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How 6 months with Florence, my virtual assistant, helped me and my patients

I recently read that more than half of teenagers today use voice-enabled digital assistants in their smart phones, PCs and laptops. That doesn’t surprise me a bit. Healthcare usually lags behind, but not this time. I’m using a virtual assistant named Florence in my practice to help me place orders and the results are exciting. I really don’t think technology adoption has that much to do with age. If a tool or app is easy and helpful, people will use it. That’s what’s working for me, and I have the results to prove it.

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The healthcare industry is embracing AI to help with EMRs, and give physicians a little help from virtual assistants to avoid burnout and focus on patients

As the Chief Medical Officer for Landmark Hospitals, I’m responsible for seven long-term acute care (LTAC) environments, where we primarily treat high acuity medical patients. I am also the CMIO for Chartpad, a cloud-based EMR with Technomad based out of Bonita Springs, FL. In this type of setting our patients are very sick; they are often transferred from other hospitals and may come to us with 12 diagnoses and 20 medications. It’s our responsibility to make sure we are giving them the very best care possible.

One of the things I’ve seen in my 15 years of practice is the increasing number of requirements being placed on physicians. We’re seeing more patients every day, and with an aging population those patients are sicker. With Medicare cuts, we need to see more patients in order to break even financially. One of the ways we can combat these pressures is to look at the time-consuming processes in our day, and see how we can improve them.

Ideally, I’d like to get rid of my keyboard and mouse altogether. I want to be able to sit down at my Electronic Medical Record (EMR) and create all of my notes and place all of my orders quickly and easily, and then get back to my patients’ bedsides or to family meetings. To me, it’s all about interacting with people and spending less time at the computer.

 

Meet Florence 

That’s why I was excited to meet Florence. To set the record straight, Florence lives inside my computer. Named after Florence Nightingale, the pioneer of public health, Florence is a virtual assistant created by Nuance that uses artificial intelligence (AI) to help lighten the load of clinicians. Florence not only helps me to update the EMR more quickly, but it actually takes things a step further and thinks ahead to do things like create orders for me.

When I had the opportunity to try Florence, I jumped at the chance. Florence is now omnipresent and built into our EMR. I don’t have to type in the order, I can just speak it. No matter where I am in the record I can turn to Florence and have a conversation without touching the keyboard or mouse.

I’ve always found that one of the biggest problems of everyone moving so quickly is that doctors will put a recommendation in the plan of a patient’s medical record, but they might not place all the orders to activate that plan either because they get interrupted or are so busy that it doesn’t get done. Computer Physician Order Entry (CPOE) is very time consuming especially in a LTAC setting like ours which is why I felt that  Florence was a perfect complement for our workflow.

The real benefit to me is as I think of something, I can order it immediately. If I’m creating progress notes and creating my plan, Florence can extract all those orders from my plan, create orders on its own and confirm them with me. This is a tremendous help in eliminating that error rate of stating something in your notes, but not actually completing all the steps to get it done.

 

The hard evidence

I participated in a 6-month pilot with Nuance where Florence was integrated with our system, Over that period of time, we completed about 3,000 orders. I was truly impressed with the results. Florence reduced my time entering orders using CPOE by 35% and reduced my keystrokes to 0. Now that I’m even more familiar with Florence, I would estimate that I reduce my average input time by up to 50% on complex orders. You can see my side-by-side video comparison here.

 

How does a Virtual Assistant help? 

I’ve found that Florence really guides you through the process. It’s a “conversational agent” using speech recognition and language understanding, but the beauty is that you don’t even notice it. As I enter notes or orders, Florence makes suggestions or asks questions when appropriate. That’s the built-in intelligence to assist the clinician for that error-free rate we are all striving for when we provide care.

Teenagers are not the only ones who use technology. I believe that most doctors want and need this kind of innovation. For example, if I rattle off an order I might not notice I missed something, but Florence will see what I forgot, and will ask me for it. Busy doctors need that help.

Artificial intelligence technology has come a long way in the last couple of years. I believe that AI-enabled solutions with this type of real time intelligence will help us shift our time back to our patients, while Florence can help handle all the important, yet time consuming clinical documentation and medical orders.

Thanks Florence!

 

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Nuance Healthcare’s Mission is to serve as the trusted strategic partner for healthcare organizations by delivering world-class clinical documentation solutions that optimize clinical and financial outcomes in the global shift to value based care. We are in a great position to drive that change by improving the physician experience and driving language and meaning back into the patient record. That is our purpose and we achieve it in tight partnership with our EMR partners and clients. Our people, our purpose is to support our clients’ mission of caring for patients, and we do that by impacting clinical documentation and driving quality and financial outcomes that are pivotal to their success. This “client-in” culture at Nuance Healthcare underlies all we do, make, sell and share, and it’s why we ended up in this week’s Healthcare Informatics HCI Top 100 issue as one of the “Most Interesting Vendors of 2015.” This is an honor we attribute to our clients who are striving to make healthcare better and improve the patient experience in partnership with us. This article features one of our clients, Dr. R. Hal Baker, senior vice president, clinical improvement and CIO of WellSpan Health, who shares how important language is to convey caring and context and certainty in healthcare. “Nuance helped us insert back into the patient record, spoken language, and from that language, technology can pull data and make it actionable rather than favoring the business side of healthcare over the clinical. We are making people feel cared for and safe. That is our mission. We are caring for people, not just caring for a business or disease,” says Baker. What drives our healthcare teams is our commitment to helping hospitals, clinics, radiology centers, physician practices, and large organizations deliver high quality care to their communities. By bringing revolutionary technology and clinical solutions to the forefront, we keep them from buckling under the demands for data. These innovations enable physicians to practice the art of medicine, focus on patients, and avoid the distraction of documentation, computer screens or billing codes. That’s getting much harder for them to do. Beyond speech recognition, we leverage clinical language understanding (CLU) and AI to bring decisions and information to the forefront and drive insights and meaning into the hands of physicians, helping them efficiently engage patients and other physicians. For patients this means that rather than looking at the doctor’s back during a visit, you look at his/her eyes, and you feel that personal touch when dealing with an already intense situation. We at Nuance Healthcare envision a day when the doctor and patient are engaged in a very compassionate conversation, and technology and solutions assist in the background completely capturing the interaction in a note, and communicating it properly in different ways, all while the doctor stays focused on the patient. Gone are the days where we just captured information and put it in resting place. Now with technology and cognitive computing and AI, we are able to improve clinical notes, annotate them, and leverage virtual assistants — all with the intent of improving the quality and efficiency of the physician note to help both the clinical and financial side of healthcare. We pride ourselves in driving better quality of documentation and better clinical and financial outcomes. As Dr. Baker so articulately shared, Nuance supports healthcare as a business, medicine as a science and healing as an art. It is an honor for Nuance to be named the Most Interesting Vendor of 2015. As a company, we will continue our relentless pursuit of reinventing the clinician experience to allow them to spend more time with patients.
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Building better relationships between medical staff and health IT teams
The benefits of clinical speech recognition solutions
A perfect pair: The right health IT, for the right job
Important distinctions between consumer and clinical speech recognition solutions
Physician scorecards are an important part of managing online reputations
Surgeon scorecards can be cutting
Online patient reviews, the Art of Medicine, and physician scorecards
Secrets for creating a better patient experience
The 3 secrets to a better patient experience for people like me
How patient expectations are rapidly changing in a digital world
Frustrated physicians want more time with patients
What doctors would do with an extra 30 minutes
The time challenge facing frustrated clinicians
The Oregon Trail video game taught us four steps to pioneering health IT design for better usability
The Oregon Trail and pioneering good health IT design
Core elements that guide better usability in health IT design
Health IT regulations and ICD-10 Jeopardy
It’s time to play ICD-10 Jeopardy!
Test your knowledge of the ICD-10 movement, not the code set
The little boy who cried wolf and ICD-10 alert fatigue
The boy who cried ICD-10
The importance of not falling victim to ICD-10 transition alert fatigue
How technology can improve the patient-physician relationship
Keeping patients and physicians connected through technology
How apps are changing the patient-physician relationship
Halamka reflects on how care traffic control leads to better patient care
Care traffic control
How team-based, care traffic control and technology can lead to better patient outcomes
On Super Pi Day, we celebrate those who dare to chase the impossible and innovate a futuristic world full of things even Mr. Spock couldn't imagine
The intersection of Science Fiction, super-pi, and technology innovation
An ode to Mr. Spock and to chasing the impossible
App provides integrated dictation radiology workflow
mhealth app spotlight: Voice2Dox
Apps the are shaping the future of healthcare
What we can learn from the Super Bowl dancing shark
Super Bowl lessons: The ‘Left Shark’ in all of us
A modern-day Aesop fable on the importance of practice and trusting oneself
How 2015 trends will drive health IT adoption
Will 2015 be health IT’s knight in shining armor?
Trends that will facilitate better patient care and boost health IT adoption
smart-watch-health-IT consumers
Will 2015 be the year your watch teaches you about your health?
What innovations are in store for a new generation of health IT consumers
RSNA14 and Imaging 3.0
RSNA14: Top 3 trends helping radiologists with Imaging 3.0
News from the showroom floor of RSNA14
CHIME14: What are healthcare CIOs thinking?
Nuance’s Kali Durgampudi shares top-of-mind questions for healthcare CIOs
breast-cancer-awareness-month
When “1 in 8” was no longer just a statistic to me
A journey through diagnosis, treatment and recovery from breast cancer
breast-cancer-care-with-cloud-based-medical-imaging
Removing the middleman in breast cancer: Why hospitals need the cloud
A daughter tries to navigate a choppy healthcare system with her mother
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