Alapetite, Alexandre

Andersen, Henning Boje

Speech recognition as a medical transcript tool is now common in hospitals and is steadily increasin

Online Research Database In Technology

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Downloaded from orbit.dtu.dk on: Dec 17, 2017Speech input interfaces for anaesthesia recordsAlapetite, Alexandre; Andersen, Henning BojePublished in:Hospital Information & Technology EuropePublication date:2009Document VersionEarly version, also known as pre-printLink back to DTU OrbitCitation (APA):Alapetite, A., & Andersen, H. B. (2009). Speech input interfaces for anaesthesia records. Hospital Information &Technology Europe, 2(3), 35-36.Hospital Information & Technology Europe Autumn Vol 2 No 3 2009 Speech input interfaces for anaesthesia records Alexandre Alapetite (alexandre@alapetite.net) Henning Boje Andersen (henning.b.andersen@risoe.dk) Technical University of Denmark, Department of Management Engineering Risø Campus, Frederiksborgvej 399, P.O. Box 49, DK-4000 Roskilde, Denmark 1 The anaesthesia record During a medical operation requiring full anaesthesia, anaesthesiologists have to register their main acts (e.g. medications, gases) on a time-line in the anaesthesia record along with key physiological data (e.g. pulse, blood pressure). While the anaesthesia record is required for legal reasons, its real importance relates to patient safety: it supports anaesthesiologists’ memory (e.g. medications administered), team communication and planning, as well the briefing of additional staff who join the team during operation. Nevertheless, taking care of the patient here and now is always the primary task, while keeping the anaesthesia record updated necessarily has a much lower priority. Nowadays, electronic anaesthesia information management systems have increasingly been replacing the traditional paper records. For instance, 63% of the anaesthesia departments in Denmark were already using electronic anaesthesia records in 2004 [1], with a user interface typically built around a touch-screen and a keyboard. Electronic systems have solved some of the problems of the former paper-based records; in particular, automatic registration of the vital signs ensures greater precision, and it yields a reduced workload for anaesthesiologist and a better readability than hand-written text. However, some issues remain, and new ones have been introduced. For instance, the electronic interface is by nature less flexible than paper, and often more verbose. Furthermore, due to the spatial constraints of the operation theatre, the screen of the electronic anaesthesia record in often placed behind the anaesthesiologist, making it difficult to see both the record and the patient at once. Finally, during crisis situations when the focus must be kept on the patient, registration is necessarily postponed, leading to gaps and inaccuracies in the record, which may affect patient safety. This calls for an improvement of the user interface, in particular during crisis situations. 2 Speech recognition in hospitals Speech recognition – i.e. the possibility to talk to a computer – comes in roughly two flavours. The first type (“command mode”) makes the computer “understand” and react appropriately, as long as the user utilises a predefined, constrained language (e.g. keywords). The second type (“free text mode”) allows the dictation of natural language sentences, although primarily within a given context of discourse; this mode is less suited to deliver any “smart” reaction to such input. Today, most of the major natural languages of Europe are supported [2], but each language has its specificities and may work better or worse than others depending on the situation. Hospital Information & Technology Europe Autumn Vol 2 No 3 2009 Speech recognition as a medical transcription tool is now common in hospitals and is steadily increasing [3]. A smaller proportion of the use cases involve medical equipment that is able to react to voice commands (e.g. surgeon assistant robots). 3 Speech recognition during anaesthesia In the case of the anaesthesia record, speech recognition has been proposed as a supplementary modality (i.e. communication channel) in addition to the existing typical touch-screen and keyboard input [4,5,6]. Thus, speech recognition is not intended to replace existing input modalities, but to provide another possibility to be used when suited. The main goals of the speech interface are:   to improve the visual contact with the patient by allowing hands-free registration  to collect data more accurately   to lessen anaesthesiologists’ cognitive load burden (trying to memorize medications) during crisis situations The speech recognition interface can accept commands for the computer to register appropriately medications and most standard procedures. A free text mode can also be provided to enable the dictation of ad-hoc non-structured remarks. One of the first questions [1] that come to mind is about the impact of the background noise found in an operation room [7]. Experiments have shown that the type of microphone is of major importance when the level of noise rises, and that a suitable microphone may counteract the negative effects of noise, at least for “commands”, since “free text” is more sensitive to such disturbance. In this regard, the list of possible commands should also be chosen with great care and phonetics considerations. Supporting the above considerations, some experiments have been made [8] in September 2006 in a full scale anaesthesia simulator at Herlev Hospital (Copenhagen, Denmark), with some skilled anaesthesiologists facing crisis scenarios (e.g. anaphylactic shock, cardiac arrest). The experiments were partially “Wizard-of-Oz” (i.e. with some human assistance) due to the limited time available to train the participants. First of all, the results show that with the normal electronic interface, the queue of events or actions (typically, medications) waiting to be become registered increases as the scenario develops (Figure 1). This suggests that the normal touch-screen and keyboard interface is too slow when the anaesthesia team experiences a crisis. When speech recognition was enabled, the registration of the events in the anaesthesia record could be achieved with virtually no queue, i.e. no actions “waiting” to become registered. Indeed, 98.7% of the medicaments were correctly recorded by the end of the session when using speech input, as opposed to only 56% when the conventional touch-screen and keyboard interface was the only option available. Hospital Information & Technology Europe Autumn Vol 2 No 3 2009 01234567891011121314151600:00:0000:02:0000:04:0000:06:0000:08:0000:10:0000:12:0000:14:0000:16:0000:18:0000:20:0000:22:0000:24:0000:26:0000:28:0000:30:0000:32:0000:34:0000:36:0000:38:0000:40:00Average queue of tasks to registerTimeQueue of tasks to register during an anaesthesiaAverage queue without speechAverage queue with speechEnd of the shortest session Figure 1: Evolution of the averaged queue of events to register during the anaesthesia scenarios, with or without voice. [8] An analysis of the behaviour of anaesthesia doctors and nurses during the experimental scenarios shows that when they can use speech input, they need a bit less time to fill-in the record, but more interestingly, most of the registration by voice was done while doing something else with the patient (Figure 2). 00:00:0000:00:3000:01:0000:01:3000:02:0000:02:3000:03:0000:03:3000:04:0000:04:3000:05:0000:05:3000:06:0000:06:30Without voice With voiceTimeTime statisticsTime spent in front of the recordTime dedicated to fill the record (doing nothing else)Time spent to fill the record (possibly doing something else)Average time before registrationAverage time accuracy of registered events Figure 2: Measurements of delays and time used to fill the anaesthesia record, with or without voice. [8]   Hospital Information & Technology Europe Autumn Vol 2 No 3 2009 While these results appear so far to support speech recognition, the reader should be warned that the speech recognition rates (the percentage of inputs properly recognised by the computer) are far from perfect and are highly dependent on the training and willing of the users. Therefore, a substantial development time and user commitment must be expected before reaching satisfying results [9]. 4 References [1] Alexandre Alapetite & Vincent Gauthereau. Introducing vocal modality into electronic anaesthesia record systems: possible effects on work practices in the operating room. Proceedings of EACE’2005 (Annual Conference of the European Association of Cognitive Ergonomics), Chania, Crete, Greece; section II on Research and applications in the medical domain. ACM International Conference Proceeding Series, vol. 132. University of Athens, 197-204, ISBN:9-60254-656-5. [2] Speech recognition medical reporting in 25 languages. Hospital Information & Technology Europe, Friday 14th December 2007. [3] Nick van Terheyden. Speech recognition: the secret recipe for success of the electronic health record. Hospital Information & Technology Europe, Spring Vol 1 No 1 2008. [4] Yoshimitsu Sanjo, Tetsuo Yokoyama, Shigehito Sato, Kazuyuki Ikeda, Reiko Nakajima. Ergonomic automated anesthesia recordkeeper using a mobile touch screen with voice navigation. Journal of Clinical Monitoring and Computing, 1999, 15:347-356. doi:10.1023/A:1009972223750  [5] Andreas Jungk, Bernhard Thull, Lutz Fehrle, Andreas Hoeft, Günter Rau. A case study in designing speech interaction with a patient monitor. Journal of Clinical Monitoring and Computing, 2000, 16:295-307. doi:10.1023/A:1011456205786 [6] Achim Schmitz & M. Weiss. Are we going to talk with our anaesthesia monitors in the future? Acta Anaesthesiologica Scandinavica, 2004, 48(2):255-256. doi:10.1111/j.0001-5172.2004.00295b.x [7] Alexandre Alapetite. Speech recognition for the anaesthesia record during crisis scenarios. International Journal of Medical Informatics (2008) 77(7):448-460 (online September 2007). doi:10.1016/j.ijmedinf.2007.08.007 [8] Alexandre Alapetite. Impact of noise and other factors on speech recognition in anaesthesia. International Journal of Medical Informatics (2008) 77(1):68-77 (online December 2006). doi:10.1016/j.ijmedinf.2006.11.007 [9] Alexandre Alapetite. On speech recognition during anaesthesia. PhD thesis, Roskilde University 2007, ISSN:0109-9779 (RU/CS/RR #119), hdl:1800/310   

Speech input interfaces for anaesthesia records

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Speech input interfaces for anaesthesia records

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