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Oxford University Hospitals NHS Foundation Trust

Savings worth talking about - integrated voice recognition at Oxford. 

Swiftly informing patients’ GPs of their outpatient experience is an essential component of safe, connected care. Managing this communication for 1.4million outpatient visits every year is challenging, and the scope for improvement is considerable, so technology can have a major impact.

As one of England’s largest teaching NHS Trusts and Global Digital Exemplar (GDE), Oxford University Hospitals NHS Foundation Trust saw an opportunity to utilise technology to save time and money and improve information accuracy by enabling their clinicians to use integrated voice recognition.

Oxford were required by their local commissioners (CCGs) to send outpatient letters to patients’ GPs within ten working days – a target that has now been reduced to just seven days. A combination of a complex off-site transcription workflow, third-party providers, and staff shortages, alongside information complexity and transcription errors, and manually printing and mailing from the Trust’s post room resulted in a turnaround time of around 12 days in 2017.

Not only did the process take a long time, but it also cost a significant amount of money that could otherwise be invested in more effective ways. Historically, the Trust has needed to spend significant amounts on external transcription services, well in excess of £1m per year.

Benefits of integrated voice recognition include:

  • Removes the need for external transcription services, saving time and money
  • Enables clinicians to quickly dictate and save letters instantly to the Cerner Millennium EHR
  • Allows quicker access to medical information through the EHR
  • Improves accuracy as clinicians can correct transcription errors at source
  • Ensures documentation is automatically and immediately stored in a patient’s record
  • Requires less time for clinicians and administration to check documents for accuracy
  • The Nuance voice profile and user-set preferences are also used in the Cerner PowerChart Touch mobile solution

As part of the Trust’s ambitious 'Go Paperless' programme, they set about innovating to replace this outdated practice. The Trust’s Cerner Millennium® electronic health record (EHR) seamlessly integrates Nuance’s cloud-based Dragon Medical One voice recognition tools, resulting in a reduction in cost and turnaround time, as well as improving clinicians’ experiences. Their pilot was so successful that they are now rolling out to the entire hospital.

“I have been using VR for a while now. For me, it had a big impact on the efficiency of getting my letters done for any clinic. I am now able to send my letters within 24 hours or even instantaneously...”

- Dr Mohamed Sherif, Associate Specialist in Nephrology 

Talking about results

Although early in the project, the immediate value has been astonishing, and the team have proven that the transition from transcription to front-end voice recognition is feasible and a cost-effective investment. The visible benefits experienced so far are helping drive enthusiasm to roll out voice recognition across the entire Trust.

The Trust note a number of immediate notable improvements following the pilot in their renal outpatient services, that will grow as roll out continues:

Saving money on clinical correspondence

  • Eliminated the cost of transcription within Renal and Transplant service
  • Between August 2018 and June 2019, £442,876 had been saved on digital dictation transcription costs
  • In June 2019, 286,396 lines of text were dictated through the Voice Recognition software
  • Eliminated cost of recruiting 1 x WTE Band 3 admin support, in the renal unit
  • Reduction in printing and mailing costs to GPs and outpatient letters for case notes

Reducing turnaround time

  • Average turnaround time from 12 to just three days (two of these days are due to renal clinicians reviewing blood results taking 24-48 hours to return)
  • If no results are awaited, then letters can now be sent immediately
  • Already achieving the new seven-day target

Improving patient safety

  • Capturing the patient story at the point of care directly into notes and letters
  • Dictation and immediate correction in real time improves accuracy of detailed medical record in the EHR
  • Outpatient letters are instantly available within the EHR, ensuring other care team members will stay informed of the outpatient outcomes

Alongside these impressive benefits, the project is also generally helping to improve productivity, quality and speed of communication, as well as clinician productivity. They can now save several hours each week by capturing their patients’ stories at point of care in the EHR. Administration resources are being freed up for higher value patient-facing tasks and allowing staff to commit time to their development. Renal admin team leader, Sarah Fletcher, says that this time saving “has also permitted the renal secretaries to expand the variety of tasks that they do and work on their CPD.”

Voice recognition is also helping to reduce duplication of effort and data re-entry, ensuring that one patient’s letter cannot accidentally be placed in an envelope addressed to another.

“I have found the use of VR a huge boost to my clinical practice… VR has improved my letter turnaround time three-fold. I now dictate my letters in real time, so they are with the GP before the patient has reached the car park! I have found the accuracy of the system to be of a high standard with very few mistakes.”

- Dr Sudhir Singh, Consultant physician 

Next steps

Rolling out across the Trust will continue to generate these savings and improvements. The Trust will gradually phase out off-site transcription department by department, with the next specialties to be trained and take on voice recognition including cardiology general medicine, dermatology, geratology, and haematology. As rollout gets wider,
time and financial gains will continue to grow, to help the Trust reinvest into patient care.

The Trust is also keenly aware of the need for training to support clinical and non-clinical (administration / secretarial staff) users to maximise the benefits and ensure that the technology supports their practice, and experience. Trainers will be available, and ‘Super-User’ roles created for ongoing support.
 


Oxford University Hospitals NHS Foundation Trust calculated their own claims and shared them publicly via https://shelfordgroup.org/voicerecognition-at-oxford-university-hospitals-nhs-foundation-trust/ and via HFMA webinar: www.hfma.org.uk/education-events/hfma-event/drivingdown-the-costs-of-clinical-correspondence.

Cerner has not validated the accuracy of these claims.

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Client outcomes were achieved in respective settings and are not representative of benefits realised by all clients due to many variables, including solution scope, client capabilities and business and implementation models.