Portsmouth Hospitals NHS Trust

Portsmouth Hospitals NHS Trust, one of the largest acute Hospital trusts in England, serves almost one million people. 550,000 in South-East Hampshire, and many more from surrounding counties including the Isle of Wight and Channel Islands. On an annual income of approximately £270 million and a staff complement of 7,000, it treats around 500,000 patients a year.

To improve the quality of care, the Trust's vision is the £120 million re-development of its largest hospital, Queen Alexandra (QAH), which will provide new hospital facilities alongside existing refurbished buildings. It is the third wave project under the government's Private Finance Initiative and will be the first of 100 hospitals proposed in the NHS Plan.

Interim improvement schemes granted approval include the re-configuration of Pathology and Mortuary services into a purpose built unit on the north side of the QAH site. The 45 staff in the Cellular Pathology (Histology) Department are looking forward to the day that constant departmental moves are at an end.

In advance of that day, thanks to the modernisation fund, improvements in departmental efficiency are already underway. One project includes the installation of a WinScribe digital dictation system to streamline the Pathology report writing process and save the constant hand delivery and collection of tapes between floors.

A Modern Approach to Report Writing
The need for change in this area was identified in March 2002. Steve Traer, Head Biomedical Scientist, explains: "We had outgrown our tape-based dictation system which was 20 years old and beginning to creak at the joints, plus we were spending too much time and money having to upgrade, repair or replace parts."
The final straw came when they realised how much time was being wasted, because reports had to be re-dictated as a result of tapes being lost, damaged or accidentally erased. The department decided that a modern approach to the report writing process using a PC network based digital dictation system, with remote access, was the only answer to coping with an increasingly heavy workload generated by the ten Consultant Histo/Cyto pathologists and their five transcriptionists. It involves dictating and transcribing reports on the macroscopic and microscopic results of around 23,000 surgical specimens, 5,000 non-gynaecological cytology specimens and 1,000 post mortems per annum.

The System Challenge
To make the business case, Glenda Hickton, Pathology IT Projects Co-ordinator, drew up an in-depth functional specification. The main IT requirement was the ability to operate in conjunction with the Pathology MUMPS-based iSoft Apex computer system and the QAH Radiology and PAS systems. It also had to be compatible with the Portsmouth Hospital's NHS Trust Windows NT LAN, without large voice files clogging up the network and preventing it from functioning efficiently.

Besides that the system needed to be capable of supporting at least seven typists and 15 authors. This would give the Department room to expand and, possibly, provide access to the four registrars, who currently hand write their reports or use tapes.
But, first and foremost, the new system had to be easy to use and flexible in terms of the type of accessories that were available. For example, it had to provide for reliable hands free dictation in the Tissue Dissection Room where macroscopic specimens are being reported on while gloves and protective clothing are worn. Hand held Philips SpeechMikes, connected to the PC, are required for reporting on microscopic specimens. Finally, remote dial-in access, via the telephone, was vital for pathologists who work at the two off-site mortuaries that are not computerised. It is also useful for those who, occasionally, need to dictate an urgent item from home.

Only One Supplier Had The Solution
Of the three suppliers that tendered, only WinScribe UK could fulfil the in-depth brief criteria. Steve Traer recalls: "We had heard of WinScribe UK, who support the WinScribe product, via our Radiology department and were impressed with their understanding of our requirement.

The preferred solution, WinScribe is an open standards PC-based digital dictation and workflow management solution designed and built on industry standard Microsoft Windows (95/98, NT, 2000 and XP) and SQL database server technologies. Other systems were rejected because, although they were PC based, they were slow and did not offer remote access.

Steve Traer continues: "As WinScribe uses server technology to store voice files, transcriptionists can log on to the network, pick up dictation and type the report into our Pathology Apex computer system. In fact, one of our main interests in WinScribe was that you could have both these applications open at the same time.
"In being flexible, customisable, scalable and compatible with most types of software and PC network, it matched our Pathology Department's requirement exactly".

For remote telephone access, the system is equipped with a Dialogic card with ports to take up to 12 telephone lines. For ease of use, embedded in the WinScribe software are the telephone prompts which answer the telephone call and talks authors through their dictation such as " to dictate a new job Press 1". Typing post mortem reports can now begin as soon as they are dictated rather than waiting for the pathologist to return to the office.

Most importantly, from the IT perspective, use of WinScribe does not impact on the network because it uses streaming audio to send the digital voice files to the WinScribe server. This not only ensures more efficient use of available bandwidth, it results in faster transmission times.

If required, WinScribe also has the ability to provide detailed management information on workloads, such as transcription volumes for HR purposes, but this facility is not utilised at present.

Cost wise, the WinScribe digital dictation system could not be better, because the CD software is supplied completely free of charge with authors given unrestricted use. The QAH only pays for concurrent transcription licences and accessories, including headsets and foot pedals for the transcriptionists. This means that, if only five of the 10 transcriptionists need to access the system simultaneously, the hospital only pays for one five-user licence. If extra transcriptionists need to be on-line, additional licences can be purchased as required.

The Results Benefit the Whole Department
The results in terms of benefits to the Department speak for themselves. Pat Whitehorn, Office Manager, Cellular Pathology, says "One of the main advantages is sound clarity, which means transcriptionists make fewer mistakes, so the pathologists spend less time making on screen corrections. This attribute is particularly important in the dissection room where the radio mike is used, with the tape running in the background, and where instruments are clattered about which often made it difficult to decipher words."

Other benefits of the new system, according to Pat Whitehorn, include better planning and balancing of the working day. Instead of scanning through a long tape, transcriptionists can view on screen what dictation is awaiting completion and how long it will take. "We can also differentiate work types and prioritise as necessary and, happily, as the equivalent of one tape's worth of work can now be shared between typists. No one person needs to work on four post mortems in one go!"

But best of all, Pat believes, is ease of use, with system training taking no more than 20 minutes and faster output speed. "We no longer have to wait for an entire tape to be filled before we start transcribing. We can begin as soon as an author has completed a report. Another bonus is no longer having to worry about inadvertently erasing dictation. We keep the work on the system for two weeks, which means I can go back and check anything at any time. Previously, if a tape was erased, that was it."

Pat continues, "A year on since WinScribe was installed, it has speeded up work turnaround and improved efficiency quite considerably and certainly eliminated the headaches of lost and damaged tapes".

Operational benefits cited by authors such as Dr. Margaret Jeffrey, Consultant Histopathologist are, "Ease of use and being able to view on screen what is going on, be it verifying I am in recording mode or seeing how many seconds of dictation I have completed, or if my work has been typed. It also enables us to send work through in smaller tranches, three to four times a week, rather than waiting until we have filled a tape before taking it down to catch the next print run. Work is also available to be authorised more quickly.

"Additionally, being digital, inserting extra information is simpler and finding a single piece of dictation on a tape, that has suddenly become urgent, is no longer the nightmare it was. I also like the design and shape of the Philips SpeechMike, which is both easy and comfortable to use while recording my daily microscopic results.
"The coding system is another welcome feature", continues Dr Jeffrey: "Every pathologist has their own code and there are different codes for surgical histology and post mortem jobs, so it is easy to see whose dictation is whose. When we shared tapes, it was impossible to tell".

In short, Steve Traer rounds up, "The WinScribe digital dictation has proved a resounding success. So much so that other departments are now expressing an interest in using it. Certainly in terms of the future and integration with the new Electronic Patient Records (EPR) systems, it would pose no problem. In fact, Portsmouth's senior management have already considered using the WinScribe digital voice files as an attachment to the EPR.