Ideas in Hospital-Based Imaging

Voice Recognition Software: The Prognosis
Navigating the Relationship Between Teleradiology Providers and Hospitals
A Happy Staff Is a Dedicated Staff

Voice Recognition Software: The Prognosis

By Cat Vasko

As voice recognition software continues to advance, facilitating workflow and enabling previously unheard of reporting efficiencies, vendors are working hard to hone the capabilities of their offerings. Axis Imaging News spoke with Chris Spring, senior product manager of speech recognition at MedQuist Inc, Mount Laurel, NJ, and Peter Durlach, senior vice president of marketing and product strategy for Dictaphone Healthcare Solutions, a division of Nuance Inc, Burlington, Mass, about the future of voice recognition software.

Peter Durlach
Chris Spring

IE: What are the features of your most recent release?

Durlach: PowerScribe for Radiology 4.8, announced at SIIM 2007, will add significant new capabilities via a number of strategic partnerships, including ones with Vocada and Amirsys. PowerScribe 4.8 has voice-enabled its report coding interface to streamline the process for coding reports during the interpretation process, and the coding interface allows users to enter various codes to reports, such as ICD, peer review, critical results, risk management, mammography BIRADS, and image quality.

Spring: We just released Service Pack 6 for Version 1.1. SP6 represents a technological advancement in speech recognition. Recognizing small words is an industry-wide challenge. Speech recognition engines have an easy time with words like “cardiomegaly” because the statistical chance of it being something else is so low, but words like “a,” “and,” and “the” are difficult to separate from other words at times. SP6 has a new adaptation process that vastly improves small word recognition.

IE: What will the next release be?

Durlach: The next major release of PowerScribe will be version 5.0. In addition to the speech technology improvements, it will deliver several dozen new features and product enhancements based on feedback received from PowerScribe’s base of more than 900 customers. These capabilities will enable customers to speed up their overall report creation process, improve critical communications, meet updated peer review guidelines, and enjoy improved integrated PACS/RIS workflows.

Spring: The next planned release will be in 2008 and will focus on enterprise functionality and scalability.

IE: What is your company doing that distinguishes it from the competition?

Durlach: Nuance focuses on the primary business drivers in radiology today—fast, efficient, accurate radiology interpretation, documentation, and communication. We focus on our partnerships and integrations with more than 45 PACS and RIS vendors to provide desktop integrations that streamline the reporting process for the radiologist. We focus on flexible workflows and routing between residents, transcriptionists, and attending radiologists, fostering efficient communications between all parties.

Spring: We focus on quality. SpeechQ has now won the #1 ranking in the annual KLAS survey for 2 years in a row. In fact, SpeechQ has been #1 since it entered the survey. While the product is focused on immediate workflow options for the physicians, MedQuist is there to service and support the product. MedQuist backs up its products with unparalleled service after the sale. You aren’t buying a product with SpeechQ; you are buying a solution.

IE: What’s your vision for how speech recognition software will be used in the future?

Durlach: As radiologists spend more time within our application, we see the need to provide them with the tools and information they require to be as productive as possible. That means in addition to the best speech recognition technology, our applications will provide the radiologist with a “dashboard” where they will have access to patient information stored in external systems, data pulled from the imaging modality, and current exam and image information from the PACS. We see our applications providing a platform for communications, for not only the stakeholders within the radiology facility, but also the ordering clinician base, in order to provide information and results as efficiently as possible.

Spring: Speech recognition is evolving. The physician community is starting to believe the technology is finally mature enough for everyday use. The returns on investment and patient care improvements are well documented in radiology. We expect this to carry over into more departments in the hospitals, as well as enterprise functionality, where physicians can use speech recognition anywhere.

Navigating the Relationship Between Teleradiology Providers and Hospitals

By Cat Vasko

Teleradiology was a hot topic at the annual meeting of the Radiology Business Management Association in May. In a presentation on “understanding both sides of the equation,” Ila S. Rothschild, MA, JD, special counsel for The Joint Commission (JC), answered a question many administrators are asking themselves: How do I navigate the difficult relationships between teleradiology providers and hospitals?

Beginning with an overview of the JC’s standards and accreditation policies for telemedicine, Rothschild noted that for questions related to licensed independent practitioners with either total or shared responsibilities for patient care, treatment, and services, answers can always be found in the JC manual, along with analogous answers for issues related to ambulatory care.

“There has been an exponential growth in telemedicine in the past few years,” Rothschild said. “Originally, we saw small rural hospitals using teleradiology and telemedical services from the larger academic institutions within the same state. Now, hospitals are contracting with or using the services of physicians located in self-standing groups outside the state or outside of the United States.”

Accreditation is increasingly important as teleradiology offerings become more diversified. The process for each physician providing services involves a review of the applicant’s current licensure and specific relevant training, data from professional practice review of the organization that currently privileges the applicant, peer or faculty recommendations, and review of the practitioner’s performance within the organization. Rothschild noted that hospitals often like to establish a “comfort level” with their teleradiology providers, usually asking that a core group of teleradiologists do the hospital’s reads to ensure that the hospital can experience a closer relationship with the physicians.

“Verification of credentialing and privileging decisions can be accomplished by reviewing the ambulatory care organization’s credentialing and privileging process, or by obtaining a letter of attestation,” Rothschild said. In other words, hospitals can accept the credentialing and privileging decisions of distant ambulatory organizations, provided the decisions were made using the processes described in the JC’s Medical Staff Standards.

CMS, however, is not entirely in agreement with the JC when it comes to credentialing. The agency wants the originating site—where the patient is located—to credential and privilege any practitioner providing a “medical level of care” to the patient. (CMS does not define “medical level of care.”) An audience member asked Rothschild what the consequences could be for failing to comply with CMS’ perspective on credentialing. “We tell you you don’t have to do it,” Rothschild answered. “We’ve had no indication that CMS is currently looking at teleradiology services, though that’s not to say it’s not going to happen.” Rothschild’s overview of contractual issues was of particular interest. She averred that contracts should involve all parties—hospital, teleradiology group, and radiology group—with the roles of each explicitly stated. “You want to know what all of the other parties involved are doing,” she said. How does that kind of arrangement help the radiology group? “Imagine if a lawsuit is brought,” Rothschild said. “You want to know what kind of insurance the group has, and the hospital has, with respect to its teleradiologists. There are any number of problems that could occur. It’s helpful for you to understand what is required of each party. The sharing of information has to be contracted for.”

A Happy Staff Is a Dedicated Staff

By Dana Hinesly

Administrators eager to manage a happy, dedicated staff need to start with interviews that give insight into an applicant’s behavior and thought processes. To do this, employing behavior-based interviewing techniques, which provide an objective set of facts, is important.

Jay Mazurowski, MS, CRA, FAHRA

“Rather than just asking people about their skills and their competencies, this type of interview allows you to start drawing conclusions about their judgment skills, how they process information, how they make decisions,” says Jay Mazurowski, MS, CRA, FAHRA, the director of radiology for Concord Hospital, Concord, NH. “Instead of just asking a series of questions to identify their skill sets, they respond to a real situation they are likely to encounter.”

With this approach, the candidate should do the majority of the talking and discuss scenarios that are grounded in day-to-day reality. Interviewers should use open-ended questions, trying to learn not just what an individual did, but also why.

For example, a radiologist might be asked to describe a situation in which they dealt with an irate physician, how they handled it, and how it was resolved.

“As much as possible, you want to make the questions mirror an actual scenario they are likely to have encountered or are likely to experience at your facility,” Mazurowski says. “That requires them to draw on something very similar they encountered in the past.”

He also strongly recommends including a number of key staff members in the interview process. Not only will this provide a myriad of perspectives, but also the questions are likely to cover a wider range of experience.

“As a department head, I’m going to ask a certain group of questions, whereas the frontline person has a different perspective, so they are going to ask questions that really relate to the day-to-day work,” Mazurowski says. “More importantly, it gives the people who are currently in the business or department input, and that is one of the most important things staff want—to be in on decisions.”

Recognition Has Its Own Rewards

Identifying the staff’s desires is the only way to truly keep them happy—and productive. Along with feeling their opinions are valued, employees want appreciation for the work they do. Only hearing negative feedback about job performance can do serious damage to an employee’s desire to achieve more within the company.

“Recognition is a very important thing that is overlooked or left to chance in a lot of departments,” Mazurowski says. “I think the average person will tell you they are told what they do wrong about four times more than they are told what they’re doing right. If I tell somebody I need to see them for a minute, they immediately assume they are in some sort of trouble. No one ever thinks they’re getting a raise. With recognition, even if you think you’re doing it, you’re probably still not doing enough.”

To be successful, gestures need not be grand. Something as simple as a handwritten note or a quick e-mail can have a significant impact on that employee. Whatever it is, sincerity is key.

Dana Hinesly is a contributing writer for  Axis Imaging News. For more information, contact .