PACS/RIS vendors drive integration of voice recognition for radiologists

PACS/RIS vendors drive integration of voice recognition for radiologists

Accuracy issues take backseat to workflow pressures

Voice recognition has found an unlikely ally in its efforts to make inroads in medicine: PACS. Every major imaging and PACS vendor now offers, or is on the verge of launching, digital dictation capabilities integrated with their radiology workstations. Some are even going a step further and voice-enabling these systems to respond to spoken commands. In both cases, the goal is to help radiologists streamline workflow and improve efficiencies, and the issue of whether the technology is accurate enough seems to have become moot.

A key player in this latest image management trend, which has really only caught on in the past year, is Talk Technology. Founded in 1993 by Michael Mardini, the company has its roots in speech recognition, initially as a distributor for Dragon Systems. In 1996, when IBM introduced MedSpeak, the first commercially available continuous speech recognition product for radiology, Talk Technology began marketing the product.

But like many early VR/SR products, MedSpeak had its drawbacks. Recognizing an opportunity to improve on the core technology, Talk Technology licensed IBM's speech recognition engine for radiology and built its own workflow application around that engine. The company claims installations of its Talk Station product at more than 200 hospitals, primarily for radiology.

"The value for us is in the workflow," Mardini said. "We see this as a clinical reporting solution for radiologists to help make them more efficient. We don't necessarily save them time, but we give them the ability to do more things."

Mardini recognized early on that PACS and RIS vendors might want to embed Talk Technology's voice recognition reporting solution in their imaging systems, and he began by approaching Agfa with a partnering proposal two years ago. In addition to Agfa, Talk Technology has formed alliances with more than a dozen PACS and RIS firms, including Siemens, GE, Philips, Marconi, IDX, and Sunquest. The company has since modified Talk Station to be engine-independent and has customized the original radiology package for use in pathology and emergency medicine.

"Our vision is that Talk Station will be the de facto standard speech and reporting interface inside PACS/RIS workstations," Mardini said. "Our PACS partners are recognizing that voice recognition and clinical reporting aren't their focus, and they see that they can embed Talk Station to handle this. Having voice recognition and immediate report availability with the images adds value to the PACS purchase."

In fact, when PACS vendors include the transcription savings from Talk Station in their ROI estimates for potential sales, they reduce the overall ROI from five to four years, according to Mardini. Turnaround times are reduced from 24 hours to one hour.

"I can walk into any site and save them 50% of their transcription costs," he said. "On average, 75% to 80% of reports at our customer sites are done without the aid of transcriptionists."

Numbers like these are what helped attract the attention of Talk Technology's PACS and RIS partners. Ongoing improvements in the technology and increasing pressure for radiologists to speed turnaround times have improved market receptiveness among physicians as well.

"In the U.S. the focus is more on rapid turnaround of clinical decisions and getting the job done as quickly as possible," said Milan DiPiero, product manager for enterprise PACS at Philips Medical Systems. "Talk Technology has a lot of domain-specific knowledge that would take a lot of time for us to create or capture ourselves."

Philips began partnering with Talk Technology last year and now offers Talk Station in conjunction with its own speech engine (the Speech Mike) in its PACS workstations for radiology, cardiology, and pathology. In addition, given Philips' core competencies in speech processing technologies and the strong installed base of Speech Mike among radiologists, the company is working to voice-enable its PACS workstations.

"We feel this is one of our competitive advantages," DiPiero said. "The Philips speech engine converts voice commands into workstation commands, which allows users to control the workstations by interacting with the Speech Mike."

Through its acquisition of MedQuist earlier this year (HNN 5/31/00), Philips is also looking to leverage its speech recognition experience by improving the efficiencies of transcriptionists. The company is developing new dictation and data processing technologies that will enable physicians to dictate "on the run" and give transcriptionists digital (versus audio) documents that have already gone through the speech recognition process, so that they are editing an electronic text file rather than creating a file from scratch.

Other PACS vendors working with Talk Technology include GE Medical and Marconi Medical. GE showed a work-in-progress voice application at the last RSNA meeting that combined Talk Station with the PathSpeed workstation (PNN 1/00); the company's goal is to reduce the number of PCs sitting in the radiology viewing room and to streamline the ability to access and update images and reports.

"We built an open architecture called Xtend that allows us to use the open standards communication protocol, whether with voice or with the RIS, to exchange all context information and provide the link to the PACS," said Kathy Dalton, global marketing manager for RIS at GE Medical. "So when a radiologist selects a study on our workstation and then uses voice recognition to dictate, the Xtend architecture can automatically pass the correct patient information to the Talk Technology application."

GE is also in the early phases of integrating the Talk Technology package with Applicare's RadWorks, which is GE's lower-end PACS product. This would make the same integrated voice recognition capabilities available to smaller clinics and hospitals.

Marconi, the latest addition to Talk Technology's pool of PACS partners, is integrating Talk Station v.2 with its PACS workstations and Web-based results distribution capabilities to enable radiologists to dictate, edit, sign, and distribute coded reports in real-time or in batch mode. Marconi's results server automatically selects key images based on the report content of the dictation, eliminating the need for manual image marking.

"People will adapt to VR because of the time and cost savings associated with it and the improvements in patient care," said Vickie Sims, marketing manager for Marconi Medical. "Transcription is a very large part of the cost of the total study done on a patient. The scan lasts about 60 seconds, while the rest of the process takes two to four days. So one way to provide better patient care is to minimize the transcription chain and allow radiologists to do this on the fly."

Ultimately, Mardini sees voice recognition playing a central role throughout the hospital. Talk Technology is developing a handheld digital dictation product for enterprise applications that should be available by next year's HIMSS meeting.

"One thing is for sure beyond death and taxes: in the next five years, everything will use speech recognition for a large number of document creation and processing applications," Mardini said. "Three years from now, no one's going to be talking about who's got the best core engine. It will be the applications, and the enabling technologies that make it possible to build those applications."

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