Comments on: HIStalk Interviews Loren Leidheiser DO, Chairman & Director, Department of Emergency Medicine, Mount Carmel St. Ann’s Hospital, Westerville, OH http://histalk2.com/2009/07/27/histalk-interviews-loren-leidheiser-do-chairman-director-department-of-emergency-medicine-mount-carmel-st-anns-hospital-westerville-oh/ Healthcare IT News and Opinion Thu, 09 Feb 2012 04:50:12 +0000 hourly 1 http://wordpress.org/?v=3.3 By: Deborah Kohn http://histalk2.com/2009/07/27/histalk-interviews-loren-leidheiser-do-chairman-director-department-of-emergency-medicine-mount-carmel-st-anns-hospital-westerville-oh/comment-page-1/#comment-4949 Deborah Kohn Wed, 29 Jul 2009 17:20:39 +0000 http://histalk2.com/2009/07/27/histalk-interviews-loren-leidheiser-do-chairman-director-department-of-emergency-medicine-mount-carmel-st-anns-hospital-westerville-oh/#comment-4949 Maybe these are some of the reasons why few hospital-based (and practice-based) doctors use speech recognition. First, there are two types of speech recognition: 1) Orders-based (for the pathologists, the radiologists, the cardiologists -- with, for all intents and purposes, more limited vocabularies and dictating [via speech] ordered test result reports); and, 2) Encounters-based (for the internists, the ED physicians, etc., -- with, for all intents and purposes, more broad vocabularies and dictating [via speech] H&P, consultation, discharge summary, progress note reports). Second, there are many speech recognition products from which to choose. However, for all intents and purposes, today there are only two, commercial, speech recognition "engines" - the Dragon and the Philips engines. (IBM used to have an engine, but that went by the wayside.) Consequently, almost all the vendors providing speech recognition "products" license / partner with either / or. What is interesting is that, today, Nuance IS the Dragon engine, having acquired this engine several years ago when Nuance was known as ScanSoft. When Nuance acquired Dictaphone, Dictaphone was / still is using the Dragon engine. However, when Nuance acquired eScription, eScription was / still is using a self-developed engine. In the case of Philips (Royal Philips Electronics Speech Recognition Systems Division), today Philips WAS the Philips engine, having developed this engine (I think) around the 1990s (around when there still was Kurzweil). When Philips acquired roughly 70% ownership in MedQuist (formerly Lanier Voice Products Division), MedQuist, for obvious reasons, used the Philips engine. However, during 2008, when Philips sold its ownership in MedQuist as well as its SR Systems Division, Nuance acquired this division and its engine! Now Nuance owns both engines! The key for potential buyers of Voice (Dictation) / Text (Transcription) and/or Speech (Recognition) (a.k.a., VTS) systems / products / components is to know which Nuance speech recognition "engine" is being used (and evaluate it carefully) AND which Nuance or other VTS vendor / "product" is being reviewed (and evaluate it carefully, too). Maybe these are some of the reasons why few hospital-based (and practice-based) doctors use speech recognition.

First, there are two types of speech recognition: 1) Orders-based (for the pathologists, the radiologists, the cardiologists — with, for all intents and purposes, more limited vocabularies and dictating [via speech] ordered test result reports); and, 2) Encounters-based (for the internists, the ED physicians, etc., — with, for all intents and purposes, more broad vocabularies and dictating [via speech] H&P, consultation, discharge summary, progress note reports).

Second, there are many speech recognition products from which to choose. However, for all intents and purposes, today there are only two, commercial, speech recognition “engines” – the Dragon and the Philips engines. (IBM used to have an engine, but that went by the wayside.) Consequently, almost all the vendors providing speech recognition “products” license / partner with either / or.

What is interesting is that, today, Nuance IS the Dragon engine, having acquired this engine several years ago when Nuance was known as ScanSoft. When Nuance acquired Dictaphone, Dictaphone was / still is using the Dragon engine. However, when Nuance acquired eScription, eScription was / still is using a self-developed engine.

In the case of Philips (Royal Philips Electronics Speech Recognition Systems Division), today Philips WAS the Philips engine, having developed this engine (I think) around the 1990s (around when there still was Kurzweil). When Philips acquired roughly 70% ownership in MedQuist (formerly Lanier Voice Products Division), MedQuist, for obvious reasons, used the Philips engine. However, during 2008, when Philips sold its ownership in MedQuist as well as its SR Systems Division, Nuance acquired this division and its engine!

Now Nuance owns both engines!

The key for potential buyers of Voice (Dictation) / Text (Transcription) and/or Speech (Recognition) (a.k.a., VTS) systems / products / components is to know which Nuance speech recognition “engine” is being used (and evaluate it carefully) AND which Nuance or other VTS vendor / “product” is being reviewed (and evaluate it carefully, too).

]]> By: El Jefe http://histalk2.com/2009/07/27/histalk-interviews-loren-leidheiser-do-chairman-director-department-of-emergency-medicine-mount-carmel-st-anns-hospital-westerville-oh/comment-page-1/#comment-4935 El Jefe Tue, 28 Jul 2009 13:41:51 +0000 http://histalk2.com/2009/07/27/histalk-interviews-loren-leidheiser-do-chairman-director-department-of-emergency-medicine-mount-carmel-st-anns-hospital-westerville-oh/#comment-4935 The critical access point of the hospital is the ED. In fact, as much as 80% of all discharges are from the ED with a small % being admitted. ED overcrowding is reach epidemic proportions and patient wait times are continually increasing in many hospitals. LWBS metric which many CFO's chart on a daily basis is also increasing. Any technology that can improve the patient flow engine while improving clinical outcomes ought to be a top priority in all ED's. EDIS can carry a price tag of $100's K but there is an alternative. There are companies that sell standalone computerized discharge instruction and prescription writing software for a fraction of the cost of a full blown EDIS. For less that $10k a hospital can purchase a DCI software system and begin their migration towards an eventual deployment of an EDIS and launch their enterprise EMR strategy. Not all clinical software systems are bank busters. The critical access point of the hospital is the ED. In fact, as much as 80% of all discharges are from the ED with a small % being admitted. ED overcrowding is reach epidemic proportions and patient wait times are continually increasing in many hospitals. LWBS metric which many CFO’s chart on a daily basis is also increasing.

Any technology that can improve the patient flow engine while improving clinical outcomes ought to be a top priority in all ED’s.

EDIS can carry a price tag of $100′s K but there is an alternative. There are companies that sell standalone computerized discharge instruction and prescription writing software for a fraction of the cost of a full blown EDIS.

For less that $10k a hospital can purchase a DCI software system and begin their migration towards an eventual deployment of an EDIS and launch their enterprise EMR strategy.

Not all clinical software systems are bank busters.

]]> By: PezMan http://histalk2.com/2009/07/27/histalk-interviews-loren-leidheiser-do-chairman-director-department-of-emergency-medicine-mount-carmel-st-anns-hospital-westerville-oh/comment-page-1/#comment-4934 PezMan Tue, 28 Jul 2009 13:32:11 +0000 http://histalk2.com/2009/07/27/histalk-interviews-loren-leidheiser-do-chairman-director-department-of-emergency-medicine-mount-carmel-st-anns-hospital-westerville-oh/#comment-4934 Not sure where the hesitation is for voice dictation? So, the doctors instead of dictating vocally into a phone for a dictation analyst to decipher and type out, wait a while to get the finished report back, approve and release...can now do it in their shift & be done with it. Sorry, but there is no business model where spending $500K to go slower makes any more sense. Sure there is a slight learning curve, but just like typing...you get faster with it due to repetition and increasing advancements in the software you are dictating into. With discrete data elements and some of the macro driven notes out there, the free-text portion where you need to actually dictate is growing smaller since most of the notes will be pre-filled for you. Sorry, but I have seen tons of EDs incorporate this into their everyday life with doctors kicking and screaming. Go back a year later and try to take it away...and they will kill you. Not having work pile up on them is actually a good thing. Not sure where the hesitation is for voice dictation? So, the doctors instead of dictating vocally into a phone for a dictation analyst to decipher and type out, wait a while to get the finished report back, approve and release…can now do it in their shift & be done with it. Sorry, but there is no business model where spending $500K to go slower makes any more sense. Sure there is a slight learning curve, but just like typing…you get faster with it due to repetition and increasing advancements in the software you are dictating into. With discrete data elements and some of the macro driven notes out there, the free-text portion where you need to actually dictate is growing smaller since most of the notes will be pre-filled for you.

Sorry, but I have seen tons of EDs incorporate this into their everyday life with doctors kicking and screaming. Go back a year later and try to take it away…and they will kill you. Not having work pile up on them is actually a good thing.

]]> By: Dr. Linda Christmann http://histalk2.com/2009/07/27/histalk-interviews-loren-leidheiser-do-chairman-director-department-of-emergency-medicine-mount-carmel-st-anns-hospital-westerville-oh/comment-page-1/#comment-4933 Dr. Linda Christmann Tue, 28 Jul 2009 10:57:52 +0000 http://histalk2.com/2009/07/27/histalk-interviews-loren-leidheiser-do-chairman-director-department-of-emergency-medicine-mount-carmel-st-anns-hospital-westerville-oh/#comment-4933 Hooray for this article. I started using Dragon at version 6.0 also in my 2 doctor practice to cut out transcription fees. We were paying $20 - 25K per year and were able to cut it to 0. This put more money in our pocket, AND we got transcription out to the referrring MD within 24 hours - a great referring doctor satisfier. It is high time other physicians explore this for all the right reasons. BTW - version 10.0 is faster, more accurate, and allows non-EMR users to create custom templates. Dragon is here to stay. Hooray for this article. I started using Dragon at version 6.0 also in my 2 doctor practice to cut out transcription fees. We were paying $20 – 25K per year and were able to cut it to 0. This put more money in our pocket, AND we got transcription out to the referrring MD within 24 hours – a great referring doctor satisfier. It is high time other physicians explore this for all the right reasons. BTW – version 10.0 is faster, more accurate, and allows non-EMR users to create custom templates. Dragon is here to stay.

]]> By: disbelieving doc http://histalk2.com/2009/07/27/histalk-interviews-loren-leidheiser-do-chairman-director-department-of-emergency-medicine-mount-carmel-st-anns-hospital-westerville-oh/comment-page-1/#comment-4932 disbelieving doc Tue, 28 Jul 2009 05:45:43 +0000 http://histalk2.com/2009/07/27/histalk-interviews-loren-leidheiser-do-chairman-director-department-of-emergency-medicine-mount-carmel-st-anns-hospital-westerville-oh/#comment-4932 Voice doesn't work for most busy ED docs. It's not that it isn't pretty accurate, it's just that it's very time consuming and distracting to have to edit what you are doing.... even if it's 99% accurate you have to wait, watch and read it...which is very distracting in the busy constantly interrupted multitasking ED environment .... to say nothing about pulling up a chair and leisurely putting on some headphones. It is true the hospital admin is saving $500K though. Once volume is above 30,000 per year in the ED, a good EDIS is necessary for patient tracking (Allscripts is certainly one of the good ones), but full use of the EDIS for doc work tasks (order entry, documentation, typing DC instructions) kills doc productivity to the tune of about 30%. There are only 2 ways to efficiently document: regular dictation and a good paper 'chief complaint' directed template. This is why in most cases the tracking is adopted but physician tasks continue as before. This is what people just don't get: the patient and results tracking is great but the data entry pieces for all the commercially available electronic EDIS for docs and nurses just serve to take them away from the patients.... which is bad for EVERYTHING: patient satisfaction, patient safety, worker satisfaction and worker productivity. Voice doesn’t work for most busy ED docs. It’s not that it isn’t pretty accurate, it’s just that it’s very time consuming and distracting to have to edit what you are doing…. even if it’s 99% accurate you have to wait, watch and read it…which is very distracting in the busy constantly interrupted multitasking ED environment …. to say nothing about pulling up a chair and leisurely putting on some headphones. It is true the hospital admin is saving $500K though. Once volume is above 30,000 per year in the ED, a good EDIS is necessary for patient tracking (Allscripts is certainly one of the good ones), but full use of the EDIS for doc work tasks (order entry, documentation, typing DC instructions) kills doc productivity to the tune of about 30%. There are only 2 ways to efficiently document: regular dictation and a good paper ‘chief complaint’ directed template. This is why in most cases the tracking is adopted but physician tasks continue as before. This is what people just don’t get: the patient and results tracking is great but the data entry pieces for all the commercially available electronic EDIS for docs and nurses just serve to take them away from the patients…. which is bad for EVERYTHING: patient satisfaction, patient safety, worker satisfaction and worker productivity.

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