A practice manager explains how switching to digital dictation cut the time it took GPs to submit a letter after a consultation by half.
Dictation and transcription is a time-consuming process so it's important that it works well. When some of our old analogue (tape-based) transcription machines became unreliable we decided to investigate digital options.
To help us decide which type of system would be best for us we considered all the problems with our old system that a digital system might solve:
· Dictaphones and tapes would go missing or take time to find.
· GPs would wait until they had several letters to do and then do them in a batch.
· An urgent referral meant interrupting the day.
· Finding a specific dictation (e.g. if a GP wanted to upgrade the urgency) could take a long time.
· Tapes could get out of date order.
· Work was hard to plan, as a pile of tapes may have a lot of work or a little.
· Sometimes a letter at the end of a tape would be missed, or a tape would go missing.
· Dictations were often unclear or crackly.
· Equipment and tapes were expensive to repair or replace.
To avoid recreating all these problems with digital machines, we chose attached dictaphones so they were always available, there was no need to upload files and GPs were not encouraged to batch their letters. We quickly realised that we needed specialist software to manage the flow of dictations and typing pool automatically over the network, for ease of use and time saving and to eliminate the possibility of dictations being misfiled.
What we did
We looked at three systems Digiscribe-XL from Crescendo and WinScribe from Dictation Solutions and Lexacom that had these key features. We chose the Lexacom system because it is particularly simple to use and requires minimum network infrastructure – only a shared folder. We already had a server (which is backed up daily), but out selected system can also use a normal PC as the central store for dictation files.
Installation was done by Lexacom staff and took a few minutes on each PC. We chose to use Philips SpeechMikes as our dictaphones, because they have all the usual buttons so there is a minimal training needed; it took only about five minutes with each GP.
Secretaries have more features in their software, but the training was still straightforward. They use a digital transcription kit that is just like a traditional one except that it plugs into the computer, so the process is very familiar to them. The software cost about £200 per PC and this included installation and training. The SpeechMikes were about £180 each (cheaper options were available) and each secretary's transcription kit (foot pedals and headphones) was about £100. We also opted for support at about £40 per PC.
What were the results
We saw the benefits of the system immediately. Without exception our GPs and secretaries liked it. Dictation equipment is always available so the GPs don't have to batch their letters. When the GPs dictate a letter they tag it with the patient number and priority. As soon as each dictation is completed, it is available for transcription, giving GPs confidence their letters will be done promptly. Dictations are displayed to all the secretaries in order of priority and date and they can see how long each one is, so they have complete control over the work. They can also retrieve a deleted dictation in the event of any query.
We have only had one glitch with the system, which was down to user error. Sometimes the GPs record more than one dictation in a file; they aren't supposed to do this but old habits die hard! A new secretary didn't notice that a dictation contained three letters and she missed the second two. The error came to light when one of the patients chased up their appointment. We were able to retrieve the deleted file and use the audit trail to see what had gone wrong. Now our secretaries know not to assume each file only contains one dictation and to ensure they play each file right to the end.
We wanted to know if the system had reduced the time taken to produce letters and carried out an audit. We found that the much improved convenience of the system meant that GPs were submitting their dictations in half the time following the patient consultation. The average time taken fell from 2.1 to 1.1 days, with a reduction in the maximum from 13 to six days. We also found that the enhanced efficiency of the system meant that our secretaries could be more productive: the average turnaround time fell from 2.3 to 1.7 days. Overall, the time from appointment to letter fell by 36%.
All the hassle has gone out of dictation and transcription and the system has proved to be one of the best investments we have made.
Scott Brunt is managing director of the Robert Darbishire Practice in Rusholme, Manchester
