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How to train your Dragon: Mackay leads the way in voice to text

31 August 2023
| 1 comment
By Kate McDonald
Image: iStock

Some of the largest hospitals in Queensland are planning to roll out Nuance’s Dragon Medical One (DMO) voice recognition system following a widely applauded pilot at Mackay Hospital and Health Service (HHS) in 2021, which saw the turnaround time for GP and specialist letters in the outpatient department reduced from 30-40 days to one day during the pilot.

The solution has been integrated with the statewide Oracle (Cerner) ieMR as well as the MetaVision ICU system following the successful in Mackay Base Hospital’s emergency department.

The pilot has seen a large reduction in time spent on clinical documentation, with pilot participants dictating on average three times faster than their typing speed and releasing between one and 30 extra hours of clinical care per week, as well as reducing the time taken to process a clinic letter out to a GP from 30 days to one.

The chief digital director for medical services at Mackay HHS Pieter Nel told the MedInfo conference in Sydney recently that the pilot began in 2020, when Nuance approached the health service with the offer of 25 licences for DMO, which were distributed between ED, surgical and mental health. Five were provided to ED, with four being allocated to senior doctors and one to a nurse practitioner.

COVID made the trial difficult, although Nuance continued to provide training virtually. Clinicians used Nuance’s PowerMic Mobile device or their mobile phone microphone to dictate into DMO, and they can also access the system on tablets, desktops or workstations on wheels. It is also embedded with Microsoft Word and Outlook. Nuance Communications is now part of Microsoft.

Dr Nel said he had previous experience with Dragon in 2010, when the product needed training to be able to recognise the user’s voice. Dr Nel’s strong South African accent proved too difficult and he gave it up, but has found that the contemporary technology no longer needs to be trained.

Dr Nel said there was a degree of scepticism from his medical colleagues when trying out DMO, but seeing the words appear directly in the patient record soon got the early adopters on board. It can be used not just in the ieMR but in the MetaVision ICU system and also for emails, any legal statements and for referrals.

The trial showed results almost immediately, Dr Nel said. “What we did say is, when we did roll out to all 25 people, including all five in the ED, we compare it to the state average of documentation. At that stage it was at around eight, nine, 10 minutes per per clinician in the statewide. Compare our five clinicians in the ED, we did start off immediately a saving of two minutes. And we have reduced it even further.

“That was for us a huge selling point. We did calculate over that three months we did use DMO across the hospital, we had a saving of 140 hours of work. In dollars, conservative wages, we did save about $87,000 in that three months between the 25 licenses.”

Other advantages included workflow in the ED, where previously the clinician was focused on the screen. Dr Nel was able to immediately jump from his average of 26 words per minute with two finger typing to 120-150 words per minute. He also believes there will be a reduction in burnout.

“We’re going home on time suddenly. And not only going home on time, your words, because you do it in real time, is actually very more accurate. And when that case comes back tomorrow, there’s beautiful notes already been written in real time and accurate. Everyone could take their breaks, they could go to the coffee shop and get their coffee without feeling guilty.”

The next phase involved rolling it out to the rest of the hospital, with the state health department coming up with some money to fund 400 licences across the service, including rural facilities, as part of a patient flow initiative.

A program manager was appointed to roll it out to the rest of the service, and Dr Nel happily became a salesperson for the technology. A booth was set up in the coffee shop so clinicians could see it and play with it, and a QR code was set up to book people in for training.

New functionality was also developed during this phase. One was a time stamp, which allows users to record a time stamp at the click of a button using a Cerner token. This was found to be particularly useful in trauma situations, allowing scribe nurses to press the button to record the exact time when a procedure such as IV or intubation is done.

“That worked for us brilliant, because afterwards a really intense resuscitation, you have to go back and sit there and do your notes,” he said. “And quite often we have quite intense disagreements about what time was this given or that given. And now with this, it takes us probably two minutes to do our documentation work, whereas previously it took us up to half an hour to complete documentation.”

Another benefit was outpatient letters, he said. The HHS was aware of a lack of letters going back to the GP, and if they did go out, the GP often had to wait weeks. “Now that the doctor is using it in outpatients and sent it through the message centre to the typist, they drop it on template, and the next day the outpatient letter is arriving in the software of the GP.”

The trial also developed new PowerPlans in the ieMR. PowerPlans include groups for regular orders for the nurse for ordering pathology, radiology and medication. This previously took about four minutes, Dr Nel said, but now it takes about 20 seconds and has also helped to standardise the process.

Dashboards have been used to compare progress, which has also had the effect of encouraging uptake as people’s competitive instincts took over and they are now competing to do better than their colleagues. The dashboards also show a cost comparison, showing how much time it takes to document with DMO versus typing and how much this saves.

Dr Nel said the project was still in its innovation curve, with some sceptics still to be convinced, but it is now being rolled out to the rest of the health service, to rural facilities, and to interns. All clinical staff starting at Mackay Base Hospital will be allocated a DMO licence and be trained in its use, he said.

One comment on “How to train your Dragon: Mackay leads the way in voice to text”

  1. How are the privacy implications of Dragon Voice being handled? From what I understand, the voice inputs are being used to train Dragon’s machine learning models for text-to-speech. This raises the question of how the source data is being handled and whether clinicians are consenting to their clinical interactions being used to train these models.
    I understand that this was only a letter transcription service, but Dragon is also making a play for recording whole clinical sessions (including patient voice) and transcribing clinical summaries. That part of the system certainly shouldn’t be rolled out without specific patient consent.
    However, the main limitation I see with using text-to-speech in a hospital environment is the background noise, most doctors write their notes in shared work areas where this sort of technology is unlikely to perform well.

    • Name - Frank

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