University of Kentucky Healthcare (UK HealthCare) in Lexington, Ky. recently transitioned to a new medical transcription service and data mining solution from Atlanta-based Webmedx. Already implemented in two of the three UK HealthCare campuses, CMIO Carol Steltenkamp, M.D., talks to Healthcare Informatics ’ associate editor Jennifer Prestigiacomo about the benefits they’re already seeing from the system.
Healthcare Informatics: Can you tell me a little about how the integration between your transcription service and your campuses is going?
Carol Steltenkamp, M.D.: The Chandler campus [the Lexington, Ky.-based UK Albert B. Chandler Hospital, UKHC’s main academic medical center] [is linked] to Webmedx, and that relationship is going well. We [just integrated] the other campus, a community hospital [UK Good Samaritan Hospital] that we acquired about three years ago. On June 27 we brought 49 systems onboard. With the nature of a community hospital being what it is, there had been some special circumstances and some arrangements made to handle different physicians and their personal requests in how they like to do things. I’ll give Webmedx credit; they helped us to support what was appropriate to support in helping us to ease the transition for some of those doctors to change the way they had always done it that really wasn’t the most effective, efficient way of doing dictation transcription.
HCI: With the three choices for physician documentation [physician self-completion with front-end speech, medical transcriptionist editing with back-end speech, or traditional transcription], do you know which option has been most popular thus far?
Steltenkamp: No, I don’t. And again, it’s easing in those physician preferences so that it best meets their workflow and gets the necessary information into the system. But I say overall when you take everything into consideration, it’s going to be mostly back-end. That’s been the in most hospitals the traditional way it’s been done, as was the case in this hospital[UK Good Samaritan Hospital].
HCI: What do you plan on using the data mining solution to do?
Steltenkamp: Because we opened a 52-bed emergency department [the Lexington, Ky.-based UK Chandler Emergency Department] we had to postpone our go-live with the analytics. I’ll tell you how it works, and how we plan on using it. They are able to find terms [through] natural language processing. The terms that we ask them to look for helped us to get information back, so that saves our quality people the time from having to comb through every dictated report to find information. And one of the [quality elements] we’re going to be going after is the ejection fraction. In the natural course of dictation, when one of our cardiologists is doing an echo [echocardiogram] or a cardiac cath [catheterization] report, we are looking forward to pulling out [that information] using the analytics tool.
HCI: Why did you decide to start by mining ejection fraction results for acute myocardial infarction and congestive heart failure patients?
Steltenkamp: Because that has been something that in many instances we need for our quality reporting as it relates to our patient safety goals and CMS [Centers for Medicare & Medicaid Services]core measures
HCI: Will this be one of the quality measures you will be reporting to CMS in 2011?
Steltenkamp: Yes.
HCI: What other clinical elements are you looking at or will be mining in the future?
Steltenkamp: Some of the others as we look toward [the future] will be noted compliance to medication, so how well the patient reports that they are doing. So, that is going to be another big one. Also, the kind of education they got regarding their medication and their self-report if they are taking it or not.
HCI: How has this solution helped your health system reach meaningful use requirements?
Steltenkamp: The meaningful use requirement in 2011 is a little more general, whereas the analytics reporting gets down to some very specific things. You get to pick your quality measures. So, in that sense, the quality measures that we specified that we’re going after, the analytics products will support that.
HCI: What cost savings, if any, have you seen since adoption?
Steltenkamp: No ,we have not, but here’s my anticipation: I think we’ll have cost savings in the sense those folks who are now having to comb through those dictated reports and get those pieces of information. When we’re able to make that a standardized report and pull that out electronically, I can take those very same folks and put them toward something else, as opposed to in the [past] I’d have had to hire an FTE [full-time-equivalent] for.
HCI: As a companion question, what time savings have you seen since adoption?
Steltenkamp: The same sort of things. For example, let’s use a cardiac catheterization. That’s a very detailed report, so for them to have to go in and fill in the numbers all the time, that’s probably not optimal use of the physician’s time if I would have that templated in the electronic medical record. But they’re able to rattle it off in a dictation form, and now we’re able to pull that out from there. Because some folks will look at that and say, ‘Why don’t you just make them put in a templated note?’ And therefore it becomes a discreet piece of information you could actually pull against. But you have to look at the clinician workflow and say, ‘It’s my job as a CMIO to support their workflow, and at the same time have a solution to pull out [the data] and do the quality reporting on the backend, while not disrupting their workflow unreasonably.
HCI: Why did you go with Webmedx as your transcription provider?
Steltenkamp: At the state academic medical center [UK Albert B. Chandler Hospital], we did a very lengthy RFP [request for proposal ] and had about 10 different vendors come in do demonstrations, and this was after the round of questioning. And we felt that Webmedx was the best company to meet our needs. I’ll tell you, we didn’t pick them on the analytics alone. I always use a baking analogy—the analytics is the icing on the cupcake, and it comes with it. On the evaluation we didn’t let them talk about analytics because that is not what we asked them to respond to. So we partnered with them on the basic core transcription services, and now we’re moving forward with them on the icing, the analytics.
HCI: Can you tell me a little about your core clinical information systems?
Steltenkamp: Our main clinical system is [Atlanta-based] Eclipsys Sunrise Clinical Manager, and the Webmedx dictation flows in through SoftMed 3M [the Silver Spring, Md.- based 3M Health Information Systems] and then comes into our Eclipsys product because that is where most of the clinicians live and work. We began computerized physician order entry back in 2005; so we’re completely live with CPOE. We are live with documentation on the EMR with everyone except physicians. We’re using transcription and a combination of templates for our physician documentation, and we’ll have that completed within the calendar year.
HCI: How do you use templated notes within your EMR without losing the patient narrative?
Steltenkamp: It’s interesting that you ask that because we’ll continue to support dual models. One will be that the clinician can use a templated note because sometimes that is easy to do, it is standard each time. For instance, an example of a procedure note, like if I’m going to do a lumbar puncture or spinal tap. I do it the same way every time. That procedure note makes sense to me; I can fill in some blanks. But I’m a practicing pediatrician, and I’m going to do an evaluation of a child who potentially has ADHD, that’s very individualized, so we need to offer someone in that instance, the opportunity to pick it up and give that individual narrative through transcription so that’s not lost.
HCI: Were there any challenges when adopting this transcription service?
Steltenkamp: Not really. It’s pretty standard as far as building the interfaces to make it happen. Webmedx had done it before, so we were working with them to replicate that and have it come into our system pretty easily.
HCI: Anything else you’re excited to be doing with this service in the future?
Steltenkamp: We were awarded a regional extension center [REC] in the state of Kentucky [The Office of the National Coordinator for Health Information Technology awarded the University of Kentucky Research Foundation $6 million in April 2010, along with funding for 27 other RECs.] As we’re looking to have more and more information available, I think it’s really exciting to improve population health and research in the future.
