Christian Bellemare

Speech Recognition in the Radiology Department: A Systematic Review:

Objective: to conduct a systematic review of the literature describing the impact of speech recognition systems on report error rates and productivity in radiology departments. Methods: The search was conducted for relevant papers published from January 1992 to October 2013. Comparative studies reporting any of the following outcomes were selected: error rates, departmental productivity, and radiologist productivity. The retrieved studies were assessed for quality and risk of bias. Results: The literature search identified 85 potentially relevant publications, but, based on the inclusion and exclusion criteria, only 20 were included. Most studies were before and after assessments with no control group. There was a large amount of heterogeneity due to differences in the imaging modalities assessed and the outcomes measured. The percentage of reports containing at least one error varied from 4.8% to 89% for speech recognition, and from 2.1% to 22% for transcription. Departmental productivity was improved with decreases in report turnaround times varying from 35% to 99%. Most studies found a lengthening of radiologist dictation time. Conclusion: Overall gains in departmental productivity were high, but radiologist productivity, as measured by the time to produce a report, was diminished.

Dual vs. Single computer monitor in a Canadian hospital archiving department: A study of efficiency and satisfaction

This paper describes a comparative study of clinical coding by Archivists (also known as Clinical Coders in some other countries) using single and dual computer monitors. In the present context, processing a record corresponds to checking the available information; searching for the missing physician information; and finally, performing clinical coding. We collected data for each Archivist during her use of the single monitor for 40 hours and during her use of the dual monitor for 20 hours. During the experimental periods, Archivists did not perform other related duties, so we were able to measure the real-time processing of records. To control for the type of records and their impact on the process time required, we categorised the cases as major or minor, based on whether acute care or day surgery was involved. Overall results show that 1,234 records were processed using a single monitor and 647 records using a dual monitor. The time required to process a record was significantly higher (p= .071) with a single monitor compared to a dual monitor (19.83 vs. 18.73 minutes). However, the percentage of major cases was significantly higher (p= .000) in the single monitor group compared to the dual monitor group (78% vs. 69%). As a consequence, we adjusted our results, which reduced the difference in time required to process a record between the two systems from 1.1 to 0.61 minutes. Thus, the net real-time difference was only 37 seconds in favour of the dual monitor system. Extrapolated over a 5-year period, this would represent a time savings of 3.1 % and generate a net cost savings of

New design of care: Assessment of an interdisciplinary orthopaedic clinic with a pivot nurse in the province of Quebec.

7,729 CAD (Canadian dollars) for each workstation that devoted 35 hours per week to the processing of records. Finally, satisfaction questionnaire responses indicated a high level of satisfaction and support for the dual-monitor system. The implementation of a dual-monitor system in a hospital archiving department is an efficient option in the context of scarce human resources and has the strong support of Archivists.

The Health Technology Assessment Unit of the Centre hospitalier universitaire de Sherbrooke (Canada)

BACKGROUND: New designs of care in orthopaedic clinics are needed to cope with the shortage of orthopaedic surgeons and the lengthening of waiting times. OBJECTIVE: To assess the effectiveness of an interdisciplinary orthopaedic clinic with a pivot nurse in the Canadian province of Quebec with regard to accessibility, quality of care, efficacy and efficiency of the clinic, and patients quality of life. METHODS: Two strategies were developed: (1) a selected cohort of new patients attending an orthopaedic service from February to September 2008 were entered into a database recording patient details, source of referral, diagnosis, satisfaction, and quality of life (36-Item Short Form Health Survey version 2). In this setting, 2 sets of questionnaires were administered to the patients: the first one during the first visit and the second one, 2 months later. A total of 243 patients from the case control were compared with 89 patients of the case study, where an interdisciplinary orthopaedic clinic with a pivot nurse has been developed; (2) costs per patient were calculated using the staff timesheets provided by the two orthopaedic clinics. RESULTS: The results showed a significant reduction in the waiting-list duration (accessibility) in the case study clinic owing to a strong decrease in the inappropriate consultations with the orthopaedic consultant. The quality of care remained high, and the target surgeries for total hip and knee replacement were reached, despite a strong shortage of orthopaedic doctors. CONCLUSION: Interdisciplinary orthopaedic clinic with a pivot nurse is a new approach in the province of Quebec and first results are encouraging.

Social acceptance and population confidence in telehealth in Quebec.

The Health Technology Assessment (HTA) Unit of the Centre hospitalier universitaire de Sherbrooke (CHUS) has been created in 2004. A coordinator (middle-level manager) holding a master’s degree from the Universite de Montreal in health technology assessment and an advisor in technology assessment started the development of the unit under the management of the Director of Medical Affairs and Professional Services. By this positioning, the organization allowed the HTA Unit a proximity to clinicians while keeping strategic relations to senior management. To increase credibility among these groups, approval of HTA reports was under the responsibility of the Director of Medical Affairs and Professional Services (a physician and senior manager).