Out of the Outsourcing Business

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About a year ago, Prevea Health had a problem: The Wisconsin-based healthcare provider, with more than 200 practitioners at 16 health centers, could handle only about 60 percent of its medical transcription work. The organization had no choice but to outsource the remaining 40 percent.

And while Prevea Health had been looking at other transcription options, the situation reached a point where, even when the old system was functioning optimally, it just wasn’t good enough.

“With the volumes, it was difficult for us to manage the workload and the staffing,” says Mike Fischer, director of information services at Prevea Health. “So we ended up having to contract some of that out, and you start to lose some of the flexibility and the control.”

In the face of this growing problem, Fischer and Monica Van, Prevea’s health information manager, began to look at other dictation/transcription options. That search led them straight to speech recognition technology and the eScription Computer Aided Medical Transcription (CAMT) platform from Nuance Communications.

“I started looking at eScription as an option to really streamline our processes and found through the research that it was the best thing for us,” Van says.  

In fact, Van and Fischer were so impressed with the solution that in June Prevea Health simultaneously deployed eScription at all 16 health centers. Since going live, Prevea has done away with all outsourced transcription services and posted some impressive numbers: a 133.9 percent productivity increase in its transcription process, the ability to process 96 percent of its dictation through the speech system, a voice recognition match rate of 90 percent within a matter of  weeks, and an estimated three-year cost savings of $1 million.

“It’s going absolutely wonderfully,” Van says. “We’ve been able to get rid of all our outsourcing companies, which has been huge. We’ve taken our turnaround time, which was about five days prior to go-live, and we’re consistently under 24-hour turnaround time for all 16 clinics. It’s been phenomenal.”

And while the deployment is obviously a huge success for Prevea Health, implementing eScription wasn’t without its challenges. Chief among them was incorporating the new solution into Prevea’s existing electronic medical record system from Epic Systems.

The issue with blending the solutions was twofold. It centered around creating an integrated system that would allow for partial dictations—basically, records in which doctors switch back and forth between templated text and dictated speech—and enable providers to dictate smart links—links to patient data like current medications, past medical histories, and vital statistics—and incorporate data from those dictated links into their records.  

Once dictated into Epic, the voice file would need to go through the voice recognition program and be converted to text.  A transcriptionist working in eScription would review the voice recognition-generated text against the voice file to ensure the information was properly entered. Then, and only then, the document would need to be sent from the transcriptionist back to Epic, where the final text document would appear in the practitioner’s in-basket for authentication.

If this sounds complicated, it was. But with a little help from Nuance and Epic, Prevea blended the two systems—something that had never been done before, according to Doug Caira, who oversees the eScription client and professional services teams at Nuance.   

“We came together and worked to tightly integrate the two products in really some unique and exciting ways,” he says. “Neither eScription nor Epic had done anything of that level of integration before.”

According to Fischer, another reason for the deployment’s success—and for Prevea’s initial selection of eScription—was the solution’s back-end voice recognition system, which, unlike a front-end system, didn’t disrupt physician workflow during implementation.

“They could practice medicine the way that they had,” he says. “They didn’t have to stop and say, ‘How do I have to change this?’ They could just do their normal routines so they were the most efficient.…With the back-end voice recognition, it’s really seamless for the physicians. From the physicians’ standpoints, they didn’t recognize any difference.” 

Fischer adds that the selection of a back-end system was another reason Prevea Health implemented eScription at all 16 locations.  

“Your [medical transcriptionists] are doing the editing, doing the training,” he says. “From the physicians’ points of view, they’re about patient care.”

Prevea Health also had to address staff and provider apprehension to change during its eScription deployment. Van says these initial concerns were alleviated by staff training and the impressive results that eScription delivered.

Overworked to Overwhelmed

“Everybody—from transcriptionist staff to the providers—has just really embraced it,” Van says. “The transcription staff is just overwhelmed. They love it.”

However—training and impressive results aside—much of the credit for Prevea’s success goes to Van and Fischer for the way they tackled the deployment from the very beginning.

“Any time we implement systems, we try to concentrate on the overall workflow,” Fischer says, noting that it’s unwise to simply install hardware and software and then send staff to training classes. “It’s important to look at the total picture, the end-to-end workflow.”

And by looking at overall workflow, everyone at Prevea Health was able to communicate effectively between their different departments and work toward a common goal.

“We need to work together,” Fischer says. “I think we have a good business partnership that way. Make sure that everybody knows what change is coming down the road, what to expect, and then typically the comment that we hear is,  ‘Oh, that wasn’t as bad as I thought it was going to be.’ When I hear that, that’s a successful implementation.”

Caira also praises Prevea’s role in the deployment, noting that the healthcare provider supplied great staff and dedicated resources to finish the implementation on time and for the entire organization.

“They very much aligned the organization behind implementing this, and because of that we were able to do a very complex integration, a very complex install right on time, and to really roll out the entire organization on day one of our go-live,” he says. “And in doing so, that’s really how they’ve hit some of the numbers they’ve hit.”

Van says that before any organization chooses a product, it needs to know its services and providers and to consider its end goals.

“During implementation…the communication needs to be wide open to ensure that everybody knows what’s happening, what the changes are, if any, to their workflow,” she says. “And I think one of the biggest things for us was to take a step back for those staff or providers that needed a little extra help and go out, show up, work with them so they can understand and see it. You see it, you feel it, you touch it, you understand it, and you get good buy-in.”

Fischer also credits the deployment’s success to the use of a pilot test group prior to go-live—something that is standard operating procedure at Prevea Health.  

“That way we can lay out all the workflows, but you need to get in the real work and find out what the issues are and where you’ve got a breakdown or a disconnect,” he says. “So that way you can work all that through in a live environment, and then once you’ve proved this is the best way to do it, you go out with a lot of confidence and roll it out to everybody else. And actually I think that you’ll have a lot faster deployment using that methodology.”

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