AthletiCo Stretches Its Speech Installation

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At AthletiCo, an Oak Brook, Ill.-based provider of physical therapy, occupational therapy, and fitness services, 360 clinicians generate thousands of patient notes every day across the company’s 55 locations. That’s a lot of medical documents, which can result in heavy transcription costs.   

Since 2002, AthletiCo had been using background speech recognition courtesy of Nuance Communications’ Dictaphone Enterprise Speech System. And while AthletiCo was very pleased with the solution, the company’s clinicians were still writing all of their daily notes by hand.

According to Heather Franks, director of operations at AthletiCo, the company’s transcription department, which comprises both full- and part-time workers, could only accommodate about 500 documents per day. 

“The volume that it would take to add all of those daily notes would probably quadruple the daily volume that our transcription department was handling,” Franks says. “To increase volume and [continue to use] background speech, we would have increased the length of time it took to get all of those documents back.”

Given the company’s size, its daily document volume, and its need for immediate turnaround of documents, AthletiCo instead decided to enhance its technology, upgrade its use of the Dictaphone Enterprise Speech System, and add front-end speech recognition capabilities from Nuance. So in late 2008, AthletiCo deployed the Enterprise Workstation component of Nuance’s Dictaphone Enterprise Speech System, debuting it initially at two facilities and then rolling it out companywide during a six-month period.

Productivity Jumps Sevenfold

Since then, AthletiCo has seen some impressive results. With front-end speech recognition, which allows medical staff to immediately dictate, edit, complete, and sign off on notes and documents without increasing transcription volumes, the company has increased productivity. AthletiCo now churns out 3,500 documents per day—a 600 percent increase compared with only back-end speech recognition. Additionally, AthletiCo did not need to increase its transcription budget or the size of its transcription staff.

In selecting Enterprise Workstation, AthletiCo built on its long and successful relationship with Nuance. According to Franks, AthletiCo realized the reliability of Nuance’s products and was comfortable with recent product enhancements. 

“Without having to install all new software [and] without having to make a big end user change, we were able to just add this component to an already well-working system,” she says. 

John Vaughan, product line manager at Nuance, echoes Franks’ sentiments, noting that AthletiCo’s previous speech technology implementation made it easier for the company to be more aggressive with transcription cost savings and turnaround time.

“As front-end speech recognition has gotten better and better, what’s been nice for [AthletiCo] is that they’ve been able to migrate to that technology,” he says. “It’s not pull out the old system and put in a new one. This is a technology that existing customers…can take advantage of.”

According to Vaughan, the decision between background and front-end speech recognition depends on circumstances at the individual healthcare facilities. 

“Background speech recognition is a low-risk proposition. The technology works. It’s widely adopted. We have proven case studies with this,” he says, noting that front-end speech recognition might not be for everyone—yet. “People are migrating [to front-end speech recognition], and AthletiCo happens to be on the front edge of that.” 

According to Franks, the use of front-end speech recognition, which has eliminated handwriting on charts entirely, has yielded other benefits for AthletiCo: an immediate turnaround time of documents, which means patients and medical staff no longer have to wait for important medical information to be transcribed and returned. 

“As soon as they begin the document, they edit it right then, sign off on it, and it’s complete,” Franks says, adding that the upgrade also resulted in improved speech recognition. “We’ve seen tremendous enhancements.”

Vaughan notes that this decrease in turnaround time is one of the main benefits of front-end speech recognition because it does not rely on transcriptionists during the documentation process. “You’ve fundamentally removed a step in the process and additionally the cost associated with those resources,” he says. “When you go to front-end speech recognition, you effectively turn your turnaround time to zero.”

Additionally, Franks says the solution led to increased legibility of documents and has allowed staff to save valuable time and improve workflow by creating templates and shortcuts that can be reused or inserted into similar or recurring documents. 

Jumping Over Hurdles

But despite AthletiCo’s success with the solution, Franks notes the deployment was not without its share of hurdles. She says the major challenge was deploying the solution to all of AthletiCo’s 55 locations. And because the solution needed to be deployed to many individual workstations, the implementation was that much more challenging. 

But Franks is quick to point out that AthletiCo worked with Nuance, which sent a team to resolve the problem. 

“We had great support,” she says. “They came on-site. They worked with our IT team and really worked with us until we could get something that worked well in each of our facilities.” 

And while Franks says a few end users struggled with the new technology—something she describes as a common challenge—the reaction from the AthletiCo staff has been positive. Vaughan describes employee struggles as common, citing staff buy-in as a “universal” challenge inherent to technology deployments.

“That’s one of the areas that is going to be sensitive for any customer,” he says, noting that all doctors have their own workflow and stressing that one of the Dictaphone Enterprise System’s big benefits is it can accommodate individual workflows.

In addition, because clinicians now dictate in front of patients—often during the course of a conversation—patients are more aware of and involved in the documentation process, Franks says. “I think in general it’s a culture shift,” she says. “However, I think it’s one that has the potential to really benefit the patient in that the patient is now being involved in that documentation process.”

In terms of advice for companies contemplating a similar deployment, Franks stresses the importance of company buy-in at all levels. With any deployment or upgrade, changes are inevitable, and Franks says companies need staff members who can lead by example and demonstrate the new system’s benefits to coworkers. 

“It’s just really important when you have an undertaking like this where you’re going to change systems that you really make sure that at all levels you have a representative who is on board, bought in, and can keep the ball rolling so that it doesn’t bottleneck at any part of the organization,” she says. 

Franks predicts that AthletiCo and Nuance will continue to have a fruitful and productive relationship in the future. “We’re always excited to see the latest and greatest speech technology that comes through Nuance,” she says. 

Since deploying the Enterprise Workstation component of Nuance’s Dictaphone Enterprise Speech System to enable front-end speech recognition, AthletiCo has:
  • increased the number of documents it creates per day from 500 to 3,500; 
  • eliminated document turnaround time;
  • maintained the same transcription volume and budget; 
  • eliminated handwriting on charts; and 
  • improved document legibility. 

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