1. Voicebrook Quickens Pathology Transcription Turnaround for Enhanced Patient
Care
By Genevieve Fraser
The primary component of health care is the relationship between physician and
patient. The merger of health technology and clinical medicine is able to
streamline this relationship and improve outcomes. There are many examples of
this, including diagnostic imaging, heart rate and blood pressure monitors and a
host of biomedical equipment technologies. In addition, a quick perusal of medical
journals in the late 1990s demonstrates the medical community’s interest in
evaluating the performance of continuous speechrecognition software for medical
transcriptions. The obvious concern was with error rates, the amount of training
needed to minimize errors and the software’s ability to handle a wide variety of
speechpatterns among physicians and clinicians as well as the medical
terminology associated with the various fields.
Overall, the out-of-the-box success rates in the late 1990s for general medicine
speechrecognition software was encouraging, but transcriptionists were still
needed to insure the accuracy of medical transcriptions ( and even today as a
failsafe for some systems, double checking to insure accuracy is needed.) And
when you layered in the demands and need for razor sharp accuracy, the hope
expressed at that time was that successive generations of speechrecognition
software would someday surpass the accuracy rates found in these early
investigations. If that could be resolved, it was acknowledged that enhanced
computerized speech recognition would decrease costs associated with creating
transcribed documents and lessen transcription delays. Turn-around time is
especially important today as the Affordable Care Act, a.k.a. Obamacare, expands
access to millions of formerly uninsured Americans and pressure is added to the
transcription pipeline.
Enter Voicebrook, a privately held company that has undergone several evolutions
since its early beginnings. Its primary focus is on helping pathology laboratories
save time and money and improve the quality of patient documentation and care
through speechrecognition and reporting solutions for Pathology.
According to the company’s president Joe Desiderio, “Voicebrook’s primary
product(VoiceOver) and our service delivery model are both focused on

2. optimizing the workflow of an existing software solution in the pathology
laboratory. Going back to our formation in early 2002, we realized that building
strong relationships – typically through successfulprojects delivered for mutual
customers -- with the software providers in the laboratory spacewas
crucial; however we did not have a formal framework or language to express this
until much more recently.”
As President of Voicebrook, Joe Desiderio is responsible for strategy and business
development, bringing nearly 30 years of experience in information technology to
Voicebrook as founder of Kopia, a start-up web design and e-business consultancy
and in IT management positions at Sotheby's and Ogilvy & Mather Worldwide.
Through these experiences Joe became quite adept at aligning technology strategy
with business goals, and implementing mission-critical applications – skills he has
needed as Voicebrook has strived to become the leader in VR for Pathology.
For Joe, the central question in terms of adaptive strategies is, how does Voice
Recognition work with Pathology? To understand that you need to look at the
background and workflow associated with the field.
“Radiology and Pathology can be thought of as the primary diagnostic services
available to the physicians who are directly involved in patient care. Radiology
involves diagnosis of various imaging modalities – from digital x-ray, sonogram,
MRI, PET scans and other studies. Pathology, and more specifically, surgical
pathology, involves the diagnosis of tissue macroscopically (by eye), and after
tissue is preserved in a fixative and cut into thin sections and placed on slides,
microscopically,” Desiderio stated.
“Drilling down into the Pathology workflow, there are typically two passes to the
reporting process. First, a technician will take the tissue and describe its condition,
size, weight, color, and various other physical characteristics, including the
presence or absence of a tumor, with additional details if a tumor is present. This
tissue is then dissected and prepared for sectioning (slicing into thin pieces) and
application onto slides. Once the slides are ready, they are placed in a tray (usually
a cardboard jacket) for the pathologist to review. The pathologist will take each
slide, and observe under the microscope, describing the cellular details and
ultimately make a diagnosis of the case. In each of these steps, the information
used to be dictated (first into tapes, then into digital dictation systems) and
manually transcribed by transcriptionists,” he continued.

3. The many problems associated with the manual transcription process include cost,
delay, multiple “edit” loops, difficulty in finding / replacing qualified
transcriptionists, and transcription staff being required to perform multiple
processes,potentially causing bottlenecks in report availability. “In addition, the
macroscopic (orgross) description is performed in pretty hostile conditions, with
blood, staining agents and other fluids in proximity to the specimen, and the
technicians hands are generally ‘occupied’ – not conducive to typing….,” Joe
stated bluntly.
Voicebrook addresses these problems with a combination of speech recognition,
templating, and voice-optimized (command and control) workflow. In this model,
the dictating staff complete the report in one step, with the result placed directly in
the system of record. For the pathologist, this provides the ultimate control and
ability to sign the report out as quickly as possible, and ensuring accuracy (with the
materials being present while the report is still on screen). There is no need to
review paper long after dictation is complete, or to retrieve slides that have long
since been stored.
Speaking as the president of a highly specialized and technically sophisticated
company, Joe stressed that “Voicebrookspends considerable time and effort on the
change management process,ensuring that the pathologists and their staff
understand the changes coming early in the process, and follow it through to
ongoing productive usage, including any necessary changes after the system is
live. We have re-launched many implementations from other parties who have not
adequately addressed these needs,” he said. “We also provide on-going remote and
on-site support, as needed, with a large staff specializing in the exact needs of
surgical pathology.”
“Having worked in a niche of the healthcare IT industry for more than a decade,
we got to be a ‘known quantity’ for our particular specialty. Over time, we
continued to monitor key trends, particularly the current and projected install base
of the leading solution providers in Pathology, where a handful of vendors
comprise approximately 70% of the market,” Desiderio continued. “Each of these
companies has a different partnering strategy and ‘rhythm.’ Because we service all
customers in the market, we interact with all of these software companies, some
formally, some informally.”
On the technology side, Voicebrook also has a very strong partnership with a
leader in healthcare automation, Nuance Communications which dates backto the
late ‘90s, when they worked with the predecessorcompanies that ultimately

4. became Nuance. Bottom line, Voicebrook has been building and managing
alliances (not necessarily in a classical ASAP definition) for around 15 years.
“I had some experience in business development at Voicebrook, and had been
involved in alliances with technology providers as a customer, previously, in large
corporatesettings. Creating a formal alliance management process and program
here was a natural conclusion,” Desiderio explained. “I had been searching for a
while for a framework in which to represent partnerships when I found the
Association for Strategic Alliance Professionals in early 2014. I joined up
immediately and have been immersing myself in various publications, webinars,
and other educational materials. I look forward to attending some in-person
meetings either this fall, or early spring.”
“At the moment, the alliance management team is me,” he continued. “However, I
am involving my partners and key team managers in the process, as nearly all areas
of the company have significant involvement. Eventually, I expect to expand the
team a bit, however a main goal is to have our main functions -- sales, marketing,
productdevelopment, customer operations and administration – each own their
components.”
“We are ASAP newbies, and have not pursued certification yet. I am focused on
remapping ongoing activity into a ‘version one’ strategic alliance process, to be
built upon and improved iteratively. We are very much involved with agile
development, and are treating the development of alliance management capabilities
like an agile project. In time, I plan to complete more formal training, including
CSAP.”
“Froma competitive perspective – some of the Pathology software vendors have
tried to provide a direct service, however this is not their ‘bread and butter’ –
including keeping up with changes in speech recognition software and the various
factors involved (versions of operating system, versions of word processing
solutions, PC hardware, etc.). Also, Nuance directly provides some solutions in
this area, but again, they do not typically have the depth of expertise in our niche.
More often, Nuance will refer Pathology sites to us, as we are acknowledged to be
expert in this area within the industry, and within Nuance,” Desiderio explained.
“We are looking to forge alliances with the software providers in the anatomic
pathology space, and continue to advance our alliance with Nuance
Communications.”

5. Joe has some advice for those considering an alliance management program – even
more importantly, anyone who does not have an alliance management program and
is unaware of the discipline.
“I would strongly encourage them to get focused on alliance management, and to
get involved with ASAP, well ‘asap.’ Forwhatever reason, I didn’t find this
organization until I was pretty far into my role, but I have found it hugely helpful
(especially the Handbook of Alliance Management),” Joe commented.
“I found that we were doing many of the necessary activities (some well, some not
so well), but the planning and evaluation of alliances, including tools to help frame
discussionof individual and mutual goals, strategies to recognize and resolve
conflict, and tools (scorecards, KPIs)along with on-going education – have been
extremely helpful.”