefits of our productivity improvement project definitely exceeded our expectations and the Six Sigma and project expertise provided by Philips was very important for the success of this project.
A team-based approach to success Children s worked closely with a team of providers to make a real difference to medical reporting. Affiliated Voice & Data Systems (AVDS) from Portland, Maine, the Dolbey dealer for the region, was contracted with the implementation of Fusion Text and Fusion Speech powered by SpeechMagic. Dolbey s expert knowledge of the software helped Children s make important set-up changes that resulted in a much more efficient workflow for both transcriptionists and internal staff. Philips Speech Recognition Systems provided the speech recognition engine and also sent an expert to deploy Six Sigma methodology to analyze, streamline and optimize the process and seamlessly integrate the technologies into the hospital s workflow. Tammy Seithel Dolbey Mary Radley Children s Hospital Boston Henry Dunne Affiliated Voice & Data Systems Rupinder Hargun Philips Speech Recognition Systems
Speeding up for better service As a result of the productivity improvement project, up to 90% of the medical reports are now produced within less than one day while the transcriptionists productivity has increased by more than 40%. At the same time, the work sent to overflow vendors has been reduced by up to 28%. In our team, we estimated the productivity savings at 35%, and we have exceeded that goal. says Mary Radley. Currently, the dictations of 100 physicians are being recognized via SpeechMagic. We anticipate savings as we continue to roll out the use of speech recognition and hope to eventually introduce a front-end workflow. Speech Recognition was implemented in August which resulted in a decrease in turnaround time. Reduced need for overflow vendors (up to 28% less work sent). % of total reports transcribed in less than 1 day
First-hand experience: Making a difference to patient care The ability to complete reports quickly is critical for supporting patient care. As this project progressed, the successful decrease in turnaround time was quickly noticed by physicians and administrators throughout the hospital. Several unsolicited emails were received to confirm the increase in physician satisfaction with the rapid turnaround times they were now getting for their reports. Satisfaction of clinicians when their dictations come back quickly = priceless! Daniel Nigrin, MD, M.S., Senior VP for Information Services & Chief Information Officer Laurie Fishman, MD, Gastroenterology physician I wanted to thank you for helping to get the transcription turnaround time back to normal. In fact, has been fantastic - often I get dictations within 12-24 hours! It makes a huge difference in caring for patients. Thank you. Joseph Wolfsdorf, MD, Physician in Endocrinology There is no doubt that the things you are doing are working. I cannot be more precise, but my impression of improvement spans several weeks. However, recent dictations have returned essentially flawless; these may be the ones using the new system? From my point of view, this has been a resounding success. Bridget Stewart, Administrator in Cardiology I wanted to give you some positive feedback about the transcription process. Dr. Colan specifically made a point to tell me today that he dictated some notes this morning and they were back by about 10am. He was thrilled. I have also heard some other rumors about the improved turnaround for transcription. Gregory J. Melkonian, MD, Orthopaedic Surgeon I wanted to let you know that the speed of getting the dictations back is exceptional. You are doing a great job! Karameh Hawash, MD, Neurology physician The patient s notes through ECD (Electronic Clinical Documentation) are coming back with fascinating speed and they are pretty accurate. Who transcribes them? I am curious. I am pleasantly surprised by how well this is working especially as I have an accent even though I like to think it is faint.
Just wanted you to know how much I m enjoying editing. I knew I liked it a lot but it really hit home when I went back to typing a few jobs when editing ran out! And I have seen over the past month or so how the system is cleaning up a lot of the little quirks the doctors use in their dictations, just like they said would happen in training! This has been very positive in every way for me, helped me polish up my transcription skills. Andrea Cavallaro, Transcriptionist I have been a transcriptionist for over 15 years. The most positive thing about editing is that it has lessened the strain on my hands. The other thing that I enjoy about editing is that it moves quickly, is interesting in its variety, sometimes makes me laugh at some less than perfect translations, and leaves me feeling like I have accomplished more on a daily basis. Andrea Regina, Transcriptionist (15 years experience) First-hand experience: from transcription to editing I definitely think it s been a positive experience in several ways. I actually think it allows for quick turnaround and at the same time actually allows us to be more accurate. There are certain times when a speaker dictates too fast, too low, etc. and VR (voice recognition) gives you an idea of what is being said in an area where you may otherwise not be able to make out the phrase at all. With this and our own knowledge, we are able to decipher what is being said and to do it precisely as dictated. The second positive is that we eventually find the repetitive motion of typing has taken a toll on our bodies. Editing reduces the amount of typing so we are able to work longer without pain. I find medical transcriptionists to be extreme creatures of habit, so I was curious to see how speech recognition and editing would be received by my group. Our MTs (medical transcriptionists) with many years of experience in the field find editing a welcome respite from spending hours each day pounding away at the keyboard - and the wear and tear that results. It is also impressive how SR (speech recognition) picks up and spells correctly the most difficult medical terms. Most MTs are realizing a more profitable line count per hour doing editing. They look forward to starting off the day editing - I get complaints when the editing work runs out! It was an interesting and fairly smooth process as we transitioned our medical transcriptionists who feared the words voice recognition and its entrance into our field to correctionists who enjoy the editing process, its ease of use, and the ability to continue to learn and refine their knowledge of medical terminology. Speech recognition has been well received by our group. Linda Peterson, Transcription Coordinator I am pleasantly surprised at how well VR picks up most of the ESL (English as a Second Language) speakers with very minimal editing needed. For those who have a hard time adjusting to ESL speakers VR is a great tool. Sandy Gomes, Transcriptionist (17 years experience) I ve found editing to be mostly a positive experience, particularly after some of the earlier bugs were worked out of the system. It s interesting, and definitely easier on the hands. Bob Maurer, Transcriptionist (2 years experience) Headquarters Philips Speech Recognition Systems GmbH Triester Strasse 64 A-1101 Vienna info.speech@philips.com www.philips.com/speechrecognition 2008 Koninklijke Philips Electronics N.V. All rights reserved.