Comprehensive, accurate and accessible patient documentation is an essential component of quality in patient treatment. Stefan Herm, Vice President and Managing Director EMEA at Nuance Healthcare, spoke to Business Computing World about speech recognition’s potential for the improving the quality of healthcare and reducing costs.
Which factors are crucial today for the successful use of IT in healthcare?
The key questions that medical professionals ask when assessing new Healthcare technology, is ‘how will this benefit my patients?’ or ‘how will this make me more productive?’ Other questions often relate to ease of integration with existing systems – such as hospital information systems – and the degree of change management and staff training required to drive maximum benefit post deployment.
It is good that medical professionals ask challenging questions, because the questions often point to the source of the issues they face daily. This helps healthcare IT providers ensure that they really are developing products that meet the needs of medical professionals.
It is worth reflecting on the change of mindset with respect to IT in healthcare over the last ten years. Only a decade ago, manufacturers of hospital information systems did not define the benefits of their products clearly, from a patient care or cost-saving perspective. It was thanks to the rise in concerns about how to improve healthcare efficiency, that the advantages of IT as an efficiency-enabler, moved to centre stage.
At the same time, healthcare IT providers became more mature in their ability to articulate the benefits of their solution, and how it is able to meet the increasing need for high quality patient care services, but within a reasonable deployment cost framework.
Thanks to these developments, today Healthcare IT innovations and deployments happen far more quickly, and enjoy a much wider adoption rate. This is reflected in the case of hospital information systems for example, which has led to them now being found in many facilities across Europe. We’re going to see a similar adoption pattern for speech recognition, too.
Given the challenges you have mentioned, what benefits does speech recognition offer?
To answer that, I’d like to emphasis one point that underpins everything we do; the accuracy of clinical documentation is an absolutely essential component for ensuring the quality of patient treatment. Clinical documentation must be comprehensive, accurate and easily accessible; these are the fundamental attributes clinical documentation has to have, because, when it does, the quality of treatment improves dramatically.
Speech recognition enables and ensures this desired level of document quality, because dictation is converted immediately into a formatted, accessible and secure document, more quickly, accurately and less expensively than ever before.
Are doctors key to the broader acceptance of speech-based documentation?
Everyone in the decision making process is important, but without the doctors supporting it and championing it, speech won’t enjoy the level of acceptance or uptake it needs to deliver tangible patient care and productivity improvements. Of course “acceptance” doesn’t mean that speech recognition is forced upon the doctors by eliminating all the other tools available to them; instead, it’s part of their tool kit. The important thing is that doctors recognise and accept that today speech recognition offers a quick, accurate and efficient documentation tool.
Doctors are persuaded first and foremost by clinical benefits. Can you explain the benefits a documentation system that integrates speech recognition offers in concrete terms?
When information is recorded immediately – for instance, at the patient’s bedside during the doctor’s rounds – the timeliness of the recording increases the accuracy of the diagnosis. This precision and accuracy ensure that the treatment prescribed is appropriate for the diagnosis. Radiologists are a good example. They assess an x-ray and document it simultaneously in real time.
This is how it should be, because evaluation and documentation of the findings go hand in hand. The same is true at the nurse’s station: I see something, I do something, and I record what I have done. Highly accurate documentation is, thus, part of the patient care process, and central to delivering the clinical benefits that medical professionals are striving for.
Could this altered documentation process degrade the doctors’ productivity?
Speech recognition doesn’t add stages to processes. When integrated into a workflow, it can actually strip out processes, and reduce the time it takes to create accurate patients records, letters or other clinical documentation. For instance, the established process is for a report to be dictated on an analogue dictation device, and the tape – which could get lost – is then sent to a typing pool.
It is not unusual for the typing process to then take a couple of days or more. This stage alone delays the speed at which the patients receive the treatment they need. This might be the ‘established’ way of doing things, but you have to ask ‘is it still acceptable to do this when an accurate and more reliable alternative exists?’ In time, we believe this will change, with the broader acceptance and use of speech being accelerated by many younger doctors, who are already familiar with the obvious advantages in using speech recognition and how it benefits their work.
In which countries has Nuance made the most rapid progress in the introduction of speech recognition?
Germany, Austria, Switzerland, France, and Spain have the highest number of hospital information systems, so we have seen rapid uptake of speech recognition in these countries. In the Nordic countries, the demand is almost fulfilled. In Norway, for example, we have almost achieved market saturation.
Outside of healthcare, but related to it, we’re seeing interest in speech recognition from a new audience in Denmark and in Great Britain: the social services. They are required to quickly provide accurate onsite documentation. Nuance Healthcare’s varied and flexible portfolio meets a wide range of needs. In some countries across Europe, hospital information systems are found in almost every healthcare institution, which means the infrastructure necessary for the rapid integration of speech recognition is already in place.
Why, then, does the implementation process frequently take so long?
There’s still an awful lot of education that has to be done, and even perceptions to shift. Often there haven’t been enough discussions held with hospital administrations that need to be educated about how speech recognition can reduce costs and – because documentation is done faster – speed up the billing process, which means faster re¬imbursement from the insurance companies and other payment sources. Doctors, meanwhile, need to reconsider their views on speech recognition and be made aware that today it is a real step forward and a powerful technology that saves time, and helps manage documentation and information efficiently.
Which of Nuance’s products do you plan to introduce into this discussion of benefits?
One is SpeechMagic, a technology available in 23 languages and definitely one of the best in the world. It is deeply integrated in the most popular clinical solutions – and is a strategic product for Europe. So if a university hospital seeks to deploy a comprehensive speech-recognition system, an integrated solution based on SpeechMagic can be the answer.
Another of our products is Nuance’s revolutionary cloud based eScription service, an on-demand, end-to-end and automated transcription platform that features background speech recognition technology. In the UK, the eScription service is being trialed at a select number of NHS Trusts with impressive results.
But if doctors in a university facility want to use speech recognition, without specific integration and be totally independent in the management of their documentation, then Dragon Medical will be a perfect fit. Dragon Medical is a front-end program for real-time speech recognition that is also perfectly suited for primary care practices. The development of our products is based on delivering solutions oriented toward the user’s needs; it isn’t technology driven.
In closing, let’s expand the horizon a bit. Given the broad availability of hospital information systems throughout Europe, is the Continent in a position to cope with the demographic change of the coming years? In Europe, the markets’ competitive IT infrastructure gives us a good foundation to build on the speech successes we have to date – perhaps even better than in the USA.
Furthermore, there are already many innovations, such as those offered by the cloud providers and other technologies that will help further drive the adoption of speech in healthcare. While this is encouraging and a good foundation, there’s a lot more that needs to be done to make speech the de facto interface in healthcare.