In recent years, West Columbia, S.C.-based Lexington Medical Center (LMC) has grown through the purchase and integration f local physician practices. As a result, the organization has been forced to knit together or replace disparate technology systems in order to maximize efficiency. Among its top priorities has been implementation of a unified approach to dictation that speeds transcription and reduces associated costs.
When diversity hampers efficiency
Located in one of South Carolina's fastest growing communities and providing care to all of Lexington County, LMC is comprised of a 346-bed healthcare complex with 27 affiliated physician practices and six community-based medical centers. Historically, the hospital had relied upon cordless memory-dial telephones to meet its dictation needs. This approach gave physicians significant mobility and the flexibility to transmit dictation from any area of the hospital equipped with a phone jack. The approach was not without its limitations, however. Physicians needed to dial into the transcription system, wait for a connection and key in a 14-digit code in order for patient files to be dictated.
As LMC added each new physician group, the challenge of efficient transcription was compounded. Physicians were using various dictation technologies and were forced to toggle between their own system when they saw patients in the office and LMC's telephone system when providing services in the hospital. Not surprisingly, the need to switch between technologies added unnecessary confusion and cost to the delivery of care, and hindered the development of a constructive relationship between LMC and its affiliated physicians.
In addition to solving this overarching problem, LMC wanted to ensure that dictation was transcribed in a timely, cost-effective manner, and that any technology adopted was easy for physicians and transcriptionists to use.
With these goals in mind, LMC began to evaluate dictation alternatives early in 2003. Practice representatives researched the various systems used by its community-based physicians, as well as reviewed product literature and met with vendor representatives.
Ultimately, LMC determined that digital dictation best fulfilled its requirements. These units replicate the convenience offered by the memory-dial phones, but they allow physicians to download their dictation from a wider variety of locations. Users can plug the recorder into their personal computer or a docking station, and automatically download the voice file via intranet or Internet.
During the selection process, LMC also considered a more traditional approach to dictation: analog recorders with micro-cassettes. While handheld analog recorders met LMC's mobility requirement, they would have forced physicians to rely upon cassette tapes that must be physically delivered to a transcriptionist.
LMC ultimately selected the Philips Pocket Memo 9450 VC, and purchased the recorders and accompanying docking stations for use on surgical floors, in patient care areas, at nursing stations and in physician lounges. Each of the handheld units included the Philips SpeechExec Pro Dictate software, and is supported by DVI speech recognition software and Cquence transcription software. Cost for each recorder was $449, while the docking stations were $79 apiece.
LMC physicians found the transition to the new technology to be relatively straightforward. Once physicians complete dictation, they dock the recorder. Files are immediately downloaded to the LMC server via the organization's network and routed to the appropriate transcriptionist. Advanced encryption restricts access to files, so dictation is secure no matter where it is recorded or transmitted. After download, transcriptionists can access all files by author, length of dictation, priority or other identifiers.
Time spent to complete dictation has been significantly reduced. Physicians are able to "train" their recorders to recognize voice commands like patient identifiers and work types. These verbal instructions are automatically transformed into file headers on the recorder itself before file downloading. When patient identifiers are used, the record is populated with pre-selected patient demographic information. This data appears on the recorder's screen as well, so the physician can review the information for accuracy. In the future, LMC has the option of incorporating barcode scanners with recorders for added efficiency.
Physicians can also leave a file "open" to add dictation later — after lab results or radiological reports come in, for example. This provides a benefit to physicians who previously used cassette tapes. Transcriptionists would then have to go back and forth to ensure the information was inserted at the proper spot in the finished file. Physicians now can access any point within a file, and insert comments wherever needed. Users select a specific document from the recorder's menu screen — as they would on a computer — and access it directly for review or revision.
When initially confronted with the concept of transmitting dictation electronically, LMC physicians were concerned their files might get lost in cyberspace. To ease their concern, LMC opted to archive downloaded files on the memory cards in the recorders for 30 days. If there is a problem with the facility's server or network during download, the files can be resent without loss of data.
LMC has documented increases in physician productivity as well. On average, each physician is able to see one additional patient a day, without extending hours. Physicians report that they save time because they are able to do all of their dictation whenever and wherever is most convenient. In the past, for example, a physician might perform a pre-operative exam, but then needed to go to his or her office and dial into the hospital system to complete the dictation so it would be available during the procedure.
Time and money are likewise saved on the transcription side of the equation. Dictation is uploaded directly to transcriptionists, who are automatically notified that a new job has arrived for transcription. This allows them to better manage their workflow because they can see all jobs and their current status (inbox, work in progress, completed, etc.). Plus, they no longer have to alternate between analog equipment and their workstation. All pending work is displayed on their computer, so transcriptionists move between tasks with fewer interruptions. When completed, the transcribed dictation can be printed out for the physician or stored directly into a patient's electronic health record.
LMC processes dictation on a "first in, first out" basis, but digital also provides the capability to assign a priority designation so specific jobs can be transcribed first. While LMC has not chosen to adopt this level of functionality, it is an option that may be considered to enhance efficiency at some point.
Streamlining transcription workflow has allowed staff to keep pace with the organization's growth, handling a larger volume of dictation while minimizing the need to add staff. Currently, LMC relies upon 40 full-time equivalency (FTE) transcriptionists to support more than 135 physicians and about 35 mid-level providers. Medical transcriptionists are able to work from remote locations, saving office space and associated costs. Transcribing 1.5 million lines a month, the staff has been able to accommodate a steadily increasing load without having to use expensive outsource services, which charge 14 cents per line.
Carolyn Gates is transcription manager with West Columbia, S.C.-based Lexington Medical Center.