Speech-Driven Documentation and Communication Strategies for Closed-loop Radiology Workflow

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1 Speech-Driven Documentation and Communication Strategies for Closed-loop Radiology Workflow Providing Appropriate Order Guidance, Radiology Reporting, Critical Communication and Data Analysis

2 With over 1 billion radiology exams performed each year in North America, diagnostic imaging has nudged out pharmaceuticals as the fastest growing component of medical costs. William M. Salganik Boom in medical scans presses health payers. The Baltimore Sun May, 2007

3 As a radiologist, harnessing advanced technology to provide superior patient care is what you do. MRI. CT. PACS. RIS. You use them all. You have the latest, most innovative technology to help you identify the faintest anomaly in a matter of minutes. Yet, your work relies heavily on the appropriateness of the diagnostic order, how quickly reports are dictated and delivered to the ordering clinicians, the communication of critical patient results and analytical review of outcomes. You have millions of dollars worth of imaging systems at your command and almost no control over the order-to-results delivery cycle. Until now. What Radiology Chiefs Want You want your ordering clinicians to order the most diagnostically appropriate imaging studies. You want your radiologists to dictate and sign reports at the time they review diagnostic images. You want your reports delivered at the same time as the images not arriving hours or days later. You want to be able to collect quality improvement data and meet industry guidelines. You want to be able to communicate critical test results in a verified, compliant, and efficient manner. You want to better understand the data that your department generates. What Radiology Chiefs Need You need your ordering clinicians to utilize diagnostic imaging appropriately. You need to give your radiologists total control over dictation, review and signing of reports. But you can t turn them into typists. You need a system that lets them complete diagnostic reports fast and that is fully integrated with your RIS and PACS, even in a multi-site environment. You need to offer radiologists the freedom to choose between speech recognition and speech-assisted transcription all in one system. You need to provide your radiologists with critical communication tools that are integrated directly into the reporting process. You need data visualization tools that allow you to make more educated business decisions. You need a closed-loop radiology solution that s battle-tested by thousands of ordering clinicians and radiologists at teaching hospitals, medical centers, and imaging facilities. solutions for healthcare 3

4 Clinically appropriate image order guidance Speech-driven reporting and communication Utilization management and outcomes analysis Managing the Order-to-Results Delivery Cycle The practice of radiology is wrestling with optimizing use, spiraling costs, decreasing reimbursements, and its expanded role in improving patient outcomes. To address these challenges, radiology practices must make more effective use of clinical data available today. Improving services to the referring physician, while improving patient safety, allows a radiology practice to set itself apart. Closing the Loop on Radiology Workflow Nuance Healthcare offers an innovative new strategy for managing radiology as a single, end-to-end or closed-loop process. This approach gives radiologists and administrators a continuous view of the order from diagnosis through results process, which allows for analysis that can drive improvements at each stage. The benefits of closed-loop radiology are evident: saving time, money, and resources, improving patient safety and care, and better clinical documentation. Nuance Healthcare offers the broadest portfolio of imaging documentation and communication software, including RadPort, PowerScribe, RadWhere, Veriphy, and RadCube. RadPort Appropriate high-tech imaging utilization and pre-certification through decision support Decision Support & Pre-Certif ication Speech Repor ting RadCube Improved decisionmaking through clinical data mining and outcomes analysis Data Mining and Analysis Critical Clinical Communication 4 solutions for healthcare

5 Manage costs more effectively Improve turnaround time Enhance patient safety Improving the Appropriateness of High-Tech Diagnostic Image Ordering Studies have shown a significant percentage of radiology spending may be unwarranted. A renewed focus on utilization has increased administrative overhead for referring physicians and radiologists alike. RadPort provides clinical decision support for high-tech diagnostic imaging, which means that each and every order entering your department meets clinical care and reimbursement guidelines. RadPort also eliminates the need to spend time with radiology benefit management (RBM) companies to obtain prior authorization. Reducing Turnaround Time and Transcription Costs Using PowerScribe, radiologists can dictate, review and sign reports while the images are still on the screen, significantly cutting reporting time. PowerScribe s unique combination of free-text dictation, PowerNormals which allow the radiologist to dictate a report with a single command and structured templates turn radiologists into expert dictators. PowerScribe Workflow optimization through speech-driven reporting RadWhere Multi-site reporting through speech-driven workflow Veriphy Reliable delivery, management and auditing of urgent patient findings through critical test result management What s more, Nuance offers the RadWhere speech reporting platform for facilities with unique multi-site workflows. Customers consider PowerScribe and RadWhere to be cost-effective investments with payback in 6 months or less.* Communicating Critical Test Results In 2006, nearly two-thirds of all hospitals surveyed by the Joint Commission failed to meet National Patient Safety Goal #2 requirements: Improve the effectiveness of communication among caregivers. These hospitals would have met the requirements had they used Veriphy for critical test result management (CTRM), the preferred solution for Radiology, Pathology, Cardiology and Clinical Labs. Veriphy is available seamlessly integrated with PowerScribe and RadWhere. Improved Service and Market Competitiveness RadCube s analytic capabilities improve the competitiveness of your practice, and strengthen relationships with referring physicians. With RadCube, you can analyze years of departmental data for productivity, quality assurance, utilization management, throughput analysis, and trending and forecasting. * Individual results may vary. solutions for healthcare 5

6 Our broad range of clinical documentation and communication solutions streamline processes and reduce costs, replacing systems like traditional transcription, handwriting or typing with advanced speech recognition technologies and customized workflows to deliver significant results for your healthcare enterprise. Transcription Platforms with EHR Integration use background speech recognition to address the need for cost-saving enterprise-wide dictation and to streamline transcription processes without impacting clinician workflow. escription or Enterprise Speech System Real-Time Speech Recognition in the EHR and voice navigation for the EHR are for organizations looking to accelerate clinician adoption and productivity when compared to typing, keyboard and mouse navigation within their EHR. Leading EHR application* 6 solutions for healthcare

7 provide a complete end-to-end, closed-loop process for the ordering clinician, the radiologist and decision-support analysts covering appropriate exam ordering, pre-certification, reporting, communication, data mining and outcomes anaysis. Critical Test Result Management ensures that time- and care-critical imaging and laboratory test results get to the right clinicians using the right delivery approach, and meet compliance standards and patient safety guidelines. solutions for healthcare 7

8 Reduce ordering time Satisfy pre-certification requirements Manage high-tech utilization RadPort Appropriate High-Tech Imaging Utilization and Pre-Certification Through Decision Support The appropriate ordering of high-tech diagnostic imaging studies is a critical part of good medicine and efficiently running your department. RadPort is a secure, web-based application for appropriate diagnostic image order placement that satisfies pre-certification requirements. With American College of Radiology (ACR) Appropriateness Criteria as its foundation, RadPort s scoring methodology is continuously reviewed and enhanced to ensure clinical appropriateness. radport: Reduces ordering time up to 80% by eliminating radiology benefits management (RBM) phone calls and satisfies pre-certification requirements Eliminates unnecessary orders and educates referring physicians Manages high-tech utilization and improves patient care Major healthcare payors are accepting the decision support provided by RadPort as a form of pre-certification. RadPort in Action: Massachusetts General Hospital Since 2004, Massachusetts General Hospital (MGH), a member of Partners Healthcare, has been working to address the issue of unnecessary high-tech imaging. MGH developed a set of rules with the ACR Appropriateness Criteria as a foundation. The rules are regularly updated to reflect changes in imaging techniques, research developments, quantitative analysis of patient data and qualitative feedback from referring physicians. The ordering physician enters the patient s information and selects the desired exam. The RadPort system gives the desired exam a utility score that rates the appropriateness of the order. The physician can verify the appropriateness of the exam, receive recommendations from the system for a more appropriate exam and make the final decision as to which exam is ordered. This process provides accuracy, convenience and guidance to the ordering physician while ensuring business efficiency. 8 solutions for healthcare

9 No more interruptions No change in workflow or behavior RIS/PACS/3D PowerScribe The Leader in Speech Reporting PowerScribe is the most popular web-based speech recognition reporting solution, which radiologists use to complete and communicate their reports in a matter of minutes. One in every three radiologists in the United States is a PowerScribe user. You can use PowerScribe s speech recognition to dictate and self-edit interpretations, or have dictation completed by a medical transcription editor, who makes changes to a speech-assisted draft the choice is yours. powerscribe: Reduces report turnaround time and associated transcription costs Improves overall radiologist productivity Provides integrated critical test results communication Delivers payback in 6 months or less* Through its PACS/RIS Extension Partner (PREP) Program, Nuance Healthcare has integrated PowerScribe with more than 50 RIS and PACS vendors, including leaders such as GE Healthcare, MediTech, FujiFilm Medical Systems, Cerner, Siemens, CareStream (Kodak), McKesson, and Agfa. PowerScribe FlexChoice: dictate the way you want, keep your current workflow and pay less for the reports you generate! Nuance healthcare offers PowerScribe FlexChoice, the world s leading radiology speech reporting solution, offered in a program where radiologists don t have to self-edit or change their workflow. With PowerScribe FlexChoice, your radiology department or imaging practice pays only for the reports you generate and there s absolutely no capital outlay required. You can choose in-house or outsourced medical transcriptionists (MTs) or the Nuance Healthcare Managed Speech Solution, which provides both editing services and complete labor management. Best of all, PowerScribe FlexChoice ensures you remain competitive with the latest technology so you can prepare for the future. PowerScribe in Action: University of Virginia University of Virginia Health Sciences Center, Charlottesville, VA, has eagerly adopted Nuance Healthcare s PowerScribe. Not only is every one of UVA s 100 radiologists using PowerScribe, each is self-editing his/her reports as well. A staggering 380,000 radiology reports are completed annually with PowerScribe, and average report turnaround time for these exams has decreased from weeks in some cases to well under 24 hours. According to physicians, quality of patient care at UVA has improved through the documentation enhancements attained with PowerScribe, which has been integrated with UVA s Kodak PACS system. * Individual results may vary. PowerScribe offered much better integration with our PACS and RIS systems, was fully web-based, and had a proven track record of successes in usability, and proven cost savings. Overnight, actually, we went live with PowerScribe, so it was a very effortless procedure. We were blown away by how well it was integrated with everything else. Rasu Shrestha, MD Informatics Director Keck School of Medicine University of Southern California Medical Center Los Angeles CA solutions for healthcare 9

10 Enhance patient safety Automate critical results Comply with industry standards and quality guidelines radwhere: RadWhere is a data-driven, front-end structured speech reporting solution with the added benefit of multi-site workflow management. Departments that interpret cases from multiple sites and use more than one RIS or PACS will find comfort in a single manageable worklist for all studies. RadWhere routes the cases so your radiologists can focus on their primary job interpretation. RadWhere offers advanced multi-site worklist capabilities and report routing. It reduces turnaround time and increases competitiveness, while providing integrated critical test results communication. Veriphy Reliable Delivery, Management and Auditing of Urgent Patient Findings Through Critical Test Result Management You have a 100% likelihood of getting the right test results to the right person. Some days it [Veriphy] probably lops an hour off the radiologists time. It s not just allowing us to read more, but allowing us to read more efficiently. We can get the images and the reporting done in under an hour. Himanshu Shah, MD Medical Director, Radiology Department Wishard Memorial Hospital Indianapolis IN Veriphy is the industry-leading solution for critical test management (CTM) and critical test result management (CTRM), which automates the delivery, verification of receipt, and documentation of voice communications concerning critical test results (CTRs). For laboratories, Veriphy even automates read-backs by the nurse or other caregivers. veriphy: Ensures compliance with Joint Commission, ACR, CAP and HIPAA Enhances patient safety by verifying the receipt of critical test results Ensures consistency within the hospital and across the healthcare system with multi-site IDN support Veriphy in Action: Memorial Hermann Southeast Hospital An unannounced accreditation survey by a team from the Joint Commission is never a walk in the park, but thanks to Veriphy, Memorial Hermann Southeast Hospital in Houston (MHSE) knows it has one less thing to worry about. In the B.V. (Before Veriphy) era, those or so significant and emergent monthly test results were a frequent source of worry to the physicians and to administrators such as Cynde Chatelain, imaging manager for the hospital. They knew it was their Achilles heel. To fix the problem, the hospital started using Veriphy for critical test result management (CTRM) in July Now, she said, there is no finger pointing and no doubt about whether and when a result was communicated, because all the radiologists use the Veriphy system. After he (Joint Commission surveyor) saw how we were using Veriphy for CTRM, he was very impressed, Chatelain said. He said this was a best practice. He said we were doing a great job, and were ahead of the pack. 10 solutions for healthcare

11 Reduce external IT costs Enhance service quality Analyze business operations Veriphy offers reporting clinicians one-call-does-it-all simplicity and also assurance that a CTR has been retrieved by the responsible ordering clinician. A reporting clinician creates a message via phone or computer, and Veriphy does the rest: alerts the ordering clinician of a pending CTR, indicates the urgency of the CTR sends alerts until the message is retrieved; escalates the notification according to pre-set rules; sends a verification to the reporting clinician when the message has been retrieved all while documenting the entire process to meet audit requirements. Veriphy also provides hospital administrators with tools for realtime performance measurement so they can measure progress of reducing CTR turnaround time (TAT) and assess compliance. RadCube Improved Decision Making Through Clinical Data Mining and Outcomes Analysis RadCube is a comprehensive, yet flexible, data warehouse for multidimensional business analysis and visualization. RadCube allows your department to operate in a data-driven fashion from modality utilization to clinician ordering patterns, through radiologist reporting statistics and outcomes analysis. Maximize your available data and provide a superior level of customer service. radcube: Allows you to analyze years of clinical records to help you make better medical and business decisions Reduces IT and administrative expenses and manages costs more effectively Enhances service quality and customer satisfaction With RadCube, you can analyze the operational aspects of your business, including business productivity, quality assurance, utilization management, throughput analysis, trending and forecasting. Our early experience with RadCube has demonstrated that it is an effective and user-friendly tool that can quickly derive valuable performance metrics and business indicators. The combination of graphical presentation of data along with raw numbers provides the ideal means to instantly understand trends and calculate forecasts. This is a tool that practice leadership can use directly, on a daily basis, and will diminish the need for contract services. Dr. David Mendelson Medical Director, Radiology Informatics Mount Sinai Medical Center New York NY solutions for healthcare 11

12 Clinically appropriate image order guidance Speech-driven reporting and communication Utilization management and outcomes analysis Nuance Healthcare Your Ideal Partner Let us help you achieve your vision of speech-driven clinical documentation and communication for your radiology department, imaging center or practice. Best-in-Class Service We re here to support you. Our customer team supports more than 1,300 hospital-based radiology departments and freestanding diagnostic imaging centers. So no matter your size or your setting, we re responsive to your needs. That s why we ve built a world-class service organization to support our customers even before they ve purchased a solution. We develop a solution which fits your organization s needs, integrate it into your IT infrastructure, and support it for the life of ownership. Nuance Healthcare solutions are mission-critical relied on by busy clinicians who expect the highest levels of performance and reliability. Our experience truly speaks for itself. Nuance is now in an excellent position to offer a comprehensive layer of front end ordering interface enhancements and urgent communication within a unified interface. The integrated strength of the product is greatly improved by Nuance s commitment to enhancing the user experience and supporting good patient outcomes with better IT support. Well done. Edward J. Zaragoza, MD Radiology Clinical Director Santa Monica UCLA Medical Center Santa Monica CA 12 solutions for healthcare

13 Manage costs more efficiently Improve turnaround time Enhance patient safety The Proven Leader When you partner with Nuance Healthcare Solutions, you know you re working with the proven leader in speech-driven clinical documentation and communication solutions, backed by the expertise to ensure your success. Widespread Market Acceptance Over 450,000 clinicians in over 10,000 facilities worldwide use Nuance Healthcare solutions More than 75% of the top 21 U.S. hospitals 1 More than 80% of the top U.S. hospitals 2 More than 80% of the most technologically advanced hospitals 3 More clinicians use Nuance Healthcare solutions to create electronic patient records than all EHR systems combined More than 1,100 radiology departments and imaging centers have selected PowerScribe Unparalleled Cost and Productivity Improvements PowerScribe reduces transcription costs by up to 85% escription improves MTE productivity by up to 100% Dragon Medical 10 makes clinicians up to 25% more efficient compared to using a non-voice-enabled EMR Unmatched Investment in Best-in-Class Solutions $100 million annual investment in R&D 650+ speech-related patents most in the industry 500 speech scientists 600+ services professionals It is critical that we have one complete solution that quickly and reliably delivers core radiology reporting, critical results management and diagnostic support technologies. Our radiological staff needs the control, consistency and flexibility to rapidly complete a report anytime and anywhere. Michael Matthews Dir. of Clinical Information Systems, Department of Diagnostic Radiology Yale-New Haven Hospital New Haven CT 1 America s Top Hospitals, 2009, U.S. News and World Report 2 America s Top Hospitals, 2009, U.S. News and World Report Most Wired Hospitals and Health Systems, Hospitals and Health Networks solutions for healthcare 13

14 Turnaround time in minutes RIS/PACS/3D Improved physician service Nuance Healthcare Solutions Nuance: 2009 Corporate Snapshot FY 2009 Revenues: $1.01 billion Stock symbol: NUAN (NASDAQ) Market capitalization: $3.5 billion* Employees: 3,500 Speech patents: 650+ Speech scientists: 500 Professional services: 600+ *As of September, Nuance Communications is the leading provider of technologies, applications and services that transform the way people create, share and use information. Every day, millions of users experience Nuance when calling directory assistance, looking up account information, dictating patient records, or directing a GPS system. Nuance mobile speech solutions are used in over 2 billion phones, cars and navigation systems. Nuance spends nearly 10% of revenue each year on research and development to maintain its position at the forefront of advanced speech technologies and applications. Making each of those experiences productive and compelling is Nuance s business. Dictaphone Enterprise Speech System On-site dictation/ transcription platform with background and front-end speech recognition with full controls and advanced workflow flexibility. Dragon Medical A real-time speech recognition program that works with virtually any Windows -based or Citrix EHR system for efficient report completion, and easy navigation and adoption of the EHR. escription On-demand platform for computer aided medical transcription, using background speech recognition to turn clinician dictation into formatted draft documents that medical transcriptionists whether in-house or outsourced can quickly review and edit, typically doubling productivity. Focus Infomatics A medical transcription service organization with extensive speech editing experience, offering both on-shore and follow-the-sun models. Nuance Healthcare Managed Speech Solution A full-service, outsourced solution for clinical documentation, including technology and all speech editing and transcription workflow management. PowerScribe A speech recognition solution that can help radiology departments significantly reduce report turnaround time and lower transcription costs by as much as 75%-100% a year. RadCube A comprehensive, yet flexible, data warehouse for multidimensional business analysis and visualization. RadPort A secure, web-based decision support application that ensures appropriate high-tech diagnostic image ordering. RadWhere A data-driven, front-end radiology speech recognition reporting application designed for multi-site workflow orchestration. Veriphy A critical test result management solution that enhances patient care, increases physician productivity, improves risk management and automates compliance. To learn more about how Nuance Healthcare can partner with you to improve financial performance, support radiologists and help raise the quality of care, contact us at or Nuance Communications, Inc. All rights reserved. Nuance, the Nuance logo, Dictaphone, Dragon, escription, PowerScribe, RadCube, RadPort, RadWhere and Veriphy are trademarks and/or registered trademarks of Nuance Communications, Inc., and/ or its subsidiaries in the United States and/or other countries. All other trademarks are properties of their respective owners. 14 solutions for healthcare

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16 L /09 DTM The experience speaks for itself NUANCE COMMUNICATIONS, INC. ONE Wayside Road Burlington, MA

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