Taking Speech to the Next Level

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Standardization, clinical decision support, integration and structured reporting all are part of speech recognition’s path to the future, with many vendors well on their way to offering these advances in the near future. Some are already on the market.

Stephen E. Rosenthal, MD, associate director of the emergency department and director of medical informatics at Sir Mortimer B. Davis-Jewish General Hospital in Quebec, Canada, began piloting a mobile speech solution in the emergency department back in 2003. While that was primarily for progress notes and other on-the-fly documentation, he’s now working with Cresendo Systems to help physicians do more complex—but still mobile—documentation. “The nice thing about where we’re going is the multiplatform potential, especially with foreground documentation.”

All about integration

Hospital and departmental information systems need to become more integrated before users can, for example, go on any device and choose a particular kind of note to document. Then, users can get a default patient list—only those patients who fit the category selected. “Selecting your patient has to be easy for doctors and reliable,” Rosenthal says. And while speech technology allows for automation, macro development and templates, Rosenthal cautions against creating hundreds of templates, for example. “Nobody wants to use it if it’s too complex. It cannot take longer than writing.”

The goal of standardized documentation allows for searchable structure, Rosenthal says, which will eventually allow for clinical decision support. Reference material and other background information can help clinicians determine the best test to order and develop appropriate care plans. Structured documentation also becomes searchable for better auditing and other tasks for improved patient care.

Chris Spring, senior product manager for SpeechQ at MedQuist, also sees documents themselves becoming more dynamic in the future. For example, a physician dictating a report can click on a condition or symptom in that report and link to reference information that can assist in the diagnosis of a particular exam. He also sees the ability to tie CPT coding into documents.

Jason Koller is director of RIS and SpeechQ for Inland Imaging, a group of imaging centers headquartered in Spokane, Wash., where SpeechQ version 1.2 was beta tested. “With this release comes a new and improved integration between the Philips iSite [PACS] and SpeechQ,” he says. The integration is more bidirectional so users can open images from iSite and have that drive SpeechQ and vice versa. “Instead of having to hunt and peck for images in iSite, they can work off of a SpeechQ worklist.”

Another integration aspect of the new SpeechQ that Koller appreciates is the ability to break integration between iSite and SpeechQ. That will be helpful when radiologists are signing off on reports or even when they’re doing rounds. When pulling up a lot of studies within iSite, they can temporarily suspend integration.

Integration is a very, very important part of making speech recognition technology easier for physicians to accept and use, says Spring. “The physician lives at the desktop. We’ve already demonstrated improved patient care and return on investment with speech recognition. Now we have to make it easier for the physician to accept the technology.”

Before digital dictation, Inland radiologists spent a lot of time re-reviewing exams, Koller says. Now, radiologists can spend more time on each exam, but the organization gets more work out of the radiologist per day. “We can grow with our existing base of radiologists,” he adds. Before implementing SpeechQ, Inland typically had 4,000 to 5,000 reports in the queue awaiting transcription. Today, 90 to 95 percent of reports are turned around in 30 minutes.

Craving critical test results

Terence Matalon, MD, chairman of the department of Radiology for Albert Einstein Medical Center in Philadelphia, has been using PowerScribe from Nuance for about two years. When he joined the facility in 2003, average report turn-around time was 112 hours. Thanks to the implementation of both Fujifim’s Synapse PACS and PowerScribe, turn-around time is now 12 hours. Although that’s a significant improvement, turn-around time “is a moving target,” he says. “There’s always going to be an increasing demand to shorten that time. The ideal is to have a completed, verified report at the completion of the exam.”

While the facility’s users have