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Sunday
Aug102014

Wave goodbye to typing backlogs

No more backlogs with T-Pro

It is common knowledge around the healthcare sector in Ireland that many facilities have problems with backlogs. Treatment hits a bottleneck when it comes to getting test results, discharge letters, appointment confirmations and reports typed and out. To solve this problem hospitals have had to resort to many expensive solutions. These solutions often don’t work and lead to more problems down the line. Hospitals have traditionally hired more staff, either permanent or equally expensive temps. They have also tried to get more out of their existing resources by introducing overtime. Soon these overtime payments become an expectation and as we know from parkinsons law, the exiting work just expands to fill the time available.

"work expands so as to fill the time available for its completion" Parkinsons Law

Traditional Solutions - Risk

Another commonly attempted solution is to ship out a certain amount of the dictation to a third party transcription pool. This seems like a logical solution to the problem. A hospital has a backlog of a months worth of letters it simply contracts a company to clear this.  In reality this never works out, two big reasons, The biggest being that  no effort is made to solve the reasons behind the backlogs, why are they happening? what is the core issue? By the time this backlog is cleared another will be in the oven cooking away. The second issue is that in many cases the outside company clearing the backlog cannot deliver a quality product to the same standard as the internal typists. There are many reasons for this, dictation's are often incomplete, MRN or episode dates, even patient names are missing. Often the external typists have no access to this information (access to a system or database), even if they do they won’t have the familiarity with clinicians and their dictation styles or idiosyncrasies. What ends up happening is that they documents typed by the outsourced company have to be checked by the internal typists. This defeats the purpose of the exercise in the first place and meanwhile a new backlog is building.

Old Technology 

Many facilities are still using tapes, this only adds to the complexity of trying to make an outsourced solution work. Tapes have to be converted to digital, the quality is often awful as tapes degrade over time. Also tapes by their nature are two sides with multiple dictations grouped together. It is a big task to try and identify one important dictation that might be urgent and is lost somewhere on a tape, if you can identify which tape it is on.

Any solution to this problem has to do two things, one, solve why backlogs are occurring not just paper over the cracks. And two the solution also needs to be flexible enough to satisfy the needs of the clinicians and other hospital staff whilst making outsourcing easy and effective.

Our Solution

Our solution achieves these goals. Its very simple, everyones uses the same system, doctors, hospital secretarial staff and the outsourced typists. Everyone has access to the same information, so queues can be managed and dealt with in the most cost efficient manner.

A hospital or facility can decide when and to whom dictations are assigned.  For example, one hospital successfully using the system have set a rule that any dictation the remains in the queue for over 4 hours becomes immediately available to the outsourced transcribers. 

 

Advantages for the Clinicians dictating:

Flexible Dictation. There are many ways a doctor can dictate. Apps for both iOS and Android platforms are available, this means doctors can use devices that they already carry around with them every day. They can also dictate using any telephone, our telephony solution lets the doctors call a predefined local number and then keys can be used to control the dictation.  This solution is very popular with finance depts. One hospital told us that they used to have to buy 200 portable dictation devices at €250 per unit for each intake of junior doctors. Telephony eliminates this cost. You also get a quicker turnaround, dictations are ready to type immediately, you don't have to wait for the portable device to be docked to PC and the files transfer. 

Portable devices (and fixed mic’s) can s6till be used, especially where a hospital may have legacy equipment. They can now be pre-programmed to auto-upload to the platform. 

Integration  

Integration with the core hospital systems allows us give the doctors their list of patients to pick from when they use the smartphone Apps. This means we can save the documents or notes back into the system automatically. It also minimises the chance for human error, the patients name or identification number does not need to be typed.

Using the App we can also let doctors approve notes from draft status. This is a great advantage as the doctors are no longer tied to  a desk or PC. This mirrors the way most of them work. They are often on the move and can be operating in two or three different venues.

If they can review the dictations, make small amendments and approve documents of the fly this saves them valuable time. time wasted on admin is time that could be spent on delivering health care.

Ease of Management 

From a hospitals management view there are also other advantages. You are not just outsourcing the transcription should you wish too but you are also outsourcing the management of the dictation workflow. Often hospitals do not know who is doing what and when. With our hosted solution you get top down monitoring of who is dictating and who is doing the typing, how much they are doing and how long it takes. You can assess the productivity and value that you get from your internal resources. You can also choose to use the external transcription service when and if you require it. This can be turned on like a tap, with strong SLA’s in place all deadlines will be met without excessive expenditure. A hospital can also look at the cost of delivering the typing in-house and externally and compare costs. This sort of management information normally is only available from lengthy reviews or expensive management consultants.   

T-Pro & Diktamen

Diktamen are a Finnish company and supply the software and services to many hospitals in Finland and the surrounding region. One of there hospitals had 40 typists when they rolled out the software, from the efficiencies that this brought alone they managed to cut down the typing staff by 30%. Another clinic were under pressure to meet turnaround times for their dictation. They implemented the software and also contracted the transcription service, they set a rule that all dictation that was in a queue for over 8 hours was to be moved to the transcription companies queue. The contract in place means that this has to be processed within 4 hours. Yet another example they offer real time transcription. This is a service T-Pro now offer to a hospital in Ireland where the time taken from dictation to saving in the hospitals PAS is two hours. This is essential to maintain the integrity of the medical record. This turnaround time will only be improved upon with the improvements in Voice Recognition Technology.

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