Eclipsys and escription: Optimizing Transcription

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1 Products, B. Hieb Research Note 9 June 2003 Eclipsys and escription: Optimizing Transcription Transcription is an important but costly activity within care delivery organizations. Eclipsys' Knowledge-Based Transcription product makes the process efficient and more affordable. Core Topic Healthcare: Critical Healthcare Applications for Business Efficiency and Improvement Key Issue How will vendor applications enable healthcare organizations to respond to market demands for increased efficiency, customer service improvements and cost reductions? At an average cost of 15 cents per line of text, the annual transcription costs for a care delivery organization (CDO) can easily run into the multimillion-dollar range. In today's financially constrained healthcare markets, this makes transcription a clear target for cost-reduction efforts. However, at the same time, it is becoming more important to ensure that: Transcribed documents are rapidly made available to the clinicians who can use them to support the caregiving process. The information contained in these documents can be incorporated into automated clinical applications, such as a computer-based patient record (CPR). Knowledge-Based Transcription (KBT) is a set of capabilities offered by Eclipsys Technologies, in conjunction with business partner escription, that attempts to meet these operational goals. In 1Q01, Eclipsys signed an agreement with escription to incorporate its products into the capabilities of Eclipsys' CPR product line. The KBT system integrates with Eclipsys' Sunrise CPR so that transcribed documents are linked to the patient's medical record. KBT is a separate product that is entirely focused on medical transcription. Eclipsys' KBT product, which is based on and powered by escription technology, is designed to optimize the transcription process, and the experience of CDOs indicates that it is fairly effective in achieving this goal. Transcriber productivity typically doubles. Clinicians are not required to go through a speech recognition training process, since there is no change in the physician's dictation process. More than 90 percent of clinicians are unaware when automatic speech recognition is occurring. Gartner Reproduction of this publication in any form without prior written permission is forbidden. The information contained herein has been obtained from sources believed to be reliable. Gartner disclaims all warranties as to the accuracy, completeness or adequacy of such information. Gartner shall have no liability for errors, omissions or inadequacies in the information contained herein or for interpretations thereof. The reader assumes sole responsibility for the selection of these materials to achieve its intended results. The opinions expressed herein are subject to change without notice.

2 However, turnaround times typically decrease from days to hours and document quality is maintained. Administration tends to support the system for two reasons: The overall cost of dictation typically drops from 15 cents per line to approximately 10 cents per line, resulting in substantial savings. The system can automatically generate management reports on dictation activity, without requiring extensive management time and effort. As of 1Q03, 20 CDOs have purchased KBT, which has been shipping since 4Q00. More than 2,000 clinicians dictate into it, and KBT consists of three bundled technology components from escription: IntelliScript the voice-capture server component AutoScript the speech recognition component EditScript the transcription, workflow, and document and management distribution component IntelliScript is the dictation and voice-capture server that is installed at the client site; it interacts with the telephone system that caregivers use for dictation. It is a fault-tolerant voicecapture system that produces high-quality recordings of a clinician's dictations. This high quality ensures that the system achieves optimally accurate automatic speech recognition. As soon as the dictation has been recorded, it is delivered to EditScript server. IntelliScript is typically located at the CDO, and the dictations are delivered via secure, encrypted Internet channels to EditScript server. This eliminates any long-distance telephone charges. AutoScript is the system's continuous speech recognition (CSR) capability that operates remotely out of a data center. Speech files collected by IntelliScript are forwarded to the data center for CSR analysis. AutoScript uses a batch speech-recognition approach, in which it makes many consecutive passes over the dictation. Different passes use a variety of knowledge and analysis techniques, such as natural language understanding, to refine the system's understanding. Because it makes multiple passes over the voice input file, AutoScript operates in batch rather than real-time mode. One minute of transcribed speech typically requires three to 10 minutes of AutoScript processing. AutoScript develops acoustic and language models that are tailored to the dictating clinician and his or her work type. These models are combined with an analysis of pooled transcription patterns based on escription's aggregate database of 10 million medical transcriptions, which represent more than 4 billion words 9 June

3 of medical transcription. Finally, information on rules and formatting derived from the American Association for Medical Transcription (AAMT) are invoked to ensure that the output is consistent with the principles of best-practice transcription. The result is a report with formats and content that are similar to the final content of a document that would have been produced manually by a transcriber. During its initial "learning period," AutoScript is used to process all dictated documents, and the system records the benefits obtained from each document type. As soon as AutoScript determines that the quality of the drafts it produces will improve the transcriber's productivity, it automatically starts generating draft transcriptions. AutoScript listens to an average of two hours of dictation before it starts generating drafts, and then it generates drafts for approximately 90 percent of the dictations. AutoScript continues to "listen" to other dictations where drafts are not generated, and it will automatically start to generate drafts if and when it reaches adequate accuracy. In this way, a CDO can use AutoScript for approximately 80 percent of documents where it offers a clear benefit, but it is not forced to use AutoScript when special circumstances (for example, poor dictation by the speaker, unusual report types or insufficient volume to adequately train the CSR system) make it inappropriate. EditScript is the component that oversees transcription workflow that is, acquisition, AutoScript processing, transcriber review and editing, clinician review and signature, and document distribution. The transcriber can listen to the entire voice recording rapidly, and he or she only needs to make editing changes wherever the AutoScript process has not correctly interpreted what was said. All corrections are fed back to AutoScript to improve its subsequent recognition performance, which allows the system to improve continuously and "learn." EditScript also accumulates management statistics on each clinician and transcriber to generate management statistics and reports concerning virtually all transcription activities. Analysis Eclipsys' KBT appears to do a good job of optimizing the transcription process. Client sites report significantly improved transcriber productivity, decreased document turnaround times and approximately a 30 percent decrease in transcription costs. The KBT system includes a number of features such as AAMTcompatibility tools, which ease the transcriber's job and result in a high acceptance rate. The system's management capabilities eliminate much of the time- and labor-intensive activities 9 June

4 associated with measuring productivity and generating periodic reports. A major strength of the system's approach is that there is no change in process for the clinicians who are dictating documents. The managers who oversee the transcription process can make a case-by-case decision on the back end concerning which documents to run through the AutoScript system and which ones to run through the traditional typing-transcription process. Ultimately, about 80 percent of dictated text is successfully processed, leading to significant value for the CDO. There are two major questions concerning Eclipsys' KBT system. The first is its inability to perform real-time speech recognition because of its multiple-pass approach. Although this is not a problem for "traditional" dictation approaches, it would appear to preclude the KBT system from evolving into an approach in which a physician could directly edit (in real time) the CSR output and, thus, totally bypass the need for a transcriber. Although this real-time approach has the disadvantage of requiring substantial changes to the dictation process that physicians currently use, it has the complementary advantage of finalizing the report at the end of the initial dictation session, resulting in an overall savings of time for the clinician. The second major KBT question concerns the current absence of a natural language-processing capability to extract discrete medical information from the transcribed document. If this capability could be added, it would open the door for KBT to actively incorporate the document's information directly into the patient's clinical care data, via mechanisms such as clinical decision support, automated documentation and active case management. This could provide substantial added value to the clinicians who are creating the dictation (for example, by providing clinical decision support based on the document's contents), but it would require changes to the dictation process. Product Strategy: Eclipsys' KBT, powered by escription, is designed to minimize the cost, time and effort of the dictation and transcription process while imposing no change to clinicians' dictation habits. Strengths: No change is required to the clinician's workflow. Customers report experiencing transcriber efficiency increases (50 percent) and transcription cost savings (30 percent). 9 June

5 Eclipsys Technologies Headquarters: Boca Raton, Florida Web Location: Founded: 1994 Ownership: Public (NASDAQ: ECLP) Employees: 1,600 as of 2Q03 Financial Data: For FY02, revenue $218 million Strategic Partners: Premier (benchmarking) Ultimate (human resources and payroll) ProxyMed (e-commerce) Envoy (claims) Voluntary Hospitals of America HEALTHvision escription Acronym Key CDO care delivery organization CPR computer-based patient record CSR continuous speech recognition KBT Knowledge-Based Transcription Continuous speech recognition is incorporated. AAMT guidelines for document format and content are included. There is the ability to mix and match automated and manual transcription strategies. There are significant reductions in the turnaround times of reports. There is the ability to generate automated reports on productivity and efficiency. Challenges: Providing appropriate support for a growing client base Continuing to increase the fraction of clinicians that can be processed automatically Consider This Product When: The client wants to achieve predictable savings in transcription costs. The client wants to avoid changes in the transcription process for clinicians. Consider Alternatives When: The client needs real-time speech recognition. The client wants to extract discrete data based on the contents of transcribed documents. Bottom Line: Eclipsys Technologies' Knowledge-Based Transcription product, which is powered by escription, is gaining solid recognition as a reliable technique to obtain cost savings through increased efficiency in the transcription process. Although it is not architected in a way to deliver real-time performance, KBT still achieves a significant decrease in the turnaround time for transcription documents, and it doesn't require a workflow change by the clinician who is dictating a report. Care delivery organizations should include KBT on their shortlists when evaluating products to improve the cost and efficiency of their transcription processes. 9 June