examine|PACS: Dictating Change

Preparing for complete integration of dictation and transcription

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Increasingly, radiology departments in both hospital and clinic environments are facing growth in performed procedures and need to find ways to adapt, yet continue to provide the increased levels of service that referring physicians expect.

Too often, the time it takes to finalize a written report once the radiologist has dictated the results, called report finalization, causes one of the biggest backlogs. To address this major area of cost and backlog, radiology departments and clinics are looking to their RIS/PACS partners to come up with a solution. Today's fully integrated workflow providers have addressed this issue and generally provide dictation and transcription as part of their product offering, usually with the option of voice recognition.

Though an integral part of the product offering, voice recognition it is not a simple plug-and-play process. Thought and planning must precede deployment to ensure the expected results. A logical sequence should be followed to make this deployment successful.

Step-by-Step

First, identify a process owner and project manager, then identify all the stakeholders in the new solution and include them in the team to manage the implementation. Include representatives from information systems, administration and radiology. Be sure to have a senior member of the radiology department on the team as the management sponsor. If your new system is a major change in your organization's infrastructure, support from top management will be critical to ensure project success.

Next, identify and map your current reporting process. Start from the time of exam completion to the time the final report goes out to the referring physician. Show each step along the way, including who is responsible and what is to be done. Also, begin tracking time and costs for each step and identifying current or potential bottlenecks that need to be addressed.

In the next step of the process, ask your new vendor to provide a map of its reporting process. This map should be similar to the one completed onsite. It is important to understand how the new system works and what the new roles and responsibilities will be. Ensure all members of the team understand and buy into where you want to be when you go live. The emphasis here is on letting everyone know how the system will work.

Avoid the trap of trying to design the new system to do exactly what you are doing today, only faster. In other words, don't pave the cow paths. This could be a recipe for disaster at worst, and, at best, will negate many of the benefits of your new system. Gain acceptance from the entire team on your desired result.

You are now ready to develop a roadmap. Once the team agrees on the desired result, identify an implementation process. Put together a detailed plan on what needs to be done, who is going to do it and when. You may need to phase in certain elements of the deployment as many organizations can only handle change in increments while they are still going about their daily routine. Try to be as non-disruptive as possible and be sure to provide training and education plan for the department and all users. It is critical to follow the plan and implement changes as they are defined. Do not get distracted or try to change paths during the deployment.

Make sure you set aside enough time for training, especially one-on-one personal training of key users. Adequate training will make the transition easier for all involved. The more people understand and know how to use your new system, the easier it will be for them to adjust from "how they always did things."

As part of this implementation, much of the system's administration and configuration can occur before the users enter the process. The more that has been set up, the faster the adoption. As an example, the use of macros to put standard text into a report speeds the process and ensures a consistency of reporting for like results. Using the macros may be different than in previous systems. Pre-loading these into the database will make the training and utilization easier and will give users a sense of familiarity.

The importance of complete and personal training cannot be over-emphasized as one of the fundamental keys to successful deployment. Training will serve to help overcome much of the "fear factor" associated with new technology and counter the common complaints: "This new system slows me down because it is too complex."

Finally, verify that the new system performs well and achieves the desired results. Verification of productivity improvements can serve as a significant communication point with users. If the users see documented evidence of productivity or patient satisfaction improvement they will continue to support the change.

To be effective in measuring productivity, identify those metrics important to the organization and gain agreement from the team and management that these metrics are important. For example, analyze report turnaround - tracking the time from when a report is dictated to the time it is returned to the radiologist for signature, as well as tracking the time that the radiologist takes to sign the report. Look at costs - monitoring the amount of money spent on transcription, including any courier costs. And assess customer satisfaction - completing a survey of referring physicians to determine their degree of satisfaction with your reporting process.

Reporting Results

Once you have established your institutional metrics, begin collecting and reporting data prior to deployment of the new system. Inform members of the team and users of your results so that they understand the time, costs and satisfaction statistics. After installation, continue to collect the data and report the comparison. The better the results, the harder people will work to make the new system a success.

Preparation is a very straightforward process. Good preparation will lead to a successful implementation and adoption of the new capability. To make it successful recognize that change is good. Managing change will be the most difficult, yet most important part of the process. Former Louisiana Governor Huey Long urged voters to "vote early and vote often." This same rule applies in managing change. Communicate early to all stakeholders and communicate often. The more informed your users are, the less resistant they will be, continually emphasizing how they and their patients will be better off.

— John F. Norman is CEO of MedQ Inc. (www.medq.com), an image workflow management company and partner company of NovaRad (www.novarad.net), American Fork, Utah, developer of NovaPACS and NovaRIS radiology software.