Pioneering speech recognition in Landstinget Västmanland, Sweden, has significantly reduced lead times in radiology. Just six months after integrating Nuance’s SpeechMagic technology into their Sectra RIS, the time between examination and a signed report, preliminary or authorized, has been cut by more than 50%. And this applies to both urgent and non-urgent examinations.
We now deliver reports faster. And if we deliver reports faster, we can handle patients faster. You dictate the report, sign it and it’s available on the intranet—all in one go. And thanks to Sectra RIS/PACS, the referring doctor also has immediate access to images together with the report, which further increases the level of service.
Speech recognition is a recognized technology and widely used in radiology all over the industrialized world. It is helping to solve some of the most pressing issues in healthcare administration: staff shortages in medical documentation, long report turnaround times caused by transcription backlogs and high documentation costs. In Sweden, however, adoption levels are low compared with its neighbors. But according to Dr. Bengt Arfvidsson, Chief Radiologist at Västmanland County Hospital Västerås, things may now be changing. Following the successful implementation of speech recognition and the proven efficiency gains, Arfvidsson has noticed considerable interest from hospitals all over the country eager to hear about their experience with speech-based radiology reporting.
“We now deliver reports faster. That’s the feedback we are getting from the emergency ward. And if we deliver reports faster, we can handle patients faster. You dictate the report, sign it and it’s available on the intranet—all in one go,” says Arfvidsson. “And thanks to Sectra RIS/PACS, the referring doctor also has immediate access to images together with the report, which further increases the level of service.”
Speed was indeed the determining factor for introducing speech recognition.
“We looked at the possibility of providing a better service to our colleagues on the wards. Cost saving was not on the agenda,” Arfvidsson says. “We have a good staff of secretaries. But we thought reporting would be faster if we managed it in one step.”
The radiologists had experienced a growing demand for their services over the last year, especially with regard to “complicated examinations” such as CT and MRI which involve longer reports. Producing these reports on weekends or during a night shift made it hard for them to deliver on time. This caused delays and inefficiencies—because in Sweden, too, the number of hospital beds is being reduced and ambulatory care is being given priority over hospital stays.
“The quicker we can create the report, the quicker our colleagues can decide to put a patient on the ward or send him home,” Arfvidsson says.
100% user adoption within three months
The first speech recognition pilot project included five doctors who concluded: “We thought it would be a good system, so we decided to use it throughout the radiology department.”
The radiology department comprises 25 radiologists in addition to a few doctors specializing in pulmonary diseases who use the Sectra RIS/PACS as well. Within three months they had all switched to speech recognition.
“The roll-out has been completed and most of the doctors now use speech recognition routinely,” Arfvidsson says.
The department has been able to significantly decrease the report turnaround time since the introduction of speech recognition, especially for emergency examinations where reports are needed extremely quickly and working without a secretary has proven highly efficient. The percentage of time-consuming examinations, typically CT and MRI, has increased over the last couple of years, creating a higher workload for the radiologists, especially outside office hours. Dr. Arfvidsson has found that the radiologist workflow has improved, with significant gains for emergency examinations requested by intensive care and surgery.
“Before authorizing the report, we check the correct recognition of the numbers and figures and correct any recognition errors. This can be time-consuming for longer documents, but because of the overall time gain and benefits we have come to love speech recognition,” Arfvidsson says.
In addition, speech recognition is a technology capable of learning—and it might take just a little more time before it becomes familiar with the radiologists at Västmanland County Hospital Västerås.
“It gets better and better and better the longer you use it,” Arfvidsson says. The hospital has two secretaries who check for new words in the reports and enter them into the system, another feature which increases recognition accuracy. “Speech recognition learns in two ways: first, it automatically adapts to the voice characteristics and dictation behavior of individual doctors, and then it also allows new words to be added to the central recognition vocabulary, which are then recognised for all users,” explains Nicklas Björling, project manager at Sectra Sweden.
Rolling-out a new technology is difficult, especially in a professional environment where it is imposed on users from the top. Dr. Bengt Arfvidsson therefore decided to work very closely with Sectra to manage the changes and guarantee the success of the project. A critical factor was to focus on user support and education from the very beginning—because at the end of the day the success of a system is down to them.
“We gave a general introduction to speech recognition for all involved—radiologists, secretaries and administrators. Then we provided individual training of one hour for each radiologist,” explains Björling. “After four weeks we repeated the training and after three months we did a follow-up and asked for feedback once again. This is important as it gives users an opportunity to voice concerns and wishes.”
Upgrading from digital dictation to speech recognition: massive time savings for dictation-intensive reports
|Average report turn-around time with speech recognition*||Difference to digital dictation*|
|High priority reports||00:27:45||-59%|
* Measurements taken March–April 2009 (Digital Dictation) and October–November 2010 (Speech Recognition)
Another critical aspect is that users are given the choice to use secretarial support for specific situations or very difficult cases. The SpeechMagic system within the Sectra RIS gives them the choice between finalizing a report immediately or sending it to the secretary. The good news is that most of the radiologists now go for the first option. This is also the reason why the overall number of secretaries has declined—and continues to do so. But at Västmanland County Hospital Västerås, none of the typists has been made redundant; instead, there was a restructuring initiative within the department and the hospital. But, in some cases, doctors do still rely on their typing skills.
“We can’t dictate standard letters with the system. The SpeechMagic system has a dedicated radiology vocabulary gathered from thousands of radiology reports. It does not cover the general vocabulary for day-to-day Swedish language,” says Arfvidsson. Perhaps another gap that needs to be plugged…
Key performance indicators
- The average length of a dictation is 29 seconds
- The average recording time for reports is 1:04 minutes
- More than 50% of all reports processed through SpeechMagic achieve a 100% recognition rate
Time frame: 6 months (23.6.10 – 31.1.11)
Volume: 40,941 reports