This report investigates four of the leading voice recognition applications to determine whether this technology has become a practical option and to determine which application is the best choice. And so that this report and further study of the software can be better understood, an introduction to the subject of voice recognition software follows.
Brief history. The first software-only dictation product for PC's, Dragon Systems' DragonDictate for Windows 1.0, using discrete speech recognition technology, was released in 1994. Discrete speech is a slow, unnatural means of dictation, requiring a pause after each and every word [11]. Two years later, IBM introduced the first continuous speech recognition software, its MedSpeak/Radiology. These systems often had five-figure price tags and required very expensive PCs. Continuous speech technology allows its users to speak naturally and conversationally, relieving much of the tedium of discrete speech dictation [11].
Dragon Systems made an enormous stride in June, 1997, when it released NaturallySpeaking, the first general-purpose continuous speech software program. Much more affordable than earlier programs, it brought the realm of continuous speech recognition to a much wider range of users. Two months later, IBM released its competing continuous speech software, ViaVoice [10].
Stringent demands. Much is demanded of speech recognition programs. Accuracy is critical, and speed is essential to any effective program. Added to these challenges are the enormous variance that exists among individual human speech patterns, pitch, rate, and inflection. These variations are an extraordinary test of the flexibility of any program. Voice recognition follows these steps:
Power devourers. With all of the complex selections and tremendous flexibility demanded of voice recognition software, it is small wonder that considerable computer muscle is required to run these programs. To take fullest advantage of current speech recognition programs, a PC with a minimum of a 300 MHz Pentium II processor is recommended. A separate 16-bit SoundBlaster-compatible card is also advisable, because the sound cards that are bundled as part of a PC's motherboard can produce inferior results with voice recognition software [4].
Realistic reminders. The technology has advanced impressively over the last year, with programs variously offering smarter speech recognition engines, larger active vocabularies, integration with the most popular word-processing programs, and improved accuracy. This report sorts through these to find the most accurate program and the best value available, and determines if the accuracy is acceptable at this time [4]. It is essential to remember the following:
Eight categories of comparison will be made in order to effectively evaluate these competing programs: (1) accuracy; (2) minimum system requirements; (3) capacity to manage a specialized medical vocabulary and medical records; (4) integration with Microsoft Word; (5) ease and speed of installation, customization and use; (6) industry ratings and awards; (7) inclusion of microphones, and (8) cost.
Accuracy.
Accuracy is the single most significant consideration; without it, the program is useless.
Dragon Systems' NaturallySpeaking 3.0 scored highest on all of the accuracy tests performed by PC Magazine and was unequivocally selected as the Editors' Choice.
In their tests, the average accuracy was 91% and at times was considerably
greater
[1].
Average accuracy for L&H Voice Xpress was 87%
[2].
Accuracy for IBM's ViaVoice tested at 85%
[14],
and Philips FreeSpeech98 was 80%
[15].
At first glance, these percentages, particularly the top two, may not seem significantly different. Consider, however, that for every 1,000 words, an accuracy rate of 87% means that 130 words must be corrected. An accuracy rate of 91% represents an average of 90 errors per 1,000 words, while an 80% rate means that 200 out of every 1,000 words must be corrected.
Thousands of words are dictated daily in this practice. Time is scarce and precious. Medicolegal conditions mandate that records must be exhaustively thorough and accurate.
Under these rigorous circumstances, with every percentage point counting heavily, Dragon Systems' NaturallySpeaking yields the highest accuracy.
Minimum system requirements.
All four programs run on Pentium-powered PC's utilizing Windows 95, 98 or NT 4.0 and require 16-bit SoundBlaster-compatible sound cards.
Random access memory (RAM) requirements for software run under Windows NT are higher for all of these programs
[5].
It is important to recall that, as noted earlier, significantly greater system resources are recommended to optimize performance.
Given the sufficient system resources, none of these software programs should present a problem for the existing system.
Capacity to manage a customizable, specialized medical vocabulary.
Medicine in general, and each medical specialty in particular, have their own complex, specialized vocabularies.
Two of the four companies offer a product that provides medical terminology. IBM's emergency room and radiology add-on software is not applicable to the dictation needs of obstetric and gynecologic practices, for example.
Dragon Systems' NaturallySpeaking Medical Suite offers the same voice recognition technology as the previously mentioned NaturallySpeaking Preferred Edition, with the addition of extensive customizable medical terminology that can be tailored to other specialty practices.
Integration with Microsoft Word.
All four programs integrate with Word97 and can therefore be used with existing word processing software.
[5].
Ease and speed of installation, customization and use.
Each of the four programs uses "wizards" to install and configure hardware, and all programs support macros for frequently used phrases.
Installation of all of the programs appears straightforward, and the initial basic "training" is not excessively time-consuming for any of the products. While all provide macros, the medical customization features of Dragon Systems' product are considerably greater.
Though they will initially require more time and document input, accuracy is increased, and for this reason, Dragon's software is recommended in this comparison.
Industry ratings and awards.
Only one of these products refers to and lists awards on its web site, and that is Dragon Systems' NaturallySpeaking. None of the other three products has any such mention anywhere on its site, nor do any awards or industry recognition show up on multiple web searches for the products.
Dragon Systems' web site lists over fifty awards, some of which are listed here:
While industry recognition and journalistic evaluations are not the only considerations, Dragon Systems boasts an impressive list of awards and ratings by prestigious periodicals.
Inclusion of microphones.
As previously noted, a microphone is necessary for capture of spoken words.
None of these is a make-or-break detail, but Dragon Systems has a slight edge with the reviews provided by PC Magazine.
Cost.
Highly significant price differences exist among these programs.
L&H offers the best price by far. IBM and Philips are roughly in the same ballpark. Dragon Systems' Preferred Edition is more expensive at $200, but not significantly so. The only customizable medical software program is Dragon Systems' Medical Suite, which, at $1,243, is over ten times the cost of Philips' software, though it includes one year of technical support.
To date, the weakest link in speech recognition technology has been accuracy. This is fast changing, and current software programs have significantly improved within the last year. Can a voice recognition software program eliminate some of the problems occurring in conventional medical transcription? The following conclusions will help answer this question in the recommendation that follows:
Requirements for the Purchase of Voice Recognition Software
Based upon stated preferences and system specifications, the following conditions have been established:
Points of Comparison
The different voice recognition software programs compared are Dragon Systems' NaturallySpeaking 3.0 Preferred Edition, IBM ViaVoice 98 Executive, L&H Voice Xpress Plus, and Philips FreeSpeech98. Discussion of Dragon Systems' NaturallySpeaking will also include its Medical Suite.
Table 1. Comparison of Minimum System Requirements
Software
CPU
RAM
Hard Disk Space
L2 Cache
Dragon
Pentium/133 MHz
32 MB
180 MB
none
IBM ViaVoice
Pentium/166 MHz-MMX
32 MB
180 MB
256 KB
L&H
Pentium/166 MHz-MMX
40MB
130MB
none
Philips
Pentium/166 MHz
32 MB
150 MB
none
Summary
From business, medical, and legal perspectives, the creation and maintenance of accurate, complete records are crucial. The primary downside to such thorough record-keeping includes: (1) the time required for dictation, (2) the costs in and inherent hassles of finding and hiring a competent medical transcriptionist, (3) the necessary delays between dictation and actual availability of the transcribed records, and (4) the time needed to proof and correct the transcriptionist's output.
Recommendation
Dragon Systems NaturallySpeaking Medical Suite is strongly recommended for its superior accuracy, powerful customization features, and industry recognition and awards. No other product comes close, and its strong advantages justify its higher price. Once the program has been customized, and the user has dictated for several weeks and become familiar with the software, acceptably accurate transcription and instantly available medical records should be possible with NaturallySpeaking Medical Suite, solving some of the record-keeping problems faced by this medical practice.
Literature Cited
All references are found online:
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