VoiceIt: “Speech recognition is a strategic tool for regional EHRs”

(HealthTech Wire / VoiceIt) - Spain is working hard to make regional electronic health records (EHR) available for all its citizens. HealthTech Wire talked to Javier Quiles del Rio, head of clinical IT at Galicia Health Services, about the progress of EHR implementation in the region of Galicia and about why, in his opinion, speech recognition is an indispensable part of the eHealth endeavor.

Published: 03/10/2009

Could you tell us a little bit about the scope of the regional EHR project in Galicia?

The project started in 2004 when we deployed an EHR in the first of 14 hospitals in the region of Galicia. Since March 2008, all 14 secondary and tertiary care centers have had access to the EHR, which means that they can use a digital signature to store and validate clinical documents such as radiology, pathology and surgery reports and also issue electronic prescriptions. All information generated in the hospital network is available to any other hospital online, once the information has been validated. In 2006, we also started to involve primary care centers. More than 450 out of 493 primary care institutions are now connected to the network. All primary care institutions are using the EHR-network, mainly for electronic prescriptions, and there are now more than 600 who use EHR to register clinical information as well. This number is expected to rise to at least 2,000 users by the end of 2009.

How has the EHR been received by its users?

Acceptance is pretty high. Just a few numbers to illustrate: there were 23,800,000 contacts between patients and pharmacies based on electronic prescriptions in 2008. This represents 54% of all prescriptions issued in primary care centers registered in December 2008. 2.6 million citizens in Galicia already have an EHR.

At the European eHealth Conference in Prague the Spanish minister of health gave an update on plans for a nationwide EHR in Spain. How does the EHR project in Galicia relate to this national program?

We have 17 regions in Spain that are all working on the implementation of regional EHR solutions. On top of that, the national government plans to establish an interoperability layer so that electronic documents from a patient can be accessed not only within one region but also from other regions if necessary. There are pilot tests running at the moment. The region of Galicia is participating in the relevant working groups, for example in the technical committee for a nationwide electronic patient summary and also in the technical committee for standardization.

Apart from setting up an EHR, the Galicia Health Service is also working towards the regional deployment of speech recognition. How advanced is this project?

We are indeed aiming at a region-wide implementation of speech recognition. In 2008, we implemented the speech recognition solution SpeechMagic from Nuance in the radiological departments of all 14 secondary and tertiary care centers. And we are currently implementing it in pathology as well, with 5 centers being equipped so far. This makes a total of 350 users at the moment.

What role does speech recognition play in the broader context of EHR implementation?

I consider speech recognition an important strategic tool in the EHR system. In our experience, it has a considerable effect on the deployment of EHR solutions. Let me give you some numbers again. With speech recognition implemented in radiology, 90% of all radiological reports in some of our secondary care centers are now available electronically. In other specialties without speech recognition, this number is in the range of 50% only. So with speech recognition we can increase digitization because it is a quick and easy way to generate and finish an electronic document. Before the introduction of speech recognition, many reports were hand-written by radiologists, because this was the quickest way to do it. This has changed dramatically.

What in your experience are the success factors for speech recognition in EHR environments?

Integration is the key. We are not using off-the-shelf information systems in our institutions. Both EHR and radiology information systems have been developed by us. We worked for more than half a year to ensure proper integration. This effort was certainly worth it. Users can now start the speech recognition process from within their information systems with one mouse click, and this is very much appreciated.

What other feedback have you received from your users?

Actually, many are asking for an even deeper integration. They want to use speech recognition not only for creating reports but also for controlling the application itself. We are working on that, but this step is a little more complex.

How will you proceed in the years to come?

We will finish the implementation of speech recognition in pathology. And we will include some other specialties, for example internal medicine. There are already pilots running in two hospitals at the moment. If everything works as planned, we could reach the threshold of 1,000 users by the beginning of next year.

Mr. Quiles, thank you for your time and answers. (HTW)

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