I love new technology. I live for it. I spend inordinate amounts of money on it, much to my son's delight, my daughter's bemusement, and my wife's chagrin. If there is an electronicomechanical way of doing something that I could have done manually, well then, I'm on it. However, when it comes to Voice Recognition, I do an about-face from my progressive side and become a pure Luddite. But follow my reasoning, and you might agree.
Great article, and it was written in 1998! The italics are mine, by the way. So here we are, eight years later; why isn't everyone using VR/SR?
The problem seems to be that the technology really isn't there yet. Matrad6781 posted this on an AuntMinnie.com forum, and it tells the story in a painfully accurate manner:
My problem with our voice recognition system is that commands that used to be triggered by the thumb on a microphone are now voice commands. Often the software doesn't recognize my voice and I end up having to repeat myself several times. That never happened in the "buggy whip" days. Throughout my department you can hear radiologists saying: "Defer report...defer report...DEFER REPORT, dammit!" or "delete that sentence, DELETE that sentence, delete that SENTENCE!" Also, when I say "parentheses" or "quote" or "paragraph", my transcriptionists know what I mean. This system actually types out the words "parentheses', "quote", "unquote", etcetera. How clever is this? Is this what is meant by artificial intelligence? I have alot of "canned" reports, both normals and intro paragraphs for MRI protocols, interventional procedures, etc. At last count, I had 150 such "normals." Before voice recognition, all I had to dictate was, "Normal MRI of the left knee" and the transcriptionists called it up from their macros and sent it for my electronic signature. Now I have to remember the name I gave the normal report (ProVox calls them "Macros") and enunciate it properly (so I don't get a "Normal chest" appearing when I said "Macro Normal CT Chest Enhanced". But it happens, all too frequently. And I have to always keep an eye on the voice dictation window, the way you would a toddler to make sure it's doing what it's supposed to and not getting into trouble. By the way, that window, even when minimized takes up valuable real estate from my PACS work station (and I have four monitors!) I'm always moving the window around because it's obscuring images or the worklist. Very inconvenient. The worst is when the system thinks that I (or someone in the background) uttered a voice command that is one of the "nuclear option" commands, like "finalize report", "delete that paragraph", "cancel report." Then, poof, five minutes of dictation are gone, just like that, and I have to start from scratch. Are you guys telling me no one else has experienced any of these problems? Is it just our manufacturer? Lastly, the voice recognition is so bad, that everything ends up getting deferred by all the radiologists to the transcriptionists, so that they can correct the errors before sending to the task list for finalization. So we have as many transcriptionists as before. Last point: We have some great transcriptionists who catch errors that a voice recognition system would never recognize. I used to get electronic notes like "You said LEFT in body but RIGHT in impression." Or: " You gave a measurement of 3.5 mm in the body, are you sure you meant "mm" and not not "cm"?" These folks have saved my butt many times. I'm kind of glad that the voice recognition dictations still go through them as a fail safe mechanism. Also, one of our transcriptionists makes really good carrot cake! Let's see a VR system do that!
The bottom line is that these very expensive systems (think hundreds of thousands of dollars) do not have human intelligence behind them. No, I'm not saying bad things about the programmers! It's simply that there is a very rich background to our communications, and no machine has risen to the level of understanding, or perhaps I should say intuiting, what we put into it. The left/right and cm/mm problems are good examples. I suppose you could program the machine to count how many times you say "left" and how many times you say "right", but then what? Should there be an equal number? Not necessarily. So what is a poor machine to do? The human transcriptionist can easily find the discrepancies of this sort, but a machine just can't do that yet.
What are the advantages of SR that make it worth the kind of trouble Matrad describes? I can think of only two: time and money. If all works well, the SR system can have a report available online the instant you sign off. That's a good thing. Which can be equalled or even surpassed by having an adequate pool of human transcriptionists on-line and ready to do their thing. But speed doesn't seem to be the main impetus in many places. Sadly, what SR allows is the shifting of work onto the radiologist. The transcriptionist's job is really two-fold: she (or he) commits to the screen what the rad has dictated, and then she edits out the errors that may have occured. SR can do a passable job of typing (if one trains it to one's voice for a very long time), but it just can't do the editing. Since the radiologist is ultimately responsible for the report, some administrative types have decided that the rad should do the editing as well! Wonderful idea, if you are trying to rid yourself of transcriptionists. Unfortunately, this adds a lot of editing time to the rad's day that he or she should be spending reading studies. Another poster, Jack (Dr. Death) Kervorkian puts it in these terms:
(S)orry guys, in my book - time is money. If I have to spend 20% of my time correcting reports and looking for content, syntax, grammatical and/or spelling errors, that is 20% which I am not productive. Furthermore, it now makes me not a radiologist, but an editor of reports. Just think, in an 8-10 hour day that amounts to an extra 1-2 hours of agonizing editing. I'd rather have a second set of eyes and ears - which know my dictation style to look over me. Can't tell you how many times a transcriptionist has saved my ass from looking stupid, with the usual 'right/left" errors, or at the 12th hours calling a CT scan an MRI scan.. Although voice recognition will catch spelling errors, it won't catch content, grammatical or syntax errors, as mentioned above.
So everyone loses in this scenario, except for the bean-counters who justify the expense and the pain to the rads with the savings in personnel. Just great. Those who support SR call those of us with doubts "Luddites" and "buggy whip makers". AuntMinnie member Frank Hartwick suggests that we stick to the principles of the "OODA Loop" for decision making such as this to keep from being left behind. OK, what's an OODA loop, you ask...is it like a Fruit Loop? Not quite, and it really is germaine to this discussion. Click on the diagram below to blow it up...
The OODA loop (Observation, Orientation, Decision, Action) is simply a way to describe a decision-making cycle, designed by a retired fighter pilot, Col. John Boyd. Basically, it describes a dynamic process that one should go through to evaluate evidence and make choices, and how those choices are dependent on your background (even your "genetic heritage") and the information you get. The decision impacts your observations, changes your orientation toward the problem, and you remake your decision.
Got all that? So, I think Frank H's OODA loop tells him that SR gives good service and should be implemented. But MY OODA loop observation is that there are a lot of complaints about SR, and with my genetic heritage of worrying, and previous experiences of getting burned on buying some of the latest and greatest, lead me to the decision that SR isn't ready for me as yet, and thus the action of, well, inaction. I'm digging in my heels on this idea. I have told our administration that I and my group will not accept SR unless they promise us total human backup. In other words, if they want to spend $300,000 or so on a fancy microphone for me, that's just fine. As long as they realize that we rads refuse to become editors, they can go ahead and spend the cash. But don't wave the expenditure in my face when it comes time to replace some of the worn-out scanners that really need to go.
Am I really being a "Luddite" on this? I think not. My job is to interpret my studies, not edit the reports. No one has yet convinced me that SR technology has reached the point of really being ready for prime-time. And I don't make buggy whips...to really stretch the analogy, one could say we use buggy whips in our trade. SR could then be likened to an electric cattle prod, I suppose. But to carry this to its logical end, SR will eliminate the horse, and I'll be forced to use the cattle prod on myself! No thanks, guys. I'd rather walk.
I just had to add this from a post from William Fife on the AuntMinnie.com thread...
This was just posted to AuntMinnie.com by "breastguy", hopefully a mammographer, and I think it really seals the deal against SR:
I heard of one rad at a children's hospital in PA who was trying to get a lawsuit together against Dictaphone for their false claims about the product. Every so often our chief circulates examples of gibberish that was sent out and cautions us to look at what we are siging - but it still happens -- one major problem is there is no "undo" button or delay- once you hit sign report it is gone and as it disappears you see "clitoral history" fly by and there is no delay to catch it. The quality of the reports clearly suffers. And you cant say "known Carcinoma" it comes out "No carcinoma" -- I curse the Powerscribe apps people that spent days with us yet never called attention to possible pitfalls like this - they never pointed out the weaknesses- we had to stumble over them ourselves. Sure you can save the reports and review them later, or send every one to the editor (be sure to keep some transcriptionsits to edit) but I can tell you, in our large group , with editors, crap still gets sent out and ref docs gleefully call you up to say "Did you mean Clinical History instead of Clitoral History?" Certainly makes us look foolish. As far as it not understanding the instructions to call up a macro- it was driing me crazy! I solved that - instead of my saying "Mammo Heterogenous Normal Compared" I renamed it "Hubert Nancy Carol" Dense mammo is " Denise Nancy Carol" etc and so on for the many screening mammo macros I created- here it does save time.
I really think that's enough. Frankly, after looking into this, I'm inclined to say "NO SR" altogether. The machines seem to compound the possible errors, making the transcriptionist/editor's job that much harder. This is a really, really, REALLY bad idea.