1. Implementation of Enterprise Wide Speech Recognition, Text-based Documentation and Automated Document Distribution May 27, 2013 Michelle Leafloor

2. Faculty/Presenter Disclosure No conflict of interest to declare

3. >$1.2 B Operating budget >1100 Inpatient Beds >12,000 Employees > 1,250 Physicians 2,020 Volunteers > 3,600 Residents / Students 47,000 Admissions 60,000 Surgical Cases 138,000 ED Visits +$60M research grants Active regional partner TOH Today

4. Opportunity Organizational imbalance with transcription service presented unique opportunity – “Have not’s” pressing for a solution beyond handwriting – Why not address those that had centralized services as well Dragon roaming profile capability Funding opportunity with Canada Health Infoway’s Ambulatory EMR and HIS Connect programs

5. Driving Objectives There were two primary objectives relative to the strategic focus areas of Quality and Finance Quality: Improve patient safety and quality of care through immediate access to patient electronic records Finance: Be a responsible and accountable steward of health care resources

6. Driving Factors Quality: 14 Day average turn around time on transcribed documents Finance: $3M annual budget for Central Transcription GOAL: Ensure timely access to patient information for all involved in the circle of care

7. Evolution of Tools for Clinicians TOH has a proven track record of successful implementation of voice and self-editing technologies Extend the past experience and leverage the technology far more broadly in the organization Well understood that the broad move to voice and text-enabled self-editing would come with challenges

8. Project Overview Identify physicians with central transcription access, train them on our clinical document manager tool within our EHR and the use of dragon, support them with template development and measure success Scope : All medical divisions (22 Divisions in 15 months) All physicians/residents & medical students as appropriate Measure achievements Mandate: Timelines – 15 Months January 2012 - March 31, 2013 Two offerings: Use of tool set or Opt to pay for central services

9. Approach 18 week transition period emphasized gradual transition Personalized training in Voice Recognition Option for Fee for Service Transcription Workflow Analysis Customize Templates Install Hardware TrainSupport 18 Weeks Build Generic Templates

10. Workflow Considerations PC to MD Patient Homogeneity Clinic Volume Dictation Length Case Complexity Environment Noise LEGEND Risks: High, Medium, Moderate, Low Criteria Ideal for Voice Recognition Not Ideal for Voice Recognition Points Computers to Physician Ratio 1 to 1 2 + users share 1 computer 1 to 5 Clinic Volume (dictations required) >30mins between patients <15mins between patients 1 to 5 Length of Dictation Short notes Long narratives 1 to 5 Patient Homogeneity Surgery follow-up General Medicine clinic 1 to 5 Patient Complexity Simple Complex with many problems 1 to 5 Environment al Noise Private Office Small clinic with many health providers 1 to 5 Below 15, significant issues facedMax = 30 Six factors affect adoption rates of physician self-edit dictation

11. PC to MD Patient Homogeneity Clinic Volume Dictation Length Case Complexity Environment Noise UROLOGY Score: 21.5 / 30 Difficulty: Moderate Clinic volume can be Mitigated by one-to-one PC to MD ratio

12. Project Status Well over 1500 physicians and residents trained Over 350 word and dragon templates created Very Positive Feedback from our referring physicians Allied Health Care Professionals transitioned Over the first six months, the number of documents authored by physicians using this technology increased 1000%

13. Growth Self-edited/authored Documents 260K documents were created over the past 12 months by services across the hospital

14. Transcription Contract Status Approximately 130 physicians signed ongoing contracts for centralized transcription services However – they are only using it for about 35% of their previous activities and leverage the new technologies for the remainder. Covered by 3 FTE’s We Knew You Would Ask?

15. Outcomes Quality: Immediate availability in hospital electronic medical record Immediate e-distribution to Family and Referring physicians No more 14-21 day turn around for documents Breadth of documents continues to grow Finance: $4M to implement $11 M in savings after 5 years

16. Keys to Success Unwavering leadership support Ability to address many workflows Training & Support – project and ongoing

17. Thank you to Canada Health Infoway for supporting this initiative under their Ambulatory EMR and HIS Connect Funding Programs, without such support the immense positive patient impact would not have been realized.

18. Mission Accomplished The original mission scope has been completed!

19. Contact Information: Michelle Leafloor Director, Solutions Delivery Information Services, Admitting & Health Records mleafloor@toh.on.ca Questions ?