Speech UnderstandingUnlocking the Clinical Information in Health Documents<br />Nick van Terheyden, MD<br />Chief Medical ...
Background<br />The Current Situation<br />
Problems Facing Clinicians<br />	According to an American College of Physician Executives survey, 6 in 10 physicians have ...
Electronic Health Record Universe<br />	Critical to the success of EHRs is to reconcile two opposing needs<br />Enterprise...
The Current Situation – Structured<br />Tedious manual process<br />Time-consuming<br />Documentation lacks expressiveness...
	“Although completing such templates may help physicians survive a report-card review, it directs them to ask restrictive ...
The Current Situation <br />Transcription can be expensive<br />Subject to longer turn-around times<br />Clinical data los...
The Current Situation<br />High cost of documentation<br />Cost of ownership and physician time vs. transcription cost<br ...
The Current Situation<br />Direct data entry, physician<br />Direct data entry, not physician<br />Structured Data<br />Sy...
Unlocking Clinical Knowledge<br />
Value of EHRs over Dictation<br />EHRs save you time<br /> but it takes much longer to enter the information<br />You have...
Data Entry Time<br />The average physician spends 33 seconds dictating an establish office visit<br />92% of all office vi...
Cost Comparisons<br />1 MGMA Dashboard, $340,000 collections for IM professional charges<br />2 Outsourced transcription a...
Speech Understanding<br />
Dictation and Speech Recognition<br />Speech Recognition<br />Background to technology and history<br />What speech recogn...
“Best of Both Worlds” Approach<br />Creation and validation of meaningful clinical documents that are accurate, complete, ...
Conversational Documentation<br />EHR<br />… transformation of dictation directly into structured clinical documents while...
Meaningful Clinical Documents<br />Meaningful Clinical Documents are a blend between free form text and fully structured d...
Speech Understanding in Action<br />Document Model incl.Concepts,Extractors<br />Dictation Recording<br />Editing &Implici...
Technical View<br />Document Model incl.Meds, Allergies…<br />SpeechUnderstanding<br />
One Voice – Many Outputs™<br />
How it works<br />
The Healthstory Project and CDA<br />
Meaningful Clinical Documents vs. Text<br />Structured and encoded clinical content enables…<br />pre-signature alerts, <b...
Health Story Document Types<br />Implementation Guides<br />Completed<br />History & Physical <br />Consultation<br />Oper...
Conclusions<br />
Crossing the Chasm…Babel Must Go<br />Medical text “typed” from dictation <br />	has “no meaning”<br />black marks on a pa...
Health Story…<br />Captures meaningful clinical documents<br />Is the bridge between<br />free form narrative and expressi...
Impact<br />Allows providers to maintain preferred workflow and documentation methods<br />Increases the value and usabili...
Getting Involved<br />Join the Health Story Project <br />www.healthstory.com<br />Participate in HL7 Structured Document ...
Q&A<br />See the solution at work at:<br />GE Booth 823<br />M*Modal: 216/7<br />
Nick van Terheyden, MD, CMO, M*Modal<br />Twitter			http://twitter.com/drnic1<br />Technorati		http://technorati.com/peopl...
M*Modal Speech Understanding:<br />Nick van Terheyden, MDChief Medical OfficerM*Modal<br />
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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

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  • Hieb, Barry, MD. (2003). Taming medical text: five key CPR technologies emerge. Com-18-5157. Gartner Research.
  • Speech Understanding – The Key To Unlocking Clinical Knowledge Delivering Safer, Cost Effective Care

    1. 1. Speech UnderstandingUnlocking the Clinical Information in Health Documents<br />Nick van Terheyden, MD<br />Chief Medical Officer, M*Modal<br />
    2. 2. Background<br />The Current Situation<br />
    3. 3. Problems Facing Clinicians<br /> According to an American College of Physician Executives survey, 6 in 10 physicians have considered leaving the profession due to:<br />burnout<br />low morale/depression<br />loss of autonomy<br />low reimbursement rates<br />patient overload<br />bureaucratic red tape<br />loss of respect, and <br />medical liability environment<br />Complexity and workload is crippling physicians and hindering their ability to deliver high quality care<br />
    4. 4. Electronic Health Record Universe<br /> Critical to the success of EHRs is to reconcile two opposing needs<br />Enterprise need for structured and coded information capture<br />Physician’s practical need for a fast and easy method for creating clinical notes.<br />
    5. 5. The Current Situation – Structured<br />Tedious manual process<br />Time-consuming<br />Documentation lacks expressiveness of natural language<br />Lack of Flexibility<br />Poor user interface<br />Cost<br />Fails to Meet Individual Physician Time vs. Benefit Test<br />Cultural resistance<br />Oblivious to HIM Requirements<br />Incomplete and Inadequate Semantic Standards<br />Direct Data Entry: Structured and encoded information.<br />
    6. 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.” <br />Pamela Hartzband, M.D., and Jerome Groopman, M.D.<br />n engl j med 358;16 april 17, 2008<br />
    7. 7. The Current Situation <br />Transcription can be expensive<br />Subject to longer turn-around times<br />Clinical data lost, because documents are neither structured nor encoded<br />Majority of attested information is only in the document<br />Contains the detail and comprehensive scope of patient information<br />Support human decision making<br />Reimbursement is based on narrative documentation<br />Retains current workflow, favored by physicians<br />Interoperable<br />Under utilized source of data for EMR<br />Dictation: Fast and easy, expressive.<br />
    8. 8. The Current Situation<br />High cost of documentation<br />Cost of ownership and physician time vs. transcription cost<br />60% of the data lost to the EHR<br />Care process inefficiencies and impact on quality<br />
    9. 9. The Current Situation<br />Direct data entry, physician<br />Direct data entry, not physician<br />Structured Data<br />System generated or interfaced data<br />Unstructured Data<br />Dictation and Transcription<br />Dictation and Transcription<br />Handwritten<br />High cost of documentation<br />Cost of ownership and physician time vs. transcription cost<br />60% of the data lost to the EHR<br />Care process inefficiencies and impact on quality<br />
    10. 10. Unlocking Clinical Knowledge<br />
    11. 11. Value of EHRs over Dictation<br />EHRs save you time<br /> but it takes much longer to enter the information<br />You have more discrete data<br />over 700 data elements<br />but you only use about 3% of these data elements<br />E&M coding improves<br />in theory, but EHR vendors have no 3rd party validation studies<br />EHRs provide orders and alerts<br />but you can have the same with Health Story enabled EHRs<br />Data and Chart courtesy Mark R. Anderson, FHIMSS, CPHIMS, CEO, AC Group<br />
    12. 12. Data Entry Time<br />The average physician spends 33 seconds dictating an establish office visit<br />92% of all office visits are established<br />If the average physician sees 40 patients a day, total dictation time of 30 minutes plus time to search for the data.<br />Using a traditional EHR application, the same number of patients would require 140 minutes of data entry time.<br />Physicians are not willing to spend an additional 90 minutes per day for data entry.<br />(40 X 92% x 33 seconds) + (40 x 8% x 125) = &lt; 30 minutes per day <br />Data and Chart courtesy Mark R. Anderson, FHIMSS, CPHIMS, CEO, AC Group<br />
    13. 13. Cost Comparisons<br />1 MGMA Dashboard, $340,000 collections for IM professional charges<br />2 Outsourced transcription at 16 cents per 65-character line<br />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<br />
    14. 14. Speech Understanding<br />
    15. 15. Dictation and Speech Recognition<br />Speech Recognition<br />Background to technology and history<br />What speech recognition often means for physicians…<br />Disruption of their workflow<br />Change in their dictation style<br />More time spent on documentation<br />“Typing with your tongue”<br />The real world of dictation:<br />Disorganized speakers <br />Mumbled/fast speech<br />Corrections<br />Instructions to transcriber<br />Different dictation habits<br />
    16. 16. “Best of Both Worlds” Approach<br />Creation and validation of meaningful clinical documents that are accurate, complete, accessible and shareable…<br />…by leveraging existing workflow<br />…to populate the electronic health record,<br />…without requiring change for the physician.<br />Significant productivity gains in generating high quality medical documentation from dictation - across all work types and medical specialties.<br />
    17. 17. Conversational Documentation<br />EHR<br />… transformation of dictation directly into structured clinical documents while encoding data depending on the care givers and organizations needs<br />
    18. 18. Meaningful Clinical Documents<br />Meaningful Clinical Documents are a blend between free form text and fully structured documentation that<br />represent the thought process, and<br />capture the clinical facts<br />
    19. 19. Speech Understanding in Action<br />Document Model incl.Concepts,Extractors<br />Dictation Recording<br />Editing &ImplicitValidation<br />Publishing &Querying<br />SpeechUnderstanding<br />Clinical Context<br />Feedback: corrected structured and encoded draft documents and medical facts<br />
    20. 20. Technical View<br />Document Model incl.Meds, Allergies…<br />SpeechUnderstanding<br />
    21. 21. One Voice – Many Outputs™<br />
    22. 22. How it works<br />
    23. 23. The Healthstory Project and CDA<br />
    24. 24. Meaningful Clinical Documents vs. Text<br />Structured and encoded clinical content enables…<br />pre-signature alerts, <br />decision support, <br />best documentation practices,<br />multiple output formats, <br />multi-media reporting, <br />data mining<br />Implements HL7 CDA4CDT standard compliant document types<br />Increases quality of documentation<br />
    25. 25. Health Story Document Types<br />Implementation Guides<br />Completed<br />History & Physical <br />Consultation<br />Operative Report<br />DICOM Imaging Reports<br />Upcoming<br />Discharge Summary w/IHE<br />Billing and Reimbursement Requirements <br />Progress Notes<br />.PDF work with Adobe<br />
    26. 26. Conclusions<br />
    27. 27. Crossing the Chasm…Babel Must Go<br />Medical text “typed” from dictation <br /> has “no meaning”<br />black marks on a page… <br />info must be tagged as discrete data <br /> elements in order to assign meaning <br />Clinical documentation uses wide variety of terms with same meaning….<br />and terms that sound the same that have different meanings…..<br />authors have a wide variety of styles, accents, methods of dictation…<br />
    28. 28. Health Story…<br />Captures meaningful clinical documents<br />Is the bridge between<br />free form narrative and expressive notes, and<br />fully structured clinical data<br />Improves the quality of clinical documentation<br />Generates semantically interoperable clinical data that will<br />solve the fundamental challenges with EMRs - allowingclinical decision support, alerts, decision support, data mining<br />enable interoperability, reporting, patient safety initiatives, PQRI (pay for performance), PSI (patient safety indicators) and improve billing data capture <br />
    29. 29. Impact<br />Allows providers to maintain preferred workflow and documentation methods<br />Increases the value and usability of narrative documents (dictation/trans, SRT)<br />Accelerates the implementation of interoperable electronic health records<br />Allows reuse of information<br />
    30. 30. Getting Involved<br />Join the Health Story Project <br />www.healthstory.com<br />Participate in HL7 Structured Document work group<br />Participate in HL7 ballots<br />Encourage implementation<br />EHR vendor adoption<br />provider preference<br />transcription RFPs<br />
    31. 31. Q&A<br />See the solution at work at:<br />GE Booth 823<br />M*Modal: 216/7<br />
    32. 32. Nick van Terheyden, MD, CMO, M*Modal<br />Twitter http://twitter.com/drnic1<br />Technorati http://technorati.com/people/technorati/nvt1<br />RSSSpeech Understanding http://speechunderstanding.blogspot.com/feeds/posts/default<br />MyBlogLog http://www.mybloglog.com/buzz/members/nvt<br />LinkedIn http://www.linkedin.com/in/nickvt<br />Plaxo http://nvt.myplaxo.com<br />FaceBook http://profile.to/drnick<br />Digg http://digg.com/users/nvt1<br />Delicious http://delicious.com/nvt1<br />E-Mail nvt@mmodal.com<br />GrandCentral (301) 355-0877<br />Where You Can Find Me<br />
    33. 33. M*Modal Speech Understanding:<br />Nick van Terheyden, MDChief Medical OfficerM*Modal<br />

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