Even in the midst of a boom in speech-recognition technologies, don’t expect medical transcriptionists to go the way of dinosaurs. Do expect reduction and changes in transcription as technology advances. Radiology, for example, is comparatively well suited to take advantage of speech recognition.

“Radiology is a great area for speech recognition installation as it uses a finite grammar to describe a procedure,” says Nick van Terheyden, MD, chief medical officer at Philips Speech Recognition Systems. “On a chest x-ray, for example, if I see 150 of those a day and of that number 80% are normal, the standard components of a normal chest x-ray report could be called up using speech recognition and autotext so the radiologist doesn’t have to repeat the same thing over and over.”

Van Terheyden believes it’s inevitable that the healthcare industry will move further in this direction. “Speech-recognition technology has reached top-priority status,” he says. “It’s had a checkered past, but the software technology has grown exponentially.”

Many speech-recognition programs come with the capability to analyze prepared documents and pick up specialty-specific words used by physicians. Many products feature voice recognition that offers accuracy rates 30% higher than their recent counterparts. The advances also include out-of-the-box software that is a preconfigured model of a medical specialty.

Front-End vs. Back-End
Front-end speech recognition is used to describe systems where the provider dictates into a speech-recognition system, the recognized words are displayed immediately after they are spoken, and the dictator is responsible for editing misrecognition and making other changes before signing off on the document. It never goes through an editor.

Back-end speech recognition refers to the process by which the provider dictates into a digital dictation system, the voice is routed through a speech-recognition machine, and the recognized draft document is routed along with the original voice file to the transcriptionist editor, who verifies the accuracy of the draft and finalizes the report for physician approval.

The front-end approach suits radiology—and significantly changes radiologists’ traditional workflow—because it allows the radiologist to more rapidly report findings to the referring physician. Rapid report turnaround is a core service component of radiology and the standard time considered “fast turnaround” is decreasing. In that sense, a radiology facility uses speech recognition differently than a primary care practice where a treating physician routinely dictates his or her records primarily to document what he or she found, and then did, in an uncomplicated case.

Service Boost
Referral specialists treating patients can gain a similar benefit in report turnaround. Board-certified dermatologist Matthew Doppelt, DO, is a fan of front-end speech recognition. “When I have a difficult case that doesn’t fit one of my EMR templates, I use speech recognition in a front-end fashion [instead of typing] to enhance the readability of my notes,” he says. “…The process of getting a note back from the [transcriptionist], reviewing it, correcting it, and sending it to the referring physician would sometimes take a week. Now I can have the note done and off to their primary care doctor before the patient even leaves the office. This is not just a convenience, it enhances patient care.”

Of course there are many doctors—in radiology and other specialties—who don’t want to change how they work and who may be candidates for the back-end approach. According to Matt Revis, product marketing manager for dictation products at ScanSoft, many physicians are reluctant to change how they work. Revis says there are two factors that have slowed speech recognition acceptance:

1. There was a “hypecycle” in the late ’90s and early 2000s about the promise of speech recognition. However, the software at that time wasn’t up to the challenge technically, leaving many people disappointed. Speech recognition was sold as a way to completely eliminate transcription rather than bring efficiencies to the transcription process.

2. Even if the technology had been perfect, it would have required physicians to change the way they work and document clinical encounters. Many physicians were reluctant to do that.

Speeding Turnaround
In radiology, the front-end approach has the obvious potential benefit of speeding report turnaround. That benefit isn’t as clear in all areas of medicine. Because most doctors are reluctant to use the front-end approach, Revis says what the industry is seeing is speech recognition being deployed in two ways.

“One is the front-end technology and the other is the back-end where the dictation is done the same way it’s been done for the past 20 years,” he says. “The main difference is that now the dictation is being recorded and rerouted to a speech recognition technologist who gets a draft output along with the original recording. The [medical transcriptionist] looks at the draft, listens to the recording, and makes changes. The [transcriptionist] is acting more in an editorial capacity. A successful deployment of speech recognition must have both front-end and back-end components that work in an integrated way.”

Van Terheyden believes not changing the physician’s clinical routine is the key to success in many institutions. “Choice is the critical factor in successful speech-recognition implementations,” he says. “All physicians document in different ways and have a different affinity for the various tools that help speed up documentation.”

“The doctors need to know that the technology does improve patient care because records can be available almost immediately throughout the enterprise,” Revis says. “And the [transcriptionists] need to know that speech recognition can dramatically improve their productivity and value as medical language specialists rather than typists.”

Van Terheyden agrees that speech recognition will not make the transcriptionist skills obsolete. “That was the overwhelming fear for many MTs [medical transcriptionists] but in reality the reverse is true,” he explains. “Transcription today is in high demand. Speech recognition is not a panacea. There are some physicians whose speech is well adapted to the technology but there are those poor speakers, or those with heavy accents, that will still need to utilize the MT.”

Traditional transcription turnaround times will be increasingly perceived as slow and manual transcription will eventually be replaced, van Terheyden says, but adept transcriptionists will develop additional skills and be able to offer value-added services to other departments in the healthcare facility.

“MTs who migrate to this role will need to have exemplary interpretive and editorial skills,” says Lea Sims, CMT, FAAMT, director of publications and communications at the American Association of Medical Transcription. “They will need to be the cream of the crop, since they will be expected to be the final authority on the accuracy of the speech-recognized information and the final quality of the document.”

The EMR Factor
The spread of electronic medical records (EMRs) will increase the use of speech recognition and ultimately will likely reduce and/or change the role of transcriptionists. When Doppelt’s dermatology practice implemented an EMR that uses speech recognition as one means of inputting information, it eliminated the need for a transcriptionist.

Girish Kumar, vice president of sales and marketing with EMR vendor ClinicalWorks, agrees that EMRs are replacing transcriptionists and explains that speech recognition is becoming a catalyst for EMRs. He believes speech recognition has become quite accurate and is now on par with what traditionalists expect in the tools they utilize.

“In five years, there will be a dramatic impact on [transcriptionists]. They will have to come up with different value propositions,” Kumar says. “EMR is the driving force behind speech technology,” he continues. “If it were just speech recognition for speech recognition’s sake, it wouldn’t have been adopted as quickly. EMRs drive the adoption of this technology.”

Transcriptionists will still play a role in the speech-recognition world, Kumar says. “If a doctor uses dictation rather than speech recognition, some MTs will be involved in background technology to create the notes into text,” he explains. “Other MTs will edit for accuracy.”

Revis says that for a transcriptionist to thrive in the new environment, he or she will need a strong knowledge of not only medical terminology but editing skills as well. “MTs have to work differently, but speech recognition will make them much more productive if they embrace the technology,” he says. “We are seeing dramatic productivity increases for MTs editing on our speech-recognition solution.”

Many providers are clamoring for speech-recognition technology because they have been told by vendors that it will “replace transcription.” When physicians and clinicians discovered the demands of a front-end scenario, many have settled for a back-end option. This is particularly true of older physicians who are less familiar with technology and have less desire to expend the time and resources.

Make It Seamless
“If there are two minutes of extra effort on the doctors’ part, they will balk at the technology,” van Terheyden explains. “It has to be an almost seamless transition in order to be effective and accepted.”

There are many doctors, Revis believes, who like front-end speech-recognition projects. “The front-end products bridge the gap from traditional dictation to the EMR and what we’re saying to clinicians is that you can’t continue traditional dictation and get that info into an EMR,” he says. “That message is resonating not only with the doctors but with those making the EMRs.”

Van Terheyden says speech recognition’s true value lies in its multifaceted approach. Information can be available instantaneously and if there are six or seven teams in a facility that need access to that technology, it’s there. Combined with EMR, it helps make all of a patient’s information available to the healthcare system the same way PACS makes diagnostic images available.

If a facility chooses a physician to be a champion for the new technology, more of the staff will be inclined to emulate that behavior, Kumar says. The radiologists who find speech recognition to be a truly viable solution are those willing to invest in the technology and make a commitment to retooling their dictation skills to maximize the usefulness of speech recognition.

“Poor dictators will not migrate easily and will find that they have spent a lot of money on a technology solution that still requires the same amount of work on the back end from an editor,” Sims says. “They will essentially pay more for the final product that way.”