Impact

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,  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:

• Interview in English
• Interview in Spanish
• Interview in German

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.