Speech Recognition in the Electronic Health Record. Appendix B: Best Practices for Using Speech Recognition

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Defining a Successful Project
Facilities deploying speech recognition technology measure success differently, based on the unique objectives for that facility. There are therefore many different ways to define success, but this definition must be based on the original objectives established.

In a general sense most facilities will define success based on improvements in one or more of these areas:

  • Decreased costs
  • Improved patient care
  • Increased customer (either patient or physician) satisfaction
  • Improved compliance with state and/or federal standards

Sites deploying speech recognition and realizing the most significant gains in the areas outlined above have been analyzed closely. They all followed a consistent set of practices during the implementation and go-live process. These practices have been consolidated here into a list of critical success factors.

The critical success factors outlined below contributed to providing the following benefits to facilities deploying speech recognition:

  • Improved the level of success realized
  • Minimized the risks associated with such a project
  • Provided a smoother transition from the legacy system

Critical Success Factors in Deploying Speech Recognition

  • Define measurable objectives prior to implementation
  • Establish a target return on investment (ROI), including time frame for achievement
  • Secure executive sponsorship
  • Actively involve users from all levels throughout the project
  • Designate both a technical and functional system administrator
  • Identify key benefits for end users
  • Align the medical transcriptionist's (MT) compensation with the new technology
  • Develop an operational plan in advance
  • Provide key stakeholder updates regularly during the project
  • Establish benchmarks prior to deployment for postdeployment analysis and comparison

Additional detail for each of the critical success factors is provided below.

Measurable Business Objectives

Clearly defined business objectives serve several purposes, including:

  • Maintaining project focus
  • Providing measurements for success
  • Dramatically improving the likelihood of achieving desired results

To succeed, the business objectives must be specific. Rather than “Decrease turnaround time on reports,” the objective established should be “Attain a 30 percent decrease in turnaround time within 90 days of go-live.” (Consider the establishment of a “stretch” objective, with specific rewards provided for the accomplishment of the “stretch” objective). Establishing a specific objective will enable you to establish measurement criteria and map goals to that objective.
The next step is to examine the current methods and processes to identify specific areas where quantifiable gains can be realized. In the case of the above-stated objective, the measurement criteria and goal may be the usage of templates and macros, with the goal of “Analyzing the current usage of templates and macros and increasing this by 25 percent.” Attainment of multiple goals of this nature would enable us to meet the stated objective.

This requires benchmarking each agreed-upon measurement criterion prior to system go-live. Doing so provides the necessary comparative data to work with postimplementation and serves as the baseline against which successful attainment of objectives is measured. In some cases, the realization of the stated objective is due only in part to the deployment of the technology, with the rest of the benefit realized from process re- engineering.


  • Reduce report turnaround time by 30 percent within 90 days of go-live
  • First measurement criterion: use of macros and templates


  • Increase usage by 25 percent

Target ROI with Timetable

Establishing a specific ROI goal, along with a timetable for attainment, is one of the strongest ways to ensure proper focus by all interested parties. In line with the principles outlined above, the ROI objective must be specific. An acceptable objective would be “Reduce transcription costs by 25 percent annually on a pro- forma basis within six months of go-live.” This is in comparison to a vague objective of “Reduce transcription expenses.”

The identification of specific areas where quantifiable gains can be realized would now occur. This step is followed by establishing specific goals that will enable you to meet the objective. In this example, perhaps one measurement criterion is outsourcing, and the goal is to reduce this component of transcription by 50 percent within six months. Therefore, our goal now is to “Analyze the current usage of outsourcing and reduce this by 50 percent within six months of go-live.” Once again we are mapping measurement criteria and goals to a specific objective.


  • Reduce transcription costs by 25 percent annually on a pro forma basis within six months of go-live
  • First measurement criterion: use of outsourcing vendors


  • Decrease usage by 50 percent within six months of system go-live

Securing Executive Sponsorship

Deploying speech recognition is strategic in nature and therefore requires commitment from the executive level of the facility to succeed. The executive sponsor, at a minimum, reinforces the importance of the project to the key stakeholders.

By participating, this person demonstrates senior management's long-term commitment to the project. This serves to elevate the project from “another one of the IS department's cutting-edge ideas” to being of strategic importance to the overall facility.

Another benefit of an executive sponsor is that this person can secure additional resources if needed or participate in the timely resolution of unforeseen issues.

User Involvement

The initial success of the system deployment depends greatly on the level of acceptance demonstrated by the users of the system. In the case of speech recognition, this would include the transcriptionists and physicians. These users should play a key part in selection and deployment planning for this type of system.

Key representatives from each of the two groups outlined above should be involved in the project planning and assist in identifying the specific benefits for their particular area. The goal is to develop these users into system “champions” so that advocates are in place at all appropriate levels within the facility.

Designate Both a Technical and Functional System Administrator

In addition to the resources required to plan for and implement the system, a facility must designate appropriate ongoing resources to ensure the continued success of the project. The two primary resources are a technical and functional system administrator. These roles are typically filled by two separate individuals, as the skill set for each task varies considerably. Each of these positions is part-time. The actual time commitment depends upon the overall size and scope of the system deployment.

Identify Key Benefits for End Users

Human nature is to resist change. Therefore, it is of critical importance that the value of the project for physicians and MTs be clearly defined up front. If the physicians perceive the project as merely a cost-saving effort on the part of the facility, there may be a high level of resistance on their part. Statements common in this situation include “My time is more valuable than a transcriptionist’s; let them take care of creating reports,” or “I was trained as a physician, not a transcriptionist.”

To avoid this potentially hostile environment, it is imperative to:

  • Identify improvements that will be directly realized by the physicians and MTs
  • Develop agreement as to the importance of these improvements
  • Emphasize these improvements as key project objectives. This will ensure the continued support of the project from both of these key groups and develop system champions among them.

Align MT Compensation with New Technology

For a speech recognition system to achieve the maximum level of success (in the shortest amount of time), those most affected must be compensated and rewarded appropriately. The introduction of this technology represents a change to the MTs, creating new activities and responsibilities.

Adjusting their compensation will accelerate the adoption of the desired new behaviors, which, in turn, ensures attainment of ROI goals.

Develop an Operational Plan in Advance

An effective operational plan will consist of three primary areas:

  • Recommendations to improve the existing documentation process
  • Pocess changes required to accommodate the new technology
  • Optimal method and rate to integrate speech recognition into the documentation process

Each of these components is reviewed in further detail below.

Recommendations to Improve the Existing Documentation Process

The existing process must be as efficient as possible prior to the introduction of any new technology. If the manual process is inefficient, the automated process will likely be inefficient as well. The full potential of the new technology will never be realized by integrating it into an inefficient process. Recommendations made in this area are focused on improving the manual documentation process and are irrelevant to the deployment of new technology.

Process Changes Required to Accommodate the New Technology

To fully benefit from the new technology, certain processes may need to be modified, and others may need to be introduced. Recommendations made in this area are exclusive to the introduction of the new technology and are designed to maximize the benefits that can be derived from deployment.

Optimal Method and Rate to Integrate Speech Recognition into the Documentation Process

This component of the operational plan details the pace at which the new technology can be integrated successfully into the documentation process. The unique factors in place at the facility are incorporated into this section, and optional scenarios should be developed, along with the effect and potential consequences of each.

Key Stakeholder Updates during the Project

End users often resist change, yet their acceptance of this technology is vital to the project's success. A clear strategy to address their concerns prior to go-live is important. A successful strategy to accomplish this goal includes the following components:

  • Provide informational sessions for transcriptionists and physicians to demonstrate how the system meets the objectives of their respective areas
  • Conduct interactive updates with user representatives from all key stakeholders to keep them current on the progress of the project during the implementation phase
  • Once the system has gone live, provide regular communications to the end users emphasizing the project's benefits, the rollout schedule, and future plans

Establish Benchmarks Prior to Deployment

To accurately measure the success of the project, it is critical for predeployment benchmarks to be established. This provides the baseline for comparison once the system is installed, which will enable you to gauge the success levels for various components of the project.

Additional benefits of analyzing these benchmarks postdeployment include:

  • Justification to senior management to deploy the application in additional areas
  • Validation to end users of concrete benefits realized as a result of their cooperative participation in the project
  • Provides an incentive to users or departments that have not adopted the technology as rapidly as others

Speech Recognition and Accuracy Levels

Much has been written on this topic over the years. The standard topical analysis is that, even with 98 percent recognition, the caregiver will need to edit one of every 50 words dictated. Although true, the problem with that assessment is that it is not being compared to the accuracy provided with the current transcription process and methods in place.

Most outsourcing vendors avoid contractually committing to any level of accuracy, and when they do commit it is usually at the 95 percent level. Therefore, 98 percent accuracy with speech recognition may represent a significant improvement over the current process and require less time and effort on the physicians' part to correct or edit required changes. This is not to say that 100 percent accuracy is not the goal. However, when evaluating the efficacy of speech recognition, care should be taken to make a fair comparison of the technology versus the current method.

Also, once the time-saving methods available to the doctor are factored in, the net result may be an increase in physician efficiency. Rather than sending a report back to transcription for editing, re-reviewing the report, and then signing, a physician could simply voice edit the error, sign, and be done with the process.

Source: AHIMA e-HIM Work Group on Speech Recognition in the EHR. (October 2003).