Speech Understanding Dictation To Clinical Data - TEPR 2009


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Speech Understanding automatically converts the spoken work into structured and encoded clinical data that provides access to relevant diagnostic support, evidence based medicine and real time alerts.

Unlocking the data tucked away in the vast mountain of documents produced as part of delivering care to patients is possible today with Speech Understanding, the next generation of speech recognition technology that not only improves the overall efficiency of the documentation process by producing higher quality, more accurate clinical data but also produces structured encoded clinical data that can populate EMR’s that are crying out for high quality input. This information is encoded using the HL7’s Clinical Document Architecture (CDA) and Common Document Types (CDA4CDT).

With knowledge of the meaning the output from Speech Understanding is now able to identify concepts, organize documents into meaningful categories and create a semantically interoperable document .

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  • Speech Understanding Dictation To Clinical Data - TEPR 2009

    1. 1. Speech Understanding Dictation to Clinical Data: Automating the Production of Structured and Encoded Documents Nick van Terheyden, MD Chief Medical Officer M*Modal
    2. 2. Speech Understanding Dictation to Clinical Data: Automating the Production of Structured and Encoded Documents TEPR Annual Conference Tuesday February 3, 2009 Nick van Terheyden, MD Chief Medical Officer, M*Modal Technologies
    3. 3. Current Problems Facing Clinicians in Healthcare <ul><li>According to an American College of Physician Executives survey, 6 in 10 physicians have considered leaving the profession due to: </li></ul><ul><ul><li>burnout </li></ul></ul><ul><ul><li>low morale/depression </li></ul></ul><ul><ul><li>loss of autonomy </li></ul></ul><ul><ul><li>low reimbursement rates </li></ul></ul><ul><ul><li>patient overload </li></ul></ul><ul><ul><li>bureaucratic red tape </li></ul></ul><ul><ul><li>loss of respect, and </li></ul></ul><ul><ul><li>medical liability environment </li></ul></ul>Complexity and workload is crippling Physicians and hindering their ability to deliver High Quality Care
    4. 4. Electronic Health Record Universe <ul><li>Critical to the success of electronic health records is to reconcile two opposing needs </li></ul><ul><ul><li>Enterprise need for structured and coded information capture </li></ul></ul><ul><ul><li>Physician’s practical need for a fast and easy method for creating clinical notes. </li></ul></ul>
    5. 5. EMRs Need Structured Encoded Clinical Data
    6. 6. EMRs Need Structured Encoded Clinical Data How does this fit in
    7. 7. The Current Situation – Structured <ul><li>Tedious manual process </li></ul><ul><li>Time-consuming </li></ul><ul><li>Documentation lacks expressiveness of natural language </li></ul><ul><li>Lack of Flexibility </li></ul><ul><li>Poor user interface </li></ul><ul><li>Cost </li></ul><ul><ul><li>Fails to Meet Individual Physicians Time vs. Benefit Test </li></ul></ul><ul><ul><li>Cultural resistance </li></ul></ul><ul><li>Oblivious to HIM Requirements </li></ul><ul><li>Incomplete and Inadequate Semantic Standards </li></ul>Direct Data Entry : Structured and encoded information.
    8. 8. The Current Situation - Dictation <ul><li>Transcription can be expensive </li></ul><ul><li>Subject to longer turn-around times </li></ul><ul><li>Clinical data lost, because documents are neither structured nor encoded </li></ul><ul><li>Majority of attested information is only in the document </li></ul><ul><li>Contains the detail and comprehensive scope of patient information </li></ul><ul><li>Support human decision making </li></ul><ul><li>Reimbursement is based on narrative documentation </li></ul><ul><li>Retains current workflow, favored by physicians </li></ul><ul><li>Interoperable </li></ul><ul><li>Under utilized source of data for EMR </li></ul>Dictation : Fast and easy, expressive.
    9. 9. The Current Situation <ul><li>High cost of documentation </li></ul><ul><ul><li>Cost of ownership and physician time vs. transcription cost </li></ul></ul><ul><li>60% of the data lost to the EHR </li></ul><ul><li>Care process inefficiencies and impact on quality </li></ul>
    10. 10. <ul><li>“ We have uncovered powerful evidence that sophisticated EMR technologies positively correlate to improved measures of patient outcomes.” </li></ul><ul><li>HIMSS analytics </li></ul>1. White Paper: EMR Sophistication Correlates To Hospital Quality Data, (HIMSSanalytics 2006) *1
    11. 11. <ul><li>What if you could continue to use narrative and dictation and at the same time increase usage of the EMR and make more records available for the health information exchange? </li></ul>Crossing the Chasm…
    12. 12. Conversational Documentation The Missing Link in Information Capture in Healthcare
    13. 13. Speech Recognition Challenges <ul><li>Challenges faced in understanding regular dictation </li></ul><ul><li>Good dictators </li></ul><ul><li>Challenging Dictators </li></ul>
    14. 14. Nothing but Speech to Text
    15. 15. Speech to Text Dictation Regular Transcription Speech Engine Text Document/ Report
    16. 16. Speech-to-Clinical Document
    17. 17. “ Best of Both Worlds” Approach <ul><li>Creation and validation of meaningful clinical documents that are accurate, complete, accessible and shareable… </li></ul><ul><ul><li>… by leveraging existing workflow </li></ul></ul><ul><ul><li>… to populate the electronic health record, </li></ul></ul><ul><ul><li>… without requiring change for the physician. </li></ul></ul><ul><li>Significant productivity gains in generating high quality medical documentation from dictation - across all work types and medical specialties. </li></ul>
    18. 18. Conversational Documentation <ul><li>… transformation of dictation directly into structured clinical documents while encoding data depending on the care givers and organizations needs </li></ul>EHR
    19. 19. Meaningful Clinical Documents <ul><li>Meaningful Clinical Documents are a blend between free form text and fully structured documentation that </li></ul><ul><ul><li>represent the thought process, and </li></ul></ul><ul><ul><li>capture the clinical facts </li></ul></ul>
    20. 20. How it works
    21. 21. Meaningful Clinical Documents The Missing Link in Information Capture in Healthcare
    22. 22. Accessible Clinical Data
    23. 23. One Voice – Many Outputs™
    24. 24. Clinical Documentation Architecture <ul><li>Meaningful Clinical Documents vs. Text </li></ul><ul><ul><li>Structured and encoded clinical content enables… </li></ul></ul><ul><ul><ul><li>pre-signature alerts, </li></ul></ul></ul><ul><ul><ul><li>decision support, </li></ul></ul></ul><ul><ul><ul><li>best documentation practices, </li></ul></ul></ul><ul><ul><ul><li>multiple output formats, </li></ul></ul></ul><ul><ul><ul><li>multi-media reporting, </li></ul></ul></ul><ul><ul><ul><li>data mining </li></ul></ul></ul><ul><ul><li>Implements HL7 C DA 4C DT compliant document types </li></ul></ul><ul><ul><li>Increases quality of documentation </li></ul></ul>
    25. 25. Document Types <ul><li>History & Physical (completed) </li></ul><ul><li>Consultation (completed) </li></ul><ul><li>Operative Report (completed) </li></ul><ul><li>DICOM Imaging Reports (completed) </li></ul><ul><li>Progress Notes </li></ul><ul><li>Specialty reports (eg, Pediatric H&P) </li></ul>
    26. 26. Get the Full Healthstory CDA4CDT: bridging the gap between EMRs and eDocuments <ul><li>CDA implementation guides are being embraced by the EMR community </li></ul><ul><ul><li>Clinical societies: </li></ul></ul><ul><ul><ul><li>ASTM/HL7 Continuity of Care Document </li></ul></ul></ul><ul><ul><ul><li>CDA for anatomic pathology, imaging, anesthesiology, pediatrics, periodontal, long term care, others </li></ul></ul></ul><ul><ul><li>Reimbursement: HIPAA Attachments </li></ul></ul><ul><ul><li>HITSP: included in all use cases </li></ul></ul><ul><ul><li>IHE </li></ul></ul><ul><ul><ul><li>2006: 14 vendors, 1 content type </li></ul></ul></ul><ul><ul><ul><li>2007: 22 vendors, 7 content types </li></ul></ul></ul><ul><ul><li>Reporting: </li></ul></ul><ul><ul><ul><li>Public health: Cancer abstracts & Infectious Disease </li></ul></ul></ul><ul><ul><ul><li>Quality: Pediatric </li></ul></ul></ul><ul><ul><li>Providers: in production at Mayo, UPMC, NY Presbyterian, VA, MHS, others </li></ul></ul>
    27. 27. Project Members <ul><li>Founders: </li></ul><ul><li>Promoters: </li></ul><ul><li>Original Benefactors: </li></ul><ul><li>Management: </li></ul>
    28. 28. Conclusion
    29. 29. Conclusion… <ul><li>Crossing the Chasm… Babel Must Go </li></ul><ul><li>Medical text “typed” from dictation has “no meaning” – </li></ul><ul><li>Black marks on a page… </li></ul><ul><li>Information must be tagged as discrete data elements in order to assign meaning </li></ul><ul><li>Clinical documentation uses a wide variety of terms that have the same meaning…. </li></ul><ul><li>And terms that sound the same that have different meanings….. </li></ul><ul><li>Authors have a wide variety of styles, accents, methods of dictation… </li></ul>
    30. 30. Conclusion <ul><li>Meaningful Clinical Documents </li></ul><ul><ul><li>Bridge between </li></ul></ul><ul><ul><ul><li>Free form narrative and expressive notes, and </li></ul></ul></ul><ul><ul><ul><li>Fully structured clinical data </li></ul></ul></ul><ul><ul><li>Improve the overall quality of clinical documentation </li></ul></ul><ul><ul><li>Generates Semantically Interoperable Clinical Data that will </li></ul></ul><ul><ul><ul><li>Solve the fundamental challenges with EMR’s allowing clinical decision support, alerts, decision support, data mining </li></ul></ul></ul><ul><ul><ul><li>Enables interoperability, reporting, patient safety initiatives, PQRI (pay for performance), PSI (Patient safety indicators) and improves billing data capture </li></ul></ul></ul>
    31. 31. Speech Understanding Dictation to Clinical Data: Automating the Production of Structured and Encoded Documents Nick van Terheyden, MD Chief Medical Officer M*Modal
    32. 32. Where you can Find Me Twitter http://twitter.com/drnic1 Technorati http://technorati.com/people/technorati/nvt1 RSSSpeech Understanding http://speechunderstanding.blogspot.com/feeds/posts/default MyBlogLog http://www.mybloglog.com/buzz/members/nvt LinkedIn http://www.linkedin.com/in/nickvt Plaxo http://nvt.myplaxo.com FaceBook http://profile.to/drnick Digg http://digg.com/users/nvt1 Delicious http://delicious.com/nvt1 E-Mail [email_address] GrandCentral (301) 355-0877