2. Paper is no
longer fit for
purpose
Slide Courtesy of Dr Michael Bainbridge
3. Current Methods for Data Capture
Unstructured
Data
Structured Data
Dictation
and
Transcription
System
generated or
interfaced
data
Direct data entry,
not physician
Direct data entry,
physician
Handwritten
5. ∗Tel the patient story
∗Fill in the data Gaps
∗Unambiguous Sharing of information
The Purpose of the EMR
6. ∗ Conventional Wisdom:
∗ The EMR is the solution
∗ Documents are the problem
∗ Questions:
∗ Are EMRs and documents mutually exclusive or
complementary?
∗ Can eDocuments bridge the gap between
physicians and EMRs?
… and enable Computer-Assisted Coding too?
More EMR planetary wisdom …
and some questions
7. ∗ Why do documents have such a bad rap?
∗ Can’t compute
∗ Can’t automate decision support
∗ Can’t validate conformance to content requirements
∗ And why are documents still prevalent?
∗ Nuanced & precise
∗ Support human decision making
∗ Can be supplemented by multiple coded entries
(optimized for reimbursement, decision support,
quality metrics, research)
∗ Retains current workflow, favored by physicians
∗ Interoperable
Documents and narrative text
9. Supporting the Clinician in the Avalanche of
Increasing Demands
POA/HAC Medical
Necessity
Core
Measures
MU
Patient
Safety
Outcome
Measures
CMI
Severity
of Illness
12. • Meaningful Use
• Quality Reporting
• Decision Support
• Value-Based Purchasing
• Coding/CMI
• POA/HAC
• Medical Necessity
• Coding
• Documentation Integrity
Financial
Integrity
Compliance
Patient
Care
Narrative
In EHR
MT-editing
Feedback
With a
RIS/PACS
In EHR
Self-editing
On the Go
On a PC
At a Dictation
Station
On an
MFP
EHR
13. Key Challenges with Current Process
DISRUPTIVE CDI QUERIES
CDI SPECIALIST“The patient has
respiratory failure”
What is the acuity?
14. Fits Your Workflow
• Interactive clarifications while physician is documenting
“Patient has altered
mental status, abnormal
liver function and
treatment with
lactulose”
Evidence suggests that this
patient has hepatic
encephalopathy. Do you
agree?
“Yes” Hepatic Encephalopathy
Hepatic Encephalopathy
15. Fuel for intelligent clinical applications
DETAILED, ACTIONABLE PATIENT RECORDS
Fine Grained
problem lists
Up to date
allergies
Current
medications
Diabetes, Tumor,
CHF Registry
Automated
Extraction
From dictated notes to
patient care
16. Fuel for intelligent clinical applications
GRANULAR PATIENT DATA FOR CLINICAL DECISIONS
Sepsis
Screening
Cardiac
Monitoring
Venous
Thromboembolism
Stroke
Indicators
From dictated notes to
patient care
17. ∗ As Greg Shorr Said
∗ Patients want the doctor to focus on me not on the
technology
∗ Showing Empathy improves Outcomes
Focus on the Patient
18. ∗ Study done by the Mayo Clinic in 2006 identified the most
important characteristics patients feel a good doctor must
possess
∗ The Ideal clinician is
∗ confident,
∗ empathetic,
∗ humane,
∗ personal,
∗ forthright,
∗ respectful, and
∗ thorough
∗ You won’t get these by focusing on the Technology
Focusing on the Patient
Mayo Clin Proc. 2006;81(3):338-344
19. Nick van Terheyden, MD CMIO, Nuance Communications
AboutMe http://about.me/obiwan
Twitter http://twitter.com/drnic1
LinkedIn http://www.linkedin.com/in/nickvt
Voice of the Doctor http://drvoice.blogspot.com/
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FaceBook http://profile.to/drnick
E-Mail drnick@nuance.com, drnic1@gmail.com
GrandCentral (301) 355-0877
Where You Can Find Me
