Transcription system knows you by your voice

Challenges: Work-flow issues, physician reluctance

An integrated system that combines speech recognition technology with transcription and dictation capabilities for radiology departments promises dramatic cost savings and faster report turnaround. How dramatic the results are, though, depends on how physicians at a health care facility use the system.

"The average results [of the PowerScribe Radiology system] are tremendously driven by the style of implementation of the customer," explains Peter Durlach, executive vice president of fonix corporation’s HealthCare Solutions division in Boston. HealthCare Solutions first offered the PowerScribe Radiology system to providers at the beginning of 1998.

To achieve PowerScribe’s maximum efficiency, a physician dictates a report using the speech recognition technology. The text is immediately available for the physician to edit. Once the edits are made, the physician approves and signs the report, and the report is sent through an interface to the facility’s radiology system or health information system.

The entire process can take only minutes for each report. (For more technical information about PowerScribe, see related story, p. 11.)

Health information managers at Emory Healthcare in Atlanta, for example, saw the turnaround time for the transcribing of reports decrease from an average of 30 hours to under 10 for attending physicians using the software. Emory was a beta site for PowerScribe Radiology and started the final implementation of the software in July 1998.

"We have seen some dramatic decreases in our turnaround time," says Greg Cassimus, administrator for radiology at Emory.

Using initial figures, Emory estimated that it might realize immediate savings of 65% of its annual transcription costs. When Cassimus examined the cost factor between the hospital and its clinic, he decided the system would pay for itself in little more than a year.

Emory has had ongoing challenges in implementing the system, though, including physician-resident work-flow issues and some physicians who are reluctant to use the system.

Physician-resident work-flow issues are common in teaching institutions such as Emory, Durlach says. Depending on how the teaching site is set up, a resident’s dictated report goes into the attending physician’s queue, unless he or she is available to review and sign the report immediately. If the attending physician decides not to correct the report for a day or more, then it stays in the preliminary queue until he or she accesses it.

Deciding when to sign reports is a user training issue, Durlach says. "Historically, doctors are used to dictating and then approving them eight, 24, or 36 hours later."

When resident dictation times are figured into the equation, the turnaround times at Emory almost double, Cassimus says. "But it’s still a lot better than where we were before." As one way of resolving the issue, Emory is considering allowing physicians to sign reports from home, since many residents dictate reports at night.

To ease work-flow problems, physicians have to get into the rhythm of signing all of their reports every day or every few hours, Durlach says. Prompt approval of the reports is important since billing and distribution of reports to referring doctors don’t occur until after they are signed.

How much users are able to decrease turn-around times depends on how aggressive the site wants to be in implementing the technology, and how forceful the leadership of the group is in getting people to sign the reports, he says.

To edit or not to edit

Another challenge facing Emory Healthcare has been encouraging physicians to use the new system. Physician utilization is now up to 60%, Cassimus says. "We still have some physicians who don’t want to use it. They say that we have turned them into transcriptionists, and it increases their time."

With the old system, the radiologist would dictate a report and a transcriptionist would make the edits. The report would then come back to the radiologist, and the radiologist would review and sign it. The quality of the transcriptionist’s work would determine the amount of work the radiologist had to put into the report.

Under the PowerScribe radiology system, physicians are encouraged to make their own edits. The more they edit and approve their own work, the faster the turnaround time. Plus, transcription costs decrease. Some physicians, however, see the new process as time-consuming.

"They are having to do more work, but it’s up-front work as opposed to back-end work," Cassimus says. "It’s a different way of doing business. I think it reallocates their time," he continues. "They have not fully realized it, since we have not implemented the full benefits of the system yet."

Once the work-flow issues are resolved, Emory plans to switch totally from its old transcription system and use the PowerScribe Radiology system only.

HealthCare Solutions realized that physicians would vary in how they wanted to use the system, so PowerScribe Radiology is designed to handle all of their differences, Durlach says. "The real issue is who is going to do the editing of the report."

The radiologists who want to do things in the old style and who don’t want to correct their own work can do it the same way in PowerScribe. For example, the radiologists can dictate the reports, and then the reports go to transcriptionists or medical editors.

The transcriptionists review the physicians’ reports, which already have been speech recognized. They make the edits. The records go back into the radiologists’ queues, and the radiologists sign them. "The amount of work that radiologists do is identical to what they did before with the old dictation/transcription paradigm."

Radiologists also can decide at any time whether they want to do their own editing. If they are busy, for example, they can send some reports to medical editors. "We made it so you can fully integrate transcription and third-party editing into the process so that the doctors can adopt a new technology and the new work flow at their own speed," says Durlach.