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Digital Dictation and Voice
Recognition – a “Top 10” Project in
support of Quality,
Innovation, Productivity and
Prevention (QIPP)
Part of the NHS North West
Strategic Informatics Framework
17th June 2010,
Alan Spours, Chief Information Officer
Keith Richardson, DD / VR Lead
North West QIPP Challenge
• Circa £3.5b of efficiency savings over next few years
• Challenge has two components:
– Cash Pressure from increased cost of pay &
goods
– Ongoing growth in demand/needs of population
• E.g. out patient referrals annual growth of 3%+
• Response will need to look at improving
„productivity‟…doing more with the same amount of
money
• Opportunities to deliver within limited funding, and
drive up the quality of patient care
North West QIPP Workstreams
• Transforming Community Services
• Demand & Threshold Management
• Procurement
• Prescribing
• Leadership & Workforce
• Provider Productivity
• Informatics
• Estates
• Primary Care Contracting
Informatics Workstreams Contributing to
QIPP
• Diagnostic Imaging
• Summary Care Record
• Choose & Book
• Electronic Prescriptions
• Map of Medicine
• Care Records
– PAS
– Order Comms & Results
– Letters
– Scheduling
– Prescribing
• Mobile Working
• Voice to Text
– Digital Dictation
– Voice Recognition
• Collaboration (Video)
• Interactive Web 2
• Telehealth
• Data to Intelligence
• Technology Management
Integrated Clinical Communications
Management System
• Whole system strategic view
• Clinical “letters” Workflow,
• Digital Dictation & Voice Recognition
• Electronic Letters Management
• Mobile working
• “Letter” flows across the Trust - GP
boundary
• Like “BACS”
Digital Dictation – A definition
• Recording and editing spoken word for transcription in digital
audio format.
• Several advantages over cassette tapes :
– Instant rewind , fast forward to any point within the dictation
file to review or edit.
– allows inserting audio at any point without overwriting the
following text.
– Dictation produces a file which can be transferred
electronically, e.g. via WAN, LAN, USB, e-mail, telephony,
BlackBerry, FTP, etc.
– Large dictation files can be shared with multiple typists.
– Quality sound good - improves transcription accuracy and
speed.
• Efficiency & visibility - reports on volume or type of dictation
transcription outstanding or completed. • Reference - http://en.wikipedia.org/wiki/Digital_dictation
Voice Recognition – A definition
• “Voice Recognition“ converts spoken words to text.
• Aka “Speech Recognition”
• Can implement front-end, or back-end process.
• Milestones:
– 1952 - device for the recognition of single spoken digits
– 1964 - BM Shoebox -New York World's Fair
– 1982 Kurzweil Applied Intelligence and Dragon Systems
release speech recognition products
– 1993 - recognition accuracy 10%
– 1995 - recognition accuracy over 40%
– 1997 - Dragon Systems released "Naturally Speaking“
– 2001 - recognition accuracy over 80%
– 2009 - recognition accuracy high 90%‟s - good
RADIOLOGY
1315 GP Practices, 63 Trusts
15 million + Events per year in NWExcludes PAMs, nursing, midwifery contacts
How big an opportunity is DD / VR?
Excludes PAMs,
nursing, midwifery
contacts
Dictated Clinical letters – 7.5 million pa
NW Trusts - Secretaries
• Circa 4,650 medical secretaries
• Salaries = £93m pa
• £93m / 7.5m letters = £12.40 per letter
plus paper, stamps etc
• Value of DD / VR potential savings in
time and / or money:-
– 5% = £4.5m pa
– 10% = £9m pa
– 25% = £23m pa
Consequences at the GP Practices end
• “staff in my Practice spend 5 hours a day
processing and scanning paper clinical
letters received from hospitals into my
GP System” … Manchester GP• 1300 NW Practices, 7.5m letters pa
• 5 hours x 1300 = 6,500 hours per day across NW
• 6,500 x 240 working days per year = 1,560,000 hours per year
• 1,560,000 hours / 8 hours = 195,000 man days per year
• 195,000 man days / 240 = Time spent processing paperwork
• = Equivalent to 812 staff• 812 staff x £20,000 salary per person
• = Equivalent to £16.25 million pahttp://www.reecesrainbow.com/images/pileofpaper.jpg
Consequences at Hospital Level
• Example
– “We have three staff who do nothing but stuff
envelopes with clinical letters - cost = £60,000 per
year”
– “We send about 75% of our letters out to our local
GPs practices on the “Pathology Tests pick up
van”, but the rest we have to put in the post.”
– 7.5m x 25% = 1,875,000 x 39p per stamp = £0.7
million pa, plus cost of paper and envelopes = circa
£1m pa – IM&T Director of medium sized Trust
Medical Records - Pull Case
NotesTraditional End-to-End Process
STEP 1. Author Dictates
Analogue Voice
Recorder
STEP 2. Deliver Tape for
Transcription to Secretary
Tapes
STEP 4. Print & Return to
Author for checking
Return Handwritten
Corrections
STEP 5 Author Signs
and returns to Secretary
for amending or posting.
STEP 6 Secretary puts
in envelop & posts to
Patient’s GP Practice
STEP 8. Clerk may scans letters
into GP system / &/or file paper
letters in Patient Files Paper based
STEP 7.a GP - Review and
action with staff / patient
Circa
7.5 million letters per year
flowing from
NW Trusts to
1300 GP
practices =
5750 per
practice = 110
per week
STEP 3. Transcription –
may need to refer to
paper case notes
New End-to-End Process – Option 1STEP 1 Author Dictates
using one of several
methods
Office or Home
Phone
Digital
Dictation Voice
Recorder
Laptop / PC
Mobile Phone
STEP 2. Capture,
Store & Allocate for
Transcription
STEP 3. Transcription
3a. Secretary, or Transcriptionist Group
3b. Speech to text conversion
via background translation
using Voice Recognition Software
In Office
At Home
Remote
Sound
file
Sent
over
network
STEP 4. Return to Author for electronic
sign off
Or via Email, text
Review Via Online Access
Check, amend, approve
STEP 5. Output
“Electronic
Letters”
Import into EPR / PAS
Hospital PAS /
Electronic
Patient Record
System
Computer System
N3
Hub
STEP 7. Review ONLINE and
action
Automatically imported
into GP System
Electronic
Referrals
Interface to
PAS for
demographic
s & reference
data
New End-to-End Process – Option 2STEP 1 Author Dictates
using one of several
methods
Office or Home
Phone
Digital
Dictation Voice
Recorder
Laptop / PC
Mobile Phone
STEP 2. Capture,
Store & Allocate for
Transcription
STEP 3. Auto Transcription
3b. Speech to text conversion
via background translation
using Voice Recognition Software
Sound
file
Sent
over
network
STEP 4. Electronic sign off
Or via Email, text
Review Via Online Access
Check, amend, approve
STEP 5. Output
“Electronic
Letters”
Import into EPR / PAS
Hospital PAS /
Electronic
Patient Record
System
Computer System
N3
STEP 7. Review ONLINE and
action
Automatically imported
into GP System
Electronic
Referrals
Interface to
PAS for
demographic
s & reference
data
Same person who dictated it, edits the text
that was generated automatically in the
background by Voice Recognition System
New End-to-End Process – Option 3
STEP 1 Author Dictates
using Voice Recognition
Laptop / PC
STEP 2. Capture,
Store Transcribed
Authorised Text
/letterSound
file
Sent
over
network
STEP 3. Output
“Electronic
Letters”
Import into EPR / PAS
Hospital PAS /
Electronic
Patient Record
System
Computer System
N3
STEP 4. Review ONLINE and
action
Automatically imported
into GP System
Electronic Referrals
(may be via Choose
& Book)
Interface to
PAS for
demographic
s & reference
data
Immediate
Electronic sign
off
1. Dictate using VR,
2. Correct if needed
3. Sign off
done (with the GP)
N3 Hosted
Hub – routing
“electronic
letters” to right
place
Hospital Trust A
Automatically
imported into GP
System
Integrated Clinical Communications Hub
Hospital Trust E
Hospital Trust B
Hospital Trust C
Hospital Trust D
Hospital Trust F
Hospital Trust G
Hospital Trust H
GP Practice A
GP Practice A
GP Practice A
GP Practice A
GP Practice A
GP Practice A
GP Practice A
GP Practice A
Referrals, Outpatient Letters, Discharge Letters, etc
Example of an Integrated Clinical
Communications Hub
