St. Luke’s Radiology Group Accelerates Reporting with Speech Recognition Technology

As the IT group, you can do a good job with the technology, but it is the cultural change, the enthusiastic adoption by doctors and staff, that really makes it a success.“
– Adrienne Edens, Chief Information Officer, St. Luke’s Health System

Toward Timely Transcription

As part of a new consolidated PACS installation for archiving digital images, St. Luke’s Health System wanted to implement a speech recognition technology for its radiology group to accelerate reporting and facilitate more responsive patient care. At the time, the turnaround time for manually transcribing a radiologist’s dictation averaged seven hours. Patients had to wait that much longer for the results of an x-ray or other medical image. “The goal of speech recognition was to eliminate transcription and shorten this process,” said Adrienne Edens, Chief Information Officer for St. Luke’s.

St. Luke’s Health System is an Idaho-based, not-for-profit health care provider for southern and central Idaho, northern Nevada and eastern Oregon. It operates medical centers in Boise, Meridian, Magic Valley, McCall and Wood River as well as more than 70 clinics. St. Luke’s Boise Medical Center is Idaho’s largest hospital, and St. Luke’s Children’s Hospital is the only children’s hospital in the state.

St. Luke’s medical imaging process involved several steps. When a physician ordered a medical image, a technician performed the scan and sent the image to a radiologist for diagnosis. The radiologist dictated an audio report that was forwarded to the transcriptionists. After the text version came back, the radiologist approved it and the official report and diagnosis went to the referring physician and became part of the patient’s medical record.

Manual transcription was the most time-consuming step. If automated speech recognition could mitigate or even eliminate the need for it, the overall time to deliver a diagnosis could be reduced dramatically.

Speech Recognition Development

Speech recognition technology has been in development for decades. Programming a computer to recognize and decipher human speech is particularly complex and challenging. While the accuracy rate has improved over time, progress has been slow and incremental. Today, the technology has advanced to a point where it is a viable for certain applications. “Even in the last couple of years the technology has come a long way,” said Dan Talley, IT Service Team Leader for St. Luke’s.

Collaborative Approach

St. Luke’s took a collaborative approach for reviewing options and approving a speech recognition system. All stakeholders had a seat at the table: the IT group who would manage it, the hospital administrators who oversaw budgeting and compliance, and the radiologists who would ultimately use the system as part of their jobs. They also enlisted Santa Rosa Consulting, an IT and management consulting firm for the healthcare industry, to provide guidance and expertise in this area.

From the beginning, the radiologists were active proponents of a speech recognition system. “It was not administration saying we needed the system, or even IT. The radiologists were the most enthusiastic advocates,” said Edens.

RadWhere from Nuance Healthcare

After considering several speech recognition solutions, the project team chose RadWhere from Nuance Healthcare. RadWhere is a speech recognition solution with reporting and workflow management designed specifically for radiology. The software transcribes a radiologist’s dictation in real-time, thereby speeding up report writing. It includes templates and macros based on procedure codes for structuring the reports. RadWhere’s workflow engine also automatically routes documents through the creation, review and delivery process.

To roll out the system, the IT group installed software on the radiologists’ workstations and the primary RadWhere application on a host server that is replicated to a remote site for disaster recovery. If a failure occurs at the local site, the system will fail over and continue to provide service to the radiology group. Furthermore, each user had to “train” the system to understand his or her voice by speaking scripts into the computer.

The radiologists were quick to incorporate the new system into their routine. “Normally these types of projects are phased in slowly, but in this case, radiology no longer needed transcriptionists after only two weeks,” said Talley.

It felt great to experience such an improvement, especially after being a part of this project.“
– Dan Talley, IT Service Team Leader, St. Luke’s Health System

More Responsive Patient Care For Less

As a result of the fast adoption, the benefits to St. Luke’s and its patients accrued quickly. The average turnaround time for radiology reports dropped from 7 hours to about 30 minutes. St. Luke’s is saving $450,000 per year in radiology transcription costs for the Treasure Valley alone (Boise, Meridian and surrounding areas). Most significantly, patients receive faster and more responsive care.

Talley gave a personal example. His elderly mother had fallen down occasionally in the past, and Talley would take her to the hospital for an x-ray. Typically they had to wait hours for the results, but the last time this happened, after the speech recognition system was in place, the x-ray and diagnosis came back in only 20 minutes. “It felt great to experience such an improvement, especially after being a part of this project,” he said.

Edens added, “We are thrilled and wish all of our IT projects went this well. We give the radiologists credit for the success. As the IT group, you can do a good job with the technology, but it is the cultural change, the enthusiastic adoption by doctors and staff, that really makes it a success.”

Based on the success of the RadWhere system, St. Luke’s is looking at standardizing on Nuance technology for all of its medical speech recognition applications.

 Copyright © 2011 Apropos LLC. All rights reserved.

Arlie and Company Revamps IT with Server Virtualization and Unified Storage

It took more than all night to do tape backups of the data. They would roll over into the daytime and really affect mail flow and access time to files on the file server.“
– Adam Falk, Director of Technical Operations, Arlie & Company

Toward More Robust and Efficient IT

After a period of fast growth, Arlie & Company founds its server and storage infrastructure no longer provided the robustness and efficiency that the business needed. Nightly tape backups did not complete within the backup window. “It took more than all night to do tape backups of the data. They would roll over into the daytime and really affect mail flow and access time to files on the file server,” said Adam Falk, Director of Technical Operations for Arlie & Company. The servers were not configured for redundancy and failover, so the company was at risk of losing access to applications like email and printing potentially for days if the server hardware failed and had to be replaced. Furthermore, CPU and memory utilization on the servers was very low, and Falk felt the assets were not being well-utilized.

Arlie & Company is a privately-owned real estate development and management company based in Eugene, Oregon. By mid-2008, the company had doubled in size over a period of six years, reaching 28 employees, and was planning to double again. It was at this time they decided to upgrade the IT infrastructure.

The existing infrastructure consisted of two Windows servers running with about a half terabyte each of internal hard drive storage. One was a Dell PowerEdge 2800, a high-availability tower server with dual Intel Xeon processors, running Microsoft Small Business Server which included Exchange, SharePoint, the domain controller and a public-facing FTP site. The company had purchased it three years prior with the idea of growing into it. The other server was running Windows file and print services.

VMware and NetApp as Foundation

To address the problems of performance, resiliency and efficiency, Falk proposed two key technologies: server virtualization and consolidated, shared storage. After reviewing multiple products, they decided to purchase and install VMware vSphere 4 and a NetApp FAS2020 storage platform.

VMware is the market-leading server virtualization platform. It partitions a physical server into multiple virtual machines, each of which acts as a discrete server environment. Virtual machines are far easier to create, delete and move than physical machines and provide greater flexibility and higher server utilization.

The NetApp FAS2020 is a unified storage platform that includes both SAN and NAS, block and file storage, in one system. The FAS2020 supports iSCSI and Fibre Channel block protocols and CIFS, NFS and FTP file protocols. It expands to 12 disk drives internally and 68 drives overall through external expansion units. It runs NetApp’s Data ONTAP operating system that offers space-efficient differential snapshots and numerous other data management and protection features.

Arlie & Company based its upgraded IT infrastructure around the FAS2020 as a centralized, shared storage platform that connects to servers and clients over a Gigabit Ethernet network. Six of the twelve internal drive slots in the FAS2020 contain 1 TB SATA drives, and the others are available for future expansion. The drives are configured for redundancy using a combination of double-parity RAID and internal mirroring. Some storage capacity is allocated as a Windows file share accessed via CIFS for storing documents, photos, etc. The remainder is dedicated to iSCSI LUNs for VMware virtual machines. NetApp is integrated with Windows and VMware at the functional and management layers, enabling these technologies to leverage each other’s functionality and minimizing the learning curve for IT administrators. Of the storage platforms that Falk evaluated, the FAS2020 was the most tightly integrated with VMware and Windows.

The two existing host servers were repurposed to run Windows Server 2008 and VMware. Each has dual Gigabit Ethernet ports for high-bandwidth connections to clients and storage. The servers boot off USB drives and then access their primary storage over the network on the FAS2020. (Network boot for VMware is also an option available today.) Exchange, SharePoint, the FTP server, web presence, and primary and secondary domain controllers now run in virtual machines distributed between the two servers. In addition, VMware has a large community that provides free virtualized applications, where Falk found ProjectPier, an open-source, web-based application for project collaboration and task management. He installed ProjectPier in a virtual machine and saved $50 per month the company used to pay for a commercial hosted project collaboration service.

In this virtual environment, upgrading or moving an application is non-disruptive to the other applications running on the same physical server. Testing and development is streamlined as well. Instead of deploying a physical server, Falk tests new software by installing it in a virtual machine. If he decides not to keep the software, it is a simple matter to roll the virtual machine back to the previous state.

I am very pleased and very comfortable with the level of systems security and uptime.”
– Adam Falk

Robust, Non-disruptive Data Protection

The company’s critical data is now protected with disk-based snapshots, local replication and nightly backups to tape that are stored offsite for disaster recovery – all without slowing or disrupting user applications. The FAS2020 is scheduled to automatically take snapshots of the Windows file share five times per day and keeps 30 days of snapshots online. If a file is accidentally deleted or dragged and dropped into an unknown folder, users can retrieve any previous version right from the Windows interface, thanks to the NetApp integration. Each night Symantec Backup Exec 12.5 backs up the last daily snapshot to tape.

A different backup application called Veeam Backup and Replication protects the virtual machine images. Veeam is the market-leading backup and recovery solution designed specifically for VMware virtual environments. It offers instant recovery of virtual machines and files and recovery of application objects like email. It also verifies the recoverability of every backup image and replicates them locally or to a remote site for disaster recovery.

In this case, Veeam Backup and Replication takes nightly snapshots (changed blocks only) of the virtual machines and stores them on the backup server’s local hard drive. (Backup Exec uses the snapshots as the source for tape backups.) Furthermore, every seven hours Veeam takes snapshots of the images for Exchange, the domain controller and company’s web presence and replicates them to the local drive on a separate blade server. “If something happens to the OS in the virtual machine or if the hardware fails, I can immediately turn on that replica and bring up the mail server, which is our most critical application,” said Falk.

“I am very pleased and very comfortable with the level of systems security and uptime. IT is a service department. I don’t bring in money. I’m an expense area. So my job is to make sure everyone who does bring in money has the tools they need to do their jobs. That means the highest availability and least disruption possible to services,” he added. The upgraded infrastructure has been run smoothly since it was installed two and a half years ago. In fact, Arlie & Company has experienced only a single email outage, which lasted ten hours, in the last seven years – a solid record for a small business with a one-man IT shop.

Room to Grow, Space to Breathe

The virtualized servers and shared, unified storage are utilized at closer to capacity, so the assets are more efficient and “green.” At the same time, there is plenty of headroom to expand when business starts to grow again. The infrastructure is also easier to manage. “The amount of time I spend on IT has decreased to the point that I have actually picked up other duties in the company, because I don’t have to babysit so much,” said Falk.

 Copyright © 2011 Apropos LLC. All rights reserved.