Using speech recognition technology to reduce administrative burden of updating patient records

Background

Worcestershire Health and Care NHS Trust is the main provider of community and mental health services across Worcestershire. With 26,000 recorded patient contacts per week, the Trust employs more than 3,500 clinical and non-clinical staff.

Administrative backlogs were causing staff to become overwhelmed by paperwork.

Situation

Due to the lack of administrative support, many staff within the community and mental health teams were spending long hours updating patient records, writing GP letters and other clinical documentation. This heavy administrative burden was leading to staff working longer hours, or producing abbreviated notes which could be difficult for others to understand.

Worcestershire Health and Care NHS Trust wanted to free up healthcare workers from the administrative overload, enabling them to focus on patient care.They wanted a user friendly tool to help:

• Support remote working
• Reduce the clinical documentation workload
• Eliminate the backlog of reporting
• Replace slow analogue dictation workflows

Aspiration

Introduce the use of speech recognition technology to reduce the burden of paperwork and backlog of administration.

Solution and impact

Worcestershire Health and Care NHS Trust deployed the cloud based Dragon Medical speech recognition system.

The speech recognition software allows for fast and easy record updates. It also works with the Trust’s OneAdvanced electronic patient record (EPR) and other office tools used to improve productivity when sending emails and GP letters.

Around 300 staff across a range of clinical teams – from Child and Adolescent Mental Health Services (CAMHS) to the community aided recovery service – use the tool which

• Cuts clinical documentation workload
• Supports remote working
• Eliminates backlogs associated with detailed patient records.

This has resulted in a reduction in paperwork and improved clinician and patient relationships.

The feedback has indicated:

• Enhanced workforce mobility
• Zero backlog
• Patient records updated within hours
• Staff have more time to care
• Improved patient experience

Using their voice to create notes means staff spend less time writing documents and can spend more time with patients creating a better experience for both staff and patients. It also increased staff productivity and reduced work loads for clinicians.

Karen Edwards, community occupational therapist Wyre Forest.

Functionality

• Advanced speech recognition including accent detection
• Autotext for commonly used content and information
• Customised templates
• Real time guidance to highlight missing clinical information and coding
• Customisable workflows, including
  • EPR navigation commands
  • Drafting of personal emails
  • Navigating between documents

Capabilities

• Transcribing effort can be omitted
• Clinician can dictate and confirm as the text is entered directly into the clinical note
• Improved document storage, and management within EPR.
• Clinicians dictate directly into a patient's clinical record and confirm entry at the same time.
• Reduces time spent with confirming clinical notes entered by admin staff.
• Faster turnaround of patient communication, resulting in letters reaching patients in a timely manner
• Less pressure on clinicians to remember consultations as time lag is shortened.

Scope of capacity

Speech recognition systems could be used in any setting requiring the management of patient records.

Key learning points

• The solution is not available for Community staff who use tablets to record consultations. Full integration with One Advanced Mobile Application would require One Advanced to interface with the Nuance Product.
• As there was a dependency on 3rd party IT support providers to install and configure the required technical platforms, an element of ‘lag’ was built into the timescales when planning to allow for any delays in this area.
• Our pilot was driven by the Service Lead with significant support from the Clinical Team. However, not all of the team were keen to change their current processes. Challenges identified included an initial increase in workload for clinical staff and concerns around subsequent effect on staffing levels within the admin team.
• Fear of technology was another barrier identified amongst some staff members. Key to success was having the service leads fully on board and promoting the solution as a complete replacement across the team of other dictation methods in place.
• We discovered that network speed would have an impact on the duration of the install across the network which helped us to plan our installations according to the location.
• It was important to determine how much space the Dragon network required to store master user profiles based on our number of users. We also needed to allow space for automatic backups that the NetView Management Console (NMC) Server creates, as they are stored on the same device where the master profiles reside.
• HSCN compliance was required for configuration by third party technical architects.
• Although a need for Document Management was identified, this was managed as a separate project as it would have required additional resources and would have resulted in a change of scope to the original Dragon software implementation.
• We were limited on the complexity of reporting we could produce from the raw data extracted from the NMC console.
• As day to day support for Dragon was not provided by our third party support provider, they agreed with the Trust on how reporting of incidents and faults could be incorporated into existing systems for users of the tool to ensure continuity.

Digital equalities

• A training programme was developed to ensure that the training was comprehensive enough to help combat some of the fear about the change and introduction of new technology.
• It was agreed to build in an additional training phase in the implementation plan to cover full trainer sessions, enabling the Trust’s in-house training team to cover all training requirements for digital dictation.

Needs Analysis

• Through completion of a ‘Needs Analysis’ Survey, requirements were identified by users who were experiencing difficulties for a number of reasons to complete their clinical notes.
• Users with sight issues or dyslexia were able to use the ‘speak back’ facility to check and correct their text input.
• The software also helped users who had difficulty using a keyboard for lengthy periods due to arthritis, carpal tunnel syndrome, and other similar conditions.
• As Dragon Medical has proven to be an assistive tool with huge benefit to these users, it has now been built into the new starter process for all new Trust members. New starters are asked to identify any difficulties or conditions which would affect their use of a computer/keyboard, a positive answer will result in a new request for Dragon software via an Occupational Health referral.

Key figures/ quotes

Karen Edwards, Occupational Therapist spoke about her experience using the system:

Find out more

Dictation Software - Dragon

Key contact

Lesley Bennett, IT Project Manager, Herefordshire and Worcestershire Health & Care NHS Trust
lesley.bennett11@nhs.net

Elizabeth Vanderhorst, Director, International Account Management, Customer Success Organisation
Elizabeth.Vanderhorst@nuance.com

Give us feedback

Workforce Digital Playbook feedback survey

Page last updated: October 2022