[EMAIL PROTECTED] wrote: > Hi Geoff, I accept what you say about the GP world needing motivation.
The motivation will come when there are really good decision support available - not just catching prescribing errors, but tools which genuinely help with differential diagnosis, investigation ordering and care planning and monitoring - but such tools can only ever be as good and as detailed as their input data, which is why SNOMED-CT and the like are so important. Of course, we have a chicken-and-egg situation (or since this is an informatics list, I should say a bootstrapping problem): clinicians won't enter detailed SCT-encoded data until there are reasons to do so i.e. good decsision support tools, and the investment and R&D to create those tools won't happen unless clinicians collect detailed, coded data. Which is why Jon's projects to make SNOMED-CT encoding from free text and other forms of natural or semi-natural language are so important. Ahh, you, say, but that presumes that GPs will type all this stuff in... but see below. > As for migration tools I would hope that the Text-to-SCT converter we have > created would be seen as the start to filling that role. Now with the > release of the general license I expect we will be able to a switch over > to delivering SCT codes on-line, so you will be all be able to see it > working easily. I am visiting NEHTA today to open discussions with them > directly about our work and how we might be able to collaborate with > them. Voice recognition. Yep, mumbling at the computer, just like they do in Star Trek and every other sci-fi TV series. It is already being used in specialist fields with somewhat stereotypic and constrained reporting requirements and voabs eg radiology, endoscopy, but practical, affordable systems running on commodity hardware, which GPs could use, really are only 5-10 years away - 5 for early adopters. In that context, Jon's Text-to-SCT stuff looks doubly attractive. And general practice obeys Pareto's law: 80% of the work relates to only 20% of the range of conditions seen and managed. Thus a speech-to-text-toSCT(-to-decision support) system really only has to cope with the protean, and degrade gracefully back tot he keyboard and mouse and SCT code look-up systems for the rest in order to be useful. Following is a copy of the latest email tickler from E-Health Insider, a UK health informatics industry e-rag. Finally, I think that Geoff's message is a reminder that we cannot expect private enterprise, which is necessarily market-driven, to drive such innovation. We still need our universities, our CSIRO and perhaps even private R&D facilities to work on such things without immediate regard for exactly how many GPs would use such facilities in the next week or next month. It is also why we need more general practices which are affliliated with universities or research institutions and which are willing and able to be funded to engage with cutting-edge stuff like SNOMED-CT coding and the use of the results for advanced decision support. Alas, we have so few such practices. Tim C E-HEALTH INSIDER SPECIAL REPORT - VOICE RECOGNITION SYSTEMS July 2006 ********************************************************************** Nuance The world's leading provider of speech recognition, dictation, and transcription systems http://www.e-health-insider.com/o.cfm?o=8,0,4194,3773,3774 ********************************************************************** TALKING ABOUT A REVOLUTION What's new in speech recognition and digital dictation? Neil Kelly talks to users and suppliers about recent developments in voice technology. http://www.e-health-insider.com/o.cfm?o=8,0,4194,3773,3776 ********************************************************************** Talking Point The complete speech recognition system See bottom of e-mail for details. ********************************************************************** Philips Speech Processing Digital Dictation, PC-Connected and Mobile. http://www.e-health-insider.com/o.cfm?o=8,0,4194,3773,3778 ********************************************************************** SUPPLIER UPDATES CRESCENDO PRESENTS FOREGROUND SPEECH RECOGNITION Crescendo front-end speech recognition powered by Speech Magic is a particularly attractive feature for physicians who prefer to look after the full report generation process. It enables them to edit and finalise documents on-screen in real-time, without the involvement of a transcriptionist: fantastic on weekends or for highly confidential documents. It is also best suited for environments such as Radiology, Pathology and Emergency Medicine, where reports are relatively short and usually "normal" (negative findings) and experienced medical transcriptionists are more and more difficult to find. Crescendo's front-end speech recognition can also be implemented in combination with their back-end solution, leaving all document correction options open for healthcare facilities. Email: mailto:[EMAIL PROTECTED] Tel: 0870 7701717 (John Bendall) Web: http://www.crescendosystems.co.uk/ SPEECH RECOGNITION TURNS INDUSTRIAL GRADE Philips provides healthcare professionals world-wide with industrial grade document creation technology. The upcoming version of Philips SpeechMagic optimizes the accuracy, security and administration of medical document creation. The software architecture allows for fully centralised administration and management, facilitating integration with medical IT systems such as Electronic Patient Records (EPR) systems. The error rate has been reduced by 30% and scalability has been raised to up to 15,000 users per cluster. Sophisticated learning algorithms ensure automated and immediate adaptation to the dictation style and pronunciation of each author. SpeechMagic even calculates the amount of correction a recognised text will require and intelligently routes the document to the most suitable transcriptionist. Crescendo, G2Speech, Hospital Engineering, IMS Maxims, Soliton IT, and Voice Technologies offer medical reporting solutions "powered by SpeechMagic". Major international firms also use the technology to speech-enable their products, among them AGFA Healthcare, Kodak Health, GE Healthcare, iSOFT, Siemens Medical Solutions and Philips Medical Systems. </p> Email: mailto:[EMAIL PROTECTED] Tel: +44 (0)7789 650 190 (Gary R. 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Email: mailto:[EMAIL PROTECTED] Tel: +44 (0)1908 847171 (Jim Robinson - Sales Consultant) ************************************************************ > Quoting Geoff Sayer <[EMAIL PROTECTED]>: > > > Hi all > > > > This all assumes that "average" GPs care about terming, coding and > > classification... evidence would suggest the contrary. > > > > Nearly all the GP clinical apps have controlled medical vocabulary > > already > > (and some have classification capability to international standards > > already) > > yet I have never heard a GP say (one that doesn't subscribe to > GPCG)... > > > > "If only I had SCT I would record reasons for prescribing and provide > a > > complete/current patient medical history... it was the lack of a > > suitable > > medical vocabulary that was holding me back" > > > > I think a standard is important but the fundamental lack of interest > > amongst > > the masses remains the same... I can hear a deafening silence from the > > mainstream on this development... > > > > We need to think about selling what the benefits of SCT will be to the > > end > > user from a day to day practical perspective... and great for research > > won't > > wash... > > > > What will it mean to those GPs who have recorded data > > inconsistently/consistently over the past number of years... got some > > migration tools ready to bring into the new SCT era or do we right of > > the > > past... > > > > What will it allow GPs to do now that they can't do now? > > > > This type of information on benefits may inspire vendors as well I > would > > suggest. > > > > Geoff > > > > > > [EMAIL PROTECTED] wrote: > > > Quoting Tim Churches <[EMAIL PROTECTED]>: > > >> Just to clarify the architecture that I had in mind: > > >> > > >> a) most of the look-up and other functions exposed as Web services > > which > > >> can be called from any Web service-aware application, including GUI > > >> desktop clinical applications > > >> > > >> b) a separate Web browser front-end that uses those Web services, > to > > >> allow browsing of SCT from anywhere there is an Internet connection > > > Tim, is it your intention that this evolve towards a "SNOMED module" > > > which can be served up to vendors on a platter, ready for > integration > > > into their own products? > > > > Yes, exactly. By having the software module as cross-platform open > > source and the SNOMED-CT data freely available to all under the NEHTA > > sublicense, it would exert competitive pressure on clinical > information > > system vendors to either incorporate the module into their software or > > to provide something better. > > > > > Hopefully this will partly answer the "it's too hard" excuse from > > vendors > > which > > > has stymied other attempts (as Ken Harvey knows) to get > > decision-support > > into > > > the GP's desktop. > > > > Yup. One less excuse. > > > > > For true integration you would need a local server otherwise the > > > EHR would experience a performance hit (to which users in this > domain > > > are exquisitely sensitive) > > > > Yup, that's what I proposed. > > > > > Would you consider the LGPL licence, as this allows integration > > > but requires vendors to contribute back changes (to the module). > > > I agree BSD-type licence is much simpler and would be more > reassuring > > > to them legally (even Microsoft use BSD licensed code) > > > > Either LGPL or Mozilla licenses would be fine - they are functionally > > equivalent in that they both require changes to the open sourced code > to > > be contributed back to the community, but neither presents any > > impediment to tight integration of the open source code with closed > > source code in a vendor's product. BSD would also be OK but less > > optimal, although likely to be more favoured by closed-source vendors > > since it does not require them to make any enhancements they make tot > he > > code available to others. After seeing how well the development of the > > PostgreSQL open source database proceeds using a BSD (non-copyleft) > > license, I am a lot more relaxed about the whole copyleft thing than I > > used to be. Ultimately it is up to Jon Patrick and his team at USyd > how > > they might license the proposed modules, but I would strong recommend > > that they don't use the GPL, which would be sure to discourage other > > software vendors from using the modules. > > > > >> Automatic periodic refreshing across the Internet of the Web > service > > >> software code and the SCT data which it uses should be built-in. > > > ^^^^^^^^^^^^^ > > > > > > I agree with auto-updating the SCT codes, but the software itself? > > > The could get needlessly complicated if done in the first iteration > of > > the > > > > > module. IMHO users who want such a facility should select an OS that > > provides > > > it ;-) > > > > Yes, probably. I suppose I had in mind that the modules might use > > various soft-coded rules or other parameters which could be updated > > dynamically from time to time, rather than the compiled code. > Whatever. > > > > > A client-side module which regularly (say ~1/month) polls the > central > > > SCT webservice for updates would be simpler to adminster, as well as > > faster, as > > > it saves the GP the adminstrative overhead of running a dedicated > SCT > > server > > > on their own network, at the cost of some bandwidth (as each client > is > > > independently updating) but this would not be significant given the > > size > > > of the data. > > > > Yup, that would work. > > > > > The question then is what interface to provide to the EHR. A C > > interface > > > (that is, "DLL" on Windows) is the most widely-acceptable solution, > > this > > is how > > > HeSA provide their module for HIC Online. You could also use > > .NET/Mono, > > but I'm > > > not sure how many EHRs are written in .NET at present. > > > I have nothing against webservices per se, but it's important not to > > let > > > them be a solution in search of a problem, there may be simpler and > > more > > > appropriate options. > > > > I only suggested that Jon mention "Web services" at every opportunity > to > > keep NEHTA happy... BTW, Argus Connect should re-write all their > > promotional material to say they their products uses Web services (and > > in very, very fine print mention that the Web service runs on port 25 > as > > a Simple Mail Transfer Protocol service). > > > > Tim C > > > > _______________________________________________ > > Gpcg_talk mailing list > > [email protected] > > http://ozdocit.org/cgi-bin/mailman/listinfo/gpcg_talk > > > > _______________________________________________ > > Gpcg_talk mailing list > > [email protected] > > http://ozdocit.org/cgi-bin/mailman/listinfo/gpcg_talk > > > > > > > ---------------------------------------------------------------- > This message was sent using IMP, the Internet Messaging Program. > _______________________________________________ > Gpcg_talk mailing list > [email protected] > http://ozdocit.org/cgi-bin/mailman/listinfo/gpcg_talk _______________________________________________ Gpcg_talk mailing list [email protected] http://ozdocit.org/cgi-bin/mailman/listinfo/gpcg_talk
