Pipeline session speech and medical intelligence – revolutionizing the doctor and patient experience
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speech and medical intelligence – revolutionizing the doctor and patient experience Speech is delivering efficiencies and improves EHR adoption Adding Clinical Language Understanding is set to revolutionize healthcare delivery allowing the clinician to focus on the patient not the technology delivering real time medical intelligence at the point of care. Medical Intelligence helps healthcare providers transform patient stories into high-value clinically actionable medical information Improving the quality, efficiency and value of documentation and help drive better care without burdening the clinicians with data entry tasks
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Pipeline session speech and medical intelligence – revolutionizing the doctor and patient experience
- 1. Pipeline Session Dr. Nick van Terheyden, MD @drnic1 CONFIDENTIAL | © 2002-2013 Nuance Communications, Inc. All rights reserved. HEALTHCARE SOLUTIONS
- 2. Objectives • Speech is delivering efficiencies and improves EHR adoption • Adding Clinical Language Understanding is set to revolutionize healthcare delivery allowing the clinician to focus on the patient not the technology delivering real time medical intelligence at the point of care. • Medical Intelligence helps healthcare providers transform patient stories into high-value clinically actionable medical information • Improving the quality, efficiency and value of documentation and help drive better care without burdening the clinicians with data entry tasks CONFIDENTIAL | © 2002-2013 Nuance Communications, Inc. All rights reserved. HEALTHCARE SOLUTIONS
- 3. Paper is no longer fit for purpose CONFIDENTIAL | © 2002-2013 Nuance Communications, Inc. All rights reserved. Slide Courtesy of Dr Michael Bainbridge HEALTHCARE SOLUTIONS
- 4. The Art of Medicine JAMA. 2012;307(23):2497-2498. doi:10.1001/jama.2012.4946. http://jama.jamanetwork.com/article.aspx?articleid=1187932 CONFIDENTIAL | © 2002-2013 Nuance Communications, Inc. All rights reserved. HEALTHCARE SOLUTIONS
- 5. Improving Healthcare “If you can not measure it, you can not improve it.” Lord Kelvin (1824-1907) CONFIDENTIAL | © 2002-2013 Nuance Communications, Inc. All rights reserved. HEALTHCARE SOLUTIONS
- 6. Reinventing the relationship between people and technology • At the forefront of the next chapter of human-computer interaction • Deeply invested in creating effortless and natural user experiences • Rapid advances in voicerecognition technology CONFIDENTIAL | © 2002-2013 Nuance Communications, Inc. All rights reserved. HEALTHCARE SOLUTIONS
- 7. 7 CONFIDENTIAL | © 2002-2013 Nuance Communications, Inc. All rights reserved. 2002-2011 HEALTHCARE SOLUTIONS
- 8. Current Methods for Data Capture Direct data entry, not physician Structured Data System generated or interfaced data Direct data entry, physician Dictation and Transcription Unstructured Data Handwritten CONFIDENTIAL | © 2002-2013 Nuance Communications, Inc. All rights reserved. HEALTHCARE SOLUTIONS
- 9. Challenge – Clinical Knowledge-Processing Burden “Current medical practice relies heavily on the unaided mind to recall a great amount of detailed knowledge – a process which, to the detriment of all stakeholders, has repeatedly been shown unreliable” Knowledge processing requirement This gap injures patients Knowledge processing capacity Crane and Raymond The Permanente Journal Winter 2003 Volume 7 No.1 Kaiser Permanente Institute for Health Policy Years ago CONFIDENTIAL | © 2002-2013 Nuance Communications, Inc. All rights reserved. Today HEALTHCARE SOLUTIONS Slide Courtesy of Dr Michael Bainbridge
- 10. Automating the Extract of Clinically Actionable Data Natural Language Processing CONFIDENTIAL | © 2002-2013 Nuance Communications, Inc. All rights reserved. HEALTHCARE SOLUTIONS
- 11. CONFIDENTIAL | © 2002-2013 Nuance Communications, Inc. All rights reserved. HEALTHCARE SOLUTIONS
- 12. CONFIDENTIAL | © 2002-2013 Nuance Communications, Inc. All rights reserved. HEALTHCARE SOLUTIONS
- 13. CHIEF COMPLAINT PAST MEDICAL HISTORY CONFIDENTIAL | © 2002-2013 Nuance Communications, Inc. All rights reserved. HEALTHCARE SOLUTIONS
- 14. CHIEF COMPLAINT PAST MEDICAL HISTORY CONFIDENTIAL | © 2002-2013 Nuance Communications, Inc. All rights reserved. HEALTHCARE SOLUTIONS
- 15. • Meaningful Use Quality Reporting Decision Support • Value-Based Purchasing • • At a Dictation Station Patient Care In EHR • Self-editingCoding/CMI On the Go • Financial Integrity POA/HAC In EHR MT-editing With a RIS/PACS On a PC On an MFP • • EHR • Medical Necessity Coding Documentation Integrity Compliance CLU Capture Understand CONFIDENTIAL | © 2002-2013 Nuance Communications, Inc. All rights reserved. Use it for HEALTHCARE SOLUTIONS
- 16. From Clinical Narrative to Facts CLINICAL LANGUAGE UNDERSTANDING Rules: explicit linguistic models 93% Machine learning: discovery of new patterns 86 % Syntactic parsing & Statistical semantic processing 63 % LinKBase® ontology Oct ‘10 CONFIDENTIAL | © 2002-2013 Nuance Communications, Inc. All rights reserved. Feb ‘12 HEALTHCARE SOLUTIONS
- 17. Computer Assisted Physician Documentation Extending the value of clinical documentation into efficiency, quality and report turn around metrics CONFIDENTIAL | © 2002-2013 Nuance Communications, Inc. All rights reserved. HEALTHCARE 2011 Nuance Communications © SOLUTIONS 17
- 18. QualityAnalytics SUPPORTING YOUR ANALYTIC NEEDS Clinical Sources of Input Automated Reporting Clinical Documentation Improvement Concurrent Monitoring DASHBOARDS Quality Measures Patient Action Lists Clinical Documentation Patient Safety Indicators Automated Clinical Data Extraction CONFIDENTIAL | © 2002-2013 Nuance Communications, Inc. All rights reserved. On-Demand Search HEALTHCARE SOLUTIONS
- 19. Possibly the first step in this journey could be instant access on mobile platform CONFIDENTIAL | © 2002-2013 Nuance Communications, Inc. All rights reserved. HEALTHCARE SOLUTIONS
- 20. Electronic Medical Records Data Capture and Presentation Complexity CONFIDENTIAL | © 2002-2013 Nuance Communications, Inc. All rights reserved. HEALTHCARE SOLUTIONS
- 21. Intelligent Voice Interactions • Minimize need to remember “gate commands” & “command order” • Allow multiple forms of expression and handle ambiguous input • Allow for more conversational spoken utterances, less utilitarian • Reduce distance between complex spoken commands and desired outcome or action – finding becomes doing • Customizable to provide levels of seamless access to any content on device CONFIDENTIAL | © 2002-2013 Nuance Communications, Inc. All rights reserved. HEALTHCARE SOLUTIONS
- 22. Example of Intelligent Voice Interaction Intelligent Voice transforms how you complete tasks by understanding and classifying your spoken request • Ability to categorize Tell me the risks associated with this disease, treatment or specific set of clinical facts • Complies with directed interaction Show me the laboratory results for this patient • Understands intent Prescribe a specific treatment for my patient Understanding the context of the patient, the drug including dosage, side effects and patient specific contraindications CONFIDENTIAL | © 2002-2013 Nuance Communications, Inc. All rights reserved. HEALTHCARE SOLUTIONS
- 23. CONFIDENTIAL | © 2002-2013 Nuance Communications, Inc. All rights reserved. HEALTHCARE SOLUTIONS
- 24. PART NERSHIPS CONFIDENTIAL | © 2002-2013 Nuance Communications, Inc. All rights reserved. HEALTHCARE SOLUTIONS
- 25. CONFIDENTIAL | © 2002-2013 Nuance Communications, Inc. All rights reserved. HEALTHCARE SOLUTIONS
- 26. Where You Can Find Me Nick van Terheyden, MD AboutMe Twitter LinkedIn Voice of the Doctor Plaxo FaceBook E-Mail GrandCentral CMIO, Nuance Communications http://about.me/obiwan http://twitter.com/drnic1 http://www.linkedin.com/in/nickvt http://drvoice.blogspot.com/ http://nvt.myplaxo.com http://profile.to/drnick drnick@nuance.com, drnic1@gmail.com (301) 355-0877 CONFIDENTIAL | © 2002-2013 Nuance Communications, Inc. All rights reserved. HEALTHCARE SOLUTIONS
- 27. CONFIDENTIAL | © 2002-2013 Nuance Communications, Inc. All rights reserved. HEALTHCARE SOLUTIONS
Hinweis der Redaktion
- A Piece of My Mind June 20, 2012The Cost of TechnologyElizabeth Toll, MDJAMA. 2012;307(23):2497-2498. doi:10.1001/jama.2012.4946.http://jama.jamanetwork.com/article.aspx?articleid=1187932No one was more surprised than the physician himself. The drawing was unmistakable. It showed the artist—a 7-year-old girl—on the examining table. Her older sister was seated nearby in a chair, as was her mother, cradling her baby sister. The doctor sat staring at the computer, his back to the patient—and everyone else. All were smiling. The picture was carefully drawn with beautiful colors and details, and you couldn't miss the message. When he saw the drawing, the physician wrote a caption for it: “The economic stimulus bill has directed $20 billion to health care information technology, largely funding electronic medical record incentives. I wonder how much this technology will really cost?”
- Presenter Notes— Put simply, we advocate everything that’s second-nature by simplifying the way people interact with machines— We humanize technology so that doing your job and finding what you need feels natural and effortless— We invent amazing technology that makes everyone easier to understand— We convert burdensome tasks and workflows into seamless experiences
- Plus, as we transition to electronic health records we need to ensure we communicate the complete patient story and not get caught up in just checking the boxes Structured data and physician narrative is necessary for the best careSo while everyone works hard to adapt to the new structureThey still need to make the existing system more and more efficientReduce costsAnd continue to improve the quality of care
- The ability for clinician to capture there documentation in any workflow and any device is essential to capturing the whole patient storyAnd capture is only the beginningFirst we must make clinical data digital……then we must make digital data meaningfulAnd that’s no small feat!
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- Nuance is evolving speech from capture and recognition, to understandingTo do that, we’ve built a technology engine that enables this kind of deep understandingIt extracts the clinical facts from the narrative (Voice or Text) and transforms those facts into codified standard terminology while still retaining the original captured story
- The Clinical Language Understanding Engine normalizes and translates your data into standard medical terminology – how does it do this…Our CLU engine contains the largest medical knowledge base in the worldWhat differentiates our CLU is the optimal combination of our four best of breed technologies; ontology, syntactic parsing, using both NLP rules-based and statistical enginesThe knowledge elements represent the standard controlled medical vocabularies, SNOMED-CT, ICD-9, ICD-10, RxNorm for medicationsThe medical concepts and relationship types represent information gathered from hundreds of thousands of clinical documents analyzed and codified in a way that reflects how these different types of data are related to each otherOur CLU technology engine has been tested to within 94% accuracy and precision well beyond any other system in the healthcare IT market. The engine is not only accurate, but flexible, as what your needs are tomorrow are not necessarily what your needs are today either from a quality, audit, or federal regulatory requirements perspective. The engine constantly analyzes and learns with each new document it processes, always improving, always growing. What this means to you is that information gathered through the process of dictation and transcription via our Nuance documentation creation solutions passes through the CLU engine to be codified in a way that makes narrative unstructured data meaningful and actionable.
- We have this model where we surround the clinicians with the ability to document where ever, whenever and with whatever device they want in whatever language they want fully integrated with the EHR. On the go, hot spot, on a mobile device, in Spanish, in German, on Citrix, on a thin client… We take CLU we fully envelop that flow of information and the EHR so we’re not just taking narrative but we’re also taking structured information and we make that information actionable so the customer can drive patient care, financial integrity and compliance.Recapping the key points:CAC is an important component of your ICD-10 transition strategy, but its not the only solutionSuccess requires focusing on the beginning of the process, and ensuring your physicians are engaged and empowered with the tools to help them capture high quality documentation from the beginning, in their preferred workflow, and tightly integrated with the EHRIncreasing the percentage of electronic documentation capture will increase the efficiency and effectiveness of the computer assisted solutions including CAC, CAPD and Analytics and empower your coding, CDI, quality and safety teams. Dragon and eScription progress note features can help make it easy for your physicians. A clinically focused CDI approach engages your physicians with evidence based strategies, education and through CAPD automated technology giving them the tools to help ensure documentation is clear and accurate from the moment the patient enters the hospital, enabling better communication between caregivers, especially at critical transitions of care, and that documentation better reflects the true severity of illness and risk of mortality of each patient. Concurrent review allows care teams to make a difference while patients are still in the hospitalAnd by ensuring complexity and severity levels are included in documentation they can be reflected appropriately in your Case Mix Index ensuring more accurate reimbursement and quality scores are where they need to be
- A great example of solutionwhich relies on knowledge, statistics and linguistic framework is our CLU.Physicians generate narrative reports of patient encounters – these contain a wealth of critical information, but are difficult to consume by others. Further, entering this information EHRs is now mandated.Our technology automatically extracts the salient medical facts.Since the last time we spoke to you about this we have made further progress, and now our performance is at the limit of human performance.
- Next we announced the extension of our clinical language understanding in broad strategic partnership with 3M in which we’re combining our expertise in clinical documentation (speech recognition and CLU) with their prowess in coding and billing, to make it easier for physicians to create documentation that is ready to be coded. Collaboration is directly related supporting your transition to the new ICD-10 standard.You can think of CLU as an information processing system that is smart enough and powerful enough to process vast amounts of data, including physicians’ dictated narrative notes.Initially, CLU will be used to pull specific data elements from narrative notes and codify these elements to be consumed by your EHR and other backend systems.
- QualityAnalytics’ cloud-based clinical intelligence platform uses CLU technology to search narrative clinical documentation and extract key information.QualityAnalytics unlocks key clinical and financial indicators from free text notes.And that just makes Nuance’s transcription and speech recognition platforms even more valuable.QualityAnalytics receives text notes from multiple dictation platforms, processes them and then presents the resulting data in Web-based user interface. Powerful search capability enables on-demand searching, allowing you to identify patients at risk and additional reimbursement opportunities much more efficiently than manual chart review
- Current examples includeDragon Go and Siri
- And our partnerships with EHR companies make the capture process even more beneficial because it’s integrated into the new workflow Which improves clinical adoption and reduces the time to go-liveNuance has deep and established relationships with the following partners in that various regionsRIS / PACS and EHR vendors –Agfa, Carestream, Cerner, Epic, GE, iSoft, McKesson, Medasys, Sectra, Siemens, Softway, PhilipsOur R&D departments work together to ensure integration and adoption of these solutions Dictation workflow vendors G2 Speech, Max Manus, Winscribe and distributors Mysoft, Emerging Technologies, Ordiginal, Voelter