Documented Savings Abound

Just a few years ago, Lifetime Health Medical Group, an operator of healthcare clinics and community-based doctors’ offices serving more than 100,000 people in the northwestern New York cities of Buffalo and Rochester, was spending $1.3 million per year for in-house transcriptionists to generate reports and file doctors’ notes and patient records. It cut that amount to $750,000 when it outsourced most of those services to local contractors, but even that bill was too high.

"In the medical community, everything is driven by the financials," says Douglas Golding, M.D., codirector of medicine for Lifetime Health’s Buffalo region and associate chief of healthcare informatics. "We had a challenge in trying to streamline our costs, and a lot of it had to do with our outside contractors."

So in February 2006, Lifetime Health began a limited rollout of Dragon NaturallySpeaking Medical, a healthcare-specific, speech recognition-based transcription and dictation software solution offered as part of Nuance Communications’ Dictaphone Healthcare Solutions product family. Four months later it completed a full rollout of the solution across the seven health centers it operates in the Buffalo area, as well as the supporting pharmacy, laboratory, radiology, internal medicine, pediatrics, family practice, and specialty care facilities. Lifetime Health’s Buffalo region also includes a number of facilities for obstetrics/gynecology, dental care, colonoscopies, urgent care, physical therapy, and complementary medicine, and a number of contracted community doctors’ offices.

Currently, 69 Lifetime Health employees in the Buffalo area use Dragon NaturallySpeaking. With it, they generate about 70,000 lines of text (representing about 80 percent to 85 percent of all documents) per week. Only about 15 percent of documents, amounting to about 15,000 lines of text per week, are handled by outside contractors, at a cost of about $70,000 a year. The typical transcription service in the area charges roughly 12 cents to 15 cents per line of text.

Using Dragon NaturallySpeaking, Lifetime Health cut $415,000 from its transcription budget in the first year, and expects to save between $680,000 and $690,000 a year moving forward.

In addition to the obvious financial benefits, Lifetime Health began seeing other positive results almost immediately. "With Dragon NaturallySpeaking Medical, care providers can reduce time on documentation by as much as 50 percent, deliver accurate documentation through [electronic medical records], and produce a more comprehensive medical record," says Peter Durlach, senior vice president of healthcare marketing and product strategy at Nuance, which is based in Burlington, Mass.

Dragon NaturallySpeaking also includes product lines geared specifically for corporate, government, and legal markets. It brings automation to many business functions within those verticals, from simple email creation and filling in forms to generating very detailed documents.

Today more than 50,000 physicians in North America alone use Dragon NaturallySpeaking Medical. In addition to Lifetime Health’s 69 users in the Buffalo area, in Rochester—where the organization operates a network of four primary health centers and other facilities for dermatology, eye care, urgent care, and other services—about 30 percent of the staff use Dragon NaturallySpeaking.

A HEALTHY RETURN
The medical version of Dragon NaturallySpeaking uses speech recognition and natural language processing technology that lets doctors create and file clinical notes and patient records in their own words through free-form dictation and quickly create, navigate, edit, and search through reports using spoken commands. It is packaged with 14 medical vocabularies covering 60 subspecialties, and comes with a number of templates and macros specific to the medical field already built in. Healthcare professionals can create and use additional templates, dictionaries, macros, formatting, and text shortcuts on their own with simple voice commands.

The software can be integrated with any Windows-based electronic medical records solution or Microsoft Office application without having to add complicated middleware or interfaces. It also can be used on any PC and includes tools for network deployments, such as support for Citrix thin-clients. Users can input data through their computers’ integrated microphones, external USB headsets, or wireless Bluetooth-enabled microphones.

At Lifetime Health, doctors and other caregivers use the software on Lenovo tablet PCs. Documents are created using Microsoft Word and stored on network servers. Roaming user profiles allow healthcare practitioners to pull up their voice files, templates, finished reports, and related files at any location within the network via mapped drive, Universal Naming Convention (a file identification system) path, or Internet connection. It automatically synchronizes and updates any adaptations created locally with files stored on network servers.

Documents produced with Dragon NaturallySpeaking are more accurate because the software displays files on the computer screen as they are transcribed. "By being able to see their notes on the screen, [doctors] can catch any mistakes easily and go in and correct them," says Golding, who also practices family medicine at Lifetime Health’s health center in Hamburg, N.Y.

Lifetime Health also has noticed a significant reduction in report turnaround time, which is enabling better care to patients and streamlining reimbursements. "We had a 24-hour guarantee with our outsourcing service, but the problem is that sometimes we needed the information more quickly, and that could cause delays in our patient care," Golding says.

Patient care is also improving because other doctors can go into the system and access reports filed by their colleagues. That makes it easier for the other doctors to review a patient’s condition and the type of care prescribed by the doctor, and make other suggestions or recommendations, he adds.

Doctors also spend far less time on documentation, as most people speak 120 words per minute, but type less than 40 words a minute. Dragon NaturallySpeaking lets them create letters, reports, and emails about three times faster than typing by hand—that’s time that they can better spend with their patients and in other care-related activities.

Training them on the system was no big deal either. "The biggest issue with technology in a specialized area like this is the training and hand-holding needed to get people familiar with the product," Golding says. "The usability with this has gotten so easy, it’s as close to an out-of-the-box product as you can get."

When Golding began deploying Dragon NaturallySpeaking at Lifetime Health, version 8.1 was in circulation. "With version 8.1, the accuracy was good enough for our needs," he says. The software is now in version 9, and Lifetime Health is bringing the upgrades online. Accuracy with Dragon NaturallySpeaking Medical 9 is said to be up to 30 percent better than with previous versions, and Nuance claims 99 percent accuracy with it.

Prior to deploying Dragon NaturallySpeaking, Golding looked at a number of other automated transcription solutions, but at the time most of them were Web-based applications; he was hesitant to use them, fearing that confidential patient information could be compromised if they were transferred to the database over the Internet.

Golding first came across much earlier versions of the Dragon product in the private practice where he worked prior to joining Lifetime Health in 2003. At that time, the product wasn’t very good, he says, noting slow processing speeds and a significant number of recognition errors. Those problems have been addressed in subsequent software upgrades.

"So far, we’re all quite happy with it," Golding says. And with the financial results he has seen alone, he has every reason to be.