What are the challenges in ensuring speech recognition systems stay up-to-date with the latest medical terminology and with the wide range of accents found in the NHS? NHE got a supplier’s perspective from Nuance’s Carina Edwards and Joseph Petro, who also discuss alignment with the QIPP agenda and the changing role of medical secretaries.


words ‘Lady Gaga’ ahead of around 2008 – but the minute people started talking about her online, the systems’ models were updated to ensure they remained at the cutting edge of language use.


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The exact same process is applied for medical terminology, which like pop music is full of its own trends, jargon, homonyms and frequent newcomers, especially in terms of drugs and medical devices.


Nuance Communications’ Joseph Petro, senior vice president for healthcare research and development, and vice president for healthcare solutions marketing Carina Edwards, are both based in the US but have become much more knowledgeable about the NHS as the company has expanded in the UK via its more than 30 partners, as its software is built into many other systems.


Edwards spoke to NHE from Boston, saying: “I’m very familiar with the QIPP programme and the shift from digital dictation to speech recognition really supports the goals of QIPP. First and foremost, you get improved quality; as the physician is able to document with their voice and not to have to fumble around with their new electronic health record systems, which although they do capture all that wonderful information, at times can be cumbersome to navigate and get information into.


“We’ve been very focused on allowing the clinician to capture


58 national health executive Jan/Feb 12


oice recognition software might have struggled to know what to do with the


the patient’s story and all their information quickly, in their workflow, on any device, so they can share that information for a faster turnaround time across the organisation.”


The patient narrative


Some Trusts that have shifted to electronic health records are using systems that allow them to put the patient narrative right into the record, and navigate the record


through voice alone. Among those not yet using such systems, many have at least switched to digital dictation rather than tapes.


Edwards said: “In the past, there’s truly been departmental and one-on-one medical secretaries; but now, the technology allows the secretaries to free up their time a little bit and almost ‘pool resources’ to have maybe one or two people truly focused on multiple departments and multiple workflows, typing for different doctors, and the speech recognition element of it really turns them into editors. We’re very familiar with that here in the US, but it’s not really been adopted yet in the UK.


“But today, with digital dictation, they get an audio recording, they put on their headset and they type. In eScription, for example, the speech recognition not only does voice-to-text, but also pre-formats that information into whatever type of template or format they would like. If a clinic has a certain letter format or if they want the patient report in a certain way, it does the hard work for them and knows and understands what is said. Medical secretaries really become editors, and you can imagine the amount of time that takes out.”


‘This is my job’


She acknowledged, however, that medical secretaries tend to be most suspicious of the new technology at first – needlessly so.


She explained: “With physicians, the first time they take that microphone in their hand, they kind of go ‘hmm, I don’t know about this’. But once


they see they’re able to do that dictation very quickly, they see how accurate the speech recognition capture is, and that they’re able to use macros and templates, they jumped at the opportunity.


“Once they see how accurate the speech recognition is, they realise it’s not that hard, then it’s the opposite problem –it becomes hard to prise that microphone out of their hands.


“On the radiology side, they’re just wired to be efficient. They’re trying to get as many scans and as much information back out to the constituents as quickly as possible. In the past, transcription was always a challenge, because it had an increased turnaround time. You could wait a day or even up to two days to get that report back, or that letter out to the patient, or the ordering physician.


“Where there is hesitation is among medical secretaries. They’re concerned, thinking: ‘I’ve done this job, this is my job, I don’t want our jobs to be pooled’.


“But what we’ve found out with the pilot sites is that it’s actually very liberating for them. We had some examples where there were departments saying ‘it’s 2pm and I’m done with a pile of work that would have been on my desk, and now I can actually build a better relationship with my clinical staff because I can get them more organised, and really focus on the patient’s schedule’.


“It’s important to overcome that fear, and change the mindset. It probably takes them a week for


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