From the library of What’s next: archives from From the editor

What does the transition to SNOMED CT mean for big data in healthcare?

The NHS is set for a phased transition to SNOMED CT this month, meaning that the public healthcare system will conform to one standardised vocabulary of clinical terminology that consists of over 300,000 medical terms. However, will the integration of a singular coding regime be as simple to implement as the healthcare sector had hoped? This new clinical coding language offers many opportunities for clinicians, but it is worth noting the issues that may also arise.
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The NHS phased transition to SNOMED CT began earlier this month, marking the beginning of a new coding regime, which will facilitate the seamless exchange of coded documents. A standardised vocabulary of clinical terminology intended to be used in Electronic Patient Records (EPR), SNOMED CT contains in excess of 300,000 medical terms that can then be easily recognised across different hospitals, practices, and even countries.

According to the official SNOMED website it is, “the most comprehensive, multilingual healthcare terminology in the world [and] is already used in more than fifty countries… SNOMED CT can be used to represent clinically relevant information consistently, reliably and comprehensively as an integral part of producing electronic health information.”

In practical terms, the rollout of SNOMED – or Systematised Nomenclature of Medicine – Clinical Terms – will help NHS practices and hospitals to capture patient records with greater depth and accuracy. The replacement of three existing medical vocabularies with a single coding system will also reduce any possible confusions that may occur and thus improve patient care, particularly when transferring patients.

SNOMED CT also presents an opportunity to analyse big data in healthcare, with the standardisation of coding making it easier to identify trends and draw conclusions at both local and national levels.

However, what are the challenges that lie ahead during the implementation?

SNOMED CT – Opportunities and issues

As clinical coding becomes standardised across the NHS, there is a clear opportunity for medical professionals at all levels to reduce errors and create richer electronic patient records. But in order to do so, it is vital to use complimentary medical coding products that will make it possible to get the best out of the new system for coding in healthcare.

A Guardian article about the work of a clinical coder reveals a potential seam for problems, even with new coding: “This time, poor handwriting and conflicting accounts by clinicians make it difficult to determine whether my patient has a malfunctioning tracheostomy or if it’s her artificial voice box playing up.”

While errors of this sort can be reduced by the digitisation of patient records, how those records are created in digital form is important. For example, if practice GPs dictate these notes to be typed up by secretaries, errors can still occur, with terms being misheard or otherwise recorded erroneously. Medical professionals typing up patient notes themselves meanwhile can also produce errors, as well as taking additional time that could be spent treating patients.

Digital dictation – The key to accurate clinical coding

Medical transcription software such as Dragon Medical provides a solution to the problem of inaccurate coding, as well as saving time and resources. Direct voice-to-text dictation with accuracy levels of 99%+ ensures that what is said is what is recorded. As Dragon Medical solutions can be setup to record direct to the EPR, substantial amounts of time can be saved, whether in non-medical staff hours spent typing or time spent by GPs typing the patient notes themselves.

Dragon Medical solutions can work in tandem with SNOMED CT to revolutionise clinical coding and the EPR. While SNOMED provides the common language with which to describe and categorise patients sessions, Dragon Medical solutions provide the direct intuitive interface and accuracy to enable medical professionals to create rich and detailed narratives.

In short, use of medical transcription software can help improve the integrity and depth of clinical coding and patient notes, by providing clinicians with the means to transform their own voice into accurate digital notes.

Find out more about Nuance’s solutions for medical voice transcription enabling better clinical coding.

Improve clinical coding compliance today!

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How I learned my ABCs: The similarities between AI and toddlers

Artificial intelligence (AI) is quickly transforming decision-making in healthcare. From improving the accuracy and quality of clinical documentation to helping radiologists detect abnormal images to make them high priority, AI is freeing clinicians to focus more of their brain cycles on delivering effective patient care.
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Now, thanks to the impact of deep neural networks (DNN), the application of AI and machine learning to healthcare may finally be reaching a crucial tipping point. But what are neural networks? One of the best ways to understand this is to think about how children learn.

I’ve been teaching my two-year old about animals, pointing to different ones in a book. It struck me that there are a lot of similarities in the basic elements of animals, yet small children are able to learn and tell them apart. Four legs and a tail— this could be almost any land-dwelling animal. But one has a very long neck while the other has a trunk. These distinguishing characteristics help our brain analyse the information and arrive at the correct conclusions: A giraffe versus an elephant.

Neural networks are designed to work in much the same way the human brain works. An array of simple algorithmic nodes—like the neurons in a brain—analyse snippets of information and make connections, assembling complex data puzzles to arrive at an answer. The “deep” part refers to the way deep neural networks are organised in many layers, with the intermediate (or “hidden”) layers focused on identifying elemental pieces (or “features”) of the puzzle and then passing what they have learned to deeper layers in the network to develop a more complete understanding of the input and produce a valid output.

Just like my two-year-old, and all other humans, the network is not born with specific knowledge; it must be trained, like understanding the difference between a giraffe and an elephant noticing one has a big neck and the other has a short one. By feeding the network large amounts of data with known answers, we are effectively “teaching” it how to interpret and understand various inputs— this is also known as “machine learning.” For example, training a DNN to perform medical transcription might involve feeding it billions of lines of spoken narrative and resulting textual output to create a “truth set”—spoken words connected with accurate text. The truth set expands over time as the DNN is subjected to more inputs and the network’s ability to deliver the correct answer becomes more robust. If it gets something wrong, the DNN then must be corrected to reinforce it’s understanding. Like a toddler just learning to identify colours, shapes and animals, the DNN will soon be able to deliver the right answer.

So how are DNNs changing the way healthcare is practiced? Two areas among many potential applications include clinical documentation improvement (CDI) and radiology image processing. Clinical documentation includes a wide range of inputs, from speech-generated or typed physician notes to labs and medications. Traditionally, CDI involves having domain experts review the documentation to ensure a physician put into documentation an accurate representation of a patient’s condition and diagnosis. However, this approach requires time and resources, and can be disruptive to physician workflow. One approach to automating this process is an arduous, complex processing task that involves capturing and digitising the domain expertise to create a knowledge base, then applying natural language processing technology to then generate a query for the physician in real-time as she is entering her documentation.

Neural networks improve this process dramatically. Now we can use historical clinical documentation from physicians, including the queries generated by domain experts, to create a truth set for training the neural network. This allows us to skip all the complexity in the middle. The DNN figures that out for itself, based on what it “learned” from the historical truth set. Ultimately, this helps improve documentation by having AI figure out the missing pieces or connections to advise physicians in real time while they’re still charting. What AI is doing here is allowing physicians to focus on patients while the system manages the billing codes, regulatory requirements, quality measures and safety indicators in records.

DNNs are also changing the game for evaluating visual data, including radiological images. It takes the highly experienced set of eyes of an expert who has studied thousands of similar images to read the subtle clues found there. With neural networks, we can leverage this experience by training the network with thousands of radiological images with known diagnoses. The more images fed through it, the more “experienced” and accurate it becomes, enabling the network to detect the subtle differences between a positive finding and a negative finding. This technology is going to augment the busy workflow of the radiologist and truly amplify their knowledge and productivity by helping them to do things like prioritise the most critical studies. Today when some radiologists read 100 images a day, having AI sift through and spot atypical images to prioritise them first delivers value to physicians and patients who are both looking for the best outcomes.

The possibilities for neural networks are incredibly exciting—they are powerful tools for augmenting human expertise, not replacing it. Clinicians today have so many responsibilities, and AI is a promising way to help offset that work and allow them to focus more on patient care and activities that require a human touch.

Explore AI in medicine

Learn how artificial intelligence is helping physicians focus on patients, while technology supports efficient decision-making and clinical documentation with Nuance’s AI-powered solutions.

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The dilemma of medical documentation: GP and practice manager’s response to EMR

Today, GP practices are under pressure from both increasing patient numbers as well as the need to maintain accurate electronic patient records. Such pressures may require practice managers and GPs to view the situation from a different angle. For Dukinfield Medical Practice in Tameside, that meant turning to voice-to-text speech recognition technology.
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With growing numbers of patients, and the increasing need for all patient records to be stored and accessed electronically, medical documentation is becoming a burden for many general practitioners and practice managers.

Accurate, in-depth patient records can, of course, enhance the level of care given to a patient. But with increased amounts of time being spent on medical documentation, many NHS staff are finding it difficult to actually find sufficient time to spend with those patients. This presents a dilemma.

Recent research has revealed that:

  • 50% of doctors’ time is spent on clinical documentation
  • The amount of time wasted is equivalent to three outpatient clinics per doctor per week.

 

Finding a solution

While some might view the introduction of electronic medical records (EMR) as an added pressure, there is also a technological solution within easy reach which can save considerable amounts of time.

With 11,000 patients treated a year and these numbers steadily rising by 5% annually, Dukinfield Medical Practice in Tameside was one such practice which was feeling the pressure of medical transcription.

With the retirement of one of the practice’s secretaries, Practice Manager Julie Pregnall found that the time was right to investigate digital solutions. The discussions that took place eventually led the practice to adopt the speech-to-text solutions provided by Dragon Medical Practice Edition.

The road to Dragon Medical

 

  • Prior to trying Dragon Medical, the practice’s six GPs had been recording patient notes verbally using digital voice recorders. These electronic files were then transcribed by the secretaries. This system resulted not only in a duplication of effort, but also in backlogs when secretaries were away or were engaged in other vital work.
  • After having Dragon Medical recommended to her by another practice, Dukinfield’s Practice Manager engaged the services of one of Nuance’s reseller partners to begin the process of switching to the software. Dragon Medical was set up for each of the GPs, and one-to-one training was provided to ensure that the correct medical vocabulary was set up and that the team knew how to use the software.
  • Voice-recognition user profiles were set up on a shared drive, so that when doctors needed to work from a different area they could easily dictate medical notes wherever they were in the building.
  • While the previous dictation and manual transcription method took considerable amounts of time and led to backlogs, Dragon Medical’s speech recognition solution allows GPs at the practice to transcribe directly to electronic patient records (EPR) at speeds of up to 160 words per minute. With an accuracy rate of up to 99%, doctors felt comfortable relying on the software, while secretarial staff were free to concentrate on other, more patient-focused tasks.
  • Feedback from GPs at Dukinfield Medical Practice stated that patient letters were able to be more detailed than ever before, and that by capturing a more complete view of the patient story they were able to provide better care.

Find out what Dragon Medical Practice Edition can do for your practice.

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Speech-to-text software gives you more time to spend with your patients. Find out how it can benefit you.

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NHS Five Year Forward View: How does Dragon Medical harness technology and innovation?

One of the core next steps of the NHS Five Year Forward View is ‘harnessing technology and innovation.’ As the health service drives toward entirely digitised patient health records, NHS staff can at times feel themselves under increased pressure to deliver these. Dragon Medical offers an ideal solution for the Forward View, as it enables clinicians to use their own voices to create rich and detailed electronic patient records.
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The NHS Five Year Forward View (5yfv) has given the health service a framework for improving and modernising itself. To quote from the report itself, it has, “set out a clear direction for the NHS – showing why change is needed and what it will look like.” ‘Harnessing technology and innovation’ meanwhile is one of the important ‘next steps’ currently being discussed for realising the 5yfv.

One of the cornerstones of the NHS Forward View is that the organisation will, “exploit the information revolution,” including implementing, “fully interoperable electronic health records so that patients’ records are largely paperless [and so that] patients will have full access to these records.” The 5yfv also calls for a, “1.5% net efficiency increase each year,” in line with reduced budget increases. This, and a drive to “make patients records available to the right clinicians wherever they are”, calls for innovative IT solutions across all NHS workplaces, and this is where Nuance’s Dragon Medical can help.

Driving efficiency in patient documentation

Dragon Medical provides NHS practices and trusts with the ability to turn healthcare professionals’ verbal notes and clinical narratives into detailed textual health records which can be accessed as needed, either locally or via the cloud. Using sophisticated speech-to-text technology, the software recognises an extensive range of clinical vocabulary and is able to adapt to the individual clinician’s voice, style of speaking and even accent. This has several positive impacts on patient documentation:

  • Less time taken on EPR – While some doctors and others dictate notes verbally at present, often this is done via a simple voice recorder, and the notes are then typed up by a secretary. By being able to speak directly into the EPR system, at rates of up to 160 words per minute with 99% accuracy, less time is spent on the notes and personnel are freed up to engage with patients more.
  • More in-depth notes and letters – Clinical notes can flow much more freely when they are spoken with the confidence that they will be automatically transcribed. This can mean enhanced communications between different clinicians and specialists, and thus better care for the patient.

 

Digitising the NHS

A paperless NHS is at the heart of not just the Five Year Forward View but the organisation’s view of itself beyond that scope. Dragon Medical is the ideal tool for this challenge because it provides a direct interface between the clinician’s observations and the electronic health record. It’s even been found that doctors can dictate three times faster than they can type, so voice recognition solutions are a logical choice going forwards.

Reducing administration costs

Whether it’s the hours spent by medical staff themselves on typing up patient notes or the hours that their secretaries spend typing up their dictated recordings, accurate and detailed patient records usually carry a substantial price tag over time. By reducing the amount of time spent on those notes, Dragon Medical can help the NHS to reduce these overheads significantly.

If you’re looking to improve your clinical documentation, take a closer look at Dragon Medical.

Discover the power of speech-to-text

Wondering how you’ll keep step with the NHS’ goal towards greater digitisation and efficiency. Find out more about Dragon Medical today.

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Histopathology and radiology – the perfect marriage?

It has been described as one of the toughest winters in 20 years for the NHS. So, in 2018, the year in which the NHS turns 70, it is imperative that ‘innovation’ takes centre stage and common-sense ideas be allowed to blossom One such idea from Dr Pedro Oliveira, histopathologist at Manchester’s Christie Hospital meets this brief. He suggests Radiology and Histopathology should break out of their departmental silos and ‘get married’.
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The marriage of digital histopathology and radiology speeds NHS innovation and transformation

 

A marriage of radiology and histopathology?

Both radiology and histopathology generate images and are the foundation of the 21st Century digital health vision. Dr Oliveira explains that radiology became digital because it had no choice; the multiple CT, MRI and PET images simply could not be evaluated ‘dynamically’ without the power of digital reconstruction.

Histopathology is very similar to radiology. A stained slide of physical tissue is a different view of the tissue or organ being captured by the plain film, CT, MRI or PET scan. A cascade of different radiology and histopathology image profiles combine to provide the clinician with the clues for diagnosis.

However, using the microscope invented by Robert Hooke in 1667, histopathology still lurks in the Dark Ages. Dr Oliveira is confident that a 2018 histopathologist could make a diagnosis of a basal cell carcinoma with the Hooke’s microscope. He gives an example of a typical 1976 breast cancer report: ‘a breast comprising a nipple bearing skin ellipse and underlying fibro-fatty tissue in which there is a scirrhous tumour. Section shows spherical cell carcinoma of the breast has migrated to complex datasets requiring a deep level of clinical, family history, histopathology and genetic information’.

Today’s histopathology report is far more detailed with expectations that demand faster diagnosis to meet the premise that ‘early diagnosis is key to survival’.

Dr Oliveira believes the only way to achieve report detail and speed – replacing the present out-dated Laboratory Information Systems (LIMS) –  is to think completely outside the histopathology box and create a new ‘Pathology Powerhouse’ with a move to digital scanners, a more comprehensive IT infrastructure and most importantly, a reformulation of the ‘workflows’ for both histopathology cut-up and reporting and a reskilled workforce particularly amongst biomedical scientists. It is also the only option to meet the expectations of the increasingly complex nature of histopathology reporting. This is the magic bullet to overcoming the ballooning workload.

The Vision of the Pathology Powerhouse

Dr Oliveira has been leading a Digital Pathology Vanguard at Christie NHS Foundation Trust.  Amongst the changes he’s made are a new LEAN digital histopathology workflow fully integrated into the EPR.

Once his vision is complete Manchester would have a single Histopathology ‘shop’ with all cutup by fully trained biomedical scientists covering all hospitals within a twenty-mile radius. Rapid processor and automatic embedding technology that removes laborious human processes would be complemented by smart digital machines providing continuous scanning, resulting in a fully automated digital pathology service. This would be supported by a hub and spoke digital network between the Histopathology ‘mothership’ and the satellite hospitals.

The solution will allow histopathologists to provide a faster, higher quality and cost-effective service for their local community and go some way to addressing the present manpower shortage. Report turnaround times and referrals would all be much more efficient with experts in certain areas e.g. neuropathology more easily accessible.  Missing slides, lost slides or even misfiled slides would be a frustration of the past.

Digitisation brings Revolution

The change does not stop there. Dr Oliveira describes a three stage ‘hop, skip and a jump’ process to this mini revolution in the medical imaging space.

To complement the ‘hop’ of creating large merged Histopathology departments, the ‘skip’ is for them to divorce themselves from the other pathologies (haematology, biochemistry and microbiology) resulting in a ‘creative destruction’ of the histopathology department. Then, instead of becoming a standalone department, the ‘jump’ process returns to my opening theme i.e. to terminate the stand-alone radiology department and marry it with histopathology. He suggests they have been dating for years and cites joint working in the neuro, bone and breast clinical areas and their natural interaction and dependencies as part of the multi-disciplinary team (MDTs) process.

Digitisation speeds innovation and transformation

The Carter Review describes how the NHS could reduce £5 billion of variation in outcomes through a gain in efficiency. It recommends using technology to achieve this. In this marriage of common sense, Dr Oliveira is not simply considering technology but re-working the fabric and infrastructure of an established but broken model.

Despite automation and digitisation, there will always be a need for histopathologists and trained biomedical scientists to report and one technology that will be essential to realise this vision will be the universal use of speech recognition integrated into  the reporting workflow. For example, in Plymouth, Derriford Hospital’s histopathology services implemented speech recognition and overcame a 600-report backlog with their present report turnaround now exceeding national targets. The initiative has been recognised with an NHS Innovation Award.

The first pioneer to disrupt the status quo and roll out a newly configured ‘Department of Diagnostic and Tissue Imaging (DDTI)’ across a whole health economy covering a population of millions, will no doubt be shortlisted for the Oscar equivalent of an innovation award.

As Steve Jobs once said: ‘The ones who are crazy enough to think that they can change the world, are the ones who do’.  Does Dr Pedro Oliveira fall into that category? Time will tell.

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5 reasons why artificial intelligence in healthcare makes a difference

Nuance’s latest version of Dragon Medical Practice Edition boasts a host of artificial intelligence features but what does this really mean for GPs and practice teams dealing with challenges of the here and now; increasing workload and a demand for improved healthcare outcomes. Here we decode the AI jargon and explain 5 reasons why the AI in our new version of this ever-popular clinical speech recognition software really matters.
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1. AI in speech recognition.

AI is a very broadly used term and there are very many definitions but, simply put, it is the use of computing power to perform tasks that usually require human intelligence. Dragon Medical Practice Edition is clever, powerful software that adapts to you and your environment. Using your voice as an interface with the device (computer, tablet, smartphone etc), the AI in the Dragon Medical Practice Edition uses acoustic (sound) and language learning programs (algorithms) to interpret your voice and by doing so it replaces traditional methods of typing, pointing and clicking with keyboard and mouse. You are able to do a previously time-consuming part of your job – capturing and updating the patient story within clinical documentation – much more naturally, quickly and accurately.

2. Deep Learning.

Traditional AI algorithms analyse data linearly. Deep learning algorithms process data in a non-linear way and mimic the way in which our human brain learns and recognises patterns. The software can then make predictions based on this. The application of this sort of tech has been enabled by more data and more powerful hardware. Our speech recognition engine recognises and learns your voice patterns, dialects and accents to significantly improve precision during the dictation even in environments with more ambient background noise e.g. in open office or on-the-go. This means the speech recognition is fast and accurate wherever you are dictating. Get more done in less time and with greater accuracy, wherever you are

 

3. Neural Network.

Is an interconnected group of nodes, akin to the vast network of neurons in the human brain and it enables the the software to check the context of the dictation on a much larger scale resulting in great speech recognition accuracy. Using the software is ‘feels’ fluid, adapting to your style. There are very few interruptions to the flow of your dictation

4. Next Generation.

Our speech recognition is very powerful, fast and very accurate in fact it is the most advanced in the healthcare market and our ongoing commitment to R&D ensures that the investment you make in Dragon Medical Practice Edition today will last a very long time into the future.

5. Nuance are pioneers in research and development of speech recognition technologies.

Nuance’s focus and investment in speech recognition R&D ensures our healthcare products incorporate the latest, most powerful and proven technology. We keep abreast of developments in healthcare, adapting our software to meet its changing needs and making sure we stay ahead of competitors. Dragon Medical Practice Edition is designed with general practice needs in mind. It is easy to learn, easy to use, very fast and its accurate and reliable making you more productive more quickly.

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7 cybercrime questions for business leaders to ask

Business leaders must recognize that cybercrime is now a day-to-day business reality and priority. No one is immune: It’s not a question of “if” your organization will be affected; it’s a question of “when.”
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Business leaders must recognize that cybercrime is now a day-to-day business reality and priority. No one is immune: It’s not a question of “if” your organization will be affected; it’s a question of “when.”

That’s a sobering thought, but also one that should inspire business leaders to change and move their organizations forward. A malware incident like the NotPetya attack of June 27 required a cascade of quick reactions to contain the incident, protect our clients and safely restore services as quickly as possible.

It also represented an opportunity for us to reflect on how we act and think as an organization.

First, it’s critical for everyone to recognize how truly malicious malware can be. Viruses and worms that once explored a limited network or stole a limited amount of data have evolved into the current crop of infiltrators capable of business disruption and destruction.

In this day and age, it is the difference between a burglar who comes into your house just to prove he can or a thief who steals a few valuables, and a new type of criminal who comes onto your property solely to wreak havoc and destroy everything possible.

These criminal viruses and worms are evolving each day and we must all work together to prevent their intended business disruption and destruction.

At Nuance, we have taken the time to go the extra mile, including implementing comprehensive network hardening and micro-segmentation. We also have enhanced security practices and protocols, for example, adding additional access controls.

While enhancing our systems and making them more resilient, we also are learning a lot about how individuals and teams perform during the pressure of an event like the malware incident.

We believe every organization should consider how to identify leaders who can inspire their teams, remain optimistic and help others handle the personal pressures of working through serious operational challenges. After all, cybercrime is not only a direct challenge to technology resilience—but also to business resilience.

To better prepare for the sophisticated cybercrimes of the future, business leaders need to ask the right questions now. Below are seven important security questions every leader should consider:

Cybercrime is part of the new reality for every company, organization, and person. What can you be doing now to prepare for this scenario?
Do those policies actually translate into deployed security capabilities?
Have you developed a crisis and disaster plan and communicated it broadly throughout your organization?
How would you communicate to your staff, your board, your customers and your patients?
What are your primary vulnerabilities? What measures are you taking to ensure patient data is protected?
Do you understand and align with your vendors’ security policies, and do you have the appropriate validation and/or risk assessment programs in place?
Have you identified a team of outside experts to help in case of an incident, including cyber security firms?
We are learning and sharing everything we can from our cybercrime experience. This experience has made us and those that partner with us stronger.

Allied Health Professionals lead system improvements in the NHS

With 170,000 Allied Health Professionals (AHPs) in the UK delivering over 4 Million client/ patient interactions per week, AHPs are very well placed to positively influence public health in the UK across NHS, Social Care, Education, Private and Voluntary Sectors, working across the life-course in a wide range of specialties, using evidence based behaviour approach, deploying interventions which develop ongoing relationships and rapport with patients.
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Physical therapist stretching mans leg

DynamicHealth, provided by Cambridgeshire Community Services NHS Trust, is actively involved in an initiative called fitforthefuture.org. This is a sustainability and transformation programme covering hospital services, community healthcare, mental health, social care and GP services (primary care). The aim is to work together and take joint responsibility for improving the Cambridgeshire and Peterborough population’s health and wellbeing, outcomes and experiences of care.

Community Services getting fit for the future

To accommodate the growth in demand for services, and reduce the dependence upon back-office support, Sarah Saul, Service Manager, DynamicHealth chose investments in technology and partnerships with technology providers that would maximise front-line services and reduce/release administration backlogs and workload.

“Physiotherapy and other Allied Health Professional services are undergoing exciting changes leading to whole system improvements in the NHS. Dragon Medical integrated into our clinical documentation delivers efficiencies that support that change and our growth”, confirms Sarah Saul, Service Manager, DynamicHealth.

Speech recognition takes the strain

Sarah chose Nuance Dragon Medical Practice Edition front-end speech recognition integrated into the clinical documentation workflow. During or between patient appointments the Therapists use Dragon Medical Practice Edition to directly update the EPR using voice macros to speed navigation between fields and populate regularly used blocks of standard text. For clinic letters, a voice command is used to call up the template for the clinic letter with pre-created ‘Clinical Impression’ and ‘Management Plan’ fields followed by an area for free text. Using Dragon Medical Practice Edition, letter creation, proof reading and finalising takes five to ten minutes for a new patient and less time for a follow up appointment. Swiftly, following the clinic, letter processing is then completed by the administrator and sent out to the GP and patient.

Service improvement

The goal for the length of time on the MSK pathway is eighteen weeks and the whole team has experienced improvements to this timescale as a result of reduced report and letter backlogs, faster referrals to secondary care and time freed up to chase diagnostic reports and patient and other patient facing activities. Dragon Medical has improved the quality of notes within the team easily dealing with accents and mumbling. Accurate spelling, fewer abbreviations and more complete notes have improved communication with patients, within the team and with other specialties. Letter turnaround has been reduced from weeks to days.

Let us help you accelerate your transformation!

But where to start? Read how our customers used speech recognition to make a change and contact us to speak to an expert!

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5 tips for rolling out successful healthcare speech recognition projects

“Speech recognition should be considered a project in and of its own right not just about adding a usability feature. It’s a disruptive technology which must be deployed as a full-blown project,” insists Olivier Boussekey, IT manager at Saint-Joseph Hospital, Paris who rolled-out a successful paperless healthcare project. Based on the feedback from this and other customer and partner projects we have identified five tips you should follow to achieve your own successful speech recognition deployment.
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hands and fingers

 

1. Map out and engage ALL your stakeholders including your medical secretaries and back-office support team

Speech recognition rollouts are usually part of a broader healthcare efficiency strategy which will involve new service models and ways of working. Historic workflows involving clinicians, medical secretaries and other back-office resources should all be considered and reviewed when planning the new workflows.  The early engagement of all your support and back-office resources are essential. Why? Because the devil is often in the detail. Medical secretary and other administration resources will have detailed knowledge of processes, links to interfacing organisations, current snags and great ideas about how to overcome them. Also, they are often the personal interface with the patient.  Their positive involvement can be the difference between project success and failure.

2. Put yourself in your clinicians’ shoes

The relationship between clinicians and IT departments is not always easy. Clinicians criticise IT for not understanding their daily lives and vice versa. Several practical examples have revealed the benefits of the IT team immersing themselves in the daily life of the clinicians. At Saint-Joseph Hospital in Paris, actively listening to the needs of medical practitioners was a priority for the IT team who spent time in each department, observing the uses of speech recognition in medical practice. They were able to detect problems that the project team had not previously raised: clinicians were accustomed to leaving an audio or paper note for the secretary advising them of a specific action to take. With front-end speech recognition clinicians weren’t able to do this in the same way. Instead, the IT team created a “Post-it” in the EPR that delivered the same result.
Get down onto the ‘shop floor’, get close to your clinicians and put yourself in their shoes. Technology should serve the clinicians – not the other way around.

3. Training, training, training

At the first level, speech recognition training is quick and easy. At St Joseph it took less than 4 weeks for 100 clinicians to be operational. However, for clinicians to maximise the full potential and power of speech recognition in their day-to-day work they must master a multitude of standard and customised features and commands. For example, for a medical note or report, rather than dictating and correcting as you go along it is preferable to dictate the entire text first and then correct any errors by voice once that segment of dictation has ended. In this way the software learns from its errors. Without correction, just like any individual, the software will repeat its error.
Training doesn’t have to take place in a classroom environment. If the basics are in place then innovative ways of delivering training on-the-job, as at Alderhey Children’s Hospital, can be efficient and effective.

4. Support, support, support

Deploying a dedicated support team to help clinicians in real-time is a common feature of successful projects. In all healthcare organisations that have successfully completed their projects, the IT team have set up a system to quickly respond to clinicians’ requests, identify bottlenecks and speedily resolve any user problems. At Saint-Joseph Hospital the IT Director was part of the support team and included himself on the ‘hotline’ for clinicians to report difficulties or request support. direct to his mobile phone. Finding and taking ownership of a solution always requires supervision, even when the solution is easy to use.

5. The end of the beginning

Speech recognition is not a secret sauce although the new generation of technology based on deep learning and neural networks is truly amazing in terms of its immediacy, precision and quality. Once your clinicians are using speech recognition on a daily basis and are beginning to understand and feel the benefits it is time to refine the use of automatic templates and voice commands customised to their workflows and specialties. At CHU Nantes, the project team organise regular meetings with clinicians in order to share experiences and answer outstanding questions. At St-Joseph Hospital in Paris they distribute newsletters to share tips and tricks from colleagues.

Each project is unique but in our experience these 5 simple tips hold true for all successful healthcare speech recognition projects.

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Let’s give GPs more time to care

The Chair of the Royal College of General Practitioners (RCGP) has called for GPs to be given more time to care; especially for patients who are isolated and lonely. Capturing information about these patients, who often have several comorbidities, is an important part of delivering their care, particularly with multidisciplinary teams. Recording sufficient level of detail in the electronic patient record (EPR) therefore becomes a crucial link and communication tool and with GPs hard-pressed for time, speech to text is one way this detail can be captured quickly and easily.
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Male nurse and boy using stethoscope

With UK general practice under significant pressure and GPs showing their frustration by threatening to leave the NHS, it feels as though we have reached a crisis point. The situation looks bad for GPs who struggle to spend what they feel is an appropriate amount of time with their patients. There is also a detrimental impact on patient care to consider, especially for those patients who are lonely and isolated.

Recently the Chair of the Royal College of General Practitioners made this a central theme at the RCGP’s annual conference in Liverpool. At the conference, Dr Stokes-Lampard said: “GPs see patients, many of whom are widowed, who have multiple health problems like diabetes, hypertension, and depression. But often their main problem isn’t medical: they’re lonely.

“The guidelines say we should be talking to them about their weight, exercise, and prescribing more medication, but really what these patients need is someone to listen to them and to find purpose in life. GPs need the time to care — don’t make us spend it ticking boxes, preparing for inspections, or worrying that we haven’t followed guidelines for fear of repercussions. Trust us to be doctors so that we can treat our patients like human beings and tailor their treatment to their needs.”

However, giving pressured GPs the task of addressing the complex issues of loneliness and social isolation is not only a big ask, it comes at a time when workloads have also increased. Research from the Universities of Oxford and Bristol published in The Lancet found that workloads in general practice have increased by 16 per cent over the past seven years.

These facts were echoed by the BMA’s Urgent Prescription for General Practice that calls for a safe manageable workload and more time with patients.

As I have highlighted in previous blogs, the primary care team is drowning under the burden of clinical documentation. When you take into account factors such as loneliness and social isolation, there is a wealth of relevant contemporaneous detail that needs to be recorded in the EPR.

This cannot be easily captured in a tick box type of documentation format and the unstructured output of the consultation needs to be recorded. This is one important area where the use of speech recognition could not only make that capture easier, but also save time with its completion.

Not being able to capture this level of detail in the EPR can have a significant impact for people who are a greater risk of developing health illnesses because they are lonely and isolated. From a multidisciplinary team perspective, it means there will be gaps in the record and a reduced likelihood that potential problems will be picked up.

This is just one area where capturing detail can be improved. GPs I have spoken are using speech to text for insurance reports, DVLC requests and also to send and receive emails.

If you are still in any doubt about whether it works, consider the results at the Dukinfield Medical Practice. The speed with which the reports are completed has enabled the practice to treat four more patients per day – this is particularly important for the practice, which is facing the challenge of patient numbers rising by approximately 5.0 per cent a year.

The GPs have also reported that patient letters are now much more detailed than before, capturing a more complete view of the patient’s story which, in turn, leads to better care. The new process has also enabled the secretarial team to concentrate on other, more patient-focused, tasks.

There are also financial savings that can be made as Waterloo Medical Group has discovered. By using speech recognition, it has been able to ease several of the pressure points shared by many doctors, while also making cost savings of approximately £15,000 within 12 months and improving the turnaround times for clinical documentation.

At the RCGP’s conference Dr Stokes-Lampard called for increased funding. “We need the £2.4bn [€2.7bn; $3.2bn] a year extra for general practice—promised in NHS England’s GP Forward View—delivered in England, in full. And we need equivalent settlements for Scotland, Wales, and Northern Ireland, and we need them fast,” she told the RCGP’s conference.

The extra funding would of course be welcome, but it has to be used effectively. The challenge for the NHS is how to ensure that can GPs benefit from technology like speech to text. NHS England has recognised the need for action to address GPs’ workload with a three-year £30m ‘Time to Care’ development programme, which will support the release of up to 10 per cent of GPs’ time. Investing in smart technology and innovative ways of working need to be factored in – and that includes painless yet simple ways to capture clinical data as part of the clinical documentation process – speech recognition has an important role to play to meet that need.

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