Doctor Dictation and Electronic Health Records

The real scientist is ready to bear privation and if need be, starvation rther than let anyone dictate to him which dicrection his work must take.

Albert Szent-Georgia (193-1986), Science Needs Freedom

October 11, 2012 -  Electronic health records express a physician’s freedom of expression.  EHRs rely on voiceless data to guide to document what a physician thinks, how his performance is judged, and what he may be allowed to do.  Besides it is impersonal and lacks humaniiy.

That is why I found this opening paragraph on personal technology by Walter S. Mossberg, an IT expert, so compelling.

“I am writing these words – without touching a key. I’m dictating them into a word processore on a laptop.  To do this, I’m using a very versatierl program that not only allows me to dictate text but to correct it delete it, and format it, all with my own voice.

This software enables me to perform other tasks on the computer by just talking. I can lauch and clost eappliations. I can search the Web and jump diretly to Web pages using only my voice. I can address, compose and send emails.”

Which reminds me of a post I wrote on April Fool’s Day, except I wasn’t fooling.

The Human Voice as an EHR and Dictation Game Changer

Sweet is every sound.
Sweeter thy voice, but every sound is sweet.
Alfred North Tennyson (1809-1892)
Now the race is on to make the voice the sought-after new interface between us and our technologies.
Natasha Singer, “The Human Voice, as Game Changer,” New York Times, April 1, 2012

April 1, 2012 – Back on August 16, 2010, I wrote a blog “Searching for Medical Information Through Speech Recognition.”

In the bIog, I complained :

“With EHRs doctors can’t express themselves in plain English, just in data bytes. EHRs too often generate numeric gibberish. They fail to pass the useful narrative test.”

I went on to describe how a company called Nuance Healthcare in Massachusetts had developed software allowing physicians to dictate their messages into EHRs. I cited an article by Drs. Gordon Schiff and David Bates in the March 24, 2010 NEJM to back up my claim that voice recognition software might translate into a useful clinical tool.

I may have been prophetic. In today’s April 1 New York Times,“The Human Voice, as Game Changer,” a reporter describes how Nuance, Inc. has become a high tech IT powerhouse employing 7300 people with revenues of $1.3 billion, $575 million of which come from the health technology sector.

The article says Google, Microsoft, and Apple are heavy into voice recognition. Notes the reporter: ” Nuance, meanwhile, has similarly ambitious plans for its health care business, In collaboration with I.B.M, the company is developing analytics to scour the medical notes that doctors dictate after they see patients. The idea is to search the text for common red flags – like medicines that interact dangerously – automatically alert doctors , hopefully reducing problems and health care costs.”

This smacks too much of Big Brother is watching you, but perhaps I am paranoid. To me, the chief benefit of speech recognition is allowing doctors to tell the patients story without wading through reams of data. I believe in the power of narrative.

Tweet: Nuance Inc, and other big IT companies, think of speech recognition as a health care game changer, bringing new efficiency to the table.

Sources

1. Natasha Singer,”The Human Voice, As Game Changer,” New York Times, April 1, 2012.

2. G.D, Schiff and D.W. Bates, “Can Electronic Clinical Documents Help Prevent Diagnostic Errors, : New England Journal of Medicine, March 25, 2010.