Speech Recognition and the Evolution of the MT

Vol. 13 •Issue 15 • Page 18
Speech Recognition and the Evolution of the MT

From the craftsperson to the specialist, inventions and innovations have long altered the duties of a given workforce. The medical transcription industry is no exception, and today the big question is a two-parter: Is speech recognition technology (SRT) the cotton gin of this industry? If so, where does it leave those in the field?

Wait a Cotton-Picking Minute

For the time being, most agree: medical transcriptionists (MTs) aren’t going anywhere. Part of this consensus comes from the long road speech recognition technology had—and still has—ahead for itself. But significant progress has been made.

“Technology only gets better as time goes on,” stated Julie Weight, CEO of AlphaBest in Los Angeles. “We’ve seen really good improvements in the technology and the accuracy,” she observed. “More offices and facilities have the computer hardware to handle the speech technology.”

Some big players on the vendor side are putting this much-improved technology to the test as a means to increase productivity.

“We have a product that’s embedded in our DocQment™ Enterprise Platform that we call Speech Q™,” explained Ron Scarpone of MedQuist. “We’re increasing the productivity upwards from 30 percent to 35 percent on certain physicians in certain medical disciplines, with a correctionist.”

As Weight sees it, depending on how SRT is used, “It does increase productivity some, and as the technology improves, it will increase productivity a lot more.”

Behind the Scenes SRT

Outlining the background SRT workflow process MedQuist MTs use, Scarpone explained, “What we’ve done is put SRT in the background, so the author basically just dictates the report and hangs up the phone, then the speech engine starts doing the transcribing.” And the reports in the queue awaiting these home-based MTs are not what they used to be.

“Instead of getting the job and having the audio to type from scratch, when the MT gets the job, she receives the text and audio file to correct it,” said Scarpone. This process is referred to as backend, server-based, or even delayed recognition technology, and it’s also being used in some hospitals.

Take Maine Medical Center in Portland for example, a facility working with e-Scription. “We’ve been involved in both the alpha and beta testing process using an application service provider (ASP) model,” explained Jefferson Howe, MSA, CMT, transcription manager at the facility. As the process goes, he explained, “Recognized files come back to the MT as a draft, along with the audio, and the MT edits the report.” It’s a little different than straight transcribing, according to Howe, who likens it to part Karaoke, part video game.

“The MTs follow a box that highlights the word that’s recognized,” explained Howe, adding that the process seems to be working well. “We had hoped for an increase of 20 percent in productivity to consider the pilot a success. We’ve even achieved a higher percentage than that.”

A Change in Skill Sets?

“If more facilities start using server-based SRT, the MT will become more of an editor,” Weight pointed out. But with such a significant change in duties, does a name change follow?

If so, Brenda J. Hurley, CMT, FAAMT, director of MT development for MedWare Inc. in Maitland, FL, isn’t crazy about “correctionist.” It’s a connotation thing.

“Unfortunately, some in the industry may—to save money—hire less skilled individuals to come in and serve as editors,” said Hurley. “I don’t think we can hire people off the street to be a medical editor for these types of reports any more than you can have someone come in off the street and serve as a medical transcriptionist.”

Merideth Fulton, director of marketing services for MedQuist, is quick to point out that MedQuist currently does not segregate their editors from their MTs. “Right now, they’re all employed as MTs,” she said.

But Scarpone can see the day when a new tier will develop in the profession. “It’s a slightly different role. You almost have to take an MT and make her an editor,” he offered. “It’s not just a matter of looking at the screen and making sure a word is spelled correctly.”

“The sense that I get from my MTs is that they are less physically tired at the end of the day and maybe a little bit more mentally tired,” said Howe of his staffers in their new roles. “Our findings have been that it requires a higher skill level on the part of the MT. I originally thought it might be a good training tool, but I was wrong,” he added.

One change is certain, however. “I don’t think strong keyboarding skills will be nearly as essential a tool for the editor,” stated Hurley. “What MTs bring to the job is not how fast we type, but how much we can understand and interpret the medical language.” Of course, this has been the case all along, Hurley emphasized, suggesting that SRT might work to emphasize this.

One Man and a Horse

Of his whirlwind invention, Eli Whitney wrote in a letter to his father: “One man and a horse will do more than 50 men with the old machines.” But according to the National Archives and Records Administration (www.archives.gov), while it was true that the cotton gin reduced the labor needed for removing seeds, it increased the need for land and slave labor because it became so profitable.

The comparison is not that MTs are slave laborers, but as Hurley speculated, the increased productivity–rather than eliminating the need for MTs–may expand the use and demand for documentation. “If institutions would look at turnaround time, just consider that you can free up MTs by using better technology.” In doing so, she suggested, “You can start to dictate other kinds of notes you’re not allowed to dictate now, such as therapist, dietitian and nurse practitioner notes, in addition to other specialties.”

Scarpone agreed. “There’s more health care information being generated by more physicians. That means one thing: There’s more work than we can handle,” he offered. “What we need on a consistent basis is MTs, and we need the ability to make them more productive.”

Highest and Best Use

Backend SRT isn’t without its snags. “The problem with server-based SRT is garbage in, garbage out,” said Weight. “If the doctor never says ‘period, new paragraph,’ you have a transcribed document that’s all text,” a formatting nightmare.

In some instances, such as physician offices or radiology departments, SRT is being employed on the front end.

In fact, “Ten years ago they were saying radiology was all going to be done using SRT,” said Weight, who explained that these reports are often short with a lot of “normals.” The author can produce the finished document him/herself with the use of templates.

But with more detailed documentation, some consider front end transcription less cost-effective. “You’ve got the most expensive person in the hospital doing editing,” offered Scarpone.

That’s not to say that backend SRT use will become ubiquitous.

“We feel that about 20 percent to 25 percent of the dictators we do work for are what we’d call a qualified candidate for speech recognition,” said Scarpone.

Similarly, Howe’s program only targeted between 20 percent and 25 percent. His MTs still split their time between editing and transcription.

In the meantime, while those in the industry gauge the best use of SRT, Hurley’s advice to MTs is to expand their knowledge. “MTs truly need to broaden their skills and make transitions into multi-specialties.”

Weight’s long-range vision even sees a speech enabled electronic medical records system, which could completely replace the typing MT.

She doesn’t see this as a bad thing.

“Transcription is such a labor intensive field,” said Weight. “I see SRT helping move MTs more toward knowledge-based value rather than production-based value.” With this evolution, “MTs will get paid for what they know rather than how much they can type.”

Linda Gross is an assistant editor at ADVANCE.