Listen Up: Speech Recognition Technology Spreads in EHR Era

Elizabeth Barton
Published: Monday, Mar 07, 2011
Medical records have changed significantly in the past decade, with powerful servers and digital archives replacing rooms jammed with filing cabinets and folders stuffed with hand-scribbled notes. Although many physicians’ offices and hospitals still retain paper records, growing pressure from the federal government to convert to electronic health records (EHRs) is making speech recognition transcription software an increasingly popular tool in medical facilities.

Will this technology simplify the transition to fully digitalized health records, including in oncology settings?  Experts say it already has revolutionized the creation of patient  records in radiology and that it will continue to spread across the healthcare spectrum. Adopting such technology, though, is more nuanced than loading software into a computer, according to healthcare industry observers and recent research. 

David Hirschorn, MD, director of Radiology Informatics at Staten Island University Hospital, New York, New York, said the technology is a “fait accompli” in radiology. “It’s a matter of time before it happens in the rest of healthcare,” said Hirschorn, who also conducts research in the field at Massachusetts General Hospital in Boston, during an interview with Oncology Net Guide. “There are drivers that are pushing for speech-based documentation.”

Jan P.H. van Santen, PhD, director of the Center for Spoken Language Understanding (CSLU) at Oregon Health and Science University in Portland, said automated speech recognition (ASR) is widely used for medical dictation these days.

“Several companies have sold very good systems.  These systems work better— none are perfect!— the smaller the vocabulary is and the more technical and longer the words are,” he said in an email.  “Radiology, including radiation oncology, has always been among the bigger users of ASR, in part for these reasons and also, of course, because it has stricter reporting requirements than, for example, psychiatry.”

Yet Van Santen already is looking beyond the use of speech technology for straightforward dictation to exciting new applications.

“One is where the physician talks into the system while interacting with the patient. This is much more difficult because the vocabulary will be larger and more unpredictable, and there is going to be background noise (eg, the patient talking),” he said in the email.  “But it is enormously important now that EHRs almost force the physician to be typing away while at the same time interacting with the patient— not good, in particular in oncology, where intense and empathic physician-patient communication is so important.”

He also said CSLU is studying ways in which speech technology can be used to analyze speech patterns that signal disease. “For example, throat cancer may cause specific acoustic markers that are different from those resulting from regular hoarseness; certain physicians can hear the difference, but most can't,” he said.

“Another example is brain metastases. Some of these may be too small to be picked up by imaging, yet by being lodged in a functionally critical area may manifest themselves behaviorally, and one of these behavioral manifestations can be speech (about 35% of brain cancer cases present with one or more of clearly audible dysphasia, aphasia, or slurred speech). I underline here ‘clearly audible,’ because we are convinced that computer analysis of speech will be capturing many cases that are not audible to the human ear.”

Advocates See Many Advantages

Advocates of speech recognition technology say it has many advantages. It makes hands-free computing an option for clinical documentation, test result management, speech-enabled EHRs, and diagnostic reporting.  It is also helpful for fully documenting patient feedback and extemporaneous explanations since a patient is generally more comfortable speaking responses than typing them, and the information is generally easier to understand if taken from a patient’s natural speech rather than a typed response. These full-text responses can be attached to a patient’s medical report and forwarded to subsequent practitioners.

In radiology practices, dramatic savings have been reported. At Staten Island University Hospital, the adoption of speech recognition technology cut annual reporting costs from $300,000 to $50,000, Hirschorn said during a presentation at the Society of Imaging Informatics in Medicine conference in June. He said the radiology department was able to cut 7 full-time transcription jobs.

In addition, the turnaround time for generating reports dropped from 2 weeks to less than 10 minutes.

The cost of traditional dictation can easily exceed $12,000 per physician per year while voice recognition software costs approximately $1000 to $1500 per physician, according to Bruce Kleaveland, president of Kleaveland Consulting, a healthcare technology management consulting firm in Seattle, Washington. [Physicians Practice story]  

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