Implementing speech recognition for radiology reporting before a hospital mandates can be advantageous for radiology practices, Dr. John Floyd of Radiology Consultants of Iowa told attendees at an informatics scientific session the RSNA 2007 meeting. The session was reported by Editor Cynthia Keen in the AuntMinnie Radiology Magazine:
Radiology Consultants of Iowa in Cedar Rapids serves two urban hospitals, seven rural hospitals, and one imaging center. In 2005, with a 37% error rate for internally transcribed reports at one hospital, and a report turnaround time of three to 10 days at another, executives at both hospitals were discussing the purchase and adoption of speech recognition systems as a way to alleviate the problems.
A Single SR System
Floyd said that he and his colleagues recognized the inevitable, and offered to take over all aspects of radiology report transcription, processing, and distribution. After evaluating different systems for six months, the practice purchased a single speech recognition system to be interfaced with five different RIS and three different PACS.
The benefits of having a single system were that the radiologists and transcriptionists/editors would only need to learn how to use one system, rather than several, and would only need to work with one database with respect to adding vocabulary and teaching the system to correct errors.
The radiologists planned to phase in usage in the first hospital to go live over a several-month period. “However, the speech recognition system launched abruptly in March 2006 when the transcriptionists learned what was being planned and walked off the job,” Floyd said.
A Majority of Free-Text Reports
“We self-edit 97% of approximately 1,000 unstructured reports each day,” Floyd said. He believes that the practice’s ownership of the speech recognition system contributes to this high level of self-editing compliance.
Approximately 90% of the reports generated are free text, with less than 10% using standardized responses. Transcription editors are available from 6:00 a.m. to midnight, but are typically used only when a report is particularly complex or when data need to be entered with the report. “This can add an additional five to 10 minutes of time,” Floyd explained.
Comparing Error Rates
Concern about high error rates of SR systems reported at RSNA 2006 convinced the practice to conduct an analysis of accuracy of SR-generated reports as compared to reports still being generated through traditional dictation at one rural hospital. The group compared 493 SR reports with 283 traditionally transcribed reports. The total number of errors for the SR reports was nine, compared to 13 for the traditionally transcribed reports, and 0.6% of the SR reports had a significant error, compared to 2% of the traditionally transcribed reports.
Productivity Gains
Although a direct correlation cannot be attributed to the implementation of speech recognition, Dr. Floyd said that during the remaining months of calendar year 2006, productivity increased 12% as it related to reporting. In the first eight months of 2007, productivity increased by 28%. Floyd attributes financial ownership to making the project a success.
Integrating Dictation with PACS
In the RSNA same session, a group from Santa Barbara Cottage Hospital reported that by integrating a dictation system using structured templates with its PACS, a reduction of 45% in full-time employee (FTE) transcription was achieved within 90 days from implementation in February 2006. Compared to the same months of the prior year, report turnaround time for STAT exams improved by 70% and overall turnaround time improved by 8%.
Speech Recognition 
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