How implementing digital dictation encouraged one trust to review its service provision

Every NHS trust is under pressure to improve efficiency while at the same time ensuring standards are maintained. With this in mind, we reviewed our dictation system to help improve the service we provide to our patients by using a more efficient and secure solution.  

Our clinicians at Birmingham and Solihull Mental Health Foundation Trust traditionally used analogue tape systems to record information, but this system was not entirely secure as tapes could potentially be misplaced and were not encrypted. This, along with the steady increase in workload, meant we needed to explore other ways for clinicians to record information.

With over 80 sites spread across a 172-square-mile region and a budget of £215m, BSMHFT is one of the largest mental health foundation trusts in the country. We have around 135 consultant teams, each comprised of a consultant and several doctors and nurses, and they provide care to patients both at home and on-site. Managing dictation for such a mobile workforce poses a number of challenges. 

Traditionally, consultations were recorded on tapes and then ferried to and from various locations across the trust to medical secretaries. These recordings were then typed up by the secretaries and printed out for approval by the consultants before copies are posted to staff or other agencies.  

With this system there was a likelihood for tapes to be misplaced and, if they were, they were not encrypted, which could potentially breach patient confidentiality. We also experienced delays in receiving tapes from clinicians who would often record many dictations and then deliver them to secretaries in one load.  

We began looking at digital dictation solutions, most of which involved replacing tape recorders with digital recorders. However, this would have only partially solved the problem as digital recorders still had to be physically returned to the office. In addition, purchasing a whole new fleet of digital recorders would have proved very expensive.

So we took a different tack. We recognised that it was the process that needed changing not just the technology. Since all the senior doctors and consultants were already using smartphones for mobile email we realised we could get even more value from the devices we were already successfully using.

From the outset it was our strategic goal to have our senior doctors use BlackBerry smartphones for dictations while junior doctors were offered alternative mechanics. We implemented BigHand digital dictation for around 500 users, with all our senior doctors using the solution, which enables them to create new recordings directly from their smartphones.

Dictations are then automatically sent over a network to secretaries for transcription. The application also lets doctors see the status of each transcription, in real-time, and review final documents directly via their smartphone.

At the end of the first phase, with the system deployed to 100 of our heaviest users, 74 per cent of all dictations were coming through the new system.

The approach provides several advantages over the previous analogue tape system.  It has brought remote dictation to more of our clinicians without requiring any investment in new devices, and has enhanced data security compared to analogue tapes.

Turnaround times have improved because consultants no longer have to return to the office to hand over tapes, reducing the bottlenecks that used to be caused by the sudden arrival of cassettes - instead dictations are now handled as they arrive. Urgent recordings are dealt with more swiftly because the consultant can flag priority cases.

The way we allocate work has also been improved. Previously, the support services manager had no way of seeing how many recordings were in the backlog and could not reassign recordings to other secretaries. In one pilot area, the backlog has now almost completely gone and most correspondence is being sent out just a few days after recording, instead of a few weeks as sometimes happened in the past.

I think that what we have learnt from the move to digital dictation can be applied to many other processes in hospitals across the UK. Instead of making the obvious move from tape-based machines to digital machines we took a step back and looked at the existing process, the needs of the people using it and the resources we already had in place. This approach enabled us to drive more use out of existing assets, ultimately giving us a far more efficient and cheaper solution.