Rasu Shrestha, MD, MBA, is the Vice President of Medical Information Technology and Medical Director of Interoperability & Imaging Informatics, University of Pittsburgh Medical Center, Pittsburgh, PA, and a member of the Applied Radiology Editorial Advisory Board. 

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Monday, September 17, 2012
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Voice recognition: Onwards and upwards (2)

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By Rasu Shrestha, MD


The end result of every case that a radiologist interprets is, quite basically, a report. Voice recognition and related technologies need to save radiologists time when possible and aid in the workflow. Many radiologists, having been exposed to scars from earlier iterations of voice recognition technologies that were less than optimized to their workflow, are highly sensitized to the introduction of any technology that could possibly distract them from their core mission of caring for their patients and interpreting the imaging studies to the best of their capabilities. The radiologist’s workflow, or readflow, is hence a critical consideration in the development or implementation of any voice recognition and related technologies.


Central to workflow considerations is the art and science of understanding Human Computer Interaction (HCI). Too many healthcare-related applications are designed without consideration for important parameters, such as user-centered design guidelines, usability, automation, hand-eye coordination and radiologists’ flow in reading studies and capturing the data within the report. It is not an inconceivable concept that radiologists need to spend more of their time with their eyeballs tracking the images, looking at pixel data and regions of interest that are pertinent to the patient study. Any time looking at dropdowns, menu options, and onscreen streaming text transcribed from voice equates to time away from core interpretation processes.

 

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Posted by cristen bolan at 09/17/2012 05:43:43 PM | 


I have been in IT for nearly 50 years. As usual, you are too kind. HCI principles have been completely ignored in nearly all medical software I have seen to date, including and especially PACS/RIS and, yes, continuous speech recognition (CSR) software. Learning curves are unnecessarily steep, potentially useful functionality is hidden or unused, error occurrence and propagation are too prevalent, and radiologist frustration with these systems is universal. I have never (well maybe once or twice) seen a software engineer visit a radiology dept. and actually SEE how the product gets used. This needs correction. Not just an occasional visit, but repeated visits at reasonable intervals, since hardware/software design, implementation and end utiliization is always a moving target, sometimes a very FAST moving target.
Posted by: stujonesmd@aol.com ( Email: ) at 10/19/2012 8:03 PM


I'm REALLY good at using voice recognition software (PowerScribe and Dragon Medical) and self-editing my reports. I speak clearly and the recognition is very good. I've been doing this for about 7 years, full time. However, FINDING the misrecognitions in each report is like playing a game of "Where's Waldo:" It takes me about 2 1/2 hours per day to edit all of my own reports (as quickly as humanly possible), they do still contain misrecognition errors which I didn't catch, and I find it distracting to go back and forth using different parts of my brain (imaging/medical vs. text/editor) on average probably 10 times per exam. It's not that we radiologists are "upset" about having to inherit 2.5 hours of work each day, in becoming our own transcription editors, that I find most unpleasant... instead, what I find most unpleasant is the fact that I have to continually divert my attention FROM the patient's images (her mammogram, for example) TO things like punctuation, capitalization, font size, bold text, etc. It really does a huge diservice to the patients. As an analogy, I really would like to believe that the mechanic fixing the brakes on my care is able to give his full attention to that task. I would not trust his work if he's also responsible for editing the equivalent of the Wall Street Journal each day as well. (In that case, he's done NEITHER the service work NOR the editing well.). I hope others will speak up about this subject, because we need a paradigm shift back to the common sense way of practicing medicine.
Posted by: Mary F. Murphy, M.D. ( Email: ) at 10/26/2012 2:08 AM


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