Experience with voice recognition in surgical pathology at a large academic multi-institutional center.

There are few reports of institutional use of voice recognition technology in clinical practice. We describe our experience with voice recognition-integrated synoptic-like dictation, associating templates with key spoken phrases, that we have used in gross examination of common specimens and as a major component of our workflow since 2001. The primary application is VoiceOver Enterprise (Voicebrook, Lake Success, NY), which uses Dragon NaturallySpeaking Medical Edition (Nuance Communications, Burlington, MA) as its speech engine. This integrates with the anatomic pathology laboratory information system (APLIS) and other applications, such as Microsoft Office (Microsoft, Redmond, WA). The largest user group, pathology assistants, mainly dictates biopsy reports, numbering approximately 210,000 specimens since 2001. The technology has been useful in our anatomic pathology workflow and provided a good return on investment, including marked improvements in turnaround time, results standardization, error reduction, and cost savings. The most helpful features of the software are templating, the seamless integration with APLIS, and the voice command creation tools.

Historia clínica en soporte electrónico: experiencia de un servicio de Dermatología / Electronic medical history: Experience in a dermatology departament

La informatización consiste básicamente en una alternativa a la gestión clásica de la información, pasando del soporte en papel al electrónico. Este modelo aporta ventajas en la legibilidad, uniformidad, accesibilidad y explotación de los datos. Sin embargo, no es sencillo aplicar este proceso a la práctica clínica, pues requiere un adecuado soporte de equipos en red, el desarrollo continuo de las aplicaciones, una estrategia de implantación y la colaboración de todo el personal implicado. Revisamos nuestra experiencia en el desarrollo e implantación de una historia clínica (HC) en formato electrónico y su adaptación a un Servicio de Dermatología pionero en España. El modelo elegido en nuestro hospital desde su apertura en 1998 fue el de historia única centralizada electrónica de uso común (HCE) que se complementa con aplicaciones departamentales. La HCE se concibe como una base de datos relacional, centrada en el paciente y estructurada por procesos, que cumple los requisitos legales y permite prescindir del soporte físico (papel o placa) en la práctica totalidad de las situaciones. El sistema funciona en los servidores centrales bajo el mantenimiento del departamento de sistemas de información. Las potencialidades son ilimitadas, destacando: asistencia por guías de actuación clínica, conexión remota con Atención Primaria, gestión on-line de actividad, consumos y estándares de calidad. Buscando alcanzar estas potencialidades en 2003 se inició un cambio tecnológico hacia lo que después sería el sistema elegido en la Comunidad de Madrid para soportar el trabajo de los nuevos hospitales (AU)

Computerization, with a change from paper to electronic format, represents an alternative to traditional information management. This model offers advantages in legibility, uniformity, accessibility, and use of the data. However, it is not easy to apply this process to clinical practice as it requires a suitable network, continuous application development, an implementation strategy, and the cooperation of all staff involved. We have reviewed our experience in the development and introduction of electronic health records and their adaptation to a pioneer dermatology department in Spain. Since our hospital was opened 1998, the model used is that of a single, centralized electronic health record, with supplementary departmental attributes. The electronic health record is conceived as an interactive database designed around the patient, with a procedure-based structure, and that obviates the need for hardcopies (paper or films) in practically all situations; it must comply with legal requirements. The system is installed on central servers maintained by the information technology department. The potential is unlimited; particularly important possibilities include clinical guideline-directed care, remote connection for general practitioners, and online activity, stock, and quality management. With the aim of realizing this potential, a technological change was started in 2003, moving towards what was to become the chosen system in the Community of Madrid to cope with the workload arising from new hospitals (AU)

HIM jobs of tomorrow.

Tomorrow's HIM jobs are arriving today, as technology transforms how we capture, manage, and use information. Following are 11 jobs that represent evolving roles and emerging opportunities. Some are familiar roles with a new twist. Others are new roles, and some are possibilities. All are opportunities for HIM professionals to use their core competencies in new ways and move into positions that have not been thought of as career tracks for HIM.

Evaluación del Sistema de Radiocomunicación Implementado en el Área de Salud Nº3, del Cantón Salcedo de la Provincia del Cotopaxi / Evaluation of the System of Implemented Radio communication in the Area of Health Nº3, of the Canton Salcedo of the County of the Cotopaxi

Los procesos, trámites, actividades, tanto adminsitrativas como técnicas de salud; desde años atrás se los ejecuta de manera lenta, a destiempo, y en algunos casos sin considerar fuentes de información adecuadas y reales. esta situación pone en serio peligro la vida humana individual y colectiva sobre todo de grupos vulnerables, quienes por su ubicación geográfica, condiciones socio-económicas, políticas, religiosas, culturales, de género, medio ambiente, tienen dificultades para el acceso a las unidades de salud con el consiguiente riesgo para su vida. El servicio de salud podría operar eficientemente a través de una red de comunicación que conecte el centro urbano con el rural, de esa manera se podría resolver algunos de los problemas que enfrentan estas unidades tales como déficit de profesionales y funcionarios de salud, reducido presupuesto

Comparison of voice-automated transcription and human transcription in generating pathology reports.

CONTEXT: Software that can convert spoken words into written text has been available since the early 1980s. Early continuous speech systems were developed in 1994, with the latest commercially available editions having a claimed accuracy of up to 98% of speech recognition at natural speech rates. OBJECTIVES: To evaluate the efficacy of one commercially available voice-recognition software system with pathology vocabulary in generating pathology reports and to compare this with human transcription. To draw cost analysis conclusions regarding human versus computer-based transcription. DESIGN: Two hundred six routine pathology reports from the surgical pathology material handled at St Joseph's Healthcare, Hamilton, Ontario, were generated simultaneously using computer-based transcription and human transcription. The following hardware and software were used: a desktop 450-MHz Intel Pentium III processor with 192 MB of RAM, a speech-quality sound card (Sound Blaster), noise-canceling headset microphone, and IBM ViaVoice Pro version 8 with pathology vocabulary support (Voice Automated, Huntington Beach, Calif). The cost of the hardware and software used was approximately Can 2250 dollars. RESULTS: A total of 23 458 words were transcribed using both methods with a mean of 114 words per report. The mean accuracy rate was 93.6% (range, 87.4%-96%) using the computer software, compared to a mean accuracy of 99.6% (range, 99.4%-99.8%) for human transcription (P <.001). Time needed to edit documents by the primary evaluator (M.A.) using the computer was on average twice that needed for editing the documents produced by human transcriptionists (range, 1.4-3.5 times). The extra time needed to edit documents was 67 minutes per week (13 minutes per day). CONCLUSIONS: Computer-based continuous speech-recognition systems in pathology can be successfully used in pathology practice even during the handling of gross pathology specimens. The relatively low accuracy rate of this voice-recognition software with resultant increased editing burden on pathologists may not encourage its application on a wide scale in pathology departments with sufficient human transcription services, despite significant potential financial savings. However, computer-based transcription represents an attractive and relatively inexpensive alternative to human transcription in departments where there is a shortage of transcription services, and will no doubt become more commonly used in pathology departments in the future.

The future of HIM: an operational view.

What will HIM processes, departments, and the patient record look like 10 years from now? The author offers a view of HIM operations at an academic medical center with an eye for operational, organizational, and functional structure.

Implications of new organizational relationships and fiscal incentives on health information managers.

Whether the health field in the United States should be dominated by more competition or by more government regulation is now at the center of the public policy debate. After examining the market-driven and regulatory models to constrain cost, improve quality, and enhance access to care, the article argues that our current centrist political philosophy can be expected to continue on Capitol Hill and among the state legislatures. As a result, this will force health information managers to labor within a blended approach that is partially market driven and partially governed by regulations. How such a hybrid system will affect the future role of health information professionals, integrated information systems, and other related topics is also discussed.

Estadísticas y costos de los pacientes ingresados al servicio de cirugía con heridas por armas de fuego, Hospital Dr. José María Benítez, la Victoria Estado Aragua, enero-abril 1997 / Estadistic and cost of the patients and average a service of surgery with gun wounds Hospital Dr. Jose Maria Benitez, La Victoria State Aragua, january-april 1997

Se realizó el estudio estadístico de los pacientes que fueron ingresados desde enero a abril 1997, en el Servicio de Cirugía del Hospital José María Vergas. La Victoria, Estado Aragua, por heridas de arma de fuego y se estimaron el costo de los ingresos para este hospital. Fueron admitidos 43 pacietnes, todos del sexo masculino, con un 67,43 por ciento entre los 11 y 30 años. Un 76,74 por ciento de las heridas ocurrieron en el abdomen, siendo el intestino grueso y el intestino delgado los órganos más afectados (24,49 por ciento cada uno). El costo promedio por paciente fue de Bs. 410.669,32 para un total de Bs 17.658.780,85 para los pacientes ingresados en este período de 4 meses

Facing change--preparing for the future.

This case study demonstrates that team development takes time. It involves interpersonal skill development for staff members, management training, and specific team building sessions after the teams form. It is crucial that the specific content of training for managers, staff members, team leaders, and team members evolves from an assessment of organizational needs coupled with involvement of all levels of the department. You may ask if this entire process has made a difference. Yes, it has. Staff members are beginning to be more open and honest with one another regarding issues detrimental to the group process. Above all, team leaders and staff are assuming responsibility together for the workload and process improvement. Implementing the team process without proper training and assessment is sure to fail. Yet we must continue to work and shape the team process toward the final level of self-direction.

New medical record system in Queen Elizabeth Hospital, Hong Kong.

During the 1980's, the medical record problems had been identified and it was not until 1991 that Queen Elizabeth Hospital was chosen to be the pilot hospital for the development of a new medical record management system for the Hospital Authority hospitals. The new medical records system was implemented in Queen Elizabeth Hospital in December, 1993. Six month after implementation, a pre-implementation and post-implementation review of the medical record services were conducted to compare the results of the new and old system. The results showed that there were significant improvements in the record retrieval and record integrity in the new system. New medical record services such as the delivery of readmission records to the ward, filing of medical records forms in pre-defined order and filing of loose sheets in the relevant hospital notes are able to facilitate the efficient, effective and complete access to patient information. The support and cooperation of the hospital staff are crucial to the success of the new system. Continuous review and improvement of the new system is essential in order to obtain the best results.