Smart Healthcare: Dictation | SmartHealthcare.com

Digital dictation: a voice for healthcare

Steve Gold — Wed, 01 Sep 2010 08:00:00 GMT

SmartHealthcare.com looks at eight of the main UK suppliers: BigHand, Dictate IT, G2 Speech, Nuance, Softech, SRC, Voice Technologies and WinScribe

Digital dictation (DD) suppliers are split broadly into two camps: those with their own platforms, and integration vendors that develop bespoke systems for clients. Most sell through resellers and partners, with support functions split between the partner and the vendor.

Most will supply an integrated system that interfaces with, for example, a patient administration system (PAS) and electronic workflow systems, but some - notably Nuance - will supply shrink-wrapped software for healthcare IT departments to deploy and customise.

The market is evolving rapidly, largely owing to the increasing speed of PCs, servers and smartphones. The following list, organised alphabetically, is not intended to be exhaustive but provides a guide to some of the major suppliers.

BigHand (site)

London-headquartered BigHand was set up in 1996, and its DD software is now used by more than 100,000 users in more than 1,000 organisations. The firm is financially backed by the private equity division of Lloyds TSB.

As well as offering a server-based DD system, the BigHand3 platform is available for the BlackBerry, iPhone and WindowsMobile smartphones in areas as diverse as legal and healthcare. In August, it launched a healthcare specific version of its suite of products, with product features designed specifically for the NHS.

The firm's latest flagship trust project is at the Mid Yorkshire Hospital trust, which services a population of 500,000, with new hospitals entering service in Pontefract and Wakefield this current financial year.

BigHand has been quite successful in signing new NHS trusts to its list of clients, including the Princess Alexandra Hospital trust and, more recently, three trusts using the Yorkshire and Humber NHS framework deal for DD: Basildon and Thurrock University Hospitals, The Ipswich Hospital and Airedale NHS foundation trust.

Dictate IT (site)

Another London-based firm, Dictate-IT has two flagship NHS trusts, Derby Hospitals foundation and Newham University Hospital, and has a platform based on software originally developed by GPs and other doctors.

With a total of 27 trusts using its technology - including Imperial College Healthcare, The Royal Free, St George's Healthcare, Barts and the London, Barnet & Chase Farm Hospitals, Guys & St Thomas Foundation, East and North Hertfordshire - the firm claims its product is unique in terms of its GP origins.

The company boasts a wide range of partnerships with Cerner, EMIS and iSoft, as well as Microsoft for Windows and Philips. The firm's DD technology interfaces with some PAS and electronic patient record (EPR) systems.

In April 2010, Barnet and Chase Farm Hospitals trust integrated Dictate IT's technology into a Cerner Millennium electronic patient record system following two years of usage. The trust is now using it general surgery, paediatrics, cardiology and 22 other specialities.

In July 2010, the company won the UK's largest ever NHS outsourced transcription contract with Barts and the London, covering an estimated 7m lines of text a year.

G2 Speech (site)

Founded in 1998 by two medical professionals, G2's technology centres on speech-to-text technology, which it claimed is up to seven times more efficient than traditional transcription systems, with a direct cost saving of 30% compared with conventional secretarial support services. The firm has offices in Belgium, Ireland and the Netherlands, as well as the UK.

The company, which unlike some of its rivals is focused on healthcare, claims to have 10,000 users of its technology. UK trusts are serviced from two offices, in Leeds and London.

In March 2010 G2 was nominated in three categories at the Philips Partner Awards Ceremony for its marketing, partner and technical prowess. The firm won the former category award. Since then the company has aligned its technology with the Dragon voice recognition platform and most recently with Microsoft Windows 7.

The firm's flagship trusts include Scottish health board NHS Borders and Southampton University Hospital foundation trust, where its MediSpeech platform was installed earlier this year.

Nuance Communications (site)

Massachusetts-based Nuance supplies both speech and imaging software to a variety of sector including healthcare, where its Speech Magic and newly-introduced Dragon Medical packages are in widespread use.

The firm's technology is based on the old Dragon Naturally Speaking speech recognition platform, which dates back to the early 1990s and has been updated to support medical terminology in 75 specialities and sub-specialities.

The firm claims that Dragon Medical is up to 99% accurate when used out-of-the-box, allowing staff to 'drive' their own speech-text sessions, with the resulting files then stored in EPRs.

Nuance's software is sold as a shrink-wrapped package for trusts to install themselves, as well as through DD partner firms.

Softech Global (site)

Formed in 1990, Softech has its headquarters near Brighton, with a sales and marketing operation in North Yorkshire and research and development operations at two sites in India. Over the last eight years the firm has invested more than £2 million in R&D.

Its Nomad DD system is used by a number of trusts, including Leeds Teaching Hospitals, Oxford Radcliffe Hospitals and The Rotherham foundation trust.

Earlier this year, Softech announced an expansion of its software's use at University Hospital Birmingham foundation trust where, after a year of usage, around 400 users in 29 departments across two sites are using Nomad.

In April 2010, The Rotherham started a complete implementation of Nomad, following a series of trials lasting four years, during which it was integrated into the trust's McKesson PAS. The system is already live in orthopaedics and rheumatology.

SRC (site)

SRC sells and services DD systems from Grundig, Nuance, Olympus, Philips and Winscribe. The London headquartered firm has systems installed at more than 2,500 sites in different sectors worldwide.

NHS clients include Chesterfield Royal Hospital, Dartford and Gravesham trust, Ealing Hospital, Royal Wolverhampton Hospitals, Taunton and Somerset Hospitals, Trafford Healthcare and more than 40 others.

In February 2010, SRC secured a 2,000-user contract with University Hospitals of Leicester. Spanning three sites, the Winscribe system supports the DD needs of 50 specialities in nine clinical directorates, making it the largest acute hospital implementation in the UK.

This summer (2010), the firm deployed a trust-wide electronic discharge summary system for the Hillingdon Hospital trust in west London, catering for 800 patient discharges a week.

In August the firm launched a web-based clinical correspondence platform in conjunction with Bluewire Technologies, following trials with two NHS trusts. As with many DD systems, this integrates closely with PASs as well as with SRC's Winscribe system.

Voice Technologies (site)

Voice Technologies, with offices in Glasgow and Sheffield, claims to be the largest supplier of DD technologies to the NHS, with its systems in use by more than 350,000 clinical staff worldwide. Covering the health and legal sectors, the firm is a Philips and Winscribe senior partner.

In July 2010, the firm won a contract to supply its WinVoicePro platform to NHS Tayside, NHS Highland and NHS Dumfries & Galloway boards in Scotland. The system is being used for inter-department electronic documents, as well as workflow with GP practices.

WinVoicePro, the firm's flagship software, was launched in March 2010 and is in active use by six trusts in England and Wales, interfacing with PASs from several vendors, notably Cerner Millennium, iSoft, Philips and SCI Store.

Winscribe (site)

Founded in 1995 by Amtel Communications in New Zealand, Winscribe is in active use across sectors including healthcare, with more than 350,000 users worldwide. The firm's technology extends beyond DD into workflow management.

The company has offices in the US, New Zealand, Australia, Switzerland and in Reading, and has more than 100 service partners around the world.

As well as offering a server-based DD platform, the firm supports BlackBerry, iPhone and Windows Mobile smartphones using a mobility suite that relates data, once transcribed, to the server, allowing 'dial-in' access to DD services.

In July 2010 the firm linked with Nuance Communications to allow close integration between the firm companies' products. The move effectively embedded speech recognition into Winscribe's software-based DD, transcription management and workflow routing system.

Steve Gold

Barts outsources transcription

Thu, 08 Jul 2010 11:51:28 GMT

Barts and the London NHS Trust has signed what is claimed to be the UK's largest contract for outsourced transcription of clinical notes

It has come to a three year agreement with Dictate IT, a provider of digital dictation, speech recognition and outsourced transcription services to the NHS, to provide the service on a 'fee per line' model, under which the trust will only pay for dictation that has been transcribed.

Mark Miller, the company's managing director, said it is the largest outsourced transcription service ever awarded in the UK. This is based on Barts' plans to send 90% of its annual transcriptions to the company, and that with 1,400 beds it is the largest trust to sign such a deal.

"This will not only assist the trust in meeting clinical record guidelines, but could also lead to 40% resource cost savings through reductions in agency staff, overtime, stationery and transcription backlogs," he said.

The system to be used has been tailored to integrate with the trust's current electronic patient record system. It will also allow consultants to review and approve documents via a web interface.

The award falls under a 2009 framework agreement to supply digital dictation, outsourced transcription and speech recognition to 200 NHS trusts.

Velindre implements digital dictation

Fri, 16 Apr 2010 08:00:00 GMT

Cardiff's Velindre NHS Trust cancer centre has introduced MediSpeech digital dictation across all of its services

Velindre Cancer Centre, one of the 10 largest oncology centres in the UK, has said it hopes to implement the software by May 2010.

The centre, situated in Cardiff, is working with system specialists G2 Speech to deliver digital dictation. Project manager at the centre Alison Mackie said: "We are very excited about the project and already have medical secretaries who are confidently predicting turnaround of reports in less than a day.

"We envisage that priority reports which have been dictated at our out-reach clinics, for example, could be typed up and ready for consultants to sign off immediately on their return to Cardiff."

The centre said that its twin goals for the project are to modernise technology for the centre's clinicians and secretarial service and create a more efficient service for patients.

"With analogue tapes, reports can potentially take several days to be completed and there is always a risk of lost or damaged tapes. Now patient information will be more readily available to all those involved with the care pathway," added Mackie.

Velindre has said in future, it may consider implementing speech recognition software at the centre as an addition to digital dictation. The centre provides specialist cancer services to more than 1.5m people living in south east Wales and beyond.

Patient from Hell: The doctor should email you now

Dick Vinegar — Wed, 07 Apr 2010 08:00:00 GMT

Why do patients have to wait up to a month for reports on check-ups sent through the post, asks The Patient from Hell

A month ago, I had my annual check-up after my op a year ago at 'Fastrack' Hospital. I am part of a 'copying letters to patients' initiative, a scheme I greatly value. It makes me feel that I am a conscious active part of my treatment. And it gives me some reassurance that the quacks are not pulling wool over my eyes.

Only one thing worried me about these letters. They usually took as long as two weeks to arrive, although they were always dated the day after my treatment or out-patient appointment. They came by snail-mail, of course, like most correspondence between doctor and patient in the email-free NHS. But I can't blame strike-prone Royal Mail for the delay, as the letters come by TNT. I suppose the delay is because the letters would probably have been shipped out to Hyderabad or the Philippines for transcription.

I could live with a two-week delay, because the clinicians have learnt to explain themselves to me in words of one syllable, or undergo a rigorous cross-examination. And my wife writes down everything the doctor says (see 'The Patient's better half') So the letter has not usually added much to my understanding of my condition. It was just nice to receive it.

But this time the letter arrived four weeks and one day after my appointment. That is not acceptable. I don't blame the doctor, but the system. I suspect the transcription process. Why can't doctors learn to use voice recognition systems, and produce the letter (or preferably email) on the spot?

The technology has been around for decades. The doctors only need the will to get through an uncomfortable, but hopefully brief, learning curve. And then the patient and GP would get the out-patient report in days not weeks.

It would of course lighten the doctor's transcription task if he didn't have to produce a beautifully-printed letter with the hospital's crest and logo, but instead a simple email. And the hospital would not have to print several hard copies to distribute. My letters go to three other people as well as the GP and myself.

And a consultant I see in 'H' hospital, my regular hospital, tells me that whenever he refers a patient to 'Fastrack' they send him hard copies of reports on that patient in perpetuity, which he finds marginally useful, but clogs up his filing system, and is a shocking waste of money. Email would cut out all this paper – and millions of pounds off NHS costs – at a stroke. I should have mentioned this to Alastair Darling.

What do doctors have against email? Other professions have accepted it. Even MPs, who are perceived generally to be even more luddite than doctors, now carry out 60% of their correspondence with their constituents by email. One techie MP, Derek Wyatt, told me that in January this year, he sent 150 emails but only two formal letters to his constituents. Yet an MP's correspondence is only marginally less confidential than a clinician's.

"Ah, but," I hear the doctors say, "a lot of our patients are old and computer-illiterate, and couldn't handle emails." I think they overstate these numbers. The doctors should talk to Martha Lane Fox, Gordon Brown's inclusivity czarina. She will tell them what the numbers really are, and will tell them what she is doing to reduce the digital divide. She would probably also tell them that a switch by the NHS to email would give a colossal boost to her efforts to get the old to embrace the internet. Everybody would win.

Dick Vinegar

South Manchester awards dictation deal

Mon, 08 Feb 2010 16:36:07 GMT

SRC has won a contract to provide a digital dictation system to hundreds of staff at an acute trust in Manchester

University Hospital of South Manchester NHS Foundation Trust will introduce the WinScribe digital dictation system, along with workflow technology and speech recognition.

The system will be integrated with the trust's IPM patient administration system, which will insert patient and hospital information to Word templates, saving further time for typists transcribing recordings.

The trust looked at each of the six systems offered under Yorkshire and Humber Commercial Procurement Collaborative's framework agreement for digital dictation services, awarded last August, which is open to 40% of trusts in England, and which was used for this deal.

SRC said it was not disclosing the value of the contract, but said that the new system will be used by hundreds of staff.

Digital dictation: cost-saver or efficiency-gainer?

Steve Gold — Wed, 03 Feb 2010 09:00:00 GMT

Many trusts have replaced tapes with digital systems to save money, but can such systems also help healthcare professionals

Digital dictation is taking off in the NHS, largely because at the press of a button the files can be sent to a transcription service on the other side of the world. But digital dictation (DD) systems have gained a reputation for involving big upfront costs, for both software licences and hardware, and such capital spending requires specific managerial approval.

To tackle this, a number of suppliers are offering DD facilities on a software-as-a-service basis across the internet. This means that trusts no longer have to tap scarce capital funding and can instead pay for the service as they use it out of operating budgets.

NHS Salford is one trust using DD on this basis. It uses WinScribe's service at its Walkden Gateway Clinic, a health centre which is jointly maintained and serviced by the local council and the NHS. The web-based dictation system has been active since the centre opened in September 2008.

Where analogue tapes were used previously - taking up to three weeks to transcribe patient notes and relay the printed words to the patient's GP - WinScribe's OnDemand technology means that the notes often come back, fully transcribed, during the same half-day session.

"It's a web-based system that allows our staff to dictate the notes into the computer and send them off securely to a transcription centre in the US, where it is transcribed and sent back," says consultant physiotherapist Victoria Dickens.

So why not simply get the staff to keyboard-enter the data themselves at the point of clinical care? According to Dickens, there's just too much data to enter and, in any case, it's not a good use of NHS funds for a trained physio to perform secretarial duties.

Staff at Colchester General Hospital tell a similar story. The Essex hospital has five secretaries, more than 30 patient-facing staff, as well as ultrasound technicians, radiographers and consultants spanning five sites. This made the physical handling of audio cassettes - including shuttling them between sites - a logistical nightmare.

Switching to DD was a logical move, especially after the hospital's IT systems crashed for nine days in March 2005, making analogue transcription impossible. Radiology services manager Sue Maughn worked with the hospital's clinical director Martin Gould to commission a system from G2 Speech, whose system is based on Philips DD technology.

According to Maughn, switching to DD has allows secretarial staff to prioritise which tasks needs to be done and in which order through the software. "You can even dictate and use Windows applications at the same time," she says, describing the ergonomics of DD technology as perfect.

A national conversation

While staff at Walkden and Colchester are keen adopters of DD, what about the national view? Are trusts adopting the technology because of the clinical care advantages, or are the economic benefits alone driving its adoption?

Chris Hart, chief executive of DD specialist SRC, argues that both ongoing cost and clinical advantages are apparent. Hart, whose company has signed technology agreements with a number of NHS procurement hubs, says that most consultants and medical staff are well used to dictating their notes, so it does not matter whether the technology is analogue tape or DD.

"The main advantage we see stems from the use of the technology in acute departments, where you get a lot of patient throughput and there is lot of human contact involved," he says. "The last thing you want is a doctor typing between patients."

He adds that SRC is also starting to see trusts integrating DD technology with their electronic health records (EHR) systems, including West Sussex and Chichester hospitals.

It is possible to improve efficiency at the same time as improving patient care, he argues. "Take the example of Brighton and Sussex University Hospitals Trust - they use barcoded capture and DD to speed the transcription process. Once the transcribed text comes back, the admin staff can load up a patient letter template and populate the letter with data from the transcribed text," he says. "Using this approach means that the letter file can then be checked and approved by the doctor - and off it goes."

Legacy systems can be accommodated by using software modules that interface between the SRC dictation platform and specific third party applications or - where the modules have not been developed for a given legacy package - using standard open database connectivity protocols.

But James Kippenberger, healthcare director of rival DD vendor BigHand, says that integration with EHR and other systems is far from universal, however, although some trusts including Mid-Yorkshire have integrated the technology,

"What they have done is to create an intermediate step between the file being dictated and typed. If a member of staff accesses the patient's record in the interim, they can click on the audio file and listen to it," he says.

Kippenberger is also seeing trusts starting to move away from the need for text based EHRs and notes, and an increasing interest in digital streaming. Young staff coming into the NHS are comfortable with audio-visual files being streamed on the internet, so medical staff are starting to append the spoken words of the patient to their medical files.

"GPs know that their patients can describe their type of pain far more effectively using the spoken word rather than text based notes. Moving to audio attachments to patient notes makes a lot of sense in these situations," he says.

Steve Gold

Dealpulse August: Procurement hubs sign digital dictation framework

SA Mathieson — Wed, 16 Sep 2009 08:00:00 GMT

More than 200 trusts have access to a digital dictation and speech recognition framework deal established by Yorkshire and Humber's procurement hub

In August, the organisation completed a two part framework agreement to supply such services, used extensively by hospital departments such as radiology and by consultants.

Six suppliers won a place on the first, involving the lots for digital dictation and speech recognition systems: BigHand, Dictate.it, G2 Speech, Softech Global, SRC and Voice Technologies. The second, for transcription services, involves Dictate.it, Dict8 and Scribetech.

Apart from Yorkshire and Humber Commercial Procurement Collaborative, the other hubs involved cover the East of England, South East Coast and the North West, as well as the Health Purchasing Consortium representing trusts in the West Midlands, Luton and London and Pro-Cure, which covers the South Central strategic health authority.

When the tender was first published in January, by Yorkshire and Humber on its own, it estimated that it might be worth £500,000 to £5m over four years, although on a framework agreement no work is guaranteed.

On the award of the deal, suppliers said that with six hubs involved the deal could be worth as much as £20m, as it covers 40% of English trusts.

The month also saw Dorset County Hospital NHS Foundation Trust award one of the framework suppliers, G2 Speech, a £234,000 contract to provide a digital dictation and voice recognition system for use by both clinical and non-clinical departments.

Health facilities were also included within a Building Schools for the Future tender published by the councils of Halton and Warrington, worth between £167m and £500m.

The main aim of this deal, which may last for as long as 15 years, is to set up a local education partnership to renovate or rebuild the area's schools. This would include the provision of ICT services, although Halton and Warrington have said that in their case the partnership may be extended to construct primary health buildings, including GP surgeries, pharmacies and polyclinics.

Telemedicine for stroke patients is the aim of a £750,000 tender published by Solent Supplies Team, on behalf of 16 hospitals in and around the South Central strategic health authority area. The hardware purchased under the resulting framework contract will allow those suffering serious strokes to have round-the-clock access to thrombolysis treatment involving clot-dissolving drugs, through remote assessment by a stroke consultant.

This equipment will include video cameras, screens, access to picture archiving and communication systems (Pacs) and mobile workstations. The three year tender will enable hospitals in the South Central area to implement the National Stroke Strategy.

Other deals saw the Royal Marsden NHS Foundation Trust in London award Philips Healthcare a £982,000, 10 year deal to provide an electronic charting and critical care monitoring system, to be used in critical care units, theatres, anaesthetics and interventional radiology, and the Royal Wolverhampton Hospitals NHS Trust pay £321,000 to BioMerieux for a computer controlled system to automate microbiology processes.

SA Mathieson

Speak and be recognised: digital dictation

Cath Everett — Wed, 05 Aug 2009 08:00:00 GMT

The adoption of digital dictation technology in the NHS may have increased dramatically, but few trusts have added speech recognition

When it comes to dictation systems, replacing analogue tape-based systems with digital dictation equipment is seen as a natural progression. It results in better sound quality, leading to fewer errors during the transcription process.

Moreover, because users speak into dedicated recording devices or PCs, which create a digital audio file that is transferred over a network for access by transcriptionists, the whole process is speeded up. There is also less risk of files being lost or mislaid as was often the case with tape.

But far fewer NHS organisations have taken the next step: adding a speech recognition layer, where words are immediately converted into text. This can streamline activities further, particularly if the technology is integrated with electronic healthcare record systems, as information can be entered directly into individual documents in real time, although it still needs to be checked for accuracy and edited.

The downside of introducing such technology, however, is that it significantly alters the way that clinicians work. This means that a large change management programme, which includes training, may be required.

In addition, many trusts are only just starting to deploy electronic healthcare record systems, and they tend to introduce the former before introducing speech recognition. Adoption is more widespread in specific departments such as radiology and cardiology however and, once implemented, such systems tend to spread to other departments.

One organisation that has bitten the bullet is East Kent Hospitals University NHS Foundation Trust. As part of its aim to move to a paperless environment, and because its existing analogue dictation technology was coming to the end of its life and becoming increasingly difficult to support, the trust's histopathology department undertook a review in 2007.

It decided on a three-phase plan to update existing facilities with the help of service provider SRC. Paul Williams, head biomedical scientist at the trust's department of cellular pathology, explains the rationale: "We felt that implementing the project in stages was the best way to do it as it's a quantum leap to move from writing to voice recognition in one step. Digital dictation is a useful way to start, but voice recognition is the icing on the cake for improving turnaround times." A significant justification in this context is meeting and exceeding national targets on cancer waiting lists.

The first stage of the £30,000 initiative started in January 2008 and led to the deployment of Winscribe's digital dictation workflow management system to allow pathologists to describe tissue specimens at the cut-up area using wireless headsets. The voice files were sent immediately to a back-end server, where they became immediately available to a team of transcriptionists, resulting in time savings of about 10%.

Going faster at traffic lights

The second phase of the scheme was implemented in June last year. It lets pathologists record microscopy reports at their workstations rather than needing to write them by hand.

The move led to time savings of 20% and also generates an audit trail for voice files, which makes it easier to track changes and find missing information. A traffic light system was provided so that users could see whether transcribed files had been fully, partially or not checked at all.

Then in November, Nuance Communications' Dragon NaturallySpeaking voice recognition software was integrated with both the WinScribe applications and the trust's iSoft Apex laboratory information management system to enable staff to enter information directly into Apex.

Although this approach means that there is no audit trail because voice files are not saved, it does result in same day report turnaround times – as opposed to the one to two weeks which were common in the days of tape, which led to backlogs.

One pathologist out of a team of 10 is currently using the voice recognition system, although another two are expected to start employing it soon. Two others have stated a preference for remaining with digital dictation, while a further two have fast typing skills and prefer to enter information directly. This means that only one is still employing the older analogue system, although this will be phased out by the end of the year.

"The technology side of things isn't a big deal, but what is, is getting people to change their mindset. As a result, training is vital as is following up maybe a month or so later to fill any gaps in people's knowledge," Williams says.

Another important consideration is engaging secretarial staff from the start, as the introduction of such technology inevitably leads to fears of job losses. East Kent dealt with the issue by training the team to the level of Band 2 healthcare support scientists, which means that they can now assist in cutting up specimens.

"The variety means that they now find their job more interesting," says Williams. It also means that the lab will recoup its investment within three years as it has been able to fill the equivalent of 2.5 healthcare support scientist positions without hiring more staff.

The next step is to roll the software out to cover additional applications such as emails and letters and to encourage GPs to access reports held in the LIM system using a web browser. This will enable them to see documents as little as 20 minutes after they have been authorised, rather than waiting for information to arrive on paper.

"The faster turnaround times will be reflected in cost savings in terms of patient treatment as it should result in a faster turnaround of beds because people will be treated more quickly. It's a hidden cost, but for the trust, it all represents savings," concludes Williams.

Cath Everett

Supply Chain cuts computer consumables deal

SA Mathieson — Wed, 15 Apr 2009 08:00:00 GMT

Contract awards in March included a large deal on the NHS's computer consumables, as well as GP support deals for the Isle of Wight and west Hertfordshire

The largest deal by far to affect health IT in March was worth an estimated £200m over three years – although only a part of it has anything to do with IT. NHS Supply Chain, the outsourced health service trust supplier run by DHL, awarded its framework contract for computer consumables, stationery and other office products to Banner Business Services, Office Depot, Premier Business Papers and Supplies Team.

Supply Chain added that it has overhauled its online catalogue, NHS Cat, with the aim of making it easier and quicker to use. It is now available through the public internet, rather than the 'nww' network pages only available on health service networks.

Other awards announced during the month were of a more modest size, according to Kable's database of government IT deals. The Isle of Wight's primary care trust, working through Solent Supplies Team, awarded Data Swift Network Services, a firm based on the island, a £350,000 contract to supply IT support services to GPs around the island for four years.

Hertfordshire Primary Care Trust awarded a similar contract, for the support and maintenance of GPs' computer hardware and networks in west Hertfordshire, to Egton Medical Information Systems for an undisclosed amount.

Leeds Teaching Hospitals, the largest NHS trust in the UK, awarded Soliton IT a deal to supply, install and commission speech recognition software for radiology reporting across a number of its sites, again for an undisclosed amount. The speech recognition functionality will have to be linked to the trust's existing systems, and users will be able to operate it through voice commands.

Among the month's tender notices, Birmingham and Solihull Mental Health Foundation Trust said it plans to spend around £225,000 on networks and cabling across more than 100 locations. Bedford Hospital Trust published a tender for a wireless data network, consisting of about 300 access points, costing between £150,000 and £200,000.

The news that BT will maintain the Cerner Millennium installations at eight acute trusts in the south of England emerged on 2 April 2009. NHS Connecting for Health was yet to provide full details at time of publication.

SA Mathieson

Salford Royal wireless pilot draws blood

Thu, 26 Feb 2009 09:00:00 GMT

A hospital cut unnecessary tests and increased the productivity of its blood testing staff by issuing them with mobile clinical assistants

Salford Royal NHS Foundation Trust's phlebotomists were able to take blood from 222 patients each shift, compared with 180 before, using three MCA computers, a wireless device designed specifically for healthcare.

The MCAs also reduced unnecessary blood tests, as the work was recorded immediately on a central system. Junior doctors also take blood tests, but as no record was kept, patients often had samples taken twice, particularly as doctors could not book tests after a certain time each day. With the new system, these could be requested until the phlebotomist entered the relevant ward.

"When we finished the pilot, we had to take away the three (MCAs) and the staff were heartbroken," Christine Walters, associate director of IM&T at Salford Royal, told Kable's Mobile and Wireless Healthcare conference in Manchester on 24 February 2009.

The trust negotiated a further year's use of the devices, which also printed labels at the bedside as the sample is taken. Previously, labels were printed in batches, leading to mistakes. The trust reckons the three devices saved £30,000 a year. "The process is so much simpler, so much safer, so much quicker," said Walters.

Salford Royal was one of three healthcare organisations globally, along with hospitals in Singapore and California, to test the MCAs. The devices, which were designed with input from NHS Connecting for Health, have a large screen which works through either touch or a proximity stylus, a large handle and smooth surfaces suitable for regular disinfecting.

Walters said Salford Royal is using in-ward computing, also including computers on trolleys and laptops, for other applications including pathology and radiology results. It plans to move electronic prescribing and all nursing and bedside documentation to mobile computers.

The trust has also piloted speech recognition, although there are problems over accuracy – particularly with short words such as 'two/to' – and over confidentiality issues from people overhearing dictation.

"We plan to be paper light," Karen Hill, head of electronic patient record services for the trust, with the focus on reducing paperwork rather than eliminating it completely.

However, she added that Salford Royal's work in this area had been delayed by Connecting for Health: "It's been our first taste of the National Programme – a bitter one, actually."

Dealpulse January: London Ambulance buys £12m despatch system

SA Mathieson — Wed, 11 Feb 2009 09:00:00 GMT

This month's biggest value contract award is the London Ambulance Service NHS Trust's deal with Northrop Grumman to replace its internally developed computer aided despatch system

In the award notice, published on 26 January 2009, London Ambulance said the deal, worth around £12m, will including training, support, hardware and associated services.

It will also cover the integration of the new despatch system with other systems, both within the ambulance service and externally, and will be built around a commercial off the shelf product. The trust received 13 initial responses and two final offers for what it called the cad2010 contract.

The month also saw the publication of four large healthcare related tenders, with a total estimated value of up to £30.5m. In total, there were 16 health IT tenders published during January.

A couple were rather unusual. Manchester Primary Care Trust, in association with the city council, will spend £4m to £15m on a loyalty card style scheme which will reward Mancunians for healthy activity. Points4Life is the city's contribution to the England-wide Change4Life health campaign.

Perhaps the most challenging part of this deal, which will include non technological activities such as marketing and public relations, will be the tracking of "unstructured physical activity" such as cycling, walking and running. A spokesperson said this might involve participants wearing RFID tags while they take part in such exercise, and passing tracking stations around the city.

NHS Scotland published a tender to spend up to £10m on consultancy for a 'lean' transformation programme, which will include IT projects. Lean manufacturing is an established technique from vehicle makers, and involves eliminating wasted time, energy and material. It has been used by some English trusts to improve clinical techniques.

More conventionally, NHS Yorkshire and the Humber Commercial Procurement Collaborative published a tender worth between £500,000 and £5m for digital dictation software and hardware, including speech recognition technology and outsourced transcription services. The four year framework deal will cover any NHS trust in the Yorkshire and Humber region.

Plymouth Hospitals NHS Trust, which includes Derriford Hospital, and NHS Plymouth, the city's primary care trust, jointly advertised for a telephony solution, asking for expressions of Interest "from experienced suppliers with the ability to support the needs of a large acute hospital and a large primary care trust".

The winning bidder will have to work with Plymouth's existing telephony systems, including the development and expansion of the current Mitel infrastructure and support for legacy Siemens equipment. The trusts did not provide an estimated contract value.

Doncaster and Bassetlaw Hospitals NHS Foundation Trust and Salisbury NHS Foundation Trust also published tenders for digital dictation technology, while Derby Hospitals NHS Foundation Trust awarded Dictate IT a £365,500 contract for providing such a system, for both medical and general secretarial services.

The past month has also seen the continuation of a recent increase in the number of tender cancellations. Kable's database of contract activity included 38 tenders cancelled in November, December and January, compared with 26 in the same three months a year earlier, a rise of 46%, with some citing the poor economic climate as a reason for the change of plan.

Four health IT tenders were withdrawn during January. Hull and East Yorkshire Hospitals NHS Trust cancelled two, for a health management information system and for its existing management reporting system, neither of which were valued in the original tender notices. It said of the latter that "the requirement to tender this service has gone away".

Meanwhile, Mid Cheshire Hospitals NHS Trust ended its tender for a web based clinical benchmarking service, and County Durham and Darlington NHS Foundation Trust did likewise for its tender for a digital dictation system, although it said it might re-advertise. Again, neither of the original tenders had values attached.

All information is drawn from notices published in the Official Journal of the European Union. These, along with a monthly analysis of ICT tenders in all government sectors, are available to customers of KableDIRECT.

SA Mathieson

Whadya say? Voice activated systems

Tue, 02 Jan 2007 00:00:00 GMT

Voice activation systems are slowly emerging in the NHS, but how well do American systems understand the way we speak?

Being able to chat to a computer or control medical equipment using voice activated systems (VA) is still largely the talk of hope rather than reality in the UK.

Although prevalent in the American healthcare market, to the extent that robots can lend a hand with surgery procedures, there is still a long way to go before VA systems make a strong impression on the NHS.

The reason is simple: most VA systems originated in the USA and the world is no stranger to understanding the American accent - Hollywood has seen to that. But trying to get the computerised systems to understand the regional nuances of the English language with its multitude of accents and dialects deriving from our increasingly multicultural society, is no mean feat.
The problems faced by voice technology developers primarily lie not in getting the systems to talk, but getting them to listen.

Speech recognition technology has been around since the early 1990s and it is a difficult nut to crack. This is because every person's voice is different, and words can be spoken in a range of different nuances, tones and emotions.

The complexity of these problems has meant that most of the voice recognition systems (the basis of VA systems) use small, vocabulary isolated word recognition or large vocabulary single speaker recognition.

Creeping progress

Despite this, VA systems are creeping into the NHS: orthopaedic consultants are using it for keyhole surgery; nurses are carrying hands free voice activated badges; and at the most basic level VA telephone systems are being used by hospitals across the country.

Probably the most innovative use in the UK so far is in support of orthopaedic keyhole surgery. Royal Gwent Hospital in Wales had such a system installed in May 2006. But implementation of the Control of Digital Operating Room (Condor) system, which uses a customised platform, has highlighted how much work needs to be done before voice activation can safely be used in a theatre setting.

Condor, developed by Smith&Nephew (S&N), is supposed to enable surgeons, via a microphone attached to their coats, to maintain hands free control of medical equipment and even be able to control the lightening and temperature of the room itself. This should mean less need for nursing staff, who can then be deployed elsewhere in the hospital. Those who are required to stay should be able to spend more time looking after the patient.

In practice, surgeons have found it is not so straightforward.

Rohit Kulkarni, Gwent Hospital consultant orthopaedic surgeon, says: "Condor takes five or six attempts to respond to the standard 'wake up command' and does not recognise its own name, which is a problem.
"It's to do with the technology. It seems to have problems picking up certain hard or soft syllables."

The hospital has got around some of the teething problems by keeping its three nurses, including two runners on site, but this defeats the objective of having such cutting edge technology.

"It's very frustrating when Condor does not work, it delays the operation and can be dangerous," says Kulkarni. "However, when it does listen and understands it's brilliant."

He speaks with an Indian accent, which prompts the thought that the system may struggle to comprehend it, but he is not so sure. "The system's developer is Indian," he says.

The hospital is working closely with S&N to improve the technology. S&N does have a touch pad system which has proved consistently reliable.

Finding a route out of America is not easy, as Californian based Vocera will testify. The company's first attempt to take its 2oz voice activated badges (where hospital staff can locate other users instantly just by pressing a button and calling their name or department) to Australia, four years ago, failed dismally.

"We had a number of challenges," says Vocera vice president Brent Laing. "The device did not understand the Australian accent and our resellers did not know how to get around the problem."

After much deliberation, the company redesigned its badges to understand common use of grammar, dialects and accents in geographical areas. Therefore, devices sold in the UK are different to those sold in North America, Australia and New Zealand.

The badges, which only hold up to 50 standard commands, run through a centralised system that now retains users' profiles and any changes the individual has made, including training it to understand his or her accent or dialect.

"If you ask the device to find a person in your group profile then it will work. If you ask that person to order you a pizza, it won't understand," says Laing.

Another key to the company's success is basic training for every user, which the company claims has helped tremendously. So far hospitals from Cornwall to Belfast have embraced the devices.

Steve Argent, head of community relationships at Sherwood Forest Hospitals Trust, says: "Vocera has bought us time to work to the four hour A&E target. Just being able to speak to a site coordinator instantly takes seconds rather than minutes and contributes to achieving the target."
Some hospitals are now looking to use the device to alert nurses to the availability of patients' test results.

The badges, which have small LCD screens, also have the ability to alert a nurse via text message that a patient's blood pressure or heart rate is too high. The nurse can then 'voice activate' the device on the way to the patient as a call for help.

"The secret is to keep it simple. I have seen too many suppliers try to make VA systems complex and they have failed," says Laing.

Misinterpretation

James Walker, head of Telindus, agrees. "The Vocera badges hold a limited number of words and not the alphabet; therefore there is room for the device to misinterpret words," he says.

"If words are to be added, the machine needs to be taught and process them one by one, which can be time consuming."

Ironically, he says, VA systems are more likely to understand a Glaswegian or Liverpudlian accent than those from the south east of England. He believes this could be because those with stronger accents are more likely to pronounce words better rather than merging them together, which Londoners in particular are prone to do.

For now, it seems only a handful of NHS trusts are being adventurous with VA systems. But a potential growth area is speech to text dictation. In the healthcare area alone, it is estimated that more than £8bn a year is spent annually on the manual transcription of doctor's notes.

Konstantinos Nikolopoulos, Frost and Sullivan industry analyst of healthcare IT, says: "The move to electronic systems, such as the picture archive and communications system (PACs) and the electronic medical record system (EMR), will also make it easier for the wide spread use of VA systems.
"The NHS is still three or four years away from really using VA or speech recognition systems. University hospitals are likely to test new technology first and if it works it will be rolled out.

"Imagine a time when we no longer have paper but you can come to work and say 'Good morning computer, open my emails.' Or a doctor on his rounds asks his wireless device to verbally update a patient's records on a central database."

Nikolopoulos knows this is still a fantasy but says that in a few years time "it will become reality".