The role of speech recognition in improving quality, speed and turnaround of clinical documentation - Dr Simon Wallace Chief Clinical Information ...

The role of speech recognition in improving
quality, speed and turnaround of clinical
documentation
Dr Simon Wallace
Chief Clinical Information Officer, Nuance Communications

                                                     © 2020 Nuance Communications, Inc. All rights reserved.

Agenda

o   The complexity of healthcare
o   The clinical documentation challenge
o   To speak or not to speak………
o   The opportunity for speech recognition
o   Case studies: The power of clinical engagement

                                                     © 2020 Nuance Communications, Inc. All rights reserved. 2

The Complexity of Healthcare

    “Medicine used to be simple, ineffective and relatively safe”

      “Now it is complex, effective and potentially dangerous”

Professor Sir Cyril Chantler, Honorary Fellow, ULC Partners
Former Chair of General Medical Council Standards Committee – stated in 1998

                                                            © 2020 Nuance Communications, Inc. All rights reserved. 3

The Clinical Documentation Journey

Handwriting           Typing

                               © 2020 Nuance Communications, Inc. All rights reserved. 4

The Challenge of Clinical Documentation
Clinicians are overwhelmed and de-motivated by excessive admin

                                            Almost 1 in 3 doctors                  47% cited having too
                                            ‘burnt out’ and stressed               many bureaucratic tasks
                                                                                   (e.g. note-keeping,
                                            (Based on UK survey                    paperwok) as their
Research suggests clinicians spend on
                                            conducted before                       reason for burnout.1
average around 11 hours per week
                                            COVID-19 pandemic).1
adding to clinical documentation (doctors
slightly more than nurses)2
                                                                                References:
                                                                                1.     Medscape UK Doctors' Burnout & Lifestyle Survey 2018
                                                                                2.     Nuance Clinical Documentation Challenge Report

                                                                       © 2020 Nuance Communications, Inc. All rights reserved. 5

To Speak or not to Speak………….

                         © 2020 Nuance Communications, Inc. All rights reserved. 6

Clinical Speech Recognition
Dragon Medical                                                              PowerMic Mobile
AI-powered clinical speech recognition                                      Secure wireless microphone for iPhone and Android

     Voice to text into clinical notes (e.g. EHRs) – digital tool to
      support the ‘paperless’ journey
     Dictate at the point of cursor
                                                                            Dictation Box                                                           Transfer Text
     We speak 3x faster than we type
     Mature, proven technology – 99% accurate
                                                                                 Dictate
     Smart AI and comprehensive medical dictionary                            (Record)
                                                                            Toggle on/off
                                                                                  button
     NO initial speech profile training required – recognizes accents
     Single voice profile – accessible on different devices in different
      locations                                                                      Tab
                                                                                                                                                    Tab
                                                                                                                                                    forward
                                                                                backward
     Use of speech activated macros to improve quality and speed                 Rewind                                                            Fast
      of documentation                                                                                                                              forward

     Microphone can be on smartphone – iOS/android

                                                                                                     © 2020 Nuance Communications, Inc. All rights reserved. 7

COVID-19 Note

                © 2020 Nuance Communications, Inc. All rights reserved. 8

Myth or Reality?

                   © 2020 Nuance Communications, Inc. All rights reserved. 9

Outpatient (OP) Setting – The Challenge
Two large NHS Hospitals
o High clinical correspondence volumes:
        3.4 millions letters/year (1.8M OP clinic letters) - Oxford
o Missing national target of OP letter to GP turnaround time
  (TAT) of 7 days:
        Average – up to 17 days
o Admin staff shortages:
        Secretarial sickness and vacancies
        No secretaries to support the off-site transcription workflow
o   High outsourced transcription costs
o   Longer worklists with backlogs building up
o   Delays and costs due to complex workflows
o   Clinicians:
        Hand written notes - using secretaries to type them
        Staying late to do admin
o EHR – Cerner Millennium
                                                                         © 2020 Nuance Communications, Inc. All rights reserved. 10

Outpatient (OP) Setting – The Outcome (I)
Two large NHS Hospitals
o   Paperless outpatient letter workflow: administration & clinical
o   Turnaround time of letters: reduced from 17 days to 2-3 days
         Sent real time if no results awaited
         Patient could leave clinic with OP letter
o   Financial savings:
         Outsourced digital dictation: £180,000 per year (Homerton)
         Staff costs - 1/3 reduction in spend on medical secretariat costs (Homerton):
            • Medical secretaries who left not replaced
            • Bank and agency staff costs reduced
o   Clinicians: better level of care & less catching up on paperwork after
    clinic
o   Secretaries: focus on patient contact rather than typing letter backlog
o   Patients: Leaving clinic with letter – few lost or missed FU appointments
o   Initial pilots resulted in business case for organisation-wide deployment
        Incremental roll out across all clinical specialties
o   Homerton Case Study
o   Oxford Case Study
                                                                                    © 2020 Nuance Communications, Inc. All rights reserved. 11

Outpatient Setting – The Outcome (II)
Oxford University Hospitals NHS Foundation Trust
Renal Department
o Renal Consultant:
    ‘Big impact on the efficiency of getting my letters done for any
      clinic. I am now able to send my letters within 24 hours (or even
      instantaneously if there are no blood results awaited for), as
      compared to pre-VR era where the letters may take up to 2
      weeks or even longer to be done’.

o Renal Admin Team Leader:
    “The introduction of VR into renal has resulted in a dramatic
      change in clinic letter turnaround times. As a result of time
      being freed up from letter reviewing, this has also permitted the
      renal secretaries to expand the variety of their tasks and work
      on their CPD.”
                                                               © 2020 Nuance Communications, Inc. All rights reserved. 12

Speech Recognition in ED
o   Emergency Department
o   Dragon Medical integrated into EMIS Symphony,
    PowerMics, Professional Services
o   Independent post-implementation study of impact
    of clinical speech recognition integrated into the
    EPR revealed:
        SR the preferred method for capturing notes
               • No more hand writing or digital
                  dictation
        Time saving - 40% faster than typing
        Ave. time saving in documenting care of 3.5
            mins per patient equivalent over a year to   Study Results here
            2 full time ED doctors (389 days)
o   What did the clinicians think:
        Time savings compared to typing (98%)
        Reducing delays and improving flow of
            communication (86%)
        Improved quality of the patient record (88%)
                                                              © 2020 Nuance Communications, Inc. All rights reserved. 13

University Hospitals Plymouth NHS Trust
Histopathology Department
o   Challenge:
      Backlog of 600 reports outstanding. Shortage of staff.
      Complex workflow – registering the specimen (secretary),
          preparation of specimen (lab tech) and microscopic analysis
          (histopathologist)                                                Written case study here
      Integration with Laboratory Information Management System
          (LIMS)
      Meeting requirements for national cancer reporting
          requirements – use of voice commands to navigate through
          the form
      SNOMED coding and the TMP format
o   Outcomes:
      Removal of 600 report backlog
      Turnaround time now meeting national target
      NHS Innovation Award
      Lead pathologist – “not work in hospital without speech”
                                                                        © 2020 Nuance Communications, Inc. All rights reserved. 14

Cambridge Community Services NHS Trust
www.eoemskservice.nhs.uk/

o   Community-based musculoskeletal services and uro-
    gynaecological physiotherapy
o   Reflects system and service changes across NHS
o   Speech to create all outpatient letters (18
    physiotherapists and one podiatrist)
o   Dragon Medical, PowerMic and support services from
    Nuance partner Talking Point
o   Results:
       Letter TAT reduced from 6-12 weeks to 2-5 days
       Increased patient throughput and decreased
           waiting times
o   Reduced backlog
o   Faster referral to 20 care (screening of 10 care referrals)
o   Team able to complete admin within contracted hours
    and go home on time.
o   Written Case Study here

                                                                  © 2020 Nuance Communications, Inc. All rights reserved. 15

Mental Health & Community Setting
https://www.hacw.nhs.uk
o   Community & Mental Health Trust:
       4000 clinical and non clinical staff
       26,000 recorded patient contacts per week
o   An NHS England Global Digital Exemplar (GDE)
       Used funding to enable more efficient, accurate capture of patient
          encounter and reduce burden of administration
o   OneAdvanced Community EHR, GP letters etc.
o   Outcome:
       Zero backlog
       Notes updated within work hours
       ↑ EHR adoption
       More time to care
o   100 licenses now another 100.
o   Let them speak for themselves:
    https://youtu.be/-J4jI1b52V4
    Written Case Study here
                                                                        © 2020 Nuance Communications, Inc. All rights reserved. 16

7-year old girl’s drawing published in JAMA, June 20, ©2012,  Vol 307,
                                                        2020 Nuance      No. 23,Inc.
                                                                    Communications, Thomas        G. Murphy,
                                                                                     All rights reserved. 17 MD
                                        http://jama.jamanetwork.com/article.aspx?articleid=1187932

Innovation Roadmap
Journey to ambient clinical intelligence
Nuance is constantly advancing the frontiers of AI innovation

 Transcription &    Front-end speech                                Virtual assistants
back-end speech         recognition      Voice command                                                      Ambient clinical
   recognition     integrated into EHR      & control                                                      intelligence (ACI)
                                                                 Real-time intelligence

                                                               Clinical guidance, knowledge
                                                             access, coding eg. SNOMED CT

                                         Cloud-based speech recognition solutions

                                                                                         © 2020 Nuance Communications, Inc. All rights reserved. 18

The Telehealth Opportunity
Dragon Medical                                                           PowerMic Mobile
AI-powered clinical speech recognition                                   Secure wireless microphone for iPhone and Android

     Shift to more remote consultation due to COVID-19
     Balance needs to be found between face-to-face & remote
     Speech recognition has a key role to play:
                 Traditional capture of note and letter creation
                 Ambient clinical intelligence
     ‘Clinic Room of the Future’: conversational AI
                 No more typing, clicking or back to patient
                 Voice biometrics
                 Conversation fully diarized
                 Summary, coded clinic note using structured headings

                                                                                                 © 2020 Nuance Communications, Inc. All rights reserved. 19

Nuance and Microsoft partner to transform
the doctor-patient experience | Nov 2019

 Strategic partnership accelerates delivery of ambient technologies to reduce clinician
 burnout by enabling doctors to focus on patients, while AI focuses on administrative tasks.

  “The Microsoft partnership will accelerate our   “We have an incredible opportunity to use
        ability to solve for healthcare’s most     advances in cloud and AI technology to
            pressing challenges—together...”       transform healthcare delivery...”
                 Mark Benjamin, CEO, Nuance        Satya Nadella, CEO, Microsoft

                                                                     © 2017 Nuance Communications, Inc. All rights reserved. 20

Thank you
Dr Simon Wallace
simon.wallace@nuance.com

                           © 2017 Nuance Communications, Inc. All rights reserved.