1. Speech Recognition: The State of the Business VR = Voice Recognition Resources Interviewed Bill Grube (Agfa Talk Technology) Tim Fagert (Dictaphone Powerscribe) By Rex Osborn Sr Manager Digital Imaging Practice

2. ©2003 First Consulting Group 1 Why Transcription is an Issue  Transcription, and our ability to distribute a diagnostic report has been a key to measuring the management success of Radiology “Turnaround time equals Hospitals perception of how efficient Radiology is.”

3. ©2003 First Consulting Group 2 The 7 Steps (Manual) 1. Analysis of the study 2. Radiologist dictates study 3. Transcriptionist types dictation 4. Radiologists signs report 5. Professional billing and clinical coding occurs 6. Diagnostic (dx) report is printed 7. Dx report; fax and mail  Ordering physician  Medical records  File room copy  Radiologist copy Analysis Dictation Transcription Sign Rpt $ & Coding Print Report FAX & MAIL

4. ©2003 First Consulting Group 3 Why Conventional Transcription Needs Help…  Transcription costs are rising  Preliminary reports not promptly available “The driver for VR technology is PACS related, the Images are available immediately, where is the Dx Report?”  Error-prone, Re-dictations  Signature Delays

5. ©2003 First Consulting Group 4 Key Components For a VR System  Language Model  Acoustical Model (engine)  Input Device (microphone)  Post Processing of recognized text

6. ©2003 First Consulting Group 5 Key Features: Language Model  Language models are a set of rule-based statistics that increase the accuracy of speech recognition  A language model anticipates the user’s vocabulary and style of speech  Language models are the key ingredients that enable applications to achieve high accuracy rates

7. ©2003 First Consulting Group 6 Language Model Provided by Speech Recognition Vendors Speech Recognition Application for Radiology Speech Engine built with Radiology Language Model Radiology Vocabulary Speech Engine built with Radiology Language Model Radiology Language Model Radiology Data

8. ©2003 First Consulting Group 7 Key Features: Acoustic Model  Acoustical models are created by comparing sounds, or acoustic data  Acoustic data provides most of the information required for human speech to be recognized by software  Acoustical models are typically adapted (refined) after a given period of time

9. ©2003 First Consulting Group 8 Key Features: Input Device  Noiseless button technology  USB technology which eliminates sound cards  Primary device for dictation – microphones and headsets

10. ©2003 First Consulting Group 9 Key Features: Post Processing  AI for recognized speech  Designed to minimize extra dictation  Designed for easy editing and navigation via key strokes  Allows Radiologists to retrain system to enhance vocabulary recognition

11. ©2003 First Consulting Group 10 Who are the Pioneers of VR?  VR Application Vendors  Language Model Innovators  Speech Engine Designers

12. ©2003 First Consulting Group 11 Who Should I Trust?  Technology and Workflow Innovators  A vendor that has an integration strategy and approach  A proven record of successful implementations

13. ©2003 First Consulting Group 12 How Can They Ensure Success? From a Vendor Perspective…  Experienced team that has been successful with the deployment of this technology  Clinical knowledge  Joint deployment strategy  Test environment for education and integration validation

14. ©2003 First Consulting Group 13 How Can You Ensure Success? From A Client Perspective…  MUST have a Project Champion (Radiologist)  Must have support of Radiologists  RIS and PACS Integration must be outlined to ensure tenable workflow  Removal of Legacy Dictation System  Do a small group at a time, this way you can have measurable outcomes

15. ©2003 First Consulting Group 14 How Do You Measure success?  ROI Strategy Did we save money? Are we more efficient?  Report turn-around time reductions Is the report getting to the people ordering the studies? Have phone calls asking for reports been reduced?  Physician productivity

16. ©2003 First Consulting Group 15 Road Map Items for VR Vendors  Hardware USB microphones (elimination of sound card) Portable dictation devices  Software/integrations Desktop integration (Physician Workstation) Remote capabilities Integration to SR DICOM in Future

17. ©2003 First Consulting Group 16 Drawbacks of Technology  Perception of being a transcriptionist rather than a Radiologists because of on-line editing prior to signature  Vendors efforts to place within workflow a place for a full time Correctionist  Easy to break Sound Cards and Microphones  Software stability  Recognition accuracy will improve but will require Radiologists’ patience…

18. ©2003 First Consulting Group 17 The VR Workflow  Report is dictated and voice recognition creates diagnostic report Radiologist must read through report and correct (on average 3-8 words) Sign report (electronically)  Dx report distributed via existing integration with appropriate results outbound transactions ANALYZE, DICTATE, SIGN Dx REPORT Distributed Via RIS - HIS - EMR - CDR

19. ©2003 First Consulting Group 18 To MAKE VR Successful:  Set realistic expectations  Transcriptionist don’t have to go away immediately  PACS workflow should drive integration with VR solutions for optimal efficiency  Target areas where the greatest impact and can show acceptance... don’t fight with the Radiologists “Identify where success is likely, and build momentum”

20. ©2003 First Consulting Group 19 VR Integration; Agfa Example