George Washington University Hospital - DR Systems

George Washington University Hospital (GWUH), a leading 371-bed institution in Washington, D.C., uses the voice recognition feature of its DR Systems (San Diego, Calif.) Picture Archiving and Communications System (PACS) to significantly improve the quality and speed of patient care. The voice recognition feature on DR Systems’ PACS reduces the time before radiological reports can be accessed by referring physicians who are treating critically ill patients. The technology also dramatically reduces transcription costs, freeing financial resources for other clinical needs.

Situation

Until 2004, GWUH generated radiology reports the traditional way -- that is, by having radiologists and radiology residents dictate the content and then having the dictation transcribed by an outside transcription service. This method slowed patient diagnosis and treatment because turnaround time -- from the time of dictation to the time the report was faxed or mailed to the ordering physician -- was from two to four days. (Clinicians had the time-consuming option of listening to reports via a digital dictation server.) The method was also costly, with transcription expenses typically running from $30,000 to $40,000 per month, depending on volume.

Solution

GWUH recognized that the voice recognition capability, a tightly integrated feature of its PACS, could improve patient care by tremendously speeding up turnaround time for reports. The same change would reduce costs by slashing transcription expenses. The hospital performs approximately 150,000 radiology exams per year, so the potential impact of fully implementing the technology was considerable.

In helping to pioneer voice recognition for radiology, the hospital started slowly with voice recognition, but by 2005, the system was being used to generate reports for all radiology modalities except mammography and interventional radiology. In conjunction with the voice recognition system, GWUH drew on another PACS feature – template reports -- to cut turnaround time. The software generates template reports -- defined and keyed-in by the user -- by exam type. The templates suffice for normal reports, without editing.

Better Health & Lower Costs

Overall, the switch to voice recognition technology and template reports has reduced turnaround time (TAT) for reports from days to as little as a few minutes. The actual time to turn around any single report varies, depending on the availability of an attending radiologist to review a report draft dictated by a medical resident. Those reports are not fully distributed until an attending radiologist reviews and signs off on them. The hospital is transitioning to a new and faster protocol, however, in which voice recognition-generated reports that were initiated by a resident will be available immediately in preliminary form. This next step will improve the overall report TAT beyond the considerable gains already made.

This new workflow is expected to be especially helpful for improving patient safety and the timeliness of medical care in the emergency room. The faster a report can get from the radiologist to the physician treating the patient -- especially in an emergency situation -- the sooner the physician can make informed diagnosis and treatment decisions, with full radiology information at hand.

Regarding the financial impact of voice recognition, GWUH determined cost reduction by tracking the invoices it received from its transcription vendor during a period when its use of the technology grew substantially. In the first year of implementation, transcription cost savings averaged approximately 50 percent, ranging as high as 60-to-70 percent for specific months. As of this writing in October 2005, savings for the previous four months have averaged roughly 60 percent. Because of projected volume increases, savings are expected to be greater for 2005.

Savings should increase even more when use of voice recognition expands to include mammography and interventional radiology. Administration projects savings of up to 80 percent when the system is used to generate reports for all radiology modalities.

As an added benefit, the ability of the DR Systems PACS to generate user-defined template reports improves radiology department productivity. This is because the templates make it possible for physicians to quickly process large workloads.

While change can be difficult for physicians, many doctors at GWUH have come to prefer voice recognition over traditional transcription because the faster TAT makes a large difference in the quality of patient care. The technology provides a cost benefit that is also a clinical benefit.