Sunshine Coast, Wide Bay Health Services – Nambour Hospital

In many parts of the world, radiologists are a scarce “resource”. Australia makes no exception. Outsourcing the interpretation of radiology images helps tackle staff shortage in radiology, but providers need to make sure to return their findings quickly. By using speech recognition, Nambour Hospital in Queensland, Australia has reduced turn-around time for radiology reports from 33 to 5 hours – a drop of 85%.

“Public radiology in Queensland is plagued by a shortage of radiologists to do the reporting”, explains David Ward, Director – Medical Imaging Services, Southern Cluster, Sunshine Coast – Wide Bay Health Service District. “They therefore outsource the reporting function to private radiology firms and they pay a lot of money for that. Or, they decrease the value of the input from radiologists and do not report on plain-film studies.”

Some hospitals might only report on half of the studies they do and before speech recognition, Nambour Hospital itself reported on about 80% of the performed studies, Ward tells us.

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“For a plain-film study we would not produce a report, but only add a note saying that if a clinician or referrer needs more detail they should contact the radiologist”, David Ward says.

The radiologists are only one side of the coin. On the other side is the audio typist who transcribes the dictations and produces the reports. Needless to say, that Nambour Hospital was experiencing the transcription backlogs common for the healthcare industry. “Some reports took 6-7 days to be produced”, David says.

Nambour turned to SolitonIT, a Nuance integration partner, to evaluate the potential of a technology “many people tried 10 years ago with dissatisfactory results”: speech recognition.

A decade later, a world away

Speech recognition technology of today is a lot different from what it was ten years ago. The first programs didn’t deliver on their promise. Today, they do. In many European countries for example, more than 50% of radiologists are working with speech recognition – so do two out of three in North America.

Speech recognition can support the radiology workflow, especially with regards to faster turnaround-times for reports – but it isn’t the answer to all challenges.

“Some people think it is the answer to all the problems, but it is not. We don’t have any misconception that speech recognition will replace audio typists. But it makes them happier people,” David says.

Previously the transcriptionists were constantly fighting against a backlog of tapes and later audio files waiting to be typed.

“They never had a sense of achievement. They left Friday evening, knowing that Monday morning the piles will have increased. It was demoralising”, David Ward says.

“Clinicians referring patients for an MRI, Ultrasound or CT are now able to view the report on their system within one or two hours on average.”

Dr. Troy Stapleton, Director of radiology

Creating system unity

Soliton Workflow Manager with Nuance speech recognition has been implemented for 15 radiologists at Nambour. Centrally installed and managed, the system was expanded into Caloundra Hospital and Gympie Hospital, so that more than 100 doctors are working with Soliton Workflow Manager powered by the Nuance speech technology.

A key benefit is the HL7 interface to the Radiology Information System (RIS) and the desktop integration with the Picture Archiving and Communications System (PACS) which eliminates what David Ward says once was “the number one big issue for potential inaccuracy”: the possibility of a medical secretary typing the wrong report for the wrong patient.

“Thanks to the [Soliton’s] desktop integration with the PACS and RIS, image, report and patient file are one single unit and it is virtually impossible to mix them up.”, David underlines.

Radiologists are given the choice between digital dictation and front-end speech recognition. Latter provides great relief during weekend-shifts, as instant report creation by the doctor is possible.

“We have fairly young radiologists accustomed to operating a mouse. They are heavy users of the speech recognition system and encourage other to come on board. We didn’t have any acceptance problems,” says David.

What surprised David Ward the most, was the ability of the Nuance speech recognition engine to learn and adapt to the users – which constantly improves recognition accuracy and is the basis for developing a site-specific vocabulary and understanding.

Factual decision support

“Over the last 30 years the job of radiologist was to dictate reports. I wasn’t involved in dealing with the patient conditions before,” says Ward.
Today, they have multi-disciplinary team meetings in which radiologists get together with surgeons, technologists or medical students to discuss a patient and decide on treatment options.

“If there is a report on the system from 10 am, it can be discussed in the team meeting that same day,” says David Ward.
CT reports for example, are always prioritised.

“CT reports are often used for clinical decision making – more so than plain films. With CT, but also Ultrasound, clinicians are more dependent on radiology knowledge – the interpretation is essential”, explains Ward.

Thanks to speech recognition, all Ultrasounds dictated up to 3pm have reports attached on the same day.

“The system is working fantastically well, the features and the improved integration is making everyone’s life so much easier”, concludes Ward.

“We were anticipating issues around the change process and user adoption, but the opposite occurred. Staff endorsement is outstanding.”

“Initially we introduced speech recognition to enable radiologists to produce reports during afterhours. Now, the technology is used during business-hours as well.”

David Ward Director - Medical Imaging Services Southern Cluster Sunshine Coast - Wide Bay Health Service District

He is not the only one…

“Both the consultant radiologists and registrars are very happy with the product. It has especially improved our afterhours report turnaround times, and is easy to use. The voice recognition integrates well with Workflow Manager, and has in fact converted skeptics in this technology into users”, highlights Dr Troy Stapleton, Medical Director at Nambour. “Accurate and rapid diagnosis is one of the keys to improving patient management and thanks to the new system we could achieve a marked reduction in our report turnaround-times.”

“From an admin point of view, Soliton powered by Nuance’s SpeechMagic has contributed to a less stressful environment resulting in a typist being able to help in other admin areas of the department” adds Nonie Allen, the Nambour System Administrator.

The implementation of Soliton IT and SpeechMagic has improved the productivity and services and it has boasted the staff morale at Nambour. With the message spreading into other organizations, radiology speech recognition in Australia has the potential to experience the same adoption rates as in Europe and North America…

Sunshine Coast, Wide Bay Health Services – Nambour Hospital