New service transforms charting in Saskatchewan

Emergency physicians in Saskatoon, as well as medical practitioners across the province, are getting used to speaking into microphones, and it’s changing the way they work and care for patients.

As part of a province-wide rollout of a new, standardized dictation and transcription service, all three of Saskatoon’s emergency departments are using real-time speech recognition software from M*Modal Canada. Instead of typing notes into the Allscripts Sunrise Clinical Manager electronic patient record – a time-consuming process doctors often left to the end of their shifts – they now dictate directly into patient records, reviewing, editing and signing their notes within minutes.

Each computer in the department is equipped with a microphone and doctors usually document directly in the EHR after seeing a patient.

“It’s just one example of how the move to a provincial service model for front-end speech recognition and transcription is changing the way people work,” said Julie Johnson, director, Provincial Dictation and Transcription Services at 3sHealth, the shared services organization supporting the newly integrated Saskatchewan Health Authority.

“It’s a revolutionary change within acute care that we probably wouldn’t have been able to predict five years ago,” said Johnson. “It’s transforming the way doctors are working and reducing frustration with a significant benefit to patients.”

The move to a single provincial service coincides with Saskatchewan’s journey towards a unified health system. Starting in December 2017, the province’s 12 separate regional health authorities began operating as one integrated organization. When the business case for a unified, speech-driven clinical documentation strategy was made two years prior, each regional authority had its own technology and process.

“It was all over the map, some were using cassettes, others had made a technology investment,” explained Kendell Arndt, 3sHealth vice-president, Strategic Information & Corporate Services, noting that in some cases patient reports were backlogged for weeks.

The new provincial service is supported by M*Modal Fluency for Transcription. Some parts of the health authority are continuing to use transcriptionists and back-end speech recognition; others, like Saskatoon’s three emergency departments, have transitioned to front-end speech recognition using M*Modal Fluency Direct and are dictating into desktop computers or smartphones.

Either way, each clinician has a single, cloud-hosted voice profile which enables them to easily move between devices, locations and workflows (mobile documentation, front-end speech recognition and/or transcription) as preferred.

Whether using front-end speech recognition or back-end transcription workflow, clinicians at the health system are supported by top-ranking, market-validated solutions: 2017 #1 Best in KLAS, Speech Recognition: Front-End EMR, M*Modal Fluency Direct, and 2017 #1 KLAS Category Leader, Speech Recognition: Back-End, M*Modal Fluency for Transcription.

Since completing its 18-month M*Modal implementation in November, 2017, the province has set a target of 24-hour turnaround for all reports. For those clinicians using front-end speech recognition to document directly into Sunrise Clinical Manager, reports are available immediately.

“The biggest change management piece we’ve tried to focus on is readiness,” explained Johnson. “It’s about fully understanding the current and desired workflow of the practitioner so that the technology supports what they need to do to ensure patient information is flowing.”

3sHealth recently hired two full-time System Change and Adoption specialists whose focus is to help clinicians transition to the M*Modal solutions, including front-end speech recognition. The first step is understanding the current workflow so that the technology can enhance the individual and preferred workflows of clinicians and drive better quality clinical documentation. For those who want to self-report, the support is there to help them.

Family medicine physician Dr. Mark Brown decided to move to front-end speech recognition so that he could chart between patient visits. Not only does the new way of working allow him to include more meaningful information in his charting, such as negative findings and conversations with patients, he also has more time for his clinic now that he spends less time typing.

Additional time is saved using an M*Modal Fluency Direct feature that automatically inserts blocks of standard text using key words.

“I used to stay late or take charting home with me,” said Dr. Brown. “Now I take coffee breaks and lunch. I am home in time to have supper with my family and to be ‘Dad taxi’ for my kids.”

Dr. Terry Zlipko, an ER physician in Saskatoon, echoes Dr. Brown’s enthusiasm. “I love this new system. I know for sure that I’m now doing my charting in half the time it used to take me. That gives me more time to spend at the bedside. Instead of spending 23 minutes typing a report, I can now do that same dictation, edit it and send it on its way in about three or four minutes tops. It’s been incredible.”

Clinicians who prefer real-time documentation are further supported by M*Modal Fluency Direct’s Computer-Assisted Physician Documentation (CAPD) functionality.

This real-time, fully-automated and AI-powered technology delivers high-value clinical insights to physicians as they dictate or type the clinical note in the EHR. This closed-loop documentation solution proactively suggests improvements in quality, coding and compliance, and reports on physician engagement with the system.

The system delivers physician feedback on ICD-10 codes, gender and laterality mismatch, gaps in documentation quality, variance in patient care, etc.

“Our mission is creating time to care and improving the patient-physician encounter. To that end, our real-time artificial intelligence (AI) and natural language understanding (NLU) technology continually analyzes the note, contextually understands the physician narrative, and provides in-workflow insights to physicians at the point-of-care.

“Our solutions are designed to significantly improve the speed, ease, efficiency and quality of clinical documentation so that doctors can focus on patient care,” explained Carey Silverstein, Vice-President, Operations, M*Modal Canada.

As of now, the only groups not using the provincial speech recognition and transcription service are physicians operating fee-based private clinics and medical imaging.

All others, including laboratory, pathology and the provincial cancer agency, are on the M*Modal platform.