Speech Recognition For Family Medicine
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Louis Spikol M.D. Educational Objectives: At the end of this presentation
you should be able to: 1. Understand the capabilities of
medical speech recognition. 2. Evaluate the use and utility of
voice macros. 3. Understand the ability of
medical speech recognition software to complete various regions of medical
forms. 4. Identify how medical speech
recognition software can interact with other commercial form creation
software. 5. Evaluate the use of speech
recognition within the context of an electronic medical record. Intended audience: 1.
Providers of medical care including physicians, physician assistants,
nurse practitioners and others. 2.
Medical secretaries and transcriptionists. 3.
Anyone with an interest in speech recognition technology. Introduction: My name is Lou Spikol
and I practice full-time in The
Medical Speech Recognition Scene 2003 I never thought I would say this
but speech recognition and specifically medical speech recognition is now
"ready for prime time". What
this means, is that with proper instruction and motivation and proper equipment
any physician canned learn and implement medical speech recognition. In 2003 a number of factors have converged
to make this possible: 1. Incredibly fast and relatively cheap
desktop and laptop computers with plenty of memory and processor power to run
speech recognition along with any other medical software that is
necessary. Every morning when I turn
on my computers I load up speech recognition and it remains ready to use when
needed. 2. Increasing recognition by almost every
electronic medical records software vendor that speech recognition represents
a tool that most physicians will want to have available. Accommodations are being made to include
the easy use of speech recognition by their software. 3. A significant core group of physicians who
now use speech recognition effectively and are willing to demonstrate and
teach others. Getting Started with Speech Recognition The
Hardware Desktop computers: the
processor should be at least a Pentium 3 (or Athlon)
800 MHz or greater with ideally 512 MB of RAM. The amount of RAM is especially important
for speed and accuracy. If you have a
choice between some extra processing power and extra RAM, choose extra RAM. Many
of the newer speech recognition versions are optimized for the Pentium 4 processor. Notebook
computers: again,
the processor should be at least a Pentium 3-800 MHz or greater with ideally
512 MB of RAM. I believe notebook
computers are becoming the platform of choice for physicians and speech
recognition. They have greatly matured
in terms of their capabilities. In
addition, laptop computers can be used quite easily in the examination room. Sound Cards: in desktop
computers the sound card should be a separate sound card. Sound cards integrated into the motherboard
have too much noise and are not acceptable for speech recognition. Internal sound cards of notebook computers
tend to vary-some are acceptable and some are not. Recently, external USB sound cards have
become available. They are
approximately $50 and are worth trying if you have difficulty with
recognition either on a desktop or laptop using the internal sound card. Microphones: the
microphones that ship with most speech recognition software are good but not
excellent. I recommend that you invest
in a better microphone. Excellent
microphones cost approximately $60-$100.
A few excellent, high-quality microphones cost from $100-$400. Hot hardware tips:
adequate RAM, consider a USB sound card, consider getting a good microphone. Installation and
Training ·
Follow instructions to train your voice for general
English. ·
After you have finished training for general English,
check the program to make sure that your accuracy is adequate. Your accuracy should be at least 90 percent
or above after this initial training (try to speak continuously pronouncing
each word.). If your recognition is
not adequate, consider your setup, microphone, computer etc. as noted
above. If your recognition is
adequate, you must now teach the program family practice language. ·
The method that you use to teach the program the language
of family practice depends upon whether you have text files of your
dictation! The ideal situation is
where you have text files, perhaps produced by your Secretary, of your
medical dictation. Every speech
recognition program has a module that can analyze your previous text
dictations, present you with new words and learn your specific speech
patterns and words. I really cannot
emphasize enough this aspect. By using
your own text files it's possible to get very high accuracy within a few
minutes of using the program. If you
have written your notes and do not have text files, family practice language
programs are available commercially. ·
Be patient initially and try to correct most
miss-recognized words. The program will learn rapidly from corrections. Hot
installation and training tips: follow directions, test your recognition for
general English, and let the program analyze your previous medical dictation
if available, purchase a medical language model if necessary. Speaking to the computer and general tips: ·
Speak in a clear, continuous manner, inserting all
punctuation, leaving out extraneous sounds (uhs and
ehs). Don't
"baby the program" by speaking in single words-it will learn much
better if you speak clearly and fairly rapidly. ·
If you use a headset microphone, adjust the microphone
properly to the side of your mouth with proper spacing. ·
Consider running the microphone setup each time you begin
a long dictation session. ·
Consider buying the professional version of your chosen
speech recognition program. The extra
capabilities, especially the macro capabilities make this worthwhile. ·
Consider learning and using the macro capabilities of
your program to expedite your work and minimize the amount of speech
recognition that you need to perform.
Let's face it, much of medical transcription is redundant and can be
automated. ·
If you use speech recognition for medical and general
English consider setting up two separate language models. This serves the purpose of just keeping
medical phraseology within the medical language model. ·
Consider participating in a speech recognition user
group. Believe me; if you have a
question, someone "out there" has an answer. Many of these people are unbelievably
knowledgeable and helpful. ·
Consider using medical speech recognition as part of an
overall strategy to improve documentation, compliance and billing. If you have been under-coding and under
billing but feel you have been doing the work and not able to produce documentation
this is just your ticket! If you feel
you have been over coding with the amount of documentation that you have,
this will help to increase compliance. ·
Finally, consider minimizing the need for speech
recognition in the first place. I
understand that this sounds like heresy in a document about speech
recognition but I'm quite serious.
Consider using speech recognition with other programs such as template
programs, electronic medical record programs, database programs etc. that can
build up most of your notes without speech recognition. An additional bonus is that by using some
of these programs, information and chart construction can be performed in the
examination room to a large extent.
Speech recognition can then be used to fill in the free text and
finish the note. Voice-activated Data Entry Dragon NaturallySpeaking: The speech
recognition program and especially the professional program have significant
capabilities in the following areas: 1. The ability to create
"boilerplate text" and activate the text using a speech macro. 2.
The ability to create placeholders within boilerplate text whereby the
physician can use speech macros to jump from place to place and fill in
variable text. 3. The ability to create macros that perform
an action such as cutting and pasting text and activating other programs. In addition to the basic speech recognition program there
are other very useful add-on programs that function quite well with speech
recognition. They are all quite
useful, relatively inexpensive and many provide you with the capability of
trying the program before purchasing.
I will list them with highlights and to their web site. Adobe Acrobat www.adobe.com The full version of Adobe Acrobat makes it possible to
create boilerplate text as well as interactive forms which can then be filled
out using speech recognition. OmniForm 5 www.scansoft.com This program can also be used to create interactive forms
and will also convert paper forms into electronic forms. Again, speech recognition can be used to
fill out the forms. Multiblock Storage www.mbs4you.com This program is a very nice macro utility that runs in a
taskbar at the top of your screen. It's function is to create boilerplate text. It is especially useful in that it gives
you visual cues as to what boilerplate text is available. Microsoft Word www.microsoft.com Microsoft Word has fairly sophisticated macro
capabilities that can be used quite well with medical speech recognition. Shorthand www.pcshorthand.com in addition to a macro utility this
program allows the completion of check boxes which allow for fairly good
flexibility and variable input during the patients encounter. Soapware
www.docs.com A reasonably priced, well supported electronic medical record
that works well with speech recognition. Amazing Charts www.amazingcharts.com A reasonably priced, well supported electronic medical
record that works well with speech recognition. Medical Speech Recognition Resources Software and microphones: www.scansoft.com -dragon systems home page. You can also
find the support forum here. www.dragonsys.ca an excellent source of software and
microphones. www.emicrophones.com - another excellent source of
software, microphones and general information. www.voiceautomated.com
-source of software as well as medical language models. www.zydoc.com
-software and medical language models. www.fastplates.com - an add-on database program for Dragon NaturallySpeaking Miscellaneous Sites http://voicerecognition.com/voice-users/
-Voice recognition users group. www.onelist.com
the medical speech recognition users group and IBM users group can be found
here www.knowbrainer.com commercial site specializing in customized
Dragon macros www.out-loud.com
general helpful speech recognition site. Louis Spikol M.D. |
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