Speech Understanding – The Key To Unlocking Clinical Knowledge Delivering Safer, Cost Effective...
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Speech Understanding Unlocking the Clinical Information in Health Documents Nick van Terheyden, MD Chief Medical Officer, M*Modal
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Presentation to AHRA Annual conference in Las Vegas 2009
Transcript of Speech Understanding – The Key To Unlocking Clinical Knowledge Delivering Safer, Cost Effective...
Speech UnderstandingUnlocking the Clinical
Information in Health Documents
Nick van Terheyden, MDChief Medical Officer, M*Modal
Background
The Current Situation
Problems Facing Clinicians
According to an American College of Physician Executives survey, 6 in 10 physicians have considered leaving the profession due to:– burnout– 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
Electronic Health Record UniverseCritical 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.
The Current Situation – Structured
• Tedious manual process• Time-consuming• Documentation lacks expressiveness of
natural language• Lack of Flexibility• Poor user interface• Cost
– 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.
“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
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• Interoperable• Under utilized source of data for EMR Dictation:
Fast and easy, expressive.
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
The Current Situation
Unstructured Data
Structured Data
Dictation and
Transcription
System generated or
interfaced data
Dire
ct data
en
try,
not p
hysicia
n
Handwritten
Dire
ct data
en
try,
ph
ysicia
n
• 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
Dictation and
Transcription
Unlocking Clinical Knowledge
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
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
Cost ComparisonsTranscribed Note
Time Physician Cost 1
/minTranscription Cost 2
/min
Total Cost
Dictate Note 1 min $2.70 $2.70
Transcribe and edit note
4 min $0.40 $1.60
Total 5 min $4.30
Structured Data Entry
Time Physician Cost 1
/minTranscription Cost 2
/min
Total Cost
Data Entry 5 min $2.70 $13.50
1 MGMA Dashboard, $340,000 collections for IM professional charges
2 Outsourced transcription at 16 cents per 65-character lineSource: 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
Speech Understanding
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– Corrections– Instructions to transcriber– Different dictation habits
“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.
Conversational Documentation• … transformation of dictation directly into
structured clinical documents while encoding data depending on the care givers and organizations needs
EHR
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
Speech Understanding in Action
Dictation Recording
Clinical Context
SpeechUnderstanding
Editing &ImplicitValidation
Publishing &Querying
Document Model incl.Concepts,Extractors
Feedback: corrected structured and encoded draft documents and medical facts
Technical ViewDocument Model incl.Meds, Allergies…
SpeechUnderstanding
One Voice – Many Outputs™
How it works
The Healthstory Project and CDA
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
Health Story Document Types
Implementation GuidesCompleted• History & Physical • Consultation• Operative Report• DICOM Imaging Reports
Upcoming• Discharge Summary w/IHE• Billing and Reimbursement Requirements • Progress Notes• .PDF work with Adobe
Conclusions
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…
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 - allowing
clinical 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
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
Getting Involved
• Join the Health Story Project – www.healthstory.com
• Participate in HL7 Structured Document work group
• Participate in HL7 ballots• Encourage implementation
– EHR vendor adoption– provider preference– transcription RFPs
Q&A
See the solution at work at:GE Booth 823
M*Modal: 216/7
Nick van Terheyden, MD, CMO, M*Modal
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Where You Can Find Me
M*Modal Speech Understanding:
Nick van Terheyden, MDChief Medical OfficerM*Modal
