Nuance Healthcare Overview. Keith Belton, Senior Director, Solutions Marketing, Clinical Documentation

Transcription

1 Nuance Healthcare Overview 1 Keith Belton, Senior Director, Solutions Marketing, Clinical Documentation

2 About Nuance Healthcare Offer speech-driven clinical documentation and communication solutions which save clinician time and accelerate EHR adoption Improve quality of patient documentation enhance patient care and safety Improve revenue cycle effectiveness. Used by 3,000 hospitals and 450,000 physicians 180,000+ physicians using Dragon Medical (~20% of MDs) 100,000+ physicians use escription speech assisted Tx Provide professional services which optimize the clinician documentation process.

3 Solutions that Bridge to EHR Adoption Transcription Cost & Turnaround Time Traditional Transcription Service 2009 EHR Study 3,500+ Respondents 93% 67% 97% EHR does not reduce time spent documenting care Reliance on keyboard and mouse within an EHR is a major hurdle Narrative is more valuable to treating patients 96% May lose the patient s unique story with transition to point-andclick EHRs Point and Click EHR Systems EHR Adoption & Meaningful Use

4 Solutions Which Help Clinicians Smoothly Adopt EHRs Supporting your mix of physicians workflow preferences Transcription Cost & Turnaround Time Point & Click Background Speech Front-end Speech Point & Click Background Speech Front-end Speech Background Speech Point & Click EHR Adoption & Meaningful Use 2011 Nuance Communications 4

5 Nuance Medical Intelligence Solutions Speech-enabled clinical documentation Dragon Medical; Real-Time Speech Recognition escription & Dictaphone Enterprise Speech System; Computer assisted medical transcription PowerScribe 360; Speech recognition for closed-loop radiology workflow Decision support and analytics solutions Veriphy; Critical test result management RadPort; Radiology clinical decision support RadCube; Data warehouse for multi-dimensional business analysis Expert services and support Nuance Transcription services; Fully outsourced transcription solution Implementation & Technical support 2011 Nuance Communications 5

6 Driving Change Through Value Creation with Illinois Masonic Medical Center Nuance Dragon Medical Speech to Text Recognition Technology Adem Arslani BSN, MS Director of Information Systems & Clinical Informatics

7 AIMMC Overview A 408-licensed bed teaching hospital serving Chicago s North and Northwest Sides More than 880 active physicians on staff representing 43 medical specialties More than 2,400 associates (employees), making us Lake View s largest employer Trains 300 residents and 500 medical students each year One of only four Level I Trauma Centers in Chicago, treating more than 1,100 trauma patients a year Level III Neonatal Intensive Care Unit (NICU), the highest designation awarded by the state 7

8 Application Environment Inpatient Cerner RHO Outpatient Allscripts E-Clinical Works Mosaiq Medical Oncology I-Connect Independent Physicians 8

9 Electronic Documentation ü DIAGNOSIS AND PROBLEM LIST ü ORDERS ü MEDICATION RECONCILIATION ü NOTES: Progress Notes, H&P, D/C Summary, Consults, Post Op 9

10 Paper Documentation ü CONSENTS ü CODE DOCUMENTATION ü EKG, FETAL MONITOR STRIPS ü NURSING PLANS OF CARE ü ANESTHESIA INRAOP NOTES ü SPECIALIZED ASSESSMENTS 10

11 Why Speech Recognition? Recent Joint Commission findings related to illegible physician documentation Hybrid State (paper records) is unsafe Meaningful Use requirements Instant EMR adoption physician by overcoming human factors (for all those MD s who do not want to type into PowerNotes) which in turn improves patient care 11

12 Creating Value As Paul Strassman remarks in his book, The Squandered Computer, The principle purpose of investing in IT is not overhead cost reduction but value creation. Cutting costs can contribute to profitability, but in the long run one does not prosper through shrinkage. The objective of all investments is to improve overall organizational performance. 12

13 AIMMC Return on Investment Improve patient care Lower operating costs Provide physicians on staff with the tool THEY WANT TO USE TO HELP CARE CONNECTION WORK FOR THEM! This will differentiate Advocate from other hospitals Save physician time and money more productivity Provide easy to use technology PHYSICIAN ROI 13

14 Improving Patient Care 14 Speech-recognition technology Improves EMR adoption amongst physicians A study by health care research firm KLAS found that 76 percent of clinicians who use speech recognition to control an EMR system report faster medical report turnaround time, better service to patients and reduced costs. Improves accuracy of the reports through greater legibility and offers more complete reports through accuracy, point-of-contact reporting, and prompting by technology Provides quick access to patient data throughout the hospital which, in turn, should have a positive impact on patient care

15 Dragon Rollout Timeline Jan-March An IMMC pilot was completed for 7 hospitalists to demonstrate proof of concept Local PC install March Department of Surgery agreement for 200 providers WebDAV (Web-based Distributed Authoring and Versioning) June 2010 AIMMC site agreement covering all Associates January 2011 Network Edition & PowerPack 1 June 2011 Go Live EMR Physician Mandate vsync 15

16 Rollout Summary Dragon software is functional out of the box but the application needs to be integrated into Care Connection by customizing the PowerMic commands and developing verbal instruction cues called workflows 16

17 Department of Surgery The Department of Surgery installation for Dragon limited site software, 200 PowerMics, system design and training. IMMC is already begun to roll out Cerner Power Notes for MD documentation but without Dragon, physician resistance and dissatisfaction will occur. This is based on the positive results learned from the pilot and direct comments from medical staff leaders pleading for Dragon. Connecting the Dragon and PowerNote roll outs is a win-win approach. Waiting could be a disaster?? That is why IMMC chose to fund the first phase. 17

18 Department of Surgery In order to reduce the initial cost commitment, the first phase focused only on the Department of Surgery The concern is that this creates haves and have nots and limits the ability to leverage the full capabilities of Dragon. While this is underway, alterative funding from the Medical Staff, restricted funds, grant applications and other budget sources were pursued. However, if we go no further with Dragon, there is potential to slow the adoption of PowerNotes!! 18

19 Full Site License Approach Key benefits The Site License software will be installed on a server that will allow us to make it accessible to physicians from anywhere making it more conducive to their workflow. This will favorably effect IS service, support, and maintenance. The site agreement and 600 additional PowerMics will accommodate growth as the number of providers and other associates grow. Under this model any provider or associate can use the software, and any new incoming MD, medical student or other associate can use the technology. Because Care Connection EMR entry will become a requirement the entire medical staff will expect this enabling technology. 19

20 Full Site License Approach Key benefits Physicians are already buying this software for their own offices and in their IMMC departments this is unmanaged and has limited benefits at higher costs. System design and training are contracted to obtain experts with both Dragon and Cerner knowledge. Consolidate PowerNote and Dragon training The Full Site agreement will also allow us to improve provider to provider communication related to patient handoffs because the PowerMics can be used with other technologies and disciplines improving overall organizational performance. An effective physician recruitment tool 20

21 June 1 st Physician EMR Mandate Sidney Feldman, MD Internal Medicine "I completed a History & Physical and a Progress Note using Dragon. It gets easier. If I can use Dragon, then anyone can." 21

22 Change Management Principles Strong executive leadership Representation of all stakeholder groups from project planning through implementation Establishment of executive ownership and accountability Recruitment of champions Clear communication of project goals as they relate to organizational goals Realistic timeline for project implementation 22

23 Realizing Value in Dragon Investment Value of investment goes beyond ROI Evaluation framework Identification of Project Benefits and Metrics Determination of Baseline Measurements Calculation of a Benefits Opportunity Analysis Calculation of a Post-Implementation Benefits Analysis 23

24 AIMMC 2009 Outsourced Transcription Costs Savings potential will need further investigation JANUARY DECEMBER 2009 CONSULTATIONS $ 11,206 OPERATIVE REPORTS $ 68,061 DISCHARGE SUMMARIES $ 120,599 HISTORY AND PHYSICALS $ 117,048 TOTAL $ 318,311 *6 INTERNAL TRANSCRIPTIONISTS FTE S $ 375,000 TOTAL 24 $ 693,311

25 $45, $40, $35, $30, Monthly Cost To Transcribe Dictated Reports: July 2010 thru May 2011 $25, $20, $15, $10, Outsourced Transcription (QED) Inhouse Transcription (HIM Associates) Total Transcription Expense $5, $- 25

26 Number of Dictated Reports Using Transcription Services: July 2010 thru May History and Physicals Consultations Operative Reports Discharge Summaries TOTAL REPORTS 0 26

27 Turnaround Time from Dictation to EMR: Transcription Services History and Physicals Consultations Operative Reports Discharge Summaries

28 Comparison between Transcription and Dragon Time lag between dictation and validated entry into chart 28

29 Time from Dictation to chart (Average time varies for different types of reports) 29

30 $ savings from use of Dragon over time Considerations Transcription types Operative reports, Admitting Hx & Pxs, Consultations, Discharge summaries Internal costs Support staff, paper shuffling, etc. Changing patterns of workflows Ease of use of technology, speed of results, recognition of benefits, etc. 30

31 31 Paper Notes

32 Turnaround Time Dictation & Transcription Services 32

33 Dictation & Transcription Services Turnaround Time 33

34 Turnaround Time PowerNotes & Dragon 34

35 35 PowerNotes & Dragon

36 Dragon Survey 36

37 Dragon Readiness Optimizing the user experience 37

38 38 Adequate Training Facilities

39 39 Replace Old PC s

40 40 Add More Devices

41 Upgrade Network -1G to User Desktop Before 41 After

42 Security 42

43 Variety of Input Devices Plantronics Wireless headsets Philips 9600 Pocket Memo Philips SpeechMike Air Wireless dictation microphone PowerMic II 43

44 Self Service Tools 44

45 45 Reference Tools & Job Aids

46 46 Management Tools

47 Resources 1 Project Manager 1 Clinical Analyst 1 Senior Analyst 1 to 3 Consultants 2 Technical Resources 47

48 48 Dragon Dictation Performance OSAT Systems Based Practice Competency

49 Dragon Dictation Performance OSAT Systems Based Practice Competency Completion of Basic Dragon Medical Training Dragon Medical login process Dragon Medical logout process Use of Simulated Narrative Dictation of Operative Reports Mastery of Dictation Correction Function Creation of Dragon Custom Command Templates Mastery of Utilization of Dragon Custom Command Templates for Dictation Knowledge of using Dragon Medical in the Electronic Health Record Dictation of an Actual Operative Report Overall Performance 49

50 Additional Value Creation Opportunities 50 Professional Services are key to adoption and success Use one device, PowerMic II, for speech to text recognition and other applications like Office, SoftPhone, and Camtasia Relay Improve provider to provider communications related to the patient handoff process Allows clinicians to use with other EMR s and applications Nursing and other multidisciplinary opportunities Easier for IT to support and manage one device that can be used for multiple applications and is more cost effective

51 Professional Services Workflow design Training Go live support Optimization Flexibility 51

52 Training Approach Kick Off Workflow Analysis Training Optimization Engagement of Key Stakeholders Metric Identification Validation of Approach Project Plan and Timeline Review Shadow/ Observe Providers and Clinical Environment Build and Validation of Templates/ Custom Commands EHR Content and Optimization Customized Training Curriculum Provider, Support, Train the Trainer Courses Delivered by Trainers with EHR/Dragon experience Metric Measure Provider Training Optimization Workflow Adjustment Template, Command Modification Technical Consult 52

53 Example Project Timeline: Dragon Implementation Week 1 Week 2 Week 3 Week 4 Week 5 Project Management Project Planning (1 day) (1 day) (3 days) (1 day) High Level Project Tasks Remote Workflow Prep Initial Dragon Installation Steps Remote Workflow Analysis Build/Test Commands Final Dragon Installation Steps Training Prep (9 days) Provider /TTT Training & Optimization 2010 CAI. All rights reserved. 53

55 AIMMC Training Timeline February 10 November 10 Hospitalist and Wound Care General Surgery and Trauma Surgery Ortho, Urology, Ophthomology, ENT Surgical Residents Neurosurgery, GI, Cardiothoracic Anesthesiology Psychology and OBGYN Cardiology December 10 Optimization Month Reinforce training Train stragglers 55

56 Numbers Trained: Dragon Implementation IMMC Dragon Project Scaling: 531 Total Trained - 40 Workflows - 12 Months Attending Residents - 27 APNs, Nurse Midwives & other 56 Time (months) 2010 CAI. All rights reserved.

57 Implementation Challenges 57 Training Requirements 4 hours 2 hours of PowerNote 2 hours of Dragon Scheduling Physicians Showing up to training Can t keep up with the demand - Resources Physicians and clinicians want Dragon Inpatient vs. Outpatient Cerner Allscripts E-Clinical Works Independent Physicians Technical challenges

58 New Product: Dragon Network Edition Key Capabilities Nuance Management Console (NMC) Central Profile Storage & Management NuanceLink User Security Profile Optimizer vsync for EHRs Creates virtual channel between client PC and Citrix server Full Text Control Enablement in Citrix Users can dictate into an EHR running on Citrix with voice-edit, voicenavigate, and play back dictation fully available Server-based application connected to all Dragon Med clients Central management of Dragon Medical users across entire organization including assignment of batch setting and updates Platform to provide visibility into usage and other needs User profiles now created, managed, and safely stored centrally, backing up profile data Continuous link between Nuance Update Server and NMC Provides updates to vocabularies, macro lists, medication lists, diagnoses lists, and disease lists User login / passwords meet HIPAA standards and prevent accidental login 58

59 Dragon Network Management Console 59

60 Group Settings 60

61 61 User Audits

62 Introducing the CAI PowerPack Reid F. Conant, MD, FACEP President and Physician Consultant Conant and Associates, Inc. 62

63 What s Next? CAPD Implementation October 2011 Nuance s Clinical Language Understanding (CLU) Technology and 3M s extensive knowledge and experience in Clinical Document Improvement (CDI) programs to provide automated and real-time feedback to physicians to help them improve the quality of clinical documentation. The key focus is on documenting more specific and clear clinical information in the context of ICD-9 and ICD

64 How does CAPD Work? Help physicians transition to ICD-10 and improve their clinical documentation to achieve appropriate reimbursement 64

65 65 Questions?