Remember doctors walking down halls, talking into tape recorders like Agent Dale Cooper from Twin Peaks? Now they're holding conversations with their mobile devices, taking a page from David Bowman and Frank Poole's interactions with HAL 9000 in 2001: A Space Odyssey.
Ubiquitous mobile devices such as iPhones and Androids offer both opportunities and challenges for physicians. Critical EHR data is accessible almost anywhere and near instantly, and patient notes can be recalled with a few taps on a screen. But minimized screen real estate is at a premium: What data should be shown? And that's to say nothing of the challenges of entering the data: Typing full notes on a mobile phone can be a carpal-tunnel inducing strain.
Nuance Healthcare's Jonathon Dreyer thinks these strengths could be improved – and the weaknesses could be eradicated – with strong integration of voice recognition, cloud-based applications and natural- or clinical language understanding technology. He says these tools create "better access for the physician," who can have an interactive dialogue with his or her device to access and create medical records on the fly.
Dreyer offers four reasons voice recognition and mobile devices were meant to be together.
1. Speech to text. "There's no question that these mobile devices are great for consumption of information, but when it comes to generation ... they fall flat," says Dreyer, who says he's noticed more and more people attaching external keyboards to their mobile phones, effectively turning them in to mini laptops. That's contrary to the point of a mobile device, he argues, and "even with a keyboard I can't imagine a physician entering data that way."
Speech-to-text services for mobile devices resolve that shortfall. As a majority of doctors are comfortable around dictation already, this enables them to allow patient notes or clinical information directly in to their device, on the fly. Dictating to a service that can automatically convert a doctor's speech to text lets them deliver notes in a conversational style. This is good for several reasons: It frees them up from typing on a small keypad and it means that they may include things they'd forget to type.
2. Custom commands and navigation. "You've got so much information in an EMR, especially within the confines of a four inch screen, it becomes really difficult to present that information," says Dreyer. While software vendors are getting better at choosing what data to display and when, he envisions a better approach. Voice recognition lets physicians "have a free form and flowing conversation" with their devices, "like they were actually talking to a person at their side."
Dreyer references a study that found 81 percent of doctors own a smartphone and that a majority of them use their devices to access reference materials at point of care. "A physician can simply say, 'Show me my patients for the day,' or, 'Show me Mary Smith's info,'" and have that information brought up as he or she is walking in to the room to see the patient, says Dreyer. That level of flexibility can make a physician's workflow much more efficient and can allow them to devote more time to patient care and less to retrieving and looking through records.
3. Clinical language understanding. Natural or clinical language understanding is a process that can pull relevant medical information out of a narrative conversation and convert it in to actionable data that a computer can act upon. A physician "can take speech recognized text, run it through a CLU engine that extracts clinical data and pull structured information out of a patient narrative," says Dreyer. This allows a physician to concentrate more on getting an accurate narrative from the patient, as opposed to asking routine questions. Having a CLU to sort all of the data "allows physicians to document the patient's whole story," says Dreyer. Capturing the entire narrative means the resulting care will be better. "You don't want to force patient narratives in to a template."
4. Future developments. What if a doctor saw a patient and dictated the notes, mentioning the patient showed signs of a certain ailment and that they were prescribing a certain medication, and had a speech recognition and CLU system that was able to send a prescription order to a pharmacy – all in real time? "That scenario is totally feasible," says Dreyer. "For as much as there is unknown [in medicine], there is a lot of known." With actions and protocols centered around so many day-to-day routines, integrating voice recognition and CLU systems with a physician's commands could simplify and streamline workflows.