What is required to be successful in automating your patient charts?

• The proper technology -- Speech Recognition Software -- See recommendations
• Fast & powerful Hardware -- 1.7GHz speed and 512MB RAM -- See Hardware Specs
• A Vocabulary specific to your medical discipline -- See our list
• Office Workflow Analysis by our physician consultant -- See our outline
• A custom Patient Chart/Template System -- Jointly designed with you on-site
• On-site, one-on-one Training with a professional -- See our recommended schedule
• Automation of document clerical work -- All with your verbal commands
• Selective use of the Internet for Client support and contacts -- Go Here for On-line Backup

Speech Recognition Software -- Beware of toys

The two brands of software which have captured the majority of the market are IBM and ScanSoft Corp. (Dragon NaturallySpeaking was acquired from L&H in February 2002. Many versions of the software exist and can lend confusion and disappointment to those who acquire home or retail versions and try to make them work in an exacting environment requiring professional features. The same comments apply to the microphone that is usually included with the software. These must be professional units the have noise cancelling mics -- one facing the user and the other facing the opposite direction to sense ambient background noise.

We meet many physicians at medical shows who state that they have this brand or the other and when asked if they are using it they respond that: 1) “It wasn’t accurate enough for my work” or 2) “It took too long to use or to train”. These are typical reactions to the past experiences of many users. In our opinion, both IBM and Dragon are guilty of flooding the retail market with limited feature products that some users are trying to use for very professional applications. We feel that this has resulted in adverse reactions and therefore you will hear so called experts say that “speech recognition is not quite ready for prime time”. As you read further, you will see that this is far from true.

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Hardware Specifications -- Beware of Home Products

Desktop PC

• Intel Pentium 4 or AMD Athlon 1.70GHz, 512MB PC2133 DDR-SDRAM
• 60GB Hard Drive, 24X CD-RW, 32MB AGP Video Card, Integrated Intel 10/100 Network Capability
• 56K Built-in Modem, Sound Blaster PCI 16 Bit Sound Card, External Speakers
• Windows 2000 or Windows XP Professional OS, 3 Year Warranty, No Home Edition
• MS Office 2000 or Office XP Small Business Office Suite, No MS Works

Notebook PC

• Intel Pentium 4 or AMD Athlon 1.20GHz, 512MB PC2133 DDR-SDRAM 
• 40GB Hard Drive, 24X CD-RW, 32MB AGP Video, Integrated Intel 10/100 Network Capability
• 56K Built-in Modem, Sound Blaster compatible integrated sound chip, External Speakers
• Windows 2000 or Windows XP Professional OS, No Home Edition, 3 Year Warranty
• MS Office 2000 or Office XP Small Business Office Suite, No MS Works -- Not mandatory
• Weight under 4.5lbs, 15" LCD Screen size, wireless capability plus smart card (security card slot)
• Acer Travelmate notebooks seem to be the only notebooks which approach these specs

Additional Considerations

• 400W uninterruptable power supply with power isolation
• Install LAN (local area network) and cable modem, DSL line or conventional private telephone line

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Office Workflow Analysis Tasks

Phase I - Needs Analysis

• Survey current methods
• Evaluate present computer equipment
• Define office records goals/objectives
• Chose direct dictation or tape dictation
• Evaluate personnel
• Research records management system requirement

Phase II - Project Plan

• Define strategic objectives
• Outline project steps
• Layout timeline
• Define required computer equipment
• Write work statement, equipment specs and contract

Phase III - Project Implementation

• Acquire computer equipment
• Install software & vocabularies
• Provide customer orientation and speech enroll
• Conduct initial client training - Session 1
• Follow-up Training/Coaching - Session 2
• Refining customer vocabulary & building templates/macros
• Integrate records management with ASR
• Prepare customer documentation/operational manuals

Phase IV - Quality Control

• Redefine objectives & achievements
• Relate performance to economic advantages/benefit
• Prepare ASR economic justification and client sign-off

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Patient Chart/Template System -- Customized for the Client

System Description -- Create Electronic Charts using Speech Recognition & MS Office Automation Procedures

System Step Sequence

• Start Dragon NaturallySpeaking & MS Word Software 
• Select from displayed Buttons the type of Patient Note to Create
• Dictate Text into the Patient Note Template Fields
• Select Document Completion Task Button

^{Outline of System Features}

Templates - Customized for You

• Initial Visit
• Follow-up Visit
• Procedure Form
• Lab Report
• Letters

Text Macros for fast Freeform Dictation

• Review of Systems
• Vital Signs
• Normal Brief Exam
• Normal Complete Exam

Automated Document Completion Task Buttons

• Save Note & Print Locally
• Append & Save to Patient’s Chart - Locally & Remotely
• Format and Print Note/Letter to Local Printer
• Retrieve Existing Patient Chart to Review
• Send Fax to Insurance, Legal & Referring Physicians
• Add photo to Visit Note
• Print Prescription - 4 Copies

On-line Instruction - Buttons & Fields

• Button Roll-over expands Descriptions
• Template Field Roll-over prompts for correct dictation style & tex

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Training and Performance Accuracy Considerations

IThe following is a discussion of the factors that affect speech recognition performance/accuracy when used with speech recognition software.  Accuracy can be defined as the inverse percentage of word and punctuation misrecognitions. For example, if a user’s text has 4 misrecognitions out of a total of 100 words and punctuations then the accuracy would be 96%.

Some of the factors that impact successful performance and accuracy are:

• User pride and commitment in achieving high dictation accuracy -- users with muscular skeletal disorders are very motivated.
• User enunciation skill and minimal regional, foreign or ethnic accent.
• User acceptance of the coaching/training direction by our trainers.  All training is one-on-one.
• User experience with MS Windows and general computer use.
• A user’s vocabulary uniqueness for the installation -- we enhance all vocabularies with the specific installation's user’s documents. Please provide a minimum of 50 per user.
• Adequate on-site training of the users (nominally 2 days per user) -- we will train the users to learn the style of dictation required to achieve high accuracy.
• Training of the users on the techniques required to improve accuracy through continued use.
• Training to permit users to add new vocabulary terms, pronunciations and shortcuts.
• User dictation skill as well as preparation/organization before beginning to dictate.
• Training begins with an initial 2 hours of orientation and speech profile creation.  Thereafter, actual, real dictation shall constitute the preferred training methodology with one-on-one coaching to communicate and reinforce the required dictation style.

We are prepared to assure any new client that if the above procedures are followed a 96% accuracy rate can be achieved at the end of the initial two to three days (estimated) training per user training period. We can demonstrate dictation of your documents (sight unseen) by trainers at an accuracy of 98 to 99%.  We have existing installations that approach these latter numbers after a period of time.

At the end of the initial two days training for a user, an evaluation shall be made of that user’s progress. If, in our opinion, additional training will not permit the user to achieve acceptable results, we shall stop further training and notify the client.  Conversely, if additional training is required for a user to reach successful performance, we shall notify the client and would expect authorization to continue with the required additional training.

Naturally, the success of a new technology comes down to each individual's desire and motivation.  Like any new methodology, past habits can control results/outcomes. We have had positive feedback from many of our clients who share the realized financial savings of using the new technology with the physicians/users who are embracing its use. Also, when a physician's dictation is completed within minutes, without any misspellings and without any proofreading by others there can be many intangible benefits to all concerned.

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Voice: 413-732-7321   --  Fax: 413-732-1616   --  e-mail:  ken_fetterhoff@wfsco.com

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