'When only the right technology will do'

healthcare, Nuance
"We need to be providing doctors and nurses with the technology and tools to put their focus back on their patients "

(HealthTech Wire / Interview) - Speech recognition is becoming for some an important part of our everyday lives, but all technology is not the same and in healthcare we need precision and efficiency from the get-go that’s just not possible with consumer products like Siri or Cortana.

Dr Markus Vogel, Chief Medical Information Officer EMEA for global speech recognition leader Nuance International’s Healthcare division, is concerned at how far behind too many healthcare organisations are when it comes to enable clinicians by easy means to speed up documenting their cases – and simultaneously improving patient care delivery. (Webinar Jan 27)

Dr Vogel, can you outline what you see as the main challenges of clinical documentation for today’s doctors?

Quality clinical documentation supports quality care. Capturing the information while you care for the patient has always struck me as the best way to achieve a complete and accurate patient care record. However, as we move from hand written notes to the vision of a fully digitised paperless health system with all the details of patient care captured in the EMR and other clinical documentation we’re not making it as easy as we should be for doctors, nurses and other healthcare professionals. We, the industry, the law makers, care giver organisations and healthcare professionals, need to start working together better to overcome the challenge presented by the capture of the patient story and journey into the EMR.

But what evidence do you have of the challenges of clinical documentation faced by doctors and nurses?

The accuracy and completeness of clinical documentation would seem to be essential ingredients for the achievement of integrated, effective, efficient and safe delivery of care but until recently there was very little quantitative or qualitative evidence beyond individual experience. To overcome this, Nuance healthcare has undertaken original research in Germany and the UK to understand how the quality of clinical documentation throughout the care pathway impacts on patients, clinicians and care giver organisations. Also, during 2015 I personally led a field study measuring the challenges of clinical documentation at Düsseldorf University Hospital.

Tell us a little more about your study at Düsseldorf University Hospital?

The goal was to achieve a factual and impartial measure of the speed and effectiveness of speech recognition at the point of care in a live working environment. To achieve this, the research was set up as randomised controlled trial over a period of three months within the confines of day to day work at a busy hospital. Doctors were randomly presented with either typing or speech-to-text into the clinical documentation. The results of the study revealed that with the help of speech recognition technology, there was an overall increase in speed of information capture of 26%. This included time for editing and word corrections. Even more significant, and something I did not foresee was an 80% increase in the volume and level of detail in the documentation. In other words, every physician participating in this study was documenting more detail and more quickly by utilising speech recognition. Clearly, speech recognition used to capture information into the EMR helps to improve the speed, volume, detail and completeness of the clinical documentation.

What is your conclusion and recommendation about Speech Recognition technology being able support the transition to a “paperless” digital healthcare system?

What emerges from the peer reviewed research at Düsseldorf University Hospital and our Clinical Documentation studies in both Germany and the UK fits the same picture. Up to 50% of a range of healthcare professionals’ time is taken up by creating, reviewing and updating clinical documentation. Speaking for myself, as a medical doctor, this is far too much. We need to be providing doctors and nurses with the technology and tools to put their focus back on their patients whilst at the same time enabling them to quickly and accurately capture the facts and the story of the patients in their care. We need to look at ways of lifting the burden and drudgery of capturing and updating the EMR and clinical documentation. We’ve also seen from our research that inaccurate and incomplete clinical documentation has a cost impact in an already over-stretched health system. It reveals that the time-value of a doctor searching and checking for information not captured in the EMR equates to £20,000 per year for a UK doctor and up to €30,000 in Germany. The research at Düsseldorf University Hospital provides evidence that one way in which these costs might be reduced is through using voice data entry and speech-to-text conversion directly into the EMR. It’s much quicker than typing and removes the delay of voice-tape dictations or handwritten note transcriptions. It is an obvious way of speeding up both the capture of information and navigating around the EMR and notes are more complete.  

What’s interesting about what you’re saying is that the same doctors and nurses probably use consumer speech recognition applications in their daily lives on their own mobile and other devices. Why not use these in healthcare environments?

In healthcare we need to use the best tools for the job and there are a couple of good reasons why popular consumer applications such as Apple’s Sire, Microsoft’s Cortana and GoogleNow are not appropriate. Firstly, consumer applications exist in a hosted cloud held outside the hospital environment. There is no way to track or control the flow of information and this could present security and patient data protection challenges. Secondly, a general purpose consumer speech recognition solution does not contain recognised medical vocabularies or medical ontologies that understand how clinicians speak nor the specialist, complex environments they work in. Without this you just don’t achieve the most accurate and efficient way to document patient care in situations ranging from a loud emergency department packed with patients following an incident or sitting shoulder-to-shoulder with a patient capturing their clinical notes during a clinic visit.

So how would you summarise your main message?

Doctors and nurses are under pressure. They need to work more effectively and efficiently which is why we design technology specifically for them with end-to-end security, to support them as they care for their patients —whether in a hospital, clinic, or office environment, or roaming between care areas. We combine our deep knowledge of consumer speech trends and preferences with the many benefits of clinical speech recognition technology to enable, rather than hinder, them as they transition to a digital healthcare environment.

Dr Markus Vogel and other medical and technology experts are going to debate many of the issue raised in the free Industry Solutions Webinar on 27 January 2016: 'Capturing the patient story in the EPR in the era of Siri, Cortana & Co.'

For more details and registration please go here.


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Nuance Communications Inc.

Nuance’s Healthcare Business provides a comprehensive family of speech-driven clinical documentation and communication solutions that enable healthcare provider organizations to reduce operating costs, increase reimbursement, and enhance patient care and safety.

No matter the specific requirements of a healthcare provider organization, Nuance has solutions to meet its needs.