DHMC Cardiology Update 2004DHMC Cardiology Update 2004

Speech Recognition in Medical Speech Recognition in Medical PracticePractice

December 6, 2004December 6, 2004

Jon W. Wahrenberger, MDJon W. Wahrenberger, MD

Medical DocumentationMedical DocumentationOld Paradigm: hand-written documentationOld Paradigm: hand-written documentation

Jury blames doctor's bad penmanship for patient deathJury blames doctor's bad penmanship for patient death

Award = $475,000Award = $475,000

Medical DocumentationMedical DocumentationMore Contemporary Paradigm: Typewritten RecordMore Contemporary Paradigm: Typewritten Record

Medical DocumentationMedical DocumentationMore Contemporary Paradigm: Typewritten RecordMore Contemporary Paradigm: Typewritten Record

Cost of transcription? $30,000 per Cost of transcription? $30,000 per practitioner?practitioner?

Medical DocumentationMedical DocumentationToday’s ParadigmToday’s Paradigm

Electronic Medical RecordElectronic Medical Record

DHMC Cardiology ClinicDHMC Cardiology Clinic

Physician Underutilization?Physician Underutilization?

Questions:Questions:

• Has the Has the qualityquality of physician typed notes and of physician typed notes and discharge summaries improved or discharge summaries improved or worsened?worsened?

• Is typing cutting into our time with Is typing cutting into our time with patients?patients?

• Are we seeing more repetitive motion Are we seeing more repetitive motion injuries?injuries?

• Has physician generation of notes increased Has physician generation of notes increased or decreased productivity??or decreased productivity??

Alternatives to following the crowd?Alternatives to following the crowd?

Speech Recognition Speech Recognition Technology…Technology…

… … has arrived!has arrived!

Speech Recognition Speech Recognition TechnologyTechnology

• Alternative method of keyboard inputAlternative method of keyboard input• Text CreationText Creation• Computer control and navigationComputer control and navigation

• Reduction of multiple repetitive tasks into Reduction of multiple repetitive tasks into single speech commandsingle speech command

• Net result: simplifies and reduces time Net result: simplifies and reduces time when using computerwhen using computer

How does it work?How does it work?

• Statistical technology involving Statistical technology involving interface of:interface of:• An acoustic model – the sound related An acoustic model – the sound related

variables of a given pronunciationvariables of a given pronunciation• A lexicon – a group of words and their A lexicon – a group of words and their

pronunciationspronunciations• A language model – which specifies the A language model – which specifies the

relative likelihood of a sequence of wordsrelative likelihood of a sequence of words

DemonstrationDemonstration

Available ProductsAvailable ProductsDragon Dragon

NaturallySpeakingNaturallySpeakingMicrosoft Microsoft SpeechSpeech

•Best Product Best Product

•Windows OS onlyWindows OS only

•Windows & Mac Windows & Mac VersionsVersions

•Incorporated into Incorporated into OfficeOffice

•Poor user interfacePoor user interface

IBM ViaVoiceIBM ViaVoice

System RequirementsSystem Requirements

• Intel® Pentium® III / 500 MHz processor Intel® Pentium® III / 500 MHz processor (or equivalent AMD® processor) (or equivalent AMD® processor)

• 256 MB RAM 256 MB RAM • 500 MB free hard disk space 500 MB free hard disk space • Creative® Sound Blaster® 16 or equivalent Creative® Sound Blaster® 16 or equivalent

sound card supporting 16-bit recording or sound card supporting 16-bit recording or USB PodUSB Pod

• High quality microphoneHigh quality microphone

Cost of Dragon Cost of Dragon NaturallySpeakingNaturallySpeaking

ScansoftScansoft Best Best Internet Internet

PricePrice

Medical Medical Solutions*Solutions*

$1095$1095 $845$845

ProfessionaProfessionall

795795 620620

Preferred**Preferred** 199199 155155

Standard**Standard** 9999 9191*Includes extensive general and *Includes extensive general and specialty vocabulariesspecialty vocabularies

**Not Recommended for Professional **Not Recommended for Professional UseUse

AdvantagesAdvantages

• Increased productivityIncreased productivity• Economy: no transcription costEconomy: no transcription cost• Speed: Speed:

• Good typist averages 50-90 words per min.Good typist averages 50-90 words per min.• Speech dictation: 100-180 wpmSpeech dictation: 100-180 wpm

• Reduction in repetitive motion injuriesReduction in repetitive motion injuries• MobilityMobility

Speech Recognition: CaveatsSpeech Recognition: Caveats

• It is highly accurate and reliableIt is highly accurate and reliable• Dramatically easier than typingDramatically easier than typing• Voice recognition software is not for Voice recognition software is not for

everyoneeveryone• Not as easy as transcription into a Not as easy as transcription into a

telephone or Dictaphonetelephone or Dictaphone• Highly cost effective when compared to Highly cost effective when compared to

transcription (total cost of software and transcription (total cost of software and good microphone is less than $1000)good microphone is less than $1000)

Microphone OptionsMicrophone Options

Philips Philips SpeechMike SpeechMike ProPro

Sennheiser Sennheiser ME 3ME 3

Andrea ANC-Andrea ANC-600600

VXI & Andrea VXI & Andrea USB PodsUSB Pods

Studies of Speech Recognition Studies of Speech Recognition Software in Medical Settings?Software in Medical Settings?

Voice Recognition in Medical Voice Recognition in Medical SettingsSettings

47 Emergency Room 47 Emergency Room ChartsCharts

Advanced Advanced UserUser

27 Charts27 Charts

Basic UserBasic User20 Charts20 Charts

Voice Rec Voice Rec DictationDictation

2727

Telephone Telephone DictationDictation

2727

Voice Rec Voice Rec DictationDictation

2020

Telephone Telephone DictationDictation

2020

Am J Emerg Med. 2001;19:295-298Am J Emerg Med. 2001;19:295-298

Speech Recognition Vs. Speech Recognition Vs. TranscriptionTranscription

Am J Emerg Med. 2001;19:295-Am J Emerg Med. 2001;19:295-298298

Speech

RecogntionTraditional

0

20

40

60

80

100

Acc

ura

cy (%

)

98.598.5 99.799.7

Speech

RecogntionTraditional

0

2

4

6

8

10

Dic

tation

& C

orre

ctio

n

Tim

e (m

in)

3.653.65 3.773.77

Speech Recognition Vs. Speech Recognition Vs. TranscriptionTranscription

Am J Emerg Med. 2001;19:295-Am J Emerg Med. 2001;19:295-298298

Speech

RecogntionTraditional

0

10

20

30

40

50

Tim

e to

Com

ple

ted

Rec

ord (

min

)

3.653.65

39.639.6

Where Next?Where Next?

www.dartmouth.edu/www.dartmouth.edu/~cardio/voice.htm~cardio/voice.htm