Dragon Voice Recognition Computer Software for Physicians
Medical record keeping has improved significantly over the past few decades. First, a few short words about the patient, dx and rx scribbled on a blank sheet of paper. Then medical records and patient notes dictated and transcribed on IBM Selectric typewriters. In the 1980's, typewriter ribbons and white out gave way to computers. And now Voice Activated Software.
In the 1990's voice activated software, a.k.a. speech recognition, emerged as the vanguard in word processing technology. The early pioneers in this field were poorly received for a few reasons. First, the hardware on the market was not yet up to the task. For instance, Kurzweil A.I. introduced VoiceRAD when 386 processors were standard operating equipment but insufficient to drive the software. The result was a barely functional system which generated negative word-of-mouth about voice recognition. Further, when face to face with the technology, the physician was often mystified as to why he or she was unable to produce reports with the ease and skill demonstrated by the salesperson who seemed to master the software. The answer is that the salesperson had a specific script from which they worked. And the nature of the product is that both the speed and recognition capability of voice recognition software improve with use or "training". Of course, in medicine, a bewildering variety of pathology is "reported" or dictated on the voice recognition system so the physician generally doesn't repeat the same words in report after report. As a result, the physician needed to use 'discreet speech' whereby one must pause, as much as 1/5th second, between words. You - had - to - speak - like - this.
In 1994, with the advent of the Pentium Processor and the lowered cost of memory (RAM or Random Access Memory now around $40 per megabyte ) the hardware was sufficient to drive voice recognition software. And even better, a system that cost $35,000 in 1993 was priced at $15,000 in 1994, hardware included. Voice software systems became technological breakthoughs that would even pay for themselves by costing less than the annual salary of a typical transcriptionist. The ease of installing the necessary sound card (the voice hardware) was improving. The sophistication of the database, the speed and quality of the recognition and the lowered cost of hardware all led to a situation in which it was almost beginning to make sense to strongly consider voice recognition for certain specific offices. However, there is a difference between 'almost beginning to make sense' and actually being appropriate for the average office. In 1994 the field of voice recognition was far away from actually being cost effective for all but the most unusual medical facility.
120 megahertz clock speeds and Pentium processors appeared in 1995 and are considered the norm in hardware specifications in 1996. And of course, the recognition capacity of the voice recognition systems have increased dramatically. Now that Pentium processors offer clock speeds significantly over 160 megahertz the pause in discreet speech is lowered to 1/10th second, or possibly even less in most instances. In addition, some of the programs offer continuous speech recognition for digits and other small vocabulary situations.
Now not only are there 'speaker dependent' programs, but the beginnings of usable 'speaker independent' programs. The difference between the two are that 'speaker independent' programs are usable right out of the box. As soon as you unpack the program and install it into your computer you can start speaking. Many of the speaker dependent programs require an 'enrollment period' during which you teach the computer your specific 'voice profile.' This isn't such a bad idea, except that it frequently takes up to 3 hours before you voice activate your first meaningful page. That is quite a tall order to ask of a busy physician who is looking for methods of streamlining his or her office practice, not looking for new projects to undertake.
Voice activated software is now available in a wide variety of packages, at many different price ranges. There are systems available for as little $395, and of course one can spend many thousand of dollars on a system as well. Many programs do not require a specific sound card, but are compatible with the large variety of cards that now appearing as standard equipment in the modern computer system.
Most of the current systems are either speaker independent or require only a minimum of training. They can be installed by the computer neophyte on most pentiums. And while most computers are being sold with more and more RAM, many of the voice systems are requiring less of it. Typical hardware requirements are 16 to 32 megabytes of RAM to run the program, 60 megabytes of hard disk space to store the program on the hard drive and a Pentium processor.
There are 4 good contenders for the physician who wishes to take advantage of technology to streamline efficiency . In no particular order they are:
Dragon
Kurzweil
IBM
Kolvox
It is not so much that one is better than the other, but rather that they have different features, and one is more appropriate for certain specific uses.
Kurzweil, one of the original developers and purveyors of voice recognition has, by far, the most sophisticated 'Medical Reporting' system available. The use of extensive 'triggers' provides for very rapid report production once the user is quite familiar with the system. These triggers are analogous to voice macros in which speaking one or two words can produce an entire line, paragraph or even page of text. More importantly, this text will allow for the use of fill-ins within these lines or paragraphs. Thus, as an example, in discussing a knee exam the physician might wish to indicate that it was normal. However, if the physician did not wish to be terse and merely say 'normal knee' but rather wished to discuss each of the portions of the physical exam, and indicate that each of them was normal, he or she might say "knee exam - normal - left". This could lead to a sentence such as " the patient's left knee was examined and was seen to be within normal limits. There was no evidence of ligamentous laxity nor evidence of meniscal injury. There was no effusion present and the range of motion was full."
Therefore, even though the dictator needs to speak in discreet speech, with a brief pause between words, the finished product can still be produced in less time that using more conventional means.
Additionally, the specific words which are offered are entirely under the control of the physician, and can be changed 'on the fly'. If there are multiple physicians in the office using the same software, each physician may have different standard wording for each portion of each examination.
There is a price to pay for this sophistication however. The base cost of the Kurzweil VoiceMED systems, as these are called, is $6,000 for the first user, with additional substantial fees for each additional user. (Kurzweil is the only company which has a per user price.) VoiceORTHO costs $8,000 for the first user. There are additional fees for any associated hardware and training. Also, there is a learning curve with this, as with most new software. Because of the substantial pre-formatting of the wording of hundreds of exams, the physician needs to learn to anticipate what the computer is expecting in order to allow for the most rapid report formation. However, most physicians generally work within the same specialty. The results are that an Orthopedic Surgeon doesn't have to learn the wording or formatting for chest exams or eye exams. Therefore, once the physician has learned their area, report generation and turn around is faster, in fact immediate, and best of all free. A sophisticated Kurzweil system can automatically bring up patient demographics ,print prescriptions, automatically fax, and include ICD-9 codes.
Dragon has a suite of excellent products called Dragon Dictate. They were initially designed for the disability market, allowing users to voice activate their computers with an absolute minimum of keystrokes. This is quite convenient for quadriplegics and others whose use of the hands is difficult or impossible. More recently they have significantly broadened their market, aiming at general office staff, transcriptionists, attorneys, journalists and, of course, physicians. It has an excellent underlying voice recognition engine, and is offered with prices ranging from $395 (not recommended in any way for a busy physician) to $1700. The addition of DragonMED medical vocabulary, available for an additional $495, turns this into a first class medical transcription device. It is certainly a very reasonable alternative to the more expensive solutions. In fact, with the top of the line software costing less than 1 month's salary of a transcriptionist, it is an excellent money savings method for today's medical practice.
IBM, obviously a leader in many computer areas has an excellent product entitled IBM VoiceTYPE Dictation. It is by far the most widely publicized, with national media advertising on such programs as the Oscars and other very high profile occasions. Price, including the medical vocabulary, is $1500. Some degree of training or enrollment is necessary. However, it does run using a PCMCIA card, thus allowing for its use on a portable, or laptop computer.
Kolvox is the only company which does not produce its own voice recognition engine or platform but rather embellishes the underlying engine from either Kurzweil, Dragon or IBM. What Kolvox does is to place on top of the underlying engine a series of voice macros which will make the system more readily usable right out of the box. They offer mailing list and faxing conveniences as well as mail merge functions. These are more useful for the legal profession, and in fact they do have a product called LawTALK. However, their OfficTALK is a good contender for the physician who wishes to have a more sophisticated system than some of the bare bones systems, and is willing to pay around $1500 for it.
So, where are we in May 1996. There are a number of excellent alternatives. Handwriting continues to be one of them. Or you can dictate into a hand held recorder and provide the tapes to a transcription department, either in house, at $12 - $18 per hour, or send them to an outside service that will charge by the line. You will get them returned to you in a few hours, or days, and then have the pleasure of proofreading them.
Or you can take the plunge and start using the technology which will be so prevalent during the 21st Century: Voice Recognition.
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Eric S. Fishman, M.D. is a practicing Orthopedic Surgeon in West Palm Beach, Florida. After purchasing VoiceORTHO for his practice in 1994 he and his wife founded 21st Century Eloquence, a company which provides voice recognition software from all of the major voice companies in the U.S, including IBM, Kolvox, Dragon and Kurzweil. 21st Century Eloquence can be reached by phone: 1-800-245-2133
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Mailing Address:
21st Century Eloquence
205 Worth Avenue, #201
Palm Beach Gardens, Florida 33418
Telephone: 800-245-2133 Fax: 561-835-4901 Local Phone (561) 689-0055
Copyright; 1996 21st Century Eloquence, Inc.
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