Speech Recognition Uncovered

Vol. 17 •Issue 4 • Page 16
Speech Recognition Uncovered

Speech recognition helped improve Kimball Medical Center’s turnaround time and lift MTs’ spirits.

What’s so special about Lakewood, NJ? For one thing, it’s the home of forward-thinking Kimball Medical Center (KMC). With the facility’s medical transcription department using speech recognition technology to market its services, it’s easy to see this isn’t a typical HIM environment.

And it’s not just the speech recognition capabilities that set this facility apart from the rest; the physical décor of the MTs’ work area is also impressive. As you walk through the doors of KMC’s transcription department, situated across the street from the main hospital in a two-story office building, it boasts first-floor status. MTs enjoy a pleasing atrium, wide and cheerful hallways, ample space and envious-size windows.

The Arrival

One might wonder how this HIM department got so lucky, as it’s not everyday MTs are able to portray such a business-like atmosphere. According to Alice Oakerson, transcription supervisor, KMC, the implementation of the new technology was the biggest enabler. As a result of detailed research, cost analysis and negotiation, the new speech recognition technology is hitting all its marks, but it wasn’t easy. “It took several months before we felt comfortable going to the executive board to request funding,” Oakerson stated.

Kim Good, the director of HIM at the time, was responsible for the purchase and implementation of Dictaphone EXSpeech from Nuance. “We talked about different options and the best strategic plan for the process,” Oakerson recalled. Oakerson and Good knew implementing new speech recognition technology was going to be a huge undertaking, consisting of a lot of expense and time. “But we really felt in the long run we would benefit from EXSpeech, by reducing costs and generating better reports,” she stated.

There have been impressive cost and turnaround time results since EXSpeech was implemented in 2003. Oakerson offered statistics as an example of the new software’s success (see Table 1 and Table 2).

Currently used by four out of nine MTs on staff, EXSpeech is working so well that KMC started to offer its services to local physician offices. They stress the fact that EXSpeech is available, and they offer to educate physicians on new dictating techniques, so faster and more accurate reports are produced, Oakerson explained. “By offering this to physician offices we can save them money on their transcription services. We are choosing physicians who are on the Saint Barnabas system network, so it will be relatively simple to set them up and provide the service,” she continued. “This will help us to continue to reduce our costs as well.”

Kimball Medical Center is part of the seven-facility Saint Barnabas Health Care System, and because of the return on investment evident after 4 years, the 350-bed, acute care hospital can begin to assist its fellow health care facilities with the benefits of speech recognition.

The Staff’s Adjustment

The implementation process for KMC seems to closely resemble a fairytale, but even fairytales have their ups and downs. An adjustment of any kind is challenging, and altering professionals’ entire work processes adds to that mix.

Even after Dictaphone merged with Nuance, Oakerson saw some change, but nothing that wasn’t expected. Nuance decided to contract out on-site service calls—something Dictaphone used to address in-house—but Oakerson assured her admiration for the company hasn’t changed. She still has contact with their field engineer, Joe White, who has worked on their system since the first implementation of a Dictaphone product back in 1998.

Dictaphone also provided a thorough training program for the new speech recognition software. “Initially Dictaphone sent out workbooks, and our MTs trained on them for 30 minutes a day for a month before the system was even implemented. Once the software was implemented, Dictaphone came on-site for 3 days of training,” she stated. After a month of using the software, Dictaphone sent another trainer back for 1 day of additional training and follow-up. “The training was very complete. We could call or e-mail whenever we had questions,” emphasized Oakerson.

It took veteran Dorothy Miller, transcriptionist, KMC, about 6 or 7 months until she got used to the new software. After 17 years of transcribing for KMC, she wasn’t exactly thrilled with the idea of learning an entirely new skill. “But now I wish everyone would use it!” she enthused. “We didn’t have as many reports to practice on at the start of our implementation because we’re a smaller facility; not as many doctors were using it,” Miller explained. And at least 4-practice hours a day on speech recognition is needed to really get up to speed, Oakerson added.

KMC has 400 physicians on staff and 150 active dictators who are licensed to go through the fluency and adaptation process necessary for speech recognition software. Of those 150, 85 are in speech draft, meaning the system understands them and their work can be edited by the transcription staff.

Because there are so many physicians still not yet utilizing speech recognition, KMC has MTs who still perform straight transcription. Miryam Stavsky, transcriptionist, KMC, has been with the company for 8 years and actually prefers transcribing. “I didn’t have enough time to practice because of all the straight transcription still needed, and I have a lot of macros already set in my software, so I can work almost as fast as using the speech recognition technology,” she explained. But she did mention that long electromyography (EMG) reports now take a third of the time when using speech recognition, so she recognizes its benefits as well.

To maintain beneficial outcomes, the speech recognition software does need to be updated. Stavsky monitors the use of new words, adding them to the system while omitting others, because terminology changes on a daily basis, Oakerson explained. “There are always new terms, procedures and pieces of equipment; constant maintenance is necessary. We go into the system periodically to update the language database,” she stated.

The Ripple Effect

Just like the software needs updated information maintenance, the product itself will need some IT tweaking every now and again. That’s why KMC’s transcription department relies on Bob McGurrin. As a transcription technician, McGurrin helps keep things moving. He’s the department’s tech support and liaison with the physicians. As their liaison, McGurrin reported a seamless transition for the physicians; basically a ripple effect without too many ripples.

Oakerson explained that they actually never even told the physicians when the software was implemented. “But that’s something I’d do differently the second time around. We should have informed the physicians, because even though the transition was seamless for them, our department dealt with unnecessary style and aspects. We should have explained the new style of dictation earlier to them,” she admitted.

With the new software, the transcription team has uncovered some “favorite” physicians, based solely on their clarity and tone of voice. As Frank Cocco, MD, Ocean GYN/OB Associates, specialty Obstetrics and Gynecology, walked into the department to meet the transcription team, both Stavsky and Miller commented on how easy it is to edit his dictations.

Dr. Cocco was pleased to meet McGurrin, because they’ve conversed on the phone numerous times. As Miller explained the new software to Dr. Cocco, he took an interest in how it worked and how he can continue to improve his dictation practices. “It works so well I didn’t even notice it was being used,” Dr. Cocco joked.

Kidding aside, the software has churned out amazing results and Oakerson can’t say enough about its impact on her entire department and health care facility. They’re using 7 independent contractors to keep up with the regular transcription still needed to be done, but she sees speech recognition being adopted on a more regular occurrence and foresees continued growth.

“We went from transcribing for our facility only, to also transcribing for a breast center, a behavioral health facility and two long-term care facilities. And KMC is looking into EHR implementation,” she explained. Working toward that end, all MTs are set up for remote access, all reports are uploaded into the hospital’s database—so they’re already electronically available—and the physician offices are set up so they can access records on a Citrix-like server via the Internet.

She also predicts her facility, under the guidance of David Gonzalez, the current HIM director, will implement Dictaphone’s new Web-based electronic signature and begin using Olympus’ hand-held products. “Because of our new technology and ease-of-use, the HIM department is a well-oiled machine, producing outstanding results!” Oakerson raved.

Tricia Cassidy is an associate editor at ADVANCE.