This document discusses conversational interfaces for clinical information systems. It describes 5 keys to doctor-friendly electronic medical records, including being intuitive, quick, accessible everywhere, available immediately when needed, and always accurate. It provides examples of conversation snippets between a doctor and the conversational interface. The document discusses why voice is a productive interface and outlines VAL9000's key features, which allow it to complement existing clinical systems through spoken conversations. It compares VAL9000 to Nuance Dragon Solutions, noting VAL9000 handles clinical workflows and retrieves and saves structured data through two-way conversations.

1. Conversational interfaces for
clinical information systems
January 2011
VAL9000, Inc.
SM
Simplifying the practice of medicine Richard Koffler
rk@val9000.com
(310) 807-5786
Dr. Val Nenov
val@val9000.com
1
January 2011

2. Five keys to doctor-friendly
electronic medical records
1. Intuitive, unobtrusive, easy,
without training hassles
2. Quick: In, out, done!
3. Accessible everywhere:
At point of care, on the
road, between offices, at
home, etc.
4. Available immediately
Is this a productive use
January 2011
when needed, no delays
of the doctor’s time?
5. Always accurate: No
follow-up human proofing
Anything else is
unproductive, and takes 2
time from seeing patients
and practicing medicine

3. Mobile apps nice but very imperfect
Low-productivity user interfaces
• Cramped screens; cumbersome to navigate, find, retrieve
Click-swipe-type-click-swipe-click-swipe-…
• Every app behaves differently, training headaches
• User can’t multitask: Distractive to use while doing other things
One more thing to carry
• Cramped-screen smartphones fit in pocket, but tablets don’t
• Prone to forgetting, losing, dropping in sink, etc.
• And useless when battery dies
January 2011
Endless chasing after platform obsolescence
• Explosion of operating systems, hardware, apps, etc.
• Impossible to get all doctors and nurses to carry the same device
3

4. Our piece of the solution
EMR
HIS
PHR
etc.
January 2011
No apps. No keyboards. No screens.
Just pick up any phone and talk.
4
From anywhere at any time.

5. For example
Anything need my attention? Real-time
data exchange
Mary Smith presents headaches
What are her vitals?
Nursing
documentation
BP 140 over 95. Temp 101. RR 22. system
Bedside monitor
Order an MRI of the brain
Radiology
information
Patient had a CT of the brain in
January 2011
system
May. Proceed anyway?
Personal health
Yes records
Insurance records
Patient is allergic to ionic contrast.
Non-ionic requires authorization. Care protocols 5
Proceed anyway?

6. Conversation snippets
Patient follow-up
• MD What patients require my immediate attention?
• VAL 9000 John Doe, 55, stroke patient, room 1413, …
• MD Do you have his latest test results?
• VAL 9000 Yes, except for radiology. Would you like to order an MRI?
• MD No, thanks. Order full blood test and consultation with neurology
• VAL 9000 Would you like me to notify you when the results are available?
• MD Yes please
Order tests
• MD Order an MR of the brain
• VAL 9000 With contrast?
January 2011
• MD Yes
• VAL 9000 Patient appears to be allergic. Non-ionic contrast requires
insurance authorization. Do you want to order contrast anyway?
Review results
• MD When was last blood test and what was abnormal?
• VAL 9000 July 21 8am non-HDL C was 145, normal is 50 to 130 6

7. Conversation snippets
Prescribe meds
• MD Prescribe Zocor 20 milligrams
• VAL 9000 May I substitute with generic simvastatin?
• MD Yes, go ahead
Dictate notes
• MD Dictate note
• VAL 9000 Ready for dictation
• MD Patient presented with severe abdominal pain…
Schedule consults
• MD Order infectious-disease consult
January 2011
• VAL 9000 Done. Want to add notes or instructions?
• MD Yes. Patient presented with abdominal pain…
Collaborate with other doctors, nurses, assistants
• VAL 9000 You have a message from Dr Brown
• MD What is it? 7
• VAL 9000 Hi. I examined patient for a possible infectious disease…

8. Why voice?
No special training:
Users already know how to talk “medical”
Quick, targeted data access:
No click-click-type-click-click-swipe-type-type…
Ubiquitous: Phones everywhere,
January 2011
but keyboards & screens not always available
Multi-tasking: Use while giving care, walking,
driving, operating, etc. 8

9. VAL9000’s key features
Complements existing clinical information systems
• Spoken conversations replace keyboards and displays
• Doesn’t store data: Retrieves from and saves to existing systems
•Knows which systems to read from and write to
• Tasks: Timely & complete charting, submission of care plans, order
entry, e-prescribing, insurance approvals, workflows, alarms, alerts, etc.
Natural to use, quick, accurate, unobtrusive, polite
• Eliminates burden of learning multiple clinical systems: just ask
• Plain English: Speak normally, no training needed
•Understands meaning, intent, jargon, acronyms, abbreviations, etc.
•Handles accents, enunciation, pronunciation, etc.
January 2011
• Anticipates requests and suggests actions
Conveniently ubiquitous and secure
• Just pick up any phone & talk anywhere any time
• 100% voice driven using any phone: Landline, cell, VoIP, SIP 9
• No keyboards, displays, mobile apps
• Server-based intrinsically secure: Like two people having a conversation

10. How is VAL9000 different from Nuance Dragon Solutions
NUANCE’s goal:
Produce text documents
• Action: Dictate instead of typing • One-way speech-
to-text dictation
• Limited to one-way task of • Requires human
dictating text reports proofing for 100%
accuracy
• Doesn’t:
• Handle clinical workflows
• Retrieve data
• Save structured data
January 2011
• Primary metric: Speech-recognition
accuracy ‒ and still needs human
proofing
• Requires software on computer or
mobile + high-quality microphones
10
• Offline (not real-time) tools
to extract some structured
data from text reports

11. How is VAL9000 different from Nuance Dragon Solutions
VAL9000’s goal:
Simplify practice of medicine
• Action: Workflow optimization with • Two-way spoken
conversations:
two-way spoken interactions with find & save
clinical information systems structured data
• Replace keyboards & displays with • Self-proofing
throughout
speech recognition + artificial conversations
intelligence + clinical workflows
SYMPTOM CONSTIPATION
CLINICAL SYSTEMS
• Finds & saves structured clinical SYMPTOM NO DIARRHEA
data: results, notes, orders, etc. ON MEDICATION MONOPRIL 10MG
January 2011
• Automatically assembles text FAMILY HISTORY DIABETES MELLITUS
documents from structured data INTAKE BP 112 70
INTAKE RR 18
• Manages alarms, alerts, follow-ups
• Primary metric: Correctly understand
and respond to user’s intent
• Automatic 11
• No equipment or installable software report creation
needed: Call & talk from any phone only when
needed

12. It’s working at
Four piloted applications since 2006
• Bedside data capture
• Verbal order entry
• Care-coordination and patient rounds phone service
• Assets & personnel tracking via hospital-wide WiFi network
Eight system interfaces
• Radiology, oncology, pathology, lab, pharmacy (HL7, SOAP)
January 2011
• Bedside monitors (Unity Network)
• Nursing documentation system (Essentris, Clinicomp)
• Cisco Wireless Location Manager
12

13. Benefits: Efficient, convenient, immediate turnaround
Productive on-the-go data retrieval and entry
• No paper charts or click-click-type-click-type-type-click-click…
• No paper scribbling or remembering for later:
Immediate entry of care plans, orders, Rx
• Real-time compliance with workflow & care protocols
Collaboration among providers (and patients)
• Communication “through medical record” instead of interruptive
phone calls, voicemail, “phone tag”
January 2011
Less time learning new systems
13

14. ROI: Hard-dollar savings
Gives MD’s and RN’s more time to see patients
Eliminates or reduces data-entry clerks and scribes
Reduces need for multi-system portals, mobile apps
SaaS: No CapX or added infrastructure
Helps comply with meaningful-use requirements
Keeps logs for productivity & efficiency assessment
January 2011
14

15. System architecture
EMR
HIS
RULES
ENGINE PHR
• ASR • HL7
• NLP (CLP) • User profiles • Web services UCS
• TTS • Workflows • Custom
• Telephony • Templates etc.
• Care protocols
• Alerts
CONVERSATION DATA INTERFACE
January 2011
ENGINE ENGINE
• Uses off-the-shelf speech-recognition and speech-synthesis components
• Artificial-intelligence technology incorporated in all engines 15
• HIPAA compliance shared by all engines

16. System interfaces
Interoperates using standard interface protocols
• HL7
• Web services
• Custom
Interoperates with multiple systems
• Automatically routes data to/from data repositories (e.g., EMR, RIS,
HIS, LIS) and real-time devices (e.g., bedside monitors)
January 2011
16

17. Voice user interface
“Free form”, natural conversations
• Users speak as they always do: No retraining required
• Automatically handles accents, enunciation, pronunciation, etc.
• Understands meaning, intent, jargon, acronyms, abbreviations, etc.
• Verbal algebra, unit conversions, clinical calculators, date algebra
Adaptable “verbosity” and hand-holding
• Smart, silent, audio, verbose
Multiple languages
January 2011
• Could understand 4 (EN, ES, FR, DE); speaks 7 (+ CN, IT, JP)
User identification and authentication
• Voice-print, name & PIN, caller ID 17

18. Frictionless implementation
We take care
of the rest
• Rules & profiles
• Data-exchange
Customer selects interfaces When ready, customer
initial application(s) • Telephony interfaces adds applications
• Test and tweak
• Go live
• Analyze, tweak,
optimize
January 2011
18

19. Price
Hosted, in the cloud = No CapX or additional IT infrastructure
Implementation fee + three SaaS options
Per session Per port Per minute
• Cents to • $100 to • 10¢ ‒ 20¢
dollars $1000 per minute
per session per month
January 2011
19

20. MedVox: Consumer version of VAL 9000
Patients
Emergency
Caregivers
room staff
SECURE
ACCESS OF
PERSONAL
HEALTH
RECORDS
January 2011
Emergency
Doctors &
response
nurses
medics
20

21. Three to five years from now
Smarter rules,
More medical
workflows,
applications
templates
Deeper real-time
More intelligent,
integration with
versatile
clinical information
conversations
systems
INTELLIGENT
MEDICAL
January 2011
ASSISTANTS
21

22. About us
• Computer science • Inventor: VAL 9000
(MS UC Berkeley, BS MIT)
• Micro-electronics
• Career launching and growing IT (MS Prague Polytechnic),
startups computer science, neuroscience
(PhDs UCLA)
• Co-founder of highly successful
healthcare IT & telemedicine • Research: clinical information
venture systems, clinical trials, neural
networks, artificial intelligence,
natural language processing
• Founder and CTO of highly
successful provider of EMR portals
on handheld devices
January 2011
Richard Koffler Dr. Val Nenov
CEO CTO
22

23. Conversational interfaces for
clinical information systems
SM
VAL9000, Inc.
Simplifying the practice of medicine
Richard Koffler
January 2011
rk@val9000.com
(310) 807-5786
Dr. Val Nenov
val@val9000.com
23
January 2011