Homerton Hospital NHS Trust

The Radiology department at Homerton University Hospital NHS Trust has installed the WinScribe network digital dictation solution. The system has streamlined the X-ray reporting process, increased efficiency over the previous tape-based system, reduced costs and improved turnaround times considerably.

The Challenge - Mission-critical reporting
When it comes to sheer workload and tight deadlines, hospital radiology departments are under more pressure than most, as the Audit Commission has acknowledged in its review of waiting times experienced by patients requiring ultrasound and MRI (magnetic resonance imaging) scans. With Homerton's radiology department carrying out around 100,000 examinations a year, time is always a scarce commodity.

But solving the problem is not simply a question of investing in modern imaging technology or even recruiting more specialist staff. The key is to streamline the examination reporting process, as radiologists and secretaries at Homerton University Hospital NHS Trust can testify. This not only makes working far less stressful, it enables them to keep pace with an ever-increasing workload far more easily. A modern hospital based in East London, with Beacon Hospital status, the Homerton has 450 beds and employs around 1,600 staff to provide a wide range of emergency medical, surgical, maternity, paediatric and specialist services to over 275,000 patients each year.

The Radiology Department decided to replace its tape-based dictation-transcription system, which was no longer in keeping with current work practices. With the number of examinations to be reported, accuracy, speed of transcription and reporting structures were mission critical requirements for which tapes were simply no longer good enough.

Poor sound quality led to secretaries spending valuable time playing and replaying tapes or, worse still, referring back to radiologists for clarification to avoid transcription errors.

Delays in the reporting process were unavoidable with tapes and attached X-ray films being held for days until queries were dealt with, not to mention tapes being lost or broken with the need to re-dictate.

The Solution - WinScribe
With the intention to install more modern digital dictation technology, Felicity Canning, Head of Imaging Services, along with Consultant Radiologist Dr. Patel and Christine Israel, Secretarial and Admin Team Leader, decided to find a solution that would match their particular requirements. It had to be affordable; capable of supporting a minimum of 27 users, including 17 authors; and as easy-to-use as the existing tape system, with no extensive retraining.

Other key requirements were Microsoft network compatibility, with simultaneous, instant access to all dictation and transcription facilities from any user location; and workflow management facilities to ensure fast turnaround of all completed reports. With an eye on future requirements, the system of choice also needed to be capable of being integrated with the existing Patient Administration System, the HIS (Hospital Information System) and the planned national EPR (Electronic Patient Record) system.

An initial demonstration of the WinScribe system, from WinScribe UK, proved that a PC-based digital dictation-transcription solution would be not only more efficient, but surprisingly easy-to-use by both authors and secretaries. An added bonus was access to management information not available with traditional tape-based systems.

The Result - More balanced workload across the entire department
Head of Imaging, Felicity Canning, says: "The installation went very smoothly and the system has more than lived up to expectations. There is no doubt that WinScribe has improved the speed and accuracy of report typing and use of secretarial skills; and is certainly more effective and flexible than using tapes." An additional method of handling X-ray films. After the report is created and stored on the PC, under its unique patient ID code, films are returned to central filing and are not lying on secretarial desks waiting for transcription as previously.

Efficiency is further enhanced by WinScribe's PC-based Control Centre, a 'virtual supervisor' that replicates the traditional word processing administrator responsible for workflow management. Harnessing the power of SQL server technology, it stores details of all users, departments and job types, allowing individual jobs, rather than entire tapes, to be automatically routed to the relevant transcriptionist and back to the correct author. As well as allowing past examination reports to be reviewed, the system enables managers and authors to monitor work in progress, including transcription status. "As a management tool, it has greatly improved the overall efficiency of Imaging Services."

Felicity Canning says the real advantage is no longer having to manage everything, including the transportation of tapes and reports, manually.

A more flexible way of working
As Consultant Radiologist Dr Patel points out, using a SpeechMike is really no different from using a tape-machine dictation handset: "It offers all the same functions - record, play, rewind, fast forward - but with the addition of special features such as a mouse-type scroll button." An unexpected benefit was the minimal amount of retraining required.

Because all dictation is stored on the central WinScribe server, the system also supports more flexible ways of working. For example, a radiologist can begin dictating an examination report while viewing an X-ray film on the lightbox, leave the file open and complete the recording later. They can recall dictation instantly from anywhere and make corrections or insert further comments, without having to scroll through an entire tape and re-dictate as necessary.

Secretarial and Admin Team Leader, Christine Israel, confirms an enthusiastic response from typists as well as authors. "Of the three systems we tried, WinScribe was superior in every respect. It helps users maintain high standards of accuracy and enables them to manage workflows more efficiently, with an average 40 percent improvement in report turnaround times. It also allows easy job tracking and prioritising according to the degree of urgency or an author's work schedule. This is particularly important when dealing with locum's work, which has to be cleared before they leave the department.

"In short," sums up Christine, "WinScribe is an excellent system that is efficient, visually pleasing, easy-to-use and manage. On the occasions we have needed assistance, we could not fault the support we received from the WinScribe UK team who have always been helpful and able to resolve problems over the phone very quickly."

Future Integration
A major reason for choosing WinScribe was the ability to upgrade and integrate it with both existing and future applications, including the current HIS and the national EPR system when it is introduced. It will even be possible to add barcoding facilities which will eventually be an integral element of the EPR system that is destined to take data accuracy and streamline workflow management to a new level. Speech recognition and remote working are also being considered for the future.