Doctors' notes get clearer with speech recognition software

Speech tools play role in electronic health record adoption

The infamous doctor's scrawl may finally be on the way out.

Speech recognition technology is being linked to an increase in adoption of electronic health records (EHR) technologies in U.S. hospitals, as doctors are finding it easier to build more complete patient records more efficiently than with handwritten notes.

Major Craig Rohan, a staff pediatrician at Peterson Air Force Base in Colorado, has been using speech recognition for 18 months to keep EHR, especially for more complex cases where a detailed set of notes from an examination can help other health professionals involved in the patient's care.

"I'm a big fan of the technology," Rohan said in a recent interview. "It's tough to imagine practicing medicine without it at this point."

Rohan uses speech recognition technology from Nuance Communications Inc. in Burlington, Mass., and found that when he goes back to the medical record of a child long after the first examination, there will be more detail than if he had taken handwritten notes.

"When you read the actual medical record, it is kind of conversational, but it's more complete and lets you know what's going on," he said. "It's actually verbatim."

Many users of speech-to-text technologies have tried the tools to save time, but Rohan said that isn't what matters to him. "To be honest, I'm not sure it saves that much time, but it does mean I have a far more thorough note," which can help patients and hospitals in billing an insurance company and getting proper credit for care.

Rohan said he has found the technology highly reliable, meaning that the words printed are almost always what he spoke into a microphone. He had to train on the software for about 15 minutes, using a script with medical language, and he always edits the printed words. "I use a medical version full of snobby doctor words for simple ailments," he said.

Nuance boasts that its software is 98% accurate or better out of the box, but Rohan has found some obvious errors. "The software might substitute a phonetic spelling, so it might come out 'drain rumor' instead of 'brain tumor,'" which is easy enough to check on the edit, he explained.

One big advance with the technology, Rohan said, is the ability to preprogram what is involved with a routine exam. This means that a patient's medical record will have every detail of the exam, which might not have been handwritten by a doctor in a hurry. He described the function as similar to a macro key on a keyboard.

"If I had to do a head-to-toe neurologic exam that includes things we wouldn't normally do, I could tell the software to write out 'neural exam' and it would document every detail," he said.

Aside from such efficiencies, the larger question for Rohan and the medical establishment nationwide is whether EHR is making a difference in health care. Rohan believes there are signs it has, and part of the reason is speech recognition technology. "EHR has done well at my clinic, with fewer kids hospitalized because they are better tracked," he said.

In the case of a child with asthma, for example, many parents might assume that if their child isn't showing any symptoms then he is doing well, but a clinical test of a lung function might show the child needs more aggressive therapy. "The EHR helps us to track patients and use nurses more effectively," he said. "The nurses don't have to read our handwriting, and because everyone has quick access to a medical chart, care is more complete."

Rohan said he is aware that some clinics are not as efficient and that civilian doctors don't like using the EHR approach. "The results vary and reviews have been mixed," at least in the several military clinics he knows about, he said.

In fact, Datamonitor Inc., an analyst firm in New York, reported last December that "the potential for EHRs is not difficult to comprehend, but the adoption of the technology has been painfully slow."

Christine Chang, an analyst at Datamonitor, said that growth of EHR and underlying technologies such as speech recognition have increased in recent months. "The question is no longer, 'Do we need an EHR system?'" Chang said. "Now it's 'Which one should we invest in, and when can we start implementation?'"

Speech-to-text technology helps increase efficiencies, she said. "Clinicians who are not comfortable using a keyboard and mouse may find speech recognition a faster way to document patient information, as well as easier to navigate through the EHR," Chang said. One plus is that when a provider finishes a patient's notes, the notes can be more quickly seen by other providers working on a case.

Although Nuance dominates in the speech-to-text market for health care professionals, a speech recognition division of Royal Philips Electronics is a strong competitor, she said. Philips has a point of entry with health professionals because it makes imaging and other medical technology.

Philips will be running a speech recognition track at Tuesday's Towards the Electronic Patient Record conference in Fort Lauderdale, Fla., where Philips will present a number of customers. The vendor has documented a 40% increase in productivity for transcriptions at Children's Hospital in Boston where 100 physicians use the technology, according to Philips' Web site.

Nuance said its Dragon NaturallySpeaking Medical software, used by Rohan and others, is used by 6,000 clinicians in all branches of the military. Adoption of the technology by the U.S. military's health system grew by 100% over the last year, the company said.

In all, about 60,000 medical professionals use Dragon for dictating records into an EHR product from one of many vendors, a Nuance spokeswoman said.

Copyright © 2008 IDG Communications, Inc.

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