Speech recognition is increasingly used in medical reporting. The aim of this article is to identify in the literature the advantages and weaknesses of this technology, as well as barriers and facilitators to its implementation.

A systematic review of systematic reviews has been conducted in PubMed, Scopus, Cochrane Library and Center for Reviews and Dissemination up to August 2017. The grey literature has also been consulted. The quality of systematic reviews has been assessed with the AMSTAR checklist. Inclusion criteria were to use speech recognition for medical reporting (front or back-end). A Survey has also been conducted in Quebec, Canada, to identify the dissemination of this technology in this province, as well as the factors of success or failure in its implementation.

Five systematic reviews were identified. These reviews indicated a high level of heterogeneity across studies. The quality of the studies reported was generally poor. Speech recognition is not as accurate as human transcription but can dramatically reduce the turnaround times for reporting. In front-end use, medical doctors need to spend more time for dictation and correction than with human transcription. With speech recognition, major errors can be up to three times more frequent. In back-end use, a potential increase in the productivity of transcriptionist is noted.

Speech recognition offers some advantages for medical reporting, the main one being a reduction in turnaround times. However, these advantages are challenged by an increased burden for medical doctor and risks of additional errors in medical reports. It is also hard to identify for which medical specialties and which clinical activities the use of speech recognition will be the most beneficial.

The overarching goal of this research was to (i) evaluate the impact of reports with recommendations provided by a hospital-based health technology assessment (HB-HTA) unit on the local hospital decision-making processes and implementation activities and (ii) identify the underlying factors of the nonimplementation of recommendations.

All reports produced by the HB-HTA unit between December 2003 and March 2013 were retrieved, and hospital decision makers who requested these reports were solicited for enrolment. Participants were interviewed using a mixed design survey.

Twenty reports, associated with fifteen decision makers, fulfilled the study criteria. Nine decision makers accepted to participate, corresponding to thirteen reports and twenty-three recommendations. Of the twenty-three recommendations issued, 65 percent were implemented, 9 percent were accepted for implementation but not implemented, and 26 percent were declined. In terms of the utility of each report to guide decision makers, 92 percent of the reports were considered in the decision-making process; 85 percent had one or more recommendations adopted; and 77 percent had recommendations implemented. The most frequently mentioned reasons for nonimplementation were related to contextual factors (64 percent), production/diffusion process factors (14 percent), content/format factors (14 percent), or other factors (9 percent). Among the contextual factors, the complexity of the changes (i.e., administrative reasons), budget and resources constraints, failure to identify administrative responsibility to carry out the recommendation, and nonpriority status of the HTA recommendation, were provided.

This study highlights that although HB-HTA reports are useful to hospital managers in their decision-making processes, certain barriers such as contextual factors need to be better addressed to improve HB-HTA efficiency and usefulness.

Knowledge transfer (KT) of Health Technolgy Assessment (HTA) results presents numerous challenges, one being the lack of time of busy decision makers. Our hospital-based HTA unit is now part of a large network comprising 100 installations. To bridge the gap between complex HTAs and even more limited time by executive officers and managers, we needed to develop a new approach to deliver effectively key HTA messages. We initiated a new strategy with a report on drug-eluting stent (DES). DES may have the potential to eradicate restenosis and the necessity to perform multiple revascularization procedures subsequent to percutaneous coronary intervention (PCI). However, the technology is expensive and some concerns about safety remain. The second generation of DES stents show promising results in terms of efficacy and safety.

We conducted a systematic review of meta-analyses comparing bare-metal stents (BMS) with second generation DES. Data extracted were used to perform a cost-benefit analysis for our organization. Main findings were illustrated in relation to the strategic plan of our institution.

As compared to BMS, the second generation of DES is very effective and potentially leads to huge savings. Safety is improved as regard to myocardial infarction, but not to mortality. For our institution, the use of second-generation DES has the potential to reduce waiting lists for a PCI. In an effort to improve clarity of the results and increase knowledge transfer among managers, we developed a new communication strategy involving the six axes considered as strategic by our Chief Executive Officer, namely: university mission, judicious use of resources, accessibility and quality of care and services, to build for and with the staff, and to act for and with the patient and his family. This led to a smart visual scheme directly showing the results in terms of what is important for our hospital. This initiative was very appreciated by managers.

Using our institutional strategic plan to communicate our results allowed a greater visibility of HTA activities and was greatly appreciated by managers. This will help in disseminating our results locally and in promoting the utility of HTA.

In 2015, the province of Québec, Canada went through a major restructuration in its healthcare system which resulted in regional institutional merging. Our hospital-based Health Technology Assessment (HTA) unit is now part of a large network comprising fourteen institutions covering an area of 12,734 km2. This new organizational context poses major challenges in terms of addressing various local needs and for involving stakeholders into our assessments. In this paper we present how we addressed these difficulties.

This case study presents the procedural method we developed for involving local and regional stakeholders into an HTA concerning the need to extend a regional prenatal ultrasound screening program. We describe how we collected local data and networked local to regional stakeholders for producing the assessment and recommendation.

After completion of the literature review on first trimester ultrasound screening, local data from each institution were collected using a combination of focus group meetings with local managers, gynecologists and ultrasound technologists. Overall, fifteen people were consulted on diverse regional sites, including two services users. In order to assess the perception of the results regarding efficacy, users preferences, cost and organizational impact of expanding the screening program, people were asked to complete an online survey. The results of this survey were then used to write a first draft of a recommendation. A second survey was generated in order to obtain agreement of the fifteen people regarding the recommendation. Overall, this method decreased the time required to complete the assessment and reduced project operating costs. However, divergence of opinions may be difficult to resolve by this method and many rounds of consultation may be needed.

Our procedural method using a combination of focus groups and online surveys for collecting local and regional data and opinions from stakeholders and support recommendation, has succeeded to provide well contextualized information for supporting a decision.