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For other articles and previous issues click here. November 22, 2004 Speech
Recognition - Getting Radiologists on Board Administrators need to focus on radiologist buy-in for a smooth transition to speech-recognition software, but the competitive marketplace might prove the real driver behind the technology. If referrers see hospital A generating reports in two hours and hospital B taking two full days, they’ll demand that hospital B speed things up.
Gone is the clunky technology of yesteryear. Today’s SR reporting systems are smarter and faster, enabling radiology departments to trim expenses, and crank out reports in a matter of minutes, not hours or days. While SR may offer an attractive alternative to the conventional dictation and human transcription cycle, administrators nationwide are encountering one major stumbling block: getting their radiologists to simply give it a try. Helping bridge the chasm between old and new is a specialty of David Weiss, MD. A 20-year radiologist and informatics expert, Weiss arrived at Danville, Pa.-based Geisinger Medical Center in 2001 to help smooth its conversion to a new SR system. Part of the challenge, he says, was overcoming the spotty reputation of first-generation products renowned for their finicky ways. But Weiss says the latest generation is battle-tested and leverages recent breakthroughs in computer hardware and software design to enhance workflow support, report tracking, retrieval, and distribution. At a time of mounting transcription costs and spot shortages of reliable talent, this is good news indeed. Overcoming perceptions is one thing, but Weiss quickly notes deeper resistance among radiologists that concerned administrators cannot ignore. In short, the benefits SR technology bring also bring an unwelcome disruption to a radiologist’s daily routine. “There’s no denying that SR technology places a greater burden on radiologists,” Weiss says. “Users typically experience a 10-plus percent time penalty. Another potential sticking point is concern about distractions. Radiologists are deathly afraid of being distracted from their images by extra mouse clicks or other commands. Most radiologists like their turnaround time to be low, but most radiologists judge themselves by their accuracy and perhaps secondly by their productivity. When this technology is used correctly, however, they really don’t need to do many corrections, and it actually saves them time and reduces their distractions.” To further complicate the conversion decision-making process, Weiss notes that radiologists in SR-based departments must often work harder—without added compensation. Instead of receiving fatter paychecks, radiologists typically receive little more than a pat on the back or an appreciative comment. So how do you win over the radiologists? First, Weiss outlines what not to do. “Trying to force-feed this technology to your doctors isn’t going to work,” he says. “A user can make this system work very well—or very poorly. The bottom line is that you have to get your doctors on board early.” Find a Champion “The majority of radiologists will accept and use it satisfactorily,” Weiss adds. “A smaller group will be the ‘super users,’ meaning they will embrace it, tell you they love it, and want to learn all the tricks to do it faster and better. The rest just won’t click with it—and it may not even be their fault. They may have a voice the system just doesn’t like. They might not be familiar with computers or just can’t quite get the hang of it.” Assessing SR’s strengths, Agfa Healthcare marketing manager David Talton offers, “Radiologists benefit in many ways. They gain direct control of the quality and timing of their output. They see the output in front of them. They can sign off on it immediately after they’ve dictated it. They can ensure it says exactly what they want to say. And when they sign it, it gets immediately transmitted to their customer: the referring physician. The speed of report turnaround means a higher level of customer satisfaction and better patient care.” Getting Started
But if the layperson has a hard time understanding the lingua franca of the radiology world, wouldn’t the software be similarly baffled? Not so, says Weiss. “Our lingo and vocabulary sounds like nothing else,” he says. “The term diastematomyelia has no homonym in the English language, yet these systems invariably have no problem with understanding it. However, if I tried dictating a letter to a family member or recited the nursery rhyme ‘Mary Had a Little Lamb,’ TalkStation would try to convert both into medical-sounding reports.” In short, these systems work so well because they focus on a radiologist’s approximately 1,000-word clinical vocabulary while largely ignoring the remaining 29,000 words of conversational English. The downside, Weiss says, is that the simplest of words—”a” vs. “the”—can stump this technology. While TalkStation is geared toward generalists, Agfa is considering SR packages keyed to the “dialects” of subspecialists. “When a neuroradiologist would log on,” Weiss says, “such a system would be smart enough not to confuse ‘carotid’ with ‘parotid.’ If I am a head-and-neck radiologist, it might lean toward parotid vs. carotid for a neuroradiologist.” Training Time “With voice reporting, you need to meet the computer halfway,” Agfa’s Talton says. “For instance, if you once gave this verbal instruction to your transcriptionist—‘Strike the last sentence’—obviously a computer isn’t going to be intelligent enough to deal with that command. But if you think before you speak, it becomes more efficient. We find that most users adapt within a month or two.” Talton adds that Agfa also offers a digital dictation
mode, wherein the system makes a digitally formatted audio recording
that can be electronically sent to transcriptionists. Customized packages offer distinct advantages over their off-the-rack counterparts. “Vendors can add powerful additional navigational functions, larger specialized vocabularies, optimized systems to handle many users at multiple locations, and integrated features in both PACs and RIS,” Weiss says. ScanSoft’s Dragon NaturallySpeaking 7 technology allows healthcare providers to easily add speech-recognition functionality to both commercial and in-house PC- and Web-based healthcare information systems and electronic medical records applications. Weiss now hopes for integration of speech recognition and structured reporting. Looking at the national picture, Weiss predicts that the forces of competitive advantage will prod slow adopters into action. “If one hospital in a metropolitan area,” he says, “adopts this system and starts offering rapid turnaround, other institutions will be forced to follow suit. Remember: Many physicians do crossover work. If they see hospital A generating reports in two hours and hospital B taking two full days, they will insist that hospital B speed things up. This dynamic will quickly change the standard of care for the entire region.” Faster Turnaround Like any technology, then, SR systems have both advantages and downsides. Yet Weiss is a confirmed convert and believes he is riding the wave of the future. “We dropped the turnaround time at my former hospital from 72 hours to two hours,” he says. “That’s huge.” — Matthew Robb is a freelance writer based in suburban Washington, D.C. He’s a frequent contributor to Radiology Today.
As an experiment, Radiology Today writer Matthew
Robb used Dragon NaturallySpeaking 7 to write the following unedited
paragraph: In early November, ScanSoft unveiled its latest, most accurate SR package yet: Dragon NaturallySpeaking 8. — MR
“What really drove our decision was a need for faster turnaround time,” Yanchuck says. “We are a teaching facility, which means our residents used to do a preread, which they then dropped into the tank. The transcriptionist would later pick it up, transcribe it, and then the residents would approve it and drop it into the radiologist’s tank to be finalized. This entire process could take up to 72 hours—it was ridiculous. Since we instituted the new system, we’re down to 10 to 12 hours. For nonacademic health centers, I would imagine report turnaround times under an hour.” The new system is expected to pay for itself within the first four months. Burdensome to radiologists? At first, yes, Yanchuck says, but adds, “What we have to realize is that the radiologists’ few more minutes on the front end is well worth what is gained on the back end.” Yanchuck says the department is currently using
an out-of-the-box Dragon package with a built-in medical dictionary.
“In the future,” he says, “we’re hoping
for truer integration of SR with RIS and PACS. We want our physician
to literally see the images on PACS, click a button to go into the
same database, and be able to dictate right into that record. — MR |
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