Custom IVR Applications

This section of our technical library presents information and documentation relating to IVR Development and custom IVR software and products. Business phone systems and toll free answering systems (generally 800 numbers and their equivalent) are very popular for service and sales organizations, allowing customers and prospects to call your organization anywhere in the country. The PACER and WIZARD IVR System is just one of many DSC call center phone system features..

What Is IVR?. An Interactive Voice Response (IVR) processes inbound phone calls, plays recorded messages including information extracted from databases and the internet, and potentially routes calls to either inhouse service agents or transfers the caller to an outside extension.

Contact DSC today. to learn more about our IVR services and IVR application development software.

Natural speech recognition promises to bring unprecedented speed and convenience to the creation and management of medical data

by David Essex

Medical Transcriptionist's Friend or Foe?

THE ARMCHAIR ANALYSIS OF THE EFFECT ON HUMAN medical transcriptionists of automated conversion of recorded speech to computerized text and data inevitably conjures up thoughts of the early 20th century horse and buggy industry. Won't speech-recognizing computers make human transcriptionists obsolete, just as World War II "electronic brains" did to the minions who hand-calculated Allied missile trajectories?

Several factors make that unlikely, at least in the near term, though medical transcriptionists are understandably skittish.

First, transcriptionists are in such short supply that healthcare organizations and transcription outsourcing vendors can't find enough in the United States. They're looking for help in high-tech labor hotbeds like Bangalore, India, and paying more money--upward of 22 cents a line--to the lucky ones with the necessary skills. Some hospitals have given up on finding transcription help altogether. The emergency department at Massachusetts' Milford-Whitinsville Regional Hospital had little choice but to buy three Lernout & Hauspie (L&H) Kurzweil Clinical Reporter workstations when not even the hospital's local outsourcing vendor could find enough nearby help to guarantee the required turnaround time. "We looked at the standard transcription approach," says Julian Kadish, MD, who has responsibility for the emergency department's computer systems. "It became a real issue of the human services just not being available."

Latest-generation speech software isn't so reliable that it doesn't need human intervention. Most doctors don't want to make their own corrections, but since all speech recognition software saves the original digital recording, human transcriptionists are able to interpret the intended meaning of slurred and shorthand phraseology better than computers--which are good at "hearing" and grammar but still pretty dumb about the meaning of words--could ever do. You still need a human, well-trained in the terminology of medicine, to ensure the accuracy of every record--though the software is amazingly reliable at filling in forms and checking the coherence of highly structured data, which has fewer word choices and thus a generally higher recognition rate.

One longtime user of L&H's Kurzweil Clinical Reporter, Richard O'Brien, MD, of Moses Taylor Hospital in Scranton, Pa., is satisfied with the results. "I know my transcription cost is zero," O'Brien says. "My transcriptionist is available 24 hours a day, seven days a week. "Turnaround times are virtually nonexistent. "My colleagues can't believe I have [the report] done before they have their dictation done," O'Brien brags.

One transcription company, e-DOCS, inc. in Houston, (formerly known as Applied Voice Recognition, Inc.) is basing an entirely new business strategy on using automation to save transcription costs and pass most of the savings on to customers. The company also offers discounts to users of its new Voice Commander 99 system who put extra training time into improving the software's recognition rate. "We will guarantee your costs at no more than 12 cents a line," in exchange for a 39-month contract for transcription services, says e-DOCS, inc. president Tim Connolly. e-DOCS, inc. is realizing such huge cost savings from speech recognition and the use of local Internet connections to transfer files that it no longer charges the $15,000 hardware costs for customers who buy the service contract, says Connolly.

At the same time, e-DOCS, inc. recognizes the continued importance of trained human transcriptionists. The new government documentation requirements "are going to tremendously expand the demand for transcriptionists," Connolly says.

Transcriptionists and the companies who employ them may have another reason to welcome speech recognition. As a typing-intensive profession, medical transcription has a relatively high incidence of repetitive stress syndrome, such as carpal tunnel, according to Molly Malone, executive director of the Medical Transcription Industry Association (MTIA).

Malone worries about a particularly perverse outcome of speech recognition's growing popularity: that the current severe shortage might actually grow worse if people avoid entering the profession because they fear it'll go the way of, well, the horse and buggy industry. "We need more transcriptionists to come into the field," Malone says.

Transcriptionists are touchy about the subject, as one speech recognition-based transcription vendor discovered when it impoliticly posted an ad headlined "No more high transcription cost" in an Internet newsgroup for medical transcriptionists. "Are you aware that you posted this advertisement on a newsgroup FOR medical transcripionists?" wrote one group member. "Seems like we'd be the last people you'd want to market to about eliminating 'high transcription costs.'"

• Breakthroughs in accurate recognition of natural sounding "continuous" speech
• Widespread availability of cheap, raw computing power
• Onerous documentation requirements from insurers and government agencies like HCFA
• Shortage of medical transcriptionists
• Well-established doctor acceptance of dictation as a data-input method
• Large changes in organizational processes or caregiver work styles (unlike most other types of computerization) are unnecessary
• Easy-to-grasp return on investment

• Caregivers' resistance to learning new methods
• Underpowered legacy systems not suitable for running it
• Incompatible patient record and practice management systems
• Accuracy rate still inadequate for some uses
• Use in specialized medicine improves accuracy rate, but relegates application to "islands," making enterprisewide implementations difficult