Speech Recognition

…from the ConText blender. SpeechMagic is now served in the following flavours:

• Consultations - US English
• Emergency Medicine - US English

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From Stone to RFP…

I decided to turn my original Ten Commandments of Speech Recognition document into a more comprehensive list of the critical elements to consider before delving into the RFP writing process. Why? Because I believe that only a well documented Request for Proposal that reflects the operational, technology and legal issues at stake will provide the framework for the expected productivity and workflow improvements - your own organization’s Holy Grail.

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Answer to yesterday’s question:

They did.

They didn’t.

No doubt Montreal physicians have experienced more productive days. Well, Montrealers in general. For now, our hearts are ringing busy in the middle of the Bell Centre arena until the crucial question finds its one-way answer: Who will dictate the rules tonight?

Philips Speech Recognition Systems announced yesterday the launch of a comprehensive service portfolio for their integration partners worldwide, organized around four pillars:

1. Integration. Philips helps define and integrate the optimal set of SpeechMagic features; this includes input channels and the ability to deploy in Citrix Access infrastructures or on Windows Terminal Servers.

2. Deployment. Deployment services prepare for fast system roll-out with the aim of facilitating user acceptance and minimizing downtime during implementation and set-up.

3. Support. Support services provide the knowledge and tools for optimal system maintenance and fast resolution of technical issues, including training and workshops as well as standby and third-line support.

4. Productivity. Productivity services round up the service package, as Philips experts analyze end users’ working methods, evaluate results and user satisfaction, and provide recommendations to optimize workflows and processes.

Marcel Wassink, CEO of Philips Speech Recognition Systems, comments:

Philips has acquired a unique wealth of knowledge and proficiency while working with the world’s largest healthcare speech recognition sites which stretch across city-, region- and even country-wide health systems. The service offering now enables our SpeechMagic partners to apply this knowledge and experience directly to their IT applications. Our technicians, developers and consultants will help them design optimal solutions that boost productivity in hospitals and provide physicians with better information.”

> Read press release

The borders of the professional speech recognition community are expanding further South with a new member as of today:

Drs Conidaris and Partners, a private radiology group located at the Glynnwood Hospital premises in Benoni, South Africa, have completed the rollout of a Crescendo/SpeechMagic speech recognition system. After evaluating different technologies, the partners chose SpeechMagic for its wealth of built-in Radiology vocabulary and Crescendo’s unique voice streaming technology, which allows for immediate speech processing; a key feature for mission-critical environments” explains Kevin McEvoy, Managing Director, Datafer.

With the Crescendo/SpeechMagic technology, the practice was able to deliver on its initial objectives: speed up report production and reduce transcription costs. With the secretaries’ newfound ability to edit medical reports as opposed to typing them in full, fewer resources are required to process the same volume of reports. The first medical report dictated achieved over 75% accuracy and this rate is continually improving as the system learns.

“Skilled medical typists are extremely hard to find in the region, and a growing number of South African healthcare facilities welcome speech recognition technology as a reliable, cost-efficient way to address this issue. The technology has clearly matured significantly over the past few years and is delivering the expected results,” explain the radiologists at the practice.

Digital mobile recorders (Philips 9600) are used by physicians to dictate either directly from the practice or on the move. Every time the device is docked and a network connection is established, DigiService-IP automatically and securely streams completed voice files to the central server in real-time. The Secretary then uses DigiPlayer-IP, the Microsoft Word based playback and transcription application from Crescendo, to correct the document.

“South African hospitals and clinics are increasingly aware of the importance of digital technology to modernize both their practice and care delivery, and they are very selective in their purchasing process, with good reason” explains Costa Mandilaras, President, Crescendo Systems Corp. “This is why we chose a distributor, Datafer, with outstanding support services to properly deliver the Crescendo 18-year field expertise to South African customers. I believe that Drs Conidaris and Partners is the first of many more South African healthcare installations to come,” concludes Mandilaras.

In a freshly inked article from Health Imaging & IT, healthcare IT executives and vendors unveil their respective visions and roadmaps for speech recognition. Integration clearly is the main course on the menu. While this is too bad for those vendors who think HL7 is the name of a 1990’s boy band, this article further confirms hospitals’ appetite for structured documentation with a direct impact on patient care.

• Dr. Stephen Rosenthal, M.D. from the Jewish General Hospital in Montreal, QC, insists on the importance of interfaces between speech recognition and third-party systems in order to deliver the foundation for evidence-based medicine through searchable, standardized clinical data: “if speech systems aren’t relatively uniform, people will find systems on their own and use them. Then you have a hodgepodge of systems that don’t talk to each other and standardization is lost. We are much better investing in something uniform.”
• According to Terence Matalon, MD, from the Albert Einstein Medical Center in Philadelphia, PA, speech recognition & PACS integration is a must have for Radiologists since it eliminates the need to re-enter patient information or “have two applications open to attain the same goal”. Matalon even pushes the point further by making integration expertise a competitive differentiator between vendors: “there are dozens of products that can reliably show you the current exam, prior exam and reports. The differentiating factor is how well they integrate with third parties and how well they reduce amount of work involved in interpreting reports and generating reports.”
• On the vendor side, Klaus Stanglmayr from Philips Speech Recognition Systems explains how “interoperability and the ability to exchange data between systems and countries is becoming more and more critical in Europe. Standardized terminology would prevent the need to have data translated from one language to another.”
• Finally, Chris Spring from MedQuist insists on vendors’ primary mission to “make it easier for the physician to accept the technology.”

Now what’s your vision? Share it on this blog!

After Dictaphone in 2006, it is eScription’s turn to merge with Nuance. Here is an X-ray of the transaction that is about to take place in the speech-recognition-vendor supermarket:

• Seller: eScription, a software vendor specializing in transcription, back-end speech recognition and workflow management applications for healthcare.
• Buyer: Nuance Communications, giant provider of speech technology solutions - such as Dictaphone and Dragon Naturally Speaking - for consumers and businesses around the world.
• Value: $400 million (compared to $357 million paid for Dictaphone in February 2006)
• Payment:
  • $340 million in cash
  • $23 million in Nuance common stock
  • Assumption of vested employee options with a value of about $37 million
• Time frame: deal is expected to close in Nuance’s fiscal third quarter of 2008.
• Claimed objectives:
  • “Enhance Nuance’s ability to provide advanced transcription solutions”
  • “Evolve healthcare documentation and lower transcription costs by more than $1 billion over the next few years.”

The piece of news went public yesterday in the form of an official press release. The question is not so much whether this new deal will shake the competitive landscape, but more along the lines of a deeper, truly existential concern: “who’s next on Nuance’s shopping list?”

> Read press release

The Best-Practice Fairy is back with a fascinating article by Jeff Kelly on successful speech recognition implementation. No doubt that Mr. Kelly knows what he is talking about: before joining Inland Imaging, a 60-member private radiology group in Spokane, WA, as director of clinical applications, he used to perform RIS market analysis and consulting work for MedQuist on voice recognition implementation. As Kelly puts it in a 2007 AuntMinnie article, one question - “What’s in it for me?” - is the key to a speech recognition project’s success. His article sheds the most promising light on the implementation brain-teaser. Here are a few soothing extracts:

Strong support and leadership

Consider pulling in this diverse group of representatives into a VR task force that can meet at defined intervals to address issues and help break down barriers to success. Then use this task force to educate its members on voice recognition — keeping in mind that this is usually new technology for 90% of those involved. This task force can also function as the decision-making body behind the implementation.

Maximize benefit, minimize effort

A typical radiologist statement that must be addressed is, “I am not a transcriptionist.” You can respond to this statement on three levels. First, stress the improvement in patient care when the radiologists are able to review and edit the report at the same time as reviewing the films. No longer do they need to recall whether it was a left or a right shoulder MRI. The accuracy of the report immediately increases.

Second, by editing at the time of the report, they eliminate the time-consuming process of logging into the RIS/HIS at a later time and reviewing the report. Third, the ability to send to transcription still exists if they so desire.

Provide sufficient internal support

At Inland Imaging, an in-house trainer was designated to be with each radiologist for the first three days when they began using the technology. This level of support tapered to half of every day for the next three days, then reached a point in which only a phone call was necessary to check in on each radiologist. Keep in mind that each radiologist will be unique — some needing more support and some needing less.

Set realistic expectations

As stated before, the radiologists are going from a traditional bicycle they’ve ridden their entire life to a shiny new two-seater that they are going to share with a friend. This is no easy task. It’s important to be frank and honest with staff and radiologists about the implementation process. There will be application bugs. There will be times when the application or workstation stops responding. There will be days when they love the system, and days when they feel like throwing the whole thing out the window. Set these expectations up front, then address them as quickly as possible when they arise.

Making change last

Finally, maintain the health of the system. Continue to refresh hardware as necessary to optimize both client- and server-side performance. Maintain error logs and database optimization jobs. Continue to accept version upgrades. Don’t allow neglect of system maintenance responsibilities to have a damaging impact upon the workflow of its users.

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> More threads like this

Someone asked me to provide a few examples of healthcare facilities having deployed SpeechMagic in the front-end (process whereby the recognized text appears on screen as the physician dictates). It is my pleasure to oblige:

• Alegent Health, Omaha, Nebraska, USA
• Staten Island University Hospital, Staten Island, USA
• Jewish General Hospital, Montreal, Canada
• Aberdeen Royal Infirmary (ARI), Aberdeen, UK
• Ulleval University Hospital, Oslo, Norway
• Bornholm Hospital, Bornholm, Denmark
• Helsinki University Central Hospital, Helsinki, Finland

For more information on front-end/back-end speech recognition workflows, see this thread.