Speech-recognition technology is increasingly helping U.S. military doctors keep more detailed patients notes while cutting the time they spend typing on their computers.

By 2011, the U.S. Department of Defense expects to have implemented its integrated, interoperable electronic medical record system -- AHLTA -- at more than 500 military medical facilities and hospitals worldwide.

The system will be used for the care of more than 9 million active military personnel, retirees, and their dependents. Military doctors using the AHLTA system also have access to Dragon NaturallySpeaking Medical speech-recognition technology from Nuance Communications' Dictaphone health care division, allowing doctors to speak "notes" into patient records, as an alternative to typing and dictation. Over the last year, the adoption of Dragon has doubled, with about 6,000 U.S. military doctors using the software at health care facilities of all military branches, including the Air Force, Army, Navy, and Marine Corps.

AHLTA was originally designed as a surveillance system to pick up on symptoms that could indicate a health problem that's developing in military personnel, said Dr. Robert Bell Walker, European Regional Medical Command AHLTA consultant and a family practice physician for the military. And as part of that original plan, AHLTA started out as an "all structured text" system. That means it was "very rigid and burdensome" for physicians to use while entering information about patients. Over time, the military has allowed the use of "free text," and more recently voice, to more easily capture physician notes and other patient information while caring for patients, he said.

The use of Dragon Naturally Speaking voice-recognition software with the AHLTA e-health record systems is freeing doctors from several hours of typing into the AHLTA their various patient notes each week, he said.

Being able to speak notes into an e-health record at the patient beside -- rather than staring at a computer screen typing -- also helps improves doctors' bedside manner and allows them to narrate more comprehensive notes while the patients are there, or right after a visit. That cuts down on mistakes caused by memory lapses and boosts the level of details that are included in a patient record, Walker said.

The voice capability "saves a lot of time and adds to the thoroughness of notes from a medical and legal aspect," said Dr. Craig Rohan, a U.S. Air Force pediatrician at Peterson Air Force base in Colorado. The ability to speak notes directly into a patient's electronic chart is particularly helpful in complicated cases, where a patient's medical history is complex, he said. Text pops up on the computer screen immediately after words are spoken into the system, so doctors can check the accuracy, make changes, or add other details.

Also, because spoken words are immediately turned into text, the medical record has "a better flow" to document patient visits. Previously, "the notes that had been created by [entering] structured text into the AHLTA system looks more like a ransom note," said Walker, with information seemingly randomly pasted together.

Doctors can speak into a microphone on their lapels to capture notes in tablet PCs during patient visits, or speak into headsets attached to desktop or wall-mounted computers.

Also, macros allow health care providers to create special functions for spoken commands. So, for instance, a computer screen will automatically display a checklist of questions about developmental milestones to ask the parent of a 2-month-old patient or a checklist of care that a diabetic patient should receive.

So, if a diabetic patient hasn't had a foot exam recently, the system can help remind doctor. "The macros are a big benefit," said Walker. They help military doctors to adhere to clinical practice guidelines and reduce the variables in care, he said.

The storage requirement of voice notes is "small," especially when compared with other records, such as medical images, said Walker.