1. Outcome Assessment of Computerized Speech Recognition in Surgical Pathology Lanjing Zhang, MD, MS Department of Pathology Mount Sinai School of Medicine, New York, NY

2. Background CSR concept: Llaurado, J. G. (1982). "Computerized speech recognition." Int J Biomed Comput.. First use of CSR in AP: Klatt, E. C. (1991). "Voice-activated dictation for autopsy pathology." Comput Biol Med. Early use of CSR in Radiology: Lauderdale, D., N. C. Broering, et al. (1991). "Speech recognition cuts report turnaround time." Diagn Imaging (San Franc). First commercialized machine for Pathology CSR: Kolles, H. and W. Feiden (1995). "[Computer-assisted speech recognition in diagnostic pathology. Development of the DragonDictate-30 K system for documentation]." Pathologe.

3. Background Meijer, G. A. and J. P. Baak (1995). Hum Pathol. "Reporting by digital speech recognition.“ Rashbass, J. (2000). Histopathology Recommend to use CSR Henricks, W. H., K. Roumina, et al. (2002). Mod Pathol VR generated an average of 23,864 lines of text per month from outside agency, translating to $2625 savings per month. PA/MD time was not compared Al-Aynati, M. M. and K. A. Chorneyko (2003). Arch Pathol Lab Med. Lower accuracy 93.6% of CSR vs. 99.6% of TMD More editing time of CSR (1.4-3.5 times)

4. Background The use of VRS required an additional physician dictation and correction time (9 minutes vs 3 minutes) in pediatrics: Issenman, R. M. and I. H. Jaffer (2004). Pediatrics. Significant reduction of Radiology dictation time and actual time by using CSR: Rana, D. S., G. Hurst, et al. (2005). Clin Radiol. Improving productivity in ENT: Ilgner, J., P. Duwel, et al. (2006). Ear Nose Throat J.

5. Goal To examine the DC and RT by using CSR and TMD without template To examine the accuracy of CSR and TMD

6. Technology CSR is tested and established on Voicebrook ® and powerpath ®. Four trained users are recruited. Record DoCumentation time (DC, i.e., the time required to complete the documentation task) for gross examination by CSR& transcriptionist-mediated dictation (TMD) Record Reporting time (RT, i.e., the time required to review and sign out the case) by CSR&TMD

7. Design (DC) Receive specimen Accession specimen CSR (44 cases) Gross specimen Submit block Dictate by PA/Res TMD (39 cases) Gross specimen Submit block Dictate by PA/Res Transcription

8. Design (RT) Tissue process Receive slide CSR (201 cases) Read slide Dictate by attending TMD (244 cases) Read slide Dictate by attending Transcription

9. Design For gross examination, the DC for a total of 83 commonly encountered surgical specimens by CSR (44) and TMD (39) are collated. No grossing templates are used for CSR. The DC by different methods for similar specimen types is compared. The documentation adequacy is measured by the presence of key words against a third- party gross examination manual.

10. Design (cont’d) The reporting times of 445 biopsy cases by these two methods are separately collected and compared. Unpaired two-tail Student’s t test is used in statistical analysis. A P value less than 0.05 (5%) is considered statistically significant.

11. Results DC CSR and TMD require equal DC (n=18 vs. 6, Mean±SD=13.20±3.98 vs. 12.20±6.02 sec/word) for large resection specimen. Interestingly, more or equal DC for small specimens is required by CSR compared to that by TMD (n=26 vs. 33, Mean±SD =5.12±2.13 vs. 2.95±1.50 sec/word, p<0.01).

12. Results P<0.01 No significant difference is found between CSR and Dict DC of large specimen, but that of small specimen.

13. Results RT The mean reporting time of biopsy cases by CSR (n=201) was 338.8±75.4 sec/case or 77.3±20.2 sec/slide, and that by TMD (n=244) was 345.1±81.9 sec/case or 80.7±18.3 sec/slide. No statistical significance was established between reporting time by CSR and TMD (p>0.05). A documentation accuracy of more than 95% was reached by either CSR or TMD.

14. Results (cont’d) No significant difference is found between CSR and Dict biopsy RT.

15. Conclusions The efficacy and utility of CSR depend on the types of surgical specimens. For gross examination, CSR appears to require equal or more DC than TMD to complete small resection specimens, while equal DC to complete large ones. In reporting biopsy cases, CSR takes same or even less time of TMD. CSR may shorten report turn around time and cut down the cost by eliminating transcription step by office staff.

16. Perspectives Why do small specimens need more time in CSR than TMD Additional time in log-in case (2-4sec) equals the difference (5.12 vs. 2.95 sec) How to deal with it? Improve log-in process/time Template may help Histotechs, but not PA (more expensive than Res), gross biopsy specimens

17. Perspectives What’s next? Multiple center test Template usefulness Standardize report Use as guideline/reminder Additional loading time Improve software and train personnel Improve user satisfaction and awareness of CSR advantage

18. Acknowledgement Zhenhong Qu, MD, PhD University of Rochester Medical Center Divya Seth, Margaret Huynh, and Jeffery S. Van Vranken University of Rochester Medical Center Alan Schiller, MD Mount Sinai School of Medicine