Speech Understanding Dictation to Clinical Data: Automating the Production of Structured and Encoded Documents Nick van Terheyden, MD Chief Medical Officer M*Modal

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

Current Problems Facing Clinicians in Healthcare According to an American College of Physician Executives survey, 6 in 10 physicians have considered leaving the profession due to: burnout low morale/depression loss of autonomy low reimbursement rates patient overload bureaucratic red tape loss of respect, and medical liability environment Complexity and workload is crippling Physicians and hindering their ability to deliver High Quality Care

According to an American College of Physician Executives survey, 6 in 10 physicians have considered leaving the profession due to:

burnout

low morale/depression

loss of autonomy

low reimbursement rates

patient overload

bureaucratic red tape

loss of respect, and

medical liability environment

Electronic Health Record Universe Critical to the success of electronic health records is to reconcile two opposing needs Enterprise need for structured and coded information capture Physician’s practical need for a fast and easy method for creating clinical notes.

Critical to the success of electronic health records is to reconcile two opposing needs

Enterprise need for structured and coded information capture

Physician’s practical need for a fast and easy method for creating clinical notes.

EMRs Need Structured Encoded Clinical Data

EMRs Need Structured Encoded Clinical Data How does this fit in

The Current Situation – Structured Tedious manual process Time-consuming Documentation lacks expressiveness of natural language Lack of Flexibility Poor user interface Cost Fails to Meet Individual Physicians Time vs. Benefit Test Cultural resistance Oblivious to HIM Requirements Incomplete and Inadequate Semantic Standards Direct Data Entry : Structured and encoded information.

Tedious manual process

Time-consuming

Documentation lacks expressiveness of natural language

Lack of Flexibility

Poor user interface

Cost

Fails to Meet Individual Physicians Time vs. Benefit Test

Cultural resistance

Oblivious to HIM Requirements

Incomplete and Inadequate Semantic Standards

The Current Situation - Dictation Transcription can be expensive Subject to longer turn-around times Clinical data lost, because documents are neither structured nor encoded Majority of attested information is only in the document Contains the detail and comprehensive scope of patient information Support human decision making Reimbursement is based on narrative documentation Retains current workflow, favored by physicians Interoperable Under utilized source of data for EMR Dictation : Fast and easy, expressive.

Transcription can be expensive

Subject to longer turn-around times

Clinical data lost, because documents are neither structured nor encoded

Majority of attested information is only in the document

Contains the detail and comprehensive scope of patient information

Support human decision making

Reimbursement is based on narrative documentation

Retains current workflow, favored by physicians

Interoperable

Under utilized source of data for EMR

The Current Situation High cost of documentation Cost of ownership and physician time vs. transcription cost 60% of the data lost to the EHR Care process inefficiencies and impact on quality

High cost of documentation

Cost of ownership and physician time vs. transcription cost

60% of the data lost to the EHR

Care process inefficiencies and impact on quality

“ We have uncovered powerful evidence that sophisticated EMR technologies positively correlate to improved measures of patient outcomes.” HIMSS analytics 1. White Paper: EMR Sophistication Correlates To Hospital Quality Data, (HIMSSanalytics 2006) *1

“ We have uncovered powerful evidence that sophisticated EMR technologies positively correlate to improved measures of patient outcomes.”

HIMSS analytics

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? Crossing the Chasm…

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?

Conversational Documentation The Missing Link in Information Capture in Healthcare

Speech Recognition Challenges Challenges faced in understanding regular dictation Good dictators Challenging Dictators

Challenges faced in understanding regular dictation

Good dictators

Challenging Dictators

Nothing but Speech to Text

Speech to Text Dictation Regular Transcription Speech Engine Text Document/ Report

Speech-to-Clinical Document

“ Best of Both Worlds” Approach Creation and validation of meaningful clinical documents that are accurate, complete, accessible and shareable… … by leveraging existing workflow … to populate the electronic health record, … without requiring change for the physician. Significant productivity gains in generating high quality medical documentation from dictation - across all work types and medical specialties.

Creation and validation of meaningful clinical documents that are accurate, complete, accessible and shareable…

… by leveraging existing workflow

… to populate the electronic health record,

… without requiring change for the physician.

Significant productivity gains in generating high quality medical documentation from dictation - across all work types and medical specialties.

Conversational Documentation … transformation of dictation directly into structured clinical documents while encoding data depending on the care givers and organizations needs EHR

… transformation of dictation directly into structured clinical documents while encoding data depending on the care givers and organizations needs

Meaningful Clinical Documents Meaningful Clinical Documents are a blend between free form text and fully structured documentation that represent the thought process, and capture the clinical facts

Meaningful Clinical Documents are a blend between free form text and fully structured documentation that

represent the thought process, and

capture the clinical facts

How it works

Meaningful Clinical Documents The Missing Link in Information Capture in Healthcare

Accessible Clinical Data

One Voice – Many Outputs™

Clinical Documentation Architecture Meaningful Clinical Documents vs. Text Structured and encoded clinical content enables… pre-signature alerts, decision support, best documentation practices, multiple output formats, multi-media reporting, data mining Implements HL7 C DA 4C DT compliant document types Increases quality of documentation

Meaningful Clinical Documents vs. Text

Structured and encoded clinical content enables…

pre-signature alerts,

decision support,

best documentation practices,

multiple output formats,

multi-media reporting,

data mining

Implements HL7 C DA 4C DT compliant document types

Increases quality of documentation

Document Types History & Physical (completed) Consultation (completed) Operative Report (completed) DICOM Imaging Reports (completed) Progress Notes Specialty reports (eg, Pediatric H&P)

History & Physical (completed)

Consultation (completed)

Operative Report (completed)

DICOM Imaging Reports (completed)

Progress Notes

Specialty reports (eg, Pediatric H&P)

Get the Full Healthstory CDA4CDT: bridging the gap between EMRs and eDocuments CDA implementation guides are being embraced by the EMR community Clinical societies: ASTM/HL7 Continuity of Care Document CDA for anatomic pathology, imaging, anesthesiology, pediatrics, periodontal, long term care, others Reimbursement: HIPAA Attachments HITSP: included in all use cases IHE 2006: 14 vendors, 1 content type 2007: 22 vendors, 7 content types Reporting: Public health: Cancer abstracts & Infectious Disease Quality: Pediatric Providers: in production at Mayo, UPMC, NY Presbyterian, VA, MHS, others

CDA implementation guides are being embraced by the EMR community

Clinical societies:

ASTM/HL7 Continuity of Care Document

CDA for anatomic pathology, imaging, anesthesiology, pediatrics, periodontal, long term care, others

Reimbursement: HIPAA Attachments

HITSP: included in all use cases

IHE

2006: 14 vendors, 1 content type

2007: 22 vendors, 7 content types

Reporting:

Public health: Cancer abstracts & Infectious Disease

Quality: Pediatric

Providers: in production at Mayo, UPMC, NY Presbyterian, VA, MHS, others

Project Members Founders: Promoters: Original Benefactors: Management:

Founders:

Promoters:

Original Benefactors:

Management:

Conclusion

Conclusion… Crossing the Chasm… Babel Must Go Medical text “typed” from dictation has “no meaning” – Black marks on a page… Information must be tagged as discrete data elements in order to assign meaning Clinical documentation uses a wide variety of terms that have the same meaning…. And terms that sound the same that have different meanings….. Authors have a wide variety of styles, accents, methods of dictation…

Crossing the Chasm… Babel Must Go

Medical text “typed” from dictation has “no meaning” –

Black marks on a page…

Information must be tagged as discrete data elements in order to assign meaning

Clinical documentation uses a wide variety of terms that have the same meaning….

And terms that sound the same that have different meanings…..

Authors have a wide variety of styles, accents, methods of dictation…

Conclusion Meaningful Clinical Documents Bridge between Free form narrative and expressive notes, and Fully structured clinical data Improve the overall quality of clinical documentation Generates Semantically Interoperable Clinical Data that will Solve the fundamental challenges with EMR’s allowing clinical decision support, alerts, decision support, data mining Enables interoperability, reporting, patient safety initiatives, PQRI (pay for performance), PSI (Patient safety indicators) and improves billing data capture

Meaningful Clinical Documents

Bridge between

Free form narrative and expressive notes, and

Fully structured clinical data

Improve the overall quality of clinical documentation

Generates Semantically Interoperable Clinical Data that will

Solve the fundamental challenges with EMR’s allowing clinical decision support, alerts, decision support, data mining

Enables interoperability, reporting, patient safety initiatives, PQRI (pay for performance), PSI (Patient safety indicators) and improves billing data capture

Speech Understanding Dictation to Clinical Data: Automating the Production of Structured and Encoded Documents Nick van Terheyden, MD Chief Medical Officer M*Modal

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