Meditab Software Inc.'s Intelligent Medical Software, combined with speech recognition software from Nuance Communications Inc., helped the South Nassau Communities Hospital dramatically reduce its reliance on paper-based charts, lab reports and registration forms. See how this improved efficiency in this case study.
As director of the Surgical Oncology Department and chairman of the Department of Surgery at South Nassau Communities Hospital, Dr. Rajiv Datta typically spends only two days each week in his office.
A stack of 100 charts used to await him on every one of those days.
Every cancer patient at the hospital generated multiple forms, ranging from registration, HIPAA releases, medical histories and prescription lists -- five per patient on average, Datta said. Frequently there were test and lab orders and results, as well as hand-written examination notes and follow-up orders.
"I couldn't enter my room, there were so many charts," Datta said.
Datta's battle with paperwork grew increasingly time-consuming and demoralizing. A document imaging system combined with speech-recognition software, however, revolutionized the way the surgeon, his nurses and his office staff interacted with, monitored and tracked their patients.
Finding the right fit with Meditab
Datta began looking for alternatives to paper-based processes six years ago. Ultimately, he checked out seven practice-management and electronic medical records (EMR) systems over six months, putting a trial version of each system through its paces.
Eventually Datta selected Meditab Intelligent Medical Software (IMS); its electronic approach most closely mirrored his practice's paper-and-pen approach, he said.
"This one clicked because I was familiar with the way the processes flowed," Datta said. "At any point, you can look at the patient's past history, X-rays, test results. From one patient screen you can jump into any other patient screen. That I liked."
Meditab's files also include patient photos, which are taken when a new patient registers. Patients are impressed when doctors recognize them, Datta said. "It definitely helps us improve patient care, patient flow and response time," he said.
Complementing Meditab with speech recognition software
Looking to resolve the time-lag associated with his office's existing practice of sending notes out to be transcribed -- a process that could involve as long a turnaround as two days -- Datta also looked at speech-recognition software. "I had to get through the patients in the same day, and the transcriptions and letters to physicians were lagging behind. It was becoming a nightmare," he said.
Datta opted for Nuance Communications' Dragon Naturally Speaking application. Now he and his staff receive finished dictation before they leave the office.
"Since the software is accessible from any site, as records come in by fax, they get attached to the patient's chart," Datta said. "I can appropriately respond to the front desk, the nurses. There's nothing waiting for me. Everything is current."
Adding customized templates to Meditab
Because no one size fits all medical specialties, Datta also needed flexible documentation software.
Datta wanted screens that used complete sentences instead of bullet points to describe a patient's symptoms. Working with the hospital's IT staff and Meditab programmers, he created templates for cancer diagnoses.
If I get a call from a referring physician, the front desk doesn't have to leave and find a chart.
Dr. Rajiv Datta, Director of the Surgical Oncology Department and Chairman of the Department of Surgery, South Nassau Communities Hospital
To capture all the necessary information, Datta had to proceed line by line. For example, the template for a diagnosis of breast cancer included such details as left or right breast, mass, and size. The result of filling in the details was a sentence like this one: Mrs. Smith is a 27-year-old female patient with a cyst in her left breast.
The process took about six months. "It was torture, but I kept at it," Datta said. "Behind each part of the sentence, we had to write even more detail. When you click a button, everything gets written into the sentence."
The team repeated the process when it created templates for exams, as well as for other forms of cancer, such as colon and skin cancers. "You click, and a normal exam [outputs] a sentence. If somebody has something wrong, like pain in the abdomen," that outputs a sentence as well, Datta said. "I really went into every aspect of the human body."
When the software development process ended, the next step was to get buy-in from nurses and the front desk staff, the latter of whom would be using the system to register patients and schedule appointments. "For six months I had to hold onto the paper charts until everyone was comfortable," Datta said.
Some employees resisted, but because doctors, not the IT department, were behind the software implementation, the transition had fewer hurdles, Datta said. "It has to be self-motivated," he said about the move to a software-based system. "You can't have it thrust on you."
Setting up secure access to Meditab
Along with the Meditab implementation, the office installed a wireless network. This lets Datta, his partner and his nurses access patient information on their laptops anywhere in the facility.
"If I get a call from a referring physician, the front desk doesn't have to leave and find a chart," he said. "They tell me, 'Dr. Smith is calling about Mrs. So and So,' and I can see her information immediately. It improves my performance so I can spend more time with the patients and get things done -- and my desk is always clean."
For security purposes, Datta's office was linked to the hospital's network. This means that users must log onto the hospital's VPN to access Meditab. In addition, some users, including the office's billing company, have limited access to the software.
Although it took time to research, customize and launch Meditab, the payoffs were far-reaching and almost immediate.
"Once we went truly paperless, we saw the benefits within a month because it was less workload for everybody around the office, better patient care and better performance on my part," Datta said. "I just wanted to make life easier for everyone."
Alison Diana is a contributing writer based in Orlando. Let us know what you think about the story; email firstname.lastname@example.org.