Keeping medical records in-house

WHEN REPORTS surfaced recently that medical record transcriptions for Irish patients from Tallaght hospital had fallen into third-party hands in the Philippines, where the transcriptions were done, one question seemed to go unasked.

Why were hospitals using voice recognition technology to dictate files that then required a third-party company to transcribe into usable documents? Surely the whole point of voice-recognition is to enable such tasks to be done within the organisation in the first place?

On such a conundrum turns the two alternative business models of companies providing services to the medical sector in the voice-recognition area. On the one hand are firms such as UScribe, implicated in the recent data breaches, which has a dictation model of taking in voice files from consultants and then outsourcing the process of converting them to documents.

While there are some UK-based companies which will do the transcription process, many voice companies outsource to the Philippines, because it is cheaper. Outsourcing voice files in this way may raise data protection issues in Europe, an issue being examined by the Data Protection Commissioner’s office in Ireland.

The other model is to automate much of the transcription and data management process, and enable organisations to do transcriptions in-house. That’s the approach taken by G2 Speech, a company with Dutch roots in Philips technology (founded by two ex-Philips employees, G2 uses Philips’s Speech Magic speech engine, now owned by voice giant Nuance, as its underlying voice technology).

Its UK and Ireland operations are run by Cork-based managing director Henry Gallagher, a Dictaphone veteran who set up his own dictation company before joining with five other shareholders to bring G2 Speech into the English-speaking market.

“Outsourcing is what a lot of our competitors are doing. They say speech recognition doesn’t really work. We say it does,” says Gallagher.

They claim success in persuading potential clients that the entire dictation, transcription and management process can remain in-house – the company says it has won the last five major tenders for medical transcription services in the UK market. They have 95 per cent penetration into hospitals in the Netherlands, and are beginning to grow the Irish market, which the company entered four years ago.

Gallagher says the key to what they offer is not the speech recognition element. The increased power of desktop computers combined with advances in speech technology means commercial and consumer products already have very good accuracy – up to 98 per cent with some minimal training, he says.

On the speech recognition side, a consultant simply dictates the file. Words don’t even appear on the screen, because the consultant will not be managing the document initially. “Because we’ve built in workflow, the consultant doesn’t have to do the corrections. What’s key is not slowing down the consultant,” says Gallagher. “And what’s more important is how you deal with the information afterwards.”

With G2, the initial transcription is done automatically, and then goes to secretaries within the hospital itself for basic corrections rather than being outsourced to a third party, as happened with the breached Irish patient files. A corrected transcript then returns to the consultant for sign-off.

Once approved, the consultant’s report can be processed through the system in whatever way the hospital determines. It might be sent to another consultant, GP or the patient. It will enter the patient’s file automatically, and data from within the report – standard elements such as height, weight, blood pressure or blood test results – can be easily automated to fill in a hospital’s patient profile forms.

An initial report can also be made available immediately to other consultants who might be seeing the same patient, making available detail that could help prevent mistakes and incorrect treatment.

Gallagher says the greatest challenge G2 Speech faces is that so many people have outdated assumptions about speech recognition, perhaps having tried some of the initial medical systems a decade or more ago.

The problem is “the history of speech recognition, and misunderstandings based on what it used to be like”, he says. He grumbles that many companies still do speech recognition a disservice by selling medical services on the basis of how accurate the underlying speech engine is within the dictation application, when really the selling point should be the workflow process.

Such uncertainty about the capabilities of speech recognition probably persuades many hospitals to take the rival approach of using a dictation service that outsources transcriptions and returns them to the hospital. But that is changing: analysts say medical services are a major growth area for speech recognition. Nuance said the sector was a key contributor to its own high-growth earnings last quarter.

Secretaries sometimes baulk at the idea of having to deal with speech recognition files, Gallagher acknowledges, but says they often become the biggest advocates for this approach because they can process more files – up to 75 in a half day, he claims.

He also argues that costs are lower with processing files in-house, where there’s an upfront capital cost and then a far lower maintenance cost, whereas outsourced files will have an ongoing services cost that may rise.

While he acknowledges G2 Speech is “a small company in Ireland” – there are only four employees in a “virtual office” in Dublin, compared with 26 in the UK and close to 40 in Eindhoven in the Netherlands – he notes some hospitals here are already using the system, and that the company has some test programmes under way. The Health Service Executive is also testing technologies for increasing efficiency and lowering costs in hospitals.

“In Ireland I think this technology will happen because it kind of has to happen,” says Gallagher. “Not just to save money, but because there is a huge workload.” Whatever about controversies over outsourced files, consultants in Ireland need to be able to process reports more efficiently and quickly than is now the case.

While Ireland is only a fledgling market, Gallagher describes the Dutch market as “very solid” and says the company’s current growth market is the UK. “It’s a well-run company, because we don’t say ‘We’ll go everywhere’. We are in profit, we’re not heavily in debt, and we’re lucky that we can grow organically.”

He says they will look at broader markets soon, probably Austria and Canada, and perhaps Germany. The US, though, is very entrenched in using specific technologies and is not an attractive market at this time.

Gallagher is clear about his own role in any expansion: “My job is getting people aware that voice recognition is a viable alternative.”