* For the purpose of comparison, statistics were recorded for the six-month periods ending July 31, 2001 and 2002.
Midwest Physician Center’s soft dollar savings, including labor force, courier, and facsimile reduction, have further strengthen their bottom line.
The transition from a paper to an electronic workflow has not only cut costs, but improved productivity, quality, and patient care throughout MPC. With these small but important innovations, Midwest Physician Center has strengthened their commitment to its founding core values of excellence and innovation. Moving forward, MPC will continue monitoring and improving hard and soft-dollar savings in their commitment to Total Quality Management.
Disclaimer:   This case study is provided by EMDAT, a technology partner of eMedDox, LLC.  eMedDox is a leading medical transcription company using the EMDAT medical transcription software platform.

CASE STUDY #2

Creating a Transcription Paradigm Shift:

From Paper To Plug

One of the most significant clinical processes, aside from the tactical task of health care itself, is medical dictation and transcription. The simple goal of communicating a patient’s medical history and results from one day to the next and from one clinician to the next can make the difference between progress and failure within the given patient’s care.
Despite its obvious importance, dictation and transcription processing hasn’t advanced as much as would be expected with the onset of technology, email, and the Internet. Dictation is often recorded on microcassettes that are delivered to the medical transcription firm, whether in- or outsourced. This time consuming and labor-intensive procedure contradicts the urgent nature of health care itself, as time delays in delivery and processing can hinder ongoing care decisions and surgical preparedness.
Southern Illinois University Medical Center (SIU) is a state-assisted academic medical center located in Springfield Illinois. The center’s medical research has provided continued growth in biomedical related economic development and clinical care for the past 32 years. The facility houses 500 physicians and offers both primary care and specialized services, many of which are unavailable at neighboring health care centers.

The Needs: Efficiency and Cost Reduction

Facing large-scale, costly government health care reforms including HIPAA, Southern Illinois University Medical Center needed a solution requiring minimal staff time and up-front costs. The center was not prepared to invest in an electronic medical record (EMR) due to cost and the state of current technology. Nevertheless, the inefficiencies caused by manual transcription processing needed addressing.
The Manual Process: SIU processed medical transcription in-house for the first 26 years of service. As the center grew, so expanded their administrative department. SIU began outsourcing transcription in 1997. Initially, outsourcing was a move in the right direction. Yet, it was soon apparent that more research was needed to further manage costs and quality.
Even through outsourcing, transcription records were still limited to paper and required filing of both the original plus a copy. Increased delays occurred not only in the delivery and processing of reports outside SIU offices, but also between final clinician sign-off and filing. Lacking up-to-the-minute patient information created many unnecessary obstacles to the informed delivery of health care to patients.
This process absorbed a great deal of staff and clinician time. All dictators were required to use the phone. Clinicians edited reports on paper. The report was then returned for correction and cycled back until approved for final filing. Reports were passed from hand to hand, and from clinician to referral physician to file, opening the door to erroneous, delayed, and misplaced information. Further, clinicians didn’t have easy access to patient data.
The Challenge: Burdened with a highly outdated, circulative, paper-intensive process, Southern Illinois University Medical Center began researching transcription alternatives, with cost being the main objective. They needed hard dollar savings. Prices were increasing and quality was not. During a strategic planning retreat, SIU faculty challenged practice plan administrators to find a system giving faculty, residents, and staff online access to clinical notes and correspondence within one year.
The Goals:

• Lower per-line cost through a competitive bid process
• Automate workflow from dictation to chart placement through online report review and signing
• Implement software that allows SIU to use print template technology, and thus reduce printing and per-line costs
• Offer Attending Physicians a range of options—mobile hand-held or telephone-based dictation
• Automate referral document routing and eliminate interdepartmental courier and faxing

Provider Research: A Side-By-Side Comparison

When selecting a new transcription provider, several vendors demonstrated their products and competed on ease of use and pricing. Three finalists received the same five sample documents and provided line counts and per line fees. Given this comparison, SIU fairly evaluated the range of fees charged by each company.

Selection Criteria

• Cost: eMedDox technology platform powered by EMDAT bid the lowest price per line and the lowest line count. Further, an additional 15 percent line count reduction was estimated through the use of print template technology.
• Workflow: All finalists demonstrated an automated workflow process. However, the eMedDox technology platform powered by Emdat was Internet-based, allowing the Center to use their existing network infrastructure. The software offered a straightforward review and electronic signature process and provided for printing of watermarked originals in designated record rooms once signed. Referral correspondence was transmitted electronically.
• Vendor Responsiveness: the eMedDox technology platform powered by Emdat offered customizable software and standard workflow to meet SIU’s needs. Site visits to SIU supported the technology platform’s claim.
• Facility Fit: Understanding SIU’s teaching environment. The software’s platform allowed the Center to tailor the system’s functionality to accommodate the resident/teaching physician workflow.

Result: The technology platform was selected on August 5, 2002.

Implementation: Reaching Our Goals

Implementation involved the training of 175 faculty providers and 250 residents on the system in groups of 15. Seventy-five staff members trained on the use of this system and 150 clinical staff trained on conducting document searches. Department network administrators volunteered to be trainers and now orient new faculty to the new system. Two operations staff managed relationships with the new transcription company and field user issues. An outstanding Clinical Computing staff supports them. Clinicians use traditional, user-friendly dictation devices. Thus, they were already familiar with functionality. Implementation was quick, smooth, and flawless.
Results: Total Automation Efficiency
Electronic Access. Clinicians and staff obtained instant electronic access to their notes and correspondence. Dictation is uploaded instantly from an SIU desktop to the transcriptionists. After dictation is transcribed, the Center has real-time, networked access to each patient file, allowing clinicians to immediately review, edit, sign, and route reports. Searches can be conducted by clinician, patient name, patient number or transcription number using the online web based software InQuiry® powered by EMDAT – a task that previously required hours of labor. Faculty, residents and staff view clinic notes from any PC in all SIU clinics or hospitals.
Faster Turnaround. The new electronic interface is faster and more secure than the previous internal mail distribution method. Dictation verbiage is sent electronically. Once a clinician signs off, the transcription is instantly printed at SIU’s medical records department and immediately filed.
Reduced Line Count. In addition to per line fees, actual line count is reduced on every transcription report. The Center takes full advantage of print template technology for repeated headers, footers, and variables based on user, location and department. Hard dollar savings are significant when 5-10 lines are shaved from thousands of transcription reports monthly. A total hard dollar cost reduction of 55% was realized the first year.
Accountable Operations. The eMedDox technology platform powered by EMDAT provides detailed management reports showing turn-around-time, unsigned transcription and up-to-the-minute line counts. The system enables accurate monitoring of status including dictation timeliness and final signature processing. Residents and Attendings are allowed two weeks to review and sign transcription reports. Because internal referral correspondence is sent electronically, communication between SIU specialists and SIU primary care physicians have become immeasurably faster.
The transition to a scalable, electronic transcription solution went beyond achieving the initial goal of cost reduction. Southern Illinois University Medical Center has electronically converted and streamlined the process from initial dictation to final records filing. Achieving operational excellence is an ongoing process and the technology platform by Emdat provides the analysis tools necessary to effectively manage quality in SIU’s clinical environment.
Disclaimer:   This case study is provided by EMDAT, a technology partner of eMedDox, LLC.  eMedDox is a leading medical transcription company using the EMDAT medical transcription software platform.

CASE STUDY #3

The Missing Piece In The Medical Transcription Puzzle

Using eMedDox Technology powered by EMDAT, Springfield Clinic Discovers A Solution For Clinical Transcription
Ask any health care CIO where major transcription companies primarily focus and you’ll receive the same, age-worn answer: hospitals. Yet, hospitals are merely one segment of the medical transcription industry. The other piece–clinical care facilities–are often overlooked or underserved by transcription providers that are unwilling or unable to meet their unique needs.
The major difference between clinical and hospital transcription is in information centralization. Hospital transcription typically uses standardardized report and letter formats requiring only individual provider personalization. On the other hand, clinical transcription may require many more macros and canned text, accommodating a highly decentralized environment.
Central Illinois’ Springfield Clinic manages 660,000 patient visits and produces over 16 million transcription lines annually. The Center relies heavily on transcription data capture. Clinicians regularly transcribe patient visits, Radiology and special procedures and ambulatory surgery center operative reports. These reports are accessed frequently. While Radiologists read visit notes, primary care providers routinely review specialist-generated consultation notes prior to each patient visit.

With at least two failed system implementations resulting from the transcription providers’ overriding focus on hospital functionality, Springfield Clinic began researching a more adaptable transcription option geared toward our decentralized, clinical environment.

Project Goals

Springfield Clinic’s project goals were two-fold. They required unique system functionality that would simplify, not complicate its clinical environment.  They also demanded high provider standards and service.

System Requirements

• Digital dictation files that easily download from PCs
• Single platform that delivers work to multiple internal and external locations
• Effort reduction and keystroke elimination
• Patient registration/scheduling system integration that automatically populates patient demographics into each transcription
• Online report access accessibility within their network
• Printing flexibility supporting multiple locations and printer models

Provider Requirements

• Willingness to understand unique needs of the clinic environment
• A choice in digital dictation devices

 The Selection Process
After detailing their system and provider requirements, and minimizing vendor selection, Springfield Clinic interviewed other clinics experiencing similar issues to see what they’d experienced. What worked? What fell short? They also interviewed customer references. After all calls were made, eMedDox technology partner EMDAT came highly recommended for its system flexibility, clinical adaptability, and cost efficiency.
Because of sub-par implementations in the past, Springfield Clinic began with a small-scale implementation of the technology platform, converting only one physician who already outsourced his transcription. During this and gradual implementations after, the clinic evaluated:

• Ease of handheld dictation upload
• Accuracy, stability, and completion of transferred digital files
• Ability to track redirected work
• Ability to view final transcription report
• Simplicity of printing
• Satisfaction of the user with online functionality and workflow

The Results

Distribution Ease: Prior to transition, the Springfield Clinic dictation tape distribution area looked more like Grand Central Station than a medical office. The clinic packaged and delivered tapes, along with a copy of the physician's schedule to one centralized location. Tape distribution was a large, complex issue. While many at-home transcriptionists drove to pick up tapes, couriers routed others. Tapes were again redistributed when one area grew backlogged. When reports were complete, some transcriptionists printed on-site and returned reports to the physician's office. Yet, more than half were printed at the Center’s main campus and shuttled to the appropriate building or department. The system, as can be imagined, was confusing, unorganized, and unmanageable.

After implementation, physical tape and report routing became obsolete. Springfield Clinic now delivers dictations and completed transcriptions electronically – instantly, all on the same platform. This has enabled the clinic to streamline communication and report tracking.
Information integration: A general solution was needed that improved productivity all around. The Springfield Clinic had three distinct transcription systems and multiple platforms. Before the switch, a clerk had to review all work file folders, applying a program to each file in that folder to determine line count. These counts were then transferred to a spreadsheet and maintained by each transcriptionist. This took time; and there was no uniform data repository.
The eMedDox technology platform powered by EMDAT connects in-house and outsourced transcriptionists, the clinic’s service bureau, and its current patient registration and scheduling system, so patient demographics automatically populate. The software uses a word expander similar to that used previously. Some clerical printing duties have shifted from transcriptionists to clerks. Line count is automatically generated online in real-time. There’s a uniform feeling across the function that productivity has improved.
Referral Deliver: Each clinician used to have his or her own method of physician referral. Typically, he or she dictated visit notes and included a brief cover letter for the referring physician; or the transcriptionist, using a macro, created this. The process involved typing patient identification data and occasionally block copy/pasting text from the visit note into the letter.
Now, referral documents are delivered automatically. Referral physicians that work inside the Springfield Clinic receive a copy electronically. Physicians working outside receive a paper copy via an automatic generic cover letter and envelope generation that pulls the referring clinician’s mailing address and patient information.

Online Availability: Transcription reports were not accessible online. Previously, providers were required to learn a complex folder and directory navigation to access information. The time involved was never worth the value added.
On the new web based medical transcription system, all transcribed reports are available online through an easy, user-friendly, and secure interface. The setup loads automatically on start-up and requires little download interaction. Clinicians enjoy the new look-up functionality and can verify that all uploaded files reach their destination. This makes everyone feel more secure.

ROI: Because of Springfield Clinic’s system conversion, they’ve purchased about 180 digital hand-held dictation recorders ($62,000), a server to handle telephone-based dictation ($12,000) and replacement PCs for the transcriptionists, as their five-year-old hardware was extremely outdated ($40,000). The clinic views all these as sunk costs because hardware upgrades were necessary regardless of the system they chose. However, in terms of return on investment, Springfield Clinic expects to recoup the cost in only two years. They also expect a 20–25 percent total line count decrease due to consistent 65-character line measurements and cover letter templates.
Although Springfield Clinic has taken great strides toward efficiency this past year with the system conversion alone, they will continue monitoring quality and efficiency in the future. With the tools integrated in the transcription platform, continued improvements have become effortless. Workflow automation has already saved staff and clinician time. The clinic has experienced immediate improvements in reporting and turn around time. Transcription processing has become a tightly managed function. Finally, the unique clinical transcription environment is being addressed.

Disclaimer:   This case study is provided by EMDAT, a technology partner of eMedDox, LLC.  eMedDox is a leading medical transcription company using the EMDAT medical transcription software platform.