Talking the Talk

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Voice recognition software coupled with RIS and PACS cuts radiology report turnaround time by hours and even days and drives down transcription fees by hundreds of thousands of dollars - all well worth the training and adjustment they require.

The realities of modern radiology practice demand accurate, efficient and cost-effective workflow from image capture through report creation, verification and delivery.

"It's clear to me that PACS was meant to be married to voice activated transcription," says Elliot Sandberg, MD, associate professor of radiology and neurology at the University of Colorado and chief of imaging at the Veterans Administration Hospital of Denver. "With PACS allowing providers immediate access to images, any significant delay in the availability of reports reflects poorly on the credibility of the radiologist."

Radiology practices, whether on a large academic medical campus or in a small freestanding clinic, require rapid turnaround time for report generation. Voice recognition technology conquers that need. Radiologists using these systems describe a dramatic reduction in interruptions to their workflow caused by colleagues looking for a report. A corollary benefit end-users note is the reduction in cost afforded by decreased reliance on transcription services.


Sandberg is using the Agfa HealthCare Impax 4.5 PACS with TalkStation 3.0 software embedded with Dragon NaturallySpeaking (ScanSoft). Both PACS and voice recognition functions are driven by the Impax GUI (graphical user interface) to minimize redundant log-ons and order selection activities.

"From a quality management perspective, having [voice recognition] integrated has value with respect to decreased errors," says Sandberg. The more personnel involved in entering data, the greater the opportunities for mistakes in data entry to occur. Their department of 10 radiologists produces reports on 130,000 exams per year. "The number of visits from physicians wanting to view cases [in our department] has dropped by 75 percent since we started using voice transcription."

Since they are a tertiary care center, patients come from throughout the Rocky Mountain region. They schedule patients for clinic visits and imaging studies on the same day. Before implementing voice recognition, radiology report turnaround time clocked in at 24 hours or more. Now the radiologists are able to verify reports upon completion of their dictation.

Although not the driving force behind adoption of this technology, the department has realized cost-savings of $200,000 per year on transcription costs. Coupled with improved productivity for their radiologists, the cost-effectiveness of adopting this new workflow has shown demonstrable benefit.

Agfa offers two configurations for its voice recognition products; either a stand-alone PC model or an integrated option within their Impax PACS. Jennifer Caissie, the senior marketing manager at Agfa explains its approach offers three methods for accomplishing voice recognition.

With front-end speech recognition, the user dictates into a microphone, observes the words appearing on the monitor screen, corrects the report, instantly signs off and the report is sent to the RIS (radiology information system).

The digital dictation option provides the user with the same GUI and they would still dictate into a microphone, but now words appear on the screen, and the audio portion is sent to a transcriptionist. The report is returned to the clinician for further direction and sign-off.

The intermediary between the two options is called directionist workflow. The user employs front-end speech recognition, the words appear on the screen, and at that moment he or she can decide whether they wish to edit the report, or send it to the transcriptionist or correctionist to make the necessary changes and return the report for final action.


Mark S. Lerner, director of radiology services at Children's National Medical Center in Washington, D.C., is an advocate of voice recognition, having installed PowerScribe by Dictaphone in October 2000. The radiologists accomplish 65,000 exams per year, and prior to implementation of this system, they were sending all of their reports to an outside contracted service that had variable quality. The turnaround time could be very short, from a few minutes, to several days. And there were accuracy issues as well.

"When we 'went live' [with voice recognition], the change was dramatic.