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3/15/2013
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First Speech-Enabled Mobile CPOE Lacks Decision Support

Mobile computerized physician order entry (CPOE) app turns dictation into system entries, but alerts to prevent errors won't be added until a later version, say makers Intermountain and MModal.

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What has been hailed as the industry's first speech-enabled mobile app for computerized physician order entry (CPOE) will lack a key feature of CPOE in its initial iteration: clinical decision support. But Intermountain Healthcare and speech recognition vendor MModal, which are co-developing the application, say that decision support tools are on their roadmap.

Intermountain is about to roll out the beta version of the app to its own physicians, said Marc Probst, CIO and VP of information systems for the organization, in an interview with InformationWeek Healthcare. The plan is to launch the commercial version in the third quarter.

To begin with, the app will be used only for ordering of common, frequently prescribed medications. Later, Intermountain and MModal plan to expand the system so doctors can use it to order lab and imaging tests, as well as give nursing orders such as those related to catheters and checking vital signs, according to a press release.

[ Computerized provider order entry systems can prevent doctor errors. Read CPOE Cuts Medication Errors By 48%, Says Study. ]

For medication orders, users will be able to select the patient; choose the drug dosage, frequency and other qualifiers; and send the request to a CPOE system after checking it for accuracy. The physician dictates the order into an iPhone or an iPad, which transmits it to MModal's Web server. MModal's "speech understanding" software then converts the spoken words into text, which are returned to the physician's mobile device for correction. Following that, the order is sent to CPOE.

The aim of the speech-enabled application is to help physicians more easily enter simple orders, especially when they're outside the hospital, Probst noted. In a nod to the reality -- familiar in most hospitals -- that many physicians still refuse to use CPOE, he added, "This will also encourage doctors to enter orders themselves in the hospital."

The first doctors to use the app have been receptive, Mike Raymer, senior VP of solutions management for MModal, told InformationWeek Healthcare. Doctors like the idea of voice recognition helping them cut through the complexities of CPOE, and not being forced to use drop-down boxes on a screen.

Moreover, he said, the application is good at distinguishing a particular voice in a crowded environment. This is especially true when it's used with the iPhone 5, which includes a background noise eliminator.

Nevertheless, there are still a number of challenges to work through, he and Probst acknowledged. For one thing, the co-developers are trying to improve the ability of the system to extract the right medications, dosages and so on from conversational speech, so doctors don't have to use specific terms in a particular order.

Also, they want to include a bidirectional interface with Intermountain's homegrown EHR so that doctors can view clinical data before they order meds or tests. Raymer says that the plan is to provide a fact sheet with active meds and lab results in future versions of the system.

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jaysimmons
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jaysimmons,
User Rank: Apprentice
3/21/2013 | 7:02:43 PM
re: First Speech-Enabled Mobile CPOE Lacks Decision Support
I agree that if there isnGt decision support available the results could potentially be very hazardous. Speech recognition software historically has always been kind of buggy, and if physicians are going to trust this kind of software when entering medications or other orders, they would need to have some kind of decision support. Of course, if they are able to integrate decision support into their products and are able to provide a reliable speech recognition program, this could be a very useful tool.

Jay Simmons
Information Week Contributor
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