Speech Recognition

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

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

More comments came up over the weekend from Eric and David, which I would like to address here this morning.

Dear Eric, Dear David,

Eric is not the only one confused here. Actually, the bluriness that still prevails between consumer and professional speech recognition technology is what started this blog in the first place.

First, it is important to place my original thread in its context. I wrote this thread after I attended a congress on ER medicine where one doctor was explaining how he was using the off-the-shelf Dragon engine as an enterprise solution; an initiative that only reveals the overall market turmoil. To address users’ confusion, the best way is probably to analyze the reasons behind it. I believe the products’ respective sales models account for most of the blurriness:

• Dragon is sold both directly (you can buy it from your local Electronics store) and through integration partners. What this doctor did was use the out-of-the box software thinking he was using an enterprise solution. And who could blame him? I would be lost myself if I were in his shoes.

• SpeechMagic is not sold directly, but only through integration partners (workflow/dictation vendors). It is Philips policy to rely on their integration partners to provide the workflow management, interfacing and security aspects, which they consider as being as important as the speech recognition engine itself. The role of SpeechMagic in the overall EMR agenda will thereby depend on the way the partner interfaces the whole speech/system with the rest of the hospital’s IT infrastructure.

This whole dichotomy in the sales approach is not without its historic explanations. As Eric rightly points out, both products come from different worlds, addressing different markets in the first place:

• Dragon comes from the consumer world. It was later “extended” to the professional arena through the addition of medical dictionaries and, later on, integration partners. It can therefore be installed on a single user’s PC or in a network configuration. This “consumer” background might also explain why the recognition accuracy is a central point in Dragon’s marketing speech.

• SpeechMagic comes from the professional end of the spectrum and has always refused to reach out to the consumer market. It is designed for groups of users as part of a department or multi-facility approach, for which the recognition accuracy is just as important as other feature such as shared correction, acoustic adaptation and failover mechanisms. This is why David is right when he points out that SpeechMagic is not en enterprise solution; simply one that’s, in my opinion, more geared towards professional use. I will therefore rephrase that in my original post. SpeechMagic, just like Dragon, becomes an enterprise solution once integrated, depending on the workflow management features offered by its integration partner(s).

Regarding initial training: I am not sure which version of Dragon this doctor was using. I am only reporting his experience of using Dragon, which involved, in his own words, significant training time. Then again I am not questioning Dragon’s marketing speech here (who would I be to do so?), but only relaying a user specific testimonial.

Finally, David is rightly mentioning Enterprise Express (powered by Dragon) as an enterprise solution, which should be added to the list I provided on Friday.

May I conclude by inviting actual end users of any of the above systems to share their experience on this blog? I look forward to publishing your stories.

I would like to reply to the following comment from Eric Jacques: “Wouldn’t it make more sense to compare SpeechMagic to PowerScribe?” in response to the following thread: “Risking a SpeechMagic-Dragon Comparison?“

Dear Eric,

Comparing SpeechMagic and PowerScribe would be like comparing an engine to a car. It is indeed important to differentiate:

• The speech recognition engine technologies
• The enterprise solutions that integrate the above technologies and are offered to healthcare facilities as part of a comprehensive dictation/workflow management package.

In today’s marketplace, vendors of dictation/workflow solutions are typically powered by one of the two major speech recognition engines: Dragon or SpeechMagic. Hence the importance to compare these two in the first place.

What makes it slightly more confusing in the case of PowerScribe is that:

• PowerScribe is a Dictaphone product
• PowerScribe is powered by Dragon
• Dragon is a Scansoft product
• Scansoft bought Nuance in 2005 but chose to keep on doing business under the name Nuance
• Nuance acquired Dictaphone in 2006.

Still following?

So if PowerScribe was to be compared to any system, it would be to a range of enterprise solutions such as:

• Crescendo Speech Processing (powered by SpeechMagic)
• Dolbey Fusion Speech (powered by SpeechMagic)
  
• MedQuist SpeechQ (powered by SpeechMagic)
• Dictaphone Enterprise Express (powered by Dragon)
• SoftMed Speech Recognition (now powered by SpeechMagic since 3M merger)

With an industrial history firmly rooted in technology, the Nordics have always been early hi-tech adopters, clearly ahead of new market trends. While, in the early 2000’s, the rest of Europe was still getting used to the very concept of online transactions, these guys were already buying books by the dozen from Amazon.com over broadband connections. The fact that Norvegian healthcare is about to roll-out the world’s largest speech recognition installation therefore comes as no surprise.

As announced yesterday, over 1,000 physicians from the Ulleval University Hospital in Oslo - Norway’s largest clinical center - will be using SpeechMagic to generate reports across all medical specialties as of 2009. This is expected to be the world’s largest deployment of front-end speech recognition at one single hospital site. > More…

On the other side of the northern border, their Finnish neighbours also decided to step aboard the speech recognition ship with zero drowning reported so far. Instead, a rather impressive use case from the Palokka healthcare joint authority, who has been using a speech recognition system powered by SpeechMagic since December 2003. The system allowed the authority to “speed up patient care and improve data security at the same time. Patient data is always in the right place at the right time, which avoids unnecessary processing and reduces the need for doctors to consult each other.” > More

Medical Times Middle East recently dedicated an article to healthcare speech recognition based on interviews conducted at ArabHealth. Editor Vernon Baxter starts off the article by questioning Bill Gates’ 1997 prediction (”in this 10-year time frame…we will have perfected speech recognition and speech output”) in the light of present achievements.

“Gates may have been a little optimistic with his prediction, but voice-recognition is finally making inroads into healthcare (…) With the increasing presence of electronic medical records in clinics, the potential benefits of a voice-activated interface have never been greater.

Baxter goes on to comment the state-of-the-union between vendors and client healthcare organizations, quoting top vendor executives along the way, including:

- Koen Schoof, senior product manager, dictation and healthcare, EMEA, Nuance Communication.

- Costa Mandilaras, president, Crescendo Systems Corporation.

- James McPherson, project and client manager, Voice Technologies.

> Read article

I had promised an update on the MedQuist Saga outcome. Well, here it is; Season one’s grand finale. On March 10, MedQuist executed a $7,537,001.83 million settlement with “the plaintiffs and certain other putative class members represented by plaintiffs’ counsel in the South Broward customer class action.”

This settlement closes the putative class action that was filed on September 9, 2004 against the company. Plaintiffs alleged that the company overcharged certain non-federal governmental hospitals and medical centers for transcription services.

The settling parties will release the company and all individual defendants from any and all claims and dismiss the action in its entirety with prejudice.

The settlement is subject to formal documentation by the parties. Because the parties are not settling on a class-wide basis, no class will be certified, and thus there is no requirement to give notice. Neither the company, nor any of the individual defendants, has admitted or will admit to liability or any wrongdoing in connection with the proposed settlement.

> Read full press release

> Watch previous episodes

Marcel Wassink, Managing Director, Philips Speech Recognition Systems, speaks out in a recent interview conducted by HealthTechWire’s Armin Sheuer. Wassink shares his vision of market achievements and challenges, technology trends and the role to be played by speech recognition in the overall EMR agenda. Here is a sneak peek:

Challenges

The challenges in our field are indeed immense. We are expecting technology to cope with two highly complex issues: first, it has to capture and understand unstructured spoken information. Secondly, it has to turn this information into structured text, which takes into account that this is going to be used for sensitive healthcare purposes and life-affecting decisions. This requires in-depth expertise, plus detailed customer and clinical insight in order to achieve the accuracy, convenience and efficiency levels required in the healthcare industry. This focus has lead to the current massive adoption of speech recognition throughout healthcare sectors all over the world.

Speech Recognition and the EMR

Once radiology is up to speed, the entire hospital starts realizing the change which usually generates direct user demand for our technologies and services. Another trend that benefits our business is the introduction of electronic health record systems. They are seen as a key component to raise patient safety and reduce medical errors. However, physicians’ resistance is still high because of inflexible and inconvenient data capturing. Enabling verbal interaction between physicians and EHR is expected to eliminate adoption barriers, which is why we are especially active in EHR-friendly markets, such as the US, Scandinavia or Germany.

Beyond Speech Recognition: Standardizing Medical Language

Currently, we are researching solutions that integrate third-party applications, such as medical databases, diagnostic reference systems or coding applications - all of which aim to make healthcare documentation more accurate, convenient and efficient. We are looking at systems that increase patient safety during the process of capturing information in EHR systems, for example, by issuing a warning if physicians prescribe medication to a pregnant patient that is forbidden during pregnancy.

We are also working on standardizing language to support the interoperability of information systems. All healthcare applications must have a common, standardized language that allows them to share information among each other, thus giving access to critical information at the point-of-care: because knowledge is safety - in healthcare even more so than in any other field.

> Read full interview

Following a November 07 announcement in which Philips mentioned that they were reviewing their options for shelving in MedQuist, Philips CFO Pierre-Jean Sivignon said on January 21 that they were “hoping to finalize this in the near future.”

On the other hand, MedQuist’s activist shareholder Costa Brava Partnership III LP, which currently holds 1,938,821 shares (5.2% of the total outstanding), sent a letter to the MedQuist board expressing concern about whether the interests of minority stockholders were being fairly represented in the proposed sale of MedQuist. Costa Brava said they “will hold the MedQuist board of management liable if minority shareholders do not receive benefits equal to majority shareholder Royal Philips Electronics NV ahead of a possible sale of the entire company.” >More

…to be continued…