(HealthTech Wire/ Interview) - Voice-recognition technology can be a key factor in improving the process of clinical documentation and streamlining patient care. Nuance Healthcare introduced its eScription service to the UK earlier this year, allowing it to offer NHS trusts a voice recognition system that has had outstanding success in the US for several years. Simon Howard of Nuance Healthcare described to HealthTech Wire the unique benefits of eScription for healthcare organisations, clinicians and the lynch pin of clinical documentation, the medical secretary.
Since the introduction of eScription to the UK earlier this year, what has been the interest from NHS trusts?
Interest in eScription has been very high indeed. There are probably a number of reasons that make it more attractive than other voice-recognition solutions. The first point is that it is delivered integrated into hospital IT systems. It is also introduced into the background as a server-based technology, which not only means it can be delivered quite simply on a trust-wide basis, but also means it can be delivered in a clinician friendly way, which is crucial. From a clinician's point of view it means there is no change in the system and no change in the way they work. So it is a very simple process for medical professionals to engage in.
How easy is it to integrate into a hospital's existing practices and systems?
The service is very easy to deliver. We go through an implementation process where we look at the trust's individual workflow, adapt the eScription service to suit that workflow and also introduce international best-practice techniques. It supports HL7 interfacing so will support any clinical application of relatively recent times. Even with legacy systems we are able to create an appropriate interface. It is a very simple service to set up as we have built it into the clinical systems.
Has there been specific customisation for the UK market?
The system has been fully adapted to the UK NHS environment, such as the date is always the classical differential between here and the US. Also it has about 100 specialist and subspecialist dictionaries that have all been Anglicised.
It has complete NHS N3 connectivity, so is fully secure. It is a fully browser-based service so medical secretaries and clinicians in the NHS have the ability to log in to the system from wherever they want to access it, provided they have all the security protocols in place.
Are there any user features that make eScription stand out against other similar systems?
One feature that has generated a lot of interest amongst NHS trusts is its ability to deliver intelligent voice-recognition technology, which has raised the bar in terms of the expectation of what voice recognition can deliver. By intelligent, we mean that eScription is able to take a clinician's piece of audio dictation and not just speech-recognise it, but it is also able to interpret that dictation in a way that will deliver a fully formatted draft text that actually reflects content that was meant to be in the report, even if it was not exactly what the clinician said in their original dictation. The way it does that is through a learning process from the amendments that the audio secretaries make to that original audio dictation.
eScription can also do some other clever things such as automatically introduce headings into the text, automatically introduce punctuation, numbered lists and even organise the eventual design of the document. So for all those reasons we see intelligent voice recognition as being a new chapter in the technology and a very important development which is certainly generating interest among medical professionals.
I have been told by a change manager in the NHS that medical secretaries can be the most difficult to persuade to accept new systems and processes, especially when they feel threatened by new technology and change. What are the important benefits of using eScription that should be conveyed to them?
I think the key point to make from the outset is that the eScription system relies on the medical secretary's significant contribution to the process and it actually utilises her significant knowledge of clinical language and letter creation together with her keyboard skills. In fact the underlying concept of eScription is simply that it is faster than you can type and the medical secretary is pivotal to delivering that principle. So inevitably the role of the medical secretary in the context of transcription will evolve from that of a typist to an editor. Alongside that change, a set of advanced skills that focus on productivity benefits are developed, whilst freeing up time for all the other tasks that medical secretaries perform.
Has this new role been recognised yet by the NHS or professional bodies?
This evolution role has been recognised by the British Society of Medical Secretaries and Administrators and we are very much in line with their thinking when they commented, and I quote: “Undoubtedly medical secretaries' duties will change in the light of technological development, but they must be retained as an interface between clinicians, consultants and general practitioners and that is something that we whole heartedly agree with.” Furthermore, as I said earlier, change management is a key process in project delivery and our teams give very thorough and extensive training to medical secretaries, which involves not only skill building but understanding their vital role in the process also.
If you look again at the US example, transcription is a huge business. It is worth about US$10 billion, and actually becoming a transcriptionist is becoming a highly skilled and well regarded occupation with any number of qualifications involved. The process of editing that eScription offers does contain many more advanced skill sets in the way the service is delivered in understanding more keyboard shortcuts, in operating a patented dual-cursor approach that we have, so it offers all kinds of career benefits.
As the service is operated on N3, the NHS network, could an NHS trust offer transcription as a service to other organisations on the network?
Very much so and I think that is something that we are going to see evolve in the market place because eScription is very much based on volume. The greater the volume the better the efficiencies and the bigger the savings. It makes perfect sense that trusts, particularly on a regional basis, should perhaps group together to have a medical transcription service which is delivering the service at a far more cost-effective rate to all of those trusts in the area.
Mr. Howard, thank you for this interview. (HTW)
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This is a HealthTech Wire interview in cooperation with the British Journal of Healthcare Computing. © so2say communications. All rights reserved.
