Regional EHRs with speech recognition in Galicia, Spain

Acronym of the case:

Galicia Speech

Web address of the case:

http://www.sergas.es

Country of the case:

Spain

City/region:

Galicia

Posting Date:

31 August 2009

Last Edited Date:

14 September 2009

Author:

Armin Scheuer (so2say communications / HealthTech Wire)

EHR | speech recognition | medical reporting

Type of initiative

Project or service

Case Abstract

Spain is working on making electronic health records (EHR) available for all its citizens with 17 regional projects. In addition, the national government is running an interoperability project to create a nationwide infrastructure that can also be seen as a key part of the broader European efforts to create interoperability between the Member States.

In the region of Galicia in Northern Spain, the Servicio Gallego de Salud, "SERGAS" (Galicia Health Services) has been running one of the 17 EHR projects since January 2004. Meanwhile, 14 secondary and tertiary care centers have access to the Galician EHR network, which means that they can store and validate - through digital signature - clinical documents like radiology, pathology and surgery reports. Since 2006, primary care centers are also involved. They use the EHR-network both for electronic prescriptions and EHR support.

Acceptance is pretty high. A key success factor in the Galician EHR project, is the parallel implementation of speech recognition that was introduced in the radiological departments of all 14 hospitals in the network in April and May 2008. In radiology, 80% of radiologists now use speech recognition regularly to create reports for the EHR. The introduction of speech recognition led to a considerable increase in the total number of electronic documents stored in the EHR-system.

The Galician experience thus can be considered an example for a successful introduction of a shared EHR solution that might serve as a model for other European regions. Speech can be used as a strategic tool to increase the use of shared EHR solutions in Spain as well as anywhere else in Europe.

Description of the case

Domain

eHealth

Topic

Sector

Healthcare

Start date - End date

March 2008 (Ongoing)

Date operational

May 2008

Target Users

Health authorities | Health professionals

Scope

Regional (sub-national)

Status

Operation

Language(s)

Spanish

Policy Context and Legal Framework

Spain will hold the first EU presidency in the year 2010, and it will host the 8th European eHealth Conference in Barcelona together with The World of Health IT. According to the European Lead Market Initiative Â eHealth is one out of six lead markets in which innovative solutions will be supported. In this light, Spain is running an ambitious eHealth program that aims at making electronic health records (EHR) available for all its citizens.

To this end, all 17 regions in Spain are working on the implementation of regional EHR solutions. Each region is responsible for the scope as well as the Â technical and organizational details of its EHR project. Moreover, the national government plans to establish an interoperability layer so that electronic documents from a patient can be accessed not only within a region but also from other regions if necessary. There are pilot tests running at the moment for this national infrastructure. The region of Galicia is participating in the relevant working groups, for example in the technical committee for a nation-wide electronic patient summary and also in the technical committee for standardization.

Apart from creating cross-regional interoperability between EHR solutions, Spain's national government is also engaged in cross-border interoperability on a European level. Cross-border interoperability of eHealth solutions in Europe is currently gaining momentum with the publication of the proposal for an EU directive on patients' rights in cross-border healthcare which states that eHealth for cross-border care should be strengthened. Spain is actively working for the progress of Â interoperability as part of the European epSOS project on cross-border interoperability.

The key for interoperable eHealth solutions, be it on a national or on a European level, is participation in electronic documentation by the health care providers. This was one of the foci of the Galician EHR project that looked for a means to increase electronic documentation in shared EHR solutions by implementing speech recognition. The positive results can be of interest for other regional networking projects in Europe.

Project Size and Implementation

Type of initiative

IT infrastructures and products

Overall Implementation approach

Partnerships between administration and/or private sector and/or non-profit sector

Technology choice

Standards-based technology

Funding source

Public funding national | Public funding regional

Project size

Implementation: Not applicable/not available

Implementation and Management Approach

The Galician EHR project with Nuance speech recognition is a mature server-based EHR-implementation that is accessed by all 14 secondary and tertiary care centers in Galicia and by more than 470 out of 493 primary care institutions. The network is managed by Galician Health Services (Servicio Gallego de Salud, "SERGAS"), the regional public health authority. SERGAS is a governmental institution founded in 1989 to provide public health services in the region of Galicia. Since 1991, as part of the Spanish government's decentralization policy, SERGAS has built and integrated a total of 319 primary care units and hospitals. In the totality of the SERGAS institutions, there are approximately 8 000 medical professionals and 28 000 employees. They provide medical care for a population of 2.78 million people, 6% of the Spanish population.

Technology solution

Technically, the Galician EHR is a shared server infrastructure with documentation, storage and speech recognition done online in a secure environment. Both the regional EHR solution and the radiology information systems in use in the 14 hospitals are not off the shelf products but have been developed by SERGAS itself. Speech recognition is provided by a leading private company technology. Together with Nuance, SERGAS worked on a proper integration of the speech recognition into the regional EHR solution, a process that lasted all in all six months. Users can now start the speech recognition from within their information systems with one mouse click.

Further information on speech recognition is available at www.nuancehealthcare.eu and www.healthtechwire.com/nuance.

Impact, innovation and results

Impact

Since March 2008, all 14 secondary and tertiary care centers have access to the EHR, which means that they can store clinical documents like radiology, pathology, surgery reports and issue electronic prescriptions. Since 2006, primary care centers have also been involved. More than 470 out of 493 primary care institutions are now connected to the network. All primary care institutions are using the EHR-network, mainly for electronic prescriptions.

EHR and speech recognition benefits

The broad benefits of the regional EHR include better availability and access of documents when patients are referred from one doctor to another and a reduction in administrative workload through the digitization of prescriptions. Since a patient's medical history tends to be less patchy in electronic environments, patient safety increases because the probability of being misinformed decreases. Speech recognition, on the other hand, reduces the workload for medical staff and helps making patient data available immediately. If integrated deeply into the RIS as in Galicia, it does also have an impact on patient safety, since it guarantees that the DICOM images are intrinsically tied to the radiological reports, making mistakes in names etc. technically impossible.

Acceptance of EHR

Usage of the Galician EHR system is quite high, indicating that doctors perceive the theoretical benefits of an EHR as really coming into place. In 2008, there were 23.8 million contacts between patients and pharmacies based on electronic prescriptions. This is a share of 54% of all prescriptions that are being issued in primary care. As for the number of users, there are 5088 professional users in secondary care and 3331 in primary care. 2.6 million citizens of Galicia have an EHR already. In secondary care, the EHRs of 343 260 patients were accessed in 2008 monthly, making up for a total of more than 4.1 million in the whole year. In primary care, the numbers are 58 .621 and nearly 7 million respectively. When it comes to clinical reports, 545 821 were elaborated on the EHR in 2008 excluding radiology, and another 897 958 reports in radiology alone.

Acceptance of speech recognition

Speech recognition was introduced in the radiological departments of all 14 secondary and tertiary care centers in April and May 2008. It is currently being implemented in pathology as well, with five centers being equipped in March 2009. This adds up to a total of 350 users at the moment. If implementation continues as planned, a threshold of 1 000 users of speech recognition will be reached early in 2010. In March 2009, 80% of all radiologists are using speech recognition regularly.

Influence of SR on EHR usage

Speech recognition clearly led to an increase in the total number of radiological examinations that were made available in the EHR, indicating that it can increase digitalization because it is a quick and easy way to generate and finish an electronic document. In one tertiary care center with more than 1 200 beds and more than 350 000 radiological examinations per year, for example, the total number of radiological reports that were made available in the EHR was 7 520 in November 2007. After the introduction of speech recognition in May 2008, this number increased to 11 824 in November 2008. The average time between transcription and final availability of the report in the EHR decreased from 1.7 days to 0.5 days in this hospital. In conclusion, speech recognition did not only (as could be expected) lead to acceleration of medical document production, but also to an increase in the use of the EHR system as a whole.

Semantic interoperability

Among the benefits of using speech recognition for creating electronic medical documents is an increase in technical and semantic standardization. In the long run, this can be of considerable benefit both for a medical institution and in the context of cross-regional or even cross-border care. Bringing together speech recognition with coding software, for example,Â reduces administrative activities for health professionals and thus brings benefits for the medical institution. It also provides a platform for communication in cross-border healthcare scenarios, since codes offer a degree of semantic interoperability that text only documents are lacking.

Track record of sharing

Partial results of the project were made public on several conferences and workshops. Within the Galician Health Services, a high interest in the implementation of speech recognition was encountered in departments other than radiology. Apart from pathology with five centers equipped with speech recognition already, speech recognition is also being tested in pilot projects ion two departments of internal medicine.

Interviews have been published in key European media:

Lessons learnt

The project shows that shared EHR solutions are not necessarily being used widely if the process of documentation and the relevant workflows are not optimized. Speech recognition can be a valuable tool to considerably increase the use of an EHR and thus does have a considerable effect on the deployment of EHR solutions, as was demonstrated in the radiological hospitals of the SERGAS-network. With speech recognition implemented in radiology, 90% of all radiological reports in some of the secondary care centers in the SERGAS network are now made available electronically. In other specialties without speech recognition, this number is in the range of 50% only. So the key lesson in the broader EHR context is that tools like speech recognition that facilitate digitalization can increase the success of EHR projects.
In the context of implementation, the key lesson was that without a deep integration of speech recognition into the radiological or hospital information system, success will not be reached. In Galicia, Nuance together with SERGAS' IT Project Services department worked for six months to get a proper integration into the self-developed information systems. This was a considerable effort, but it was absolutely worth it as usage statistics prove.

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