More patients, more studies and more documentation are driving healthcare providers to implement solutions that improve efficiency and aid in the delivery of quality patient care. Voice recognition has been heralded as a means to that end for at least a decade, but continuous improvements to the technology are making it a viable solution right off the shelf.
Sir Mortimer B. Davis-Jewish General Hospital operates the busiest emergency department in Quebec. To improve workflow and meet demand, the facility integrated wireless Pocket PC dictation functionality within their emergency room facilities.
The hospital implemented DigiDictate-CE from Crescendo in 2003 and the company added a speech recognition module to the system in 2005.
“We needed a solution to dictate on-the-fly, wherever we were,” says Stephen E. Rosenthal, MD, associate director of the emergency department and director of medical informatics. “The initial goal was to develop a back-end system for mobile solutions. We’re now in the process of going to a front-end solution for more complex notes.”
Emergency department notes must be relatively up-to-date, says Rosenthal. “In other areas, you can wait to see notes.” And since two-thirds of the hospital’s ED volume occurs outside of the standard 9-to-5 day shift, “voice recognition offers a good opportunity to do notes whenever we need them,” he says.
Initial training was minimal, Rosenthal says. The system offers a 75 percent recognition rate off-the-shelf, he says, and “within a couple of weeks, the rate easily goes up to 90 percent.”
Northeast Missouri Imaging Associates in Hannibal, Mo., a hospital-based radiology group, had a similar positive experience, according to Practice Administrator Brandon Selle. When the group went live with SpeechQ from MedQuist in the spring of 2006, “it took to their voice and learned their speech pretty quickly. It only takes about 20 to 30 minutes to train the system to your voice. Then you’re off and running.”
A survey of referring physicians revealed that report turn-around time was their biggest concern. “Being a hospital-based group, we weren’t the ones providing the transcription service so we had no control over turn-around time,” Selle says. By implementing SpeechQ, “we could take that control into our own hands.”
The group of physicians was “a little leery, but by the time they were trained, every one of our physicians actually said they love the system,” he says. The practice has seven full-time radiologists and also rotates locum tenens as needed.
As a result, report turn-around time is now just 15 to 45 minutes for a final report. The average time before was a day or a day and a half, but sometimes up to a week. Radiologists now don’t have to sign off on a report a day or two later that they might have trouble remembering. “It’s all right there on the screen,” says Selle. Plus, after no more than an hour of training, the locum tenens know what they need to use the system effectively.
Both Selle and Rosenthal say that the implementation of voice recognition warrants a thorough evaluation of workflow and an infrastructure geared to the technology. “Interfaces needed to be set up between facilities’ management systems to generate orders,” says Selle. That way, you’ll have the same patients on the voice worklist as are on the PACS or other systems clinicians are reading off of. He recommends setting up destinations for reports once they are dictated and physicians have signed off. “Set up network printers in the ED that will print reports directly to clinicians,” Selle says. “There’s also the interface on the backend to send the reports electronically into the facility’s systems so that they’re accessible and combined with patient information.”
Rosenthal says it’s common for hospitals to underestimate the setup required for voice recognition. “You need a vision of where [the technology] will go,” he says. For example, if your bandwidth is too slow, people won’t want to use the system. Plus, you won’t have the capability to eventually expand to nurses using voice recognition and performing electronic documentation, for example.
Rosenthal says that new technology will only be successful if it adapts to the way people already function. “You can buy the nicest solutions, but if people have to go out of their way to work in a different manner, they won’t use it.” That principle has played out, he says, as vendors are offering more ways to use voice recognition