Voice To Text Technologies Shape The Future Of Electronic Medical Records

Typing memos about patient-doctor encounters into EHRs is so time-consuming that the demand for medical scribes has grown exponentially in the last couple of years. That alone still cannot solve the problem that half of physicians’ average workdays are spent conducting clerical work and administration. Artificial intelligence-based voice to text technologies promise to turn the tables: the doctor and the patient speak while a voice assistant listens in and puts down the interpreted text into the relevant columns in the EHRs. Sounds like science fiction? That’s no longer the case. We looked around where the technology stands today and how it could cure ‘desktop medicine’ in the future.

From paper-based to electronic medical records under the burden of administration

Modern medical administration was mainly born at around the turn of the 20th century when innovations in medicine, anesthesia, modern surgery resulted in the establishment of more and more hospitals. Just between 1875 and 1925, the number of U.S. hospitals grew from about 170 to over 7,000, and modern hospitals – and the growing number of patients and medical staff had to be managed efficiently. Nevertheless, a doctor from the beginning of the 20th century would truly be shocked by the changes in the medical system. Back then, there was the good old-fashioned pen and paper, where doctors usually noted the symptoms, the diagnoses of patients, and the treatment they provided. These pieces of papers ended up in a huge filing cabinet, and when they reached their full capacity, even bigger storage rooms were put in practice.

However, paper-based medical records just cannot fulfill their job as a reliable information source. Researchers, who studied five large medical facilities where hospitals and clinics used conventional paper-based patient records, reported that 5-10 percent of patients were seen in clinics without an available record, while 5-20 percent of hospital records were entirely incomplete. Of the missing information, 75 percent consisted of laboratory test results and X-ray reports, and 25 percent of lost, incomplete, or illegible textual data.

The introduction of electronic health records promised to remedy exactly this situation. They promised to streamline administration so that medical professionals don’t have to spend much time scribbling down patient histories and worry about missing medical records. Unfortunately, that’s not what happened.

Source: www.thejournal.ie

Click buttons and do not keep eye contact

These are the main messages of the parody Twitter page where frustrations around EMRs, especially the EPIC system, are played out. That nicely summarizes everything that’s wrong with electronic health records: they are time-consuming to navigate and fill out so instead of treating patients, doctors end up sitting in front of their computers most of the time. Physicians usually encounter a lengthy series of screens, tabs, checkboxes, which causes them to exhaust 5 to 12 minutes, more than 100 mouse clicks, and an abundance of manual data entry to produce a single exam note. A survey found that half of the physicians’ average workdays are spent entering data into EHRs and conducting clerical work, while just 27 percent is spent with actual patients.

Another survey has shown that 37 percent of American physicians see EHR (electronic health records) as their number one challenge, while the same percentage lists a financial issue as their primary concern. Another research pointed out that even with all the advancements in EMR technology, 70 percent of physicians are unhappy with their current system. Specialists especially have difficulties adapting to their EMR software due to their different needs and areas of focus. One reason might be that EMRs are often designed with billing rather than patient care in mind, and they can be frustrating and time-consuming to navigate. According to the article of The Atlantic, one attending doctor, tired of wading through a morass of irrelevant information, writes notes in the electronic chart but in parallel keeps summaries of his patients’ medical histories on hand-written index cards.

Source: www.wsj.com

From frustration to medical scribes

Although there are excellent examples of efficient EMR systems around the globe, one of them in the digital republic, Estonia, the general feeling is frustration. Doctors in the U.S. are even saying that they contribute to their burnout. In 2017, the American Medical Association conducted a survey among more than 15,000 medical professionals across 29 specialties about burnout. To the question of what contributes most to physician burnout, most of the respondents answered the followings: the burden of bureaucratic tasks (56 per cent), long hours at work (39 per cent), the lack of respect coming towards them (26 per cent) and the increasing computerization of the practice, including the issue around EHRs (24 per cent).

The source of the frustration is in large part because it widens the gap between the ideal state and the reality of medicine. Doctors choose the medical profession to heal patients – and as the above numbers show that’s almost the least relevant in their job. Instead of diagnosing and treating illness, they must manage patient schedules, coordinate care across institutions, and document everything.

That’s the reason why the role of medical scribes has grown so much lately. The profession was not unknown before the introduction of EMRs, in fact, we remember Doctor Peter Benton from the blockbuster series, ER, running around with a Dictaphone and passing it to a nurse to write his notes down. Moreover, in Budapest, Hungary, in the National Koranyi Institute of TB and Pulmonology, one of the nurses managing patient registration recorded the findings on the CT scans and put the recorder on the shelf where dozens of recorders were stacked. Then, another nurse came by, took one of the Dictaphones away and brought it to a room in the basement where an assistant transcribed the findings and filled into the EHRs.

The use and the growing popularity of medical scribes makes a lot of sense. They not only free doctors from administration to talk with their patients during clinic visits, but it potentially results in better documentation, too. A study published in the World Journal of Urology reported that the introduction of scribes in a urology practice significantly increased physician efficiency, work satisfaction, and revenue. So, it seems that humans can save the day when it comes to saving doctors from the administrative burden unleashed by EHRs. But what can technology do?

Source: www.glassdoor.co.uk

Voice to text technologies are coming to town

While countless creative solutions try to improve EHRs and cut back on medical administration, the most exciting ones are those innovations which promise to listen in patient-doctor visits and the ‘conversations’ between doctors and the EHR systems and provide a transcription without the doctor typing even one letter into his computer.

For example, in the first case, San Francisco-based Augmedix aims to harness the power of Google Glass to make healthcare more patient-centric and decrease the amount of paperwork. It provides a technology-enabled documentation service for doctors and health systems, so physicians do not have to check their computers during patient visits, while medical notes are still generated in real-time. Voice assistants truly have the potential to free up the time doctors spend on administration. Companies like Nuance and M*Modal already provide software-based dictation services to physicians. California-based company, Notable, launched a wearable voice-powered assistant in May 2018 aimed at helping doctors capture data during interactions with patients.

Source: www.statnews.com

When it comes to the cumbersome documentation burden of doctors, voice recognition technology started to replace conventional dictation across a variety of healthcare information systems, too, because it’s able to eliminate transcription costs and minimize transcription errors. Cody Frew, Director of Marketing at ChartLogic, another company offering voice technology to EMRs, said that thousands of dynamic, command-based responses programmed within an EHR system can substantially reduce the time it would otherwise take to perform conventional dictation. Plus, the need for transcription is removed from the equation entirely, easily saving the average physician $30,000 to $50,000 a year.

Another company, Nuance Communications offers software called Dragon Medical One, which it claims can help healthcare companies record patient medical experiences using natural language processing. The company says it already helped Allina Health, a healthcare provider, which integrated the software into its EPIC EHR, speed up the time for its doctors to fill out electronic health records. According to the case study, Allina Health saw a 167 percent increase in how much medical documentation they were able to produce by the time of publishing.

In addition, there are already smart versions of common clinical devices such as thermometers, blood pressure cuffs, and scales that automatically record readings in the patient record, so doctors do not have to type the measurements.

Source: www.germangarces.com

The future is Scarlett Johansson, we hope

Voice to text technologies mean a real alternative to medical administration done manually by doctors – and institutions agree. Research firm Technavio published a report last year projecting that hospitals globally will spend more than 72 billion by 2020, representing 6 percent compound annual growth rate. However, recent voice recognition solutions do not eliminate transcription errors fully, thus the need for proofreading and human check-up will still take up the precious time of medical professionals. Even one letter recognized differently could mean a potentially life-threatening danger for patients. That’s why we believe that an automated, artificial narrow intelligence-based voice recognition system with a similar, artificial narrow intelligence-based proofreading system might embody the final solution for medical administration. Only the problems flagged by the ANI system would be checked by a doctor. At least as the trends show, currently that’s the objective that dozens of companies are working towards.

And going even further down the road, perhaps the brilliant movie, Her, can show the way how A.I. might help physicians and nurses in the future. Cognitive assistants as the one in the movie using the voice of Scarlett Johansson could prioritize e-mails in doctors’ inboxes or keep them up-to-date with the help of finding the latest and most relevant scientific studies in seconds. They could ‘listen in’ during patient visits, record every useful bit of information immediately, and update the given patient’s medical record. Such cognitive assistants could look up patient history, prescription data, financial information in seconds, and update them with the same speed. Their work would allow doctors and nurses to finally concentrate on the tasks that they are the most qualified for: healing patients with empathy and utmost care. 

Dr. Bertalan Mesko, PhD is The Medical Futurist and Director of The Medical Futurist Institute analyzing how science fiction technologies can become reality in medicine and healthcare. As a geek physician with a PhD in genomics, he is a keynote speaker and an Amazon Top 100 author.

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