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● Thought Leaders Got speech

among the top-two technologies, with a 21.5 percent com- pounded annual growth rate at a comparatively low current market penetration of 47 percent. T e study leveraged the HIMSS Analytics Database to profi le the use of 22 support service applications in hospitals and tethered ambulatory and home health agencies. Some industry experts have commented on the fact that


speech recognition products for healthcare professionals have been around for many years, and raised the question of why we now see physicians and other care providers adopt these products at a much faster growth rate than we have seen in the past. Did the technology improve to the point that speech recognition products are now widely understood to be es- sential productivity tools for effi cient clinical documentation? Or are there other factors at play too? To answer these questions, we need to look more broadly

at the recent trends in physician clinical documentation. Ever since the HITECH act made billions of dollars avail- able to hospitals and providers for adopting “meaningful use” electronic health records (EHR) technology, we have seen accelerated growth in EHR deployments. T e Department of Health and Human Services (HHS) announced recently that it has exceeded its goal of 50 percent of physician offi ces and 80 percent of eligible hospitals having EHRs by the end of 2013. Adoption of EHRs by physicians began a steady increase about two years ago.

Along with the accelerated adoption of EHR systems,

however, we have also seen what some observers have called “rampant physician dissatisfaction” due to workfl ow dis- ruptions and productivity losses. Many physicians fi nd it challenging to maintain their historic levels of effi ciency while struggling with usability issues associated with EHR user interfaces. Clinical documentation modules of EHRs, in particular, have been found to cause major productivity losses if not implemented carefully. T e increasing trend

24 January 2014

recognition? Why free-form narratives are making headway in EHR physician documentation modules. By Juergen Fritsch, Ph.D.

ccording to a recent report from HIMSS Analyt- ics, speech recognition technology is showing one of the highest potentials for growth within the hospital IT market. T e technology is listed

Juergen Fritsch, Ph.D., is chief scientist, M*Modal.

For more on M*Modal: www.rsleads. com/401ht-201

toward data-driven healthcare has led to a misguided focus on keyboard- and mouse-driven, templated structured data entry that overburdens the physician with a plethora of check boxes, radio buttons and drop-down menus – with signifi cant risk of reduced quality of documentation when there is heavy use of standard EHR templates and copy-and-paste tools. Many healthcare organizations have realized these pitfalls

of overly structured clinical documentation, which has led to a renaissance of the physician narrative in EHR-based clinical documentation. Patient histories as well as assessments and treatment plans benefi t vastly from a thorough physician narrative that explains his/her thought process, as well as captures the diff erent levels of certainty that are inevitably associated with diff erent diagnoses and treatment options. T ese aspects simply cannot be captured via structured tem- plates or mapped to structured data models without a loss of information. It is no wonder, therefore, that the hospitals that have achieved the highest rates of adoption of their EHR physician documentation modules have implemented a healthy mix of structured data entry and free-form physi- cian narrative. T is is where speech recognition technology comes into the

picture. T ere is no faster and more natural way for a physi- cian to tell a patient story than to narrate it verbally. Speech recognition technology has matured to the point where most physicians can dictate such narratives at blazing speeds with highly accurate automatic transcription happening in real time. Not only that, but advances in technology have led to a new generation of speech understanding (SU) systems that are capable of understanding the meaning of a physician narrative in addition to just transcribing the dictated words. T at means that narrative documentation has become actionable and can be analyzed along with the structured data captured by EHR systems. Clinically focused natural language understanding (NLU) technology can now identify key patient information in free-form narrative, analyze it in context of all other avail- able patient health information and ultimately assist healthcare organizations in making more informed decisions across a mix of structured and unstructured data.


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