One of the many areas health management has to deal with is clinical documentation. Health care organizations have been using computers for quite some time – even though some hospitals may still be at the point of migrating from paper charts to digit.
What has not changed is the fact that text and data still need to be entered into whatever electronic system is being used. Only then can health professionals easily and instantaneously use the documentation and data, exchange information, look up health records, and use data for diagnostic or statistical purposes among others.
Since the seventies our expectations about computer performance have been without limits, believing that computers could eventually be intelligent (the buzz word being artificial intelligence) and that some day they would understand our natural language. Nearly 40 years have gone by, and while computers have increased productivity in all aspects of our economy and can recognize certain speech, they do some tasks better than others. To understand a doctor's speech is one of those tasks that computers are not that good at. Even though speech recognition technology (SRT) is slowly making progress, the computer is more reliable when it “listens” to the keyboard. Whether hardware or virtual, the keyboard is still the most reliable text and data entry.
While keying in text and data can be done by fast typists, this process is time consuming and costly, particularly in the health care environment where clinical documentation is voluminous and indispensable. To accelerate the text entry process and reduce turn-around-time, many electronic health managers and individual transcriptionists have turned to new technology.
One way to accelerate text and data entry is to save keystrokes by using abbreviations or word completion. A number of abbreviation systems have been around and used in transcription. Their technology was based on what was possible with the initial operating system DOS. These so-called text expanders are still in use, and Windows versions are available. However, they use old technology.
The founder of Textware Solutions and chief architect for the design of the computer language Ada, Jean Ichbiah, was among the first software engineers to insist on innovative, reliable, and easily maintainable software designed to achieve realistic goals.
He designed Instant Text to accelerate the text entry process with new technology taking into account:
Making an abbreviation list is a tedious undertaking. Once documentation is electronically available, the computer can take over this task, and it does it very fast. Instant Text is designed to compile enormous amounts of text and select the most frequently used words and phrases in a particular domain. It creates customized glossaries for any person's language or any specialty language in a few seconds.
These customized glossaries make the language available whenever the user keys in text. The new technology offers an easy way to produce words and phrases with just a few keystrokes. As soon as the user types a few letters, Instant Text matches them with the vocabulary that is in the customized glossary. A million invisible tasks are executed between keystrokes to make visible the words and phrases one may need for input in a particular context. A medical glossary will bring up bilateral salpingo-oophorectomy when the user types bso, whereas a general glossary may bring up Boston Symphony Orchestra and a German glossary will show besonders.
Compared to word completion, Instant Text is more efficient as it allows a user to employ the most relevant letters of a word. Any word can be pulled up with 3 or 4 letters: cdpu will immediately present cardiopulmonary. To pull up a phrase, one types the initials of the words, and one doesn't even have to type them all: tpor brings up all the phrases that contain Thepatient… and … the operating room.
Visual feedback lets the user see the choices in advisory windows displayed on the screen. A shortcut like copd can trigger COPD as well as chronic obstructive pulmonary disease. Instant Text suggests these phrases, and the user selects the one needed. The doctor's language is visible and at the user's fingertips. No predefined abbreviations are necessary, and no memorization is required. Why memorize abbreviations if one can, in each domain, make use of one's knowledge of the particular terminology?
When they assess a patient's health, doctors like to be able to use narrative language rather than predefined structured language. Yet, when Instant Text compiles a glossary from existing reports, it examines the frequency of the words and phrases used and discovers the structure of each doctor's language. What is in the glossary is what they frequently say.
Instant Text does not only provide the user with the most frequently used words and phrases. Based on what it finds during the compilation process, it is capable of suggesting what is likely to follow after a sentence is started. For instance, tpt expands to The patient tolerated and immediately triggers the continuation choices the procedure, the procedure quite well, the procedure very well etc. depending on what situation each doctor has encountered and described in previous reports.
Instant Text glossaries allow a much wider use of shortcuts to a point where one can easily use tens of thousands of shortcuts. The user types a few characters, and the word or phrase will be shown. Visual feedback and expansions happen instantaneously whether the user looks for a word or a whole page to expand.
Speeding up text entry has been a concern in medical transcription for a long time. The traditional way was to build a list of abbreviations and try to remember them. Many Transcription platforms still offer this kind of expansion utility. It usually takes medical transcriptionists years to build such a list, and there is a limit to what one can memorize. For the most part, these lists are not reusable when the system changes, which means that they have to start over again.
These lists, moreover, are mostly filled up with words and much less with phrases due to the fact that it is easier to figure out which words one types all day long than it is to think of all the variations of phrases. As shown in a study by Jean Ichbiah, the savings of keystrokes is limited to about 30% when abbreviating words, whereas the savings can reach 80% when abbreviating phrases. Instant Text makes it easy to abbreviate phrases and use continuations since they can be obtained in a few seconds in the form of customized glossaries compiled by Instant Text.
With a library of glossaries it is possible to use tens of thousands of shortcuts instead of the 2,000 people generally use when they have to memorize abbreviations. As there are no abbreviations to memorize, anyone can use and share Instant Text glossaries. It is quite a challenge to learn another person's abbreviation list and similar to learning a foreign language, and we all know how difficult that is.
When using Instant Text transcriptionists can develop their own personal glossary. At the same time they can combine glossaries as they see fit. Some of the shared glossaries like Drug, Address, or Heading glossaries can be maintained by just one person and dispatched to anyone in the Transcription Department.
Glossaries are not tied to a word-processor, a transcription platform or a system. They can be used wherever needed. Instant Text is an independent Windows application that links to whatever system is used for clinical documentation.
We all know that doctors need to spend their valuable time on patient care. To hold the extra time they spend on clinical documentation to a minimum, they choose the fastest method: dictation.
High hopes have been placed into SRT (speech recognition technology). However, despite some recent successes, we are far from being at the stage where we can completely rely on it. As Jean Ichbiah used to say: "Just because people wish speech recognition to thrive it does not mean that it will" In an environment where accuracy and turn-around time are key factors, health care management needs cost-effective technology that works 100% now.
Many transcription platforms have integrated back-end speech recognition technology which translates the doctor's dictation into text. Depending on the accuracy rate achieved in the SRT draft, the report is either retyped or edited.
In the case of SRT editing, the Instant Text glossaries can again be very useful. The draft may show a phrase like The patient was noted to have undergone a direct a lumbar spine fusion and needs to be corrected to thoracolumbar spine fusion. The erroneous part can easily be replaced with tclb or thcl expanding to thoracolumbar.
While hearing unclear dictation or reading an SRT draft, it may not always be obvious to figure out what was really meant to appear in a report. Based on the language in its customized glossaries, Instant Text may suggest which of the phrases is appropriate at this point.
Text entry and editing is performed by Medical Language Specialists who make sure that every report is error-free, and that nothing is lost in "translation" when they correct an SRT draft. They use the keyboard, and every time the keyboard is used, Instant Text has its role to play.
Cost savings in health care management depend very much on the right productivity tools. These tools need to be:
Textware Solutions specializes in fast text entry software that fulfills these requirements. More than 20,000 medical transcriptionists and editors are using Instant Text on a large variety of transcription platforms. They have seen their productivity increase, and turn-around-time decrease. And their fingers don’t hurt anymore.