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Pioneers in Healthcare IT

Voice recognition: The key to hospital dominance

Although still three to fi ve years away, digitized voice recognition and input may hold the key to a comprehensive electronic patient clinical record.

By Tim K. Zinn

Editor’s Note: This is the 12th and fi nal installment in our year-long 30th anniversary “Pioneers in Healthcare IT” celebration, featuring articles from past issues of Health Management Technology, formerly called Comput- ers in Healthcare. This article appeared in the December 1991 issue. At the time, Tim Zinn was president of Zinn Enterprises Ltd., a Chicago-based hospital information system consulting organization. A graduate of Harvard, Zinn was a nationally known healthcare consultant and futurist specializing in healthcare trends.


igitized voice recognition has far-reaching ramifications for healthcare information systems (HIS). It holds great promise in the hospital setting, where most professionals are working with their eyes and hands continually. This approach will allow doctors and nurses to enter informa- tion about their tasks while they are actually working, rather than relying on their memories to record accurate facts at a later time.

Documenting while doing is especially advantageous for those charged with making detailed and accurate records that are both timely and critical in nature, a situation physicians and nurses encounter regularly dur- ing the course of patient care. Further, information can subsequently be sorted into multiple data formats with only one handwritten copy of doctors’ orders. Clearly, this form of data entry will not only be more convenient, but will capture close to 100 percent of clinically nec- essary information, as opposed to the 40 percent that current HIS automation now captures.

Primary challenge for the year 2000 The primary computer challenge facing healthcare administrators today is to contain and control the enor- mous fl ow of clinical information, disseminating this data in an orderly manner. Currently, hospitals maintain three forms of in- formation for every patient: written records, such as charts, doctors’ orders and lab results (hardcopy data);

26 August 2010

X-ray, MRI and CT scans (images); and dictation notes (voice).

State-of-the-art computer systems will translate all of this information into a single format that can easily be transported within the hospital, made available to clinicians (both on and off campus) and transmitted to payers, such as insurance companies, self-insured busi- nesses and governmental agencies. If this concept sounds familiar, it is, because we have just defi ned the concept of the electronic patient clinical record. At Zinn Enterprises, we are continually conducting surveys of hospital senior executives to determine their perspectives on computing technology. When asked to rank emerging technologies relative to their importance for the future success of their institutions, CEOs ranked the electronic patient clinical record extremely high, while digitized voice was rated a distant eighth. This indicates that even the most perceptive and perhaps most experienced CEOs have failed to grasp the importance of digitized voice recognition as a critical key to the success of the electronic patient clinical record.

Status of voice recognition today

Now in their fourth generation, digitized voice sys- tems have come a long way from the initial vocabularies that were limited to a few dozen words. Current systems are capable of deciphering up to 30,000 words, thanks to the larger 386 and 486 machines now available. System designers are also realizing that each system only needs to hold the vocabulary necessary to produce certain re- cords and transactions. This will allow healthcare user interface for data entry and dictation in radiology and pathology, results reporting, inquiry, encounter records and the emergency room.

Early systems were speaker dependent and required considerable training to trace each individual’s speech patterns. Newer systems are speaker independent and require little or no training time. One major concern is the concept of continuous speech. Current systems have a 1/8- to 1/4-second pause between words, allowing 40


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