Free-text data entry by speech recognition software and its impact on clinical routine

Ear, Nose & Throat Journal, August, 2006 by Justus Ilgner, Philip Duwel, Martin Westhofen

Abstract

We conducted a study to evaluate speech recognition software in an otorhinolaryngology unit and to assess its impact on productivity prior to general implementation. Current speech recognition software (IBM ViaVoice, version 10) was implemented on a personal computer with a 2-GHz central processing unit, 256MB of RAM, and a 30-GB hard disk drive, with and without add-on professional vocabulary for otorhinolaryngology. This vocabulary was added by the automated analysis of an additional 12,257 documents from our department. We compared the word recognition error rates for three different text types and determined their impact on the amount of surgeon's time that was invested in the production of an error-free document. Although error rates without any professional vocabulary database were rather high (operation reports: 38.72%; consultation notes: 27.77%), the patient information was edited with a satisfactory result (10.65%). Best results were obtained with the specialty-related vocabulary database added by the analysis of our own documents (operation reports: 5.45%; consultation notes: 5.21%). An increase in productivity compared with that of conventional transcription was found at an error rate of less than 16%.

Introduction

We conducted a study to evaluate the performance of current speech recognition software, in conjunction with three different databases of vocabulary, and to assess its impact on productivity prior to general implementation in an otorhinolaryngology unit. Our underlying hypothesis was that in an environment where all medical documents are entered into a medical records database, the use of computer-based speech recognition technology results in greater overall productivity than manual input by surgeons via a computer keyboard.

By now, the implementation of Diagnosis-Related Groups has marked the preliminary conclusion of a transfer process toward information technology for extended quality management in healthcare administration. In contrast, computer-based documentation of medical records is yet subject to further development. A considerable share of information is still communicated by handwritten notes and orally; both of these methods pose major obstacles to the conversion of this information into electronic documents. Nevertheless, day-to-day recording of patients' clinical courses is essential if electronic clinical documentation is implemented to replace handwritten notes. This process has to be reliable, fast, and convenient for the average clinician. Speech recognition software offers a potential solution.

The first reports of this software's practical use were published in the early 1990s. (1,2) In these reports, the software was used in a professional environment in which (1) single workplaces, mostly in laboratories or nonclinical departments, were predominant; (2) a limited professional vocabulary was used; and (3) the writing of the actual medical report was the limiting factor for productivity.

The expansion of this software into radiology departments (3-5) and pathology laboratories prompted the need for extended vocabulary databases. However, further propagation of speech recognition software to clinical departments--surgical and medical--has been limited. This may be attributable to the fact that various workplaces used for different tasks (operating theater, clinical ward, outpatient department, etc.) have to be covered. Healthcare professionals often move between different parts of a unit, and these different areas are not necessarily situated in one building. Therefore, there should be access to a computer platform that either performs speech recognition itself or transfers audio data to a central server on which speech recognition software is implemented and from which the written document is distributed either to the surgeon or to a professional typist for revision.

Only a small number of studies have been conducted on speech recognition software in a clinical environment with a complex spatial structure. (6) The implementation of speech recognition software on computer networks is a challenge because these networks generally perform more slowly than stand-alone personal computers as a result of network capacity limitations. Although a network setup would fulfill the need for covering clinical departments as described above, infrastructure costs are considerably higher than those associated with stand-alone solutions.

The objective of this study was to evaluate the usability of current speech recognition software for the average surgeon in otorhinolaryngology. Intended users are junior and senior clinicians who have a general background of personal computer use at work and in everyday life but who lack expert typing skills. The purpose of speech recognition software is to transcribe different types of information that appear frequently during clinical work--such as operation reports, consultation notes on a patient for other specialties, discharge letters, and written information for patients on a specific topic--into an electronic document that can be integrated into a medical records database. The desired effect is that dictating documents into the speech recognition software plus subsequent revision by the dictating surgeon is faster and more efficient than the surgeon's typing and revising documents manually him/herself or dictating the documents to a professional typist and revising the document at a later stage.