Why We Need Natural Language Processing
Chief Complaint: “Are my testicles black?”
Operative Note: “The patient was brought to the operating suite. She was propped and raped in the usual fashion.”
Granted, these anecdotes came from colleagues using much earlier versions of voice processing software, but they show the inherent need for voice understanding.
Oh, I forgot to tell you the actual dictation:
Chief Complaint: “Are my tests all back?”
Operative Note: “She was prepped and draped in the usual fashion.”
Most long-time EMR users will agree. For documenting the ROS and physical exam, drop-down lists and templates, particularly when the users have customized them around their own workflow, have proven to be incredible time-savers. The problem is that History of Present Illness and Assessment/Plan are best expressed using free text. Moreover, these are the most critical parts of the record, as they reflect nuances and thought process associated with the true art of medicine.
Since my typing skills have improved drastically, I continue to express these areas with significant detail. To me, the thought of using voice recognition software just seems like a less efficient move from dictation. I know that there are many of you out there who have enjoyed tremendous cost savings and efficiencies, particularly with the vastly improved newer versions of this technology, but I’m holding out for something better.
Natural Language Processing (NLP) is a method that transforms text into structured data.In essence, it understands text. Clearly our growing requirements for reporting and analytics will make this technology essential, yet it continues to be discussed mostly in academic circles. Significant advances have been made in this technology and I believe that incorporation would enhance EMR adoption. Without it, I worry that we will continue to add unstructured (i.e. unusable) data into the collective medical record.
I would love for other readers to comment on this subject. (Equally important: my immature and irreverent side would love to hear more anecdotal voice-processing gaffes like the ones above).
Joel Diamond, MD is chief medical officer at dbMotion, adjunct associate professor at the Department of Biomedical Informatics at the University of Pittsburgh, and a practicing physician at UPMC and of the Handelsman Family Practice in Pittsburgh, PA. He also blogs on interoperability.