The departmental medical secretaries are often working at full capacity and it is rarely possible to reduce headcount and achieve targeted turnaround times for clinical correspondence: indeed most Trusts have to use expensive temporary staff in order to hit those targets.

However use of DICT8’s UK based medical transcription service can solve these issues. Outsourcing transcription enables movement away from large numbers of band-4 medical secretaries being used inefficiently as well as completely cutting out expensive bank and temporary staff.

On average DICT8 provides a 60% reduction in the cost of medical transcription over existing costs as well as transforming fixed into variable costs.

There is no initial set-up cost (although you will need to have digital dictation machines), monthly minimums or standing fees- you only pay for the transcription that you put through; and you can put through as little or as much work as you require- you keep control.

It is becoming increasingly important for Trusts to reduce their clerical budgets- DICT8 have helped over 50 NHS Trusts to do so over the past few years- please contact us to find out how we can help you to do so.

Reduction in cost of medical transcription

• In house medical transcription is financially inefficient – Reduction in overall cost of over 60% is often achievable.
• We can also help you to cut your reliance on expensive temporary agency staff.

Medical Transcription becomes a variable as opposed to fixed cost

• Due to the fact that you would be paying for transcription as it is needed as opposed to paying staff full-time the budgeted fixed cost becomes a variable one.
• Improved cost-efficiency on administrative functions.
• Enables the use of other budgets within the department.

Functional Benefits

Reduce Turnaround times on letters

• We can reduce turnaround times from days/weeks to hours (our average is 2 hours 34 minutes). This has a significant impact on clinical care.
• Improvements in clinical care help to achieve targets. Indeed medical transcription outsourcing is often one of the cheapest, quickest and most straight-forward things that can be done to help achieve the 18 week target.
• Less time is spent by secretaries in dealing with GPs/ patients who are waiting for letters.
• This enables the Trust to achieve targets that are critical for star ratings.

Reduce need for cover staff

• When internal secretaries are on annual leave or sick, there is a need to get temps or bank staff in for cover.
• Cutting out inefficient temp/bank staff provides an instant cost saving. We believe that our costs work out approximately 70% lower than temp staff.

Reduce management pressure to recruit staff

• This occurs for both cover and full-time staff. This has become increasingly important due to the reduction in medical secretaries that are available in the employment market as fewer enter the profession.
• Management resources can be allocated to other areas.

Allows internal staff to change roles to more of a PA role

• Due to the reduction in specialty specific knowledge needed due to typing being outsourced, staff become not only more mobile within the trust (improving efficiency) but it also allows for recruitment of lower pay grade staff in many roles.
• Reduction in the average pay level for administrative staff. NB. this is in addition to the reduction  in overall administrative staff numbers.

Maintain critical functions of staff

• Experienced medical secretaries provide a clinical safety net that cannot be replicated by voice recognition.
• Experienced medical secretaries will always be better than voice recognition, or poorly qualified temps, as they will understand the medical context of the dictation and will spot clinical dication errors and ensure that the letter makes sense- reducing clinical risk.

• Medical secretaries often act as safety nets for their clinicians. Doctors may make mistakes in their dictation (e.g. dosage and other clinical errors), a human secretary will notice, bring them to the attention of the clinician and correct those, whilst a voice recognition computer lacks the common sense and contextual understanding to do so.

• The grammar and general English used in many medical dictations is poor: whilst human transcribers will endeavor to re-order the letter so that it is clear and easy to understand for the recipient, voice recognition will not be able to do so.

• As in all other fields the great advantage that human involvement has over computer automated systems (e.g. voice recognition) is that of common sense! A letter transcribed by a computer program may contain patently absurd phrases whilst a human has the common sense to ensure that the content and context of the transcript make sense.

• In order to use voice recognition effectively it is often necessary to train both the system into the dictating clinician’s voice and also the clinician themselves to dictate in a particular way so that the system understands them. This is not only antagonistic to the clinicians but also causes problems where new or locum staff come into a department.

Hospital benefits

• A significant reduction in the turnaround time of dictation tasks from several weeks to just a few hours: increasing administrative efficiency within departments and aiding the attainment of star ratings.
• A significant reduction in the cost of dictation – approximately 50% – will often be achievable.
• Little to no start-up costs.
• Management can audit workflows and usage through their own administrative interface that allows them to see what is happening at any time and control cost.
• DICT8 utilises the skills of experienced UK based transcribers – this can lead to a reduction in the error rates suffered by many Trusts.
• Reduction of managerial pressure to find adequate secretarial coverage, as older secretaries retire and to cover sick days.
• Reduce temporary staff costs.
• Transfer fixed administrative overheads to a variable cost.
• Allow secretarial resources to be diverted to more of an organisational/PA role.
• Established system already in use by other Trusts.
• A secure system that complies with Caldicot, NHS guidelines, e-GIF and the Data Protection Act.
• Extremely low impact on Trust IT systems due to the system being browser based – you can start using the system quickly without IT problems.
• Straightforward integration with existing PAS systems (if required) to enable automatic saving of letters and notes to the patient record and population of letters with addresses etc.

Doctor benefits

• Reduction in turnaround time will enable the doctor to actually remember the consultation when signing the letter.
• Easy to use interface that works with MS Internet Explorer
• Very little change in working practices for staff – hence no retraining required.If you are interested in discovering more about DICT8′s Medical Transcription Outsourcing solution then please contact Dr. Michael Urdang on murdang@dict8.com or contact our sales department.

Finding Options for the Typing of Clinic Letters

Each year when our Trust scrutinises our budget, apart from salaries it is the quantity of paper that we go through that causes the most comment.  “What do we do with it? where does it go?”, are amongst the questions.  I emphasise that this is what we do; we write to the many people involved in the management of the complex, multi-system conditions that we see.  In mitigation, I point out that we have no drugs budget and communication in genetic counselling is our fundamental raison d’etre.  With this goes typing and lots of it, bundles of notes and tapes that overflow our office shelves.  We have had six or at times, eight week backlogs for letters going out when staff illness, especially the risk of repetitive strain injury (RSI) or holidays impact on the service. 

So there we were in middle of 2007, up the creek without either a paddle or a typewriter in sight.  We needed a fix and quickly and agency staff were proving expensive, of variable quality and unimpressive reliability.  We had heard that some clinical genetics centres around the country were using overseas typing agencies to handle their work and on our behalf the Trust explored this. We made the stipulation however, that we wanted it to be UK based to maximise the quality of the typing and their assurances for confidentiality. We were directed towards the Dict8 scheme (www.dict8.com) which quickly became very popular with our service.  It has been easy to introduce, the quality of the returned material has been as good as anything previously typed in-house and the speed of return has been breathtaking, sometimes as little as two hours from dictation to delivery back via their website.  The returned text still needs to be formatted into appropriate letters and printed out for signing and there is the cost of this Rolls-Royce service.  

Initially the four Consultant Clinical Geneticists were equipped with hand-held digital recorders, (Philips 9360), but we quickly added four more for the SpRs and a further three to share amongst our genetic counsellors and trainees.  The Phillips recorder is battery operated (a set of AAA batteries may last about 2-3 weeks) and does not need to be plugged into a computer to be used.  It is very similar to a conventional hand-held cassette tape recorder and the dictation is stored on an easily accessible memory disc (about 1 inch square) that can hold more than 50 sets of clinician and patient letters.  With digital dictation you can edit your dictation, insert additional text, mark and delete a passage even before it is sent for typing.  Once dictated onto the memory disc, the voice files of these letters can be accessed, copied or deleted by connecting the digital dictaphone into the USB port of any computer in the same way that you would read a USB memory stick or a camera photocard.  No special software is needed for this.

Dict8 have a dedicated website with password protected log-in for each member of staff.  This allows us to upload our dictation into the dict8 secure workspace area.  I finished one clinic at 5.30 pm and uploaded my dictation files at that time.  It is very easy to see which dictation files have been uploaded, and then those dictated files that are in the process of typing.  Returned files are tagged with the Genetics file number for that family and can be opened again via the password secured website into a Word document and saved in whatever format you choose.  Clinicians can check their letters on screen at this point and make any minor changes that are needed.  A secretary or clerical member needs to top and tail the letter into the desired style and format for your clinic service ready for signing and posting.  Our liking for the system is its sheer simplicity, that you take to it so quickly and it is so user-friendly. The quality of the returned typing is excellent including genetics terminology.  We are assured that all the typing is done in the UK by carefully vetted secretaries with several years experience of medical typing.  An advantage for us is that letters can be composed with patient names and addresses, reducing the risk of merging anonymous text with potentially the wrong patient identifiers.  It seems to work in all aspects providing one is confident of the integrity and confidentiality of the dict8 typists.  We understand the typing staff work from home picking up the work via the secured website.  They are self-employed and paid on a piece rate for the typing they return to the dict8 website.  In fact one of our previous secretaries is now working for them!.  The dict8 website and any work to be uploaded or retrieved can be accessed from any computer connected to the internet.  Literally letters can be dictated from clinic in Crewe, uploaded in Upton and the letters will be ready in Liverpool, often within 12 hours.  The speed up in our letter process has been truly phenomenal, without the need for any complex training or compromise in the quality of our letters.  

Written by: Dr Ian Ellis   FRCP BSc Consultant Clinical Geneticist. Text from the full article has been used with the kind permission of the author and the BSHG.

This is an abridged version of the article that original appeared in the February 2008 issue of the British Society for Human Genetics Newsletter. You can download the issue (38) here – the article is on page 44.

All of our transcribers have significant experience of working as full time medical secretaries in either NHS Trusts or PCTs. All work done by them is specialty matched: only neurology transcribers do neurology work etc.

On average our transcribers will have 11 years of full time experience within a Trust as medical typists, and it is for this reason that we believe that the quality of typing provided by the DICT8 service is higher than that of any other.

The principle benefits of UK based typing include:

• Higher quality work, especially where medical terms are concerned. This is due primarily to the fact that experienced medical secretaries will understand the context of text within the dictation.
• Less checking required at the Trust end: checking through poor quality work is the hidden cost of medical transcription. If Trust staff have to check through and correct poor quality offshore transcription then it will result in a significant addition to the overall cost to the Trust.
• Reduction in clinical risk: medical secretaries will often act as a safety net for their clinician checking their letters for clinical errors in dictation, hence reducing clinical risk. This can only be replicated by transcribers that understand the context of the letter through extensive experience within that specialty.
• Data security:  CfH has  gone on record to declare that medical data should not go outside of the EU until such time as the regulatory framework has been improved. No medical data leaves the UK in the DICT8 system and is therefore subject to UK data regulations and safeguards- these would be hard to enforce in, say, Asia. There have been many newspaper reports regarding offshore data security such as this expose reported by the Mail on Sunday, this article in the Sunday Times and this one in the Telegraph.
• Lower real costs: whilst the headline rate for offshore transcription may be lower than that of having it done by proper UK medical secretaries, the actual cost is higher. This is due to the fact that if work is being done offshore by inexperienced ‘call centre’ type staff then there will be a significant cost involved in your staff having to check through the work and correct the mistakes made.
• Political issues: outsourcing is always a politically contentious issue. We have found, however, that the greatest fear is that of secretaries jobs going offshore. Due to the fact that DICT8 utilises the skills of transcribers very similar to that of existing staff (and does so within the UK) use of the DICT8 system is often far more acceptable to existing staff. Unison condemns offshoring…

“The extent to which you can move data around will constrain the outsourcing/offshoring. At the NHS we have not crossed the line in terms of data being processed offshore; data will not go outside the European Union until there is a regulatory framework in place.” Richard Granger (whilst DG of IT for NHS)

One of the concerns that people have regarding use of a web-based system is that of security. Our system is secure meeting NPfIT and eGIF standards (we would not have been able to implement in the large number of Trusts that use our service otherwise). Please click here for more information regarding security.

The implementation process is as follows:

1. We discuss your requirements with you. Due to the fact that we only provide UK based Medical Transcription services and have supplied to a large number of Trusts, PCTs, Clinics and Private Practitioners around the country, our experience of various organisational structures and working practices can be of real benefit during this process. The DICT8 system has been built with flexibility in mind- we endeavour to work around you and not get you to work around us.
2. You are assigned a dedicated account manager.
3. We supply you with dictation machines. If required we can supply digital dictation machines, they can be procured elsewhere if required. DICT8 will work with most modern digital dictation machines.
4. We set up your user accounts. This is a straightforward process and can often be done within 24 hours. There is no charge for setting up accounts (and indeed no start up costs other than the purchase of digital dictation machines- if required). Further accounts can be added at any time.
5. We supply manuals and training as required. Your users will also have access to freephone and web support.
6. You start using the system. In most cases implementation will take 48 hours.

Having reviewed all functions, one area of concern identified was the time it took to produce clinical letters once dictated by consultants. The solution was Dict8!

Dict8 provides a very fast, efficient and affordable transcription service that doesn’t compromise on quality. We are finding that our clinical letters are now being transcribed and sent back to us within a matter of hours and are of a very high standard. The solution is very user friendly and we have experienced zero technical difficulties since its inception. The hospital has also built a strong working relationship with the company and they have facilitated the implementation of Dict8 effectively. The solution has been very well received by the consultants involved in trialling Dict8 and as a result of a very successful pilot we are now in the process of rolling out Dict8 to all consultants. Dict8 provides a solution that should be given serious consideration by anyone wanting to improve the efficiency of their back office functions.”

OLIVER BENNETT
Assistant Directorate Manager
University Dental Hospital of Manchester
Central Manchester University Hospitals NHS Foundation Trust

June 2009

“Once again, I am amazed at the quality of some of the transcription. Whoever did my reports yesterday was absolutely brilliant. I approved 12 reports without having to make a single amendment. Please let the person know. After 25 years in the game, I know how difficult this is to achieve.”

Dr SIMON BLEASE FRCR FFSEM
Consultant Radiologist
Medtel International

August 2009

Unsolicited comments in an email

See what CITY HOSPITALS SUNDERLAND NHS FOUNDATION TRUST said about us in a report to the board of governors in March 2008 on Page 6 of the document here

1. A record to enable future Doctors and care givers to understand what took place at the time of the patient’s arrival into the hospital.
2. To enable a legal document which can record the thought process of the Doctor at the time of patient consultation.
3. A document from which healthcare finances can be organised.

Arguments are made in favour of tick box templates and that the record is
immediately available for future health carers. In contrast to dictations can take some time to come back after transcription. But the real reason for template use within Emergency Rooms in the US and perhaps in the UK, is that it is much cheaper than dictation and is also easier, as the skill of dictation is not learnt by Emergency Room Physicians. My concern, however, is that tick box templates may result in an inaccurate record of what happened. I worry that medical staff will get used to ticking all the boxes without actually taking time to accurately process the examination just completed. Some of the template schemes I have seen do not have enough space next to the boxes in which to put an elaboration on the physical exam. It may also be that the incorrect box is inadvertently ticked. However, most importantly, such a brief record of a patient visit leaves almost no memory of the patient within the Doctor’s mind and this can have medical legal consequences if the chart needs to be reviewed sometime in the future as the Doctor will have a very poor record of his thought process at the time.The ideal system would be to have some combination of a charting systems. Here the doctor is prompted so that he does not forget certain exams and the chart also leaves adequate space for elaboration which could be filled in via dictation in predetermined zoned areas. Dictation works by also enabling thought processes to be conveyed in a legible manner. It is frustrating to try and read the illegible scribbles written on a chart by time pushed doctors with poor penmanship.

In conclusion, I believe that dictation of charts enables continuity of care, medical legal defence and appropriate costings to happen in a smoother and more efficient manner which in turn creates cost savings that eclipse the up front higher costs ofthis process.

By Dr Sebastian Zeki – January 2008

Long before the NHS, healthcare systems in the UK have relied on letters to detail patient consultations to others, including the patient themselves. The importance of a documented account of the meeting between patient and doctor becomes more evident the more complex healthcare systems become. It acts as a legal document, a note of reassurance, an exact layout of a treatment plan, and as such it becomes a documented trace of a patient’s journey through a complicated system.

The letter has not been replaced by newer technologies, such as phone, and email and in fact the NHS produces an estimated 12 billion lines of written text from consultations every year. This number continues to rise. The success of the letter may be partly a function of the disparate development between letter delivery systems and email or other telecommunication systems (the former having been around for hundreds of years) as well as it being more nebulously trusted.

My daily life is consists of the reading and writing of letters, and it is on these that I largely depend to tell me about a patient. I may see a patient in clinic and make decisions that will need to be acted upon urgently so I need to know that the letter that is dictated in clinic will be delivered. This is the problem with letters- there are too many stages between its creation and its delivery. I dictate, the tape is sent to the secretaries pile, and a week later I get to check the letter for errors. If there are none (if), it gets sent.

The problem is more clearly illustrated with a patient I met whilst doing an oncology job. The patient had recently been diagnosed with lung cancer, I had to dictate a letter to his GP so that he could have the adequate amount of oxygen in his house, as well as to the palliative care team who would look after his symptomatic needs at home. The letter was dictated. A week later I got a call from the GP to tell me that the patient had died, unexpectedly for the GP, at home. He had not had the palliative care support and apart from his family, had not had anyone to care for him during his final days. He had also not been given the oxygen he required at home. I went upstairs to the secretary’s office to find my badly spelt letter awaiting correction.

The advantage of digitising the process is that it is faster. The letter gets dictated and uploaded. Twenty minutes letter it is typed (often with minimal if any errors) and ready for signing. It can be emailed, or even sent for mailing at the click of a button. The additional advantage is that the letter can be retrieved easily. There is no need to dig through four volumes of notes as the letter can be found with a simple search. The whole communication process is sped up to the extent that information can be shared between practitioners before the patient has even returned home from a consultation.

I am a great advocate for the paper being in the hand, but before digitisation of the process, we were failing to deliver with the haste that healthcare needs to provide anything worthwhile. The faster the communication, the better for the patient.

By Dr S Zeki