Compared to most industries, healthcare has lagged behind in the adoption of information technology. One area in healthcare that consumes a great deal of time is documentation. Many physicians have adopted the use of portable recording devices, where they gain efficiencies by eliminating the time consuming task of handwritten or typed notes. Most practitioners have embraced recorded dictation, either having their dictated notes transcribed by an in-house transcriptionist, or, more commonly, done by an outsourced resource. Many of those services actually offshore the transcription to places like India, where labor is less costly and which allows for one day's dictation to be transcribed and back into the provider's office the next morning.
This is one area where information technology and automation has achieved widespread adoption in healthcare. Other facets of IT? Not so much.
There are also software packages out there that allow physicians to dictate directly into a computer using a microphone, either Bluetooth or tethered with a cable, and the software converts the speech to text. At the most recent ASC Communications conference in Chicago, someone asked me if such voice recognition software had become viable as a documentation tool in ASCs.
Probably the most common voice recognition software is Dragon NaturallySpeaking. In much of healthcare, Dragon and its counterparts are incorporated directly into most practice management and electronic medical/electronic health records systems. This allows notes to be dictated directly into the software system, saving that additional external step of having a transcriptionist in the loop. Dragon is currently on version 11, which means it is a very mature product that has undergone multiple upgrades over many years.
Many software vendors have incorporated this product and others into their software systems, and many providers have become very comfortable with its use. One physician we know — a general surgeon — has become so facile with the system that he uses voice recognition software to not only save time with case documentation, but he is also able to navigate among different screens and actually control his software applications without even touching the keyboard.
There are several disadvantages, though, some of which are particularly relevant to ASCs. First, significant "training" of the voice recognition software is needed to make the software recognize the user's voice. This is done by reading a series of canned phrases, and letting the system calibrate to each user. This brings up the first disadvantage — the software is user-specific, and so each user has to train it separately. And this process is time-consuming, requiring as much as 30 minutes to set up for each user.
Second, background noises typically present in an ASC can significantly affect the quality and accuracy of the voice recognition. Vacuum pumps, sterilizers, overhead paging, anesthesia equipment — even the hum of air conditioning systems — can significantly impact the system's accuracy. If you train the system in the quiet environment of your office or an empty ASC staff lounge, and then you try to use it in the OR, it could easily impact the system's performance. Likewise, if you train the software in the noisy environment of the OR or perhaps in the busy sterile corridor but then later use it in your office or when the noise in the ASC has died down at the end of the day, the quality and accuracy will suffer.
Third, most providers transition between their offices and the ASC, and the software systems they use are frequently quite different in the two settings. This can cause additional issues because the systems behave differently.
For these reasons, speech recognition has not found widespread use in ASCs. But we expect that over time, as more providers come to embrace information technology and become more familiar and comfortable with automation tools, speech recognition software will find more widespread adoption in ASC.
Marion K. Jenkins, PhD, FHIMSS, is founder and CEO of QSE Technologies, which provides IT consulting and implementation services for ASCs and other medical facilities nationwide. Learn more about QSE Technologies at www.qsetech.com.
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