OPEN Mic project – Outpatient correspondence enhancements

Aim

To reduce the backlog and turnaround time of outpatient correspondence by streamlining workflows, and optimising use of available digital technologies, including Dragon Medical One (DMO) voice to text dictation and ieMR functionalities.

Outcomes

• 94.5% reduction in outpatient correspondence backlog – 2,215 down to 121
• 98% reduction  in correspondence delay – eight weeks down to 1.24 days
• 11,645 letters completed via the new workflow in nine months
• 8,380 individual patients benefited from the faster turn-around time o 426 staff trained in DMO or DMO and outpatient correspondence workflow
• Minimum ~1,557 hours released to DMO users (clinician time – typing versus speaking)
• Reduction in the number of outpatient correspondence workflow processes (>8 to 4) o 74% of DMO licenses allocated at the end of the project with 48% adoption
• 100% of  survey respondents would recommend the new workflow to their colleagues

Background

• Backlog and delay of outpatient clinical correspondence
• Lack of standardised correspondence  workflows
• Underutilised digital solutions

Prior to the OPEN Mic Project, Mackay Hospital and Health Service (MHHS) had a significant (high volume) and long-standing backlog of outpatient clinic correspondence. This is correspondence that had been dictated
by clinicians and required typing, formatting, clinician review, approval, processing, and distribution. Delays in the delivery of clinical communication to treating clinicians can be detrimental to the patients care journey. They can lead to missed or late
diagnostic testing or treatment. The correspondence could be delayed at any stage during the process, and delays were attributed to many factors including:

• The large number of outpatient appointments resulting in a high volume of correspondences.
• Increased  clinical acuity of patients being seen by specialists leading to clinical workload pressures which in turn contribute to delays in dictating relevant correspondence.
• Staff shortages, both clinical and non-clinical.
• Locums and visiting/rotating medical officers being unable to check their correspondence before moving to their next location, creating a lengthy follow up process for approval and release of clinical correspondence.

The dictation backlog varied from week to week, however over a six-month period  (July to December 2024), the monthly average number of correspondence items awaiting transcription was 2,214, with an additional 500-600 letters typed and awaiting verification by clinicians. The backlog reached an all-time high in August 2024; with 2,869  jobs outstanding. At project go-live, 17th March 2025, the number of outstanding letters in the medical typing queue awaiting transcription was 2,215. At this time, letters were taking anywhere from six to nine weeks from the clinician dictating the letter
into the Winscribe system, to the letter being distributed to recipient/s. Senior management and clinicians determined that this posed a significant clinical risk, and was also contributing to other organisational problems, such as workload pressures and low
staff morale.

In addition to this issue, there was an absence of standardisation across the outpatient correspondence workflows which posed challenges for staff. These included; clinical productivity waste (verifying clinical correspondence that was dictated  up to nine weeks earlier and required an additional chart review for familiarity), ability to recall and follow processes correctly, the ability to provide effective training, and upskilling of staff across the different workflows. All of these challenges  contributed to delays in correspondence reaching the intended recipients, and on occasion may have also led to correspondence not reaching the intended recipients at all. The flow on effects from these impacted both patients (causing delayed or missed treatment),  and GPs or other treating clinicians (preventing them from appropriately managing or treating their patients).

These issues presented an opportunity to incorporate a new standardised workflow utilising existing ieMR functionalities, coupled with DMO, which  the health service was already paying for but was not being used to its full potential. This was the most financially responsible solution.

Discussion

We initially aimed for a 25% reduction in turnaround time for the cohort of clinicians  who were involved in the interventions. This was surpassed immediately (eight weeks to 1.24 days), and the backlog had also reduced by 25% after three weeks of training. The projects’ success relied heavily on having a digitally enabled health service, with a  workforce who is familiar with clinical technology, services operating an electronic medical record system, and access to DMO licences (which is integrated into the ieMR).

In addition to these core requirements, success was built on a number of factors. These  included a dedicated and resourced project team enabling strong facilitation and management, a collaborative and co-designed approach to new workflow development, a highly motivated and supportive executive leadership team, escalation and management of risks  and issues as they arose, a highly engaged and adaptable vendor, a passionate working group with unwavering commitment, engaged clinical champions, clinical roster flexibility, accurate data, and good communication, trust, and rapport with clinicians. We anticipated  a major barrier would be staff adoption and willingness to use the digital technologies. What we witnessed, was clinicians cared more about fixing the problem and reducing the impact from delayed correspondence, than the required change in practice. They were  quite eager to learn DMO and the new workflow.

We experienced a number of issues which were able to be navigated. These could be used as lessons for future implementations:

• Allow sufficient time between training weeks to provide elbow support and adjust  processes before the next round of training.
• Develop a rigorous issue log and management process for monitoring letter quality, prior to go-live. o Include key subject matter experts in the critical planning and preparation phase, such as ieMR application  specialists.
• Early planning for transition to BAU, supported by a comprehensive sustainability plan. o When working with integrated solutions, it is imperative to be across all system upgrades and potential impacts.
• Plan for last minute changes to participant attendance due to prioritisation of clinical duties, with options on hand to fill empty spaces, and reschedule as required.

Clinician feedback, their adoption of the new workflow, and the volume of letters created, demonstrate that this solution simply ‘works’.  Any digital health service in Queensland Health with a medical typing backlog, or who experience delays in outpatient correspondence, could implement this workflow. The functionality is already built into the ieMR, and those services who have access to DMO licences, can further streamline this process. Effective use of our existing health resources is more imperative than ever. We are proud to have implemented a digital and technology-based project, redesigning workflows and empowering clinicians, without purchasing any additional digital solutions. We have delivered measurable, sustainable change — at scale, and shown that innovation doesn’t always mean new technology — sometimes it means using what we already have, but better. Vendor quote: “The experience at Mackay highlighted how having a strong, collaborative project team can significantly contribute to the success of an implementation”.

References

An evidenced‐based strategy for timely delivery of clinical letters - Corson - 2017  - Progress in Neurology and Psychiatry - Wiley Online Library Dragon Medical One (DMO) Voice to Text in the Emergency Department | Clinical Excellence Queensland