Archive for November, 2007

Medical Knowledge and Speech Recognition: More Staggering Figures

More Staggering Figures In this month’s issue on Health Imaging & IT, Nick van Terheyden, Chief Medical Officer for Philips Speech Recognition Systems, further comments on the boom of medical knowledge and the market pressures leading healthcare facilities to seriously consider the speech recognition option:

Speech Recognition: a competitive advantage

The addition of speech recognition technology (SR) to (RIS and PACS) systems can further reduce practice overhead, while providing a competitive advantage to the groups that implement them. Speech recognition can reduce costs by 30 to 40 percent, and early users will have a very high competitive advantage.

Transcription: major costs for hospitals

As exam volume continues to grow, transcription costs will match pace; although reimbursements for the performed procedures may not. According to van Terheyden, approximately $12 billion is spent annually in the U.S. on medical transcription, making it one of the top five line-item costs of hospitals and healthcare systems.

“I think the question for everybody is not if, but when you should use speech recognition,” van Terheyden said.

5 goals for automating clinical documentation

van Terheyden outlines five goals for automating clinical documentation:
1. Reduce physician time documenting
2. Improve availability of documentation
3. Re-use standard phraseology
4. Improve quality and consistency of documentation
5. Decrease the cost of documentation

The US: largest speech recognition user in the world

There are approximately 40,000 active physician users generating about 18 million lines per month with SR technology. As the need to reduce costs in healthcare delivery accelerates, this user base will increase.

More medical information in the next 10 years than in the whole medical history…

The next 10 years will see more medical information learned and developed than has been captured in the whole of medical history. Radiology, in particular, is bearing the lion’s share of this information glut. James Thrall, MD, of Massachusetts General Hospital in Boston projects that the radiology workload will increase approximately 50 percent by 2010.

> Read full article

“Clinical knowledge doubles every 18 months…”

In a recent interview with a UK healthcare IT publication, Philips Speech Recognition Executives comment on a couple of mind-blowing figures.

Nick van Terheyden, MD Dr. Nick van Terheyden, Chief Medical Officer:

Clinical knowledge is estimated to double every 18 months. Given the massive volume of medical research, it is impossible for any physician to keep up with all new developments. A new study on a specific condition or its treatment might have been published just the day before the physician sees a patient.

Physicians are trained to identify conditions based on the occurrence of signs and symptoms. But as medicine expands and the number of diagnoses increases it becomes harder to use this information to identify specific conditions and their cause. As medicine is undergoing an explosion of information, technology must be utilized to assist the clinical team in prioritizing information, highlighting key data and guiding the care process.

…If the EHR is able to provide real-time access to clinical data the physician becomes much more of a pilot, navigating and taking decisions as critical and relevant information is presented to him in a clear and effective way.

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

A survey by the European Commission found that almost 4 in 5 EU citizens classified medical errors as an important problem in their country. Other studies suggest that:

  • In Italy, up to 90 people die per day because of an error
  • In Germany this number is estimated at 38,000 per year.
  • In the UK, 850,000 medical errors are reported each year.
  • In the US, it is estimated that 100,000 people die from medical errors each year.

First measurements show that a hospital’s overall productivity can be increased by 5-7% just by increasing reporting efficiency. Using speech recognition to improve reporting accuracy is next, along with ensuring faster availability and accessibility to information. I see this as the basis for reducing the alarming error rates in healthcare.

The feedback we receive from doctors says that the length of their reports has increased, since they started using speech recognition – because it makes reporting much easier. Today, doctors are often advised to keep their dictations short, to ease the workload on the transcriptionist. This clearly can’t be the solution – not in a time where we are moving towards evidence-based medicine. More information is what doctors need and that’s why speech recognition must be offered to doctors as a standard option for capturing information electronically, the same as the keyboard or the mouse.

The above figures are the reality check that motivated the development of Philip’s Interop, a concept demonstrator designed to advance system interoperability in healthcare with the help of speech recognition, Map of Medicine (Medic to Medic), Health Language and Elsevier technologies.

The Future of Clinical Dictation and Transcription

The Future of Clinical Dictation and Transcription In the latest issue of For the Record Magazine, Robbi Hess discusses the pros and cons of the Once-and-Done transcription model (the other name for front-end speech recognition, whereby physicians see the results of their dictation on screen and make their own corrections). First, the article highlights findings from a Gartner Report by Barry Hieb, MD, healthcare research, titled “The Evolving Model of Clinical Dictation and Transcription:”

The lack of efficiency and the money that leaks through transcription cracks have always been issues in the healthcare industry. The role of dictation and transcription in clinical documentation is evolving in response to new technologies and new functional requirements…

Traditional dictation and transcription are giving way to ‘editor-based’ approaches and that once-and-done dictation will eventually be adopted in the majority of situations.” […] Because speech recognition makes increased productivity and associated cost savings possible, it is now an integral part of most new dictation and transcription contracts.

The OAD dictation model will take longer to unfold but will be driven by the need to provide value back to physicians at the time they are dictating reports.

The importance of the physician’s sign off
The Author then quotes Peter Preziosi, PhD, CAE, CEO of the Medical Transcription Industry Alliance and executive director of the Association for Healthcare Documentation Integrity (AHDI):

The reality today is that you have physicians that don’t even sign off on charts even though they are legally liable for the content. My concern is that when we look at building a national healthcare information infrastructure, it will be that much more critical to ensure the accuracy and completeness of information. The onus of chart accuracy must be on the clinician, not the MT, making the need for clinician sign-off imperative.

Back-end vs Front-end Speech Recogniton
Hieb says using speech recognition technology cuts significant costs from the entire transcription cycle:

The editors can crank out 50% to 100% more copy a day and, as a result, the hospital gets charged less money. But the downside is there is still a two-day turnaround time, and the hospital is still paying for both transcription and dictation costs.

The advantage to the editor mode of transcription is that the doctor is not being asked to change the way he or she operates, and the report is turned around faster. Presumably, the editor is happier, is doing more work, and is being more productive. And from a documentation standpoint, you are telling the physician that the report will be back more quickly, but you still have to look at it, revise it, and sign off on it.

The OAD model, carries with it a good news/bad news scenario: The hospital can save money and enhance performance, but the doctor has to change his or her dictation routine.

Doctors are hesitant now because we will be telling them, ‘You will be dictating at a computer, but you can see what you are dictating’. Hieb acknowledges that some doctors are poor dictators, but with OAD, they can receive direct feedback and make edits as they go, while the patient information is fresh in their minds.

What the future holds…
Hieb believes that one of OAD’s benefits is that when the clinician dictates, edits, and signs off on the record, it’s ready to go into the electronic chart:

The turnaround time has dropped from four days to two days [with back-end speech recognition] to two minutes, and now any doctor can see that report as soon as the physician signs off on it. That turnaround time brings nothing but benefits and better care to the patients.

Although a hospital would have to invest in the software and hardware technologies necessary to implement an OAD system, Hieb says those expenses would pay off in the long run. “There will be set-up and maintenance fees, but they will be nowhere near the costs of the money spent on dictation and transcription.” He agrees, though, that getting doctors to change their behavior will be the largest hurdle to overcome.

With OAD, there is no subsequent time added to that chart, little hassle, and minimal risk of error. The single best defense against malpractice is good documentation, and with once-and-done, you have given the doctor the chance to do the reports and be done with it.

How physicians are accepting speech recognition technology…
Hieb goes on to comment:

Doctors are surprised to see that they can save time and money. If they spend a little bit of time up front ‘training’ the system, they are reaping dividends in time and money saved.”[…] OAD is being accepted more readily in private practices. That is where the technology is really making inroads because the doctors see they can save time and money, and if they have an electronic copy of the record, the staff isn’t busy chasing down records. In fact, they may be able to reduce the amount of staff they are paying. The OAD knows to file the record in Susie Smith’s chart, and the general trend in medicine is toward more clinical automation.

OAD can also be effective in the emergency department (ED), where time is of the essence. In the ED, the real benefit is getting that data out there and into the chart instantly. The more quickly and effectively the information is captured in the chart, the more quickly the physicians have access to that data.

Conclusion

For Hieb, the reason to embrace OAD is because the goal of the healthcare system is to help sick people get well and healthy people stay healthy. “We are entering an age when information is a critical component of achieving these two goals, and once and done is a better, more efficient way to capture that information,” he says.

Preziosi says the concept is not feasible in today’s marketplace, even with the enabling technologies that will be seen in the future. “Given the cost restraints, the persistent labor shortages, and the increased demands on the healthcare system, I don’t see OAD as being realistic,” he explains. “I think the clinical documentation sector needs to listen to the concerns of the consumers of our services and adapt our service offerings to meet their ever-evolving demands.”

> Read full article

Wireless Speech Recognition in the ER: Case Study now Available

Wireless Speech Recognition in the ER As previously discussed on this blog, the ER Department of the Sir Mortimer B. Davis – Jewish General Hospital in Montreal, QC, introduced a wireless document creation and management system that uses PDA devices and speech recognition to accelerate the delivery of critical information at the point of care. Just released, the case study provides details on Dr. Rsoenthal’s vision behind the project, key project milestones and achievements.

> Read case study

Dictation Etiquette

Dictation Etiquette We often blame physicians for their illegible writing, but sometimes, their dictation skills aren’t much better. I have the feeling that physicians and medical transcriptionists alike are going to love these videos, just released by SpeechMagic to help physicians with a few tips and tricks for optimal digital dictation / speech recognition output:

Beware of background noise

Distance to the mike

Keep a constant rhythm

On the same note, I came across a blog called “Dictation Therapy for Doctors”. The author offers Language Skills Worksheets and Consciousness Raising Exercises, my favorite being Exercise #2, “designed for physicians who vent their anger against the personnel in the Medical Record Department during the course of their dictation!” The site also displays a number of cartoons, “perfect for printing and and posting in a variety of high-impact places in hospitals and clinical settings”. Enjoy!

Risking a SpeechMagic-Dragon Comparison?

Risking a SpeechMagic-Dragon Comparison? I was at an Emergency Medicine Congress earlier this week, attending an all-day workshop on healthcare IT. After a morning spent discussing the advancement of the Electronic Health Record, the afternoon was dedicated to speech recognition technology and the various projects taking place across the province. One doctor was explaining how he was using off-the-shelf Dragon as an enterprise solution, much to the peril of his own productivity, let alone the protection of patient data. Another physician was presenting a facility-wide project involving SpeechMagic being integrated into a dictation/workflow system. By listening to these guys, I got the feeling that Dragon appears to be a great solution for individual doctors (i.e.: small physician offices) willing to spend the time “training” the software, while SpeechMagic clearly sets apart as a professional solution more equipped to fit the needs of large healthcare facilities. Here is why:

Pricing
On a licence-to-licence basis, Dragon comes out cheaper than SpeechMagic. However, when looking at concurrent pricing, the gap shrinks. Concurrent pricing takes into account the fact that all physicians don’t use the system at the same time, a flexibility reflected in Philips’ pricing model, who offers 2:1 and 3:1 SpeechMagic licences (1 license for 2 or 3 physicians that don’t operate on the same shift). Dragon doesn’t seem to offer the concurrent pricing option to date.

Shared vocabulary / corrections
The question of shared vocabulary was raised at one point; another area where Dragon and SpeechMagic differentiate. I understood that you could share vocabularies and corrections by downloading a special file from the Dragon website, but it wasn’t very clear, while on the SpeechMagic side, corrections from one author are automatically shared with other authors, which significantly accelerates the system’s learning curve. Then again you couldn’t expect much less of a network solution, could you?

Initial training
All in all, what blew me away is the amount of training required by Dragon. One of the physicians was suggesting other Dragon users to follow the initial dictation exercises offered with the software in order to reach acceptable accuracy: 50 dictations for the physician to do prior to being fully operational! Once again, I doubt that even 5% of the physician population would be willing to put in so much time and efforts, and who can blame them? Another physician in the audience using SpeechMagic explained that his team was operational right away, without having to “train” the software to their individual voice characteristics. So I find funny to see how the whole “initial training myth” is still very much alive – Dragon being the sole reason behind it – when professional technology has eradicated it long ago.

Workflow
As important as the speech recognition software are the file management and workflow aspects, which are simply non-existent with Dragon. File transfer, electronic signature, distribution: you figure it out. That’s where healthcare facilities need to be careful upon investing: yes speech recognition can be valuable to their staff, as long as it comes along with other tools to ensure that technology adapts the way they work, and not the other way round:

  • Workflow management automation: ability to activate speech recognition for certain times/users/work types/departments only, leaving all options open. For instance, a facility can decide that short reports can be reviewed by Authors in front-end mode, while more complex and detailed work can be routed to transcription for correction as a standard or on the fly.
  • Electronic signature: ability to assign a legal value to all reports completed by a physician.
  • Distribution: ability to fully automate the distribution of final reports as per rules set by the hospital (fax distribution to referring physician, e-mail distribution to nursing staff, etc.)

A standalone speech recognition software cannot deliver all this. And that’s not its “job”. That’s why companies like Philips do not sell SpeechMagic directly, but only through a number of dictation and workflow systems vendors that have worked with the medical field for years and that understand its complexity and unique requirements.

File storage and confidentiality
More distressing is the file storage issue, which directly falls under the HIPAA (US) /PIPEDA (Canada) regulations, both very strict on the subject. One doctor using Dragon explained how all of his completed reports were stored on his laptop. Then what happens if the laptop is stolen? Unless the hospital’s provides dedicated server space, those files are at risk, but then again, it’s up to the hospital to enforce a central storage policy. But is it really their role? I believe it is the technology provider’s to provide a clear and reliable answer to the confidentiality problem. The way a system like Crescendo-SpeechMagic addresses the issue is as follows: files are always kept on a central server at all times, leaving zero footprint of confidential information on users’ PCs. When a user needs to edit or listen to a dictation, voice files are streamed – as opposed to copied – to users’ desktops. If a PC is stolen, it’s a hardware loss, period.

Medical dictionaries
Potatoe-Patatoe. Both products offer a similar choice of medical dictionaries, covering general medicine and a number of specialties, in a wide range of languages. The only question mark I have is regarding the French Canadian language: I know SpeechMagic offers a specific model for French Canadian, while it is not clear to me whether Dragon simply sells its French-from-France model in Quebec.

Well, I think I have covered the main points, which to me, only reflect the development history of both products. SpeechMagic was designed as a network solution while Dragon was originally made for individual users in the consumer world. That’s why a licence-to-licence price doesn’t make any common sense in my opinion, nor adding a “Pro” sticker on a product make it acceptable for professional use. I am even tempted to conclude this SpeechMagic-Dragon comparison thread by saying both products shouldn’t…be compared in the first place (duuhh!)

Philips Gets Rid of MedQuist

Philips Gets Rid of MedQuist Another major transaction-to-be in what could be called the supermarket of healthcare IT businesses… Philips confirmed yesterday its intention to sale its 70% ownership interest in transcription software company MedQuist (Pink Sheets:MEDQ) and take a fourth-quarter charge of 320 million euros (> more on the financial aspects here). This announcement follows a number of telltale press releases from earlier this year:

  • July 6, 2007: Philips indicated it was reviewing all of its future options with respect to its stake in MedQuist, which it now viewed as a non-core holding.
  • October 4, 2007: MedQuist announced that it had become current in its SEC filings.

A bit of history

MedQuist isn’t exactly the happiest investment a giant like Philips could have been dreaming of. 1.3 billion is the total amount Philips paid for its stakes in the Mount Laurel, NJ, company back in 2000. Only 3 years later, class action suits questioning Medquist’s billing procedures started piling up, leading to its delisting from Nasdaq in June 2004 after failing to meet reporting requirements. The company was then investigated by the Securities and Exchange Commission over alleged improper billing and the Department of Labor over administration of its 401(k) retirement plan.
> More on the MedQuist billing controversy

More recently…

Adding to an already heavy conjuncture, another MedQuist stakeholder surfaced on October 30 with a “missive seeking to inspect the medical billing company’s shareholder list, books and other records for the past seven years”, according to a regulatory filing on Tuesday. In this letter, the shareholder, Costa Brava Partnership III LP, “demands that such an inspection take place on or before Friday, Nov. 9, 2007.” > More

About MedQuist, Inc.

MedQuist, which has a $416 million stock market capitalization, provides medical transcription technology and services in the United States. It also offers digital dictation, speech recognition, electronic signature, and medical coding technology and services.

Bizjournals.com reports that MedQuist cut 104 positions during the third quarter of 2007, and has about 8,000 employees who work as medical transcriptionists, service technicians, certified coding specialists, sales associates and engineers.


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