Voice Recognition & PACS Voice Recognition & PACS IntegrationIntegration

Dr Richard Harries, FRCR, MDDr Richard Harries, FRCR, MD

Northern Lincolnshire and Goole NHS TrustNorthern Lincolnshire and Goole NHS Trust

Speech recognition?Speech recognition?

……met a tart so fell on Gill…met a tart so fell on Gill…

(metatarsophalangeal)(metatarsophalangeal)

Why Introduce VR?Why Introduce VR?

Because its funBecause its fun To save timeTo save time Shortage of SecretariesShortage of Secretaries To reduce typing errorsTo reduce typing errors

What time savings?What time savings?

Dictate

Audio transcription & correctionAuthorisation

Print & distribute

What time savings?What time savings?

+ .5 secretary per radiologist?+ .5 secretary per radiologist? - .1 radiologist initially?- .1 radiologist initially?

VR - The disadvantages?VR - The disadvantages?

Can’t change report once ‘committed’Can’t change report once ‘committed’ Can’t leave messages for secretaryCan’t leave messages for secretary Radiologist has to ‘correct’ for full benefitRadiologist has to ‘correct’ for full benefit Learning curveLearning curve Adjustment of dictation techniqueAdjustment of dictation technique Large sound files for remote workingLarge sound files for remote working Software ‘crashes’Software ‘crashes’ Integration with imaging systemIntegration with imaging system

VR - The advantagesVR - The advantages

Faster and more reliable work throughputFaster and more reliable work throughput Immediate printed reports (if necessary)Immediate printed reports (if necessary) Reports out-of-hoursReports out-of-hours Complete work before absencesComplete work before absences Secretaries have a learning curveSecretaries have a learning curve Secretaries occasionally ‘crash’Secretaries occasionally ‘crash’

VR - How accurate?VR - How accurate?

The words VR finds difficultThe words VR finds difficult– numbersnumbers– thethe– ss– mesentericmesenteric– ScoliosisScoliosis

Accuracy - >99% after trainingAccuracy - >99% after training

This report includes all attendances from 9/5/03227/5/03.

Chests (attendance numbers 1255679 and 1 to 3 for right 67)On examination 2, there is patchy increased density in both lower zones but I suspect that this is old. There is no obvious recent abnormality.On examination 3, there is an endotracheal tube in situ (its tip is 3 cm above the carina). There is also a right jugular line. There is calcification overlying both hemidiaphragms and in the rightThe [right paravertebral] region (this was also present on the previous film).On examination 5, the endotracheal tube and jugular line has been removed. The lung fields remain unchanged.

The pelvis and hipsThere is an intertrochanteric fracture of the right femur, subsequently internally fixed with a DHS in satisfactory position.

VR - the two methodsVR - the two methods

On-line transcriptionOn-line transcription– Distracting?Distracting?– Quicker overall?Quicker overall?– Corrections?Corrections?

Off-line transcriptionOff-line transcription

VR - the ProcessVR - the Process

Dictate VR Transcription

Correction

Sound Database

Sound files

Acoustic adaptation

Context adaptation

VR - The hardwareVR - The hardware

Office PC

RIS Server

VR Server

VR - Model 1VR - Model 1

Dictate

VR

transcription

Correction & authorisation

Print & distribute

VR - Model 2VR - Model 2

Dictate

VR

transcription

Authorisation

Print & distribute

Correction

Should secretaries check Should secretaries check reports?reports?

Reduces potential time savingsReduces potential time savings Reduces short-term work for radiologistReduces short-term work for radiologist Slows ‘learning’ process for VRSlows ‘learning’ process for VR

Maintenance tasks?Maintenance tasks?

Acoustical AdaptationAcoustical Adaptation Context AdaptationContext Adaptation Installation of new usersInstallation of new users

Acoustical AdaptationAcoustical Adaptation

Matches waveforms to known wordsMatches waveforms to known words ~15mins/day/radiologist~15mins/day/radiologist

Context AdaptationContext Adaptation

Database of probabilities of word Database of probabilities of word juxtapositionsjuxtapositions

Rapid fillingRapid – filling – 80%Rabbit – filling – 0%Rapid – feeling – 5%Rabbit – feeling – 0%

Context AdaptationContext Adaptation

?1287883

√2399540

√ 2547762

? 1299048

? 3288473

√ 1129489

Context AdaptationContext Adaptation

.?1289344,2390045IntegratianWatermarkRabbitIschemia

Who does the maintenance?Who does the maintenance?

Secretary – won’t know individual Secretary – won’t know individual radiologists’ speech nuancesradiologists’ speech nuances

Office manager - dittoOffice manager - ditto Radiologist – takes more time initially but Radiologist – takes more time initially but

improves accuracy more rapidlyimproves accuracy more rapidly

Integrating VR with PACSIntegrating VR with PACS

VR-RIS integrationVR-RIS integration PACS-RIS ‘Desktop integration’PACS-RIS ‘Desktop integration’ Minimises processesMinimises processes Ensures correct patient & reportEnsures correct patient & report

VR-RIS-PACS IntegrationVR-RIS-PACS Integration

PACS RISVR

VR - Integration with RISVR - Integration with RIS

Initial experiencesInitial experiences– Slow and tediousSlow and tedious– Word crashesWord crashes

And then…And then…– Full Integration - SlickFull Integration - Slick

In context……..In context……..

What VR packages are What VR packages are available?available?

Philips SpeechMagicPhilips SpeechMagic DictaphoneDictaphone DragonDragon

How popular is VR?How popular is VR?

8 SpeechMagic installations8 SpeechMagic installations

How much does it cost?How much does it cost?

VR Server - ~2kVR Server - ~2k License - ~3kLicense - ~3k Speech Mike - ~£300Speech Mike - ~£300

Who should use VR?Who should use VR?

Nobody.Nobody. Departments ‘short’ of secretariesDepartments ‘short’ of secretaries EnthusiastsEnthusiasts At least one technophile per departmentAt least one technophile per department

Speech Recognition - SummarySpeech Recognition - Summary

Can improve reporting efficiency Can improve reporting efficiency significantlysignificantly

Can save significant amounts of secretarial Can save significant amounts of secretarial timetime

Can be cost effectiveCan be cost effective Requires enthusiasm and committmentRequires enthusiasm and committment