Reaching
the Apex of ED Performance
St. Anthony Hospital group uses its MEDITECH system along
with speech recognition software to improve clinician
workflow and medical record quality in the ED.
(9/2/2010)
How do you streamline physician workflow in
the Emergency Department (ED) when you're one of the busiest
trauma networks in the country?
This was the question facing the St. Anthony Hospital group,
part of Centura Health (Englewood, CO), located in North
Denver and serving the region's popular ski resorts.
Averaging 100,000 emergency room visits per year, the
facilities—which include St. Anthony Central Hospital (Denver,
CO), St. Anthony North Hospital (Westminster, CO), and St.
Anthony Summit Medical Center (Frisco, CO)—managed to
improve outcomes immediately after complementing their
MEDITECH Emergency Department Management (EDM) Physician
Documentation module with Dragon Medical Speech Recognition
software.
Now, their ED physicians save approximately one and a half
minutes per dictation, a tremendous time-savings for these
caregivers who treat hordes of outdoor enthusiasts.
Joining
Forces to Enhance Care
The St. Anthony hospitals have been using MEDITECH's Client/Server
EDM Version 5.5, including the Physician Documentation
component, since 2007. When they first implemented EDM, the
hospitals' original speech recognition product did not auto-populate
the MEDITECH system, which caused a lot of errors in the
patient record. In some cases, the information was not making
it into the patient record at all, which meant other
providers didn't have access to the ED physician's notes.
"The quality of our records deteriorated," says Rob
Schmidt, MD, a physician at St. Anthony. "In addition,
documentation turned out to be very time-consuming, and we
often didn't have time to fully document when patients
presented. We knew we had to find a more efficient and
accurate solution for documenting patient information."
St. Anthony joined forces with the consulting firm Navin,
Haffty & Associates to implement Nuance Communications'
Dragon Medical Enterprise product, MEDITECH's preferred
solution for speech recognition software. The software
seamlessly interfaces to the MEDITECH system, allowing
physicians to dictate directly into Physician Documentation.
Together, MEDITECH and Dragon Medical improve caregiver
access to information and enhance continuing care by auto-populating
patient data such as nursing notes, allergies, and home
medications into the Enterprise Medical Record (EMR).
Schmidt, who has implemented many speech recognition software
programs since 1992, was appointed Physician Documentation
Champion for the implementation. Along with the Physician
Advisory Council (PAC), Schmidt selected four pilot
physicians to test the new dictation software for four weeks,
and then met with the PAC to discuss their findings. The
committee decided it needed the thumbs up from all four
physicians; only then would they move ahead with rolling it
out to their "apex emergency physicians," the St.
Anthony group's nickname for their ED physicians due to the
hospitals' unique geographic location.
Pilot Group
Garners Positive Results
As the pilot group started documenting with Dragon Medical,
Navin Haffty worked with Schmidt to compare the efficiencies
of the new solution to their old speech recognition software.
They collected data in the following four categories:
- Average time
to dictate (per patient)
- Average time to depart (patient)
- Average number of edits observed/patient (while dictating)
- Average number of missed editing opportunities (in final
report).
Physician
Documentation with Dragon Medical scored better than their
previous solution in three of the four categories:
- Average time to dictate (per patient)
- Number of edits observed while dictating
- Average number of missed editing opportunities
"When analyzing the data, we discovered that the
MEDITECH Dragon Medical solution saved the pilot group an
average of 1.67 minutes per dictation," says Rob Hoehne,
project manager at Navin Haffty.
The only category in which their previous solution had better
results was "average time to depart per patient."
At first the team was confused, but upon further
investigation, they realized the new solution took a little
longer because they had added core measures to the depart
process.
Bolstered by these findings, Schmidt and his team were ready
to install Dragon Medical for the 40 ED physicians and 16
physician assistants. "It took us four weeks to roll out
the solution to all providers," says Schmidt. "During
the roll out, every ED physician was accompanied by a trainer
throughout the provider's first shift using the software. For
their subsequent shifts, we provided dedicated on-call
support, a help desk, and additional training, if needed."
Schmidt notes St. Anthony ED physicians took an average of
two hours to learn Dragon Medical. Most of them had used
speech recognition products before, which helped speed up
training.
Moving
Forward with Improved Integration
Today, 100% of the "apex physicians" dictate into
Physician Documentation with Dragon Medical. Now that their
documentation auto-populates the EMR, integration of nursing
and lab data has improved, and doctors' notes are available
for caregivers to access in real-time. Plus, complementary
documentation—when two providers are caring for one
patient—has improved.
For the St. Anthony EDs, perhaps the most important benefit
has been the quality improvements to their patient records.
Schmidt notes a significant reduction in speech recognition
errors, and even has a funny story to share: "After we
implemented Physician Documentation, a coworker came up to me
and said, 'your charts aren't funny anymore!' With our
previous solution, we had some very bad speech recognition
errors."
MEDITECH
Medical
Information Technology, Inc.
MEDITECH Circle
Westwood, MA 02090
781-821-3000
www.meditech.com