Voice Recognition PACS Integration Dr Richard Harries FRCR

Voice Recognition & PACS Integration Dr Richard Harries, FRCR, MD Northern Lincolnshire and Goole NHS Trust

Speech recognition? …met a tart so fell on Gill… (metatarsophalangeal)

Why Introduce VR? § § Because its fun To save time Shortage of Secretaries To reduce typing errors

What time savings? Dictate Authorisation Audio transcription & correction Print & distribute

What time savings? § +. 5 secretary per radiologist? § -. 1 radiologist initially?

VR - The disadvantages? § § § § Can’t change report once ‘committed’ Can’t leave messages for secretary Radiologist has to ‘correct’ for full benefit Learning curve Adjustment of dictation technique Large sound files for remote working Software ‘crashes’ Integration with imaging system

VR - The advantages § § § Faster and more reliable work throughput Immediate printed reports (if necessary) Reports out-of-hours Complete work before absences Secretaries have a learning curve Secretaries occasionally ‘crash’

VR - How accurate? § The words VR finds difficult – numbers – the –s – mesenteric – Scoliosis § Accuracy - >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 right The [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 hips There is an intertrochanteric fracture of the right femur, subsequently internally fixed with a DHS in satisfactory position.

VR - the two methods § On-line transcription – Distracting? – Quicker overall? – Corrections? § Off-line transcription

VR - the Process Sound Database Dictate VR Transcription Correction Sound files Acoustic adaptation Context adaptation

VR - The hardware Office PC VR Server RIS Server

VR - Model 1 VR Dictate transcription Correction & authorisation Print & distribute

VR - Model 2 VR Dictate transcription Correction Authorisation Print & distribute

Should secretaries check reports? § § § Reduces potential time savings Reduces short-term work for radiologist Slows ‘learning’ process for VR

Maintenance tasks? § § § Acoustical Adaptation Context Adaptation Installation of new users

Acoustical Adaptation § Matches waveforms to known words § ~15 mins/day/radiologist

Context Adaptation § Database of probabilities of word juxtapositions Rapid filling Rapid – filling – 80% Rabbit – filling – 0% Rapid – feeling – 5% Rabbit – feeling – 0%

Context Adaptation ? 1287883 √ 2399540 √ 2547762 ? 1299048 ? 3288473 √ 1129489

Context Adaptation. ? 1289344, 2390045 Integratian Watermark Rabbit Ischemia

Who does the maintenance? § Secretary – won’t know individual radiologists’ speech nuances § Office manager - ditto § Radiologist – takes more time initially but improves accuracy more rapidly

Integrating VR with PACS § § VR-RIS integration PACS-RIS ‘Desktop integration’ Minimises processes Ensures correct patient & report

VR-RIS-PACS Integration PACS RIS VR

VR - Integration with RIS § Initial experiences – Slow and tedious – Word crashes § And then… – Full Integration - Slick

§ In context……. .

What VR packages are available? § § § Philips Speech. Magic Dictaphone Dragon

How popular is VR? § 8 Speech. Magic installations

How much does it cost? § § § VR Server - ~2 k License - ~3 k Speech Mike - ~£ 300

Who should use VR? § § Nobody. Departments ‘short’ of secretaries Enthusiasts At least one technophile per department

Speech Recognition - Summary § Can improve reporting efficiency significantly § Can save significant amounts of secretarial time § Can be cost effective § Requires enthusiasm and committment