Hayt D B, Alexander S
Elmhurst Hospital Center, NY 11373, USA.
J Digit Imaging. 2001 Sep;14(3):149-57. doi: 10.1007/s10278-001-0014-z.
The installation and implementation of a hospitalwide image management system and a speech recognition dictation system has had a dramatic and positive impact on radiology report turnaround times at Elmhurst Hospital Center, a 543-bed municipal teaching hospital located in New York City's Borough of Queens. The "lost film" problem has been eliminated. As a result, the percentage of unreported examinations has dropped from 25% to less than 1%. These performance improvements have significantly benefited the entire medical staff. With the successful implementation of a HL-7 standards-based radiology information system (RIS), a speech recognition dictation system, around-the-clock staffing of Board Certified radiologists, and a picture archiving and communication system (PACS), report turnaround time improved dramatically. Eighty-six percent of all examinations now are reported formally within a 12-hour period compared with a 3% average before implementation of the changes. However, with the use of the PACS and speech recognition technologies, new problems have arisen within the radiology department. These technologies, designed to enhance communications capabilities, also have significantly reduced the amount of clinician/radiologist dialogue. Easy and rapid 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 facilitate communication exists within the PACS, it is not utilized by the clinicians. The dilemma is that as information about patients is made more available to the hospital staff, less information is provided about patients to the radiologists. Although the speech recognition system benefits the hospital, 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 who use it. Speech recognition dictation systems slow down the individual productivity of the radiologists' dictation process by at least 25%. Radiologists are assuming the role of transcriptionists as well as diagnosticians. Mistakes occur that would not with the use of a traditional dictation system and professional transcriptionists.
纽约市皇后区一家拥有543张床位的市立教学医院——埃尔姆赫斯特医院中心安装并实施全院范围的图像管理系统和语音识别听写系统后，对放射科报告周转时间产生了巨大的积极影响。“丢失胶片”问题已得到解决。结果，未报告检查的比例从25%降至不到1%。这些绩效提升使全体医务人员受益匪浅。随着基于HL - 7标准的放射学信息系统（RIS）、语音识别听写系统、获得董事会认证的放射科医生全天候值班以及图像存档与通信系统（PACS）的成功实施，报告周转时间大幅缩短。现在，86%的所有检查在12小时内正式报告，而在实施这些变革之前这一比例平均为3%。然而，随着PACS和语音识别技术的使用，放射科内部出现了新问题。这些旨在增强通信能力的技术，也显著减少了临床医生/放射科医生之间的对话量。轻松快速获取患者图像和报告对与临床医生进行面对面咨询产生了不利影响，这种咨询在PACS出现之前很常见，现在几乎完全消失了。在最终报告听写之前经常发生的放射科医生/临床医生交流，往往能更好地理解临床问题，从而产生更有意义的最终报告。尽管PACS中有便于沟通的会议功能，但临床医生并未使用。困境在于，随着医院工作人员可获取的患者信息增多，提供给放射科医生的患者信息却减少了。尽管语音识别系统通过减少临床医生等待诊断报告的时间以及患者在诊所和急诊室的等待时间，使医院、其工作人员和患者受益，但它不一定对使用该系统的放射科医生有益。语音识别听写系统使放射科医生的听写过程个人生产率至少降低25%。放射科医生既要承担转录员的角色，又要承担诊断医生的角色。使用传统听写系统和专业转录员时不会出现的错误发生了。
