Dr. Rosenthal, Assistant Director of the Emergency Department at the Jewish General Hospital in Montreal, Canada
Emergency departments are very particular areas in that they’re often overcrowded with up to 125 to 150% capacity. On top of that, paper charts can also be found everywhere. They’re used by consultants, they’re used by nurses, they’re used by physicians, they’re used by physiotherapists. So many people are sharing the charts and they’re everywhere. Physicians are not stationary, they’re not based at a desk and they are with patients.
We had a particular need where we found it very difficult to document progress notes. The condition of patients in an emergency changes, it evolves; it may take 5-6 different interactions with their condition changing and the treatment plan changing at every interaction. So documentation is very important. We felt there was a need to improve the on-the-fly documentation.
We use a hand-held pocket PC. The beauty is that we’ve developed an interface with the emergency system itself, so that the patient lists are on the hand-held device via the wireless network. Plus we’ve added a lot of value information to it in terms of consultations and diagnosis and disposition on the patients which we can drill down to. We are then able to select the patient from our list, press record and talk as we’re walking, just like this, from one place to the next. After we’re finished, we just press a button and it’s sent off, via the wireless network to the speech recognition server with Philips SpeechMagic. When the physician later has time, at a desk, looking up results or doing another task, they then open the reports and are able to correct them and use them and sign them electronically so they’re reusable.
The key components are the mobility, which is vital in that kind of setting, the wireless network, which is also vital, and it is amazing how we’re able to talk into a standard device, speak with a lot of background noise and it goes to the voice recognition and the quality is excellent. In terms of the whole loop of interfacing, of wireless, of voice recognition, that has not been done anywhere to the best of my knowledge.
The key components from my end are the people involved, who share a vision. We’ve had to really be cutting-edge, we’ve had to be persistent, to find solutions to any bugs that have come up. What this has allowed us to do, and what my vision is, is not to be tied to desktop solutions but, for example, as an emergency department this has allowed us to do our charging on a high level anywhere we are, including by the patient’s bedside. Coming up with solutions like this allows us to do that and to be where we need to be because the thing that suffers when we’re with patients is documentation. So the mobility aspect and the voice recognition combined have allowed us to spend time where we need to, with the patients. I believe what’s very important is to build flexibility into solutions, to be able to offer individuals what they need. And what we’re doing, together with Crescendo and SpeechMagic is offering people flexibility in how they work, fitting to their needs, rather than individuals fitting to technology.
People sometimes have false expectations. When you do have a solution, when you do have a technology that you want to implement, even though you expect everything to go perfectly, it does not. Physicians are not prioritized towards technology, they’re prioritized to patients. So if you hand it to them and there’s a bug or there’s a problem they’re going to be very resistant to reusing it. When implementing any new technology it is very important that you have a champion, that you have someone who is willing to take it, to work with it, to make sure it’s good. To make sure that any bugs that can happen, do happen, whether it be a problem with the network, whether it be a problem with an interface, and those things happen on start-up. That you work through them before widespread deployment.
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