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  • The old paradigm in medical documentation is hand-written notes. While inexpensive and creating instant documentation, hand-written notes tend to be brief, and, unfortunately, sometimes illegible. The image on the right was a prescription that led to a greater than $400,000 jury verdict against both a cardiologist and pharmacist.
  • The old paradigm in medical documentation is hand-written notes. While inexpensive and creating instant documentation, hand-written notes tend to be brief, and, unfortunately, sometimes illegible. The image on the right was a prescription that led to a greater than $400,000 jury verdict against both a cardiologist and pharmacist.
  • The old paradigm in medical documentation is hand-written notes. While inexpensive and creating instant documentation, hand-written notes tend to be brief, and, unfortunately, sometimes illegible. The image on the right was a prescription that led to a greater than $400,000 jury verdict against both a cardiologist and pharmacist.
  • The old paradigm in medical documentation is hand-written notes. While inexpensive and creating instant documentation, hand-written notes tend to be brief, and, unfortunately, sometimes illegible. The image on the right was a prescription that led to a greater than $400,000 jury verdict against both a cardiologist and pharmacist.
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    1. 1. DHMC Cardiology Update 2004 Speech Recognition in Medical Practice December 6, 2004 Jon W. Wahrenberger, MD
    2. 2. Medical Documentation Old Paradigm: hand-written documentation Jury blames doctor's bad penmanship for patient death Award = $475,000
    3. 3. Medical Documentation More Contemporary Paradigm: Typewritten Record
    4. 4. Medical Documentation More Contemporary Paradigm: Typewritten Record Cost of transcription? $30,000 per practitioner?
    5. 5. Medical Documentation Today’s Paradigm Electronic Medical Record
    6. 6. DHMC Cardiology Clinic
    7. 7. Physician Underutilization?
    8. 8. Questions: <ul><li>Has the quality of physician typed notes and discharge summaries improved or worsened? </li></ul><ul><li>Is typing cutting into our time with patients? </li></ul><ul><li>Are we seeing more repetitive motion injuries? </li></ul><ul><li>Has physician generation of notes increased or decreased productivity?? </li></ul>
    9. 9. Alternatives to following the crowd?
    10. 10. Speech Recognition Technology… … has arrived!
    11. 11. Speech Recognition Technology <ul><li>Alternative method of keyboard input </li></ul><ul><ul><li>Text Creation </li></ul></ul><ul><ul><li>Computer control and navigation </li></ul></ul><ul><li>Reduction of multiple repetitive tasks into single speech command </li></ul><ul><li>Net result: simplifies and reduces time when using computer </li></ul>
    12. 12. How does it work? <ul><li>Statistical technology involving interface of: </li></ul><ul><ul><li>An acoustic model – the sound related variables of a given pronunciation </li></ul></ul><ul><ul><li>A lexicon – a group of words and their pronunciations </li></ul></ul><ul><ul><li>A language model – which specifies the relative likelihood of a sequence of words </li></ul></ul>
    13. 13. Demonstration
    14. 14. Available Products Dragon NaturallySpeaking Microsoft Speech <ul><li>Best Product </li></ul><ul><li>Windows OS only </li></ul><ul><li>Windows & Mac Versions </li></ul><ul><li>Incorporated into Office </li></ul><ul><li>Poor user interface </li></ul>IBM ViaVoice
    15. 15. System Requirements <ul><li>Intel® Pentium® III / 500 MHz processor (or equivalent AMD® processor) </li></ul><ul><li>256 MB RAM </li></ul><ul><li>500 MB free hard disk space </li></ul><ul><li>Creative® Sound Blaster® 16 or equivalent sound card supporting 16-bit recording or USB Pod </li></ul><ul><li>High quality microphone </li></ul>
    16. 16. Cost of Dragon NaturallySpeaking *Includes extensive general and specialty vocabularies **Not Recommended for Professional Use 91 99 Standard** 155 199 Preferred** 620 795 Professional $845 $1095 Medical Solutions* Best Internet Price Scansoft
    17. 17. Advantages <ul><li>Increased productivity </li></ul><ul><li>Economy: no transcription cost </li></ul><ul><li>Speed: </li></ul><ul><ul><li>Good typist averages 50-90 words per min. </li></ul></ul><ul><ul><li>Speech dictation: 100-180 wpm </li></ul></ul><ul><li>Reduction in repetitive motion injuries </li></ul><ul><li>Mobility </li></ul>
    18. 18. Speech Recognition: Caveats <ul><li>It is highly accurate and reliable </li></ul><ul><li>Dramatically easier than typing </li></ul><ul><li>Voice recognition software is not for everyone </li></ul><ul><li>Not as easy as transcription into a telephone or Dictaphone </li></ul><ul><li>Highly cost effective when compared to transcription (total cost of software and good microphone is less than $1000) </li></ul>
    19. 19. Microphone Options Philips SpeechMike Pro Sennheiser ME 3 Andrea ANC-600 VXI & Andrea USB Pods
    20. 20. Studies of Speech Recognition Software in Medical Settings?
    21. 23. Voice Recognition in Medical Settings 47 Emergency Room Charts Advanced User 27 Charts Basic User 20 Charts Voice Rec Dictation 27 Telephone Dictation 27 Voice Rec Dictation 20 Telephone Dictation 20 Am J Emerg Med. 2001;19:295-298
    22. 24. Speech Recognition Vs. Transcription Am J Emerg Med. 2001;19:295-298 98.5 99.7 3.65 3.77
    23. 25. Speech Recognition Vs. Transcription Am J Emerg Med. 2001;19:295-298 3.65 39.6
    24. 26. Where Next? <ul><li>www.dartmouth.edu/ </li></ul><ul><li>~cardio/voice.htm </li></ul>

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