Improvement in the quality of automated dictation by making explicit use of semantic knowledge

1. Improvement in the quality of automated dictationby making explicit use of semantic knowledge Klaus Stanglmayr Friday, February 23, 2007

2. Philips Speech Recognition Systems

3. Philips Speech Recognition Systems • A business unit of Royal Philips Electronics • 12 years continuous speech recognition • The world‘s most successful speech recognition technology for professionals - 8000 sites- 50 nations • Large network of integration partners (200+) • On the forefront of technological innovation

4. Bringing sense and simplicity to life

5. Speech is the most common and easiest means of communication between people... ...and technology!

6. Speech Recognition in healthcare

7. Healthcare is the world’s largest service sector Worldwide Healthcare Expenditure: US$3,300 bln in 2002 North America makes up 49%of the worldwide spent Source: Medistat Healthcare Expenditures will grow from ~8% of worldwide GDP to ~10% in 2010 Source: WHO 4

8. Medical technology continues to transform Healthcare Imagingearlier diagnosis saves lives and reduces costs Minimally invasive surgeryreducing patient trauma and costs Healthcare ITRight Information at the right timeenables better treatment and lower costs Molecular MedicinePreventing disease from happening Around 70% of the survival improvement in heart attack mortality is a result of changes in technology.” Cutler & McClellan, 2001 Sources: Russ Coile, Futurescan 2003, SG-2

10. Hands-free Interaction in the Hospital • Advanced voice control technology • Enables clinicians to interact with medical equipment when their hands are already occupied

11. Clinical Documentation – primarily by speech • Primary use of Speech Recognition in healthcare is for clinical documentation • A large chunk of patients health records was dictated; free text • Clinician dictates as usual • Speech recognition technology creates a draft that is reviewed edited by medical transcriptionist using keyboard or speech • Transcript is returned to clinician for review and authentication and insertion into record

12. Medical Transcription • Estimated $18 to $25 billion industry • Estimated 300,000 to 400,000 MTs in US

13. Documentation is the lifeblood of healthcare

14. Complex process of caring for patients Clinical documentation comprises the essential building blocks for all healthcare processes Each step must be accurately and thoroughly documented Delivering care is a complex process with many potential failure points. Errors in medical care are usually not due to negligence by medical staff Physicians, when surveyed, indicate that they are most interested in capabilities • that reduce documentation time • positively affect their communications with patients, other physicians, and payers • provide clinical information to minimize their time away from non-patient functions

15. Challenges in Healthcare • Diminished quality of healthcare • Inadequate information • Illegible entries • Misinterpretations • Lack of shareable information • Lack of uniform capture

16. NLP/NLU • One of the tasks that an NLP system can perform is the parsing of a sentence to determine its syntax. Determining the semantic meaning of a sentence is a much harder task to perform. When an NLP system can achieve this, we can talk about Natural Language Understanding (NLU). • "Understanding" language means, among other things, knowing what concepts a word or phrase stands for, and knowing how to link those concepts together in a meaningful way. It's ironic that natural language, the symbol system that is easiest for humans to learn and use, is hardest for a computer to master. Long after machines have proven capable of inverting large matrices with speed and grace, they still fail to master the basics of our spoken and written languages.

17. SPEECH UNDERSTANDING • Understands the entire context of dictation and recognizes the physician’s intent, while adapting to a variety of speaking styles and dictation habits • Technology has the flexibility to handle the way people really speak—with varying accents, dialects, styles, and speeds • Converts free text into structured information • Organizing Meaning • Technology gleans meaning from spoken words and organizes it automatically into meaningful categories • Automatically structured documents enable efficient review • Automatically adds normals, templates, macros • Encoding Data • Services process dictation, encode clinical facts, like medications, dosages, allergies, measurements like blood pressure readings, and much more. • Semantic Interoperability

18. Intelligent Speech Interpretation (ISI) • Challenges for traditional speech recognition systems • human speech/human speakers are not perfect • punctuation omitted • disfluent speech • hesitations • pauses • silences • redundant speech • repetitions/corrections • Focus on optimizing speech recognition: “make it work in the “real” world”

19. Challenges – A perfect speaker? POSTOPERATIVE_DIAGNOSIS [AAHHMMMMM]Status post complete oral and dental rehabilitation PERIOD NEXT_PARAGRAPH[OOHHMMMMM] [NEXT SECTION] OPERATION PERFORMEDComplete oral and dental rehabilitationPERIOD NEXT_PARAGRAPH [cough] ANESTHESIA General anesthesia by the anesthesia staffPERIOD NEXT_LINE Duration of surgery: Close to 45 minutes. Incision: none. NEXT_PARAGRAPH [NEXT SECTION] [________________][paper rustling] [________________] FINDINGS[AAHHMMMMM]The patient is a 22-year-old male with missing teeth and permanent dentitionCOMMAmental retardationCOMMAseizure disorderCOMMAmicrocephaly COMMAand gastroesophageal reflux disease PERIOD Since[__]March first 2004COMMAthere has not been much change in the appearance of the patientPERIOD[AAHHMMMMM]The patient also had periodontal disease evidenced by moderate bone loss COMMAhyperplastic gingiva and tothree to seven millimeter pockets PERIOD NEXT_PARAGRAPH This is the end of dictation, thank you

20. Understanding more...Intelligent Speech Interpretation

21. Final Report POSTOPERATIVE DIAGNOSIS Status post complete oral and dental rehabilitation. OPERATION PERFORMED Complete oral and dental rehabilitation. ANESTHESIA General anesthesia by the anesthesia staff. Duration of surgery: Close to 45 minutes. Incision: none. FINDINGS The patient is a 22-year-old male with missing teeth and permanent dentition, mental retardation, seizure disorder, microcephaly, and gastroesophageal reflux disease. Since March 1st 2004, there has not been much change in the appearance of the patient. The patient also had periodontal disease evidenced by moderate bone loss, hyperplastic gingiva and to 3-7 millimeter pockets. John Smith, MD Philips Hospital Vienna Triester Straße 64 A1101 Vienna, Austria

22. All truth passes through three stages. First, it is ridiculed. Second, it is violently opposed. Third, it is accepted as being self-evident. Arthur Schopenhauer For further information please contact: klaus.stanglmayr@philips.comTel.: +43-1-60101-4110 http//www.philips.com/speechrecognition