Part one of a two-part series (Access part two):For more than two decades, speech-recognition software has held bright promise for busy physicians looking for a better way to get what was in their heads onto a printed page or into a computerized health record.
Those expectations, however, largely had been unfulfilled because, for most of those years, aside from practitioners in a few cloistered medical subspecialties and a relative handful of technology zealots in general practice, speech recognition has amounted to little more than a tantalizing, technological frippery. The bottom line has been the software remained for most physicians just too clunky or error-prone to play a major role in patient record documentation.
Larry Garber
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That's changing, according to more than a dozen health information technology experts contacted for this story, including 10 physicians of various specialties, seven of whom regularly use speech-recognition software on the job in the emergency room, pathology, radiology, other medical departments and outpatient office environments.
One satisfied daily user is Brian Zimmerman, director of the urgent-care unit in the busy emergency department at 712-bed Miami Valley Hospital in Dayton, Ohio, home to a Level I trauma center. There, he and all of his colleagues use speech-recognition software in tandem with the hospital's electronic health-record system.
Zimmerman said about four years ago he purchased a version of Dragon Speaking, now the dominant brand of speech-recognition software in healthcare. He thought it might save him time dictating e-mails and notes, he said. He was wrong.
“It was kind of a nightmare,” Zimmerman said, but added that he has subsequently changed his opinion. “If you haven't seen it in a couple of years, you should take a second look. It's just much better than you've seen in the past.”
“The administration likes it because our transcription costs went to zero,” Zimmerman said. Previously, transcription services cost the hospital $1.4 million a year for the ER alone, he said.
Speech recognition established early beachheads in radiology and pathology, medical subspecialties where free-text-based reports are key work products. Even there, its efficacy has improved dramatically in recent years, physician users say.
Keith Dreyer is vice chairman of radiology at 907-bed Massachusetts General Hospital in Boston and a user of speech-recognition software for a decade. Until recently, improvement in the technology had been gradual but steady, Dreyer said.
“I used to say, ‘If you don't like speech recognition, just wait a year—it will get better,' ” Dreyer said. Then, suddenly, in about 2004, Dreyer said, “We really saw a big difference. They really optimized it for radiology.”
Paul Valenstein, a pathologist at 529-bed St. Joseph Mercy Hospital in Ypsilanti, Mich., added that a newer version of Dragon geared to his medical specialty “produces dramatic improvements in throughput.”
And Larry Garber, director of medical informatics at the Fallon Clinic, Worcester, Mass., said a recent work study found the clinic saves about $7,000 per physician per year by switching from dictation to speech-recognition software. “The writing is on the wall for transcription departments around the country,” Garber said.
Speech recognition development has had a long, complex, storied and even occasionally notorious history. One of the pioneers of speech recognition is inventor, serial entrepreneur, author and futurist Raymond Kurzweil, whose company, Kurzweil Computer Products, founded in 1974, and later sold to Xerox, first developed a multifont optical character recognition system.
The copying machine giant subsequently spun off its Kurzweil unit to create ScanSoft, which would go on to acquire scandal-plagued speech-recognition system developer Lernout & Hauspie, or L&H, buying it out of bankruptcy in late 2001. The Belgium-based company made business page headlines with a financial scandal involving falsified financial records and a reported $100 million worth of missing money.
Before it imploded though, L&H had acquired several of its key rivals—most notably Dragon Systems, developer of the popular Dragon NaturallySpeaking brand, added in 2000; and in 1997, Kurzweil Applied Intelligence, another firm that pioneered speech-recognition development with a focus on healthcare. It also was visited by an accounting scandal, in the run-up to a 1993 initial public offering. Founder and co-CEO Kurzweil was not implicated, but two other top executives were sentenced to prison for securities fraud.
In 2000, L&H also had bought out the venerable dictation system provider, Dictaphone, which traces its roots through patents back to the first voice recorder developed in 1881 by famed telephone inventor Alexander Graham Bell. ScanSoft then acquired Nuance Communications in 2005, but the acquiring company dropped its own name and kept Nuance instead. Nuance, now headquartered in Burlington, Mass., was founded in 1994 as a spinoff from the Speech Technology and Research Laboratory at SRI International, earlier known as the Stanford Research Institute, Menlo Park, Calif. (Read about
Nuance's recent acquisition of document-management solutions provider eCopy.)
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