Creating A Transcription Paradigm Shift: From Paper to Plug
Kathy Mahaffey
Chief Operations Officer, Southern Illinois University Physicians
One of the most significant clinical processes, aside from the tactical task of health care itself, is medical dictation and transcription. The simple goal of communicating a patient's medical history and results from one day to the next and from one clinician to the next, can make the difference between progress and failure within the given patient's care.
Despite its obvious importance, dictation and transcription processing hasn't advanced much as would be expected with the onset of technology, email, and the Internet. Dictation is often conducted on micro-cassettes that are delivered to the medical transcription firm, whether in- or outsourced. This time consuming and labor-intensive procedure contradicts the urgent nature of health care itself, as time delays in delivery and processing can hinder ongoing care decisions and surgical preparedness.
Southern Illinois University Medical Center (SIU) is a state-assisted academic medical center located in Springfield Illinois. The center's medical research has provided continued growth in biomedical related economic development and clinical care for the past 32 years. The facility houses 500 physicians and offers both primary care and specialized services, many of which are unavailable at neighboring health care centers.
The Needs: Efficiency And Cost Reduction
Facing large-scale, costly government health care reforms including HIPAA, Southern Illinois University Medical Center needed a solution requiring minimal staff time and up-front costs. The center was not prepared to invest in an electronic medical record (EMR) due to cost and the state of current technology. Nevertheless, the inefficiencies caused by manual transcription processing needed addressing.
The Manual Process: SIU processed medical transcription in-house for the first 26 years of service. As the center grew, so expanded their administrative department. SIU began outsourcing transcription in 1997. Initially, outsourcing was a move in the right direction. Yet, it was soon apparent that more research was needed to further manage costs and quality.
Even through outsourcing, transcription records were still limited to paper and required filing of both the original plus a copy. Increased delays occurred not only in the delivery and processing of reports outside SIU offices, but also between final clinician sign-off and filing. Lacking up-to-the-minute patient information created many unnecessary obstacles to the informed delivery of health care to patients.
This process absorbed a great deal of staff and clinician time. All dictators were required to use the phone. Clinicians made report edits on paper. The report was then returned for correction and cycled back until approved for final filing. Reports were passed from hand to hand, and from clinician to referral physician to file, opening the door to erroneous, delayed, and misplaced information. Further, clinicians didn't have easy access to patient data.
The Challenge: Burdened with a highly out-dated, circulative, paper intensive process, Southern Illinois University Medical Center began researching transcription alternatives, with cost being the main objective. They needed hard dollar savings. Prices were increasing and quality was not. During a strategic planning retreat, SIU faculty challenged practice plan administrators to find a system giving faculty, residents and staff online access to clinical notes and correspondence within one year.
The Goals:
- Lower per-line cost through a competitive bid process.
- Automate workflow from dictation to chart placement through online report review and signing.
- Implement software that allows SIU to use print template technology, and thus reduce printing and per-line costs.
- Offer Attending Physicians a range of options - mobile hand-held or telephone-based dictation.Automate referral document routing and eliminate interdepartmental courier and faxing.
Provider Research: A Side-By-Side Comparison
When selecting a new transcription provider, several vendors demonstrated their products and competed on ease of use and pricing. Three finalists received the same five sample documents and provided line counts and per line fees. Given this comparison, SIU fairly evaluated the range of fees charged by each company.
Selection Criteria
- Cost: Emdat bid the lowest price per-line and the lowest line count. Further, an additional 15 percent line count reduction was estimated through the use of print template technology.
- Workflow: All finalists demonstrated an automated workflow process. But Emdat was Internet-based, allowing the Center to use their existing network infrastructure. The software offered a straightforward review and electronic signature process, and provided for printing of watermarked originals in designated record rooms once signed. Referral correspondence was transmitted electronically.
- Vendor Responsiveness: Emdat demonstrated a willingness to customize their software and standard workflow to meet SIU's needs. Site visits to SIU supported Emdat's claim.
- Facility Fit: EMDAT owners understood SIU's teaching environment. The software's platform allowed the Center to tailor the system’s functionality to accommodate the resident/teaching physician workflow. Result: Emdat was selected on August 5, 2002.
Implementation: Reaching Our Goals
Implementation involved the training of 175 faculty providers and 250 residents on the system in groups of 15. Seventy-five staff members trained on the use of this system and 150 clinical staff trained on conducting document searches. Department network administrators volunteered to be trainers and now orient new faculty to the Emdat system. Two operations staff managed relationships with the transcription companies and field user issues. An outstanding Clinical Computing staff supports them. Clinicians use traditional, user-friendly dictation devices. Thus, they were already familiar with functionality. Implementation was quick, smooth, and flawless.
Results: Total Automation Efficiency
Electronic Access. Clinicians and staff obtained instant, electronic access to their notes and correspondence. Dictation is uploaded instantly from an SIU desktop to the transcriptionists. After dictation is transcribed, the Center has real-time, networked access to each patient file. Meaning, clinicians immediately review, edit, sign, and route reports. Searches are conducted by clinician, patient name, patient number, or transcription number using EMDAT's InQuiry® — a task that previously required hours of labor. Faculty, residents and staff view clinic notes from any PC in all SIU clinics or hospitals.
Faster Turnaround. The new, electronic interface is faster and more secure than the previous internal mail distribution method. Dictation verbiage is sent electronically. Once a clinician signs off, the transcription is instantly printed at SIU's medical records department and immediately filed.
Reduced Line Count. In addition to per line fees, actual line count is reduced on every transcription report. The Center takes full advantage of Emdat's print template technology for repeated headers, footers, and variables based on user, location and department. Hard dollar savings are significant when 5-10 lines are shaved from thousands of transcription reports monthly. A total hard dollar cost reduction of 55% was realized the first year.
Accountable Operations. Emdat provides detailed management reports showing turn-around-time, unsigned transcription, and to-the-minute line counts. The system enables accurate monitoring of status including dictation timeliness and final signature processing. Residents and Attendings receive two weeks to review and sign transcription reports. Because internal referral correspondence is sent electronically, communication between SIU specialists and SIU primary care physicians have become immeasurably faster.
The transition to a scalable, electronic transcription solution went beyond achieving the initial goal of cost reduction. Southern Illinois University Medical Center has electronically converted and streamlined the process from initial dictation to final records filing. Achieving operational excellence is an ongoing process. Nevertheless, Emdat provides the analysis tools necessary to effectively manage quality in SIU's clinical environment.