Advances in Voice Recognition Software Win Over Doctors

Voice recognition software has earned a reputation for being a gee-whiz technology that has yet to change the everyday life of most business users. However, recent improvements in the technology have convinced more doctors to make voice recognition part of their daily routines—and part of the complex, ongoing effort to make medical records electronic.

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“We are moving fast in the emergency room and the voice interface makes us more productive and accurate,” says Dr. Brian Zimmerman, an emergency room physician at Miami Valley Hospital in Dayton, Ohio. In 2006, Miami Valley instituted Nuance’s Dragon NaturallySpeaking voice recognition software with its electronic medical record (EMR) system to reduce the complexity of paper records.

The software not only accelerates processes and saves money, but also allows doctors to make more informed diagnoses, says Mikki Clancy, the hospital’s VP and CIO. Using Dragon saved the hospital $1.4 million in transcription costs in 2007 and has improved records to include more notes from doctors, which improves patient care, Clancy says.

As the voice recognition software continues to improve its accuracy, it can more easily be implemented into a physician’s hectic workflow, Zimmerman adds.

In one recent advance, Nuance, the leading company for voice recognition software, has enhanced its Dictaphone Dragon NaturallySpeaking Medical version 9 to have 80 different vocabularies, each specific to a division of medicine (such as radiology), to increase accuracy, says Peter Mahoney, VP and general manager of desktop dictation business units for Nuance’s Dictaphone division. That unit has some 500 internal speech scientists working to advance the software’s accuracy.

Another recent improvement involves increasing accuracy by calibrating the software to “understand” accents, which greatly helps doctors who don’t speak English as their native language. The software’s accuracy rate is currently 98 percent and rising, according to the company.

For doctors, transitioning from manila folder to computer screen continues to be a complex endeavor. Without speech recognition software, hospitals typically need to hire someone or use an outside service to transcribe all the doctor’s notes into the records system, which creates costs and a significant time lag between patient data being captured and made available. Dr. Douglas Golding, the medical director and chief of healthcare informatics at Lifetime Health Medical Group, a group of primary care doctors serving more than 100,000 patients in Buffalo and Rochester, N.Y., switched from a system of transcription to Dragon’s software in 2006.

“Our staff has seen a decrease in turnover from three weeks to one day and has seen a return on their investment only 90 days after implementation,” says Golding. Lifetime’s doctors used to send notes outside the practice for transcription; staff then waited three weeks to get the notes back into the practice’s system, he says.

At Miami Valley, doctors have similarly benefited from ending the old transcription system, plus realized benefits from combining patient data from visits at nearby facilities into the hospital’s electronic medical records.

That’s one reason, says Christine Chang, an analyst from Datamonitor who specializes in public healthcare, that despite significant upfront costs and currently fragmented adoption, voice recognition software and electronic medical records save doctors time and helps them make more informed decisions—therefore increasing the quality of patient care.

At Miami Valley, an important key to success for the Dragon software has been that it doesn’t alter the physician workflow. With the old system of transcription, doctors would sometimes need to take time away from seeing patients in order to enter their notes into the system or to correct entries. But doctors can speak into the Dragon software while they see a patient, which eliminates losing information in the translation. Dr. Zimmerman carries the Dragon software on a laptop PC as he moves from patient to patient.

“I thought it would be disruptive and I would lose efficiency, but it has been a major help in the ER,” Zimmerman says. As the busiest ER in the entire state of Ohio, Miami Valley sees more than 100,000 patients a year, so his time with patients is precious.

Will voice recognition help in the expensive and complex effort to make hospital medical records more electronic and more portable between institutions? That remains to be seen.

President Bush’s 2004 technology agenda set a goal to have all medical records in electronic form by 2014. As a part of that plan, Bush signed an executive order committing the federal government to promote a national system of electronic health information technology, or National Health Information Network. Although the progress on weaning hospitals and group practices from paper records has been slow so far, voice recognition technology is helping medical groups transform their records from paper to electronic, Chang says.

Today, of the approximately 600,000 clinicians in the United States, about 60,000 use Nuance’s Dragon software technology to record patient data, according to the company.

Other than Nuance, few companies have emerged with comparable voice recognition software, though Philips and some smaller companies have entered the ring, says Datamonitor’s Chang.

Although the adoption rate of electronic medical records is only 25 percent in hospitals and 15 percent in private practices, improved speech recognition software will persuade more physicians to add the technology in their budgets and their offices, Chang believes.

Cost plays a major role in the adoption rate of the software and electronic medical records, Chang says. This is particularly true for smaller private practices, which become a missing link in the chain even when larger hospitals go electronic with records.

Another problem: Even with Bush’s initiative, there is still no penalty for medical offices or institutions refusing to switch to EMRs, says Chang. However, she notes, Medicare and some private insurance companies, such as Blue Cross/Blue Shield of Massachusetts, are now looking into issuing reimbursements to doctors and practices that use EMRs.