Adding the human touch to speech recognition

Aug 7, 2003

Converting to speech recognition is never an easy process, but techniques such as human factor engineering (HFE) and usability engineering (UE) can smooth the transition, according to Martha Koperwhats, director of radiology at Providence Memorial Hospital in El Paso, TX.

Koperwhats discussed her experience with implementing speech recognition at Texas Children's Hospital in Houston during a talk at the 2003 Advancing Radiology Imaging Services and Operations meeting in Philadelphia. TCH, a 475-bed hospital that is filmless except for the operating room, needed new dictation equipment, and faced the challenge of winning over change-resistant radiologists who liked the way things were. But the institution also needed to cut costs and improve report turnaround times, Koperwhats said.

The benefits of continuous voice recognition (CVR) systems have been demonstrated in the literature, but so has the resistance many radiologists have shown to the technology, Koperwhats said. To maximize the potential for success, TCH chose to utilize HFE and UE approaches, which yield results such as environmental and contextual analysis, and user-characteristic profiles.

Most important, these techniques also help identify factors necessary for success, which serve as the blueprint for the planning and implementation stages, Koperwhats said. Knowing these factors also helps in dealing with vendors.

"When you're dealing with a vendor, they have a way they want to implement and they have a way they want to plan," she said. "(However), it may not work for your group. That's the important thing: You need to have a plan that works for (your) group."

HFE and UE also provide a transition from a known environment to the unknown, and are proven to have greater chances for success, she said. Users are involved in decisions, and their needs, expectations, and environmental factors are known.

"The dictation and transcription process is very, very personal," she said.

Also, many users have expectations that the reporting process will stay the same after speech recognition. In reality, that won't happen, Koperwhats said.

The contextual analysis includes evaluation of users, encompassing what they do presently, how their work flows, how they accept change, what they think of change, and the time it takes to do tasks, she said.

Environmental analysis examines the work areas, lighting, desks, space, noise, and user preferences. The TCH team employed Nielsen's heuristic evaluation and severity scoring systems, and involved users in the vendor selection process, which looked at three major CVR systems.

HFE and UE data was gathered via a number of methods, including user characteristic profile questionnaires, interview, observation of work processes and tasks, and a questionnaire for physician users. Other techniques included high- and low-level task analysis and literature review.

The environmental analysis led to the determination of the work-area size, lighting, and appropriate desks, chairs, and computer spaces. Among the improvements that came from this process was the decision to embed the CVR system within the facility’s PACS software, she said.

Used to set criteria for system selection, contextual analysis looked at matters such as CVR task workflow, planning, implementation, and, most importantly, the needs of CVR users, Koperwhats said.

Critical success factors

From the contextual analysis, TCH also identified a number of critical success factors. For one, users need patience, as well as extensive and continual training. They must be involved in decisions, and their support must be obtained, she said.

It's crucial to understand users' daily interruptions, and they also need to understand the technology. Interface requirements should be validated, and that means bringing the IS department in, she said.

"In a lot of hospitals, radiology and IS departments are not the best of friends," she said. "Even under the best of circumstances -- everything was mapped out -- we still ran into a problem when IS connected our server to the network. You have to bring the IS department into the planning faster than we did. We thought we had everything planned, but one person was left out of the loop, and that was the person who was to connect the server."

It's important to understand and appreciate the integration process and the changes that will take place in user workflow. Also, remember that change does not take place quickly, and recognize users' fear of CVR's inaccuracy, she said.

To help, Koperwhats recommends employing a designated CVR administrator.

"There has to be somebody who lives, breathes, and loves CVR," she said. "And they have to be there at any second, because if five minutes goes by and something's not working (the user will blame the system)."

It's also important to have realistic expectations over cost savings, which are not realized immediately, she said.

From the task analysis, TCH determined that reports provided to the emergency center using CVR embedded in the PACS software reduced workflow from 16 steps to seven steps, with a 56% reduction in report tasks to the ER. For all other patients, reporting workflow dropped from 16 steps to 11 steps, with a 31% reduction in report tasks.

Implementation

During the implementation process, TCH utilized knowledge gained from the contextual analysis, focusing on user needs. Having a CVR administrator available was also important, as was understanding of user biases.

"You absolutely have to know where the biases are," Koperwhats said. "They're real, and they have to be contended with."

The system was installed in November 2002, and won over the naysayers.

"The biggest critics before implementation -- the ones who said, ‘No way am I ever, ever, ever going to do this’ -- became the biggest fans," Koperwhats said.

Report turnaround times have been reduced by 39%, and 80% of radiologists use the CVR system, she said.

By Erik L. Ridley
AuntMinnie.com staff writer
August 8, 2003

RIS/PACS integration -- what is it and what are its benefits?, June 6, 2003

PACS displays raise myriad issues, March 14, 2003

Voice recognition reduces report turnaround time in Vienna facility, December 5, 2002