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.

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 Copyright © 2011 Apropos LLC. All rights reserved.

WTS Sets Itself Apart with Business Continuity Services

You can actually resume the business knowing that the data is accurate and it is functional the way it was prior to the event.
– Richard Dolewski, CTO and VP of Business Continuity Services, WTS

A Service Apart

How does a managed services provider set itself apart? For WTS, which has data centers in Seattle, WA, and Denver, CO, the answer is providing its clients a special competency in disaster recovery and business continuity. “WTS does the recovery on behalf of their customers, therefore relieving the customers of this burden, especially at a time when their staff may not be available,” said Richard Dolewski, Chief Technology Officer and VP of Business Continuity Services. “WTS delivers a repeatable recovery result every time. We value the cost of any business outage and utilize High Availability software to further eliminate planned outages.”

WTS is a managed services provider that emphasizes application hosting for Oracle JD Edwards software, though it provides other services such as disaster recovery and colocation services for iSeries (also known as IBM i, System i or AS/400), Windows and Linux platforms.

Dolewski continued, “A well planned deployment of infrastructure technology with clearly defined availability and recovery objectives can help ensure hardware failures and more serious disasters do not bring a business to its knees. A truly highly available infrastructure can be a revenue engine for our customers by always keeping the systems available to support their business requirements.”

“So we are shifting from traditional HA – which is passive, it’s after a bad event – to business continuity, which means keeping systems always available for our clients. With the clients that we service, it is all about eliminating their planned and unplanned outages. Now they see a value. They’re actually saying, wow, my systems are available so much more.”

Tape Is Not Enough

Prior to employing solutions from WTS, many clients used only tape backup systems to protect their data. When a disaster or system failure occurred, it typically took 24 or 48 hours to find the tapes, load data and restart the system. The data on the restored system was already a day behind because the last backup ran the night before. Therefore a tape-only approach meant a day or two of downtime plus losing a day’s worth of transactions and file updates. For many businesses, such recovery times and recovery points are no longer acceptable.

In one example, a transportation company with four or five distribution centers suffered an outage and had to recover from tape. The information in the recovered system was a day out of date and no longer represented the inventory status in their distribution network. So they did not know if a product had been shipped or billed and were forced to do an inventory recount. It was enough for them to realize tape is not enough.

A View to a Recovery

WTS uses proven, off-the-shelf replication technologies and a good high availability monitoring system to deliver recovery times of an hour or less and a recovery point of the last successful transaction. In the event of a disaster the actual recovery is performed by WTS staff. “We provide application recovery, which is business continuity. We have unbelievable JD Edwards staff here as well as engineers on the different platforms, so the application will be functional. If you have a disaster, you are in a crisis. Turning over a system that is, shall we say, less than credible, you have a second disaster waiting for you. So you want this to be application ready. You can actually resume the business knowing that the data is accurate and it is functional the way it was prior to the event,” he said.

WTS employs replication technologies from Vision Solutions, which includes the recent acquisition of Double-Take Software. Before deploying a technology in its data centers, WTS goes through a detailed proof of concept to make sure it meets all technical criteria. It selected iTERA and Mimix for iSeries platforms and Double-Take for Windows and Linux platforms. It considers them best-of-breed host-based solutions for replicating data in real time to a remote site, whether between WTS data centers or from client sites to WTS if they just need a recovery site. They support multiple operating systems in physical and virtual server environments.

Looking forward, WTS will continue to evolve its disaster recovery services. As a managed services provider, it views these stringent, application-level DR capabilities as a differentiator. “It is all about being prepared. Our job is to be prepared for the client,” said Dolewski.

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 Copyright © 2010 Apropos LLC. All rights reserved.

It was a major win for the IT group in real­izing how we could help the company reduce cost while earning more respect from upper management.
– Rob Weis, CIO, North Wind

Interview with North Wind

Rob Weis, CIO of North Wind, discussed his company’s experience developing a portal and collaboration tool using Drupal with AIT Profiles.

Drupal is an open source content management platform. It offers a free software package for publishing, managing and organizing a wide variety of content on a website.

North Wind, an Alaska Native Corporation based in Idaho Falls, Idaho, provides environmental, engineering and construction services to governmental, commercial and industrial clients.

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AIT Profiles: Let’s go back prior to the installation. Tell us about the challenge your company was facing at the time.

Rob Weis: I noticed early on that our corporate intranet was a mess. It was running on a free version of SharePoint that was outdated, unpatched and living on the DMZ. All the while, it was completely accessible to anybody on the planet if you could get past the basic NT authentication. The intranet contained sensitive data about many government projects. This became a major security concern for the company and we decided it was time to look at a full upgrade and moving this system inside our network.

AIT Profiles: And how did you go about looking for a solution?

Rob Weis: We carefully evaluated our upgrade options by evaluating several COTS (commercial off the shelf) vendors, the latest version of SharePoint Enterprise edition and the option to develop the system in-house. Our criteria for selection were based on cost, flexibility, user interface and integration with legacy systems.

AIT Profiles: What did you select?

Rob Weis: We decided to leverage our internal software engineering team’s expertise. The team and I believed there was a huge potential for major cost savings in attempting to reproduce SharePoint, function by function. The new project was now on the high priority list and was rebranded with the name “Portal.”

North Wind had previously adopted an open source content management system, called Drupal, for several scientific applications and project collaboration websites with great success. The first appeal in using Drupal for our scientific applications was the insanely rapid application development it offered. Often times we had a working prototype for our customer by the close of business on the same day! For our new Portal intranet, we looked at this and said, “Let’s see how far we can get in 24 work hours of development before we commit fully.” After about 24 hours of work, it was pretty shocking that we had replicated a significant portion of SharePoint functionality. This gave us a confidence boost to move forward with Drupal. However, there was a lot of work to do in terms of higher hanging fruits and a fairly large data migration/cleanup.

AIT Profiles: Beyond cost savings, did you see other benefits to using Drupal?

Rob Weis: The other appeal I saw for the team to leverage Drupal is it would be a great way to invest in our own team to learn more about the software. It meant discovering new modules, integrating with Active Directory LDAP and other systems, building SharePoint equivalent functionality and finding solutions to a slew of other challenges. All of which, we could use in the future for our other Drupal installations for our customers without needing to charge them a dime to spin up for the knowledge.

AIT Profiles: So how did the Portal project turn out?

Rob Weis: When the Portal launched to the company and the project was completed, we estimated the labor cost of the project and believed we had broken even in labor cost compared to purchasing SharePoint Enterprise for one year of licensing. It may not sound like much, but the SharePoint software would have cost each year what it took to build the Portal once. Additionally, we now had the internal capability to say “Yes, we can add that feature,” instead of the previous answer “No, we’re not sure how to do that.”

Shortly after the launch of our newly launched “Portal,” we had a request come in from our CFO to automate our pay stub system. It was a manual printing process that was very costly. We did an analysis and the current process was costing about $80,000 over 5 years in time and materials. We added a small piece of custom functionality to the Portal user profiles that would connect to our accounting system and display pay stubs to the user. This small feature amounted to a savings of approximately $70,000 over 5 years! This alone paid for a significant chunk of the Portal development costs. It was a major win for the IT group in realizing how we could help the company reduce cost while earning more respect from upper management.  It was at about this time that the team and I recognized we had made the right technology decision. The investment was already paying itself back and we had just begun!

AIT Profiles: That’s a big savings. And how has the Portal affected your organization?

Rob Weis: With the new Portal system, we’ve had a completely new cultural experience for the company. The news is up to date, employee hires are immediately in the directory, and each division and employee has their own page with useful information for everyone. The Portal has features like: search, calendar, classifieds, reservation system (conference rooms, vehicles, GPS tools, drilling rigs, etc.), rotating graphics for seasons and special events (charity work, golf tournaments, etc.), profile self-marketing (resume, biography, etc,) and several other features to keep the content fresh and alive.  It’s hard to put a value on all these features and the cultural impact, but we’re betting that it may contribute to improved morale, less turnover, more involved and efficient employees, and better communication across the company.

AIT Profiles: Do you plan to build upon this system in the future?

Rob Weis: Our last major phase of the Portal project is currently underway. We’re on the cusp of launching a collaboration system for corporate groups and projects. We’ve been beta testing with several internal teams and have had success in using a software add-on for Drupal called Open Atrium. The collaboration pieces and the several other “wish list” enhancements to the Portal are sure to make a major impact to the company over the next several years. We’re helping our software development team grow with Drupal, our employees to be more efficient and excited about technology, improving our security and reducing costs to make our rates more competitive.

AIT Profiles: It sounds like developing the Portal with Drupal open source software has been a good experience. Do you have any final thoughts or advice for our readers?

Rob Weis: If you haven’t considered open source in the past, now’s the time to take a deeper look at what might be possible for you or your company.

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 Copyright © 2010 Apropos LLC. All rights reserved.