Springfield Clinic Discovers A Solution For Clinical Transcription
Tom Anthony, Chief Information Officer
Ask any health care CIO what the primary focus of major transcription companies is and you'll receive the same, age-worn answer — hospitals. Yet, hospitals are merely one piece of the medical transcription puzzle. The other piece – clinical care facilities — are often overlooked, or are underserved by transcription providers that are unable to meet their unique needs.
The major difference between clinical and hospital transcription is in information centralization. Hospital transcription typically uses standard report and letter formats requiring only individual provider personalization. On the other hand, clinical transcription requires many more macros and canned text, accommodating a highly decentralized environment.
Central Illinois' Springfield Clinic manages 660,000 patient visits and produces over 16 million transcription lines annually. The Center relies heavily on transcription data capture. Clinicians regularly transcribe patient visit, Radiology and special procedure, and ambulatory surgery center operative reports. These reports are accessed frequently. While Radiologists read visit notes, primary care providers routinely review specialist-generated consultation notes prior to each patient visit.
With at least two failed system implementations behind us resulting from their overriding focus on hospital functionality, Springfield Clinic began researching a more adaptable transcription option geared toward our decentralized, clinical environment.
Springfield Clinic's project goals were two-fold. They required unique system functionality that would simplify, not complicate, its clinical environment, and they also demanded high provider standards and service.
- Digital dictation file that easily downloads from PCs.
- Single platform that delivers work to multiple, internal and external locations.
- Effort reduction and keystroke elimination.
- Patient registration/scheduling system integration that automatically populates patient demographics into each transcription.
- Online report access accessibility within our network.
- Printing flexibility supporting multiple locations and printer models.
- Willingness to understand unique needs of the clinic environment.
- A choice in digital dictation devices.
The Selection Process
After detailing their system and provider requirements, and minimizing vendor selection, Springfield Clinic interviewed other clinics experiencing similar issues to see what they'd experienced. What worked? What fell short? They also interviewed customer references. After all calls were made, EMDAT came highly recommended for its system flexibility, clinical adaptability, and cost efficiency.
Because of sub-par implementations in the past, Springfield Clinic began with a small-scale implementation of the EMDAT system, converting only one physician who already outsourced his transcription. During this and gradual implementations after, the clinic evaluated:
- Ease of handheld dictation upload.
- Accuracy, stability, and completion of transferred digital files.
- Ability to track redirected work.
- Ability to view final transcription report.
- Simplicity of printing.
- Satisfaction of the user with online functionality and workflow.
Distribution Ease: Prior to transition, the Springfield Clinic dictation tape distribution area looked more like Grand Central Station than a medical office. The clinic packaged and delivered tapes, along with a copy of the physician's schedule, to one centralized location. Tape distribution was a large, complex issue; while many at-home transcriptionists drove to pick up tapes, couriers routed others. Tapes were again redistributed when one area grew backlogged. When reports were complete, some transcriptionists printed on-site and returned reports to the physician's office. Yet, more than half were printed at the Center’s main campus and shuttled to the appropriate building or department. The system, as can be imagined, was confusing, unorganized, and unmanageable.
After EMDAT implementation, physical tape and report routing became obsolete. Springfield Clinic now delivers dictation and completed transcriptions electronically – instantly, all on the same platform. This has enabled the clinic to streamline communication and report tracking.
Information integration: A general solution was needed that improved productivity all around. The Springfield Clinic had three distinct transcription systems and multiple platforms. Before the switch, a clerk had to review all work file folders, applying a program to each file in that folder to determine line count. These counts were then transferred to a spreadsheet and maintained by each transcriptionist. This took time; and there was no uniform data repository.
The new platform, through EMDAT connects in-house and outsourced transcriptionists, the clinic’s service bureau, and its current patient registration and scheduling system, so patient demographics automatically populate. The software uses a word expander similar to that used previously. Some clerical, printing duties have shifted from transcriptionists to clerks. Line count is automatically generated online in real-time. There’s a uniform feeling across the function that productivity has improved.
Referral Deliver: Each clinician used to have his or her own method of physician referral. Typically, he or she dictated visit notes and included a brief cover letter for the referring physician; or the transcriptionist, using a macro, created this. The process involved typing patient identification data and occasionally block copy/pasting text from the visit note into the letter.
Now, referral documents are delivered automatically. Referral physicians that work inside the Springfield Clinic receive a copy electronically. Physicians working outside receive a paper copy via automatic, generic cover letter and envelope generation that pulls the referring clinician’s mailing address and patient information.
Online Availability: Transcription reports were not accessible online. Previously, providers were required to learn a complex, folder and directory navigation to access information. The time involved was never worth the value added. Now, on the new EMDAT system, all transcribed reports are available online through an easy, user-friendly, and secure interface. The setup loads automatically on start-up and requires little download interaction. Clinicians enjoy the new look-up functionality and can verify that all uploaded files reach their destination. This makes everyone feel more secure.
ROI: Because of Springfield Clinic’s system conversion, they've purchased about 180 digital hand-held dictation recorders, $62,000, a server to handle telephone-based dictation, $12,000, and replacement PCs for the transcriptionists, as their five-year-old hardware handles nothing beyond word-processing, $40,000. The clinic views all these as sunk costs because hardware upgrades were necessary regardless of which system they decided to choose. But, in terms of return on investment, Springfield Clinic expects to recoup the cost in only two years. They also expect a 20 – 25 percent total line count decrease due to consistent 65-character line measurements and cover letter templates, and a drop in per line cost to 10 cents, or a 17 percent reduction.
Although Springfield Clinic has taken great strides toward efficiency this past year with the system conversion alone, they will continue monitoring quality and efficiency going forward. With the tools integrated in the EMDAT transcription platform, continued improvements have become effortless. Workflow automation has already shifted responsibilities and saved staff and clinician time. The clinic has experienced immediate improvements in reporting and turn-around-time. Transcription processing has become a tightly managed function. Finally, the unique clinical transcription environment is being addressed.