St Alexius Primecare

Streamlining the documentation workflow

Increasing outsourcing costs and difficulties in distributing medical documents promptly over long distances prompted St. Alexius-PrimeCare to introduce digital dictation and transcription as far back as 1995. In 2003, it switched from the Crescendo DOS-based system to an integrated DigiScribe-XL and MedRite-XL Windows®-based solution, which supports HL7 interfaces to its Electronic Medical Record - one of the key requirements for fast and accurate creation and distribution of medical documents. A 44% increase in transcription productivity and dramatic reductions in report turnaround time are the result of detailed strategic and operational planning. "We believe strongly in planning and it paid off with better implementation and fewer problems," says Tamara Darling, Director of Health Information Management at St. Alexius, "because any system is only as good as the people who set it up."

Tamara and her colleague Pam Nathan, the transcription supervisor at St. Alexius, are self-proclaimed "planning freaks". They spent one year evaluating different vendors before deciding to go with DigiScribe-XL and MedRite-XL from Crescendo. Another year was invested in developing a detailed strategy for introducing the system and embedding it into the existing IT infrastructure. They paid particular attention to getting future users on board and eliminating any anxieties caused by change and new technology. "People fear change," explains Tamara, "so you need to involve physicians from the very beginning, communicate openly about the product and not simply push the technology upon them." The same applies to the transcription side, but the transcriptionists also adopted the system quickly, and within two weeks they were working at full speed.

Today, the hospital employs 19 transcriptionists, a transcription supervisor and a part-time clerk. Of the 19 transcriptionists, 18 chose to work from home. They have been equipped with a PC, which is used for transcription purposes only and can be administered remotely. Connected to the central server through a VPN and protected by a firewall, transcriptionists can access the shared dictation work list from home and stream their voice files to their PCs. Transcribing documents is straightforward, as the most crucial aspects of data input have been automated: Physicians enter the patient's MR number, and the system automatically adds the corresponding data to the file. They also identify themselves with their PIN before starting the dictation on the phone and define the document type with a three-digit code, all of which increases dictation and transcription efficiency. In conjunction with macros that allow transcriptionists to insert standard text blocks at the click of a button, the in-depth strategic planning carried out at the beginning has resulted in a highly automated workflow, which reduces the number of mouse clicks and keyboard strokes for transcriptionists.

Another critical security feature is DigiBack, an extra safety net developed specifically for St. Alexius-PrimeCare. In addition to the nightly back-up automatically performed by the DigiScribe-XL dictation system, DigiBack makes copies of the voice files and places them in a secured location on the hospital's network for 90 hours to ensure that no data is lost. "The slightest loss of a dictation means losing credibility with our customers. It is the worst thing that can happen to us, especially considering our dictation volume of 1,483 hours per month," stresses Tamara. In three years, this feature has had to be relied upon only once, but even then it has been worth the negligible extra cost of its implementation, according to Tamara.

A resounding commercial success

Prior to implementing Crescendo's DOS-based digital dictation and transcription system in 1995, St. Alexius had to outsource overflow to external service providers, paying significantly for the privilege. Since 1995, outsourcing has been eliminated, largely due to the productivity increase resulting from the new Crescendo platform. Today, transcriptionists are working 44% more efficiently than in 1995.

The hospital pays its transcriptionists 10 cents per line and the increase in productivity has seen their salaries increase as well. "Today, they can transcribe over 40% more lines, which is fully reflected in their salary," says Pam. "The result: outstanding employee retention. Over the span of six years we had just two hospital transcriptionists leave, which is unheard of." 
 

Finding and training medical transcriptionists is expensive and time-consuming. The ability to work from home not only saves on office space, which has been reduced by at least half, but also allows transcriptionists to continue working even if they move out of town or to another state. "I have been able to recruit employees from a hundred miles away and thereby tap into an expanded labor pool," says Pam.

Thanks to the increase in productivity, St. Alexius is now able to provide transcription services to other healthcare facilities in the state. It has an affiliated clinic and is in a position to help out with its overflow. Many smaller practices and clinics without an in-house transcription department are making use of the St. Alexius transcription service. Tamara is proud of the fact that St. Alexius has managed not only to eliminate outsourcing but also to earn additional income with its transcription department.

Powerful workflow tools

St. Alexius' digital solution doesn't just help the transcriptionists transcribe dictations more quickly, it also boasts other features that optimize the entire document creation process. One of them is DigiRouter, a powerful routing tool which routes work based on various criteria. St. Alexius routes a lot of work by work type, allocating jobs to the most suitable transcriptionist. Routing can also be carried out according to turnaround time, allowing jobs whose deadlines are fast approaching to be brought forward. However, this feature is not used that much, since St. Alexius is on top of its work load. According to Tamara, St. Alexius never has any problems meeting its targets.

Another "beauty of the system", as Pam puts it, is the document distribution feature of MedRite-XL. The minute a transcriptionist hits the finish button, originals are printed, copies are printed or faxed and an electronic copy is uploaded through the HL7 interface to the electronic repository. The nursing unit and/or the referring provider thus have instant access to critical medical information. Many patients come from smaller towns up to 100 miles away. Thanks to the distribution system, GPs often receive the discharge report before the patient has even arrived home.

Distribution is done by fax, print and e-mail using MedRouter. The server can handle all three functions. "It took a lot of work up front to build and design the server, but it was well worth the effort. We won back the time in the first week or two," says Tamara. And Pam points out that she now can't imagine working without the distribution system, which has enabled her to cut down to one part-time clerk.

Tamara cites another hospital in the region, which needs 4 hours a day of clerical time to manage its daily outsourcing volume of 600 to 700 minutes. Thanks to the distribution and routing systems, the St. Alexius‘ clerk can manage the hospital's dictation volume of 2,966 minutes per day in just 4 hours.

There are a few other extremely beneficial features that have contributed to the success of the MedRite-XL digital transcription solution. One is the document design function, which allows templates to be designed easily according to the hospital's guidelines. Another useful function is the ability to extract statistics on turnaround time and dictation volume for the hospital's CFO.

However, one of the greatest features is the "job number" function: when physicians complete a dictation, they press a designated number on the telephone keypad and receive a job number, which is their receipt. "We had a cardiologist who constantly complained about us losing her dictations. Once we introduced job numbers, she couldn't believe that we never lost a dictation again," recalls Pam. She also says that it has been a good PR exercise with the physicians, as it was one of the benefits that helped them considerably speed up the adoption of the digital dictation system, given that both parties are held accountable for accurately processing dictations.

Don't take "no" for an answer

Tamara and Pam are convinced that there is no such thing as a one-size-fits-all digital dictation/transcription application that can be used in every hospital. There are always areas that need to be customized to the specific needs of each client. Therefore, they developed a requirements catalog during the planning phase which they forwarded to Crescendo Systems. "And they never refused anything," Tamara says. Tamara and Pam are delighted with Crescendo's service team, who even helped them out with problems that had nothing to do with their product.