The pros and cons of implementing PACS and speech recognition systems

Abstract

The installation and implementation of a hospitalwide image management system and a speech recognition dictation system has had a dramatic and positive impact on radiology report turnaround times at Elmhurst Hospital Center, a 543-bed municipal teaching hospital located in New York City's Borough of Queens. The "lost film" problem has been eliminated. As a result, the percentage of unreported examinations has dropped from 25% to less than 1%. These performance improvements have significantly benefited the entire medical staff. With the successful implementation of a HL-7 standards-based radiology information system (RIS), a speech recognition dictation system, around-the-clock staffing of Board Certified radiologists, and a picture archiving and communication system (PACS), report turnaround time improved dramatically. Eighty-six percent of all examinations now are reported formally within a 12-hour period compared with a 3% average before implementation of the changes. However, with the use of the PACS and speech recognition technologies, new problems have arisen within the radiology department. These technologies, designed to enhance communications capabilities, also have significantly reduced the amount of clinician/radiologist dialogue. Easy and rapid access to patient images and reports has had a detrimental effect on that face-to-face consultations with clinicians, which were commonplace before PACS, and now have almost completely disappeared. The radiologist/clinician interchanges, which occurred frequently before a final report was dictated, often resulted in better understanding of the clinical problem and, hence, a more meaningful final report. Although a conferencing feature to facilitate communication exists within the PACS, it is not utilized by the clinicians. The dilemma is that as information about patients is made more available to the hospital staff, less information is provided about patients to the radiologists. Although the speech recognition system benefits the hospital, its staff, and the patients served by reducing clinician time awaiting a diagnostic report and reducing clinic and emergency room waiting time by the patients themselves, it does not necessarily benefit the radiologists who use it. Speech recognition dictation systems slow down the individual productivity of the radiologists' dictation process by at least 25%. Radiologists are assuming the role of transcriptionists as well as diagnosticians. Mistakes occur that would not with the use of a traditional dictation system and professional transcriptionists.

Do hospital physicians’ attitudes change during PACS implementation? A cross-sectional acceptance study

“…Although clinical information systems (CIS) have clearly proven their value for health care [1,2], it took healthcare decision makers longer to acknowledge the beneficial effects of CIS than is typical for commercial or business settings (in which economic efficiency is often the primary motive, unlike in the healthcare sector). These benefits pertain to a wide range of effects, including reduction of report turnaround time, lower number of medication and transcription errors, elimination of adverse drug effects and many others [3][4][5].…”

“…In view of the financial impact of a PACS project, regardless of whether an entirely new installation or the replacement of an existing PACS is concerned, it is vital to keep the transition phase, in which both systems into (1) what actions an organization can undertake to speed up the acceptance process when PACS is introduced; and (2) when PACS is already in use, what steps an organization can take to maximize the use of PACS.…”

The Design of a Reconstructive Hand Surgery Text Database based on a Speech Recognition System in Iran

“…Accuracy, the detection power of the system, speed, ease of application for the user, cost-effectiveness [19]and communicating with hospital information systems [15,[20][21][22] are important parameters in evaluating the success of the system.…”

Non-Clinical Errors Using Voice Recognition Dictation Software for Radiology Reports: A Retrospective Audit

“…Another cause for this type of error may be user frustration with the VR system which arises when the radiologist reverts back to typing their reports. Voice recognition dictation is also widely believed to reduce the radiologist's productivity [4]. Radiologists under pressure to complete the reporting worklist may try to retrieve this lost time by dictating shorter reports with fragmented and incomplete sentences.…”