scholarly journals Challenges of developing a digital scribe to reduce clinical documentation burden

2019 ◽  
Vol 2 (1) ◽  
Author(s):  
Juan C. Quiroz ◽  
Liliana Laranjo ◽  
Ahmet Baki Kocaballi ◽  
Shlomo Berkovsky ◽  
Dana Rezazadegan ◽  
...  
Keyword(s):  
Speech Recognition ◽  
Complex Nature ◽  
Clinical Settings ◽  
Clinical Documentation ◽  
Clinician Satisfaction ◽  
Clinical Environments ◽  
Medical Concepts ◽  
Medical Scribes ◽  
Topic Structure

AbstractClinicians spend a large amount of time on clinical documentation of patient encounters, often impacting quality of care and clinician satisfaction, and causing physician burnout. Advances in artificial intelligence (AI) and machine learning (ML) open the possibility of automating clinical documentation with digital scribes, using speech recognition to eliminate manual documentation by clinicians or medical scribes. However, developing a digital scribe is fraught with problems due to the complex nature of clinical environments and clinical conversations. This paper identifies and discusses major challenges associated with developing automated speech-based documentation in clinical settings: recording high-quality audio, converting audio to transcripts using speech recognition, inducing topic structure from conversation data, extracting medical concepts, generating clinically meaningful summaries of conversations, and obtaining clinical data for AI and ML algorithms.

scholarly journals Speech recognition for clinical documentation from 1990 to 2018: a systematic review

2019 ◽  
Vol 26 (4) ◽  
pp. 324-338 ◽  
Author(s):  
Suzanne V Blackley ◽  
Jessica Huynh ◽  
Liqin Wang ◽  
Zfania Korach ◽  
Li Zhou
Keyword(s):  
Speech Recognition ◽  
Turnaround Time ◽  
Error Rates ◽  
Evaluation Metrics ◽  
Radiology Department ◽  
Clinical Settings ◽  
Clinical Documentation ◽  
Error Analyses ◽  
Institutional Cost ◽  
The Impact

Abstract Objective The study sought to review recent literature regarding use of speech recognition (SR) technology for clinical documentation and to understand the impact of SR on document accuracy, provider efficiency, institutional cost, and more. Materials and Methods We searched 10 scientific and medical literature databases to find articles about clinician use of SR for documentation published between January 1, 1990, and October 15, 2018. We annotated included articles with their research topic(s), medical domain(s), and SR system(s) evaluated and analyzed the results. Results One hundred twenty-two articles were included. Forty-eight (39.3%) involved the radiology department exclusively and 10 (8.2%) involved emergency medicine; 10 (8.2%) mentioned multiple departments. Forty-eight (39.3%) articles studied productivity; 20 (16.4%) studied the effect of SR on documentation time, with mixed findings. Decreased turnaround time was reported in all 19 (15.6%) studies in which it was evaluated. Twenty-nine (23.8%) studies conducted error analyses, though various evaluation metrics were used. Reported percentage of documents with errors ranged from 4.8% to 71%; reported word error rates ranged from 7.4% to 38.7%. Seven (5.7%) studies assessed documentation-associated costs; 5 reported decreases and 2 reported increases. Many studies (44.3%) used products by Nuance Communications. Other vendors included IBM (9.0%) and Philips (6.6%); 7 (5.7%) used self-developed systems. Conclusion Despite widespread use of SR for clinical documentation, research on this topic remains largely heterogeneous, often using different evaluation metrics with mixed findings. Further, that SR-assisted documentation has become increasingly common in clinical settings beyond radiology warrants further investigation of its use and effectiveness in these settings.

scholarly journals A standardized framework for testing the performance of sleep-tracking technology: step-by-step guidelines and open-source code

SLEEP ◽  
2020 ◽  
Author(s):  
Luca Menghini ◽  
Nicola Cellini ◽  
Aimee Goldstone ◽  
Fiona C Baker ◽  
Massimiliano de Zambotti
Keyword(s):  
Open Source ◽  
Validation Studies ◽  
Large Scale ◽  
Analytical Framework ◽  
Clinical Settings ◽  
Large Scale Data ◽  
Fast Pace ◽  
Epoch Analysis ◽  
Tracking Devices

Abstract Sleep-tracking devices, particularly within the consumer sleep technology (CST) space, are increasingly used in both research and clinical settings, providing new opportunities for large-scale data collection in highly ecological conditions. Due to the fast pace of the CST industry combined with the lack of a standardized framework to evaluate the performance of sleep trackers, their accuracy and reliability in measuring sleep remains largely unknown. Here, we provide a step-by-step analytical framework for evaluating the performance of sleep trackers (including standard actigraphy), as compared with gold-standard polysomnography (PSG) or other reference methods. The analytical guidelines are based on recent recommendations for evaluating and using CST from our group and others (de Zambotti and colleagues; Depner and colleagues), and include raw data organization as well as critical analytical procedures, including discrepancy analysis, Bland–Altman plots, and epoch-by-epoch analysis. Analytical steps are accompanied by open-source R functions (depicted at https://sri-human-sleep.github.io/sleep-trackers-performance/AnalyticalPipeline_v1.0.0.html). In addition, an empirical sample dataset is used to describe and discuss the main outcomes of the proposed pipeline. The guidelines and the accompanying functions are aimed at standardizing the testing of CSTs performance, to not only increase the replicability of validation studies, but also to provide ready-to-use tools to researchers and clinicians. All in all, this work can help to increase the efficiency, interpretation, and quality of validation studies, and to improve the informed adoption of CST in research and clinical settings.

scholarly journals 829 Is There an Ongoing Role For 'Telephone Triage Clinics' Post COVID-19?

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
B Holmes ◽  
U Mirza ◽  
C Manning ◽  
R Cooke ◽  
R Jugdey
Keyword(s):  
Common Theme ◽  
Telephone Triage ◽  
Telephone Consultation ◽  
Face To Face ◽  
Clinician Satisfaction ◽  
Set Up ◽  
Local Protocol ◽  
Telephone Questionnaire

Abstract Introduction COVID-19 has placed unprecedented demand on services at ELHT and it has become necessary to have telephone clinics to reduce the number of face-to-face clinics. A ‘telephone triage clinic’ was set up for referrals from A&E. Our project evaluated patient and clinician satisfaction on this. Method We carried out a retrospective telephone questionnaire with patients over a one-week period during the pandemic. We focussed on overall satisfaction of the consultation and quality of communication. Consultants were also surveyed for their opinion on the clinics. Results From 30 patients, 77% said they were ‘very satisfied’ with the overall experience. 80% of patients were ‘very satisfied’ with the overall length of the telephone consultation. 50% of patients felt the clinician was only ‘adequately’ able to assess them over the telephone. The consultants were less satisfied with the overall experience of telephone consultation. A common theme was that they felt ED documentation could be improved to help inform ongoing management. Conclusions Overall, patients were satisfied with the consultations. It has been successful in minimising face to face consultations however some presentations necessitate further evaluation. We need to identify those injuries appropriate for virtual follow up and design a local protocol for these.

scholarly journals Lack of recognition and documentation of stress hyperglycemia is a disruptor of optimal continuity of care

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Eric D. Moyer ◽  
Erik B. Lehman ◽  
Matthew D. Bolton ◽  
Jennifer Goldstein ◽  
Ariana R. Pichardo-Lowden
Keyword(s):  
Blood Glucose ◽  
Continuity Of Care ◽  
Clinical Documentation ◽  
Stress Hyperglycemia ◽  
Optimal Care ◽  
Continuity Clinic ◽  
Altered Glucose ◽  
Discharge Summaries

AbstractStress hyperglycemia (SH) is a manifestation of altered glucose metabolism in acutely ill patients which worsens outcomes and may represent a risk factor for diabetes. Continuity of care can assess this risk, which depends on quality of hospital clinical documentation. We aimed to determine the incidence of SH and documentation tendencies in hospital discharge summaries and continuity notes. We retrospectively examined diagnoses during a 12-months period. A 3-months representative sample of discharge summaries and continuity clinic notes underwent manual abstraction. Over 12-months, 495 admissions had ≥ 2 blood glucose measurements ≥ 10 mmol/L (180 mg/dL), which provided a SH incidence of 3.3%. Considering other glucose states suggestive of SH, records showing ≥ 4 blood glucose measurements ≥ 7.8 mmol/L (140 mg/dL) totaled 521 admissions. The entire 3-months subset of 124 records lacked the diagnosis SH documentation in discharge summaries. Only two (1.6%) records documented SH in the narrative of hospital summaries. Documentation or assessment of SH was absent in all ambulatory continuity notes. Lack of documentation of SH contributes to lack of follow-up after discharge, representing a disruptor of optimal care. Activities focused on improving quality of hospital documentation need to be integral to the education and competency of providers within accountable health systems.

scholarly journals 964 Telemedicine: Speedy Triage Tool or Clinical Record?

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
A Ghareib ◽  
Z Vinnicombe ◽  
G Visser ◽  
A Ra ◽  
M Mantella ◽  
...  
Keyword(s):  
Plastic Surgery ◽  
Compliance Rate ◽  
Clinical Record ◽  
Portal System ◽  
Clinical Documentation ◽  
University Hospitals ◽  
Record Keeping ◽  
Clinical Document ◽  
National Guidance

Abstract Introduction St. George’s University Hospitals NHS Foundation Trust is a tertiary plastic surgery centre serving a population of 3.5 million in and around South West London. Telemedicine Referral Image Portal System (TRIPS) is integral to our service, allowing triage of patients in remote locations. During Covid, TRIPS helped in reducing footfall and streamlining out of hospital referrals to reduce unnecessary transfer. The aim of this project was to assess the quality of clinical documentation for emergency referrals to plastic surgery via TRIPS. Method We performed a retrospective review of all patients referred to plastic surgery via TRIPS during April 2020. Documentation standards were determined from national guidance. After introduction of a condensed guide, a second review was performed four months later. Results In April, 131 referrals were recorded on TRIPS. Only 22.9% of records met the standard. The most common omission was treatment advice. Following introduction of guidance, 215 TRIPS records were reviewed. The quality of clinical documentation improved in all aspects with a compliance rate of 89%. Conclusions Although TRIPS remains a useful tool for triage, it is a clinical document and must meet the standards of clinical record keeping. Introduction of clear guidelines improves overall compliance.

scholarly journals Micro-Hydropower in Nepal: Analysing the Project Process to Understand Drivers that Strengthen and Weaken Sustainability

2021 ◽  
Vol 13 (3) ◽  
pp. 1582
Author(s):  
Joe Butchers ◽  
Sam Williamson ◽  
Julian Booker
Keyword(s):  
Poor Quality ◽  
Hydropower Plant ◽  
Complex Nature ◽  
Sustainable Operation ◽  
Energy Projects ◽  
Project Cycle ◽  
The Government ◽  
Hydropower Industry ◽  
Key Events

Evaluating the sustainable operation of community-owned and community-operated renewable energy projects is complex. The development of a project often depends on the actions of diverse stakeholders, including the government, industry and communities. Throughout the project cycle, these interrelated actions impact the sustainability of the project. In this paper, the typical project cycle of a micro-hydropower plant in Nepal is used to demonstrate that key events throughout the project cycle affect a plant’s ability to operate sustainably. Through a critical analysis of the available literature, policy and project documentation and interviews with manufacturers, drivers that affect the sustainability of plants are found. Examples include weak specification of civil components during tendering, quality control issues during manufacture, poor quality of construction and trained operators leaving their position. Opportunities to minimise both the occurrence and the severity of threats to sustainability are identified. For the micro-hydropower industry in Nepal, recommendations are made for specific actions by the relevant stakeholders at appropriate moments in the project cycle. More broadly, the findings demonstrate that the complex nature of developing community energy projects requires a holistic consideration of the complete project process.

Understanding the changing nature of psychological contracts in 21st century organizations

2016 ◽  
Vol 7 (1) ◽  
pp. 4-35 ◽  
Author(s):  
Carlos-Maria Alcover ◽  
Ramón Rico ◽  
William H. Turnley ◽  
Mark C. Bolino
Keyword(s):  
Social Exchange ◽  
21St Century ◽  
Psychological Contract ◽  
Social Exchange Theory ◽  
Psychological Contracts ◽  
Complex Nature ◽  
Organizational Life ◽  
Exchange Relationships ◽  
Justice Perceptions

In recent years, scholars have increasingly recognized that the theoretical underpinnings of employee-organization relationships (EOR) are in need of further extension in light of recent organizational changes. In prior research, the study of EOR has been based on social exchange theory, and the psychological contract (PC) has played a central role in understanding this crucial aspect of organizational life. The main objective of this paper is to provide an integration of the existing literature by adopting a multiple-foci exchange relationships approach. Specifically, we looked at identification; the quality of relationships and exchanges with the leader, coworkers, and other organizational agents; justice perceptions involving several organizational sources; and perceived organizational, leader, and coworker support to expand our understanding of the PC. Overall, we advocate a multiple-foci exchange relationships approach that will ultimately enable us to develop a more comprehensive understanding of the complex nature of PCs in 21st century organizations.

Analysis of Inventory Management in Reverse Supply Chain Using Stochastic Dynamic Programming Model

2008 ◽  
Author(s):  
Badr O. Johar ◽  
Surendra M. Gupta
Keyword(s):  
Dynamic Programming ◽  
Inventory Management ◽  
Reverse Logistics ◽  
Stochastic Dynamic Programming ◽  
Public Awareness ◽  
Financial Burden ◽  
Probabilistic Approach ◽  
Complex Nature ◽  
Stochastic Dynamic

Reverse logistics is a critical topic that has captured the attention of government, private entities and researchers in recent years. This increase in the concern was driven by current set of government regulations, increase of public awareness, and the attractive economic opportunities. Also, environmentalists have always demanded Original Equipment Manufacturers (OEMs) to be more involved and be responsible of their products at the end of its life cycle. However, the uncertainty in quality of items returned, and its quantity discourage OEMs from participating in such programs. Because of the unique problems associated and the complex nature of the reverse logistics activities, numerous studies have been carried out in this field. One of those crucial areas is inventory management of End-of-Life (EOL) products. The take back program could possibly bring financial burden to OEM if it is not managed well. Thus, an efficient yet cost effective system should be implemented to appropriately manage the overwhelming number of returns. Previously, we have analyzed the problem based on the assumption that the number of core products returned and disassembled parts and subassemblies are known in advance. In this paper, we introduce a probabilistic approach where different quality levels of for every component disassembled are considered and different probabilities of these qualities given the quality of the returned product. The model utilizes a multi-period stochastic dynamic programming in a disassembly line context to solve the problem, and generate the best option that will maximize the system total profit. A numerical example is given to illustrate the approach. Finally, directions for future research are suggested.

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