This is a detailed post, meant for radiologists who want concrete steps for optimizing Nuance's Powerscribe 360.
Templates improve outward service and help in meeting metric reporting (MIPS) criteria.
I am going to jump into some details for Powerscribe 360 that might be helpful for struggling radiologists. This may assist some practices in making the rubber meet the road to realize the promises of the pitch. I will end with a few comments in regards to internal workflow, billing, and quality.
Make 1 base general template (PS360 “Autotext”) for each radiology CPT code. Do this initially at the top tier “Site” level. You can start by setting up a basic shell template (“Text Fields” for typical section headers – findings, etc.). You then “clone” this “Autotext” as many times as you need, rename to each study type you need (each CPT). Spend the time to make L and R versions. Trust me. Working at the “Site” level requires “Admin” rights.
Link each Autotext to the appropriate line item/s of your system’s chargemaster. PS360 calls this assigning “Categories” and it makes the templates “Relevant”. This is an IMPERATIVE step, and should be done with the root “Site” level Autotext. So many useful things tumble from this, I cannot stress it enough. Unfortunately, this is system specific and needs to be done whether you build Autotexts from scratch or get your hands on a set from Nuance or elsewhere.
Base content: PS360 has “Merge fields” that your IT staff can set up (interface) for certain types of information. Date of service and indication are two obvious basic ones to pull from your RIS or EMR. (US measurements and NM doses are still out of reach for us, but desired.)
“Pick Lists”: These are fields that nest in the template. You can invoke a chunk of text with a single key word. We use this for “Technique” section (e.g. CT AP w/wo is still 1 template, with 5 different options in the pick list for panc, renal mass, etc…). We also use it for the set of projections on plain films (e.g. variations on a 3-view knee).
“Findings” #1: Careful of a breakdown here. You will need buy-in, especially if working with a herd of cats, I mean brilliant radiologists who have not previously used VR or who love their own template verbiage. I chose to have very basic formulaic normal findings for CR studies. I left MR/CT findings as an empty text field. US and NM were variously built out.
“Findings” #2: Only when you complete the above, THEN you “Clone” all of the “Site Autotexts” to each user’s account. Each user will have a full set of “Relevant Personal Autotexts”. We were not authoritarian in “Findings” content, in order to preserve buy-in during our transition. (Aside: There is plenty of structure to the above steps, without a line item per-organ findings section. I really can’t stand reading articles about “structured vs unstructured” reporting. It is a spectrum.). This allows your rads the autonomy to alter or add findings to take ownership of the templates without having to accept “your” way of dictating, while PRESERVING all of the structured content you embedded.
By having 1 root Autotext tied to each Category chargemaster line item, you can make it a “Default” that blows in when you launch the dictation, whether the study is normal or not. 100% of the time.
“Cloning” is key. Once you have a default set up, you can clone the autotext as many times as you want. The key here is that cloning will PRESERVE the categories that make the templates “relevant”. These clones will not be defaults. There are two huge benefits (stay with me here):
1. You can invoke and nest another autotext within your default autotext dictation. Specifically, you can have as many simple or complex variations for a “Findings” section for a given study type as you want, and they will be easy to find (and remember!) when you use the Autotext preview pane set to “Relevant Personal” at the bottom of the dictation window. The sky is the limit here, and I will admit that finding the time to create these iterations is hard.
2. You can use this same cloning approach to set up as many “tips” (i.e. crib sheets) Autotexts as you want. When you single click on an autotext in the bottom of the dictation screen you will see it in the preview pane, without dumping the content into your actual dictation. I LOVE THIS. I use this daily for various things such as Lung-RADS, adnexal consensus recommendations, Fleischner, aortic root limits, etc. It occurs to me that this could be a really handy educational tool at point of care at a teaching institution.
By having only 1 template pinning back to each CPT code, and having fixed text descriptions at the top of your report, you can avoid human error in what you do or do not dictate. Conversely, you can spot the occasional IT/Registration/Tech mix up quickly when whatever flows through from RIS/EMR/written order does not match what you are seeing in PACS. A stitch in time for a clean claim…
Similar and related to the above, you can quickly spot if the PACS study does not match what is in your default template (CR 2 views vs 3 views, L spine complete or not, CT w vs w/wo, L/R mismatch, etc…). Also, having discrete, non-generic, technique sections for your complex cross sectional studies also communicates a level of service and attention to referring specialists (e.g. all “CT w/wo” are not the same!). This is painless with a pick list and a single spoken word, but is not going to happen if you are dictating the entire protocol every case. Helps demonstrate our expertise.
This was article was originally posted on ACR Engage on February 11, 2017.
Below are YouTube videos with tips on how to use Powerscribe 360:
By Jason Mullinix - 11 videos above.
By University of South Florida above.
Matthew Brady, MD is the Alternate Councilor for the South Carolina Chapter of the ACR and Treasurer of the South Carolina Radiological Society. After obtaining a BA at The Woodrow Wilson School of Public and International Affairs at Princeton in 1997, he earned his MD at Dartmouth in 2002. Dr. Brady then went on to a Radiology Residency with subsequent combined Nuclear Medicine and Body Imaging at Duke University from 2003 to 2008. Dr. Brady is dual boarded by the ABR and ABNM and is now is in private practice at Roper Radiologists, PA in Charleston, South Carolina.