A Preference for Speech

When Baptist Healthcare System, one of the largest nonprofit healthcare systems in Kentucky, started searching for ways to increase medical transcription productivity and decrease corresponding costs, the organization found its cure in speech technology.

According to Brenda Beckham, director of health information management at Baptist Hospital East and Baptist Hospital Northeast, the five acute-care hospitals within the Baptist System did most of their transcription in-house, but were forced to outsource some of the overflow. “We were really starting to realize the pressure from the outsourcing company to come in and want to take over because they could do it cheaper,” Beckham says. “So we were trying to find ways we could compete in the outsource market and keep our transcriptionists in-house, or at least on our payroll.”

Beckham says Baptist—which already used Nuance Communications’ Dictaphone products and was on the Dictaphone platform—took its time doing due diligence. The hospitals wanted to select the right solution and evaluated several products and vendors before making a decision. But in the end, the decision turned out to be an easy one.

“When Nuance and eScription merged, that was our perfect opportunity,” Beckham says. “And we knew that that was what we wanted to do.”

What Baptist did was deploy Nuance’s Dictaphone Enterprise Speech System, an on-premises dictation/transcription system powered by background speech recognition, at all five of its facilities. The deployment took a tiered approach, with the hospitals going live during January, February, and March of last year.

Beckham says the results have been just what the doctor ordered: increased productivity, cost savings, and an easy implementation. Across the Baptist Healthcare System, productivity has increased by up to 38 percent. In addition, Baptist was able to decrease outsourcing by more than two full-time employees, decrease the number of full-time employees by 1.1, and increase the number of lines transcribed by more than 1 million compared with the previous year. 

According to John Vaughan, a product line manager at Nuance, the Dictaphone Enterprise Speech System can boost productivity because it adapts to each provider and delivers reports to transcriptionists so they can simply edit documents instead of typing them.

“It’s really a change in process for the transcriptionist,” he says. “And the bottom line is editing is faster than typing. That’s really at the heart of why people buy this technology.”

Additionally, Beckham says the deployment was very well-received and that transcriptionists were both excited about and receptive to the implementation—once their concerns about staff elimination were alleviated. 

“We told them that our very first goal would be to eliminate or decrease our outsourcing, which we have been able to do,” Beckham says. [After that they] were pretty much on board with it.” 

Physician Acceptance

Beckham says the physicians were also receptive to the Dictaphone Enterprise Speech System because deploying it did not require a change in their work flow. In fact, their transition was “seamless,” she says, adding that many of them didn’t even notice the change.

“Any time you don’t have to disrupt the physicians, that’s always a good thing,” she says. “They didn’t have to change their dictating practices.”

Naturally the process wasn’t without its share of hurdles, Beckham says. When the system first went live—at about 1 a.m., according to Beckham—it was up, running, and functioning fine. However, the next morning some issues “that don’t happen at night” cropped up, and the staff had to scramble to adjust some of the solution’s settings.

Lesson learned: Beckham recommends having the vendor give the solution “one final look” right before it is about to go live. “Have the vendor go back one more time—people who know the system and understand what it is supposed to look like—to check the settings,” she advises. “And make sure that everything looks right. One last look by the vendor would be very helpful.”

Changes in transcription work flow, the learning curve inherent in changing from one transcription solution to another, and the switch to multiple servers were other challenges with which Beckham says she and her staff had to deal along the way.

 “Once we got through that, learned how to do it, and got familiar with the processes, [it has] gotten a lot easier,” Beckham says, though it didn’t take long to learn the system. Nuance provided shortcut keys and training manuals, and most transcriptionists required only a day or less of training. “They came in and learned the keystrokes, and then went home and practiced,” she says, noting that although transcriptionists were offered additional training opportunities, no one needed them. “They hit the ground running.”

Vaughan describes the technology behind Dictaphone Enterprise Speech System as “very mature,” adding that most transcriptions don’t struggle with it. “It’s a quick learning curve, and a lot of the transcriptionists—most of the ones I talk to—actually prefer it to typing,” he says. “The technology is well beyond early adoption. It’s into prime time.” 

Also vital to the success of the deployment was the support Baptist received from Nuance. Beckham says the company sent a team of four or five people to work with Baptist before and during the deployment. “Our corporate team worked very well with Nuance, which helped as well,” she says. “They stayed around the clock.”

Physical Benefits

According to Beckham, the reaction at all five Baptist hospitals has been very positive. Transcriptionists have called her to say how much they love the system, and because they have less typing and keystrokes, there is less physical strain on their shoulders, wrists, and necks.

In fact, the hardest part of the transition for transcriptionists was going from a system where they manually typed every word to one where they listen to audio recordings of the physicians’ reports, read the transcripts, and make changes as needed.

Vaughan agrees, noting the transition from one system to the other is all-inclusive and not a selective process. “You’re basically transforming a known process that has been around for years and changing it,” he says. “It’s different, but at the end of the day, it’s still the same product as a medical report, and it’s created faster.”

Adds Beckham: “It almost takes a more-qualified transcriptionist to be able to edit, to know when the system is wrong and when you need to change a word.” In fact, some physicians dictate so well that transcriptionists only have to make a few edits in a single report.

“That doesn’t happen very often, but there are a few physicians who are just that good, and the system picks up 90 percent to 95 percent of what they say correctly,” she says.

Beckham—who notes that some hospital transcriptionists are so productive that they have spare time to take on outside clerical duties—cites training and staff communications as keys to Baptist’s success. “Communication is really big with your staff—keeping the transcriptionists informed, making sure that they feel confident that you’re not doing this to replace them, and just keeping them in the loop is really important,” she says.