Speech Recognition: What's Coming and Impact

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1 Speech Recognition: What's Coming and Impact Lincoln L. Berland, M.D., F.A.C.R. University of Alabama at Birmingham

2 Disclosure Consultant to Nuance, Inc.

3 Learning Objectives Appreciate the relatively limited role that voice recognition technology itself will play in products which include it. Be able to prioritize some of the most critical features to look for in choosing future voice recognition products. Understand how future products will overcome current perception that because radiologists act "as transcriptionists," that productivity is decreased.

4 Speech Recognition Now Limited to a few vendors Highly controversial - widespread dissatisfaction, but widespread use (>1000 installations) Least satisfaction when: Used only to replace conventional workflow Inadequate leadership strategy Inadequate local or 24/7 technical support Use not mandated throughout practice Inadequate hardware, vendor support Radiologist-specific factors limit accuracy (from typing skills to OC-ness)

5 Criticisms of Speech Recognition Systems (SRS) Decreases radiologist productivity. Proof: Reinus WR, Economics of Radiology Report Editing Using Voice Recognition Technology. JACR 2007;4:

6 Criticisms of SRS Increases error rate (22% of final reports) Changes sense of report (e.g. deleting no ) Infamous for hilarious and not-so-funny nonsense errors

7 Criticisms of SRS High error rate (However, the SRS doesn t approve the report, the radiologist does) Highly variable performance and frustration Claims of decreased productivity (However, is this credible, considering the nearly universal claim that productivity has increased?) Divide attention Compromises resident learning May decrease completeness and accuracy (depending on use patterns and software)

8 Advantages of Current SRSs - Time Savings Improved TAT (patient, not radiologist-centered) Confirmed in virtually all research High acceptance by referring clinicians Also decreases institutional costs (e.g. LOS) Critical results after called are immediately accessible and documented Decrease in routine calls for reports (compensates for much of purported productivity loss) Dictate anywhere w/o risk of duplicate dictation

9 Advantages of Current SRSs - Time Savings When optimal use of macros, structure, frequently repeated phrases, paragraphs and templates can speed dictation But too much detail and too many fields can slow process Facilitates workflow and access to historical data We now automatically download through macro: Contrast, protocol, radiation data Other comments, e.g. Glucophage, extravasation, contrast reaction, incidents, etc. These come from RIS, entered by technologist

10 Advantages of Current SRSs - Time Savings Voice controls to navigate report Rarely need to type Time savings when interrupted Do not have to replay prior sentences or report Can improve ergonomics, recognition with headsets

11 Advantages of Current SRSs Consistent information quickly available enterprise-wide 24/7. Preliminary report is final report - quality and medicolegal advantage Can refine and edit immediately May not remember details if dictate later Can improve report quality Speeds billing

12 Paradigm Change Speech recognition systems do not simply replace conventional dictation, they represent a platform for developing: Workflow improvements Improved report quality Improved patient-centered care Decision support Improved access to and analysis of data The immediacy of the report will allow many of these features only with SRS

13 Future of SRS - Workflow Improved worklists Definitions of roles and user access will clarify privileges, readiness for dictation Will facilitate data distribution (e.g. HIPAA) Collect and carry information forward History, clinical synopsis Prior measurements Other prior report content Data from RIS, PACS, teleradiology, CPOE, ultrasound, CT, MRI units

14 Future of SRS - Workflow We will learn optimal use of structure in reports Interruption management by saving state of image review and report (pick up where you left off) Enterprise-wide integration of data Including multi-media display (AIM - annotation and image markup) Will improve follow-up, closing loop of communication with proper caregivers Further improvement of ergonomics Remote reporting and sign-off Access from mobile devices (e.g. iphone)

15 Future of SRS - Report Quality Recognition will continue to improve Will add intelligent editing (spelling, tense, grammar, context) Improve changed report management Will support standardization of terminology (RadLex) Best practice templates will encourage consistency of form and terminology and save time Resident education with automated comparison of resident dictated and attending finalized reports

16 Future of SRS - Patient-Centered Care Referring clinicians want and use rapid TAT to facilitate their workflow Patients want immediate access to their reports!

17 Future of SRS - Decision Support Appropriateness guidelines For radiologist review prior to approving examination For computerized physician order entry (CPOE) Clinical guidelines Anatomic and medical reference information with links

18 Future of SRS - Data, Quality and Compliance Assist data collection and analysis - necessary for quality improvement TAT Follow-up (alerts based on structured recommendations) Outcome analysis Utilization review (ordering patterns) P4P Peer review Cumulative radiation monitoring and alerts Compliance with TJC, HIPAA, ACR, ABR, etc. Research support

19 Future As new features developed, will only be available in SRSs integrated with RIS, PACS, CPOE, EMR Features can be implemented incrementally Arguments against SRS recapitulate skepticism about PACS PACS was imperfect, but inevitable So are speech recognition systems Rapidity of adoption will be dictated by quality of the products

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