Should Doctors be Forced to Use Speech Recognition?

Cat being dragged, nopeNo doubt you’ve read marketing articles written by Nuance extolling the benefits its voice recognition software for medical professionals. That’s to be expected — they’re trying to sell a product. A very expensive, time-consuming, imperfect product that is not for everyone, no matter how hard they try to convince potential buyers otherwise.  But they are very good at making it seem like it’s the best thing since sliced bread.  Because the buyers believe the hype, and because they’ve spent a boatload of money on the system, the Powers that Be are forcing their doctors to use speech recognition.  Not only is that wrong, it’s dangerous.

Look at any marketing materials written by Nuance and you’ll see buzz words and phrases like:

  • Best practice
  • Increased productivity
  • Uniform documentation
  • Workflow efficiencies
  • Cost cutting

Really? Where’s the proof? Have the software developers and marketing gurus actually listened to the providers who are unhappy with the product? No, they have not.

Here’s the other side of the story, the users’ side of the story.

Talk to providers being forced to use speech recognition that doesn’t work for the way they practice medicine. You’ll hear words and phrases like:

  • Epic fail
  • Not user friendly
  • Way too many errors
  • Dangerously inaccurate
  • Impersonal
  • Takes too much time
  • Most frustrating thing I’ve ever dealt with in my life
  • My patients suffer because of this
  • I don’t have time to edit my own charts
  • (and a few others that are not repeatable)

Here’s a small sample taken from a large body of evidence to confirm and justify their complaints. These come from actual patient charts:

“Under treatment patient currently doing well in Adipex for a new will continue to stay on low glycemic index diet will continue bowel walking for exercise and will recheck with me in the next 4 weeks thanks.”

“She is requesting medication to help her with her appetite for car.”

“She O she actually has refills on her medication.”

“She has a prescription if needed she believes she is going to check a bowel supinating tablets or left but she doesn’t want to take this right now.”

“Cocaine patches for her low back pain which occurs intermittently one half patch usually works.”

“His entire car was kind of crunched like a Korean and he hit the Listerine as well.”

“Sensorineural hearing loss with peak drop at 500 Hz down to 35 testicles.”

“The patient has an expensive past medical history.”

“Her allergy triggers are almonds covered by palpable penile.”

“Medications: Compelling fish oil.”

“He will contact me if any changes need to be made prior to his suicide.”

How about that last one? That is simply unacceptable. Some of these would be funny if they weren’t part of a human being’s medical record. Can you imagine the chaos that would ensue if an insurance company got hold of the record containing “cocaine patches?” These are serious errors, and they are in millions of patients’ records right now. And many (most?) remain uncorrected.

Here’s what one of my employees said when she read some of the egregious errors that are now part of patients’ records:

“Dragon cannot understand or interpret the nuances and inflections that a doctor always has when dictating. A simple comma, when placed properly, can change the entire meaning of a sentence.”Did you catch that word ‘nuance?’ And what is the name of the company that sells Dragon? Yeah. Can we say ‘irony?’

Here’s what else she said:

“One of the jobs a transcriptionist does (that Dragon cannot do) is to edit/question when a doctor dictates something inaccurately. We are trained to question things that a doctor may mistakenly say (dates, dosages, medications, etc.). Without listening to what the doctor is dictating, I believe that tons of errors will fall through the cracks, even if there is someone “editing” the Dragon-dictated medical records.

“I think one of the things the doctors should consider is that doctors have historically been viewed as being very professional and are looked up to by the general population. When their communication (which is the medical records) is so sloppy and full of errors, their professionalism may come into question. And this is what medical dictation has come to.”

Am I biased? You bet I am! I’m a patient. My mother is a patient. My other family members and friends are patients. I found an error in my own chart, a diagnosis that in no way, shape or form applied to me. The chart was dictated with Dragon Medical and obviously never reviewed or edited.

In addition, I’ve developed a relationship with my clients. They trust me to make a coherent, accurate medical record. They trust that I will question them if something doesn’t sound right. They trust my experience, my training in medical terminology, my common sense, and my ability to translate regional and local dialect.

This is about patients and doctors. That’s all it’s ever been about, or should be about. But Nuance and others like them only see dollar signs.

I’m not even going to quote a bunch of statistics; statistics can be manipulated, facts cannot. And the fact is, this is not working for many, many doctors and their patients. Ask your provider how to monitor your health records through the patient portal. (We all should – it’s like monitoring your credit.) The chances of an error occurring in a record dictated using speech recognition are far greater than those occurring in a dictated and human-transcribed record.

To sum it up, a colleague had this to say, which is so succint, yet profound: “I don’t understand the reasoning behind this.” That is a very good question. If speech recognition is so wrong for so many medical providers and their patients, then what is the reasoning behind forcing them to use it?

5 Comments

Filed under Dictation and EMR

5 Responses to Should Doctors be Forced to Use Speech Recognition?

  1. Norma Whitt

    This article speaks for SO MANY workers in the healthcare profession. As a transcriptionist for 20+ years, I personally have seen many, many changes in the field of medical transcription. Forcing doctors to use voice recognition software is, in my opinion, a change that has created unparalleled chaos in the medical records industry. I am appalled at how little attention has been paid to the decline of medical records accuracy and “trustworthiness” in recent years. It may be easy for the dictators to simply speak, click and end dictation — however, we need to address what ends up being input into that chart with this sort of communication. There are so many ways for voice recognition to “go wrong”, as the author suggested above. My question is this: What happened to a patient’s medical record being considered a professional, medically and legally accurate document??

    • Nancy

      Your last question is a very good one, and I can tell you where that’s headed: In at least one multimillion dollar settlement, the judge threw out the EMR as inadmissible in court because it was so incoherent. I’ll be writing more about that soon. Stay tuned, the battle is heating up.

  2. What companies like Nuance always fail to acknowledge is that many doctors (both English-speaking and ESL) simply cannot dictate a coherent sentence. Programmers have yet to deliver a software package that can handle that function.

    It ain’t alchemy — it’s called editing.

    George Heymont
    http://myculturallandscape.blogspot.com/2007/11/about-author.html
    http://www.huffingtonpost.com/george-heymont

    • Nancy

      Exactly. You can’t force a square peg into a round hole. Unfortunately, many hospital systems aren’t willing to pay to edit the debris left by the squares.

  3. Su Majewski

    With speech recognition, you’re not supposed to edit anything more than things like the is/was, are/were combinations and blatant errors (i.e. the doctor said “below-knee amputation and the speech engine typed “baloney amputation”). Aside from that, you correct nothing. If the doctor says “Patient admitted June 15 telemetry floor” that is EXACTLY what you leave in the document (albeit kicking and screaming all the way). The hospitals are then required to allow the speech engine to learn from the corrected transcript. Failure to [1] leave things as dictated except as stated above, and [2] or the hospital to do their part, as stated, and the speech engine will deteriorate rather quickly. — And, yes, there are some dictators that should not use the speech engine … so you don’t let them.

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