As an affiliate of the Bessemer-based University of Alabama-Birmingham (UAB) Health System, the Health Care Authority for Medical West has worked diligently to turn our speech recognition challenge into an opportunity.

Our goal was to overcome the skepticism that our team of radiologists felt toward speech recognition and to, ultimately, improve report creation and distribution efficiency, increase departmental cost savings, provide high-quality service to referring physicians and enhance overall quality of patient care.

The issue we faced was that our radiology department used a speech recognition solution that caused headaches from day one. Across our 300-bed community medical center, speech recognition adoption was so stagnant that only one physician in the radiology department used the system. Approximately 80,000 radiology reports are generated annually by the 200 referring physicians with whom we deal.

The majority of our radiologists resorted to a traditional transcription workflow because our problematic speech recognition system just did not perform. The accuracy was very poor and the equipment was not consistently operating.

As we set out to identify a speech recognition solution that our team would adopt to create and
self-edit their reports, we needed to overcome various barriers. Clarity of speech for accurate transcription, synching up our radiology information system (RIS)/PACS with a front- to back-end Web-enabled solution, ensuring low impact on IT and administration ease – were all key issues we considered. But, knowing the potential end benefit, we were up for the challenge.

As we jumped in headfirst to get our entire radiology department digital, including integrating RIS/PACS with a new speech recognition solution, we not only were evaluating our options, but were also operating with the knowledge that we would have to overcome the skepticism of our clinicians. We kicked off our vendor/solution review based on specific criteria that we were searching for.

Outside of eliminating inconsistent performance and poor accuracy, we wanted to ensure compatibility with other systems, and we had developed an extensive list of RIS and PACS integration requirements.

Proven cost savings and a fast implementation track record were also high on our list, along with the necessity for radiologists to self-edit their reports with unwavering confidence that the end documents would have excellent accuracy rates.

Creating Interfaces

After reviewing a range of solutions, we chose to implement Dictaphone PowerScribe from Nuance Communications in Burlington, Mass. A large part of this decision was based on the proven accuracy and reliability of the system and the assurance that we’d be able to create interfaces between PowerScribe and our PACS and RIS.

The decision has worked out very well for our organization, helping us overcome the built-up resistance to speech recognition, improving efficiency and adding welcome flexibility to our radiologists’ work processes.

This solution has also allowed our team to work the way they want to. Establishing proper interfaces between PowerScribe has made our radiology department “paperless.” Each radiology report is initiated via the PACS, which facilitates a seamless, efficient process.

And because the system also allows our radiologists to read exams and generate reports remotely, we are not only increasing our team’s productivity, but making all of our lives easier in terms of flexibility and time management, as well.

Our radiologists were initially reluctant to try another speech recognition product due to their poor experience with the prior system. But, on the new application, their satisfaction with speech recognition has gone from fury and frustration to acceptance and reliability.

Self-editing report rates have risen from 20 percent to 100 percent of the 80,000 radiology reports that pass through the department each year, cutting out reliance on manual transcription and speeding report turnaround time.

The entire team is also enjoying the benefits of productivity tools, such as the ability to insert narrative text with simple voice commands, tabbing through fields via voice instruction and completing a report by dictating just one or two words.  

As a department, we have gone from one radiologist, using sub-optimal speech recognition, to an entire team dictating through a smart technology designed specifically for the language of radiology.

The average report turnaround time is now consistently under four hours from the time of order. We have received feedback from almost all of the 200 physicians we serve, and they all report that our services have been significantly elevated and that our quality is exceptional. This is something we’re proud to have achieved and an area where we are confident we can continue to improve.

Speech recognition technology has changed the way our radiology team operates. Looking ahead, we would like to facilitate further use of the technology, and our long-term goal is to make speech recognition part of the routine across all departments.

If our use of these capabilities within radiology is indicative of possible benefits to other departments, we would expect improvements in efficiency and return on investment across the board.

Looking back on the past 18 months, we have been able to grow our exam volume by 10 percent, without sacrificing turnaround time or hiring additional staff. These accomplishments have allowed us to achieve full return on investment in less than 11 months, and even with the small maintenance cost incurred, we maintained a consistently positive cashflow while improving patient care.

Medical West has been able to optimize our radiology department and enhance quality of patient care that has undoubtedly had a profound impact on the rest of our community.

One thing about radiology is that we tend to impact 99 percent-plus of every patient that walks into the hospital, so a small, incremental change here has made a big impact on the overall  organization.

We are proud of the positive impact the radiology department of Medical West has had on the UAB Health System and we are ecstatic that our work has added to the larger objective of maintaining a strong commitment to quality care for every patient.

— Joe Thornton, BS, RT(R)(CV), is director of imaging services at Medical West (www.health.uab.edu), Bessemer, Ala. Questions and comments can be directed to This e-mail address is being protected from spam bots, you need JavaScript enabled to view it .