POW! HIT! People & Organizations improving Workflow w/Health Info Tech
POW! HIT! People & Organizations improving Workflow w/Health Info Tech

@EHRworkflow Blog

The is a "sidekick" blog to my main blog EHR Workflow Management Systems at ChuckWebster.com. There I publish long, complicated, thoughtful blogs thousands of words in length. Here? Not so much. It's mostly for snippets of content too big for a tweet but too small to grace the main deck of the mothership.

If you're looking for my POW! HIT! Profiles, they're here (explanation and most recent) and here (alphabetical index). POW! HIT! stands for People and Organizations improving Workflow in Healthcare with Information Technology (or Ideas and Technology, depending on context). However, I'll write or post content relevant to POW! HIT! on this and the mother blog. Thanks for stopping by. Please leave a comment!

Chuck Webster MD MSIE MSIS

With degrees in Accountancy, Industrial Engineering, Computational Linguistics, Artificial Intelligence, and Medicine, Dr. Webster can see around corners. He designed the first undergraduate program in Medical Informatics, was CMIO for an EHR vendor, and wrote the first three winning applications for the HIMSS Davies Award for EHR Ambulatory Excellence. Chuck opines about healthcare workflow and related and unrelated topics from @wareFLO (#HIMSS13 Top Tweeter) and DMV: the District, Maryland, and Virginia.

My main blog is EHR Workflow Management Systems at ChuckWebster.com. Some posts are 5000 words or more! Here is for larger than a tweet, but smaller than a novella.

Dr. Nick of Nuance on Clinical NLP 3: Speech Recognition Stereotypes?

3. Are there any stereotypes about speech recognition in general and medical speech recognition in particular? What is a more accurate or useful way to think about this technology?

Speech has been available commercially for a number of years in the healthcare space and to general consumers. For a number of years it struggled to deliver value – the technology suffered from general hardware challenges and some of the challenges that exist in consumer implementations with noisy and challenging environment (your car for instance is a difficult environment with many and varied background noises and poor quality audio recording). In the clinical setting we have similar problems with noise but with added complexity of clinical workflow and fitting into the busy and complex clinical setting. In some respects, we suffered a Hollywood effect where the industry painted a picture of speech recognition that was much more than it was capable of – not just recognizing words - but understanding them.

Speech in the consumer world has moved on from a pure recognition tool to integrating some Artificial Intelligence (AI) that not only understands what is said but puts this into context. For example, some of the Nuance commercial telephony solutions include voice analysis for stress, anger and other emotions as indicators to help manage and route calls more appropriately. In healthcare, we don’t just apply voice recognition but layer on clinical language understanding that not only grasps the meaning but also tags the information, turning clinical notes and documentation into medical intelligence and making this data truly semantically interoperable.

Question 4 (Where is Nuance research going?) and Dr. Nick's answer will be published very soon.

Follow @EHRworkflow to be sure not to miss it.

Feel free to catch up on earlier portions of this interview with Dr. Nick of Nuance:


Dr. Nick of Nuance on Clinical NLP 2: Education and Career?

2. Could you tell us a bit about your education, what you do now, and how you came to be doing it?

That's a long story that started over 25 years ago, after I qualified at the tender age of 22 as a doctor in England. I practiced for a while in the UK and also in Australia but decided I wanted to try other things. My first step into the technology world was unrelated to medicine when I worked at Shell International as a computer programmer in their finance division on IBM mainframes programming in COBOL, JCL, CICS, DB2, TSO, CLIST and REXX, to name a few, for the financial returns for Shell operating companies. Check out the IBM Terminal behind my desk….!


I then used the skills I acquired in these roles when I transitioned my focus to some early development and incubator companies that emerged onto the scene with electronic medical record (EMR) type functions in Europe. During this time, I had the fortune of working at a greenfield site in Glasgow Scotland that built one of the first paperless medical records – many of the discoveries and concepts developed there remain applicable today.

Dr. Nick and Holly (his Golden Lab!) on YouTube

(Note: Video interview contains different, and
funnier, content than these ten questions and answers.)

Then, my career took me to the Middle East, working in Saudi Arabia, and then on to the US where I have had the fortune of working in New York, California and Maryland with a number of companies in the healthcare technology space, including most of the clinical documentation providers and speech technology vendors.

Question 3 (stereotypes about speech recognition) and Dr. Nick's answer will be published very soon.

Follow @EHRworkflow to be sure not to miss it.

Feel free to catch up on earlier portions of this interview with Dr. Nick of Nuance:

My Next Speaking Engagement


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