Voice Recognition
Technology in a Physician's Office
May 2005
Currently,
Dragon NaturallySpeaking Medical Version 8 is the de facto
standard speech recognition engine for all professionals, including
physicians. In fact, with 14 medical specialty vocabularies
included, it offers, by far, the highest accuracy rate available.
The 14 specialties are:
Radiology,
Cardiology, Surgery, General Medicine, Family Practice, ObGyn,
Neurology, Pathology, Orthopedic, Emergency, Mental Health,
Oncology, Pediatrics and Gastroenterology.
'Dragon' or DNS as it is sometimes affectionately
called, now offers accuracy rates as high as 99%, with rates of
speech up to 160 WPM (words per minute).
Many
physicians utilize it within MS Word, with or without a
collection of macros, to produce their entire medical reports.
Others utilize it in one of two alternative methods.
With the advent of digital recorders which offer substantially more
fidelity in recording your voice, the accuracy rates of voice
transcription have increased significantly. Using any of a
number of digital recorders from companies such as SONY, Philips and
Olympus, you can dictate just as you learned to do in Medical
School, and then have Dragon download the voice file and interpret
it with amazing accuracy. You may then perform the corrections
yourself, or offer this job to a revisionist. In either
instance, the dictation is available essentially immediately, and in
the former instance, with no cost at all.
Currently
available recorders including the SONY ICD-BM1 and the Olympus
DS4000 are excellent choices.
Digital Recorder Reviews may be helpful to assist you in
determining which is the most appropriate for your specific usage.
A second alternative method is to utilize Dragon NaturallySpeaking
within an Electronic Medical Record / Electronic Health Record.
EMRs / EHRs offer amazing benefits to physicians in maintaining the
structure of their medical practice. EMRs are becoming
more and more powerful, less and less expensive, and are
increasingly compatible with Dragon NaturallySpeaking. In
fact, many of the currently available high powered Electronic
Medical Record software packages are completely compatible with
Dragon NaturallySpeaking 'right out of the box'. In other
instances, some additional programming may be needed. In
either instance, this combination offers the best of all possible
worlds, and is our current recommendation.
In the
event that you are interested in learning more about a variety of
Electronic Medical Record packages,
EMRConsultant.com offers
free consulting advice to physicians and other medical personnel.
July 2003
With the
release of
Dragon NaturallySpeaking Medical version 7.0
the new age of voice recognition is finally at the point of speed
and accuracy that physicians have long been waiting for! We
estimate that over 70% of our client base is comprised of
physicians, healthcare workers and medical transcriptionists.
Dragon NaturallySpeaking Medical version 7.0 now offers up to
99% accuracy and dictation speeds of up to 160 words per minute.
We have seen over the last few years a tremendous increase in the
accuracy level of the basic speech recognition engine technology.
In addition, the amount of RAM memory and the speeds of today's
processors included in most desktop and laptop PCs has increased
exponentially to give speech recognition software a more efficient
and faster platform on which to run.
If you look at this article in its entirety you
will see an evolution in speech recognition technology. One thing
we strive to do here 21st Century Eloquence is to archive and keep
accessible to you, older and even outdated information about our
technology so that you can see what improvements have been made
over the years.
Lastly,
in this update we want to make sure that physicians know that
there are specific language models available that can be added to
Dragon
NaturallySpeaking Medical, Legal or Professional version 7.0.
The add-on vocabularies typically add up to 20,000 additional
terms specific to a medical specialty. By adding these
vocabularies, you will save a great deal of time and effort
training medical terms into the program that may not be found in a
general medical vocabulary or especially the professional version.
We know that your time is valuable so we encourage you to take
advantage of these affordable add-on vocabulary solutions to
customize Dragon NaturallySpeaking 7.0 specifically for your
medical practice.
February 2002
For most physicians,
the act of producing the medical records for their patients is
a rather unpleasant and expensive necessity of their medical practices.
If there were options to streamline this process, most would gladly
accept.
Voice recognition software
has been promoted to physicians for almost a decade. There were
some, albeit an extraordinarily small minority - mostly computer
geeks - who were able to accomplish something with the software
that was available 3, or even 5 years ago. However, the early
versions of most voice recognition software programs were entertaining,
but not particularly useful in a professional office.
We believe that with the release of
Dragon NaturallySpeaking Version 6.0, and the use of very high speed
processors, such as a 2 Gigahertz machine with 1024 MB of RAM, the
majority of computer literate physicians who pay for their own transcription
will benefit from the use of Dragon
NaturallySpeaking Medical Suite.
Why do I make a distinction
between those physicians who pay for their own dictation and those
who do not?
Contrary to the claims
of some of the boxes of software that will be found in mass market
retail stores, there is a substantial learning curve to get this
software to function adequately when accuracy is of extreme importance.
Yes, while it is literally true that you can purchase your software
this morning and be dictating to your computer this afternoon,
I believe that most physicians would consider the 90% - 95% accuracy
that you will be experiencing at the end of that first day is
clearly inadequate for their medical records.
It takes a significant
amount of time for training. What does the training consist of?
It consists both of training the computer to understand your voice,
as well as training yourself to speak in a fashion that will be
understood by your computer. Version 6.0 of Dragon NaturallySpeaking
makes this latter aspect of training a bit easier than before
with the ability to ignore you when you say 'um' and 'uh' during
your dictation. Nonetheless, there is a period of time during
which you will not be experiencing the 99% to 99.5% accuracy that
experienced voice users get on a routine basis.
How long will this training
take? I believe that the majority of physicians who are
reasonably articulate, can obtain functional accuracy within 2
weeks, if they utilize their software correctly for 2 hours per
day. During those 2 weeks they will need to meticulously correct
each of the misrecognitions that show up on their dictation.
Of course, during that time they will be producing reports. However,
admittedly, it will be taking them longer to do so than with more
conventional methods. However, after this period of time,
most users will be able to produce their medical reports in about
the same amount of time it currently takes for them to do so.
There will be two differences. First, they will be available
immediately, and second, the cost of getting their thoughts on
paper will be miniscule in comparison to their previous methodology
- hence my comment that those who pay for their own transcription
will be more motivated to use this new technology.
Digital
Recorders
If you insist on dictating
while walking around, rather than dictating while watching your
computer screen, you might be interested in using one of the modern
digital recorders. These can be utilized in two modes: with
and without voice recognition on the back end.
When used without voice
recognition, they are just like your current analog recorders.
However, because of the digital medium, there are no tapes to
break, the sound quality is better, and some of the editing features
are improved.
When used with voice
recognition, unfortunately, the state of the art today is such
that the accuracy, even with a well trained physician, will not
be sufficient to send out unedited. Therefore, even when
using a digital recorder and having the .wav file 'voice recognized'
on their computer, they will need to have a transcriptionist,
or revisionist review their work and make corrections. This
is time consuming, but significantly less time consuming than
producing the original work from a blank page and just your voice.
Microphones
You can use the microphone
which comes with Dragon NaturallySpeaking. However, there are
a wide variety of microphones with can be utilized for a variety
of different environments. The table below gives a brief
indication of the options.
|
|
On Phone
and PC
|
Poor
Sound Card – USB
|
Walk
Around While Dictating
|
|
|
|
|
|
|
On Tight
Budget
|
Plantronics
SR1
|
Andrea
NC-7100
|
Logitech
Cordless Freedom
|
|
Intermediate
Budget
|
Andrea
NC-700
|
Plantronics
DSP-100
|
GNNetcom
Voice Array
|
|
Best
Quality Available
|
VXI Bermuda
|
Telex
8400
|
GNNetcom
Mobile
|
Eloquently
Stated
If you are interested
in template based software, there are many shortcuts that can
be utilized to get your thoughts on paper. In the event
that there is a significant amount of repetitiveness in your practice,
you will find that Eloquently Stated is very useful. Version
3.0 is expected to be released in March 2002, and the new Eloquent
SOAP Notes library is extraordinarily easy to learn, use and modify
as needed. With an attachment manager, you can literally scan
in all of your incoming documents and put the originals in the
trash. This allows you to have a complete Electronic Medical Record,
and with the unprecedented offer of $200 per license, when purchased
with Dragon NaturallySpeaking Medical Suite, you can automate
your office for only $1195.00 in software costs.
Imaging
Software and Forms
However, if you really
wish to rid yourself of all of the paper wondering around your
office, you may wish to consider a few additional software products.
These include OmniForm, OmniPage and PaperPort. These imaging
and document management products can greatly simplify your work
flow and particularly your paper flow.
OmniForm
ScanSoft’s
OmniForm comes in two versions. OmniForm 5.0, and OmniForm Premium
5.0. We will discuss OmniForm Premium 5.0 because this product
is substantially more powerful, and much more likely to be used
in the professional environment. However, if you are on
a very stringent budget, you may wish to consider OmniForm 5.0
OmniForm
Premium 5.0 is designed to produce,
distribute and fill out forms, and manage form data. Thus, this
program could be utilized for your patient intake form, your past
medical history form, as well as any employment related forms
you may have in your office. In a truly electronic office,
patients could be handed a laptop in your office and fill out
a database driven form for their past medical history, family
history, etc. This amazing time saving feature can pay for
itself in staff salary savings in a very short time.
eOmniForm
eOmniForm,
as its name would suggest, allows for the production and publication
of fillable electronic forms on the Internet, specifically ScanSoft's
SSL compliant eOmniForm.com website. This is a wonderful
feature for large medical institutions which need distributed
form filling. After the form is published on the web as
an HTML file, anyone with web access can fill out the form, either
by typing or speaking, into the form. The form is
then sent, via email to the intended recipient.
OmniPage
OmniPage
is an OCR (optical character recognition product.) In fact,
it is the best one in its class. It can be used with any
scanner to rid your office of the reams of paper that tend to
clutter it up. After having scanned in your papers, (much
as you would do with PaperPort), you can then edit the actual
text.
PaperPort
PaperPort
allows for the organization of documents, images, and in fact
any set of files which you may have on your computer or network.
In common use, incoming papers are scanned, and assigned to an
individual file folder. Since the quality of the scanned
image is so clear, the original paper can, in most instances,
be recycled.
Scanners
In
order to utilize PaperPort or OmniPage, it is necessary to have
a reasonably high quality scanner. If you anticipate scanning
a substantial number of documents, it is recommended that you
purchase an automatic document feeder. However, these are not
suitable for small sized or irregularly shaped papers such as
EOBs and check stubs.
We sincerely hope that this discussion
of the options facing a physician is of assistance to you.
If you have any other questions, we'd be honored to offer you
our knowledge. Please call 1.800.245.2133, or email
us your questions.
September 2000
With the purchase of Dragon Systems
by Lernout & Hauspie, there is no longer much of a dilemma
for a physician who wishes to utilize voice recognition in the
production of their medical reports.
Dragon
NaturallySpeaking Medical Suite,
V5.0 is the clear leader in this industry. It appears as
if Lernout & Hauspie will discontinue promoting their VoiceXpress
for Medicine in the not too distant future. In the event
that you have tens, or even hundreds of thousands of dollars to
spend voice activating an entire hospital, some of the following
comments may not give some of the higher end L&H products
adequate discussion. However, for the overwhelming majority
of small to medium sized medical offices, Dragon NaturallySpeaking
Medical Suite is the clear choice.
However, after having spent roughly
$1000 on that product, very substantial gains in productivity
and ease of use can be accomplished by purchasing additional add-ons.
First and foremost, The
Eloquent Physician, or
in the event you are an Orthopedic Surgeon, The
Eloquent Orthopedist,
will very substantially ease the burden of producing your reports.
Each of these programs utilize Dragon NaturallySpeaking Medical
Suite for their voice recognition. However, they simplify the
process of differentiating between many of the little words such
as "He & She". They also allow for the rapid
entry of some of the more common phrases and paragraphs which,
quite honestly, get to be boring to repeat day after day.
Even more importantly, for many users,
is the ability of The Eloquent Physician to maintain an adequate
database structure for your patient reports, without any conscious
effort on your part.
Finally, the amazing document sending
features, including batch printing, emailing and faxing allow
you to dictate all of your reports during the day, and to run
the batch printing / sending with a couple of clicks at the end
of the day. All of the proper referral sources will have
their reports waiting for them the following morning.
After having chosen Dragon NaturallySpeaking
Medical Suite and The Eloquent Physician, you have still only
spent between $2500 and $3000. For many physicians, this is less
than their current monthly transcription bill. And, this system
should last for many years. However, a few hundred dollars additional,
spent on a language module from a company such as Korteam
or Voice
Automated will round
out the perfect system. Adding a medical vocabulary such
as this will significantly increase your accuracy from day one.
In the event that you absolutely
refuse to dictate while in front of your computer you still have
two choices. You can purchase one of the mini hand-held computers,
and still use the software discussed immediately above, or you
can purchase a digital recorder, such as those from SONY
or VoiceIt.
Using these recorders you may dictate in the hallways and then
plug in the recorder to the computer which has Dragon NaturallySpeaking.
Your reports will be automatically transcribed, albeit with a
few errors. Your transcriptionist, now termed a 'revisionist'
can then make corrections as necessary. Most offices realize
some medical records savings using this methodology. However,
the savings is not nearly as great as with the full system of
Dragon NaturallySpeaking, The Eloquent Physician and a language
module.
If you are not exceptionally interested
in computers, or do not wish to 'play' with the system for a while,
you will be very well served by purchasing the complete system
from a local value added reseller. We work in concert with
resellers nationwide, and if you wish to have a personalized installation
and training, we will be happy to assist you with this.
July 2000
Version 2.00 of The Eloquent
Physician is released.
October 1999
When it comes to customization,
and flexibility of use, no product can compare with Eloquently
Stated . With its already
extensive and, completely customizable, insertable libraries and
template system, custom macro creation, and many other features,
it is the Physicians' solution to dictation. This program is your
complete document creation work horse. The combination of Dragon
Naturally Speaking Medical Edition
and Eloquently Stated will have you creating top quality, professional
reports in no time.
January 1999
Physicians have required
rapid and accurate transcription of dictated reports for decades,
and for just as long there have been frustrations, inaccuracies
and delays associated with this process.
Depending upon your
specialty, there are a number of programs that are substantially
better than the ‘status quo’ of dictate, wait, review
and correct, wait and sign.
If you are lucky
enough to be practicing in a specialty for which a specific voice
recognition program has been written, such as Radiology,
there are some incredibly sophisticated packages which will essentially
completely eliminate your transcription department. These programs
offer too many features to list here.
However, for most
physicians the decision regarding ‘should I or should I not
spend $10,000 to talk to my computer’ never arises. To get
the top of the line voice recognition program, including a brand
new Pentium III 600 Mhz processor, 128 Meg RAM, a wireless
Shure microphone and/or
a portable dictation machine, you might be able to spend $5000,
but it would be difficult. On the other hand, assuming you have
an adequate computer (Pentium II 350mhz or better recommended)
you can purchase a complete system of software and standard microphone
for $995. Remote dictation capabilities can be added for approximately
an additional $300. With the newest technology you are no longer
tied to a physical presence next to your computer. You can use
a portable hand held dictation machine, or even a wireless radio
frequency microphone allowing for dictation up to 50 feet away
from your computer.
Then you look into
the Macro features. Yes, you can simplify your work so that even
the process of dictation can be less time consuming than your
standard method. With a little ingenuity, you can make macros
for many of the repetitive statements you are used to dictating.
However, unlike the canned ‘normals’ which you have
probably already taught your transcriptionist, you are able to
make boilerplate fill-in the blank forms to which you can add
relevant information on the fly.
As an example, I
am an Orthopedic Surgeon (and founder of 21st
Century Eloquence).
I am commonly called upon to offer opinions regarding work status
of employees. One such relatively common paragraph may go something
like this:
In my opinion, this
employee is capable of performing light duty work. Lifting and
carrying of up to __<>__ pounds on a repetitive basis, and
of up to __<>__ pounds on an occasional basis is to be allowed.
In addition, I would recommend avoiding bending more frequently
than __<>__ times per hour.
With Dragon
NaturallySpeaking Medical Edition
and/or L&H
VoiceXpress for Medicine
you are able to create this macro in advance. Then, while dictating
you can say ‘bring up light duty macro’. It will then
bring up the above text, and will stop at each of the blanks,
offering you the time to fill them in with the appropriate number.
Should you wish to
correct your text, you may do so. Obviously even with a 98% accuracy,
there will be errors to correct. You may do so yourself, merely
by spelling the proper word after you have highlighted the incorrect
recognition.
Or, should you wish
to avoid altering your method of dictation at all, you may hand
your transcriptionist, your tape from your hand-held dictation
machine. The revisionist will plug it into their computer and
the printed words will appear on their screen. They will then
have the ability to highlight the printed text and listen to your
voice from the computer’s speakers. The transcriptionist
will correct the few errors that are on the screen.
This process should
at least double the throughput of your transcription department,
and significantly speed the return of the reports back to you
for signature. Additionally, it is likely that it will increase
the accuracy of the final report since a significant amount of
the printed word will already be on the computer in it’s
proper form.
Here are some of the recorders that
can be used:
VoiceIt
- The easiest of them all, when using Dragon NaturallySpeaking.
Norcom
- Uses mini cassette tapes and it is a true dictation machine.
Works great with either Dragon NaturallySpeaking and/or IBM Via
Voice98.
Olympus
D1000 - A good
choice, uses flash card memory in couple of different sizes.
Microphones have an important role
where speech recognition acceptance is concerned. Many people
who express initial interest in using speech are turned off when
they find it requires a headset (especially physicians). There
are many other choices available in the market today. For example
the Philips
Speech Mike , Shure ,
Wireless , Norcom
2440 .
We anxiously await
further programs from Dragon Systems, IBM and Lernout & Hauspie
(purchasers of Kurzweil). However, as of January 1999, I believe
that voice recognition software is able to automate, streamline
and economize the medical records department of essentially every
physician's office.
Top
Written and ©1/18/98
through 02/17/02 by Eric Fishman, M.D.
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