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Dictation technology in general practice

30 March 2009

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IT Manager

Simon is an IT manager at a GP surgery in the West Midlands. He has been in the IT industry for more than 21 years, first as a programmer, then as a computer analyst/consultant/specialist. Simon has worked in general practice for the last five years. His present position involves dealing with the local PCT in all matters relating to Connecting for Health, as well as the normal day-to-day operation of the computers and network within the surgery

Dictation systems – where doctors dictate referrals and other letters for the medical secretary to type and send – in general practice today are usually portable, small, handheld tape machines that use reuseable cassettes. These allow letters to be dictated anywhere. Unfortunately, these tapes use an analogue recording system. And as the tapes are reused, they can become worn and the quality of the recording deteriorates.

We now have a 21st-century alternative: digital dictation. There are two types of digital dictation to consider. One method involves a straightforward digital voice recording, which can simply be played back and transcribed. The other is voice recognition, where the software automatically transcribes the speech recorded.

Two methods of input are commonly used: a microphone directly connected to the computer, which allows the dictation to be recorded directly to the computer’s hard drive, or a digital handheld recorder, which allows some flexibility as to where the dictation is recorded. If all recording is done at the surgery, then a decent USB microphone (ie, connected to the computer) is probably the best method of input. The sound file can be recorded directly to the surgery’s server.

Advantages of digital technology
Storing dictation digitally and transcribing has several benefits over tape systems currently used:

  • Improved sound quality, which is the feature that will be most valued by your secretaries. Digital recording is much clearer than the old analogue tapes, with no hiss and crackle. And unlike analogue systems, the sound quality does not deteriorate over time as cassettes become worn out – as there are no cassettes. Which leads to the next advantage …
  • No expensive tapes to purchase. Digital dictation systems record either to a memory card or directly to a computer’s hard disk drive.
  • If a network solution is installed – meaning the system will record directly to the computer network – then there are additional benefits:
    • The letter is immediately available to the medical secretaries as soon as it is dictated, so no waiting for the doctor to finish a tape!
    • Letters cannot be “lost” due to tapes being misplaced in transit from doctor to secretary. It also removes the time delay in transferring tapes.
    • Letters can be prioritised when saved to the server, so the secretary can see which letters are urgent and need typing first.
    • Several secretaries can deal with a doctor’s letters concurrently, as they are picked up from the central server rather than all being contained on a single tape that can only be accessed by one secretary.
    • Your secretary pool can be located anywhere in the building where there is a network access point. Any computer with suitable software installed can “play” the recording.
    • If any part of the recording cannot be understood, the doctor no longer has to go to the secretary to listen. If there is a query regarding what is being said at a particular time point in the recording, the GPs can simply access and listen to the recording on their own computer.
    • Security is improved, as there are no tapes containing unencrypted data to lose.

Transcription kits are available for most digital dictation systems, which will allow the secretary to operate the sound file just like they handled tapes, using foot pedals to start/stop/rewind/pause the recording. This will enable a smooth transition from the old tape systems to the newer digital systems.

Voice recognition software
To take digital dictation to its logical conclusion, it makes sense to investigate voice recognition software. Several systems are available, but each has the same outcome: speech is dictated, stored digitally and automatically transcribed to a printed document layout on the computer.

These systems all require a fairly modern computer specification and the more memory the workstation has installed (probably a minimum of 2 GB of Ram), the smoother the operation should perform. The modern systems claim high accuracy and usually without a lot of training – that’s training the computer to recognise your voice, not training you to operate the software!

They all require a special medical dictionary to be installed and most will create Microsoft Word documents as their output. Some will work without a specialised medical dictionary, but will not then recognise any medical terms dictated, and each word would need to be confirmed as accurate.

Also, depending on your clinical system, some voice recognition software can be used to dictate a consultation directly into the computer’s clinical record – your GP may never need type again!