The pros and cons of implementing PACS and speech recognition systems

The installation and implementation of a hospitalwide image management syst em and a speech recognition dictation system has had a dramatic and positiv e impact on radiology report turnaround times at Elmhurst Hospital Center, a 543-bed municipal teaching hospital located in blew York City's Borough o f Queens. The "lost film" problem has been eliminated. As a result, the per centage of unreported examinations has dropped from 25% to less than 1%. Th ese performance improvements have significantly benefited the entire medica l staff. With the successful implementation of a HL-7 standards-based radio logy information system (RIS), a speech recognition dictation system, aroun d-the-clock staffing of Board Certified radiologists, and a picture archivi ng and communication system (PACS), report turnaround time improved dramati cally. Eighty-six percent of all examinations now are reported formally wit hin a 12-hour period compared with a 3% average before implementation of th e changes. However, with the use of the PACS and speech recognition technol ogies, new problems have arisen within the radiology department. These tech nologies, designed to enhance communications capabilities, also have signif icantly reduced the amount of clinician/radiologist dialogue. Easy and rapi d 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 facili tate communication exists within the PACS, it is not utilized by the clinic ians. The dilemma is that as information about patients is made more availa ble to the hospital staff, less information is provided about patients to t he radiologists. Although the speech recognition system benefits the hospit al, 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 w ho use it. Speech recognition dictation systems slow down the individual pr oductivity of the radiologists' dictation process by at least 25%. Radiolog ists are assuming the role of transcriptionists as well as diagnosticians. Mistakes occur that would not with the use of a traditional dictation syste m and professional transcriptionists. Copyright (C) 2007 by W.B. Sounders C ompany.