The challenge of clinical documentation in middle-earth

New Zealand may be the beautiful backdrop for one of the greatest fictional trilogies but there are some very real opportunities to leave a world where clinical documentation is all about hand writing and typing toward one where the use of speech-recognition supports the New Zealand government’s digital health strategy.
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Examples of clinical speech recognition to meet the challenges of clinical documentation in New Zealand

 

On a recent visit to middle earth

    I was recently asked to support a Nuance partner – Comrad – on a trip to New Zealand, the backdrop for middle-earth in the Lord of the Rings film trilogy.

    I met several UK-trained doctors on my travels, perhaps not surprising given the level of discontent in the UK amongst medics. It was interesting to see the extent to which New Zealand appears to be riding the wave of immigration with an economy attracting workers from Asia to support its healthcare system.

    I discovered that although our own green and pleasant land might be very different to New Zealand, in some respects it is similar; particularly the clinical documentation challenges faced by frontline healthcare teams.
     

    The quest for clinical speech recognition in New Zealand

      Then the question on my mind was, given that the challenges are the same, has clinical speech recognition made any significant inroads in the delivery of New Zealand healthcare?

      • Despite a recent change in New Zealand government, the ambition in the Health Strategy to embrace technology solutions including clinical speech recognition is still alive “When routine tasks are automated, skilled staff can focus on what they do best.”
      • Radiology departments lead the way and are enthusiastic users of speech recognition technology whilst the remainder of New Zealand healthcare has had little exposure to this proven solution.
      • Whether secondary, primary, community or mental health, whether a doctor a nurse or an AHP paper records are all too prevalent.
      • As in the UK, although digital dictation is a well-used tool for outpatient letters, they appear to be transcribed in-house rather than outsourced. This means that turnaround times, whether that be outpatient and referral letters or discharge summaries, are a challenge.

       

      Speech recognition saves valuable time in ED

        I visited an Emergency Department (ED) seeking innovative ways to reduce the time it takes to document care and increase the throughput of patients. I told them about a study of the impact of speech recognition in ED at South Tees Hospitals NHS Foundation Trust. There, 9 out of 10 users felt that using speech compared to handwriting and typing saved time, improved the note quality and speeded up communication with others.

        Users reported that the time saved by creating clinical documentation this way was up to 40 per cent, equating to about 3.5 minutes per patient. What is more, 86 per cent of users felt their notes were more complete.

        It was not just the doctors that were facing these clinical documentation challenges. Nurses and allied health professionals were also struggling.

        So perhaps New Zealand healthcare can learn from some clinical speech-recognition implementations in the UK and Europe where the drive to move to paperless is well under way in a range of primary and secondary care settings for example:

        • Cambridgeshire’s Dynamic Health Musculoskeletal Services with a team of 18 physiotherapists and one podiatrist are using speech recognition for their clinic letters. The turnaround time of letters has been reduced from 6-12 weeks to 2-5 days with an increase in patient throughput and a decrease in waiting times. The team now does all their admin within contracted hours and goes home on time.
        • In Plymouth, Derriford Hospital’s histopathology services overcame a 600-report backlog and report turnaround is now exceeding national targets such that the initiative has been recognised with an NHS Innovation Award.
        • At Paris’ St Joseph Hospital, in one of the first of their medical departments to use speech to text, the number of records despatched after the seven-day deadline has been reduced from 32% to just 5%. St Joseph currently sends out 30% of records on the day of discharge. Rheumatology now sends out 50% of records on the same day versus 10% before speech to text was introduced. There are other success stories in the cardiology, neurology and vascular surgery departments.

        Sources:

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        About Dr Simon Wallace

        Dr Simon Wallace is the Chief Clinical Information Officer (CCIO) of Nuance’s Healthcare division in the UK and Ireland. Simon has worked as a GP, hospital and public health doctor in Brighton and London. His interest in health informatics began in the 90s when he spent a year at the King's Fund investigating the impact of the internet on shared decision making between patients and their healthcare professional. For the past 15 years, he has worked for a range of organisations including Bupa, Dr Foster, Cerner Corporation and GSK across a range of technologies which include electronic patient records, telemedicine, mobile health and lifestyle devices. Simon has a keen interest in the voluntary sector, recently completing a 7 year term as a Trustee for Fitzrovia Youth in Action, a children and young people’s charity based in London.