Speech Understanding – The Key To Unlocking Clinical Knowledge  Delivering Safer, Cost Effective Care
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Speech Understanding – The Key To Unlocking Clinical Knowledge Delivering Safer, Cost Effective Care

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Presentation to AHRA Annual conference in Las Vegas 2009

Presentation to AHRA Annual conference in Las Vegas 2009

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  • Hieb, Barry, MD. (2003). Taming medical text: five key CPR technologies emerge. Com-18-5157. Gartner Research.


  • 1. Speech UnderstandingUnlocking the Clinical Information in Health Documents
    Nick van Terheyden, MD
    Chief Medical Officer, M*Modal
  • 2. Background
    The Current Situation
  • 3. Problems Facing Clinicians
    According to an American College of Physician Executives survey, 6 in 10 physicians have considered leaving the profession due to:
    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
  • 4. Electronic Health Record Universe
    Critical to the success of EHRs 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.
  • 5. The Current Situation – Structured
    Tedious manual process
    Documentation lacks expressiveness of natural language
    Lack of Flexibility
    Poor user interface
    Fails to Meet Individual Physician Time vs. Benefit Test
    Cultural resistance
    Oblivious to HIM Requirements
    Incomplete and Inadequate Semantic Standards
    Direct Data Entry: Structured and encoded information.
  • 6. “Although completing such templates may help physicians survive a report-card review, it directs them to ask restrictive questions rather than engaging in a narrative-based, open-ended dialogue.”
    Pamela Hartzband, M.D., and Jerome Groopman, M.D.
    n engl j med 358;16 april 17, 2008
  • 7. The Current Situation
    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
    Under utilized source of data for EMR
    Dictation: Fast and easy, expressive.
  • 8. 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
  • 9. The Current Situation
    Direct data entry, physician
    Direct data entry, not physician
    Structured Data
    System generated or interfaced data
    Unstructured Data
    Dictation and Transcription
    Dictation and Transcription
    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
  • 10. Unlocking Clinical Knowledge
  • 11. Value of EHRs over Dictation
    EHRs save you time
    but it takes much longer to enter the information
    You have more discrete data
    over 700 data elements
    but you only use about 3% of these data elements
    E&M coding improves
    in theory, but EHR vendors have no 3rd party validation studies
    EHRs provide orders and alerts
    but you can have the same with Health Story enabled EHRs
    Data and Chart courtesy Mark R. Anderson, FHIMSS, CPHIMS, CEO, AC Group
  • 12. Data Entry Time
    The average physician spends 33 seconds dictating an establish office visit
    92% of all office visits are established
    If the average physician sees 40 patients a day, total dictation time of 30 minutes plus time to search for the data.
    Using a traditional EHR application, the same number of patients would require 140 minutes of data entry time.
    Physicians are not willing to spend an additional 90 minutes per day for data entry.
    (40 X 92% x 33 seconds) + (40 x 8% x 125) = < 30 minutes per day
    Data and Chart courtesy Mark R. Anderson, FHIMSS, CPHIMS, CEO, AC Group
  • 13. Cost Comparisons
    1 MGMA Dashboard, $340,000 collections for IM professional charges
    2 Outsourced transcription at 16 cents per 65-character line
    Source: Healthcare Ledger – March 2009: Medical Transcription Relevance in the EHR Age – What is DRThttp://www.healthcareledger.com/march2009.htmlhttp://www.healthcareledger.com/march2009/Medical%20Transcription%20Relevance%20in%20the%20EHR%20Age%20_%20What%20is%20DRT%20HCL%20Mar%202009.pdf
  • 14. Speech Understanding
  • 15. Dictation and Speech Recognition
    Speech Recognition
    Background to technology and history
    What speech recognition often means for physicians…
    Disruption of their workflow
    Change in their dictation style
    More time spent on documentation
    “Typing with your tongue”
    The real world of dictation:
    Disorganized speakers
    Mumbled/fast speech
    Instructions to transcriber
    Different dictation habits
  • 16. “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.
  • 17. Conversational Documentation
    … transformation of dictation directly into structured clinical documents while encoding data depending on the care givers and organizations needs
  • 18. 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
  • 19. Speech Understanding in Action
    Document Model incl.Concepts,Extractors
    Dictation Recording
    Editing &ImplicitValidation
    Publishing &Querying
    Clinical Context
    Feedback: corrected structured and encoded draft documents and medical facts
  • 20. Technical View
    Document Model incl.Meds, Allergies…
  • 21. One Voice – Many Outputs™
  • 22. How it works
  • 23. The Healthstory Project and CDA
  • 24. 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 CDA4CDT standard compliant document types
    Increases quality of documentation
  • 25. Health Story Document Types
    Implementation Guides
    History & Physical
    Operative Report
    DICOM Imaging Reports
    Discharge Summary w/IHE
    Billing and Reimbursement Requirements
    Progress Notes
    .PDF work with Adobe
  • 26. Conclusions
  • 27. Crossing the Chasm…Babel Must Go
    Medical text “typed” from dictation
    has “no meaning”
    black marks on a page…
    info must be tagged as discrete data
    elements in order to assign meaning
    Clinical documentation uses wide variety of terms with same meaning….
    and terms that sound the same that have different meanings…..
    authors have a wide variety of styles, accents, methods of dictation…
  • 28. Health Story…
    Captures meaningful clinical documents
    Is the bridge between
    free form narrative and expressive notes, and
    fully structured clinical data
    Improves the quality of clinical documentation
    Generates semantically interoperable clinical data that will
    solve the fundamental challenges with EMRs - allowingclinical decision support, alerts, decision support, data mining
    enable interoperability, reporting, patient safety initiatives, PQRI (pay for performance), PSI (patient safety indicators) and improve billing data capture
  • 29. Impact
    Allows providers to maintain preferred workflow and documentation methods
    Increases the value and usability of narrative documents (dictation/trans, SRT)
    Accelerates the implementation of interoperable electronic health records
    Allows reuse of information
  • 30. Getting Involved
    Join the Health Story Project
    Participate in HL7 Structured Document work group
    Participate in HL7 ballots
    Encourage implementation
    EHR vendor adoption
    provider preference
    transcription RFPs
  • 31. Q&A
    See the solution at work at:
    GE Booth 823
    M*Modal: 216/7
  • 32. Nick van Terheyden, MD, CMO, M*Modal
    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 nvt@mmodal.com
    GrandCentral (301) 355-0877
    Where You Can Find Me
  • 33. M*Modal Speech Understanding:
    Nick van Terheyden, MDChief Medical OfficerM*Modal