#the link will direct you to a longer video comparison with audio i did as soon as the movie came out on vod

[valkaryah]

Elvis Presley in Elvis: That's The Way It Is (1970) // Austin Butler in Elvis (2022) audio version x

[hoseas-angry-ghost]

YES YES YES I WOULD LOVE TO HEAR UR THEORIES

Hello anon! I am very surprised anyone wants to hear my chutney but here's my Strange Man Hot Take with some hopefully interesting info for curious parties:

To be honest, R* included so much misdirection around the Strange Man's identity (especially in RDR1) that I'm not *totally* convinced they're married to any one idea. RDR2 also complicated things by introducing new religions into Red Dead's world (Voodoo, Old Norse, etc.): he's no longer limited to just Christian / Western interpretations, as in RDR1, and it's possible R* might try to syncretise him with figures from other faiths (they did place Bayall Edge in Bayou Nwa, where most of the Voodoo stuff is).

At the same time, though, I think RDR2 actually narrowed things down somewhat in terms of the direction R* chose to take his character, and what we were shown of that. There's still a level of misdirection in RDR2, but IMO, it almost comes off as half-hearted in comparison to what was basically trolling in RDR1 -- it seems like they were a lot more focused on playing the "bad news" angle the second time round.

Based on what we know, and on the balance of things, I'm not convinced that the Strange Man is necessarily meant to be any one thing or figure, but I do think he's meant to fulfil some type of Satanic role within Red Dead's world, either in main or in part.

I won't compare and dissect other theories or anything, I just thought I'd list off some things that people might find interesting:

Armadillo. The deal between the Strange Man and Herbert Moon seems to be a pretty textbook Faustian bargain: Moon is offered earthly rewards ("happiness or two generations"), and although the price was (tellingly?) never specified, it seems like the recent Blood Money update for RDO all but confirmed that the cost was probably his soul. Although it's left ambiguous what Moon actually chose, the Armadillo curse was possibly an unforeseen (for Moon) consequence of the deal's terms, which would fit with similar tales of the devil or demon in question taking liberties with their end of the bargain.

In the files, there's some great audio of Moon off the shits and straight-up saying "I've made a deal with the devil, and I will never truly die!" It's possible this was cut for its own reasons (too overt?), but as a lot of stuff was apparently cut from Armadillo, I'm guessing it was either cut when Arthur in New Austin got cut, or it was part of something that R* didn't have time to implement in the epilogue. Either way, if it's not actually in the game then it's not technically canon, but it is an indication of what R* was thinking during development.

There's a lot of audio from the Armadillo townsfolk in general about devils and "devil curses," but the only thing I know of that definitely made it into the game is a line from the town crier ("Devil has the town in his hand").

There's audio of the Armadillo bartender saying "I heard the Tillworths made a deal with the devil to keep from gettin' sick! I don't wanna die any more than the next man, but ain't no safety worth a man's soul." Possibly idle gossip, but given Moon, possibly not.

RDO seemed to flirt with the idea of soul-selling a little bit with Old Man Jones' line "Well, this is America, so anything can be bought -- even souls," but then RDO pretty much just came right out and said it with Bluewater John in the Blood Money update. Bluewater John also apparently made a deal, almost definitely with the Strange Man (given the Moon deal and how close Bayall Edge is to all the drama); he was based on blues musician Robert Johnson and the myth that he sold his soul to the devil for mastery of the guitar. It's basically a rehash of the Moon deal, except it's... not subtle in its dialogue about deals, devils and souls.

"I GAVE EVERYTHING FOR ART, AND I LEARNED TOO MUCH AND NOTHING AT ALL" written on the wall at Bayall Edge also sounds like a reference to another one of these deals to me ("everything" being their soul, and "I learned too much and nothing at all" the foolishness of accepting eternal damnation for temporary knowledge). I think Bayall Edge might have originally belonged to a painter who struck a deal with the Strange Man for artistic skill, but then the Strange Man slowly possessed him or something -- which could be why some of the landscapes depict RDR1's I Know You locations, and why the writings on the wall kind of look like they deteriorate in quality. The puddle of blood at the foot of the portrait might also be linked to this somehow (whose is it?).

It's the deal-making for souls that really pushed the "devil" theory over the edge for me, because I can't think of whose wheelhouse that would be in except a devil's, or someone similarly malevolent.

Alternative name. The Strange Man's character model is called cs_mysteriousstranger in RDR2, and he's referred to as "the mysterious stranger" at least once in RDR1's in-game text. This could be a reference to The Mysterious Stranger, written by Mark Twain between 1897-1908, in which the stranger is a supernatural being called Satan. (At the end of the last version written, he tells the protagonist that nothing really exists and their lives are just a dream.)

Bayall Edge. Bayall Edge was possibly based on a Louisiana urban myth called the Devil's Toy Box, which is "described as a shack. From the outside, it is unappealing and average. ...The inside of the shack consists of floor-to-ceiling mirrors, including the walls. No one can last more than five minutes in this room. ...According to the legend, if you stood inside this mirror-room alone for too long, supposedly the devil would show up and steal your soul." The Strange Man does show up in the mirror eventually, and it's kind of curious that the paintings that change depending on your Honour act as metaphorical mirrors. This was also cut, but in the files, Arthur's drawing of the interior of Bayall Edge is unusually sloppy, like his faculties were impaired or something.

"Awful, fascinating and seductive". John writes this about Bayall Edge after the portrait is finished, and I think that's as good a description of something like the / a devil as any, but "seductive" is a big red flag for me, because it's such an odd choice of word and, from a Christian perspective, it's so loaded with connotations of evil and sin and temptation.

I Know You. Some have pointed out that I Know You in RDR1 resembles the Temptation of Christ, as it also takes place in three separate locations in the desert, and John is given moral tests in which he must choose between higher virtue or worldly vice. John is also, in a weird way, a kind of Christ-like figure in that he ultimately sacrifices his life for others. I do think the "temptation" in these encounters is very surreptitious but very much there ("Or rob her yourself" -- excuse me??), but they may also be operating on a Biblical definition of the word, i.e. a test or trial with the free choice of committing sin.

RDR1 dialogue. I don't want to get *too* much into this because I feel like we're all just getting punked in RDR1, but I think the Strange Man's dialogue broadly fits with something like a "devil" interpretation, or at least doesn't contradict it.

I'm thinking particularly of lines like "Damn you!" / "Yes, many have" (which would work metaphorically but also literally, given that the devil was thrown from heaven by God and his angels), and "I hope my boy turns out just like you" (of all the leading theories, I think Satan is the only figure who's popularly conceptualised as having a son, or prophesied to have a son -- God obviously had a son, but that ship kinda sailed).

I think the "accountant" line refers to Honour (which even uses an invisible numerical system), and how John's fate depends on the number of both good and bad acts he's committed throughout his life, and how these weigh against each other. If the Strange Man likes to collect souls, then he would have a vested interest in auditing you and seeing if your accounts are in the black or the red, as it were (and providing you with opportunities to push yourself further into the latter...), because if you're bankrupt, you're his.

Blind Man Cassidy. Interestingly, Cassidy seems to distinguish between "Death" and the Strange Man, implying that he's something else beyond his understanding: in one of Arthur's fortunes, after his TB diagnosis, he says "the man with no nose [Death] is coming for you," but in one of John's fortunes, he says "Two strangers seek thee: one from this world, perhaps one from another. One brings hatred; I'm not so sure what the other brings."

Arthur's cut dialogue. In the files, there's audio of Arthur having the exact same conversation with Herbert Moon as John in the epilogue, asking about the Strange Man picture because he "just seemed familiar". I think it's interesting that, like John, Arthur also would have apparently recognised the Strange Man despite (presumably) never seeing him before. Given how strong a theme morality is in Red Dead -- and how much both John and Arthur struggle with it -- my theory is that they find the Strange Man vaguely familiar because they're both familiar with the evil within themselves, or the potential for evil; and likewise, the Strange Man "knows" John because he embodies evil in some sense, so is aware of John's worst sins (like his involvement at Blackwater), or possibly even all of his sins (which would be, like, a lot).

Honourable mention: There's such a greater emphasis on conspiracies, myths, etc. in RDR2 that I half-wonder if the Strange Man's RDR2 incarnation was partly inspired by Hat Man (~excuse the link~ but often it's hard to find good sources for the kind of weird shit R* includes in their games).

ANYWAY, this got a little long but I hope someone found all this at least passably interesting. Thanks again for letting me ramble about the video game man, anon!

[attract-mode-collective]

Nothing Sez “Student Game” More Than The Dinosaur Evening News (that’s a good thing, btw)

The above is Mediazoic, which takes place in an alternate reality in which dinosaurs have come back to rule the earth and they've hired you, puny human, to make sure their televised broadcasts are dino family safe.

You moderate comments left on message boards, censor full frontal dino nudity, and so on. It's a student game alright, and one of my top picks from the NYU Game Center Student Showcase2018!

I was also fond of Dreams For Your Computer because CRTs, magnets, and cats...

... Here's what it looks like in action, btw.

Though the one game that I liked the most, and which would actually fare well on the marketplace, would have to be Static...

And honorable mention goes to an updated take on Flight Simulator, which recreates a 6 hour long commercial flight as a passenger...

... The best part was the look on Stephen Totilo's face, who kinda didn't get it.

When was the NYU thing btw? Over two weeks ago, and it’s been even longer since the last update. Sorry about that. You know the deal: a million, billion things going on. As usual.

Hence why it’ll take not just one, but two bursting at the seams posts, to cover the second half of May! So onto part one…  

Please, please, PLEASE let these Game Center CX Blu-rays have an English language option (via miki800.com)...

Not a day goes by in which I don’t wonder how that guy who appears in the instruction manual for Bomberman B-Daman is doing these days (via videogameartarchive & videogameartarchive)...

I really love the “are you for real?” vibe that Samus gives off in the instructions for the original Famicom Disk System release of Metroid (via nintendometro)...

If you’ve ever wondered what a pair of bosses from Mega Man 9 & 10 would look like with 8’s 32-bit sheen, well here ya go (via mendelpalace)...

A print ad for the Famicom adaptation of Akira that wasn't all that hot (via videogameads)...

Though whenever anyone hears the words “Akira video game”, this is basically what immediately comes to mind. Anything else is a disappointment, no matter what (via aaronkraten)...

Welcome to the rabbit hole that is the Memorex VIS (via @ColinWilliamson)...

Is the soundtrack to some ultra-obscure home banking software for the Mega Drive worth a listen? You goddamn right it is (via mendelpalace)...

… The accompanying article is also totally worth a read.

It’s the Battletoads X Blue Swede mashup that you can’t believe hasn’t been done yet (via SiIvaGunner)...

Replace Link with myself & Navi with my iPhone, which I use as an alarm clock, and you have earlier this morning in a nutshell (via nintendometro)...

“So where you going?”

“Down a road. A low poly road…”

“Where you headed towards?”

“Whatever’s at the end of this street. This low poly street...”

“If you look up, what do you see?”

“Low poly buildings, under a low poly sky. Who knows, maybe there’s some low poly birds up there, behind those low poly clouds…” (via pmpkn)

From looking at low poly skies to soaring high above them, but what a difference an arcade board makes huh (via kazucrash)...

This is what Metal Max 2: ReLoaded on the DS looks like, at its normal resolution...

And this is what it looks with the resolution bumped up (via gaucheartist)...

Is this sprite of a BMX biker animated unusually well or am I just out of touch when it comes to 2600 software? Granted, it does come from a game made in 1989 (via segagenesisevangelion)…

According to the law: “NO JUMPING” (via vgadvisor)

“Hi guys.” (via beowulf-ultra)

Such a heartwarming scene (via @PicturesFoIder)...

This is what VR looked like many years ago, which is basically how it still looks today as well (via peazy86)...

It’s Yuji Horii, from way back in the day, presumably before he had created Dragon Quest (via videogamesdensetsu)...

Why yes, I have heard of the Ocelot Arcade System, by virtue of it being Quality Simon Carless content...

... BTW, “Quality content” is in reference to this. Moving on: yes, I've also heard of VecFever. It plays games that you might be familiar with, since it emulates old vector MAME titles...

Meanwhile, am only just learning that Tiger released their handhelds in Japan under the Game Vision label (via segacity)...

The Sega Dreamcast: it's thinking... about you, cuz it cares about you (via posthumanwanderings)...

"Wait… was he always there?" asks the official Sonic the Hedgehog Tumblr (via sonicthehedgehog)...

And the final nail in the coffin for this gag came courtesy of the official Sonic Tumblr as well (via sonicthehedgehog)...

"Good news everyone skyrim has been ported to the Bethesda offices carpet" 

"Who the fuck designed support pillars to obstruct a quarter of the hallway?" 

"Bethesda" (via mysteriouslypeculiar)

Yet another "it's funny cuz it's true" (via highlandvalley)...

So annoyed that I only find out about this Games Glorious shirt on the very last day of kylefewell‘s Japanese extrusion (via miki800.com)...

Not a fan of the game (don’t hate, I just don’t find it very enthralling), yet for whatever reason, I REALLY want this vintage Mappy sweatshirt (via namcomuseum)...

When video game attire looks plausible IRL (via @cvxfreak)...

Much like with regular attire, with cosplay, sometimes it’s all about the accessories (via frankiebalboa)...

Don’t think I’ve ever seen this piece of Marvel Super Heroes vs Street Fighter art before (via segacity)...

For those who dig POC, as well those who dig VF, and also those who dig FV... that last one's Fighting Vipers, BTW (via fightersmegamix)...

It’s a crying shame that Fighting Vipers is such an unknown commodity these days (via kazucrash)...

Virtua Fighter vs Virtua Fighter… Kid (via segacity)...

It’s a crying shame that Fighters Megamix is such an unknown commodity these days (via segacity)...

So hyped for RPG Time, based solely upon the headline image used for this 10 ten list of BitSummit games (via @indiegameweb)...

Please enjoy yet another thing that I originally posted on a Saturday late at night, whatever time it might on your end right this second (via contac)...

Been a while since I’ve seen the handiwork of Joe Bleeps, largely since it’s been a while since I’ve been collecting Game Culture Snapshots; the man has certainly stepped up his game (boy mods) since way back when (via kotaku.com)...

Am also very much impressed by the Game Boy Macro, though once again, am super irritated that GBA games do not rest flush with the DS Lite’s body...

An example of function over form I guess (@gamesyouloved)...

Familiar with Line Wobbler? Ever wished you could play it on the go? Are you into demakes? For the Game Boy Advance? (via @diskmem)

Today’s corrupted GBA boot up sequence is (via corruptionasart)...

Can anyone tell what Famicom game we’re seeing that’s all glitched out? (via mendelpalace)...

My fave part of this NES 2 print ad is how, in order to truly drive the message of “EVOLVE OR BECOME EXTINCT” home, whomever felt it necessary to include a little picture of a dinosaur (via nintendometro)...

Was this an ad for the SNES? I ask because it’s considerably more sophisticated when compared to what you usually encountered in gaming rags at the time (via nintendometro)...

This ad for the GoldStar version of the 3DO, hailing from Korea, makes me so proud to be (half) Korean, you have no idea (via notablegamebox)...

This Space Invaders tribute piece is like the cover art to some 80s heavy metal record (via shmups)...

Meanwhile, the album art for the Metal Black soundtrack feels more Pink Floyd-ish than anything else (via reportal)...

As amazing as it would have been to attend a ZUNTATA concert 20 years ago, I desperately wanted to see them perform various Darius cuts live just the other week (via miki800.com)...

This cover art for a tribute album celebrating 25 years of Mega Man is still quite good, 31 years after the fact (via rnn-draws)...

My recommended reading this time is a comparison of all the various Mega Man sprites that have been, including a few that you may not be familiar with (via retrovania-vgjunk.blogspot.com)...

Apparently there was a Mega Man boss that was part arcade machine, but he only appeared in some mobile game, for f's sake Capcom (via mendelpalace)...

Guess now’s a good time to share another random game canter pic (via gogopri)...

Pathos at the game center, even among Sailor Scouts (via funnysailorm00n)...

A pride & joy of my personal collection is both the original retail Japanese release of Jet Set Radio & the available via Sega Direct only edition: De La Jet Set Radio (via videogameartarchive & videogameartarchive)...

Here's an alternate take on it’s alternate cover star (via @Drooling_Demon)…

Putting together the necessary gear to properly grind the streets of Tokyo-to (via kiroziki-cosplay)...

JSR tales place in a fictionalized, idealized interpretation of Japan, whereas this gif is a very realistic take, yup (via dehtyar)...

Meanwhile and elsewhere, somewhere in the United States of America it would seem (via behexagusthegreat)...

There's still dinner time in the future (via kirokazepixel)...

My contribution to #WorldGothDay (via it8bit)…

From dark & dreary, to warm & fuzzy, yet still black & white (via this old post from a few years back)...

Old photos of a Japanese school kid obsessing over the Famicom are somewhat dime a dozen, but the PC Engine? A very rare treat (via gamingremembrance)...

From black & white photographs of Japanese 80s kids playing consoles, to a full color animated gif of US 80s kids at the arcade (via tvneon)...

Time to wrap things up by touching upon something that kept me awfully busy over the past few: Death By Audio Arcade X Dreamhouse II. Here's a rather mysterious image that appeared on the FB event page, and which was utilized in my promotional push...

... Did it work? You’ll have to find out in my part 2 of my Attract Mode X Tumblr: May 2018 recap! Due tomorrow. Maybe.

[babbleuk]

5 questions for… Nuance – does speech recognition have a place in healthcare?

Speech recognition has been on the brink of major success for decades, so it feels. Rather than set of generic “when will it be mainstream” questions, I was keen to catch up with Martin Held, Senior Product Manager, Healthcare at Nuance, to find out how things stood in this, specific and highly relevant context.

How do you see the potential for speech recognition in the healthcare sector?

Right now, the most gain will be from general documentation, enabling people to dictate instead of type, to get text out faster. In some areas of healthcare, things are pretty structured – you have to fill forms electronically, with drop-down lists and so on. That’s not a primary application for speech, but anything that requires free text, there’s no comparison or alternative. Areas where handwritten notes are put into notes fields, that’s a good application. Discharge notes can be also be very wordy.

From a use case perspective, we’ve done analysis on how much time teams are spending on documentation and it’s huge — three quarters of medical practices are spending half of their time on documentation alone. In the South Tees Emergency department, we did a study where use of speech recognition reduced documentation time by 40%. In another study with Dukinfield, a smaller practice, by introducing our technology they were able to see 4 more patients (about a 10% increase) per day.

What has happened over the past 5 years in terms of performance improvements and innovation?

In these scenarios, it’s a question of “can it work, can it perform” across a range of input devices. General speech recognition has improved so much that we are in the upper 90% range straight out of the gate. Now none of our products require training, based on new technology that was introduced using deep neural networks and machine learning.

In healthcare, we have also added cloud computing and changed the architecture: we put a lightweight client on the end-point machine or device, which streams audio to a back-end recognition server hosted in Microsoft Azure. We announced recently the general availability of Dragon Medical One — cloud-based recognition.

Still connectivity is a big issue, in particular for mobile situations, such as a community nurse — it’s not always possible to use recognition back in the car, if a mobile signal is poor for example. We are looking at technology that could record, then transcribe later.

How have you addressed the privacy and risk implications?

We are certified to connect to N3 network, allowing NHS entities to connect according to requirements around governance and privacy, for example patient confidentiality. Offering a service through the NHS N3 network requires an Information Governance Statement of Compliance and submission of IG Toolkit through NHS Digital — this involves a relatively long and detailed certification process, including disaster recovery, Nuance internal processes and practices, employees with access and so on.

We are also offering input via the public Internet, as encryption and other technologies are secure so customers can connect through these means. So, for example, we can use mobile phones as an input device. We are not trying to build mobile medical devices, we know how difficult that is, but we are looking to replace the keyboard (which is not a medical device!)

As a matter of best practice, it is still required that the doctor has to sign the discharge or confirm an entry in electronic medical record system, whether it has been typed or dictated. So generated text is always a reference: and that will need to stay there. It’s more than five years before the computer can be seen as taking this responsibility from the doctor. Advice similarly can only be guidance.

How do you see the market need for speech recognition maturing in healthcare? 

Right now we’re still very much in an enablement situation with our customers, helping with their documentation needs. From a recognition perspective we can see the potential of moving from enablement to augmentation, making it simpler and hands-free, moving to more of a virtual assistant approach for a single person. In the longer-term, further out, we have the potential to do that for multiple people at the same time, for example a clinician, parent and child.

We’re also looking at the coding side of things — categorising disease, treatment, length of stay and so on from patient documentation. Codes are used for multiple things – reimbursement with insurance, negotiation between GPs, primary and secondary care about services to provide in future, with commissioner and trust to negotiate on payment levels. For primary care, doctors do coding but in secondary care, it’s done by a coder looking through a record after the discharge of a patient. If data is incomplete or non-specific, trusts can miss out on funding. Nuance already offers Natural Language Understanding based-coding products in the US, and these are being evaluated for the specifics of the healthcare market in the UK.

So we want to help turn documentation into something that can be easily analysed. Our technology cannot just recognise what you say, but in natural language understanding we can analyse the text and match against codes, potentially opening the door to offering prompts. For example, if doctor diagnoses a COPD, the clinician may need to ask if patient is a smoker, which will have a consequence in the code.

How does Nuance see the next 5 years panning out, in terms of measuring success for speech recognition?

We believe speech recognition is ready to deliver a great deal of benefit to healthcare, gaining efficiency and freeing up clinical staff. In terms of the future, we recently showed a prototype of a virtual assistant that combines a lot of technologies, including biometrics, complete speech control, text analysis and meaning extraction, and also appropriate selection — so the machine can distinguish between a command and whether I just wanted to say something.

This combination should make the reaction a lot more human — we call this conversational artificial intelligence. Another part of this is about making text to speech as human as possible. Then combining that with cameras and microphones in the environment, for example pointing at something and saying, give me more information about ‘this’. That’s all longer term, but the virtual assistant and video are things we are working on.

My take: healthcare needs all the help it can get

So, does speech recognition have a place? Over the past couple of decades of use, we have learned that we generally do not like talking into thin air, and particularly not to a computer: the main change over recent years, the reduction in training time, has done little to reduce this very psychological blocker, which means that speech recognition remains in a highly useful, yet relatively limited niche of auto-transcription.

Turning specifically to the healthcare industry, a victim of its own science-led success: it is difficult to think of an industry vertical in which staff efficiency is more important. In every geography, potential improvements to patient outcomes are being stymied by a lack of funds, symptomized by waiting lists, bed shortages and so on, while being burdened by the weight of ever-increasing bureaucracy.

Even if speech recognition could knock one or two percentage points off the time taken to execute a clinical pathway, the overall savings could be massive. Greater efficiency also opens the door to higher potential quality, as clinicians can focus on ‘the job’ rather than the paperwork.

For the future, use of speech recognition beyond the note-taking this also links to the potential for improved diagnosis, through augmented decision making, and indeed, improved patient safety as technology provides more support to what is still a highly manual industry. This will take time, but our general habits are changing as the likes of Alexa and Siri make us more comfortable about talking to inanimate objects.

Overall, progress may be slow for speech recognition particularly in healthcare, but it is heading in the right direction. One day, our lives might depend on it.

  from Gigaom https://gigaom.com/2018/06/20/5-questions-for-nuance-does-speech-recognition-have-a-place-in-healthcare/

[clarenceomoore]

5 questions for… Nuance – does speech recognition have a place in healthcare?

Speech recognition has been on the brink of major success for decades, so it feels. Rather than set of generic “when will it be mainstream” questions, I was keen to catch up with Martin Held, Senior Product Manager, Healthcare at Nuance, to find out how things stood in this, specific and highly relevant context.

How do you see the potential for speech recognition in the healthcare sector?

Right now, the most gain will be from general documentation, enabling people to dictate instead of type, to get text out faster. In some areas of healthcare, things are pretty structured – you have to fill forms electronically, with drop-down lists and so on. That’s not a primary application for speech, but anything that requires free text, there’s no comparison or alternative. Areas where handwritten notes are put into notes fields, that’s a good application. Discharge notes can be also be very wordy.

From a use case perspective, we’ve done analysis on how much time teams are spending on documentation and it’s huge — three quarters of medical practices are spending half of their time on documentation alone. In the South Tees Emergency department, we did a study where use of speech recognition reduced documentation time by 40%. In another study with Dukinfield, a smaller practice, by introducing our technology they were able to see 4 more patients (about a 10% increase) per day.

What has happened over the past 5 years in terms of performance improvements and innovation?

In these scenarios, it’s a question of “can it work, can it perform” across a range of input devices. General speech recognition has improved so much that we are in the upper 90% range straight out of the gate. Now none of our products require training, based on new technology that was introduced using deep neural networks and machine learning.

In healthcare, we have also added cloud computing and changed the architecture: we put a lightweight client on the end-point machine or device, which streams audio to a back-end recognition server hosted in Microsoft Azure. We announced recently the general availability of Dragon Medical One — cloud-based recognition.

Still connectivity is a big issue, in particular for mobile situations, such as a community nurse — it’s not always possible to use recognition back in the car, if a mobile signal is poor for example. We are looking at technology that could record, then transcribe later.

How have you addressed the privacy and risk implications?

We are certified to connect to N3 network, allowing NHS entities to connect according to requirements around governance and privacy, for example patient confidentiality. Offering a service through the NHS N3 network requires an Information Governance Statement of Compliance and submission of IG Toolkit through NHS Digital — this involves a relatively long and detailed certification process, including disaster recovery, Nuance internal processes and practices, employees with access and so on.

We are also offering input via the public Internet, as encryption and other technologies are secure so customers can connect through these means. So, for example, we can use mobile phones as an input device. We are not trying to build mobile medical devices, we know how difficult that is, but we are looking to replace the keyboard (which is not a medical device!)

As a matter of best practice, it is still required that the doctor has to sign the discharge or confirm an entry in electronic medical record system, whether it has been typed or dictated. So generated text is always a reference: and that will need to stay there. It’s more than five years before the computer can be seen as taking this responsibility from the doctor. Advice similarly can only be guidance.

How do you see the market need for speech recognition maturing in healthcare? 

Right now we’re still very much in an enablement situation with our customers, helping with their documentation needs. From a recognition perspective we can see the potential of moving from enablement to augmentation, making it simpler and hands-free, moving to more of a virtual assistant approach for a single person. In the longer-term, further out, we have the potential to do that for multiple people at the same time, for example a clinician, parent and child.

We’re also looking at the coding side of things — categorising disease, treatment, length of stay and so on from patient documentation. Codes are used for multiple things – reimbursement with insurance, negotiation between GPs, primary and secondary care about services to provide in future, with commissioner and trust to negotiate on payment levels. For primary care, doctors do coding but in secondary care, it’s done by a coder looking through a record after the discharge of a patient. If data is incomplete or non-specific, trusts can miss out on funding. Nuance already offers Natural Language Understanding based-coding products in the US, and these are being evaluated for the specifics of the healthcare market in the UK.

So we want to help turn documentation into something that can be easily analysed. Our technology cannot just recognise what you say, but in natural language understanding we can analyse the text and match against codes, potentially opening the door to offering prompts. For example, if doctor diagnoses a COPD, the clinician may need to ask if patient is a smoker, which will have a consequence in the code.

How does Nuance see the next 5 years panning out, in terms of measuring success for speech recognition?

We believe speech recognition is ready to deliver a great deal of benefit to healthcare, gaining efficiency and freeing up clinical staff. In terms of the future, we recently showed a prototype of a virtual assistant that combines a lot of technologies, including biometrics, complete speech control, text analysis and meaning extraction, and also appropriate selection — so the machine can distinguish between a command and whether I just wanted to say something.

This combination should make the reaction a lot more human — we call this conversational artificial intelligence. Another part of this is about making text to speech as human as possible. Then combining that with cameras and microphones in the environment, for example pointing at something and saying, give me more information about ‘this’. That’s all longer term, but the virtual assistant and video are things we are working on.

My take: healthcare needs all the help it can get

So, does speech recognition have a place? Over the past couple of decades of use, we have learned that we generally do not like talking into thin air, and particularly not to a computer: the main change over recent years, the reduction in training time, has done little to reduce this very psychological blocker, which means that speech recognition remains in a highly useful, yet relatively limited niche of auto-transcription.

Turning specifically to the healthcare industry, a victim of its own science-led success: it is difficult to think of an industry vertical in which staff efficiency is more important. In every geography, potential improvements to patient outcomes are being stymied by a lack of funds, symptomized by waiting lists, bed shortages and so on, while being burdened by the weight of ever-increasing bureaucracy.

Even if speech recognition could knock one or two percentage points off the time taken to execute a clinical pathway, the overall savings could be massive. Greater efficiency also opens the door to higher potential quality, as clinicians can focus on ‘the job’ rather than the paperwork.

For the future, use of speech recognition beyond the note-taking this also links to the potential for improved diagnosis, through augmented decision making, and indeed, improved patient safety as technology provides more support to what is still a highly manual industry. This will take time, but our general habits are changing as the likes of Alexa and Siri make us more comfortable about talking to inanimate objects.

Overall, progress may be slow for speech recognition particularly in healthcare, but it is heading in the right direction. One day, our lives might depend on it.

[valkaryah]

"Thank you!" Elvis Presley in Elvis: That's The Way It Is (1970) // Austin Butler in Elvis (2022) audio version [x]