A community of 30,000 US Transcriptionist serving Medical Transcription Industry

Post written by SR - sm

Posted: Nov 30, 2013

hello. I'm posting this using Google speech recognition. Its a program on my android tablet. I never noticed it was here before. It isn't dragon. It isn't capital dragon. Well I guess I can't figure out how to make the capital letter show up, but I think if I found the instructions I probably could. If this tablet computer program works this well for me now, you can imagine how well front end speech recognition works for doctors and hospitals. Sure, there are some minor typos, but overall I think it did a good job. It's a lot faster than typing this by hand on the virtual keyboard. I can see the results appear right in front of me. It's really convenient. I think I'll probably use it more often. Now that I'm getting used to it, I'm liking it a lot more.

Are you an MT? - just wondering

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I'm assuming you're an MT, since you're on MT Stars. But you don't say, so you could be someone outside of our field. In any case, that is really an amazing result with your Dragon! Not good for us still in the field, but it is impressive, I must admit.

Used to be an MT - sm

[ In Reply To ..]
I used to be an MT, but I've moved on. This isn't dragon. I think dragon has more features. This is Google voice recognition. It is on my android tablet.

I've been looking for instructions but haven't found any. There are usergroups online complaining about the lack of line spacing, initial capitals and so forth. On the other hand, its pretty good about recognizing proper names like Mary Smith and Jon Jones, although it doesn't always spell them like you expect, and it does recognize end of sentence punctuation! It does know to space afterward and start with an initial capital. it's also knows how to make a

As you can see it just skipped a line when I asked and did make a paragraph that was new. I can't say to make a new you know what because it will do it instead of typing it. on the other hand it won't do it unless you say it just right.

I am able to type a lot faster now then in the first email. I'm catching on very quickly. It actually works better when I talk faster, but I have to enunciate. It doesn't like it when you slur words. It also seems to recognize what I am saying based on the contacts. If I stop, for instance, and then start up again abruptly, it doesn't recognize what went before and sometimes types the wrong thing.it is actually transcribing entire phrases I think. Its a lot smarter than I thought it would be.in fact if I couldn't spell very well and couldn't punctuate, I would think this is perfect.

Wow! - Amazing!

[ In Reply To ..]
Well, I'm impressed. :) Thanks for showing us. If Dragon is half as fast and accurate as Google Voice is, then our careers are all but over.

You are forgetting something - see msg pls

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This girl was an MT, so knows all the pitfalls of ASR. She is talking in a steady voice, not backing up over herself, not trying to shove a sandwich in her mouth while getting the dictation out, etc.

Unless the docs truly want to talk the way the machine needs it to talk, it ain't gonna work.

I have a friend who sells Dragon, and I have done a couple of "mock" dictations on his system---a C-section and a colonoscopy. Let me tell you, it came up just fine! However, I am not the real world of doctors and knew just how to talk into it to make it work.

So, rest easy. You're job in editing isn't over.

not to mention.... - mariazkafka

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ESL doctors and others with speech impairments (I have one ESL doctor who not only has a thick accent but also says "period" every 3 words -- always wondered how THAT would come out with SR).

How it comes out - sm

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You are used to seeing badly recorded dictation that goes off-site to your company, gets fed through SR that is NOT trained to individual doctors, transcribed however, then goes to you so you can fix it up.

That is not what happens with front-end SR on EHR systems. There is NO RECORDING, good or bad. It goes NOWHERE, near or far. There isn't even a phone involved. The report does not come back to the doctor days later to be signed.

Instead, the doctor is sitting in front of a computer. With the blank document open on the screen, he speaks what he wishes to write. The computer hears him. It appears RIGHT THEN. He sees the errors, discovers why they are occurring, and changes what he says so the errors don't happen. When he is finished, he can edit it with the keyboard. He signs it.

Before that, he has a training session with the system. It learns his voice, how he says certain things, and applies that learning to his dictation.
Believe it or not, ESL doctors often do quite well because the system is trained to it.

This is the opposite of what you have.

You keep harping on how it really won't work and how doctors won't like it and how they'll always need you to edit. That might be true, but only with the system YOU have. That is NOT what we are talking about.

What we are talking about DOES work, doctors either love it right off or learn to, and there isn't even a place in the process for anyone to "edit," even if they wanted to. The doctors do this themselves.

They aren't concerned about punctuation, capitalization, and spelling because it is the content meaning that matters. People can read it just fine no matter what.

We have this. I am not making it up. It works. We have NO MTs and NO EDITORS for this.

not to mention, the younger doctors in training, - NickMT

[ In Reply To ..]
does anyone know how they are being trained now to do dictations? perhaps they are changing the way they dictate for the future. It would be interesting to know how they learn it, then we might know our future.

ty

also, MModal uses 'speech understanding' - NickMT

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which gets around all the imperfections for specific doctors, such as saying 'period' etc. it also puts text in the appropriate sections.

NICKMT - RIMT

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That is sooo not true. I work at Mmodal and their speech fluency sucks big time! It puts in periods when the doctor stops. It does NOT understand any ESL docs at all. It leaves out words and sometimes whole sentences. Or it puts sentences in that are not even dictated. I don't know what MModal you work for but it's not the one I do.

The OP does not work for MM. - Works for a hospital, read the post

[ In Reply To ..]
NM

OP - RIMT

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Was not talking about the OP. I was responding to what Nick said.

Link inside - NickMT

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I have seen what this does...it is amazing: (I doubt MModal would want to tell MTs about it, they still need MTs until they don't)

http://www.marketwatch.com/story/university-of-virginia-health-system-selects-mmodals-speech-understanding-solutions-2013-01-29

(how the heck do yout put a link on here?)

anyway, from the first paragraph:

Virginia (UVA) Health System will deploy M*Modal Fluency Direct(TM) and M*Modal Catalyst for Quality(TM) to speech-enable its electronic health record (EHR) systems, bringing greater insight and analysis to patient records. Using M*Modal's cloud-based Natural Language Understanding(TM) speech engine, these solutions enable medical staff and informatics professionals to quickly and accurately capture clinical narratives for improved billing, productivity and patient care.

More... - NickMT

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"Providers can conversationally update patient narratives while M*Modal Fluency Direct interprets and understands their statements and populates EHR templates in a real-time, single process."

There are a lot more companies out there also offering these types of programs, and these programs can even identify medication dosage errors and lab errors as it has access to labs and meds, etc. It 'knows' if a dose is 20 mEq is supposed to be 20 mg and will flag it...very sophisticated.

...and yet more - NickMT

[ In Reply To ..]
â��At M*Modal, weâ��ve taken a unique approach to capturing the complete patient story through the power of advanced Speech Understanding,â�� said Vern Davenport, Chairman and CEO, M*Modal. â��We see the doctorâ��s narrative as a rich source of unstructured clinical data that can now be easily created, explored and analyzed to enhance the quality of care in the most efficient and meaningful ways, while improving internal processes, such as reimbursement.â��

Benefiting from a decade of continuous advancements, this latest market introduction furthers M*Modalâ��s rich heritage of delivering speech technologies, contextual understanding and workflow orchestration technologies to the healthcare industry. The new line of M*Modal Fluency clinical solutions has been built on M*Modalâ��s proprietary cloud-based Speech Understanding platform. The M*Modal Fluency family of solutions was designed to orchestrate information-enabled dynamic workflows that improve the quality, completeness and compliance of clinical documentation. M*Modal Fluency Direct provides:

Speech Understanding Capability:This capability surpasses traditional speech recognition technology, by analyzing the spoken word, understanding the intent and generating actionable data that informs and drives workflow â�� all with unmatched accuracy in a real-time, single process.
Fully Integrated Enterprise-Class Technology: Whether relying on mobile reporting, direct EHR speech enablement or simply back-end transcription, providers enjoy a consistent, personalized experience from any location. All M*Modal Fluency solutions rely on a single, cohesive technology platform housed in the cloud.
Out-of-the-Box Accuracy from Day One: There is no need to train M*Modal Fluency. For the past eight years and 200,000 physician voices later, the system has processed and analyzed huge quantities of data to understand the spoken word and in what context it was spoken. It understands each physicianâ��s accent, dialect, cadence and any sub-specialty terminology right out of the gate.

The Power of the Cloud: M*Modal Fluency allows providers to access a reliable and secure platform anytime, anywhere, on any workstation and provides IT departments with a streamlined deployment model that is easy to maintain.
Meaningful Use and ICD-10: M*Modal Fluency enables providers to be more efficient at capturing patient information in their clinical systems. This in turn drives adoption of EHRs and facilitates compliance with incentive programs such as Meaningful Use, as well as assisting with the transition to ICD-10.

And doing THIS, my friends, has been your job for - the last decade

[ In Reply To ..]
Yup, you trained this thing:

"decade of learning to recognize medical terminologies and specialties, as well as different accents, dialects and cadences, for "first time right" speech understanding"

You wondered where the easy dictation went? This is where. You've been training the system. First the easy, then the more difficult.

Doctors are not "trained to do dictations." - sm

[ In Reply To ..]
Doctors are not "trained to do dictations."

They study medicine. As part of that, they learn how to examine, evaluate, assess, formulate diagnoses and plans, etc. They learn the components of medical documentation, which they do by writing them. At some point during a clinical rotation, they may have an opportunity to dictate instead of writing, or that might not happen until residency. At that point, they have seen and heard others dictating. They just follow suit.

They don't get classes in how to do this, any more than you get classes in how to use an elevator.

Just curious...have you never worked in a teaching hospital?

Not formally trained for it... however - Alice

[ In Reply To ..]
at least,I would surmise that they would know how to use plain common sense. They might take a few minutes to listen to their OWN dictation/voice to see how it sounds, ask themselves, "If a stranger were listening to this on the other end of a phone/dictaphone line, would he/she be able to understand with 99 percent accuracy required by the MTSOs?

How would they know to ask themselves that? - sm

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You think they should ask themselves if you can "be able to understand with 99 percent accuracy required by the MTSOs?"

How are they supposed to know that MTSOs require 99% accuracy????

They have no idea who does their transcription, much less their requirements for employment. They don't have any way to find out, either.

One problem with your thinking about this is that even if they do listen, they understand it just fine. How would they not? They can't help but understand it because they know what they intended to say.

They assess whether it is understandable or not by what comes back. If the report is mostly there, they learn that it was understandable and continue on.

You are all bent out of shape because you think they are being inconsiderate by not doing something they can't possibly do. Who does that hurt? You.

Where are these doctors who have time to train and edit??? - Rose

[ In Reply To ..]
.

Thy're the same ones that have the time to dictate. - the only difference

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is they won't have to wait on us to return the doc.

Think again - Something fishy

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Unless you "train" it, it will not know the difference between 2, to and too, here and hear. then and than and many other sound alike words. I hate being a naysayer, but the punctuation and spelling look awfully good for front end SR. I've seen what Dragon and Radwhere produce in the work place by docs who speak very clearly, and I've never seen anything that looks this good. Being a former MT, you would be savvy enough to make people think you are using SR when in fact you are not. You should know better, anyway - Telling a bunch of MTs who lost their livelihoods because of SR that you think it is "perfect" is like waving a red handkerchief in front of a bull.

I said IF I could not spell or punctuate, I might think - it was perfect

[ In Reply To ..]
I said that if I could not spell or punctuation, I might think this was perfect. I did not say that it was perfect.

I am dictating this straight out, without changes, and without using my knowledge of speech recognition did to modify anything. In fact I do not have a knowledge of editing speech recognition because I have never edited speech recognition material.

I am no longer a medical transcriptionist. I got out more than 10 years ago. I am an information specialist. But, I don't work with speech recognition right now. I just know about it and about the system my facility has. It works really well.

I am also dictating this as a normal speaking right. Probably even a little faster than I would normally speak. the system is still keeping up with me it doesn't have any trouble with that. The only problem I see are you well see now it messed up because I change my mind. The only problems that I see with this are related to the fact that it is a low end, application on an Android tablet. It is not dragon. It is not front and speech recognition. It is just a freaking Android application. it is something that came on my computer when I bought it its a tablet its it's an Asus Transformer tablet and this is the standard Google voice thing that comes with Android phones and tablets. In fact it is several years old. It isn't even the newest addition.

Dragon - Been there.

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I lost my job to Dragon software at my last facility. It works for the 25% of the physicians who speak perfectly. Those, who we all have trouble with, produce unrecognizable documents of gibberish which they have no time or interest in fixing. Generally, what is seen is, previous report unreadable due to Dragon.

Now add an accent and while eating, add lots of background noise, change mid sentence - what you were saying. . .

[ In Reply To ..]
and see how it does.

Then change the accent but speak really fast and look away from the speaker once in awhile so your voice fades out completely and then take a phone call. Cough or sneeze into it and see what it comes up with.

Oh, I know, try it with a room full of kids and make sure the TV is on and your house is all tile so it echoes and see how it does. Then try it while you're driving.

Do this over and over and over like there are 100s of different voices and styles, etc.

You get the idea.

None of that happens - You have the wrong idea

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None of that happens. It just doesn't.

You are still thinking this is the same thing you have now. You aren't getting that there is no phone, no recording, no possibility of this working while eating. If the phone rings, they stop. The computer does not keep going.

I've seen this in action actually by - an ENT physician. . .

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Now I understand what the OP is referring to.

My son went to an ENT and the doctor sat down and dictated into the computer. He said it was learning and getting better all the time and had me come over and look at the screen. My heart sunk, let me tell you.

I just wonder how many docs would be on board with it. This guy was young and obviously computer savvy.

When I see my own nurse practitioner, she carries around a laptop and speaks while she types the diagnosis, plan, etc., and the note is done before she walks out the door.

The same with my primary care physician - roybrit

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He dictates while in the room with me and even dictates my return to work statement and referral for nutritionist. He goes to the printer and hands them to me as we leave the exam room. He's been doing this for at least 2 years. Of course he orders prescriptions via the computer and they go directly to the pharmacy, the same with lab orders. I appreciate that everything is done before I leave the office.

or... - cloverport

[ In Reply To ..]
have the doctor dictating from home with a dog barking in the background, or have the doctor not hang up after he is done dictating, and the machine picks up all the background talking and background noises... the report was over an hour long - LOL, and I had to delete most of the report.

This does not happen. - Sorry

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They have to be IN FRONT of a computer attached to the facility EHR. They cannot do this from the car, from a phone, or from home with dogs barking.

We are talking about oranges. You are like a person who has never had anything other than apples and assumes everything IS an apple.

Actually, the apple analogy applies to you ... - anon

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You are the one who has sampled only one apple and now assumes that not only everything is an apple but that all apples are alike. What the posters are saying is that most dictators do not sit in a quiet location dictating into one speech recognition engine that only processes that one voice. I would also point out there are multiple other speech recognition systems besides Google and Dragon. Windows and MModal for starters. You have not discovered anything new.

I never said I did - sm

[ In Reply To ..]
I never said I discovered anything new. And I never implied that all SR were alike.

You are correct, most dictators do not use this now. However, I would not put too many eggs in that basket.

As for physicians not sitting quietly at one computer to use it...that is nonsense. They certainly do. Where I work, hundreds of providers either do that or type it by hand, use a template, ir a combination of the three.

Our physicians have not been able to dictate from their car, cell phone, or anywhere other than sitting quietly at a computer for years. They can't do it unless they are in the EHR and privacy restrictions prevent them from doing it in exposed and therefore noisy locations. In any event, noise is their own problem because nothing goes to an MT.

I'm afraid I agree with you - Grate MT

[ In Reply To ..]
I have a sister who has adopted several kids from Honduras. I spent some time with my sister and family when the boys were in high school. She asked me to help the one who was having difficulty with his English class. I printed out one of his compositions and circled countless errors in spelling, punctuation, and just simple little things that he had not picked up or learned yet.

Fast forward now to today, when she forwarded one of his emails to me. He has returned from Afghanistan (alive and well, thank goodness) and is going to use the GI bill to go to school for welding, which is a job he could do without being great at the English language. I made the comment to my sister how well he was writing now and that he must have really gotten better with his English skills. She laughed and said, not really; that was done by his i-phone.

I agree... - that SR works

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remarkably well when you have one speaker and one person correcting mistakes. However, we all know you don't dare tell a precious doctor anything that might possibly improve the output, just like apparently it was taboo to tell them anything that would make dictation more accurate when there is a real person doing it, and as long as there are people willing to work for pennies cleaning up the mess, it will probably never happen.

Talking to walls - Sheesh

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Did you read the thread?

There are no editors. There are no people needed, not at any price, to clean anything up.

There is no need for anyone to offer dictation hints. There is no one in any position to see anything that would result in dictation hints.

THERE IS NO RECORDING. IT DOES NOT GO THROUGH AN MT OR AN EDITOR. THOSE JOBS DO NOT EXIST.

okay, so now pretend there are 150 different speakers - on the Dragon you trained

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Then multiply that 150 by, I don't know, 10? 100? 1000? Oops.

It's not dragon, it's a google app. 2 diff. things. - not the OP. nm

[ In Reply To ..]
nm

It was NOT DRAGON, just a Google APP! - Furthermore...

[ In Reply To ..]
I just used a Google app. It was just a free thing that came with my Android tablet. I don't HAVE Dragon.

In any event, you are NOT HEARING what I said about how this works.

In the system your company uses, the system is NOT trained to understand individual dictators. You seem to think that all SR is just like that. It is not!!!

The front-end system I am describing -- NOT that I am USING in that post -- does not involve many dictators blabbing into one untrained SR system. (That is what you have now.)

Instead, every dictator trains the software to himself. One to one. That's all. ONE. The software does not become confused because it handles ONE at a time. It knows who he is. It transcribes as he speaks, right in front of him.

Again, this is NOT a dictation system which records dictation in a huge tank, sends it out to your company, runs it through mass SR, sends the mess to you, has you fix it, has someone audit you, and then sends it back to the hospital days later.

It is an EHR with front-end SR, where the doctor trains HIS system to himself, it recognizes him, he talks, it transcribes in front of him phrase by phrase, NO DELAY, he fixes anything himself, and signs it. He does this DIRECTLY into the EHR. No paper. The files are not sent to HIMS to be edited, proofread, uploaded, printed, or anything else.

It makes no difference if the system has 1 or 1000 dictators, because it handles each one separately.

Before you come backsaying that there will be all sorts of errors...there can be, but it is not a huge issue. Typos, misspellings, and bad grammar do not interfere with the readability and information content of the report.

I think there may be physicians who want to use MTs for some things, like consultations, but there will be few in hospitals and non-specialty offices. Very, very few.

I think the fact that some cannot grasp how this works this may be why so many MTs appear to be blind to the reality of SR. We have been describing something different than what you use, and you keep "hearing" us talking about what you use. You keep insisting that "editors" will be needed, when they won't. You keep insisting that doctors won't use it, when they do. You keep insisting that it can't understand 1000 doctors, when it is only 1 at a time. You keep insisting that you are saving patient lives with your spelling skills, when that doesn't matter.

You're right - oldschool

[ In Reply To ..]
We're old school, and from what I see, it's all going the other way. Spelling and grammar aren't as important to young kids, they're growing up on acronyms and apps and quick fixes. I'm surprised that a "point-and-click" style isn't more available (for meds, diagnoses, all sorts of stuff). As long as the information on the chart portrays the patient's medical conditions and course in hospital, etc., it doesn't matter. And if a SR or point-and-click app can do the job in minutes as opposed to the time it now takes, what would you pick?
That's progress, and we're at the losing end. Too bad, I love my work!

Misconceptions - BTDT

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My facility uses SR (begins with a D). The doctors individually train their own voices, so contrary to what you think about large systems, it is being done one-on-one. They hate it and spend hours fixing the mistakes, that is about 85% of our work. The other 15% is straight dictation that goes to a service and comes back to HIMS for QC. I work in a large multispecialty hospital/clinic. Our physicians want MTs for stat reports (preops, consults) because the service can't guarantee quick enough turnaround. If you don't think that editing matters, consider this: 50 mg versus 15 mg in a medication dose, or any number of laboratory errors that I can name which could be a life or death matter. Facilities get sued over errors like that. You sound like a salesperson for SR. Why would you ever come on an MT forum and tell people that their skills mean nothing?

To All - see msg pls

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We can't call every SR program Dragon. They're not. Dragon seems to have become a generic name for speech recognition. (Kind of like Kleenex--a brand name--is to tissue; Q-tip to cotton swab, etc.")

I hear it all the time used incorrectly.

We won't be the first occupation to be lost to - L&L

[ In Reply To ..]
technology, nor the last. I agree, we are dinosaurs, but I'm finally 62 and I just simply don't care anymore. In 10 yrs MTs will be a thing of the past, just like horse drawn home milk carrier deliverers.

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Aug 17, 2012

http://hdstoday.com/?tag=mmodal Below are highlights of the news article In light of the One Equity Partners purchase of M*Modal, I predicted that within the next 12 to 18 months we may see OEP turn around and sell off M*Modal’s speech recognition technology to the likes of Microsoft, especially if Apple spends some of its cache of cash on Nuance. A $12 billion buyout of Nuance by Apple would dwarf the $1.2 billion M*Modal acquisition, and it would also put control of a huge chunk o ...

Feb 05, 2013

ASR respirations 17 culprit organism Dicatate respiratons 17 per minute you just cant make this stuff up ...

Mar 27, 2014

anyone heard back from them. ...