30 Nov 2002

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How Does Speech Fit In?

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Dear friends,

The real challenge that faces us is to determine how a clinician, a
patient, and a computer should interact in order to bring about the
highest quality and most cost-effective healthcare. While speech
offers a natural way to input free text, it is not always the best
clinical documentation methodology. Entering data at the point of
care is both efficient and effective. But dictating in the
patient's presence can sometimes be obtrusive and uncomfortable. In
order to establish the appropriate role for speech, we need to look
at it in the context of the entire clinical encounter.

Things get started when the patient determines s/he has a problem
potentially deserving of a clinical intervention. Some sort of
triage process should then take place. Ideally, the patient would
provide a structured, problem-oriented history in response to a
branching questionnaire. This can be accomplished at a community
kiosk, or over the Internet (with encryption) or an intranet. If
not available prior to the encounter, the history can be provided
by the patient while in the waiting room. No need for speech so
far. On second thought, it might be cute to have the patient also
dictate a free-flowing summary of the problem, and then have that
dictation permanently archived as a digital voice file.

In any case, the codes evolving from the patient's history data
should be matched to the medical knowledge base. This will direct
any triage decisions, and will later provide guidance to the
physician for the clinical assessment. Additionally, a
computer-generated summary of the positive findings offers a more
comprehensive, and probably more relevant, history than the
physician would ever have the time to acquire - and at virtually no
provider cost. It is stupid for the physician to take the patient
history.

Any elaboration of the patient-generated history would be noted by
the physician via pen-based input - structured, or handwritten on
the screen as a memory jog for a post-encounter dictation. But the
physical exam data entry will benefit from a handsfree process.
This is a good spot for dictation, using a portable headset.
Although digital dictation will work, the fact that the text is
related to specific anatomical parts suggests that the vocabulary
is sufficiently predictable to soon lend itself to continuous
speech recognition. After all these subjective and objective data
are entered, there's another match against the (continually
evolving) knowledge base. Diagnostic probabilities are presented,
and clinical actions are suggested.

The physician takes these into consideration, along with any other
acquired information and patient preferences, and a summary
report is dictated. Once again, if the state-of-the-art of
continuous speech recognition is sufficiently advanced, then that's
the technology of choice. Otherwise digital dictation, in a manner
that is elegantly integrated with the rest of the clinical
documentation, will work fine.

Let's not forget how important it is to record the ultimate
diagnoses and outcomes (including patient and provider
satisfaction) in a codified manner, which will facilitate
correlating them with the coded findings and treatment data. This
is the essential methodology for figuring out how to provide the
very best healthcare. I think that goal is worth some effort.
Extracting data from radiology reports can also provide some
considerable benefits. Whether by structured/codified reporting or
natural language processing of free text, we should be able to
assist the overall healthcare process. For example, we can
determine which exams prove to be useful and cost justifiable,
given specific clinical indications. Managed care organizations
will love that kind of intelligence. Also, we can identify those
studies that report diagnostic findings that should lead to further
testing or specific clinical actions. Providing automatic
protocol-based alerts to the referring physician can do much to
improve the effectiveness of patient diagnosis and management
plans.

It is clear that there are three options that must be offered:
(1) dictate into something, and have a human transcribe it;
(2) dictate into something, have it automatically converted
into text, correct it yourself, and then authenticate it; and
(3) dictate into something, and ship it off to a medical editor,
who corrects it and returns it to you for signature. A total
dictation solution. And, ultimately, it must also be integrated
with some structured/codified input.

Well, continuous speech recognition is not the entire answer.
This exciting technology is clearly an important part of the
solution, but needs to be applied only where and when it will
net-positively impact the healthcare process. Although the
technology will continue to improve over time, it's good enough
right now to make it foolish (and costly) to delay implementation
in that domain.

That said, it is interesting to reflect on the fact that physicians
have been pleading for continuous speech recognition for years.
Some of those same pleading physicians - once they truly come to
terms with the (sometimes minimal) requirement to proofread and
edit their own speech-recognized reports - all of a sudden seem to
develop a profound appreciation for digital dictation and
transcription. Initially, these physicians will insist on having
their reports fixed by a medical editor, or they will continue to
use traditional digital dictation.

But hopefully they will very soon see how to catch the wave. If
their eyes and minds are open, they will recognize the beauty of
distributing the final/signed report right after they dictate it.
If not, give these speech bums a surfboard.and tell them to go
wreck a nice beach. (Say "wreck a nice beach" quickly - and see
how clever the software needs to be in order to display the right
words.) The year 2010 is not that far away!

Will Hal be born on time?

We invite our members to discuss HRD issues at the forum:
www.mtindia.org/Forum/default.cfm

Or at our moderated discussion list:
www.mtindia.org/mtdigest/default.htm

It's Thanksgiving time in North America, which means time spent
with family and friends, good food, and celebration. I
wish all of you in the US a wonderful holiday!

Cheers!!!

Maj (Dr.) Amit Chatterjee, SM
Strategist / Founder ~ mailto:amit@...
MT India ~ www.MTIndia.org
"The Community of MT Professionals"

"It takes years to become an overnight success."

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NEWS AND VIEWS :
-----------------------------

1) Blockbuster hero moves to boardroom

"I was never comfortable with the adulation and attention," says
the one time heart throb of Tamil cinema, Arvind Swami. He now
seems to revel in oblivion, working hard at his back office
business ProLease. Movies are no more than a hobby to him now.
Arvind is in partnership with an enterprising US-based Indian, Bala
Ramamoorthy, whose brainchild is ProLease.

Along with a team of other entrepreneurs, they own Business Process
Outsourcing (BPO) companies world over. ProLease operates in nine
countries, servicing 2,500 organisations in the US alone, including
the World Bank and the Federal Bureau of Investigation. The
seven-year-old Pro Lease group raked in revenue of $ 532 million
last year.

Arvind is chairman and managing director of ProLease India and
divisional president of ProLease USA. He also administers ProScribe
India, an exclusive medical vertical that does transcription,
billing, etc for American hospitals.

http://timesofindia.indiatimes.com/cms.dll/xml/comp/articleshow?art
id=28804328&sType=1

2) Working to keep medical records from being sent overseas

A group called Tighten Up America wants to raise awareness and
change the laws so that Americans' medical records cannot be sent
overseas to countries like the Philippines, Pakistan and India, to
be transcribed as they are now.

Janice Courtney of St. Petersburg could not believe that her young
daughter's medical records from Bayfront Hospital were sent to what
turned out to be India to be transcribed from a doctor's voice
recordings. "Her Social Security number, her address, her school.
They could come and take her. They could steal her identity," she
continued.

In a statement, Bayfront said, "we require vendors to adhere to
federal regulations protecting patient privacy." St. Anthony's
Hospital, which also uses C-Bay, added, "we found that C-Bay has a
higher security level than most banks."

Skip Conover, the president of C-Bay, told ABC Action News that the
records in India are very secure and workers there sign
confidentiality agreements. He insisted his company has never had a
breech in the U.S. or overseas.

http://www.abcactionnews.com/stories/2002/11/021126records.shtml

3) Dumping clause sought for services

The government-appointed committee for strategising services
negotiations at the World Trade Organisation (WTO) has not only
proposed a bar on the entry of foreign accountants, lawyers and
company secretaries, but has also recommended a framework similar
to that for trade in merchandise with safeguard mechanisms to check
dumping, subsidisation of services exports and emergency protection
measures.

In its report, the committee has noted that in the present scenario
where developed countries have placed stringent restrictions even
on Mode IV - temporary movement of personnel - India should refrain
from opening up its market for services by not allowing overseas
services companies to operate in India.

There are four modes under which services can be offered by a
country to another WTO member. Under Mode I, neither the service
provider nor the customer undertakes travel.

These are typically services like business process outsourcing and
medical transcription.

http://www.business-standard.com/today/story.asp?Menu=3&story=2741

4) Information and communications technology sectors - Revisiting
the promise

The real reason why India's experience with IT-sector growth has
attracted attention is because it lends credence to the view that
hardware and software development, besides being among the most
dynamic areas in the global economy, are sectors where the new
opportunities afforded are available to small firms, including ones
from developing countries.

This view is grounded in the perception that unlike the
`routinised' technologies that dominated industry during the
post-World War II years, the new `entrepreneurial' technologies
typical of the IT sector are characterised by entry conditions that
favour the rapid international and domestic diffusion of the
industry. The easy entry conditions are seen to result from two
features of the technology. First, the levels of investment
required for entry are low and often easily afforded by private
investors in developing countries. Second, the knowledge required
for entry is in the public domain and is transmitted through open
sources such as journals, seminars and universities.

Now there is a range of services being provided by workers located
in a country different from the one in which the service is
actually delivered. These services are delivered via
telecommunication or data networks, and are either outsourced or
organised by agents in the country of origin of the service to whom
the provision of these services are contracted out or outlocated by
subsidiaries of corporations from the country of delivery of
certain services. Examples of services outsourced include the
processing of credit card accounts, insurance claims and business
payrolls; the creation and maintenance of information bases in the
form of networked data centres and their use in the provision of
information services such as help desks; and the generation of
digitised records as in the case of medical transcription.

http://in.biz.yahoo.com/021125/17/1yfg4.html

5) Careers for young moms?

Taking a sabbatical from a career to raise kids and never returning
to it later is the story of the average woman professional in
India. Brave plans are made to rejoin the workforce once their
children become independent. But when they get back to work, the
excruciatingly long hours and the dog-eat-dog world of corporates
demotivates women. They quit and nurse their wounds for rest of
their lives.

A flexi-career or a home business is an option for such souls
facing boredom and depression. Some of the current favourite
flexible career options are: teaching , selling , data entry,
medical transcription, and software development and testing.

http://timesofindia.indiatimes.com/cms.dll/xml/comp/articleshow?art
id=27664232&sType=1

6) Online group for women in business launches Portland chapter

A national online community for women in business and technology
has formed a Portland chapter. Suzanne Mattson, a computer support
technician at Intel, is the founder and director of RoseWIT, the
local chapter of WorldWIT (World Women in Technology), a free
online networking organization.

Mattson, who also owns her own medical transcription business,
learned of WorldWIT through its web page and decided that Portland
was a prime candidate for a new chapter.

http://portland.bizjournals.com/portland/stories/2002/11/11/daily27
.html

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All original content of this newsletter is copyright 2002
Mediweb Infotech Pvt. Ltd. All cited articles are copyright of
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Thank you for your interest in MT India!

The MTIndia Team
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