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1802RE: [agile-usability] Re: QWERTY, mouse, and novel input

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  • Larry Constantine
    Dec 8, 2005
      Ron Vutpakdi wrote:

      > Just as an aside: the doctors and psychologists that I know who use
      > speech to text for dictation do so because it's faster for them to
      > dictate reports rather than typing (not that they can't type). They
      > can do so while walking around or even just sitting at their desk, but
      > speaking is faster than typing.
      > In their cases, with a special dictionary and training, the
      > recognition is generally better than 95% since the vocabulary used is
      > considerably more limited than full speech.
      > Many doctors and psychologists still dictate reports/evaluations to a
      > phone service which then uses a person to transcribe the reports.

      Another interesting example. Audio noting to the chart, whether supported by
      speech-to-text software or human transcription is a must-have function in
      modern medical informatics, but that does not mean it is truly efficient or
      sufficiently reliable to meet real medical practice objectives. Because of
      the high potential for errors (95% accuracy sounds good until you turn it
      around: 1 out of 20 words is wrong), transcribed audio does not become part
      of the legal patient record until the dictating clinician reviews and signs
      off on the transcription. Reviewing for errors and correcting is a somewhat
      tedious process and itself quite error prone, particularly as clinicians
      typically do so at a later time when the context is no longer fresh in their
      heads. Transcribed audio, even after review, correction, and sign-off, has a
      significantly higher error rate than directly entered notes and orders.

      I don't know if the analysis has been done in medical settings, but in other
      contexts, when all activities in the process are taken into
      account(including slowed speech, repetition and correction on the fly,
      review and editing), the effective total throughput is almost invariably
      less than even slow direct keyboard entry. We can process up to about 400
      wpm when heard and rapid speech clocks at nearly 200 wpm, although 120-160
      is considered tops for persuasive communication. The best commercial
      "trained" speech-to-text systems are typically only good to about 100 wpm.
      But, users typically find they can spend as much time correcting errors as
      dictating (some report as much as 2-3 times). So effective throughput drops
      to well within the range of typical typing (30-60 wpm).

      That said, it can still be more efficient use of the clinician's time if
      notes and orders can be dictated while moving between patients or while
      riding the subway. (Although HIPAA compliance may become an issue in the
      latter case.)

      I think audio notes and orders could actually diminish in use over time, at
      least in the short run, because the new generation of clinicians has grown
      up with computers. My personal physician does all his own notes and orders
      directly into the medical system, typing away at 100+ words/minute. When I
      commented, he mentioned growing up with computers and video games, then
      added that being a musician also helped!

      --Larry Constantine, IDSA
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