Writing exactly what they say

As he sat in his tiny office at Dedham Medical Associates in Norwood, Lee, a pediatrician, demonstrated how the voice-recognition software Dragon Medical from Nuance Communications Inc. translates his impressions into clean, impeccably spelled text on the screen.

“It saves me a half hour at the end of every day,’’ he said, “and it allows me to tell the patient’s story much better.’’

Lee is among an increasing number of medical professionals who are adopting voice recognition software, creating a growing market for Nuance, a Burlington company. Sales to physicians and hospitals accounted for nearly 40 percent of Nuance’s revenue last year, or about $450 million.

“Health care is now our biggest market, by far,’’ said Peter Durlach, senior vice president at Nuance.

One reason voice-recognition technology has found a home in the health care industry is that physicians are trained from their earliest internships to dictate their notes. In the early 1970s, doctors began to use Dictaphone systems, which saved their notes and observations to audio tapes, which were then handed over to stenographers.

Later, the medical community migrated to digital technology, outsourcing digital audio files to transcribers in the United States as well as in India and other developing countries for overnight transcriptions.

Today, new software can cut transcribers out of the process, using voice-recognition technology to input text directly into electronic medical records.

The adoption of voice-recognition technology has also been spurred by an aggressive push by the government to promote electronic health records, or EHR. The January 2009 federal stimulus package included nearly $40 billion to provide incentive payments to physicians to encourage the use of EHR equipment and technology.

Physicians can accrue between $44,000 and $64,000 in incentive payments from Medicare and Medicaid if they “meaningfully use’’ EHR technology by mid-2011.

By 2013, the federal government will switch its EHR incentive program from a carrot to a stick, deducting a percentage from Medicare and Medicaid payments to doctors who are not using electronic records in a meaningful way.

Although it’s possible for physicians to keyboard information into electronic records, many prefer voice, a desire that Nuance is servicing with new software.

Voice-recognition technology has also benefited from steady improvements in functionality, and the increased speed and efficiency that comes with faster computer chip sets and software upgrades.

A significant Dragon Medical upgrade is what got Lee talking rather than typing. In addition to being a pediatrician, Lee serves as director of clinical informatics at Atrius Health, a network of medical groups around Boston. In that role, and just because he’s “technically oriented,’’ Lee said, he has been experimenting with voice-recognition software for 10 to 12 years.

“Frankly, I wasn’t that impressed with the early versions,’’ Lee said.

But a few years ago, with the launch of Dragon Medical 9, Lee said he noticed a dramatic improvement in the way the software handled his patient reports, which are dense with medical terms. After a few weeks, he was even more impressed.

“My notes were getting completed earlier. I was going home sooner,’’ he said.

Lee said that the quality of his reports also improved.

“Instead of typing little blips, I could be more expansive by speaking. I could lay out my thoughts better,’’ he said.

In the fall of 2008, Lee helped to run a pilot Dragon Medical program at Atrius with 20 doctors. Out of the initial group, 19 continued using the program. During the trial, the average daily time savings was 39 minutes.

Once 150 doctors joined the program, Atrius calculated it was saving $10,000 a month in transcription costs. Within 12 months, 240 doctors were using Dragon Medical; an additional 350 physicians use another Nuance product, eScription, which combines voice recognition with outsourced editors who clean up the files.

Wes Rishel, a health care analyst at Gartner Inc., a technology research firm in Stamford, Conn., said he encountered rudimentary voice-recognition software nearly 15 years ago at trade shows.

“Voice recognition has been a long time coming,’’ he said, “but the hardware and software has been getting steadily better, so that now it’s become a big step forward in the technology available to health providers.’’

Lee said he expects future software upgrades by Nuance to extend the role of voice technology in medicine. For example, more sophisticated software may soon enable increased voice navigation of forms and data.

“I could see a scenario where a doctor in an examination room could say, ‘Show patient chart,’ and an image would move onto a screen in the room,’ ’’ he said.

That may be some time coming, but “whatever happens in the future,’’ Lee said, “I’m sure voice will play a significant role.’’

D.C. Denison can be reached at denison@globe.com.