Tuesday, March 24, 2009

Speech Recognition and MT Compensation

Speech Recognition and its relationship to compensation took on a life of its own over at the MTChat message board in this thread titled MT Exchange: MTs and "Speech Wreck". There were strong words and a concerted attack on Julie Weight....Yikes! The confusion that ensued linking and even blaming a technology with poor business practices and in particular poor compensation models that appeared to be unfair missed the point.

But it was the posting by Jay Vance of XY Files in an MT World who posted a thoughtful response to some of the criticism being leveled at Speech Recognition in this posting "Is Speech Rec Wrecked" that even featured actual data (thanks for sharing this!) from a survey he conducted in 2006 of Speech Recognition editors. In fact the data presented was helpful in assessing the actual benefits (back in 2006 - a long time ago in technology terms!) that even then showed:
a total of 51% of respondents - saw an average increase in productivity of between 25% and 50%. This confirms the anecdotal information I had collected via informal conversations with MTs working as SR editors in a variety of situations on a variety of SRT platforms.
I don't think it is a stretch to assume that this must have gotten better and productivity has improved beyond this and for a greater proportion of editors. The survey included some review of compensation changes (there was a reduction in rate but hard to determine if this was a real reduction or represented a reduction in rate that was offset by increased productivity) and a final question on satisfaction with the technology:
31% said they were somewhat satisfied
26% said they were very satisfied. These two categories totaled 57%
Not great but better than average. Overall
there is a wide spectrum in terms of the impact of SRT on productivity, compensation, and overall satisfaction among MTs working as SR editors. Consequently, I don't believe there is enough objective evidence to conclude that speech recognition has proven to be a widespread disaster for the MT working class. As with any scenario involving people, technology, and money, mileage is going to vary widely. In my experience, there are simply too many factors that can influence productivity, compensation, and overall satisfaction with speech recognition technology to draw hard and fast conclusions about the impact SRT is having on working MTs on the whole.
And this was in part the point that Julie Weight was trying to make on the MTChat board - there are many factors and there is no use trying to stall the implementation of Speech technology - that trains has left, like outsourcing.

Both Jay and Julie make the point that this technology is in use and although I probably am a stronger advocate and believer in the Speech technology I think the overriding point here is that this can and should be a good thing for the industry. Reducing the labor intensive element of producing a report has to be a good thing....freeing up the medical editor to add value to the clinical information as part of the process of review, editing and validation.

Recognizing this is old data this gives us a good reason to update this information and there is a survey currently ongoing from MTIA that can be taken here and I would encourage you to participate. This is an extensive survey and needs input but if you don't have the time I put a 4 question survey here that. If you can spare the time please take the full survey, but if not I'd welcome hearing your responses.

Monday, March 16, 2009

Reinvestment is not Just About Technology

There is lots of excitement or even frenzy over the wave of investment coming down the pipe towards healthcare technology but in this piece on the Huffington Post: Workforce Development Essential to Obama's Health Care IT Initiative Julian Alssid and Jonathan Leviss are quick to point out that there is an essential element that must be included - that of Human Capital. Healthcare is unique and transplanting technology from other industries is not a straightforward process
Hospitals are not banks, or insurance agencies, or hotels. Healthcare's unique workflows -- including many physicians and nurses sharing computers in a busy emergency room, the challenges of maintaining working hardware in an intensive care unit, and the vast realm of data accessed to care for a sick human being -- require novel technologies and processes that cannot be easily translated from other industries.
While I agree that some technologies have stalled many are being implemented and are delivering success today. Speech Recognition did suffer problems in noisy environments (that's why the early adopters of this technology are Radiologists who mostly work in quiet reading rooms). But newer Speech Understanding which is modelled on nature's success in speech understanding by not only using audio inputs but also getting information from the patent's previous history, demographics, prior reports and any other elements that will help in understanding what was said.

But that's not enough
Physicians, nurses, and other health care providers routinely learn new skills and adopt new technologies....What is missing, however, is a parallel training track for a sufficient workforce to develop, implement, manage, and support advanced information technologies in hospitals, doctors' offices, and other health care venues.
So providing the infrastructure is one thing but having the resources to support it is an essential part. This is especially true for the embattled medical transcription industry that has been fighting declining rates of pay as hospitals and healthcare providers continue to push for lower and lower line rates. All this is driven by the perception of the medical transcription is a cost, when in actual fact it is a value added service that frees up the clinical staff to focus on taking care of patients rather than the drudgery of data entry. There are lots of examples of systems trying to turn clinicians into data entry clerks and while there are instances where this methodology makes sense in many cases it does not. Technology will help (see above - Speech Understanding is moving speech into the 21st Century) but even with this technology there is still the requirement to provide support and expertise to facilitate the process of capturing information that is essential to the new age of data driven medicine. The Medical Transcriptionist is the knowledge worker who delivers the value add of helping turn clinical information into structured clinical data that includes the fine detail in the free form narrative that clinicians need and want to include while adding tagged structured data to deliver the full Healthstory for the patent's episode of care.

Tuesday, March 10, 2009

Computers Don't Have to Depersonalizes Medicine

The NY Times article this week; The Computer Will See You Now written by a pediatric physician complains that the electronic medical record has depersonalized her interaction.

HISTalk commented on it in his morning update and highlighted the complaints:
  • using the computer in front of patients is intrusive
  • standard questions must be asked in order even when they clearly don’t apply
  • the doctor might swear in front of patients when the computer does something wrong
  • computers lose context because doctors can’t underline, write bigger, or otherwise highlight something important
And I would add that because it gets printed out and is held in a computer it appears to carry more weight/validity.

As the author says:
The benefits (of the EMR) may be real, but we should not sacrifice too much for them
And the end result for her is
In short, the computer depersonalizes medicine. It ignores nuances that we do not measure but clearly influence care
But the prescribed treatment of a hybrid using a tablet ignores most of the issues and concerns highlighted and forgets the relative difficulty of interacting with tablet or screen based technologies while facing and talking a patient. No doubt there are some circumstances where this does make sense but the key to success is the hybrid approach or blended model that does uses all the available methods and tools.

It is important to not turn our clinicians into data entry clerks and utilizing the finely honed and developed skills of the medical editor/transcriptionist to convert this audio into the data necessary to drive the EMR. Technology can assist and provide some efficiency to the process and specifically Speech Understanding can automate some of this process. But this method of capturing the voice is repeatedly dropped or forgotten in this discussion. There are circumstances where this technique may not apply (public forum in earshot of nosy eavesdroppers fro instance) but for circumstances where it does voice provides a ready and efficient method. Historically this created text that the EMR systems had difficulty using (they are essentially data driven repositories) but with the addition of tagged information that is linked to the narrative all held in the complete Healthstory we bridge the gap. Not only allowing for the inclusion of the fine detail that is essential and influences care but linked and part of this same material is tagged structured and encoded data that can feed the data hungry EMR.

Tuesday, March 3, 2009

Annoying Hard to Use Systems Won't Be Used

It is no real surprise to find that criminals are getting a pass because the police in Queensland Australia don't want to waste time using an expensive "time-consuming data entry system" that takes hours for jobs that used to take an hour.

The QPRIME (Queensland Police Records and Information Management Exchange) is supposed to reduce the burden and improve efficiencies but due to the complexity of navigation, officers are:
reluctant to make arrests and they're showing a lot more discretion in the arrests they make because QPRIME is so convoluted to navigate....minor street offenses, some traffic offenses and minor property matters were going unchallenged
Naturally the Queensland Police Service are standing by their $100 Million investment with the tired and worn out mantra
....the benefits of the QPRIME system into the future far outweigh short-term disaffection by some officers
It's the same in healthcare and the EMR systems being pushed onto the busy clinician today. In some cases they rebel and refuse to be stuck in a system that forces inefficiencies but in many cases find themselves turned into data entry clerks. I've said it before and I'll say it again - why is it Healthcare is the only industry that tries to turn our most highly skilled knowledgeable resources into data entry clerks?

Stop the madness, allow clinicians to capture information without creating a burden of data entry. Clinical documentation is supposed to support clinical care and capturing it should not be a burden that prevents adoption of essential healthcare support technology like the EMR. There is a swathe of clinical documentation specialists who spend their lives offering highly skilled review and editing services that free up the clinician to focus on patient care. They are not just a cost - in fact they offer a value add service that has been delivering grammatically correct, well structured and presented clinical reports for many years. Allow clinicians to capture the full Healthstory that contains both these elements and satisfies the clinical need and computer’s insatiable demand for structured data.

Otherwise patients, like the criminals in Queensland, will find that their symptoms may go unchecked or noticed as clinicians are unable to do both data entry and deliver high quality care.

If you are a patient watching your clinician attempting the nigh impossible feat of paying attention to you and your clinical condition while juggling a laptop, tablet or some other computer based data entry system, do him and yourself a favor. Insist you want the full Healthstory and let him know he can deliver that with the help of his friendly clinical documentation specialist/knoweldge worker without him having to do hunt and click through endless screens. And if you do tell him, let me know what he says and leave a comment here.