| Beth Israel Deaconess Medical Center |
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| Keeping Pace with the Challenges of Paperless Medical Records |
Challenge
Beth Israel Deaconess Medical Center (BIDMC), of Boston, MA, is a large healthcare institution and teaching affiliate of Harvard Medical School serving nearly a quarter million patients a year. According to CIO, Dr. John Halamka, "Beth Israel Deaconess Medical Center is committed to paperless medical records and is one of the most wired hospitals in the country, yet only 40% of all clinical information is recorded electronically. Inpatient notes are still handwritten, over 400 paper forms are used in the process of care, and many documents appear only in the paper chart. The five year goal is to achieve an 85% electronic medical record."
Dr. Halamka noted, "One of the greatest challenges is capturing text information in electronic form. Dictation is highly effective because clinicians can dictate anywhere, at anytime, using a multitude of devices. However, transcription can be expensive and slow."
Three of the hospital's divisions - its primary care center Healthcare Associates (HCA), its Specialty Clinics, and its Radiology Department experienced several problem areas with manual transcription workflows:
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slow and inconsistent turnaround times, often 4-6 days |
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unreliable report distribution and printing |
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high costs of medical transcription services. |
Solution
In 2002, BIDMC selected the EditScript solution for Computer Aided Medical Transcription from eScription. Unlike other speech recognition technologies, the EditScript solution was designed by eScription not only to provide high quality content, but also to format documents according to an institution's standards, thereby establishing document consistency and increasing MTs' productivity, allowing them to focus on critical editing tasks.
Today at BIDMC, more than 21 million lines of transcription per year are being produced using the EditScript solution. The organization has successfully reduced turnaround time and achieved cost savings of more than $2 million. Dictations from more than 800 clinicians in the three divisions have been processed through the system and 95% of the dictation volume is currently going through the speech recognizer to produce first drafts for editing. No clinician training was required, and clinicians had minimal change to their workflows when the new system was installed.
Prior to switching to EditScript, Transcription Managers at BIDMC spent a great deal of time managing multiple transcription resources. With the new EditScript solution, BIDMC was able to streamline this process. "We found that standardizing our outsourced transcription to two vendors through competitive bidding would keep our costs lower while helping us better monitor the transcription companies," stated Sheila Linehan, IT Application Analyst and Project Lead at BIDMC. An in-house Radiology MT group remained in place.
Report distribution had become an unreliable process for these groups at BIDMC. Through the use of the EditScript solution, report distribution is now seamless through integration with a 'homegrown' RIS report writer in Radiology, and an existing Online Medical Record (OMR) in the specialty clinics.
At BIDMC, intelligent speech recognition produces drafts according to the organization's formatting standards including:
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Full support for the JCAHO "safety first" text expansion standards: "once daily" instead of "q.d." and "5 g" instead of "5.0 g." |
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For privacy reasons, eliminating patients' last names in the drafts; using Mr. ?? instead of Mr. Smith. |
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Depicting diabetes types as Arabic numerals instead of Roman numerals: "type 2 diabetes mellitus," yet formatting heart-murmur grades with Roman numerals: "grade II/VI murmur." |
In addition to increasing productivity consistent formatting greatly simplifies searching for information and extracting data from transcribed reports, such as with natural language processing (NLP). Since the change to EditScript, consistency as improved in both the headings and the body of documents produced through speech recognition.
The BIDMC implementation followed a successful process, which helped drive the excellent results the organization has achieved. An IT project team at BIDMC handled responsibilities of Project Management, System Management and User Support, and worked closely with the medical records staff.
CIO John Halamka concludes, "The most significant lesson we, as IT professionals, have learned is the importance to clinicians of timely, accurately transcribed notes, which help in providing high-quality patient care."
Results
Using Computer Aided Medical Transcription, Beth Israel Deaconess Medical Center was able to achieve significant, near-term economic benefits and process improvements, while moving toward its strategic goal of paperless medical records.
"eScription delivers a cost effective, technologically sound product. It reduced our cost of transcription and was easy to rollout and integrate into our existing IT and medical records infrastructure." ---Dr. John D. Halamka, CIO
"Our clinicians are very satisfied with the turnaround time and impressed that their dictation/transcription workflow did not need to change." ---Sheila Linehan, IT Application Analyst and Project Lead
Today at BIDMC:
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The organization has achieved cost savings of over
$2 million |
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Turnaround time in the primary care center has been reduced by 90%, from 5 days to 12 hours; radiology reports are delivered within 30 minutes |
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Report distribution is seamless and efficient through integration with an electronic medical record |
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The organization streamlined its monitoring and management of transcription processes and costs, and reduced the number of MTSO vendors |
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Clinicians continue to follow the same dictation workflow, without training or interruption |
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Transcription productivity has doubled and in some cases tripled |
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Consistency has improved in both the headings and the body of documents processed through speech recognition. |
eScription helped streamline the transcription process at BIDMC, resulting in faster turnaround times, lower costs and improved report distribution through an EMR. Learn more about the complete EditScript solution in our Products section.
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