The Ten Commandments of Digital Dictation

ten_commandments_of_digital_dictationBy Claire Betis – Oct 15, 2013

Digital Dictation, a.k.a DDS: a buzz word that has people talking, but who’s here to shed light on the market players and technologies at stake? After speaking with several practices who have taken the big leap, all agreed they could have done with a tablet or two to guide them through. Well, here you go…

1. Thou shalt not frustrate users

Seems obvious, but then again, it looks like suppliers didn’t get their definition of user-friendliness from the same dictionary. Users who have to go through endless training for instance are most likely to show early symptoms of RTC, also known as Resistance to Change. And who could blame them?

This is why usability is the very first of many points to be considered when investigating digital dictation technology. The system shall be easy to use for everyone, including locums and non-PC-literate doctors.

Beyond instant ease of use, what about daily use: can you create and sign off a dictation without having to touch the mouse or keyboard? Do you have to minimize and maximize different screens all the time? Can the system take you straight back to your patient record screen automatically? These are questions worth asking.

2. Thou shalt have no other gods before real-time

Although suppliers might never agree with it, there are two ways to run a digital dictation system: asynchronous or real-time.

The asynchronous system is nothing more than a giant copy and paste factory: the only way it found to make sure everyone has access to voice files is to copy those files around. Hmm, very creative; not to mention that in this approach, there is no way to monitor current workflow since you can’t get a precise picture of where files are at any point in time. Referral #1245 could be at the Southampton surgery on Doctor Humphrey’s PC while Secretary Johnson is currently listening to a copy of it. Good luck finding your way, not to mention the bandwidth bottlenecks created by such traffic jams.

If you want visibility over the workflow, no choice: you need real-time. This approach revolves around a rather useful piece of hardware called “server”, which keeps and streams the master voice file to the appropriate recipient when required. It’s called “voice on demand” (VOD) technology and when you top it off with a proper N3 accreditation, you get a winning combination for your surgery: instead of moving files around like stinky laundry and copying them to make the mess more stinky, VOD preserves data integrity and streams files across your N3 network for increased speed and security. The result? No dirty laundry on users’ PCs. And zero impact on your network speed – the kind of bonus news your IT guy will be glad to hear.

3. Thou shalt not kill the sound of my voice

I’m not saying I’m Mariah Carey, but still: isn’t decent sound a key requirement for a secretary to transcribe a referral properly?

Because they need to replicate and move voice files around easily, asynchronous technologies will need a format that doesn’t take too much space (understand: “kills quality”). And the winner is: .DSS format – not the wisest move when you have formats like .VOX that deliver a much better sound quality in a similar file size.

Real-time technologies, on the other hand, couldn’t care less about file size since they rely on streaming. They can therefore work with the best (.WAV format), ensuring optimal sound quality at any point in time with, again, zero impact on your network speed.

4. Thou shalt support any workflow

Workflow flexibility is the Holy Grail of digital dictation: a couple of suppliers found it, others are still looking.

Regardless of how many doctors, secretaries, supervisors and branches within your practice, your DDS must support any scenario – and by any, I mean any. This starts with the system’s ability to support multiple input methods: from Philips or Olympus dictation devices all the way to the iPhone – via a FREE app, of course.

Then if your practice is spread over several sites, real-time turns out to be (once again) the only option if you want to pool secretarial resources: if it takes 4 hours to copy an urgent voice file to Secretary A who is totally overworked, I’m afraid the patient will have to wait. And since there was no way to know that Secretary B was free to type it right away other than by calling or visiting her, you’ve lost yet another opportunity to save NHS money in the 21st century.

Hence the need to make sure you’re dealing with a system that gives you real-time visibility over the entire workflow, so you can see exactly what referrals are scheduled to be done or outstanding for typing at each surgery. Should there be an overload at any of the surgeries, you can then move work (not secretaries!) to the surgery needing help, at the click of a button.

5. Remember patient data, to keep it holy

Ah, privacy. Here comes a flat-out requirement that suppliers don’t address equally. First things first, all patient demographics and voice files must be stored in one location: your premise based server. No patient data should ever reside on PC, on a handheld device or in the “cloud”, and there should never be multiple copies of a file anywhere.

More questions that should help suppliers clear their voice: how do you ensure that remote dictation is as secure as dictating on-site? Are you able to support our multiple surgeries through our N3 network?  Last but not least, which authentication mechanisms does your system support (i.e.: Virtual Private Networks (VPN), Remote Access Service (RAS) and Windows® NT authentication)?

6. Thou shalt integrate with my clinical system

Clinical systems integration is your supplier’s problem, so beware of those who try to make it yours. It’s up to their technical experts to work out any technical roadblocks and provide you with a solution that guarantees automatic labeling of demographics into the report, thereby eliminating the risk of referrals being associated with the wrong patient.

  • Patient Name, Date of Birth and NHS Number are entered automatically for doctors in order to speed up dictation creation and eliminate demographic input errors.
  • Demographics are also visible on the transcription screen to provide secretaries with more patient visibility within their referral list.
  • To further improve security and save time for the secretary, there should also be a look up feature that opens the correct patient in the clinical system (i.e.: SystmOne) when a dictation is selected for transcription.

Price wise, such an integration module shouldn’t cost more than £49+VAT per annum to support. Anything above that is called stealing and is punishable by the next Commandment.

7. Thou shalt not steal from me

Oh yeah, you’ll meet a decent amount of big mouths full of marketing promises. Problem is: when you get to find out their actual delivery ratio, it’s usually too late. Hence the need to pay attention to Mr. Bigmouth’s body language while you’re bombarding him with all the right questions: any fishy move and you’re guaranteed a disaster with no recovery plan. Next.

I also recommend that you take a closer look at the pricing model, for it’s a place full of smoke where evil likes to hide. Does the supplier charge you per user and PC, even if the user in question only works part-time? Or are they open-minded enough to offer concurrent pricing, so that you only pay for the number of users logged into the system at any one time?

8. Thou shalt report on all referral trends

A good DDS should keep track of what was dictated and typed when and where, by whom and for which patient ID from the Clinical System. It can also prompt the clinician for the specialty and referral type at the outset. So let’s face it: refusing to pull up a fully-fledged referral report at any point in time would be one lazy move for a DDS, knowing that it’s got ALL the data in store.

Yet, very few systems provide such reporting at the moment, resulting in yet another aspirin prescription for the lucky practice manager in charge of cross-checking and analysing referrals through multiple spreadsheets on a rainy Saturday afternoon. When choosing your DDS, demand no less than instant reporting on referral patterns within your practice, CCG and locality – for that’s what you need to make informed clinical and commissioning decisions in the new NHS. Who is referring what to where? Do I have any high referrers? Are the referrals allocated to my practice the ones we’ve actually referred? And so forth.

9. Thou shalt practice what thou preaches

While marketing is the mother of all sins, dialogue is definitely that of wisdom. What you need at this final stage, beyond brochures and fact sheets, are real people to talk to. These real-life customers are the only ones able to either back-up or invalidate the sales speech while checking up on a few commandments. Through the course of this final reference check, you also want to make sure that you are talking about full-scale, live installations, not just pilots or proof-of-concepts.

10. Thou shalt not let me down

While the question of the supplier’s financial stability is often overlooked – much to the peril of client organisations – it is all the more critical in fast-paced technology environments where new opportunities emerge like apples in a sweet garden. This stability indicator will help you evaluate the chances of your system being supported five, ten years from now.

Last but not least, you should pay particular attention to the supplier’s responsiveness to technical issues as well as to new feature additions based on users’ feedback: when you call the Helpdesk, are you given a number in a musical queue, are you asked to open yet another ticket on some dark extranet, or are you speaking right away with a human being who has the kind of expertise you desperately require? Then again, speaking with existing customers is the best way to gauge the supplier’s ability to turn into a real business partner – and not just a bunch of hungry geeks who are just in for quick money.


Once you have all the right questions accurately lined up, thou shalt sit back and wait for the first crystal-clear responses to come out of Mr. Bigmouth. Enjoy, and don’t waste time trying to “be wise in your own eyes”. Let him prove wise in yours…

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CRESCENDO SYSTEMS LIMITED - Unit 1, Fiveways Business Centre, Feltham, TW13 7AQ - UNITED KINGDOM
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