SpeechWorks Workflow

SpeechWorks provides the workflow required to simplify the creation and distribution of reports, greatly reducing the expense of integration and implementation, particularly for remote reading services. A description of the workflow is provided below:

(1) Studies are DICOM stored to Roentgen Works. This can be done over a LAN, a VPN, or, if the sending side supports DICOM TLS, then it can use that protocol (which means that a VPN is not required). Optionally, (Optional (1)), the study may never be stored and the study information comes from an HL-7 interface.

(2) Roentgen Works create the order information from the receipt of storage (optionally, the order information can come via an HL-7 interface).

(3) The radiologist is connected into Roentgen Works via https (note, Roentgen Works can also handle the distribution of the study to a DICOM Viewer and this is normally done via DICOM and a VPN). The stored study is shown on an appropriate worklist tab or query within the radiologist’s web application. Upon selection, it launches the study into the workstation (one of BRIT’s or, with integration, another vendor’s). At the same time, it opens the dictation window, and,

(4) Displays the default report or macro for that exam type and that user. The macros are stored on the Roentgen Works server, so they are available anywhere and can be shared by users. If the study is normal, the radiologist can simply sign-it. This provides a one click normal.

(5) When using a BRIT workstation, the radiologist can also use voice controls for navigation. The SpeechWorks Dictation and VR products both understand the difference between commands and dictation and only the dictations are included in the recordings. Likewise, with Dictation and VR, entries made in BRIT’s Vision workstation can be transferred directly into the report. This includes measurements and key images.

(6) The radiologist dictates and the words appear on the screen. Note, with the Dictation product, the radiologist may not care to see the words since the radiologist’s lexicon is not included. The words are useful in navigation and it displays the words the transcriptionist can see while matching the recording to the sound. The actual translation from sounds to words is accomplished via the one of the following:

a )For SpeechWorks Basic: An OEM speech to text product with a radiologist’s lexicon, such as Dragon, MacSpeech Medical or Speech Q. b) For SpeechWork Dictation and VR: the Microsoft’s VR Engine. For Dictation, it is the standard product that comes with the operating system. For VR, it includes BRIT’s radiologist’s Lexicon and Knowledge Tree.

(7) Upon saving the report/recording , the text is stored to the Roentgen Works Server. For SpeechWorks Dictation and VR, the sound file is also sent. The report/recording is saved by the radiologist with a status of “dicated”, where it will go to a transcriptionist; “preliminary”, where it will be held for further review(or made available to a limited category of users); or, “final” indicating that is ready for distribution. At anytime during the process, the radiologist can create a “macro” from a screen selection. There is no need to go outside the regular reporting routine to accomplish this.

(8) The transcriptionist, also connected to Roentgen Works via https, selects the “dictated” reports from the list. This displays the text and plays the sound, which is linked to the text. For the VR product, corrections made by the transcriptionist create a learning event. Note: there is no transcriptionist support within SpeechWorks Basic as no sound is available with OEM products. The transcriptionist saves the transcribed report as “transcribed”. Note: for sensitive sites, the transcriptionist can be set up to only see the accession number and not see the patient name or ID.

(9)The radiologist views the "transcribed" reports, if there is a transcriptionist involved. Once reviewed, the radiologist signs the report, same as above. The process repeats until the radiologist signs the report as "final".

(10) Final signature of the report triggers the report to be distributed to systems via HL-7 and to users, as per their preferences. Users can also log into a Roentgen Works server and access the report along with the study’s images and other patient studies (if the studies have been sent). The report can be viewed in the format defined by the end user. For example, the "Impressions” section can be at the very top of the report. Reports can be converted to pdf’s with a click of the button, downloaded, printed, etc. If critical findings are called out, then the critical finding history may be placed at the bottom of the report. The history includes the time the critical finding was communicated to the end user or end user location and the time the end user acknowledged the communication.

(11) Optionally, if the Urgent Works product has been purchased, a call is placed to the referring physician or patient location to start the Urgent Findings communication workflow when appropriate.