eScription

Brigham and Women's Hospital

Reducing Expenses, Turnaround Time, and Management of Transcription Services Throughout the Hospital

Challenge

Brigham and Women's Hospital is a 719-bed nonprofit teaching affiliate of Harvard Medical School and a founding member of Partners Healthcare System, an integrated healthcare delivery network. As a world leader in patient care and research, Brigham and Women's Hospital was looking for a way to upgrade its existing transcription process. The system in place was expensive and slow, hampering clinicians' ability to maximize the use of transcribed reports to determine diagnoses and plan patient care.

"We were experiencing a growing demand for transcription services," stated Mr. Kevin Coughlin, Director, Revenue Operations at Brigham and Women's Hospital. "Further, we were contracting with multiple medical transcription service organizations (MTSOs) and as a result, had an increasingly complex technical and billing infrastructure to deal with. We hoped to streamline the process on a number of levels."

Solution

In January of 2001 Brigham and Women's Hospital selected the EditScript solution that uses speech processing technology to turn clinicians' dictations into draft documents that are then quickly edited by MTs. As a result of the increased productivity, eScription has helped save Brigham and Women's Hospital over $1 million per year in transcription costs. The new workflow takes approximately half the time of traditional, manual transcription.

The hospital's previous system was yielding turnaround times that were long and inconsistent, typically between four to seven days. Since the installation of the EditScript solution, turnaround time has been significantly reduced to well under 12 hours on average for all reports. Primary Care and multi-specialty reports are typically completed within eight hours, inpatient documents such as Operative Notes and Discharge Summaries within four hours, and stat dictations within two hours.

No clinician training was required. Clinicians who previously used a tape recorder are now primarily dictating into the telephone, and those who were using the telephone continue to do so. "The key advantage for us is that there is so little change to what we are doing," stated Robert C. Goldszer, MD, MBA and Associate Chief Medical Officer at Brigham and Women's Hospital. In fact, many clinicians are not aware that they are using a new technology. What they do see is improved turnaround time and decreased cost in their P&L statement.

Today, over 20 million lines of transcription are flowing through the EditScript solution, which is used regularly by more than 1,000 clinicians from across the hospital. More than 50 medical specialty groups and sub-groups from Cardiovascular to Neurology to Orthopedics are using the system. Across the hospital, work types ranging from Correspondence to Operative Notes to ED stat dictations are being edited in half the time it used to take MTs to type these documents from scratch.

A study published in December of 2003 alleviated any concern of a negative impact on document quality as a result of the new system. Despite gains in productivity of 64 to 137 percent when MTs functioned as editors, there was no significant change in document quality as defined by the number of errors clinicians needed to correct, before electronically signing their reports.

On the front lines of transcription services, the EditScript features for editing and document management are well appreciated. "There are many transcription management capabilities that make my job easier every day," stated Georgette Wilson, RHIA, Manager of Health Information Services at Brigham and Women's Hospital.

The implementation of EditScript allowed Brigham and Women's Hospital to reduce from fifteen to two, the number of outsourced transcription vendors it was using (and the associated interfaces into the hospital's core information systems). Since using EditScript, interface errors of transcribed reports into the hospital have decreased from 5% to less than 0.2%, more than a 20-fold improvement.

As a result of the new system, the Health Information Services department now administers the entire transcription function for the hospital, and document management for both inpatient and ambulatory clinics is now centralized. Previously, the responsibilities were separated, making the coordination of document flow difficult. In addition, instant access to reports, including the number of lines edited versus typed and accurate predictions of transcription expense, has enabled the billing process to be significantly streamlined.

Results

Brigham and Women's Hospital has successfully implemented the EditScript solution, allowing it to continue to meet its goals of reduced transcription expense and increased operating efficiency with little training or change for the clinician.

"Overall the EditScript Solution has enabled us not only to consolidate multiple transcription processes, but also to manage and improve our turnaround times,"
— Jackie Raymond, RHIA, Director, Health Information Services.

According to CIO, Sue Schade, "Investing in an advanced technology such as speech recognition with minimal to no disruption for physicians while demonstrating significant cost savings and improved turnaround time is a win-win proposition for any hospital provider."
— Sue Schade, Chief Information Officer.

Today at Brigham and Women's Hospital:

• MT productivity gains have reached triple digits. When MTs function as editors productivity increases 64 to 137 percent, depending on the individual.
• More than $1 million is saved annually with a cost reduction of over 30%.
• Turnaround time for a 'non-stat' dictation is well under 12 hours, reduced from 4-7 days.
• Over 1000 clinicians are dictating on the system, which is being used organization-wide.
• Outsourced transcription service organizations have been reduced from 15 to 2.
• Document quality has remained steady (as reported in a 2003 study) despite the increase in productivity.
• Document management for both inpatient and ambulatory clinics is now centralized in the HIS department, increasing operational efficiency.

eScription helped streamline the transcription process - delivering lower turnaround time and cost - for this major healthcare organization. Learn more about the complete EditScript solution that is delivering real results to Brigham and Women's Hospital in our Products section.

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