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Aurora Health Care's Metro Region is one of five regions affiliated with Aurora Health Care, a large, non-profit, integrated health care provider based in Eastern Wisconsin. Aurora Health Care is focused on the premise of "finding a better way." Having to find a better way is just what we were faced with when we were approached by our finance department to decrease transcription costs in an effort to enhance value throughout the organization.
The Push for Change
In 2005, Aurora Health Care initiated an organization-wide effort to improve operational efficiencies and control costs-all while continuing to provide top quality care. This initiative forced us to look for ways to help.
Indeed, our previous transcription system, which we used with an in-house staff of MTs and a medical transcription service organization (MTSO), was costly and had many shortcomings. We experienced slow turnaround times, complaints from MTs about the sound quality and lower than desirable MT and support staff productivity. Several of our regular administrative tasks were time-consuming and cumbersome. It was difficult to assign work to our MTs and balance the service levels, as we were supporting four very busy hospitals and their associated clinics. We had to update three different databases every time a new clinician came on board. The system's poor reliability forced us to deal with frequent crashes and lost reports.
The Move to Speech Recognition
With our cost reduction goal in mind, the two of us set out to explore the potential of speech recognition technology. Our hope was that if we could increase our own MTs' productivity we could decrease our cost per line enough to eliminate the threat by our finance department to outsource this service.
Based on our previous challenges, we established additional criteria for the selection of our new system. It needed to be seamless for clinicians. We insisted on excellent customer support. We required a single system that could interface with all of our existing systems and would be scalable to an eventual system-wide implementation at Aurora Health Care.
In 2006, we selected Computer Aided Medical Transcription (CAMT) software from eScription, following an evaluation of four vendors' product offerings. eScription software imposes little to no change on clinicians. It uses background speech recognition to produce draft documents from clinicians' dictations, which are then edited by MTs. As part of the evaluation, our team attended a site visit to view the company's proprietary software in action. We were struck by the MTs' enthusiasm-they were boasting about their productivity gains and the ease of editing. The transcription manager was amazed at how accurate the eScription software was in recognizing dictations.
The Goals We've Achieved
Despite initial skepticism, today our 47 in-house MTs appreciate the quickness of editing vs. typing. Editing has more than doubled the amount of work they can complete. Productivity gains have jumped upwards of 110 percent.
Our MTs are editing draft transcriptions for about 80 percent of the entire dictation volume. As part of the CAMT process, these documents are automatically formatted according to our set standards, thereby creating increased consistency for our medical records, and speeding the editing process for the MTs.
Our department realized improved turnaround times (TATs) within a very short timeframe. Clinicians were marveling that some reports were coming back in less than 1 hour of dictation vs. a TAT of several hours or days with our previous system.
In addition, detailed management reports give us the opportunity to monitor TAT and MT productivity all on one database. All reports are readily available online, which has helped us improve our overall management of the department. Assigning work to MTs or adding clinicians to the database (which is now one vs. three) are efficient, routine tasks.
From an administrator perspective, we have the ability to access the voice files for a long period of time after dictation. We have found this to be helpful both for giving clinicians input on improving their dictation, to dispel any accusation by a dictator about what was actually said in a given dictation and for helping MTs improve.
Addressing our primary goal of cost reduction, we have successfully eliminated our reliance on outsourcing. Our staffing costs have decreased by 30 percent as well. On a per line basis, transcription costs have been reduced by 42 percent. As a direct result of choosing eScription, within only 12 months of implementation we had a notable savings of just more than $1 million.
As a result of our success, our colleagues at Aurora Health Care's Kettle Moraine Region recently deployed CAMT, and Aurora Health Care's North, South and Central Regions, currently in the implementation phase, will begin using CAMT in 2008.
The benefits we've experienced exceeded our projected outcomes. Moreover, we are now able to focus on managing and continually improving our departments, rather than "putting out fires." This is certainly a better way to deliver value to Aurora Health Care.
Cathy Ptak is the regional director of clinical information services and Cindy Janick-Pederson is the regional manager of Metro Medical Transcription of Aurora Health Care's Metro Region.
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