Ross Weinstein
In parts one and two of this blog series about selecting a speech solution, I discussed identifying the needs and finding appropriate features to address those needs. In each case I provided examples from other Pathology practices that can be used as guidelines for organizations experiencing similar issues. In the final chapter, I am going to address best practices to make sure that the expected benefits of the solution will be achieved.
As mentioned in my initial post, features and price are just line items on a document. They are not predictors of success. One of the best methods to determine whether features can lead to a positive outcome or whether you can generate a return on investment is to find similar organizations to yours and see how they fared with any particular solution. Customer testimonials, case studies, reference calls, and site visits can provide an excellent crystal ball for what you can expect from a solution. That said, not all organizations are the same, but if you can find a reference with many of these same characteristics, you will have a higher probability of predicting whether a particular solution will be right for you.
Here is a hierarchy of things to consider when performing due diligence...
1. Medical specialty
Pathology reporting is unique and very complex compared to other healthcare specialties. Unlike other transcription-heavy specialties like Emergency Medicine, Radiology, or Surgery where one person is responsible for report creation, Pathology has multiple people taking part in creating the same report, and the environment in which report authors are dictating is typically more challenging due to specimen contamination and tools used to view specimen. As such, there is a higher requirement for hands-free reporting, and devices and workflows that accommodate these challenges. Comparing the success of a speech recognition solution in another specialty is never a great idea, because even from an accuracy standpoint, the speech model being used for recognition does not rely on a Pathology vocabulary and reporting model.
2. Type of users
In Pathology reporting, not all users are created equal. Each performs a different function in the report creation process and has a unique set of challenges to overcome when creating their piece of the report. The Pathologist Assistant or resident who is responsible for the gross description may be dictating a very lengthy report that adapts better to structured templates than a Pathologist who may be dictating a few-line diagnosis. A Pathologist may prefer to use a handheld microphone, but for a PA this is not an option since they need to be hands-free. A per diem Pathologist or resident with a short rotation may not adapt well to self-edit workflows due to the limited time they have to learn how to use a new system. We suggest looking at the following user types when evaluating whether a specific solution will work for your users.
- Pathologist
- Forensic Pathologist
- Teaching Pathologist
- Cytopathologist
- Resident
- Pathologist Assistant
- Per diem or locum
3. Type of AP System
As mentioned in the previous blog posts, the speech recognition reporting solution needs to be fully integrated with the AP System, and in many cases users have difficulty identifying where one begins and the other ends. Not every AP System is the same, and each comes with different types of text editors and reporting fields that have different capabilities for accepting dictated text and being able to edit that text. In addition, most Anatomic Pathology systems are disparate from the hospital information system, and there is no one system that dominates the market in terms of use. As such, any reporting system needs to be adaptable to accommodate the multiple solutions by those vendors.
4. AP System Infrastructure
Even when evaluating the same AP Systems there can be huge variations between how they are deployed, and these variations can impact text input and workflows in ways that make two of the same systems appear to be distant relatives. When doing your due diligence you should always look to see whether the AP System is implemented as a Client/Server Desktop Application, virtual machine (e.g., Citrix), or as a cloud-based solution (coming soon to a laboratory near you).
5. AP System Workflow
Again, there are variances even within the same AP System, and workflow could vary slightly within the same report section. Systems need to be adaptable to deal with all of these variations and knowing that a vendor solution is adaptable to your specific workflow is important. Here are some workflows to consider.
- Gross dictation
- Microscopic dictation
- Sign-out
- Autopsy
- Specialist workflow (e.g., Dermatopathology and Hematopathology)
- CAP eCC
6. Site locations
Another consideration is the physical facility that pathologists practice in. There are different challenges that need to be addressed when implementing a solution in a single physical location versus a distributed environment with multiple locations. When addressing multiple location facilities, networking and connectivity play a much larger role and coordinating Go-Lives between facilities where users may practice in multiple locations can present more of a challenge. In some cases, different IT staffs between facilities (i.e. hospital IT staff versus private practice staff where the same practice is also performing work in a hospital) and non-connected infrastructures can also come into play.
7. Type of organization
There are many different types of Anatomic Pathology practices and each comes with its own set of unique needs and challenges. For example, an academic hospital has to address resident needs and the volume of reporting per Pathologist may not be as great as those in a private laboratory or non-teaching hospital. In these laboratories, being bleeding edge in technology may address a greater need than in private laboratories where productivity and return on investment usually play a greater role in the decision to acquire a solution. When looking for a comparable Pathology organization, we suggest the following breakdown.
- Academic hospital
- Non-teaching hospital
- Children's hospital
- Hospital group
- Private laboratory
- Reference laboratory
- Veteran's Administration laboratory
- Veterinary laboratory
8. Integration Testing
While the above checklist is very helpful in selecting a reference site that most closely helps you predict success in your environment, not every single consideration needs to be a perfect match in order to select a solution that is right for you. For example, what happens if you are implementing a solution against an AP System with no referenceable solutions? Should you just not move forward with the potential benefits or is there still a way to mitigate your risks?
In cases like these, we suggest an on-site workflow integration test. This benefits both the client and the vendor, because if success is the goal then getting on site and showing how the software can be integrated in this unique environment will go a long way towards ensuring that future goals will be met.
In Pathology one size does not fit all, and vendors with limited experience with Pathology reporting and all of the various systems, workflows, users, and environments face a huge learning curve and a lower chance of successfully meeting specific solution requirements. Pathology organizations that accurately define their needs up front and look for solutions that have demonstrated success in similar environments are going to have a higher probability of success than those who simply rely on price and features that haven't demonstrated success in solving the problems identified.
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