Whether the user is interacting with a mobile device, a web site, or a phone-based health technology system, there is often a large gap between what the user wants to accomplish and how they want to accomplish it, and what they actually get from the system. The interface can be challenging and capturing any feedback or user interactions is difficult using on keyboards and point and click tools. Speech Recognition is changing this interaction by capturing the clinical input and allowing clinicians and healthcare users to access systems that listen and responds seamlessly understanding the context and the intent turning what the users wants into what they get.
- 1. HEALTHCARE SOLUTIONSNick van Terheyden, MD,Chief Medical
Information Officer CLUNuance Communications
2. HEALTHCARE SOLUTIONSOutline Medicine and the Importance of
Documentation History of Speech Recognition Types of Speech
Recognition technology Natural Language Understanding and its link
to Speech Recognitiontechnology in health care Current and future
issues 3. Medicine used to be simple, ineffective andHEALTHCARE
SOLUTIONSrelatively safeNow it is complex, effective and
potentiallydangerousSir Cyril Chantler, Kings Fund Chantler C. The
role and education of doctors in the delivery of health care.Lancet
1999;353:1178-81u 4. Challenge Clinical Knowledge-Processing
BurdenKnowledge processing requirementYears ago TodayThis
gapinjures patientsHEALTHCARE SOLUTIONSKnowledge processing
capacityCurrent medicalpractice reliesheavily on theunaided mind
torecall a greatamount of detailedknowledge aprocess which, tothe
detriment of allstakeholders, hasrepeatedly beenshown
unreliableCrane and RaymondThe Permanente JournalWinter 2003 Volume
7 No.1Kaiser Permanente Institute forHealth PolicySlide Courtesy of
Dr Michael Bainbridge 5. 5 CONFIDENTIAL | 2002-2011 Nuance
Communications, Inc. All rights reserved. HEALTHCARE SOLUTIONS 6.
UnstructuredDataHEALTHCARE SOLUTIONSDirect data entry,not
physicianStructured DataDictationandTranscriptionSystemgenerated
orinterfaceddataDirect data entry,physicianHandwrittenCurrent
Methods for Data Capture 7. HEALTHCARE SOLUTIONS 8. First
SuccessBell Labs 1939 Worlds Fair VoderHEALTHCARE SOLUTIONS 9.
History Past, Present and FutureHEALTHCARE SOLUTIONS 1964 Star
Trek"Computer, compute to the last digit the value of pi" -- Spock
(Wolf inthe Fold episode) 1968 2001 A Space OdysseyDave Bowman:
Open the pod bay doors, HAL.HAL: Im sorry Dave, Im afraid I cant do
that[i]. 10. HEALTHCARE SOLUTIONSSpeech Recognition Time Line 1870s
Alexander Graham Bell 1939 Voder Speech Synthesizer 1952 Bell Labs
Speech Recognition 0-9 digits over the telephone 1970s HARPY
Carnegie Mellon 50 computers to process 1970s Hidden Markov
Modeling approach 1990s Discrete Speech Recognition 1995 Continuous
Speech Recognition Power PC Chip with IntelsPentium 200Hz chip 11.
HEALTHCARE SOLUTIONSWhat is Speech Recognition?Automatic conversion
of spoken words tocomputer text 12. HEALTHCARE SOLUTIONSConverting
Sounds to Speech 13. Tools for Converting Sound to TextHEALTHCARE
SOLUTIONS Statistical Language Model Grammars 14. Types of Speech
Recognition in HealthcareHEALTHCARE SOLUTIONS Front End or Real
Time Server Based Speech Recognition Physician Self Edit 15.
HEALTHCARE SOLUTIONS 16. HEALTHCARE SOLUTIONSHurdles to Adoption
Pronunciation Separating Background Noise Resolving Ambiguity I
made her duck I cooked waterfowl for her I cooked waterfowl
belonging to her I created the (ceramic) duck she owns I caused her
to quickly lower her head or body I waved my magic wand and turned
her into a undifferentiated waterfowl Grammar and Punctuation 17.
What you Speak is Not what you get Clinicians do not typically
speak in structured coherent format Literal speech recognition does
not provide enough value Newer solutions provide speech recognition
combined with someelements of Natural Language Processing to
develop andUnderstanding of What was meant vs what was
saidHEALTHCARE SOLUTIONS 18. Challenges A perfect
speaker?POSTOPERATIVE_DIAGNOSIS[AAHHMMMMM] Status post complete
oral and dental rehabilitation PERIODNEXT_PARAGRAPH
[OOHHMMMMM][NEXT SECTION]OPERATION PERFORMED Complete oral and
dental rehabilitation PERIODNEXT_PARAGRAPH[cough]ANESTHESIAGeneral
anesthesia by the anesthesia staff PERIOD NEXT_LINEDuration of
surgery: Close to 45 minutes.Incision: none.NEXT_PARAGRAPH[NEXT
SECTION][________________][paper rustling]
[________________]FINDINGS [AAHHMMMMM] The patient is a 22-year-old
male with missing teeth and permanent dentitionCOMMA mental
retardation COMMA seizure disorder COMMA microcephaly COMMA
andgastroesophageal reflux disease PERIOD Since [__] March first
2004 COMMA there has not been muchchange in the appearance of the
patient PERIOD [AAHHMMMMM] The patient also had periodontaldisease
evidenced by moderate bone loss COMMA hyperplastic gingiva and to
three to seven millimeterpockets PERIODNEXT_PARAGRAPHThis is the
end of dictation, thank youHEALTHCARE SOLUTIONS 19. HEALTHCARE
SOLUTIONSFinal ReportPOSTOPERATIVE DIAGNOSISStatus post complete
oral and dental rehabilitation.OPERATION PERFORMEDComplete oral and
dental rehabilitation.ANESTHESIAGeneral anesthesia by the
anesthesia staff.Duration of surgery: Close to 45 minutes.Incision:
none.FINDINGSThe patient is a 22-year-old male with missing teeth
and permanent dentition, mental retardation, seizuredisorder,
microcephaly, and gastroesophageal reflux disease. Since March 1st
2004, there has not beenmuch change in the appearance of the
patient. The patient also had periodontal disease evidenced
bymoderate bone loss, hyperplastic gingiva and to 3-7 millimeter
pockets.John Smith, MDPhilips HospitalBethesda Medical
CenterMaryland 20. HEALTHCARE SOLUTIONSNatural Language
ProcessingThe Technology and How it Works 21. Speech is Reinventing
the relationshipbetween people and technologyHEALTHCARE SOLUTIONS
At the forefront of the nextchapter of human-computerinteraction
Deeply invested in creatingeffortless and natural userexperiences
Rapid advances in voice-recognitiontechnology 22. HEALTHCARE
SOLUTIONS 23. HEALTHCARE SOLUTIONS 24. HEALTHCARE SOLUTIONSCHIEF
COMPLAINTPAST MEDICAL HISTORY 25. PAST MEDICAL HISTORYHEALTHCARE
SOLUTIONSCHIEF COMPLAINT 26. From Clinical Narrative to
FactsCLINICAL LANGUAGE UNDERSTANDING63 %93%86 %Oct 10 Feb
12HEALTHCARE SOLUTIONSRules: explicit linguistic modelsMachine
learning: discovery of new patternsSyntactic parsing &
Statistical semantic processing 27. HEALTHCARE SOLUTIONSIn
EHRMT-editingFeedbackEHRQualityReportingCoding
&BusinessIntelligenceReal timedata &feedbackEPRQuality
MetricsCodes / Clinical DocImprovementOutcomesClinical
FactsNarrativeWith aRIS/PACSIn EHRSelf-editingOn the GoOn a PCAt a
DictationStationOn anMFP 28. HEALTHCARE SOLUTIONSPossibly the first
step in thisjourney could be instantaccess on mobile platform 29.
NLU Technology Across IndustriesBRINGING THE POWER OF LANGUAGE
UNDERSTANDINGAcross a Number of Domains100+ apps and countingDragon
Go! Cluzee EviDragon Assistant Voice Ask Google CleverbotSpeaktoit
Siri Ask ZiggyHEALTHCARE SOLUTIONSAndyirisSkyvi Pannous EVA 30.
HEALTHCARE SOLUTIONSCustomer careWhats the current ratefor a 30
year fixed rate mortgage?Donna: The most recent published rate for
aqualifying 30 year fixed rate mortgage is4.750%/4.878% APROK, how
about variable?Donna: For a variable mortgage, the mostrecent
published rate is 3.5%/3.286% APROK. Are there any otheroptions I
should look at?Donna: We also offer 15 year fixed ratemortgages
would you like to hear moreabout them?RISING EXPECTATIONSConsumer
apps creating expectations ofnatural interactionsNLU promises to
cut through deep menusTransition from a ROI-model to a
'must-haveNative apps with migration path tobrowsers and
standardsMulti-platform, multi-channel 31. HEALTHCARE
SOLUTIONSIntelligent Voice Interactions Minimize need to remember
gate commands &command order Allow multiple forms of expression
and handleambiguous input Allow for more conversational spoken
utterances,less utilitarian Reduce distance between complex
spokencommands and desired outcome or action finding becomes doing
Customizable to provide levels of seamlessaccess to any content on
device 32. The Current State of On-line ContentHEALTHCARE SOLUTIONS
Input is a keyword Not keywords Treatment of onychomycosis Just a
single keyword onychomycosis The result is a chapter to scroll
through The need is for more granular input leading to more
granular results At a minimum, the right page, not the right
chapter The ultimate goal is the right paragraph onychomycosis
treatment is multiple keywords To really improve the physician
experience, natural language What is the treatment of
oncyhomycosis? Even better with real understanding How do you treat
toe-nail fungus? And this is just the first step 33. Natural
language interface to allow doctorto request information in a
comfortable way.Show me his last chest
xray=SHOWXRAY>=chest>=latest>Application maintains patient
context andassumes request is for current patientHEALTHCARE
SOLUTIONSA Possible Future PlatformUse Cases Voice Enable a EHRLabs
for James JonesShow me lab results for JonesCBC results for James
JonesJames Jones, lab resultsLast labs for James
JonesDM360PlatformNLU=LABRESULTS>=Jones, James>Application
receives XML and displayslab results for the specified patient. 34.
HEALTHCARE SOLUTIONSFuture Hospital Label Warning Please be advised
that this hospital uses manual, paper-basedmethods for tracking the
process of your care andfor implementing the orders of your
physicians.Therefore, many orders that your doctors initiate will
notbe carried out as written. As a result, you may
regrettablyreceive the wrong medicine, the wrong dose of the
rightmedicine, the wrong route of administration, or possiblythe
correct medicine at the wrong time.Presidents Information
Technology Advisory CommitteeRevolutionizing Health Care Through
Information
Technologyhttp://www.hpcc.gov/pitac/meetings/2004/20040617/20040615_hit.pdf
35. HEALTHCARE SOLUTIONSPrediction Paper, manila notes and folders
willbecome memorabilia of the past andrelegated to museums 36. Nick
van Terheyden, MD CMIO, Nuance CommunicationsAboutMe
http://about.me/obiwanTwitter http://twitter.com/drnic1LinkedIn
http://www.linkedin.com/in/nickvtVoice of the Doctor
http://drvoice.blogspot.com/FaceBook http://profile.to/drnickE-Mail
[email protected], [email protected] Voice (301)
355-0877HEALTHCARE SOLUTIONSWhere You Can Find Me 37. HEALTHCARE
SOLUTIONSNick van Terheyden, MD,Chief Medical Information Officer
CLUNuance Communications
