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Intelligence at Work: MaxQ AI’s ACCIPIO intracranial hemorrhage (ICH), stroke, and head trauma software platform

Healthcare faces unprecedented pressure - with less money available, more patients, and a care provider shortage. MaxQ AI is addressing these pressures by leveraging AI and machine learning. Its ACCIPIO ICH and Stroke Platform improves care delivery and outcomes by improving intracranial hemorrhage (ICH) detection and potentially reducing missed ICH. MaxQ AI’s FDA cleared Accipio Ix and Ax solutions are available for review on Nuance’s AI Marketplace for Diagnostic Imaging, and will be integrated with Nuance’s PowerScribe One reporting platform and PowerShare Network connecting 6,500+ healthcare facilities, including stroke centers.
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Randy Rohmer, Director Commercial Operations of MaxQ AI, shares his insights about how MaxQ AI-driven algorithms aim to meaningfully help reduce misdiagnosis and healthcare costs by making artificial intelligence intrinsic to the diagnostic process for time-sensitive and life-threatening conditions.

MaxQ AI is at the forefront of Medical Diagnostic AI. The company is transforming healthcare by empowering physicians to provide “smarter care” with artificial intelligence (AI) clinical insights. Based in Tel Aviv, Israel and Andover, MA, USA, MaxQ AI’s team of deep learning and machine vision experts develop innovative software that uses AI to interpret medical images and surrounding patient data. Working with world-class clinical and industry partners, the company’s software enables physicians to make faster, more accurate decisions when diagnosing stroke, traumatic brain injury, head trauma, and other serious conditions.

Q&A

Jonathon Dreyer: Tell us about your business – when and how you started and your development journey.

Randy Rohmer: MaxQ AI is at the cutting-edge of innovative medical diagnostic artificial intelligence. We aspire to make a meaningful impact on stroke and brain trauma treatment, driven by the question “what is the cost of a missed intracranial hemorrhage (ICH)?” The potential is massive – if our solutions are able to divert only one patient per year in the US/EU acute hospitals from stroke care to wellness care, that would represent billions in savings in the first year alone, and a lifetime of difference to the patient and family.

MaxQ AI is ushering in empowered care – the partnership between AI and the skilled care providers to extend expertise to every patient. Dedicated to improving a physician’s ability to make a faster and more confident diagnosis, our solutions hold significant potential to increase the quality of care in emergency rooms in rural and community hospitals across the globe.

Our first platform of medical devices, ACCIPIO®, which means “to learn” in Latin, uses artificial intelligence in review of non-contrast CT to enhance intracranial hemorrhage (ICH) diagnosis and treatment. In collaboration with our world-class clinical partners, along with state-of-the-art technology, we envision revolutionizing acute care and treatment standards to become a globally influential entity that provides universal access to expert-level diagnosis that will make a significant difference in patients’ and physicians’ lives. When minutes matter, Accipio, plus the skilled care provider, are better together.

JD: What AI algorithms do you have, and what do they do?

RR: MaxQ AI has developed a full ecosystem of algorithms providing a comprehensive workflow solution designed to benefit the patient, care provider, and facility. Our ACCIPIO ICH and Stroke Platform with INSIGHT™ supports the radiology department, emergency room, and neuroradiology teams with a fully automated solution, designed to empower healthcare decisions in acute care settings.

  • ACCIPIO Ix (FDA cleared & CE approved, commercially available) – Provides automatic identification/detection, notification, acceleration and prioritization of suspected ICH.
  • ACCIPIO Ax (FDA cleared & CE approved, commercially available) – Provides automatic slice-level annotation of suspected ICH and a comprehensive summary of all suspected slices via MaxQ AI’s unique SliceMap™.

As future regulatory approvals are garnered, and the range of technologies work interactively, the Accipio ecosystem will gain more traction in acute care settings across the globe. The future Accipio platform will also provide AI diagnostic tools (currently in development), such as ICH expert-level diagnostic rule-out, lesion-level annotation of suspected ICH, and quantification of suspected ICH volume (currently in development).

JD: What’s the big “Aha” moment when you first show users what your AI algorithm(s) can do for them?

RR: Our users have embraced the fact that Accipio is a comprehensive workflow solution for ICH, stroke, and head trauma, not just another algorithm looking for a nail. Comprehensive, seamless, and secure. For our customers, a comprehensive solution that has seamless integration into workflow is key – clinicians and radiologists in acute care settings need answers, not more analysis. That’s why we’ve integrated AbsoluteZero™ with all of our solutions. Zero clicks to Accipio results. Zero need to leave workflow. Zero stored PHI. Zero change to original series. No on-site IT integration required. Seamless from the Start™.

JD: What challenges or needs did you see that drove you to focus on this?

RR: MaxQ is an aeronautic term that actually means ‘maximum pressure,’ which is typically the point where failure will occur. Today’s healthcare system is this breaking point with an urgent need for solutions that will open up capacity, and relieve the pressure of increased patient volume, decreased revenue, and fewer care providers. Instead of more data and analysis, adding to the decision-making burden, care providers need solutions that provide answers while seamlessly integrating into their current workflow.

MaxQ AI’s platform of medical diagnostic AI solutions do just that, which holds great promise for healthcare through significant quality, clinical, and economic advancement in the empowerment of the talented care providers having to make the “minutes matter” call. Lives will be changed, both for patients and care providers alike.

JD: What’s the number one benefit you offer?

RR: MaxQ AI will support the complete ACCIPIO ICH and Stroke Platform with INSIGHT: It will support the Radiology Department, Emergency Room, Neuroradiology, and the Stroke teams with a fully automated solution. The ACCIPIO platform will provide tools for identification & prioritization (lx) 1, slice-level annotation (Ax) 2, and triage guidance for suspected ICH presence and diagnostic quality rule-out3. The complete Accipio solution for head trauma and stroke promises to:

  • Greatly increase ICH detection and reduce missed ICHs through near real-time triage, annotation and diagnostic rule-out – because every minute matters for TBI, trauma, and stroke patients.
  • Potentially enhance clinical confidence, including mobilization of ischemic stroke and neurosurgery teams.
  • Provide the right care readied faster, improving quality to potentially avoid poor patient outcomes and to decrease costs and liability.
  • Provide slice-level annotation, lesion-level annotation and quantification of lesion volume within suspected ICH.
  • Provide automatic diagnostic ICH rule-out.
  • Address the total workflow needs of the reader; not a single algorithm –– an ecosystem designed to benefit the patient, care provider, and facility.

JD: Are there any stories you can share about how your algorithm(s) drove measurable patient care outcomes?

RR: A typical acute hospital in the Northeast US, Capital Health, is seamlessly using MaxQ AI’s Accipio Ix ICH (intracranial hemorrhage) solution, to automatically identify and prioritize non-contrast CT head images with suspected ICH. Capital Health leverages the solution to process over 1,000 non-contrast head CT scans each month, including upwards of 30 stroke cases per week. Capital Health’s quality process includes overreading a subset of cases that were read by a third-party remote radiology service overnight. One of these cases included a head trauma patient that was non-responsive when brought into the ED. The original interpretation by the night service failed to identify the presence of a suspected ICH. As part of a larger assessment of the Accipio solution in retrospective cases, Accipio Ix correctly identified a suspected ICH, in this case confirming that there was a missed ICH on the initial interpretation. What had taken hours later to find by the second read the following day, Accipio could have done in minutes. Capital Health is rolling out Accipio across the enterprise.

JD: What benefits does Nuance and its AI Marketplace for Diagnostic Imaging bring to your users?  What problems does the marketplace and integration into Nuance’s workflow solve?

RR: Our partnership through the Nuance AI Marketplace for Diagnostic Imaging will expand access to our revolutionary AI-powered ICH, stroke, and head trauma solutions to radiologists and connected healthcare facilities across the globe, who trust Nuance as a valued partner to deliver quality solutions. We view this as a powerful collaboration that will bridge the technology divide to enable more and more hospitals and healthcare organizations to seamlessly integrate our Accipio platform. Through Nuance’s cloud-based marketplace and connected PowerShare Network, we will drive potential diagnostic improvements and, in turn, improve patient outcomes and lower healthcare costs. This will fuel the best possible care in all market segments by bringing near real-time clinical confidence to the radiologist or reader.

JD: What has your experience been working with the Nuance team?

RR: The entire Nuance team has been collaborative, supportive, and excited to bring our AI algorithms and solutions to the AI Marketplace. Our organizations are committed to innovation – driving new solutions that will make a difference to healthcare and patients.

JD: What is your vision for how your solution(s) will evolve over the next 5 years?

RR: MaxQ AI is focused on the area of time-sensitive, life-threatening situations that have profound clinical and economic impact and an opportunity to help empower physicians make better decisions. For our immediate product roadmap, we will continue to focus on that area, and we anticipate additional regulatory approvals that will further extend our Accipio ICH, stroke, and head trauma platform.

Long-term, we aspire to leverage our commercially seamless adoption approach through Nuance’s intuitive and streamlined user experience to optimize the power of our medical diagnostic AI-powered solutions and provide new acute disease indications.

JD: In one sentence, tell us what you think the future of medicine will look like.

RR: We see AI as ushering in a new era of augmented healthcare through AI-powered medical diagnostic solutions, in partnership with care providers, to empower physicians around the world to better prioritize and identify life-threatening conditions in acute care settings, which will improve the quality of care, and lower system costs—all while improving the lives of the physicians themselves.

Learn more:

To learn more about MaxQ AI, visit www.maxq.ai or follow us on Twitter and LinkedIn.a

To learn more about Nuance AI Marketplace for Diagnostic Imaging, please visit https://www.nuance.com/healthcare/diagnostics-solutions/ai-marketplace.html

Intelligence at Work is a blog series by Jonathon Dreyer, Vice President, Solutions Marketing, Nuance Communications. Intelligence at Work showcases projects and applications that demonstrate how Nuance technologies extend the value, use, and performance of integration and development partner offerings. This blog series focuses on inspiring the healthcare developer community to think beyond their current state and take their innovations to new heights by tapping into the latest in artificial intelligence.

1Accipio Ix: FDA Cleared, CE Approved

2Accipio Ax: FDA Cleared, CE Approved

3Diagnostic Rule-Out, Future Device: CAUTION–Investigational device. Limited by United States and international law to investigational use.

The Way Forward: An eye on future healthcare technologies

It’s no secret that many rural hospitals operate with negative margins. Nuance CMIO Dr. Robert Budman explains why it is essential for these organizations to maximize their limited capital and take advantage of AI-enabled technologies.
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artificial intelligence in healthcare

This article was first published on November 1, 2019, by Health Data Management. Reposted with permission.

Throughout this series, I wrote how critical access and rural hospitals face the same day-to-day struggles that larger healthcare organizations do. The difference is that the challenges are amplified in critical access settings because of limited resources. It’s no secret that many rural hospitals operate with negative margins. It is thus essential for these organizations to maximize their limited capital and take advantage of AI-enabled technologies.

AI is expected to vastly expand clinicians’ treatment insights, and improve physician workflows from radiology and diagnostic decision support to complex acute hospital care and busy ambulatory environments.

Virtual assistants are helping to ease the burden of documentation workflows by enabling providers to use their voice to retrieve information, place orders and create follow up tasks. Rather than searching through multiple screens in the EHR, providers can say, “show me the last chest x-ray” or “read me the medication list” to quickly gain access to the necessary information.

Additionally, exciting technologies, such as ambient clinical intelligence are expected to significantly impact the physician-patient experience. Ambient clinical intelligence (ACI) helps alleviate the burnout care teams experience from the extra time spent documenting visits, navigating patient charts, and following up on documentation details. It securely listens to clinician‑patient conversations and complements the EHR by surrounding the encounter with assisted workflows, task and knowledge automation. By doing so, it promotes a better patient experience and automatically documents patient care—all without taking the physician’s attention off of the patient. Curious about how it works? See for yourself.

Imagine the impact on rural hospitals’ financial success when complete and accurate documentation tells every patient’s story fully and physician satisfaction and retention rise exponentially with vastly reduced burnout.

This blog post is the last in a four-part series. To see the first three, please click here.

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Intelligence at Work: CuraCloud’s ICH algorithm speeds brain bleed notification

Read how CuraCloud’s machine learning-driven solutions use artificial intelligence to improve medical diagnosis and patient care through collaborative development with leading clinical partners and device manufacturers. A major initiative is CuraCloud’s ICH algorithm, currently pending FDA 510(k) clearance, that assists radiologists’ triage and prioritizes reading of images for patients with intracranial hemorrhage (ICH) to improve patient outcomes. Once FDA cleared, CuraCloud’s ICH algorithm will be integrated with Nuance’s radiology reporting and workflow solutions.
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Intracranial hemorrhage (ICH) can be a “time bomb” if not detected and treated promptly.  The actual cost of delays can be measured in monetary terms that impact patients, families, and the health care system.  But even more importantly, the cost in terms of loss of function and loss of life can be staggering.  CuraCloud has developed software that can detect ICH on non-contrast head CT images in just a few seconds based on a deep learning model. The software can be used to help triage and prioritize reading of images for patients with ICH, thus improving the likelihood of prompt detection and intervention.

CuraCloud’s mission is to collaboratively develop medical AI solutions with healthcare delivery organizations and medical technology leaders to improve diagnostics, care processes, and clinical outcomes. CuraCloud is interested in teaming up with clinical partners to solve their unique clinical challenges using their unique data.

Qi Song, CEO of CuraCloud, shares his insights about how their machine learning and algorithm development activities leverage collaborative projects with industry and technology leaders to improve patient care.  He discusses the potential impact the ICH algorithm can have on the morbidity and mortality associated with ICH, and how the ICH triage tool availability can be expanded via the Nuance AI Marketplace for Diagnostic Imaging.

Q&A

Jonathon Dreyer: Tell us about your business – when and how you started and your development journey.

Qi Song: CuraCloud is a medical AI R&D services company. We collaboratively develop medical AI solutions with clinical partners to improve diagnostics, care processes, and clinical outcomes for healthcare organizations.

Our founding team is a group of senior research scientists and technical leads who have extensive R&D experience in medical image analysis from leading medical imaging companies. In 2016, we secured funding and started CuraCloud. We have recruited more than 15 data scientists and computer vision experts who are interested in applying machine learning to the healthcare industry. Over the past three years, we have developed into a strong professional services organization working with clinical collaborators and device manufacturers all over the world.

JD: What AI algorithms do you have and what do they do?

QS: We have a portfolio of R&D projects including ICH detection, lung nodule detection and characterizations, coronary artery segmentation and stenosis quantification, ultrasound breast cancer classification, chest X-Ray disease classification, digital pathology cancer metastasis detection, and NLP based structured clinical reports. FDA-cleared algorithms will be made available on the Nuance AI Marketplace for Diagnostic Imaging.

JD: What’s the big “Aha” moment when you first show users what your AI algorithm(s) can do for them?

QS: Our clinical partners are impressed by the spectrum and depth of the R&D projects we have demonstrated within the past several years. We have published more than 20 peer-reviewed scientific journal articles and conference papers regarding our AI projects. Our scientists are capable of delivering high-performing machine learning algorithms with state-of-the-art deep learning techniques.

JD: What challenges or needs did you see that drove you to focus on this?

QS: ICH affects over 67,000 people in the USA each year. When patients are being evaluated for ischemic stroke, hemorrhage needs to be ruled out before they are given certain clot-buster drugs. Time is of the essence. With the consolidation of radiology practices, radiologists increasingly have a backlog of scans to read from multiple hospitals. It is important to flag suspected ICH cases as soon as possible so that treatment decisions are not delayed.

JD: What’s the number one benefit you offer?

QS: The number one clinical benefit of using our AI-assisted triage tool is reduced turnaround time (TAT) for ICH patients who need to be treated immediately.

JD: Are there any stories you can share about how your algorithm(s) drove measurable patient care outcomes?

QS: We have carried out a Monte Carlo simulation study to mimic a single radiologist’s one-week worklist for 2,000 times under different clinical settings, in order to quantify the clinical benefits and risks of using AI for optimizing triage prioritization. The study compared the AI-assisted triage with the standard of care prioritization and showed that almost all ICH positive patients have a shorter turn-around time as a result of the prioritization. Notably, “routine” outpatient studies that have positive ICH findings have substantial TAT savings that ranged from several hours to multiple days. In the meantime, we are collaborating with a large radiology group to collect performance data in a clinical setting. We hope to share some clinical study results soon.

JD: What benefits does Nuance and its AI Marketplace for Diagnostic Imaging bring to your users?  What problems does the marketplace and integration into Nuance’s workflow solve?

QS: Nuance enjoys a significant market share for its reporting platform and also has an enterprise worklist solution. We wanted to leverage the customer base that Nuance has established and the cloud hosting infrastructure that Nuance offers to shorten the time-to-clinical-use for our solutions.

We also find Nuance’s built-in feedback channel to be a valuable feature that will allow the users of our app to share their results with our team. This will create a communication channel between radiologists and our developers that will enable us to improve our algorithm iteratively over time. We are looking forward to being part of the collaborative community of healthcare developers and users that Nuance has created.

JD: What has your experience been working with the Nuance team?

QS: We are proud to be working with the Nuance team to bring our solutions to radiologists. The Nuance team is incredibly knowledgeable at making innovative healthcare technologies accessible to their customers. We are excited to see the cloud hosting capability that is newly available, and we are eager to be fully integrated and become a part of the AI portfolio of the Nuance AI Marketplace.

JD: What is your vision for how your solution(s) will evolve over the next 5 years?

QS: We plan to expand this specific ICH application from the relatively simple triage functionality to a more comprehensive diagnosis decision support tool. For example, we plan to include more head CT findings, such as hemorrhage subtypes, the hemorrhage location, and measurements, mass effect, and midline shift detection, etc.  Beyond that, we have other exciting projects that are ongoing and hopefully will have more significant impacts in the next 5 years. Our main focus is to further expand our professional R&D services to gain more clinical experience by working closely with our clinical partners on their unique needs and challenges by applying state-of-the-art deep learning techniques on their own clinical data.

JD: In one sentence, tell us what you think the future of medicine will look like.

QS: The future of innovation in medicine will be driven by technologies developed in multidisciplinary collaborations that will solve the challenges we face today.

Learn more:

To learn more about CuraCloud, please visit https://CuraCloud.net

To learn more about Nuance AI Marketplace for Diagnostic Imaging, please visit https://www.nuance.com/healthcare/diagnostics-solutions/ai-marketplace.html

Intelligence at Work is a blog series by Jonathon Dreyer, Vice President, Solutions Marketing, Nuance Communications. Intelligence at Work showcases projects and applications that demonstrate how Nuance technologies extend the value, use and performance of integration, and development partner offerings. This blog series focuses on inspiring the healthcare developer community to think beyond their current state and take their innovations to new heights by tapping into the latest in artificial intelligence.

 

 

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Keeping key diagnostic drivers top of mind in the challenging emergency department environment

Failure to diagnose remains one of the most pressing challenges in emergency medicine, but documentation guidance can help providers and healthcare organizations improve their patient safety and quality efforts. Please enjoy this guest blog post by Daniel J. Sullivan, MD, JD, FACEP, who helps us understand three key diagnostic drivers that, when kept top of mind, can have positive impacts on both the failure to diagnose and the frequency of litigation.
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We know from new research that just three diagnostic errors are the cause of almost 75% of patient harm—not to mention $1.8 billion in malpractice payouts—in the emergency department (ED): misdiagnosed cancers, vascular events, and infections.

But what if there were a way to help improve the risk profile here?

I recently had the opportunity to speak with Dr. Daniel Sullivan, whose illuminating work in the areas of patient safety and healthcare risk management spans three decades and dozens of facilities. I invited him to write on this topic and help us better understand how documentation guidance can help overcome these core risks to patient safety in the ED.

Improving risk, safety, and quality: a guest blog by:
Daniel J. Sullivan, MD, JD, FACEP, President & CEO |
The Sullivan Group

Diagnostic uncertainty is a fact of life in the practice of emergency medicine (EM). In EM, the failure to make an accurate and timely diagnosis is the most common medical error and cause of patient injury and exposure to litigation. Although there are other safety issues, the failure to diagnose is by far the number one issue for any EM risk and safety program.

The Sullivan Group (TSG) has studied the failure to diagnose in EM for three decades, working with some of the world’s largest healthcare organizations. The critical issue is that there is significant variability in practitioner evaluation of key diagnostic elements in the highest risk patient presentations. TSG has been able to demonstrate that reduction in that variability and alignment around those key diagnostic drivers can result in dramatic reductions in both the failure to diagnose and the frequency of litigation.

Examples of diagnostic drivers include the following:

  1. In an adult patient with chest pain, the practitioner must assess whether there has been movement or migration of the pain into the low back or abdomen. Although this finding points directly to the diagnosis of acute aortic dissection, in a TSG analysis of over 15,000 chest pain patients, movement or migration of pain was not addressed or documented in over 50% of adult chest pain presentations.
  2. In a child with fever, the practitioner must be aware of the child’s immunization status. Immunizations lacking or not up to date drives a critical thought process relating to a serious bacterial illness. In a TSG analysis of over 10,000 children with fever, immunization status was missing in over 20% of cases.
  3. In a TSG analysis of 90,000 patients, 9,000 were found to have a very abnormal vital sign; 16% of those patients were discharged home without a single repeat of the abnormal vital sign.

There are many similar examples of missed opportunities across the spectrum of high-risk presentations. Addressing key diagnostic drivers creates opportunities to decrease diagnostic uncertainty and reduce the failure to diagnose. So how do we support practitioners’ cognitive processes to harness those opportunities?

Fortunately, the solution is not complicated. The three issues above are far more addressable when the practitioner keeps them front of mind during the patient encounter. But there’s the rub! How to keep these key diagnostic drivers front of mind in the challenging environment of the emergency department.

The answer is real-time decision support available in the practitioner’s workflow during the patient encounter. TSG has partnered with Nuance Healthcare to build these key diagnostic drivers into a program called Dragon Medical Advisor (DMA) ED Guidance. As the practitioner creates a medical record (via dictation, typing or otherwise), DMA continuously processes the ED note and suggests those missing key elements of the history, physical exam and medical decision-making critical to forming an appropriate differential diagnosis for high-risk conditions.

DMA recognizes when those elements have been addressed and retires them from the list. It is, in essence, an interactive checklist. Designed for efficiency, with no change or interruption to the workflow, the practitioner merely completes the diagnostic process, leveraging the ED Guidance as needed. When the DMA window is empty, the practitioner has addressed those diagnostic elements most critical to getting to an appropriate differential diagnosis. High reliability at its best!

This is a new and exciting program that can dramatically impact risk, safety and quality. It is a proven approach that now harnesses the power of Dragon Medical One and Dragon Medical Advisor.

You can learn more about this topic here: Nuance-Sullivan Group press release.

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A Real View of HealthCheck: An analytics service for improving patient and financial outcomes

Radiology quality chairs and other practice leaders know which questions to ask to evaluate performance. But getting answers to those questions from existing data has typically been a difficult and time-consuming task. HealthCheck is a service powered by Nuance’s mPower Clinical Analytics that scours unstructured data in radiology reports and generates detailed analyses to help practice leaders improve patient and financial outcomes, and address physician burnout. The service has analyzed more than 12.6 million radiology reports at 62 health systems to date. Using HealthCheck and mPower also can help prepare for PAMA compliance in 2020.
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Easy access to detailed analytics is something most of us take for granted. That’s true in nearly every aspect of our business and personal lives, from sales and P&L reports, to web and social media analytics, to home banking apps, and even our workout routines and favorite sports. That’s why it’s so ironic that physicians, who capture, use, and create huge amounts of data every day, have had a difficult time obtaining actionable insights from healthcare performance and quality metrics.

Thankfully, that is changing with Nuance mPower HealthCheck, a clinical analytics service that provides a performance snapshot and informs programs for continuous clinical, quality, and financial improvement.

The HealthCheck service is run by the mPower analytics team led by Nuance CMIOs Woojin Kim, MD and William Boonn, MD. I sat down with Dr. Boonn to discuss the factors behind HealthCheck, the results from the healthcare systems that have used it to date, and how it can be used to improve clinical, quality, and financial outcomes.

KH: Nuance has been offering the HealthCheck service for a few years, and it’s having a big impact on the radiology practices that have used it. Can you bring us up to speed on that?

Dr. Boonn: Yes, Karen. It’s not an overstatement to call the impact transformational. To date, HealthCheck has analyzed unstructured data in more than 12.6 million radiology reports at 62 health systems of different types and sizes across the country. We’re seeing very positive reactions from radiology practice leaders when they realize the wealth of reports available and the ability to document specific aspects of performance.

KH: How did HealthCheck originate?

Dr. Boonn: mPower, the analysis tool that HealthCheck is built on, originally began as Dr. Kim and I were trying to answer performance, productivity, and quality questions we had as practicing radiologists and teaching professionals in Pennsylvania. We started a company, developed the mPower Clinical Analytics software, and later brought the solution to Nuance. HealthCheck uses mPower and the customer’s own data to introduce radiology practices to the power of clinical analytics with an assessment focused on five key areas.

KH: What are the key areas, and how does a customer initiate a HealthCheck evaluation?

Dr. Boonn: Five KPIs that we evaluate in HealthCheck include:

  • Failed follow-up recommendations
  • Compliance failures
  • Laterality errors
  • Sex errors
  • Report variability and inconsistency

A customer simply contacts their Nuance account manager to start the process. We load a copy of the customer’s reporting data into mPower, analyze and validate it, and present key findings numerically and graphically. Radiology leaders are then able to use standard KPIs to assess their group’s performance and determine ways to respond. The data and analysis are confidential and anonymized. That means we also can provide industry benchmarks that customers can use to compare their performance to other hospitals that have conducted HealthCheck evaluations.

KH: Can you talk a bit more about why these KPIs, in particular, are so important?

Dr. Boonn:  Those KPIs have the greatest impacts on clinical outcomes, financial performance, imaging usage, physician burnout, and malpractice risk.

Two or three KPIs typically stand out for each institution. For example, some looked closely at “easy wins” such as gender or laterality errors by site, shift, or radiologist. The metrics can then be used to structure continuous, personalized quality improvement programs and reduce the rework that leads to burnout. Others used the reports to determine if they could hire more radiology staff, while academic facilities wanted to leverage the data to support of research grant funding.

Others tackle failed follow-up compliance, which is a serious problem that’s been documented in at least three studies. That includes one in April 2014 that reported a 71% follow-up failure rate in patients with incidental pulmonary nodules. Another in November 2017 found that 57% of follow-up recommendations were not completed on time, and a third in March 2019 reported that up to 60% of ED patients did not receive recommended follow-up exams within one year. Our HealthCheck analyses have consistently found similar rates.  A HealthCheck analysis can allow practices to identify low hanging fruit – opportunities to improve follow-up compliance rates, reducing risk and improving revenue.  Once identified, Nuance has a suite of solutions including Follow-up Manager, which can address these issues directly.

Patients are falling through the cracks and cancers that could have been treated early with good outcomes are progressing to advanced stages with more expensive treatments, poorer outcomes, and higher medico-legal risks. As recently as late August, a jury in Pennsylvania awarded a couple $8.5 million in damages because doctors failed to notify the patient of incidental findings of a possible tumor following a 2015 exam related to kidney stones. An ultrasound two years later revealed multiple tumors requiring surgery to remove his bladder and prostate and undergo chemotherapy. A new law in Pennsylvania requires radiologists to notify patients of certain findings directly. Even without a legislative push, it benefits all parties to get ahead of the issue now.

HealthCheck KPIs are an effective way to begin that process. If you can quantify the problem in detail at your institution, you can take advantage of new automated tools to mitigate it. A handful have done that already including Dr. Ben Wandtke at the University of Rochester who led the 2017 study I mentioned.

KH: What’s the takeaway from customers that have used HealthCheck?

Dr. Boonn: Many started the continuous improvement process because they knew the questions that they wanted to answer but had neither the tools nor the time to perform the analysis. The insights gained have been significant and wide-ranging.

Benchmarking has been important to show how the customer compared to other practices. It contextualizes the results and enables health systems to focus their QA projects where they can have the greatest impact.

KH: What’s next for HealthCheck and for using analytics to improve patient and financial outcomes?

Dr. Boonn: We expect that more radiology practices will reach out for a HealthCheck assessment. We also expect that many will take the next step and deploy the full mPower analytics solution to drill down further.

There are many compelling reasons to do that. Clinical quality, patient outcomes, revenue generation, and physician burnout top the list. Analytics can help increase revenue through improved compliance with evidence-based recommendations for follow-up exams. HealthCheck also can provide the data needed to evaluate ROI and calculate the total cost of ownership when seeking approval from hospital management for new purchases.

Finally, HealthCheck and mPower can be very effective tools for preparing for CMS Protecting Access to Medicare Act (PAMA) compliance next year. HealthCheck and mPower can analyze referral physicians and study outcomes to help practices understand and identify outliers in exam appropriateness ordering patterns. In particular, our HealthCheck analysis includes an evaluation of ordering patterns for CTA to evaluate for pulmonary embolism, one of the Priority Clinical Areas that CMA has identified for PAMA.

KH: Where can radiology leaders obtain more info about HealthCheck and mPower?

Dr. Boonn: The best way is to contact their Nuance account manager. There is a white paper that describes the role of analytics in value-based care and how mPower and HealthCheck can help. I’d also recommend Dr. Wandtke’s blog post where he shared his results using mPower and Follow-up Manager to dramatically improve follow-up compliance.

KH: Thank you, Dr. Boonn.

Arthur C. Nielsen, the founder of the ACNielsen marketing research company and the “Nielsen ratings” for measuring TV, radio and newspaper audiences, described the value of data analytics clearly when he said, “The price of light is less than the cost of darkness.” You could say the same about the actionable insights from HealthCheck and mPower. The data they provide are essential for addressing the challenges that all health systems face in improving patient and financial outcomes and alleviating physician burnout. The benefits of using data analytics – as well as the costs of not doing so now in an increasingly data-driven industry – are too great to wait.

The Real View is a Q&A blog series with Karen Holzberger, Vice President and General Manager of Nuance Healthcare’s Diagnostic Division. The Real View cuts through the hype and gets to what’s real, here, and now. The blog series features interviews and insights from health IT movers and shakers – and uncovers disruptive technologies that solve challenges, optimize workflow, and increase efficiencies to improve patient care.

 

 

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What’s in the CMS FY2020 IPPS Final Rule?

In August, the Centers for Medicare & Medicaid Services (CMS) released their 2020 Final Rule. Mel Tully, Nuance’s VP of Clinical Services and Education, highlights some of the changes and what they represent. 
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With the release of their FY2020 IPPS Final Rule, CMS appears to be sending a clear message: they’re working to transform the healthcare delivery system to bring patients better value and better outcomes. The new policies reflect some historic changes as well as more traditional, expected updates; in all cases, the Final Rule has important implications for clinical documentation improvement (CDI) professionals.

A few highlights:

  • First and foremost, the Final Rule encompasses more than 2,000 pages of text that include many changes to co-morbidities (CCs) and major CCs (MCCs), and ICD-10-CM codes. The volume of changes is extensive and calls for the most accurate documentation and coding possible in order to capture appropriate specificity for all procedures and supplemental codes.
  • Consider an example: with perioperative haemorrhage or hematoma, is it is very important to distinguish between ecchymosis, which is flat bruising; hematoma, bruising that does have a mass; and haemorrhage, which is excessive blood loss. Some procedures inherently have a large volume of expected blood loss. If this is the case, documentation should reflect whether the blood loss is within limit expected for the procedure. If the clinical documentation does not clearly describe the circumstances of the haemorrhage or hematoma, whether it is routinely expected or inherent to the procedure, or whether it is a complication, it’s incumbent upon the CDI professional to ask the question and assure the most accurate documentation possible.
  • Second, a range of updates in the FY20 rule accounts for innovations in healthcare devices and pharmaceuticals. In short, CMS does want hospitals to take advantage of innovations that contribute to better patient care and outcomes. Within the Final Rule, new technology add-on payments provide additional dollars to hospitals for each case that uses resources for approved new technology and breakthrough pharmaceuticals. And while some technologies have been discontinued, this is an important opportunity to look at what devices and drugs are in use in your organization, learn about new technologies, and expand your clinical knowledge.

Ultimately, the impact of precision coding and clinical documentation integrity permeates every use of patient information. From clinical care and care coordination to research, quality reporting, and billing, providers and CDI professionals alike must consider the impact of clinical documentation integrity in an environment that mandates better patient care at a lower overall cost. Quality is not a clinical intervention; it’s a pervasive approach to all aspects of patient care. The accuracy, quality, trustworthiness, and integrity of clinical documentation have the power to transform healthcare delivery for better patient care and outcomes.

Check out my recent Nuance in Healthcare podcast: Achieving Advanced Practice CDI.  While the episode does not highlight the CMS Final Rule, it does feature how best-in-class CDI is about building on the facility’s current infrastructure and supporting the current staff with the resources and education they need. When this happens, accuracy, outcomes, and patient care are impacted.

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The Way Forward: Key advice when upgrading or deploying new technologies

Done right, new technologies can alleviate administrative burdens for providers; done wrong – they may magnify them. Dr. Robert Budman, CMIO at Nuance, gives advice to organizations considering healthcare technology upgrades and deployments.
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This article was first published on October 1, 2019, by Health Data Management. Reposted with permission.

Healthcare organizations continue to focus effort and attention on combating physician burnout to not only improve the health and wellbeing of providers, but also to have a positive impact on patient care, safety, satisfaction, and quality; physician retention and turnover; and organizational financial metrics. Organizations tackle some of these issues by implementing healthcare enabling technologies including speech recognition, computer-assisted physician documentation, and even voice-activated virtual assistants

These technologies have been designed and refined in ways that make documentation processes and working within the Electronic Health Record (EHR) more efficient and intuitive while promoting usability. Simply implementing new technologies, however, doesn’t magically solve all the challenges an organization faces. Done right, new technologies can alleviate administrative burdens for providers; done wrong – they may magnify them.

Over my career, I have worked on and through many healthcare technology deployments, and while implementations vary in complexity and alterations in workflow, I can offer a few key pieces of advice to providers and organizations based on this experience.

1. Take advantage of the training. Make it crisp and mandatory. In fact, double down on the training; good training will pay off, but bad training will cost you dearly and isn’t good for patient care or providers. Focused, intensive “at-the-elbow” trainers can set up your providers for success.

2. Train to your organization and EHR workflow, rather than teaching providers how various buttons work. That means you’ll want to train on all your tools, not just the EHR, or just the speech recognition, or just CAPD. Going back for multiple rounds of remedial or “salvage” training is costly and time-wasting.

3. Don’t train to buttons or functions; train to end-to-end workflow excellence and expertise. Trust me – providers will be happier and more efficient. Then, when you’ve got your experts, rely on them to help train other providers. It works!

4. Use checklists and videos and short, high-value, frequent refreshers, especially when software is upgraded or expanded. Aim for the crisply targeted “need to knows” of your system. Break bad habits and close the training gaps as soon as discovered.

5. Open personalization “labs” or sessions to support providers in their specific use cases and create a sense of community among physicians. These environments will also reinforce the good habits and workflows of expertise and efficiency.

Recent research reveals that investments in technology training have a wide range of positive benefits from improved provider satisfaction to better patient care. After all, at the end of every digital healthcare interaction is what’s most important: the patient.

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New ACDIS scholarship to help CDI professionals advance their careers

Continuing education is vital for every professional in their long-term career success, and that’s especially true in healthcare. Education happens in and out of the classroom, including at networking events and annual conferences. But funding these types of opportunities can be a challenge for some organizations, and so ACDIS has launched its first-ever scholarship program to support three individuals in their professional development.
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Every profession evolves over time—and that’s no truer than in the realm of CDI professionals, who must learn and adapt each and every day. Continuous learning happens daily, with every new case and each interaction. But, formalized continuing education remains especially vital. The benefits of continuing education are wide and well-documented, from improving your earning power and career path to staying current with clinical learning and supporting your organization in its success.

Education happens in and out of the classroom; I’ve learned so much from the people I’ve met at networking events, where I’ve had the opportunity to converse and collaborate with people who share my values and do the same types of work as me. Likewise, we at Nuance strive to help our clients be successful, and so we have long focused on education for our clients. For decades, we have taught documentation strategies supporting final coding strategies, rather than codes, as a means to CDI success.

Because we value continuing education and fully appreciate the importance of in-person, structured, and unstructured learning, we have partnered with the Association of Clinical Documentation Integrity Specialists (ACDIS), who earlier this month announced their first-ever scholarship program for CDI professionals. Funding for these types of opportunities can present a challenge for some healthcare organizations, and so this program is designed to support three individuals in advancing their knowledge and education – and therefore their careers – as well as share best practices with colleagues.

In closing, I wanted to share another resource for continued learning. Check out our recent Nuance in Healthcare podcast episode, The impact of CDI on the patient story with Angie Curry. Angie highlights the importance of educating oneself as much as possible and taking advantage of educational opportunities to support your knowledge.

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Intelligence at Work: Qure.ai applies deep learning and artificial intelligence to streamline and improve radiologic diagnosis of chest x-rays and triage brain CTs

Qure.ai’s team of experts work to define clinically relevant problems and design real-world solutions that are deployed in 14 countries around the globe. The company seeks to improve diagnostic efficiency and accuracy in radiology, with an initial focus on chest X-rays and head CTs. Once FDA-cleared, Qure.ai algorithms will be integrated with Nuance’s next-generation reporting platform, PowerScribe One.
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Access to accurate and early diagnosis has become key to delivering quality healthcare around the globe. In many locales, the doctor-patient ratio is low, and even more so in the case of specialized practitioners such as radiologists. In underserved and remote regions, radiologist expertise is scarce, costly, and unequally distributed. Even in developed parts of the world, workloads are creating burnout issues and higher error rates for radiologists. This means that not all patients receive the most accurate, timely diagnosis. AI-driven radiology solutions can automate a lot of the routine work, saving precious time for radiologists and help mitigate clinician burnout.

Chiranjiv Singh, Chief Commercial Officer of Qure.ai, shares his insights about how Qure.ai’s algorithms aim to make radiologic diagnoses more accurate and efficient, by delivering AI capabilities within radiologists’ everyday workflows, to optimize results and deliver better patient care.

Qure.ai’s product philosophy is to solve clinical and workflow needs of customers and to go deep into certain areas rather than spreading across a spectrum of clinical areas.  Qure.ai has trained its algorithms on more than 7 million exams sourced globally and prides itself on having been validated by multiple papers in peer-reviewed research.  In line with this philosophy, Qure.ai has commercially released two algorithms to date, one focusing on detecting abnormalities in chest X-rays and the other for triage and diagnostic support of head CT scans. As of writing, the CT algorithm is 510(k) Pending with the US FDA.

Q&A

Jonathon Dreyer: Tell us about your business – when and how you started and your development journey.

CS: Qure.ai is a healthcare AI startup that applies artificial intelligence and deep learning technology to radiology imaging for quick and accurate diagnosis of diseases. Our algorithms can automatically detect clinical findings and highlight the relevant areas from X-rays, CT scans, and MRIs in a few seconds. This allows physicians to spend more quality time with patients to better understand their specific case/symptoms, communicate the diagnosis, and determine and discuss customized treatment plans – leading to better patient care.

Qure.ai was founded in 2016 by Prashant Warier and Dr. Pooja Rao. Prashant is a career data scientist and entrepreneur, and Pooja is a trained clinician. Together they bring complementary skills of engineering and medicine critical to product development. From humble beginnings in India 3 years ago, Qure.ai is now present across 14 countries through 80+ deployments and has processed more than 200,000 scans.

Our solutions have been validated and reviewed by clinicians at leading healthcare institutions such as the Massachusetts General Hospital and the Mayo Clinic, among others. The Lancet published validation of our technology, making it the first radiology AI article released by the journal. Qure.ai’s software is vendor-neutral and is deployed online with cloud-based processing capabilities integrated with the radiologists’ current reporting workflow.

JD: What AI algorithms do you have and what do they do?

CS:  We have two commercially released algorithms so far and are working to get them regulatory cleared for clinical use in the US market.

  • qXR scans abnormal chest X-rays to identify and localize 18 clinically relevant findings with an accuracy of over 95%. We have deployed this in various use cases, from screening to radiology assistance, to even post-read quality control. For example, qXR can screen for tuberculosis and is used in public health screening programs globally. When used as a point-of-care screening tool for TB, followed by immediate bacteriological/NAAT confirmation, qXR significantly reduces time to diagnosis.
  • qER is designed to triage critical cases and provide diagnostic assistance in head CT scans – a first-line diagnostic modality for patients with head injury or stroke. qER automatically detects intracranial hemorrhages (ICH) and its subtypes (intraparenchymal (IPH), intraventricular (IVH), subdural (SDH), extradural (EDH) and subarachnoid (SAH)), cranial fractures, midline shift and mass effect from non-contrast head CT scans.

JD: What’s the big “Aha” moment when you first show users what your AI algorithm(s) can do for them?

CS: The first Aha moment we get from customers is the depth of our capability. Unlike other AI algorithms in the market that may detect only a few findings on x-ray, we are able to detect and show accuracy numbers on 18 clinical findings from qXR. Similarly, for qER, we detect multiple sub-types of ICH along with cranial fractures, midline shift and mass effect – a larger triage capability than what most customers have seen so far from other AI vendors.

The next big Aha is when customers see our richness of peer-reviewed publications. Every AI company wants to claim high accuracy numbers, and yet there is a lack of trust among clinicians. We take this job of building trust as core to our company and therefore have invested resources to expose our algorithms to multiple independent reviews and peer-reviewed publications that help us reduce that trust deficit. The fact that our algorithms can identify and label the exact abnormalities, as well as their locations within the scans in a matter of minutes, with near-radiologist accuracy in a clinical setting, has been our biggest highlight.

Lastly, our integration within radiology workflow is the final wow! For example, we have worked with Nuance to integrate our AI algorithm outputs in PowerScribe One to allow radiologists to consume these outputs according to their preferred workflow. We are also integrating our outputs to help to prioritize radiologist worklists using PowerScribe Workflow Orchestration.

JD: What challenges or needs did you see that drove you to focus on this?

CS: Access to accurate and early diagnosis is crucial to delivering quality healthcare. In many places around the world, the availability of specialized radiology resources is limited. And even in more developed countries, the volume is increasing exponentially, putting limits on the ability of radiologists to deliver timely, accurate diagnoses.  Burnout is increasing as well as the potential for errors.  Our solutions can help automate a lot of the routine work, saving precious time for radiologists and thereby preventing clinician burnout.

We saw this as a need and simultaneously an opportunity to leverage the power of deep learning to develop solutions dedicated to this market. Our mission is to use artificial intelligence to make healthcare more accessible and affordable.

JD: What’s the number one benefit you offer?

CS: The number one benefit we offer our users is “trust and peace of mind.” This is possible only when a product is reliable and also invisible. We want our users – be it radiologists or public health experts – to focus on their patients and trust us for the accuracy of our algorithms. We also want to embed ourselves into their workflow in a manner that almost becomes invisible to their daily practice. We believe that our AI solutions shall be successful only if we are able to build integrated solutions with companies like Nuance that solve clinically relevant problems.

This is easier said than done. It means working hard to build solutions that are globally trained and validated, built on a large volume and variety of data, and embedded into diverse clinical workflows. It’s the challenge of meeting our customers’ expectations on this benefit that keeps us up at night.

JD: Are there any stories you can share about how your algorithm(s) drove measurable patient care outcomes?

CS: One of our customers is the Philippine Business for Social Progress, a local screening agency and the first adopter of artificial intelligence algorithms for tuberculosis detection in the Philippines. Working with their team, we built a custom, end-to-end TB workflow and patient registration software that helps health workers immediately refer potential TB suspects for confirmatory tests. Our solution is deployed in multiple mobile vans that move across different pockets of Manila and have been in use for >6 months. Prior to using qXR, the time to complete a patient diagnosis was >2 weeks. We have reduced that time to <1 day (from screening to x-ray to lab tests). We have identified 25% more TB cases than the original workflow and have screened 30,000+ individuals using our AI solution.

JD: What benefits does Nuance and its AI Marketplace for Diagnostic Imaging bring to your users?  What problems does the marketplace and integration into Nuance’s workflow solve?

CS: Nuance and its AI Marketplace brings two key benefits to our users. The first benefit is that it offers a single platform to review, try, and buy AI algorithms. Customers need a trusted partner with vetted solutions that connect trusted AI developers to clinical users. The Nuance AI Marketplace does this for every stakeholder in the user organization – clinicians get access to algorithms they can evaluate for clinical accuracy; IT administrators get easy integration without running multiple deployment projects with independent vendors; purchase/finance teams get streamlined negotiations and reduced time to execute multiple contracts.

The second and equally important benefit is seen once the purchase decision has been made. For our solutions to work and be used, they need to be accessible to the users when they are reviewing images and dictating their reports. We want to embed ourselves into customers’ workflow in a manner that is almost invisible to their daily practice. Nuance offers the right point and platform for this integration into the radiologist workflow for AI solutions like ours, and we are really excited to be part of this platform.

JD: What has your experience been working with the Nuance team?

CS: The experience of working with the Nuance team has been one of dealing with a team that is not only professional but also extremely knowledgeable and proficient in diagnostic imaging and reporting workflows. They understand the use cases of bringing in technologies like AI to meet real needs of their customers. I am looking forward to this partnership as we jointly work with our customers and deliver value to them.

JD: What is your vision for how your solution(s) will evolve over the next 5 years?

CS:  In the next five years, I see us offering more comprehensive solutions across various clinical domains, solving customer challenges at various points in the diagnostic journey of patients. We will enhance our capabilities by increasing our clinical coverage beyond chest x-ray and head CT that we offer today. In terms of diagnostics workflows, we see ourselves being able to offer more measurement and diagnostic tools to aid radiologists in their reads and even do tasks like treatment progression monitoring to aid other clinical users. Five years is a very long time in the field of AI, and I am confident that Qure.ai will be a dominant global player and a trusted partner for our customers over that time frame.

JD:  In one sentence, tell us what you think the future of medicine will look like?

CS: The future of medicine will be custom designed and served, focusing both on prevention and cure, and most importantly, accessible to all.

Learn more:

To learn more about Qure.ai, please visit www.qure.ai

To learn more about Nuance AI Marketplace for Diagnostic Imaging, please visit https://www.nuance.com/healthcare/diagnostics-solutions/ai-marketplace.html

Intelligence at Work is a blog series by Jonathon Dreyer, Senior Director, Solutions Marketing, Healthcare Division for Nuance Communications. Intelligence at Work showcases projects and applications that demonstrate how Nuance technologies extend the value, use, and performance of integration and development partner offerings. This blog series focuses on inspiring the healthcare developer community to think beyond their current state and take their innovations to new heights by tapping into the latest in artificial intelligence.

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What if we decided what had been done before was the least we could do?

Over the course of his life and career, major life obstacles haven’t stopped Dr. Lucian Newman from doing what he loves: playing golf and football, skiing, practicing surgery, and getting every ounce of joy from life. In fact, he has found that there is great joy in doing the things people say you can’t. In our new series, Dr. Newman will explore how he finds the extra time, effort, and joy to do all of those things and then some.
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Photo: Dr. Lucian Newman (right) performing laparoscopic colon resection surgery. 

We have roughly 28,000 days to live, and so we must strive to make the most of every day—extra time, extra effort, extra joy. Through the course of those 28,000 days, we are all bound to experience adversity, accidents, illnesses, and how we respond to them is how we build our character.

I was born in Birmingham, Alabama, in 1961 and contracted Guillain-Barre, a rare disorder that causes paralysis. As a child, I wore leg braces, not unlike those Forrest Gump wore in the movie, but which I threw away by the time I got to first grade—they got in the way of playing football.

Later on, I suffered a gunshot wound while hunting and lost my left arm as a result. Losing my arm hasn’t stopped me, however, from doing the things I love: playing golf and football, skiing, practicing surgery, and eking out that extra joy from my life. In fact, there is great joy in doing the things people say you can’t.

My specialty within surgery is minimally invasive procedures, which mitigated the disturbance in my career. I generally only hold the camera with my left hand. Prior to my accident I had operated and spoken about laparoscopic techniques in 22 countries. More importantly, overcoming this adversity has taught me how to be thankful for what I have, not to be regretful for the things I don’t. That’s a message I try to share with everyone I encounter in every walk of life. And it’s part of why I’m passionate about protecting physicians by offering meaningful education and solutions to help them find extra time in every day. A few years ago, I had the great honor of sharing all of this and more at a Tedx Talk at Rush University, and I look forward to exploring further over the coming weeks and months here.

Dr. Lucian Newman has conquered some of life’s most pressing challenges—and along the way, he has learned important lessons. He shares with us how he finds extra time, effort, and joy in life and work in his new blog series, The Joy of Doing what Others Say You Can’t.

At the End of the Day…it’s a privilege

Why we do what we do: support care teams and health systems in fulfilling their mission to provide quality of care to all patients.
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Last week my husband had shoulder surgery. We are very fortunate that he has a world-class surgeon and that we have good insurance. The operation cost over $55,000; however, our out of pocket was just under $1,000. My husband has been in a lot of pain and ready to get his shoulder repaired. While in the hospital waiting room, I reflected on those with injuries that do not have the insurance or money to be able to have surgery. There is an expression in hospital systems, “no margin, no mission.” Many people do not realize the average hospital system has operating margins of 2 – 3%. Compare that to the average S&P top 500 companies at 11.7%. The hospital systems’ mission is to serve ALL persons to create healthier communities. Although hospital margins are much lower than the average business, without that margin, they cannot serve those in need.

My husband’s surgery was a great reminder for me of why we do what we do at Nuance. At Nuance, one of the things we do is ensure proper reimbursement for health systems. Without that revenue integrity, they cannot serve those in need. We also have solutions to make surgeons more productive to capture the surgical documentation easily to save time and help get the hospital reimbursed much more quickly. My husband’s surgeon did three difficult surgeries that day and then was on call for the trauma unit that evening. She was back rounding with my husband at the hospital at 5:45 am. Nuance is working on some exciting new ambient technology powered by AI that will save her time in the clinic by providing clinical documentation that writes itself. It is a privilege to work in healthcare, and I am inspired to continue to pursue how we can help support care teams and health systems to fulfill their mission of providing everyone the quality of care that my husband received.

At the End of the Day… is an expression meaning an assessment of essential facts and truths. It’s a summation of the pros and cons of any situation and a straightforward statement of what really matters. It’s also the title of this blog series by Brenda Hodge, Nuance Healthcare’s Chief Marketing Officer, with insights about leadership, empathetic customer relationships, and marketing techniques.

 

Celebrating CDI superheroes who help make high-quality patient care possible

As the Association of Clinical Documentation Improvement Specialists (ACDIS) celebrates CDI Week in September, we at Nuance also recognize and honor all the CDI specialists who are truly “the heroes hospitals deserve.”
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Superheroes, it’s been said, symbolize hope as well as “the power to overcome any adversary.” They do good deeds, sweep in to save people who can’t save themselves, and act courageously in the face of adversity. Superheroes don’t exist only in fiction, however, and as the catchphrase goes, “not all heroes wear capes,” and the truth is that hospitals and healthcare organizations are filled with heroes who don’t wear capes.

Certainly, physicians and nurses are on the front lines of healthcare, providing the life-saving care and treatment patients need. But they aren’t the only heroes. The efforts and good deeds clinical documentation improvement (CDI) specialists accomplish every day help ensure that providers have access to the most accurate documentation possible to make the best possible decisions about each patient’s care. Just as importantly, CDI specialists are helping healthcare organizations receive appropriate reimbursements for the care provided.

For example, when Baptist Health in South Florida established its advanced practice CDI program, the organization realized a 9-point increase in the capture rate of severity of illness, as well as a nearly 7-point increase in risk of mortality capture. These changes in quality metrics better reflect the health of the patient population, which means providers can better care for patients; but it has also meant that the organization is realizing appropriate reimbursements as a result. None of this would have been possible without the superhero CDI team, whose role has been to help accurately document the complexity and severity of every patient’s illness.

As the Association of Clinical Documentation Improvement Specialists (ACDIS) celebrates CDI Week in September, we at Nuance also recognize and honor all the CDI specialists who are truly “the heroes hospitals deserve.” In this spirit, we launched a podcast series: Nuance in Healthcare. In season one, we focus on the passion that surrounds CDI. Speakers share stories of how their CDI expertise and role within clinical documentation are improving patient care. Check it out.

Thank you for all you do, and enjoy your week of recognition – it is well deserved!

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Customer Success: 6 steps to make your customer touchpoints count

Good, bad, or indifferent, every customer touchpoint is meaningful—and they accumulate in your customer’s mind. It’s therefore important to be thoughtful about every touchpoint to ensure the customer’s success is the first priority and remains at the heart of their customer experience journey.
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In recent years, organizations large and small have made the customer experience journey a strategic priority. Why? I think McKinsey said it best: “Many businesses are coming to understand that, increasingly, how an organization delivers for its customers is as important as what product or service it provides.”

I added the emphasis on how because it’s not just the services and products you provide to your customers, it’s how successful your customers can become as a result of their interactions and relationship with you. Healthcare organizations aren’t, for example, purchasing Nuance’s platform and solutions per se; they’re purchasing a path to better patient care and to improved financial performance. Their success then becomes our success.

Harvard Business Review notes touchpoints bring the customer experience to life. Every individual experience and encounter—or touchpoint—your customer has with you must have their success in mind: every phone call, email, in-person meeting, troubleshooting chat with your contact center, your most recent digital ad campaign, exchanges with your billing department, even the signage at the airport. These touchpoints all count, they all add up…  So how can you make your touchpoints more meaningful?  McKinsey & Company suggest the following six actions:

  1. Step back and identify the nature of the journeys customers take—from the customer’s point of view.
  2. Understand how customers navigate across the touchpoints as they move through the journey.
  3. Anticipate the customer’s needs, expectations, and desires during each part of the journey.
  4. Build an understanding of what is working and what is not.
  5. Set priorities for the most important gaps and opportunities to improve the journey.
  6. Come to grips with fixing root-cause issues and redesigning the journeys for a better end-to-end experience.

A customer’s experience with your organization becomes the sum total of every touchpoint throughout their journey with you. Make your touchpoints count.

The Customer Success blog series with Brad Morrison, Senior Vice President of Nuance Healthcare Customer Success, is an honest take on the ways to build and maintain strong relationships with your customers. The Customer Success blog shares industry insights, lessons learned, and humble advice based on both customer fails and success. 

 

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At the End of the Day…benefit all stakeholders

In this week's "At the End of the Day" series by Nuance Healthcare Chief Marketing Officer, Brenda Hodge, Brenda reflects on Business Roundtable's recently redefined purpose of a corporation.
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I was pleased to read that the Business Roundtable last week redefined the purpose of a corporation. Previously, corporations were defined to exist primarily to serve shareholders. The Business Roundtable’s new statement signed by 181 CEOs, is a commitment to lead their corporations for the benefits of all stakeholders – customers, employees, suppliers, communities, and shareholders.

This direction, if followed, will have a lasting impact on individuals, our communities, and our world.

The Business Roundtable Statement on the Purpose of a Corporation is below and worth reading.

Statement on the Purpose of a Corporation

Americans deserve an economy that allows each person to succeed through hard work and creativity and to lead a life of meaning and dignity. We believe the free-market system is the best means of generating good jobs, a strong and sustainable economy, innovation, a healthy environment and economic opportunity for all.

Businesses play a vital role in the economy by creating jobs, fostering innovation and providing essential goods and services. Businesses make and sell consumer products; manufacture equipment and vehicles; support the national defense; grow and produce food; provide health care; generate and deliver energy; and offer financial, communications and other services that underpin economic growth.

While each of our individual companies serves its own corporate purpose, we share a fundamental commitment to all of our stakeholders. We commit to:

  • Delivering value to our customers. We will further the tradition of American companies leading the way in meeting or exceeding customer expectations.
  • Investing in our employees. This starts with compensating them fairly and providing important benefits. It also includes supporting them through training and education that help develop new skills for a rapidly changing world. We foster diversity and inclusion, dignity and respect.
  • Dealing fairly and ethically with our suppliers. We are dedicated to serving as good partners to the other companies, large and small, that help us meet our missions.
  • Supporting the communities in which we work. We respect the people in our communities and protect the environment by embracing sustainable practices across our businesses.
  • Generating long-term value for shareholders, who provide the capital that allows companies to invest, grow and innovate. We are committed to transparency and effective engagement with shareholders.

Each of our stakeholders is essential. We commit to deliver value to all of them, for the future success of our companies, our communities, and our country.

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At the End of the Day… is an expression meaning an assessment of essential facts and truths. It’s a summation of the pros and cons of any situation and a straightforward statement of what really matters. It’s also the title of this blog series by Brenda Hodge, Nuance Healthcare’s Chief Marketing Officer, with insights about leadership, empathetic customer relationships, and marketing techniques.

 

How AI-driven CDI programs give people more of what we need most: time

The transition to value-based care has made doing more with less increasingly important, especially through healthcare business management. Patient documentation must accurately reflect not only the patient population’s health and history, but also the level of care required to appropriately care for patients. Today’s technologies and artificial intelligence (AI) solutions are designed to support CDI teams in their quests for efficiency, and a well-coordinated approach gives people more of what they need most: time.
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Improve-documentation-productivity-get-back-time

Originally posted in the August 2019 ICD-10 Monitor.

The concept of “doing more with less” is far from uncommon. You hear it every day in nearly every aspect of life: at home, we strive to live simply; in the community, we build resiliency; and at work, we are asked to boost productivity while improving effectiveness.

The transition to value-based care has made doing more with less increasingly important. That is, clinical documentation is a core function across healthcare business management, as documentation must accurately reflect not only the patient population’s health and history but also the level of care required to appropriately care for patients. Documentation that is either inaccurate or lacking in appropriate specificity (or both) can have a negative impact on reimbursements, quality ratings, denials, and—most importantly—patient health and wellbeing. On the other hand, we know from extensive available research that healthcare organizations with robust CDI programs consistently rank high in terms of quality, especially around observed-to-expected mortality ratings, an area that is most directly affected by the quality of documentation.

For example, if a patient’s documentation reflects a urinary tract infection, but that patient died, the documentation was clearly wrong. There was a missed diagnosis within the record, which not only affects reimbursements, but it also is publicly reported that healthy patients may die while in the care of that organization.

In short, we need to do more, to work smarter and more efficiently. Through the focus on clinical documentation improvement (CDI), a great responsibility falls to coders and CDI specialists, as they’re charged with applying their skills and experience in new ways. Not only must these professionals possess the appropriate knowledge to help ensure excellent clinical documentation, but they must also have the finesse to collaborate with physicians and executives along the way. That is, their responsibilities have expanded, but they have no more time in the day.

Today’s technologies and artificial intelligence (AI) solutions are designed to support CDI teams in their quests for efficiency. Consider a CDS which has 100 patient charts in their workflow. Research suggests that only 30 of those charts require follow-up or clarifications—but which 30 should you spend your time on? In the past, each record would need to be manually reviewed to uncover only those charts that represent quality improvement opportunities. Today, however, the right technology can help CDSs home in on those more complex cases automatically, allowing Clinical Documentation Specialists to apply and use their skills more effectively and spend their time in ways that can make the most impact.

Similarly, AI can be applied to the front end of the documentation process, supporting providers and physicians as they add specificity where it matters most. A healthcare virtual assistant, for example, is one AI-powered platform that augments providers’ knowledge, recognizing natural language to make chart searches, EHR navigation, and CPOE more intelligent, simpler, and voice-powered. By helping providers create more complete and compliant documentation upfront, these technologies are creating efficiencies on the backend, giving even more time back to CDI specialists and coders. Now, they’re able to dive deeper into patient records, free from the weight of retrospective queries and rework.

Engaging the entire organization in denials prevention

Denials remain a costly burden for healthcare organizations, both in terms of financial impact as well as the amount of time coding and CDI specialists must dedicate to addressing denials as they arise. The rules around denials are fluid, and it can be difficult to keep up with them; this is complicated by the fact that once a claim has been denied, there is typically a short timeframe in which to address it. The process chews up time and other resources and requires extensive knowledge of the appeals process.

It is in this area that today’s clinical documentation technologies are well-positioned to support organizations’ denial prevention strategies. CDI and coding specialists can rely on tools that capture greater specificity in clinical documentation, mitigating the risk of denials upfront. On the backend, the right technologies will also include appeals templates to help CDI teams effectively and efficiently address denials as needed.

While the technologies themselves are designed to support any organization’s denial prevention strategy, adding a guidance and educational program will optimize the impact of these investments. These programs can drive toward organizational goals by keeping all clinicians and specialists on top of changing payor requirements and processes, helping continuously improve the quality of documentation, and engaging the entire organization in quality improvements.

In other words, the combination of educational programs and technology solutions help improve the quality of documentation upfront, which alleviates the burden of rework while also helping to prevent denied claims going forward.

The future of CDI: education, process changes, and AI-powered improvements

In December 2018, McKinsey published its research on the “promising” effects of natural language processing (NLP) in healthcare. Indeed, from the ability to identify appropriate and accurate ICD-10 diagnosis codes to the creation of time-savings opportunities, the influence of NLP—itself a subset of AI—can have a significant and positive impact on CDI teams’ ability to expand case coverage while maintaining resources.

This progress, of course, is made more powerful by the advanced analytics only available through innovative technologies that can aggregate and process large amounts of data. We hear consistently that one of the most challenging aspects of healthcare leadership is benchmarking: how are we doing? How are we doing relative to our own performance, or that of other organizations like ours? Where are our problem areas? Has our patient population changed and affected the case mix?

Getting answers to these questions used to be incredibly difficult. Today, however, with real-time intelligence that’s available within advanced CDI technologies, it has never been easier to uncover areas where education, process changes, and other interventions can have a positive impact and give all of us more of what we need most: time.

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Meet your patients where they are with 24/7/365 answers to their portal questions

We conclude our series, “Making the most of your Epic MyChart Patient Portal,” with real advice on how to empower your patients to take a more active role in their healthcare—and support them on their journey.
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As patients take increasingly active, hands-on roles in their healthcare—truly becoming part of the care team—they need immediate, reliable access to the medical records, test results, and care plans so they can continue to advocate for themselves.

With the Epic MyChart Patient Portal, healthcare organizations enable exactly that: secure, online, on-demand access to their health information. But as we have written over the last several weeks, it isn’t enough to simply turn on the portal and assume patients will have positive, engaging experiences that keep them coming back. From choosing the features that drive adoption to attaining and maintaining organizational buy-in, there can be a lot to manage—including, perhaps especially, the need and ability to resolve your patients’ questions in real-time.

Consider the patient who’s trying to log into their MyChart on Saturday evening and has forgotten their username and/or password and has been waiting for important lab results. Likewise, patients may have trouble navigating the self-service tools for refilling prescriptions or requesting appointments. They need to reach out to someone for support in that moment or chances are good that they’ll leave the site and not return, meaning your organization is less likely to achieve your meaningful use goals.

Thus, the focus of the final chapter in our series, “Making the most of your Epic MyChart Patient Portal,” is to answer this key question: how do you help your patients utilize MyChart whenever, wherever, they need help? The allure of a patient portal is its around-the-clock accessibility, but most IT departments are simply not structured to operate and respond to patients in this way.

The answer lies in a real-time, patient-centric support model. Supporting your patients in this way helps encourage adoption of the key features and builds confidence and trust in a well-defined patient portal and, by extension, your office. When you’re evaluating your options, look for a partner who becomes an extension of your own team and shares your view of patient care. In addition, look for a partner who:

  • Knows and understands Epic MyChart, through and through, and can help optimize the development of the patient portal to align with your patient engagement objectives.
  • Understands how to help build a successful cross-departmental committee and gain buy-in for maximum results
  • Acts as an extension of your organization’s patient-centric culture to help navigate billing, prescription refills, e-Visits, eCheck-in processes, and more
  • Provides certified, bilingual representatives to resolve your patients’ inquiries through omni-channel communication 24/7/365
  • Can organize, manage, and support customized outreach campaigns to your patients to help make the most of your investment
  • Resolves patients’ questions quickly and successfully: within an average of 60 seconds on the phone, and in less than two hours via email

Healthcare is, and always will be, personal. When we have questions about our health, we need answers urgently, and not just during “normal” business hours. Make the most of your Epic MyChart patient portal investment by meeting your patients where they are with timely, effective support as they navigate the valuable tools you’ve given them. At the end of the day, you’ll create happier, healthier patients who are actively engaged in their care.

Learn more about the Nuance Epic MyChart Service Desk, and hear from our customer, Dr. Stephanie Lahr, CMIO from Regional Health, about how the service has improved their patients’ experience using, and adopting the patient portal.

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The Way Forward: Physician retention and turnover in critical access and rural hospitals

Physician retention programs remain a strategic initiative for healthcare organizations of all sizes. But rural facilities may feel the impact of turnover more acutely than larger ones, both in terms of patient care and financial cost. In our continuing series with Robert Budman MD MBA, former CMIO of Atlanta’s Piedmont Healthcare, we explore “The Way Forward” in offering strategic direction and help for critical access and rural hospitals.
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This article was first published on July 15, 2019, by Health Data Management. Reposted with permission.

Rural health facilities and critical access hospitals face the same inherent operating challenges as larger and urban organizations; the difference, however, is that the impact of each is heightened in more rural environments. Physician recruitment and retention are no different.

The loss of even one provider at a small facility can carry an enormous impact, both in terms of patient care and financial cost. In many cases, critical access facilities are the only nearby source of patient care, so when a provider leaves the organization, the result is limited access to healthcare services and a disruption to the community; it may also necessitate travel under duress. The financial impact can also be overwhelming. A recent article estimated the “staggering” cost of physician turnover to be as high as $400,000 per provider when you factor in the recruitment, onboarding, and training costs in addition to lost revenue opportunities.

There are ways forward. First, it’s helpful to learn why physicians may leave your organization. Rural communities are by definition more isolated; is that having an impact on dedication to remote entities? Are other incentives and amenities sufficient to positively affect providers’ quality of life? Consider how your organization might be able to effect change among these factors, including the intangible factors. One has to provide a mix of values and opportunities to succeed professionally and personally.

Second, we previously discussed the profound impact that administrative burden has on providers. Physicians tend to be increasingly busy in today’s healthcare environment, and that’s especially true in rural and critical access hospitals when the load can’t be shared across a large practice group the way it can in bigger organizations. Creating efficiency and enhancements in the daily workload and making more time for meaningful patient interactions deepens the providers’ connections to the community and may strengthen their attachment to that facility.

Various healthcare technologies and artificial intelligence (AI) can, as Deloitte has written, enhance the physician-patient experience, thus making it easier to integrate valuable data into the patient record. Improving outcomes, alleviating administrative burden, and automating routine and often mundane tasks make up the holy grail of modern digital healthcare. Together, all of these factors may help reduce burnout, which could lead to lower turnover rates, not to mention the impact on patient care in terms of quality, safety, outcomes, and reimbursement.

As the digital transformation marches on, we expect to see more and more opportunities for rural healthcare organizations to take advantage of advancements that lead to efficient and satisfied physicians, better patient experiences, improved provider retention, and organizational performance enhancements. That’s why it’s essential for organizations to rely on a consultative technology partner who can provide proven solutions that can help establish a technology roadmap that leads to a stronger and more stable future state.

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Intelligence at Work: Knee Osteoarthritis Labeling Assistant (KOALA) for detecting signs of knee osteoarthritis by IBL

Read how IBL’s KOALA AI-driven application, currently pending FDA 501K approval, can help improve assessment and diagnosis of many musculoskeletal conditions and impact patient care. It will support physicians in detecting signs of knee osteoarthritis based on standard joint parameters, and help track disease progression. It is available for review on the Nuance AI Marketplace for Diagnostic Imaging, and once approved, will be integrated with Nuance’s next-generation reporting platform, PowerScribe One.
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As the population ages, arthritis and other musculoskeletal diseases are an increasing cause of physician visits and health care spending.  With increased prevalence comes an increased burden for rapid, precise diagnosis and staging, as well as an ability to predict future disability. Unfortunately, interpreting orthopedic images can be laborious. There is a need for standardization and simplification while providing quantitative disease parameters to support treatment decisions. Having precise measurements is the missing link to tracking the slow progression of degenerative diseases.

Dr. Richard Ljuhar, CEO and co-founder of ImageBiopsy Lab (IBL), shares his thoughts about how IBL’s AI-driven musculoskeletal imaging algorithms aim to improve assessment and diagnosis of a range of musculoskeletal conditions, including osteoarthritis (OA), osteoporosis, and rheumatoid arthritis.  The goal is driving timely and appropriate interventions to reduce morbidity and disability – relieving pain and improving patients’ lives.

Interpreting musculoskeletal images is a challenge due to the lack of objective analysis methods and standardized digital documentation of radiographic changes. Because of these shortcomings, diagnosis and predictive assumptions show significant inter-rater variabilities and are thus often unreliable. IBL uses state-of-the-art artificial intelligence technology to efficiently address these challenges, relieving physicians and researchers of time-consuming image analysis tasks, while at the same time improving diagnostic accuracy and predictive capability.

Q&A

Jonathon Dreyer: Tell us about your business – when and how you started and your development journey.

Richard Ljuhar: ImageBiopsy Lab (IBL) was founded by a team of experienced professionals and specialists in medical technology and AI, along with board-certified doctors in orthopedics and radiology. Based on personal experience of the management team, plus intensive discussions, brainstorming, and surveys of medical users, core elements of our AI modules have been successively worked on since 2012.  IBL was incorporated in 2016 and began implementing its business strategy. The initial focus has been on applying deep-learning methods to knee osteoarthritis (OA), and this was our first use case. But our modular platform technology is designed to be applicable to any orthopedic imaging data, so we have expanded beyond knee OA to other musculoskeletal disease applications.

JD: What AI algorithms do you have and what do they do?

RL: The focus of IBL is on digital X-ray and musculoskeletal diseases, with artificial intelligence-driven solutions for anatomical regions such as the knee, hand, hip, whole leg, and spine. Our first CE-marked/510k pending module KOALA (Knee Osteoarthritis Labeling Assistant) supports physicians in detecting signs of knee osteoarthritis based on standard joint parameters and OARSI criteria of standing radiographs of the knee. PANDA (Pediatric Bone age and Developmental Assessment) supports an objective and standardized determination of pediatric bone age. HIPPO (Hip Positioning) supports objective and standardized measurement of the most important hip angles based on digital x-rays.

JD: What’s the big “Aha” moment when you first show users what your AI algorithm(s) can do for them?

RL: A remark from Peter Steindl, MD, an orthopedic surgeon, sticks in my mind.  He said, “I guess my biggest “Aha moment” was that I realized the potential to measure and compare sclerosis, joint space narrowing, and OA-grades in an objective way in a particular patient over a couple of years. I think this device/software might be very helpful in finding the optimal timing for planning a joint replacement surgery of the patients’ knee.”

JD: What challenges or needs did you see that drove you to focus on this?

RL: After years of experience and discussions with medical experts, IBL identified that orthopedic diagnoses could benefit immensely from AI-driven solutions. Workflows are time-consuming and elaborate with interpretations often subjective and difficult to reproduce. Additionally, image reading and interpretation often hasn’t changed significantly since the introduction of radiography. The need to bring musculoskeletal/orthopedic radiology into the digital age drove our motivation to change the status quo. IBL’s software offers simplification and standardization while at the same time providing quantitative disease parameters to support treatment decisions.

JD: What’s the number one benefit you offer?

RL: While we support medical experts and their patients in numerous areas during the diagnostic pathway, we see the greatest benefit of our solutions in automation and in consistent documentations of radiological parameters. Big data and artificial intelligence cannot replace physicians, but they can relieve them of time-consuming routine tasks. This should allow medical experts to invest their time where it is most needed—with their patients!

JD: Are there any stories you can share about how your algorithm(s) drove measurable patient care outcomes?

RL: Our experience and that of our customers has shown that through our solutions there is a higher level of agreement between physicians, improved patient communication, more appropriate and timely therapy decisions, and an increase in patient loyalty.  In fact, we even had patients approaching us directly asking if we can run the digital analysis of their X-rays as they wanted to get an accurate assessment of their disease progression.

JD: What benefits does Nuance and its AI Marketplace for Diagnostic Imaging bring to your users?  What problems does the marketplace and integration into Nuance’s workflow solve?

RL: IBL and Nuance deliver their core value at the most critical interface of the radiology workflow: Translating the image information to a report. Our AI solutions facilitate this transition by providing quantitative and objective measurements. Thus, the flawless integration of our AI output to pre-fill reporting templates via Nuance delivers the most value to existing workflows. Being delivered at the heart of where radiologists’ time and decision making matters the most is what is streamlined by Nuance while proving a scalable IT infrastructure and customer base to build a win-win-win situation for IBL, Nuance and the physicians benefiting from time-saving and quality improvements.

JD: What has your experience been working with the Nuance team?

RL: We at IBL especially like the forward-thinking design of how AI results are injected to existing reporting workflows which made it highly attractive for us to collaborate. The early designs of the Nuance AI-driven solutions already reflect the experience and professionalism of a company with tremendous domain knowledge and ability to deliver the promised value of AI for physicians. Nuance’s responsive support allowed IBL to quickly ramp up demos and use cases, and we are very happy to be part of the family.

JD: What is your vision for how your solution(s) will evolve over the next 5 years?

RL: IBL will expand its portfolio of fully automated AI solutions for musculoskeletal radiology where automation matters the most – time-saving and objective outcome measures on standardized, high-volume tasks that enable easier comparison between repeated visits of the same patient. With this, the workload of the orthopedist and radiologist can decrease, while the quality of results can increase. And because precise measurements are the missing link to tracking the slow progression of certain MSK diseases, radiologists using IBL’s solutions deliver the perfect service to their referring orthopedists, who can apply IBL’s outcome measures to tailor personalized treatments and monitor their efficacy over time. The longitudinal structured data of our AI solutions supports powerful prediction models which use our AI results and clinical data to predict the future progression of the patient’s condition. This is possible due to IBL’s decade-long experience of building image processing algorithms and experience to transform immense datasets to actionable clinical decision support.

JD: In one sentence, tell us what you think the future of medicine will look like.

RL:  Automation and standardization will lead to an increasing amount of structured data which in turn will lead to a growing number of AI-applications in the years to come.

Learn more:

To learn more about ImageBiopsy Lab, please visit www.imagebiopsylab.ai

To learn more about Nuance AI Marketplace for Diagnostic Imaging, please visit https://www.nuance.com/healthcare/diagnostics-solutions/ai-marketplace.html

Intelligence at Work is a blog series by Jonathon Dreyer, Senior Director, Solutions Marketing, Healthcare Division for Nuance Communications. Intelligence at Work showcases projects and applications that demonstrate how Nuance technologies extend the value, use, and performance of integration and development partner offerings. This blog series focuses on inspiring the healthcare developer community to think beyond their current state and take their innovations to new heights by tapping into the latest in artificial intelligence.

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At the End of the Day… gather knowledge

When you invest the time and energy into gathering knowledge from people with diverse points of view, you gain powerful, valuable insights and collective knowledge.
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Last week I traveled to Atlanta to a training facility we often refer to as going to “camp.”  Although the accommodations are basic, the work we do there together is always worth the trip.

A cross-functional group gathered to share knowledge on some of our competitors and discuss our right to win against those competitors.  It’s always fascinating to hear viewpoints from others in the organization that have a different vantage point and comparing the viewpoints to various inputs from client conversations.

It’s a difficult task to gather local knowledge and combine it into insights and collective wisdom. Many companies have systems to gather these insights, but nothing is as powerful as the uninterrupted face-to-face time to collect knowledge and insights.

At the End of the Day… is an expression meaning an assessment of essential facts and truths. It’s a summation of the pros and cons of any situation and a straightforward statement of what really matters. It’s also the title of this blog series by Brenda Hodge, Nuance Healthcare’s Chief Marketing Officer, with insights about leadership, empathetic customer relationships, and marketing techniques.

The Way Forward: Physician burnout

Critical access and rural hospitals provide vital healthcare services to a significant portion of the U.S. population but continue to face significant challenges. Although these are small facilities with tight staffing, the day-to-day struggles basically are really no different than the largest healthcare organizations—but the issues tend to be amplified because of limited resources. In our new series with Robert Budman MD MBA, former CMIO of Atlanta’s Piedmont Healthcare, we explore “The Way Forward” in offering strategic direction and help for critical access and rural hospitals.
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This article was first published on July 15, 2019, by Health Data Management. Reposted with permission.

Over my career, I have had the privilege of working in a wide variety of family medicine practices, emergency departments, urgent care centers, and hospitals around the globe and at organizations large and small. I find it highly rewarding to care for patients directly as well as to support hospital staff as we successfully deliver services. Some of the most vital needs are provided at rural and critical access hospitals across the U.S. In some communities, in fact, these facilities are the only source of patient care.

The providers at these smaller facilities face similar challenges as those at larger organizations: administrative burdenburnout, and financial pressures(due to both an aging population and payor reimbursements)—all of which combine to affect organization-level safety and quality, plus concerns around physician recruitment, satisfaction, and retention.

These demanding realities are amplified at smaller facilities. Consider how a 1 to 3% improvement in efficiency, for example, would affect a large healthcare organization versus a critical access hospital. For the critical access hospital, this could be the difference between survival and failure. Whereas a large organization may have a better cushion in terms of its medical staff and financial resources, smaller organizations will be more sensitive to staffing issues, modest changes in reimbursement, and health information management.

There are ways forward. Let’s start with the notion of alleviating the administrative burdens that have been lumped into a physician’s workday. A new report reveals that 38% percent of providers spend 10-19 hours per week on administrative tasks; 32% spend more than 20 hours per week in these activities. I know from experience that physicians would rather spend their time caring for patients, so we must streamline the processes of documentation, improve the efficient use of the EHR, and eliminate downstream inflows of added work.

Today’s technologies offer numerous opportunities to move the needle. For example, speech recognition solutions accurately and more quickly capture the narrative of patient encounter notes and assist physicians in capturing correct and pertinent documentation details. In addition, virtual assistants automate tasks like lab and radiology searches, retrieve evidence-based guidelines, and carry out CPOE to help save innumerable clicks.

All these ways forward hold great promise for organizations of all sizes. For facilities with limited resources, the impact may be even more consequential, which is why working with technology partners who have a concrete vision and way forward for smaller hospitals will become imperative. And, the future holds even more promise than the present; we’ll touch on where we’re headed in our coming articles.

To learn more, please go to www.nuance.com/healthcare

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Attaining and maintaining organizational buy-in for your MyChart Patient Portal

Our blog series, “Making the most of your Epic MyChart Patient Portal,” continues as we discuss the importance of organizational buy-in as a key success factor in your program. From physicians’ timely responses to patient communications to confirmation of scheduling requests, every area must fully support your portal program. Here, we explore how best to attain and maintain buy-in throughout your organization.
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According to research just released this summer, access to a patient portal leads to “fewer emergency department visits and more outpatient clinic visits”—meaning that these patients are making better decisions about how to manage their care and conditions, avoiding costly emergency visits and inpatient admissions. And while the majority of healthcare organizations have given their patients access to these portals, utilization continues to lag, despite the benefits they provide.

Over the last few weeks, we have shared with you our perspective on how to make the most of your Epic MyChart Patient Portal program: how it drives patient engagement and better patient care, why your portal program needs an oversight committee, and the high-value portal features that lead to greater adoption and utilization among your patient population.

Another key pillar of this conversation is the way in which organizational buy-in contributes to a successful program. Consider an example: if your organization has implemented a secure messaging feature, but physicians—for whatever reason—do not reply to patient questions in an established timely manner, that will diminish patients’ desire to continue engaging in the portal. Likewise, if patients can request appointments, but no one confirms them, that too can lead to frustration with the portal.

Similarly, imagine a patient given instructions to access the patient portal for lab results within three business days, but two weeks later, after multiple attempts, the patient still cannot find the results. Would this experience build the patient’s confidence and see the value of using the portal the next time? Or, would a patient revert to simply call the office for the results? A bad experience or frustration can lead to a patient no longer seeing the value of the patient portal. From the physician perspective, when a patient initiates the manual process – which can include multiple phone calls between parties to resolve – all parties are spending more time on the task than experienced with the patient portal.

Instead, think about how valuable it would be to proactively address these simple yet impactful items and have all care team members bought into and supportive of your Epic MyChart Patient Portal program. It’s more than just adopting and implementing the features; it’s about getting all clinicians and administrative staff on board and realizing what is in it for them as well.

So, how can organizations encourage cross-departmental buy-in?

Start by making sure each involved department has a champion on the oversight committee to represent their perspective and needs. Ensure that each group has a say in how MyChart features can help the individuals, departments, and is part of the organization’s overall strategy. True collaboration for the greater good can be challenging to achieve and may seem too time-consuming. But the benefits of collaborating to gain cross-departmental buy-in will result in achieving results more quickly. Slow down and gain cross-departmental buy-in from your teams. Your patients and your internal teams will thank you for it.

Once you have the right groups involved, invest in defining workflows, providing role-based training, establishing clear expectations with change management, and provide the ongoing support necessary to maintain long-term buy-in and involvement. Not knowing how to perform a task is a huge barrier to buy-in, so everyone in the organization must understand how they contribute to the patient portal’s success.  Each interaction with a patient can make or break adoption.  Equipping resources with the information and skills they need to interact with and use the features of the MyChart patient portal will ultimately impact the patients’ experience.  Physicians should not only know that they must respond to patients’ questions within the benchmark time frame; they must also know how to access those messages. Schedulers should know how to access patients’ appointment requests and integrate them into the daily schedules. Clinicians should know how to access patients’ online questionnaires efficiently, and so on.

With so many factors that contribute to a patient’s experience, the time you invest in building a robust MyChart patient portal program will go a long way toward success. Build a team and success will follow.

Last month, Nuance’s Director of Epic MyChart Service Desk, Mandy Love, hosted a webinar on making the most of your MyChart investment. If you missed it, you can find it on YouTube. Also, look for our conclusion to this series as we examine how you can best support your patients in their use of the portal.

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Customer Success: When you do more than listen, you do more than win

Our customers’ problems are ultimately our problems to help solve, and doing so means we must go beyond simply listening to what they have to say. In this post, we explore how a customer influenced our shift in mindset so we could solve one of their biggest challenges and keep them moving forward on their journey to clinical documentation excellence.
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I’ve written before that our customers are at the center of all we do, and that we can succeed only when our customers succeed. And so, we must truly listen to what our customers have to say and remain engaged and committed to the feedback loop.

But what happens when we take it a step further? What happens when we treat and care for customers and prospective customers like the patients they serve?

Imagine you’re meeting with a new physician. You start by providing a complete medical history and a description of what brought you to the office that day. The physician listens to what you have to say, likely orders some lab work or imaging exams, and when the results are in, you reconvene to determine your treatment path forward.

We aim to treat our customer relationships similarly: asking questions to get a complete history of their technology journey, an understanding of the challenges they face, and an assessment of their existing systems and workflows—all of this before determining the best “treatment” plan moving forward.

We at Nuance recently had the privilege of hearing one of our valued customers speak at an event. Jill Tays of Magnolia Regional Health Center shared her journey toward clinical documentation excellence, which began a number of years ago when the organization was looking at a range of fragmented health technologies and wondering how standardizing to a single provider might make significant improvements both to patient care and financial metrics.

Standardize they did, but not with Nuance, and over time, the physicians and leadership grew dissatisfied with the clinical documentation improvement (CDI) approach; they identified a need to drive documentation improvements from a quality perspective. Eventually, the organization restructured, and the opportunity to consider Nuance’s technologies for CDI emerged—though, admittedly, there were some challenges. Magnolia was invested in their suite of systems, so there were reservations about making a change not only to technologies but to how the organization approached CDI entirely.

We give Jill a lot of credit for helping us truly understand that our customers’ problems are ultimately our problems to help solve. In fact, it’s because of Jill that we began to consider the customer-as-patient perspective. To win the business and truly help Magnolia improve their CDI program, we had to step back, get a full history, do some assessments, work together on the treatment plan, and partner to implement the treatment plan. These steps were not something the previous technology vendor was willing or able to do.

You can hear more from Jill about Magnolia’s success and journey to clinical documentation excellence in this video or read the complete story here.

As Jill states in the video, “Nuance wants you to succeed…they went above and beyond to make sure we were successful as an organization with our documentation…as a leader, that lets me know they care about the results we are getting.”

And so, I firmly believe that when you do more than listen, you do more than win.

The Customer Success blog series with Brad Morrison, Senior Vice President of Nuance Healthcare Customer Success, is an honest take on the ways to build and maintain strong relationships with your customers. The Customer Success blog shares industry insights, lessons learned, and humble advice based on both customer fails and success. 

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A Real View – The best reasons for joining the largest image-sharing network? Patient outcomes.

More than 6,400 care facilities of all sizes have made PowerShare the largest image-sharing network in the country. Many choose PowerShare because of its impact in everyday, ordinary usage – thanks to its size, reliability, ease of use and 24/7 support. But it’s in those extraordinary or potentially life-threatening circumstances -- when time and speed of access matter most --- that they discover PowerShare’s greatest strength is in fostering positive patient outcomes. Here are a few real-world examples.
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In my last blog entry, I shared how care facilities of all sizes have made the Nuance PowerShare Network the largest image-sharing network in America. The network has even grown since then and now serves more than 6,400 facilities spanning nearly 25,000 physicians and more than 26,000 patients exchanging almost 1.5 million studies each month. It’s a turnkey, scalable and EMR-integrated solution that helps providers #DitchTheDisk and improve patient experiences unfettered by institutional walls and geography.

PowerShare Network reliably delivers those benefits in day-to-day, ordinary usage and during challenging, unanticipated or potentially life-threatening circumstances when its size and ease-of-use are critical for positive patient outcomes. Here are a few ordinary and extraordinary examples of the PowerShare Network in action:

Children’s of Alabama: PowerShare eliminated hundreds of unreadable CDs that disrupted workflows, delayed care and required rescanning of young patients at the third-largest pediatric medical facility in the U.S. and the only Level I pediatric trauma facility in Alabama. PowerShare was especially valuable for surgeons who gained time to evaluate cases and prepare care teams before a patient arrives.

WellStar Health System: The ability to send images via PowerShare directly from the PACS for viewing within minutes has improved healthcare experiences and access to specialist care for patients served by Georgia’s largest health system. Rapid image-sharing can help quickly determine if stroke patients in areas without neurologists require a consult, medication, or transfer. Mammography patients also receive the results of their latest exams more quickly, including much larger, data-intensive 3D mammograms.

Orlando Health: PowerShare has eliminated time-wasting CDs and given more than 2,200 physicians real-time, mobile access to images. Orlando Health first implemented PowerShare after several frustrating efforts to build its own network. The health system subsequently wanted to give physicians the ability to look at echo and moving image studies on mobile devices and at home. The Nuance PowerShare team made that happen within 45 days.

Great Plains Health: A patient of the Nebraska health system urgently needed an imaging exam to have a custom prosthetic built and schedule surgery before an imminent insurance deadline. The care team used the PowerShare Network to route the images to the prosthetics builder within an hour of the exam and quickly completed the entire process. It would have added at least two days and possibly complicated insurance coverage if they had to ship CDs.

Indiana University Health (IUH): A community hospital initiated the transfer of a woman to IUH’s Methodist Hospital Level I Trauma Center 45 minutes away in Indianapolis after an abdominal CT indicated serious injuries suffered in a fall from a moving vehicle. With the ambulance en route, the local facility sent the images to IUH via PowerShare. The IUH trauma team quickly determined that the woman had active bleeding in her spleen and alerted the interventional radiology team.  The IR suite was prepared and ready when the patient arrived.

Holmes Regional Medical Center, Arnold Palmer Hospital for Children and Winnie Palmer Hospital for Women & Babies: Baby Christian began vomiting a day after full-term delivery at Holmes Regional in Melbourne, FL. An abdominal X-ray indicated an emergency requiring the pediatric trauma resources at Arnold Palmer Hospital more than 70 miles away in Orlando. Holmes Regional sent baby Christian’s X-ray via PowerShare to Arnold Palmer Hospital where the pediatric surgeon viewed it on his iPad and ordered an upper GI scan. Holmes Regional completed and sent the scan to the surgeon who accessed the images from his car and sent them to colleagues at the adjacent Winnie Palmer Hospital. Baby Christian arrived via medical helicopter and was rushed directly to the fully prepped OR at Winnie Palmer Hospital.

The PowerShare Network is a linchpin of our comprehensive diagnostic solutions – providing not only an image-sharing vehicle but also providing a robust platform that supports the key components of the end-to-end radiology workflow. Its large and robust infrastructure enables us to deliver value at scale from the moment a customer joins. But in the end, the most important reason why customers choose it and then recruit their own healthcare partners to join is the impact that PowerShare has on care quality, physician satisfaction and patient outcomes every single day.

For us, the thought of a young, happy, healthy boy named Christian about to begin his first day of elementary school is one of the best reminders of that fact.

A Real View is a Q&A blog series with Karen Holzberger, Vice President and General Manager of Nuance Healthcare’s Diagnostic Division. The Real View cuts through the hype and gets to what’s real, here, and now. The blog series features interviews and insights from health IT movers and shakers – and uncovers disruptive technologies that solve challenges, optimize workflow, and increase efficiencies to improve patient care.

 

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How to connect with the unconnected patient

Despite our always-on, always-connected world, patient portal usage remains low. In part three of our series, “Making the Most of your Epic MyChart Patient Portal,” we examine the ways in which key features have a positive impact on patient experience and satisfaction as well as adoption of the portal.
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As our lives become increasingly digital, we all expect—and maybe even depend on—connectivity. From pre-ordering a coffee to checking on our bank account, we want easy, online access to the fundamental aspects of modern life.

And those expectations extend to our medical information too. Patient portals in general and Epic MyChart, in particular, have been created to meet those expectations, giving patients an easy way to engage with their providers to ultimately receive better care. Making the most of your investment in these resources has become a central focus for many healthcare organizations, and a significant part of this effort lies in driving adoption of the portal.

So how can an organization drive patient portal adoption? Patient awareness campaigns are the right first step, but unless a patient has a positive experience accessing and using the portal the first time, adoption and engagement will remain low. Several features are available within the patient portal to help provide patients with the experience they expect. Given the multitude of touchpoints a patient has with your office—from the front office personnel and billing to seeing the physicians—it is essential to have ongoing discussions with your patient portal oversight committee about which features to enable and, more importantly, support. Let’s examine some of the features that have been shown to create the most value for patients and the organization.

Seven high-value patient portal features for Epic MyChart

Bill payment – Consider offering an easy way for patients to pay their bills directly online. It is a win-win for you and the patient by providing a lower-cost, convenient, and easily accessible way to collect payments for services delivered.

Test results – Whether lab work or imaging exams, patients want a convenient way to find their test results in a reasonable timeframe. Establishing a results release process and communicating what the patients can expect to see in the portal can significantly improve patients’ engagement with their care team. Online delivery also saves your teams the time, effort, and cost that would otherwise be involved with manually communicating test results.

Scheduling – Today’s patients are more technologically savvy—and desire more mobility—than ever before. Online access to appointment scheduling/rescheduling, and even finding coveted last-minute appointments, can be a huge success factor in adoption of the patient portal; this feature has been proven essential to patient satisfaction and your organization as a whole.

Communication – By far, communication is of the utmost importance between care teams and patients. Enabling secure communication between physicians and patients helps with efficiency, consistency, and ease of access to help. Secure messaging ties each communication to the patient’s record, further improving care teams’ ability to deliver follow-up and continuity of care.

Mobile apps – Complement the online portal with a mobile application to keep patients’ information at their fingertips, on the go. We live in a mobile world, and the flexibility for patients to update records, check results, pay a bill, manage appointments, submit a question, or request a prescription refill is no longer a “nice-to-have.” Empowering your patients with mobile access to the patient portal can be a game-changer for adoption and satisfaction.

e-Visits – As telemedicine becomes a more significant part of healthcare, enabling e-Visits through Epic’s MyChart mobile application for specific complaints is another way to help improve patient engagement. Through a series of questions to narrow down the complaint, patients can be guided toward the need for an in-person visit or an e-Vist.

Questionnaires and eCheck-in – Creating a smooth in-office experience with online questionnaires and check-in processes; patients can complete these online, ahead of their appointments, which goes a long way in improving their perceived value of the patient portal. These tools can also make it easier for your organization to capture patient-generated health data and use it effectively to deliver better care.

When patients have access to these features, they’re not only more engaged with their care—which leads to better outcomes—they’re also more satisfied “customers” because they’re receiving what they need, when they need it.

Last month, Nuance’s Director of Epic MyChart Service Desk, Mandy Love, hosted a webinar on making the most of your MyChart investment. If you missed it, you can find it on YouTube. And, be sure to stay tuned as we continue our series over the coming month. In our next edition, we’ll explore how organizational buy-in is a crucial success factor in MyChart portal programs.

 

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Intelligence at work: Visualizing functional lung tissue with LungPrint and Hyperion View by VIDA

Read how VIDA’s LungPrint Discovery AI-driven application, coming to the Nuance AI Marketplace for Diagnostic Imaging and integrated with Nuance’s next-generation reporting platform, PowerScribe One, can significantly impact the time it takes to interpret a study with a greater understanding of the underlying patient condition.
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Lung disease is among the highest causes of morbidity and mortality in the world, yet traditional imaging techniques don’t easily account for the complexity of the airway structure to make a fast, accurate diagnosis.  Due to these complexities and the increasing resolution of scanners, radiologists are challenged to review complicated reconstructions of airway trees via conventional modalities.

Susan Wood, CEO of VIDA, shares her thoughts about how VIDA’s LungPrint solution and its patent-pending and AI-driven Hyperion View airway visualization is aimed to provide greater workflow efficiencies and targeted evaluation across a range of lung conditions, including cancer, emphysema, airway obstructive diseases, asthma and interstitial lung disease.

Like a fingerprint, each lung is unique. This poses challenges in measuring lung function. LungPrint is an innovative AI-powered lung analysis solution that delivers quantitative CT information with novel airway visualizations.  It promises to empower radiologists with fully automatic lung quantification and significant boosts in reading efficiency.

VIDA’s mission is to transform pulmonary care with AI and predictive analytics to increase the efficiency, quality, and precision in reporting lung CT abnormalities.  LungPrint takes complex workflows and analyses and puts them into a context and conciseness to help radiologists’ efficiency — shaving minutes off each read.

Q&A

Jonathon Dreyer: Tell us about your business – when and how you started and your development journey.

Susan Wood: VIDA is the leading lung imaging analytics company, transforming care for pulmonary patients by empowering care teams with superior information.  VIDA has been focused on bettering outcomes and the patient journey for pulmonary patients since our beginning, over ten years ago.  We’ve developed and validated more than 30 quantitative imaging biomarkers that have been utilized in both clinical trials and clinical practice.  These biomarkers have the potential to increase the precision and personalization of lung care.  We also target a third “P” – prediction — as we develop models with the ability to assess progression and outcome probabilities.

 JD: What AI algorithms do you have and what do they do?

SW:  We offer LungPrint, starting with a product we call “LungPrint Discovery.”  It provides fully automatic quantification of lung physiology and functional tissue, including both high- and low-density analysis by lobe to flag emphysema-like and interstitial abnormalities.  It features a novel patent-pending airway visualization called “Hyperion View” with the potential to significantly accelerate interpreting complex airway anatomy.  What’s particularly exciting is that “LungPrint” is unique in every individual – like a fingerprint.  Through imaging analytics, we can uncover a unique lung profile and help providers identify personalized care plans for their patients. 

JD: What’s the big “Aha” moment when you first show users what your AI algorithm(s) can do for them?

SW:  We previewed LungPrint Discovery at RSNA 2018.  When we showed it to a renowned chest radiologist, the response was humbling: “This is a dream.  I’ve been through all these massive booths at the show and haven’t seen anything quite so unique as your Hyperion View.  Here you are with a small booth, yet, you have the most impressive technology.  How do I get it?”  When we heard that response and others like it, we knew we had something special.

JD: What challenges or needs did you see that drove you to focus on this?

SW: LungPrint helps radiologists with three key challenges:

  1. Through automation, LungPrint hopes to minimize the mundane aspects of reading a chest CT.
  2. Chest CTs are tedious to read because there are so many anatomical structures to inspect. Airways pose a unique challenge because their complexities make them difficult to visualize in any one plane.  LungPrint includes a novel, patent-pending airway visualization tool to address this challenge.  Early feedback on the feature indicates a potential for significant time savings in image review and a more complete understanding of any underlying condition.
  3. By helping radiologists provide a more precise, quantitative report to clinicians, radiologists have the potential to elevate their value among the care team.

JD:  What’s the number one benefit you offer?

SW:  Increasing the efficiency of each chest CT read while empowering radiology with auto-quantification and richer reports for referring clinicians.

 JD: Are there any stories you can share about how your algorithm(s) drove measurable patient care outcomes?

SW: One that comes to mind is the story of a 59-year-old farmer who was misdiagnosed with asthma.  Using traditional methodologies, his emphysema was missed visually; however, with the help of VIDA’s precision analysis, a lower-lobe predominant high density was flagged.  This led to additional testing and a differential diagnosis of alpha-1 emphysema. LungPrint helped to indicate the visually missed emphysema and lead to the differential diagnosis and correct treatment path for this patient.

JD: What benefits do Nuance and its AI Marketplace for Diagnostic Imaging bring to your users?  What problems does the marketplace and integration into Nuance’s workflow solve?

SW: The Nuance team has been fabulous to work with across the board.  In the course of our joint interactions, starting at the executive leadership level, to the product development teams, to the commercial implementation teams, we are seeing the very strategic fit between Nuance and VIDA take concrete form.  Specifically, the seamless integration of VIDA’s LungPrint directly into the Nuance platform provides the workflow efficiencies required for clinical acceptance of this AI solution. The depth and breadth of the Nuance team, as well as the collaborative approach, has been an exceptional experience for VIDA.  We are excited to be working with Nuance on our shared vision of bringing the power of AI to the radiologist in routine clinical practice.

JD: What is your vision for how your solution(s) will evolve over the next 5 years?

SW: We see so much potential for LungPrint through the Nuance platform.  Step one, as we’ve described, is all about clinical efficiency.  Features like Hyperion View (airway analysis) and auto-quantification by lobe will have a material effect on both chest CT report value and interpretation efficiency.

Looking beyond efficiency gains, we see exciting opportunities to make a deep clinical impact throughout the care path.  For example:

  • Detection – AI will help flag areas of interest. Beyond nodules, there are several anomalies in the thorax with which we can assist in identifying.
  • Diagnosis – Many lung diseases are diagnosed late or inaccurately because of limited evaluation methods. There is greater potential in the future for AI to provide significant value beyond detection and into disease stratification and identification of risk. We hope to help care teams identify a correct diagnosis early, leading to disease management strategies that can be employed while quality of life is high and care costs are low.
  • Disease Monitoring –Tracking of disease progression with more objective and precise information can empower physicians to make highly informed care decisions on objective, actionable data. This area is where AI can uncover hidden insights, flagging at-risk patients and predicting adverse events before they happen.
  • Treatment Selection – AI will increasingly serve a decision support role in the selection of treatments or combinations of treatments. We foresee a day where a set of potential treatment options are input into an AI model and the model outputs outcome and risk predictions to aid the physician.

In summary, we see the application of AI expanding along two axes: (1) along the care path to address needs from detection through treatment and (2) along a path of increasing maturity to the point of being truly predictive. We intend to build our product portfolio over the next 5 years to tackle many challenges in these areas.

JD: In one sentence, tell us what you think the future of medicine will look like.

SW: Healthcare will be increasingly precise, personalized, and predictive, driven in large part by the evidence and in AI-powered assistance throughout the care path.

Learn more:

Learn more about VIDA.

Learn more about Nuance AI Marketplace for Diagnostic Imaging. 

Intelligence at Work is a blog series by Jonathon Dreyer, Senior Director, Solutions Marketing, Healthcare Division for Nuance Communications. Intelligence at Work showcases projects and applications that demonstrate how Nuance technologies extend the value, use and performance of integration and development partner offerings. This blog series focuses on inspiring the healthcare developer community to think beyond their current state and take their innovations to new heights by tapping into the latest in artificial intelligence.

 

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At the End of the Day…stand up for what you believe in

Whether you agree with an individual’s points of view or not, it’s difficult not to respect those who take on tough topics and unapologetically stand firm in their beliefs.
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Most of us were cheering on the U.S. Women’s National Soccer Team over the last couple of weeks. The July 4th holiday timing of the games seemed to make cheering the U.S. on even more fitting and enjoyable. Winning two consecutive Women’s World Cup titles is just awesome! Fans and new followers have been so impressed with the team’s confidence, execution, and resilience. The whole team obviously trained to a level of envy from other nations. Each team member contributed, and they won games with star players injured and other players stepping in.

Despite the pride and joy from this victory, what has impressed me most about this team is their willingness to stand up for what they believe in. There are a variety of topics, beliefs, and values they represent. Whether you agree with their individual points of view or not, it’s difficult not to respect their willingness to take on the tough topics, and unapologetically stand firm in their beliefs and values.

At the End of the Day… is an expression meaning an assessment of essential facts and truths. It’s a summation of the pros and cons of any situation and a straightforward statement of what really matters. It’s also the title of this blog series by Brenda Hodge, Nuance Healthcare’s Chief Marketing Officer, with insights about leadership, empathetic customer relationships, and marketing techniques.

Photo Credit: Getty Images/Richard Heathcote

Healthcare and the wisdom of people around us

Successfully improving patient experiences, population health, and healthcare costs requires more than great technology and innovative products – it demands a larger sense of purpose that keeps you focused on what matters most.
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Whenever any of us face important personal or professional challenges it’s vital to have clear sense of purpose to guide our decisions and actions. One’s sense of purpose is informed by our own experiences and by the wisdom of people around us.

Sometimes that wisdom comes from the uncluttered mind of a child.

This crayon drawing was created by a 7-year-old girl following a visit to her pediatrician. It shows her colorful recollections of sitting on the exam table, her older sister, and her mother holding her baby sister seated nearby, and the doctor at the computer with his back to her and everybody else in the room. It was first shared by New Jersey pediatrician Dr. Thomas Murphy in 2011. The drawing resonated with so many physicians that it has since been widely shared on social media and appeared in numerous publications including The Wall Street Journal, the Journal of the American Medical Association, and MIT Technology Review. The picture vividly captures the frustration that many physicians feel about the administrative and reporting burdens imposed to document exams, and to get reimbursed for their services.

Relentless paperwork is not the reason why physicians took out huge education loans and trained for so many years. They did it because they are passionate about caring for and healing people. Doctors are doing their best with to manage all the required documentation and other administrative requirements. They now spend about twice as much time entering or re-entering data into computers than they do interacting with patients. That’s causing what the president of the World Medical Association has called a “pandemic of physician burnout,” with 51% of physicians reporting frequent or constant feelings of burnout.

Burnout is a serious barrier to improving the cost and availability of healthcare services. A study published in the May 2019 issue of Annals of Internal Medicine reported that physician turnover and reduced clinical hours attributable to burnout costs of $4.6 billion, or about $7,600 per physician, in the United States each year. It also stated that burnout can effectively be reduced with moderate levels of investment. In other words, burnout reduction programs that include new AI-powered systems designed to help physicians care for patients instead of clicking and tapping away at computers can pay big dividends in the quality, cost, and availability of healthcare. AI and speech-driven Ambient Clinical Intelligence (ACI) will drive those improvements by automatically documenting medical visits and adding clinical insights in real-time while the doctor stays focused on the patient.

You can use the crayon drawing to illustrate our purpose at Nuance Healthcare as we create AI-powered and speech-driven Ambient Clinical Intelligence solutions to improve healthcare experiences, quality, outcomes, and costs. At Nuance, we’re bringing those innovations directly into the healthcare workflow to tackle the “Quadruple Aim” of improving the patient experience, improving population health, reducing costs, and improving the work lives of healthcare providers. The first three goals address a wide range of systemic challenges. Improving provider experiences is the key to making the other three happen. That’s why Nuance is focused on delivering solutions that automate time-consuming routine tasks, eliminate inefficiencies, and bring clinical intelligence and decision-support data to clinicians at the point of care.

Wisdom from my 10-year-old self

I feel fortunate to have been instilled at a young age with a clear sense of purpose in using technology to help others. That began when I was a 10-year-old kid in my dad’s lab at the Massachusetts Institute of Technology (MIT). My father, Nat Durlach, oversaw the Sensory Communications Group lab, conducting research to help people with vision and hearing impairments. I vividly remember spending a lot of time running around there, sitting in on discussions about topics I didn’t understand at all. But the content informed my purpose and work today helping our team create AI and ACI solutions for clinicians.

What’s more important than ensuring that the people caring for us and our loved ones are cared for by giving them time, energy, and expertise to make a difference in that care? That defines our purpose as we build AI-powered solutions that help healthcare providers have more satisfying and rewarding work experiences and happier and healthier lives. We strive to focus on what matters.

At Nuance, we believe technology should empower life, not distract from it. That is why we build systems that take obstacles out of the way to help people focus on what matters. To help doctors spend more time with patients and less on paperwork. To help drivers get there safely. And to help every customer service call, comment, and text make life a little easier. We use our talents to enable people to amplify theirs. We give them back their time and voice and empower them to do what they do best, better. Because we don’t make technology that stands in the way of what matters; we make technology that puts what matters in focus.

Focus on What Matters is a blog series by Pete Durlach, Senior Vice President of Healthcare Strategy, and recognized Voice and AI thought leader. In this blog series, Peter boils down the facts and fiction surrounding AI in healthcare into the essence of what technology can and should do.

Photo credit: DRAWING BY AG, AGE 7, COPYRIGHT THOMAS G. MURPHY MD 2011

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Why your patient portal needs a committee

In our continuing series, we explore how healthcare organizations can make the most of their Epic MyChart patient portal to engage patients for better care while also having a profound impact on the “business” of healthcare. With this post, we consider the role of an oversight committee—how and why this group and its guidance lead to a successful MyChart program.
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This blog post is part two in a five-part series to explore how healthcare organizations can make the most of their Epic MyChart patient portal to engage patients for better care. 

When it comes to the adoption and use of an online patient portal, recent industry data offers a bit of a mixed bag. The good news: 90% of healthcare organizations offer a patient portal of some sort. The discouraging news: only 30% of organizations actively use the portal to engage patients in their care.

So the question becomes: What’s holding organizations back from making the most of these investments?

In some cases, patient reservations and preferences are to blame. We know, for example, that if patients do not have a good first-time experience, it’s unlikely that they will come back and try again. (We’ve got some ideas on addressing this; look for our upcoming article in July.) Often, it’s a matter of providing education and support so patients understand the hows, wheres, and whys of accessing and using their portals and, more importantly, so your staff is on board to build and nurture a successful program.

An EpicMyChart oversight committee can take on this mission. One of the best aspects of the patient portal is that it touches so many layers within a healthcare organization: billing, appointments, healthcare providers, compliance teams, patient experience advocates, marketing, and information technology. Electing a champion from each of these areas to an oversight committee is an essential first step toward a successful portal program.

Ideally, their work would begin well in advance of a MyChart rollout. Begin by composing a charter that establishes goals and objectives. Explore and validate the features and functionality that drive the desired patient experience, and—especially—understand the ways these layers intersect and affect each other. Imagine a patient reads in the portal brochure that lab results are available in MyChart within three business days. On the third day, the patient cannot locate their lab work because their specialized test requires 14 days of turnaround time. The patient is frustrated, which could have been avoided had an oversight committee collaborated on patient communications and marketing materials.

You may be wondering how successful healthcare organizations establish their oversight committees. Below you’ll find an example of leaders from key departments who define the roadmap and strategy for the MyChart patient portal and continually work across departments to support patient interactions and needs.

Example MyChart Patient Portal Oversight Committee Charter

As healthcare organizations continue to evolve, as patients demand more from their patient portal, and as the model of care adjusts, the oversight committee will play a key role in defining an innovative roadmap for long-term success.

On June 20th, Nuance’s Director of Epic MyChart Service Desk, Mandy Love, hosted a webinar on this very topic. If you missed it, you can watch it on-demand. And, be sure to stay tuned as we continue our series over the coming month. Next up: we dig into the MyChart features that positively affect patient adoption.

 

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A Real View: In life, in work — and in radiology — the power of your network is the key to growth and success

Each of us knows the importance of personal and professional networking. Those who do it best focus on using the size and reach of their networks to deliver and receive value. The same applies to the Nuance PowerShare Network, which connects more than 6,000 facilities exchanging over a million imaging studies each month. It is an interoperable image-sharing platform delivering benefits from #DitchTheDisk through EMR integration, teleradiology and AI-powered, workflow-integrated diagnostic and decision support tools. The ultimate value of PowerShare is its demonstrated ability to improve patient experiences and outcomes.
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We all recognize the value and importance of networking in our personal and professional lives because of the connections we can make to gain access to useful information and resources. While networking seems to come more easily or naturally to some, it actually takes purposeful, continuous effort to build and maintain a robust network. Those who are most successful with networking generate value beyond the number and quality of their connections by amplifying and extending the capabilities of other network members.

You can say the same thing about the Nuance PowerShare Network. PowerShare connects more than 6,000 facilities in the United States that use its speed and scalability to exchange over a million imaging studies each month. It gives clinicians and patients secure access to imaging and completes the clinical record with deep EMR integration. Nuance establishes and maintains the connections quickly and at scale, enabling providers to overcome the multiple problems that ineffective image-sharing creates in patient experiences (duplicate imaging, delayed diagnosis and treatment) and in operating inefficiencies (CD burning, unusable CDs, maintaining VPNs and security agreements).

Healthcare providers of all sizes have made the PowerShare Network the largest and fastest-growing radiology image-sharing network in the United States. They join it for a variety of reasons, including its ability to deliver immediate, practical clinical and operational value, and its capacity to address strategic imperatives including cost reduction, outcomes-based reimbursements, interoperability, and deployment of new AI-powered diagnostic tools.

The turnkey scale and nearly ubiquitous reach of the PowerShare Network itself is one of the most important practical reasons. The fact that it offers the largest number of connected locations tells users that it’s where they need and want to be. As more facilities come online, others naturally follow their lead.

Another factor is the commitment that customers see from Nuance in supporting and expanding PowerShare connectivity and capability. That begins with a dedicated team of PowerShare Outreach experts that addresses each customer’s priorities even before they go live on the network. For example, the Outreach team directly supports initiatives like the American College of Radiology’s #DitchTheDisk effort. The team asks each new client to identify which facilities or clinicians often send or request CDs, then adds those facilities to the PowerShare Network at no charge. Post go-live, each customer continues with their PowerShare Outreach expert to ensure their continued connectivity expansion and success throughout their PowerShare Network subscription.

The goal is not just enabling connections between different PACS and EMR systems but creating a seamless, integrated environment for the entire care team including radiologists and “image intensivists,” or clinicians who depend on seamless access to imaging. That’s made possible through a combination of network speed, connectivity, and usability. Instantaneous and mobile connectivity enable care teams to receive and review images from another facility even before the patient arrives. Usability comes from the integration of the PowerShare Network with the EMR, one-click PACS access, a zero-footprint diagnostic viewer, the ability to update patient information and auto-generate orders, plus image and report sharing. All of that saves time, reduces unnecessary imaging, and can save lives.

Improved patient experiences and outcomes can translate directly into operational efficiencies that address healthcare cost reduction and value-based care. A recent analysis by Deloitte of Medicare providers found that “having central physicians to help coordinate the flow of information/care is strongly associated with lower costs.” Their study reported that tighter networks decreased average episode-of-care cost for hip fracture by almost 15 percent and for coronary artery disease by 26 percent.

The PowerShare Network infrastructure also is essential for strategic interoperability initiatives. The network serves as a platform for supporting both image-enabling  Health Information Exchange (HIEs) and Stage 7 of the HIMSS Digital Imaging Adoption Model efforts, including the requirements for image, report and clinical note exchange between providers, and for electronic patient access to imaging.

The PowerShare Network further enables the next-generation PowerScribe One radiology reporting platform and access to the AI Marketplace, giving radiologists one-stop, workflow-integrated access to the largest storefront of AI algorithms and a feedback loop for developers to improve the quality of those algorithms.

Having a large, scalable, ubiquitous image-sharing network for exchanging images is important for responding to changing priorities and the shift to value-based care. But the ultimate value of the PowerShare Network is in its demonstrated ability to improve patient experiences and outcomes. We’ll give you some truly meaningful real-world examples of how the PowerShare Network does that in a coming blog post.

A Real View is a Q&A blog series with Karen Holzberger, Vice President and General Manager of Nuance Healthcare’s Diagnostic Division. The Real View cuts through the hype and gets to what’s real, here, and now. The blog series features interviews and insights from health IT movers and shakers – and uncovers disruptive technologies that solve challenges, optimize workflow, and increase efficiencies to improve patient care.

 

 

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Engaging patients for better care: making the most of your Epic MyChart Patient Portal

Although Meaningful Use and the implementation of EHRs made patient portals a requirement for healthcare organizations, the truth is that these portals are actually ideal for engaging patients in their own care. The result? Happier, healthier patients and a seamless experience. Most organizations, however, aren’t getting the most value out of these investments. Today, we kick off a unique five-series blog exploring the Epic MyChart Patient Portal and how you can best support your patients’ use of the portal and get them engaged in their healthcare.
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Voice biometrics has gone mainstream due to recent increase in fraud and security needs, more mobile consumers, increased attention on other biometric authentication such as iris and fingerprint, and the growing expectations of consumers for an omni-channel experience.

It’s something that makes sense intuitively, and research bears it out: patients who are engaged and involved in their healthcare have better outcomes and better experiences. Online patient portals are one way to create this engagement.

And while providing access to the patient portal is a critical first step toward complying with Meaningful Use objectives, ensuring the portal is both valuable and easy to use is equally important. Epic MyChart portal is a convenient way for patients to schedule appointments, communicate with their providers, request prescription refills, check lab results, and pay their bills. The challenge, however, has been that organizations did not think much beyond turning the portal on. In fact, about 52% of patients nationwide have been offered access to a patient portal, and of those, about only 50% ultimately accessed the system.

That means a majority of healthcare providers are letting valuable investment dollars go to waste while—more importantly—missing key opportunities to create healthier, happier patients and having profound effects on the “business” of healthcare, from streamlined patient communications and workflows, improved patient retention, and fewer disruptions during the day. Consider, too, how patient populations are changing; personally, I expect to have online access to my medical information, to be able to request appointments, and so on. Don’t you?

In other words, it’s essential for healthcare organizations to make the most of their MyChart patient portal and Epic EHR investments by getting patients involved and engaged in their care, but you may not know how or where to start. Over the next several weeks, we will explore this topic in detail. We’ll discuss, for example, how you can build a successful patient experience and patient portal program, what it means to establish an oversight committee, how providers benefit from portals, and how you can best support your patients in maximizing their use of your program.

In addition to our upcoming articles, you still have time to register for our upcoming webinar, where you can learn more about how you can make the most of your Epic MyChart Patient Portal. Join us June 20 at 1:00pm ET to hear from Mandy Love, Nuance’s Director of Epic MyChart Service Desk.

 

 

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Voice biometrics has gone mainstream due to recent increase in fraud and security needs, more mobile consumers, increased attention on other biometric authentication such as iris and fingerprint, and the growing expectations of consumers for an omni-channel experience.

At the End of the Day…acceptance leads to more joy

Is there something you cannot change but are still struggling through? Is it a work situation? A family situation? Can a change of mindset prompt a surprising result?
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“God grant me the serenity to accept the things I cannot change; Courage to change the things I can; And the wisdom to know the difference.” Reinhold Niebuhr

I recently experienced a once-in-a-lifetime family vacation. We planned it months ago and have been looking forward to it ever since. It was our first time in French Polynesia. Given the beauty of the islands, our plans involved a lot of outside activity. The first day it rained all day. I woke-up on the second day to more pouring rain and admittedly was disappointed.  We met another couple that was vacationing and experiencing their tenth day of pouring rain.

Rather than be disappointed, I decided quickly to accept these circumstances and go play in the rain.  After this shift in my mindset, we had the most fantastic day. And at the end of the day, the rain prompted the most beautiful sunset I’ve ever seen.

It’s such a simple life lesson but applies to so many areas of life. Going forward, I will seek to get to a mindset of acceptance much more quickly as the resulting serenity leads to more joy.

Is there something you cannot change but are still struggling through? Is it a work situation? A family situation? Can a change of mindset prompt a surprising result?

Acceptance leads to more joy.

At the End of the Day… is an expression meaning an assessment of essential facts and truths. It’s a summation of the pros and cons of any situation and a straightforward statement of what really matters. It’s also the title of this blog series by Brenda Hodge, Nuance Healthcare’s Chief Marketing Officer, with insights about leadership, empathetic customer relationships, and marketing techniques.

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Committing to a growth mindset

As we at Nuance welcome two new leaders to our team, we consider what it means to lead with a growth mindset. From encouraging a lifelong commitment to learning to embracing failures, we believe we are up to the challenge.
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Thirty years ago, Stanford psychology professor Dr. Carol Dweck began her pioneering research into why some students rebounded and flourished after a failure whereas others were defeated by it. The result of this work, initially based in the world of education, is what we know today as “growth mindset” versus “fixed mindset.”

In short, people with a growth mindset seek to continually learn, improve, and become stronger at whatever it is they want to do; they are also more committed to the effort, the process, and the practice of getting and doing better. On the other hand, people with a fixed mindset believe that intelligence, strength, and talent are innate qualities that don’t change over time. They believe that these qualities themselves lead to success, regardless of effort. People with a fixed mindset may document their successes, rather than develop their skills.

No one, of course, has a purely growth mindset or a purely fixed mindset, and as Dweck has written, achieving the former requires hard work and perseverance. But what’s interesting here is the fact that these mindsets are not strictly associated with people. Organizations function similarly, and those companies that operate with a growth mindset reap significant benefits, including more innovative and collaborative employees.

The effect on employees may be particularly important as the ways in which we do our work continues to evolve in this age of digitalization. As more work becomes automated and influenced by AI, for example, people must adapt and recommit themselves to the process of learning, trying something new, and—yes—even failing. And it all starts with the leadership team, who is responsible for defining the growth of the business, and who must therefore encourage and engender learning, ownership, and collaboration along the way.

We are humbled at Nuance to have a leadership team that is committed to leading with this growth mindset, and we are thrilled to welcome two new leaders to our team this month. Karen Simonenko has joined our Provider Solutions leadership team as Vice President, Quality and Revenue Integrity. Throughout her career, she has focused on creating consistency, promoting best practices, and creating an ideal customer experience. Mike Jones joins us as Vice President of Ambulatory and Mid-Markets, where he will focus on expanding and delivering outcomes and growth for our clients in these areas.

We look forward to partnering with Mike and Karen in new and exciting ways. Although continuing to embrace and achieve a growth mindset will require hard work and persistence, we know we are up to the challenge.

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Customer success: listen and learn

Customer success metrics are a valuable and convenient way to understand how your customers think you’re doing. But the scores alone don’t give you the complete picture. You must ask your customers for feedback and then really listen to the answers. Moreover, when you’ve asked the question, you need to be ready to learn—to adjust and get the entire organization on board.
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For nearly 20 years, Net Promoter Score (NPS®) has been the hallmark of measuring the customer experience journey. Why? Because cultivating a sustainable business means you must cultivate loyal customers. With NPS, we gain a core measurement of customer loyalty and our customers’ likelihood of recommending us to others. It’s a valuable and convenient measurement, and it has sparked an interest in a wide range of performance metrics, benchmarks, and KPIs.

But.

Measuring the customer experience journey and learning from it are two different things. In fact, McKinsey has written that too many organizations “squander the treasure that is customer feedback.” Knowing that customers are willing to recommend your business is one thing, but we have to dig deeper. We should want to learn why, to find out what we’re doing right and keep doing it.

As for the detractors? They’re just as important; we must learn what needs to be changed, fixed, adjusted, or downright eliminated. Then, and this is equally important; you must focus on doing it.

When you ask your customers for feedback, you’ll not only learn something valuable, but you’ll also make your customers feel important and involved. That’s true for both detractors and promoters. Hearing what your customers have to say and being accountable to it—that is, closing the loop and acting on that feedback—leads to improvements in both customer and employee retention as well as increased customer spending. In other words, what you do with the feedback matters.

The feedback loop cannot exist solely on the front line, either. Your entire organization must be aligned to the common, higher purpose of asking for feedback, listening to what your customers say, and then learning something from it and doing something about it. Ultimately, performance metrics are important and valuable but cannot—and should not—replace the value of listening. Best-in-class companies focus on a closed loop process: listening to customers and taking action based on that customer feedback. Listening provides valuable information – and doing something with it drives actionable intelligence; the result is customer success.

And so with all of that said: We’re ready to listen and learn from you. Opt-in to our NPS surveys by dropping us a line: clientloyalty@nuance.com.

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At the End of the Day…own your mistakes

Although sometimes human frailty makes us feel we cannot make mistakes, people will think more highly of you when you own your mistakes and work to fix them. 
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Despite the best of intentions, we all make mistakes. Mistakes make us human. I always am surprised by people or companies that do not own their mistakes, much less attempt to fix them.

Recently, my husband and I had some yard work done. The company made a few mistakes; it was an expensive service, so we let them know about our concerns. The office responded quickly with their concern over the mistakes and fixed them the next day. Great service and relationships aren’t just about getting it right the first time; they’re about how you handle things when you don’t get them right. I will hire this company again because they owned and fixed their mistakes.

Your personal reputation is as much about what we do well as it is about how we handle situations when things go wrong. Colleagues, friends, Moms, Dads, and siblings all need to be willing to own their mistakes. When we make a mistake does our integrity stay in check? Do we attempt to blame others or take responsibility for our short comings? Do we strive to correct the mistake?

Although sometimes human frailty makes us feel we cannot make mistakes, people will think more highly of you when you own your mistakes and work to fix them.

At the End of the Day… is an expression meaning an assessment of essential facts and truths. It’s a summation of the pros and cons of any situation and a straightforward statement of what really matters. It’s also the title of this blog series by Brenda Hodge, Nuance Healthcare’s Chief Marketing Officer, with insights about leadership, empathetic customer relationships, and marketing techniques.

Customer Success: recognition matters

Great managers make a habit of recognizing their employees for a job well done. But what about our customers? What happens when we recognize their efforts and successes? At Nuance, we are honored to recognize and celebrate our customers’ successes, exciting achievements, and progress they make while leveraging Nuance’s technologies at every level.
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Search “employee recognition” and Google serves you a trove of great think pieces that tell us something we should instinctively know – recognizing employees for a job well done matters. Recognizing our employees positively affects their happiness and morale and therefore their loyalty, performance, and productivity. It also improves the relationships between employees and managers. In fact, Harvard Business Review says employee recognition is “the easiest thing you can do to be a great boss.”

The personal “glow” we get when we’re recognized for our efforts doesn’t just apply when you’re an employee. That is, when you’ve done great things, solved big problems, overcome obstacles—being recognized for it matters.

In other words, customer recognition matters, too. At Nuance, we try to go well beyond loyalty rewards and tokens of appreciation. At Nuance, recognition extends into fully celebrating our customers’ successes; after all, our customers are at the center of all we do, and our success depends on their success.

For example, we recently had the distinct honor of celebrating eight Nuance customers who have leveraged our technologies to make significant contributions to the patient experience, to their organizations’ financial and quality outcomes, to innovation, and to organizational culture. We awarded these customers in five categories (Patient First, Growth, Innovation, People and Culture, and Efficiency), recognizing extraordinary programs such as the Backstop program at the University of Rochester Medical Center, quality outcomes at UHS, Johns Hopkins’ Joy in Medicine initiative, and others.

We are grateful for the ongoing opportunities to do and make what matters in healthcare – with and for – our customers. And, we recognize the value of their success.

The Customer Success blog series with Brad Morrison, Senior Vice President of Nuance Healthcare Customer Success, is an honest take on the ways to build and maintain strong relationships with your customers. The Customer Success blog shares industry insights, lessons learned, and humble advice based on both failure and successes. 

 

A Real View: the last mile in implementing AI

Nuance Healthcare Diagnostics Vice President and General Manager Karen Holzberger sat down with Nuance Senior Director of Product Management Sander Kloet to discuss the importance of addressing the “last mile” challenge in deploying AI for radiology, one of the key topics that he and other industry experts will cover at the RSNA regional course on AI on May 31 in San Francisco, CA.
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Imagine that you are a busy professional whose very long days are packed with a mix of routine and critical time-sensitive tasks, each of which requires close attention and thorough and accurate paperwork. One day you learn that powerful new tools can help you get more work done in less time with improved quality and greater benefit to those counting on your expertise. But there’s a catch: to achieve these gains you must take time you don’t have to fit the new tools into your workday.

That’s the essence of the “last mile” challenge facing radiologists looking to leverage a growing number of AI diagnostic models and workflow tools to manage increasing workload volumes, maximize value-based reimbursements, reduce administrative burdens that contribute to burnout, and ultimately, improve patient outcomes. The ability to integrate AI tools into current radiology workflows seamlessly and intuitively is vital to realizing the benefits.

I recently sat down with Sander Kloet, who will lend his expertise in product design and implementation to the upcoming RSNA regional AI course by discussing the “last mile” challenge and the solutions and approaches to address it.

KH: What’s the “last mile” problem and what does it mean for radiologists and AI?

Sander: The idea of the “last mile” connoting the final leg of a journey originated in telecom and logistics to describe the work remaining to get to the intended destination or outcome. At the same time, it indicates that although there are still a few hurdles to clear the goal is within reach. In that sense it’s a highly motivating and energizing challenge.

When we think about the last mile problem for radiologists, we recognize that in order to realize the potential AI has to advance radiology it must fit seamlessly into a radiologist’s workflow and not be an add-on requiring extra steps. It must deliver both practical and clinical value as an integral part of how radiologists work. If it doesn’t it simply won’t be used.

The key from a product design perspective is to think comprehensively. For example, image characterization algorithms can be invaluable in helping radiologists identify pulmonary nodules or brain bleeds quickly. But those results need to be delivered before the radiologists has read the study and dictated the report, otherwise they have to take additional time to review the AI findings and modify their reports if needed. That also means making sure that image processing is optimized so that the AI results are available promptly alongside the images from the PACS and history from the patient’s EHR. Those are complex issues but getting the workflow right is essential.

KH: How is access to AI models integrated into the workflow?

Sander: That’s a two-part issue. The first part is simplifying the development and deployment of the many different algorithms that are needed to address the wide variety of modalities, exams, and specialties. A radiology department could potentially require over a hundred algorithms from dozens of developers, each addressing a specific diagnostic use case. Developers need to be able to reach users at scale to justify app development. Healthcare systems need to consolidate vendor access, so they don’t have to establish relationships with every developer they want to work with. Adoption of AI-driven solutions will take a frustratingly long time if there’s not a unified market where developers can reach large numbers of radiology users who can easily discover and purchase new models. That’s where the Nuance AI Marketplace for Diagnostic Imaging comes into play. It’s essentially an app store for AI diagnostic models and workflow optimization tools. It connects the 75% of radiologists and 6,000 healthcare facilities in the U.S. who use Nuance radiology reporting or image sharing solutions with AI algorithm developers in a collaborative marketplace, with a built-in feedback channel for continuous improvement.

The second part is that access to the AI Marketplace is integrated into the radiologist’s workflow tools, the worklist, the PACS and the Nuance PowerScribe reporting system. That allows AI Marketplace clients to quickly evaluate and use the latest AI solutions and then seamlessly integrate the results into their current workflows.

KH: That covers AI model access, but what about enhancing workflow and augmenting radiologists’ expertise with AI?

Sander: Yes, good question. Physicians know from past experience that new technologies that promised improvements instead impeded their ability to deliver quality care. It was a case of the doctors having to serve the needs of the technology instead of the technology serving the needs of the doctors. Our fundamental top-down mission at Nuance is to create technologies and solutions that not only get out of the way but really empower clinicians to do what they love – take better care of their patients.

Ensuring that access to AI models is seamless from within the PowerScribe workflow is one way. A great example of that is the FDA-cleared ICH detection application developed by Aidoc and deployed at the University of Rochester to prioritize unread exams. It analyzes CT exams indicating a suspected intracranial hemorrhage and then prioritizes them on the PowerScribe worklist for a radiologist’s immediate attention when time-to-treatment is critical.

Another excellent example is the new PowerScribe One platform. It helps radiologists review and if necessary, edit AI results and automatically prompts the users with appropriate follow-up recommendation based on the ACR AssistTM clinical guidelines.

All of that is driven by our innovations in natural language processing and clinical language understanding (CLU) that actually understand the meaning and context of what the radiologist is dictating and correlating it with the AI findings. It recognizes and stores the narrative report contents as structured data, all without requiring the radiologist to change how they work or add additional steps. That’s a very big deal because it can make every part of a report accessible to the EMR and to clinical data analytics. Now, incidental findings, follow-up recommendations, and many other radiology report elements can be leveraged and tracked in ways that previously were too difficult or impractical.

I think it’s important here to note the importance of combining workflow-integrated access to AI with the collaborative feedback loop of the AI Marketplace. Access from within the PowerScribe desktop makes AI usable from a practical point-of-view. Giving radiologists and developers a built-in channel to share feedback on AI model implementation and results makes it truly useful. It enables ongoing refinement of AI models for improved accuracy and specificity and addresses radiologists’ preferences and priorities. It creates a virtuous cycle that builds confidence and capability in the technology and fosters increased adoption.

KH: What should radiologists expect as we move forward on closing the AI last mile?

Sander: In a word, I would say “momentum.” By that I mean accelerating progress toward widespread practical adoption in the near term. As I noted earlier, there are still multiple challenges ahead. For example, there will be issues connected to using AI including how reimbursements will be structured, and things like access to diverse training data to create robust diagnostic models. We also are seeing interesting report creation challenges resulting from data generated by AI that was previously impractical to obtain by radiologists, and we look forward to collaborating with our clients to determine how to leverage all this data in reports in the future.

The growth and advancements we’re already seeing with the AI Marketplace, PowerScribe One, and CLU are really making the destination more clearly within reach than ever before. We’re also seeing work by multiple stakeholders on issues like reimbursements, for example, and by the ACR Data Science Institute on the data challenges. As you noted in a blog post late last year after the RSNA conference, there has been a real sea change in the outlook for AI within the radiology community. It’s highly motivating.

Ultimately, where we end up at the end of that last mile is using AI to augment radiologists to enable them to work more effectively and efficiently, meaningfully address burnout, and most of all, improve patient outcomes.

KH: Thank you, Sander. It’s exciting to hear the details of how we and the radiologists with whom we work closely are addressing these last mile challenges. Beginning on May 31, Sander will share these and other insights during RSNA’s spotlight course, “Radiology in the Age of AI.”

The Real View is a Q&A blog series with Karen Holzberger, Vice President and General Manager of Nuance Healthcare’s Diagnostic Division. The Real View cuts through the hype and gets to what’s real, here, and now. The blog series features interviews and insights from health IT movers and shakers – and uncovers disruptive technologies that solve challenges, optimize workflow, and increase efficiencies to improve patient care.

 

 

At the end of the day… everyone walks a different path

My daughter, a recent college graduate, reflects back on what she's learned through her service work: I learned in order to meet someone where they are, we have to realize where we are.
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My youngest daughter is graduating from the University of North Carolina (UNC), Chapel Hill this weekend. I am very proud of the fact that she’s been a great student, graduating as a business major from Kenan-Flager business school, as well as a political science double major. She will graduate as a Buckley Public Service Scholar (BPSS), and already has a great job lined-up in Austin, TX after graduation.

My daughter chose as a freshman to become a BPSS.  She chose to do 300 hours of public service during her 4 years at UNC, as well as attend a variety of awareness and skills training classes in her free time. To complete her BPSS work, she wrote a reflections paper. I am so proud of what she has learned about herself, and the person she has become.

Her reflections are worth sharing. Below are some excerpts from my daughter’s reflections:

Public service should be actions that are taken with the understanding that everyone walks a different path. Service should meet someone on their life journey, helping them in the way that they need, and in a way that focuses on their path.

I realized that the reason I was the one volunteering at the food pantry and not the one needing its services, had little to do with me. 

I will always remember volunteering at Heavenly Groceries during first semester of sophomore year. It was November and the cold had hit, and I was working one of the tables at the food pantry. A guy came up wearing a Vanderbilt sweatshirt, my mom’s college and my childhood dream college, and I asked him if he was a Commodores fan. He looked down not even realizing what the sweatshirt said and stated, “I am a fan of being warm.” I was born a white woman, to a financially able family, in a nice neighborhood, to parents that gave me every tool they could to ensure my education. I started a mile ahead of the pack and had to merely keep up, not catch up. 

My journey with BPSS is somewhat of a love story. I came to UNC with an idealized version of service. But during my time and continued education, I realized that I was doing it wrong. I realized that if I was creating change, I should not leave happy. The problem was not immediately solved from one meal. I felt pain, I felt guilt, I felt an inadequacy. I would go to the food pantry and hate the small amount I could do. I would go to Relay for Life meetings and hate the band-aid we were putting on things without even attempting systemic change. Part of my four years was falling out of love with service.

 One of the speakers we had said, “A charity doing their job right should be working themselves out of a job.” The goal should never be a band-aid or a short-term solution that focuses on the symptoms and not the problem. That makes your service about you and not about them.  We were not realizing the road that they walked and meeting them on their road.

 That semester I fell out of love with service because it wasn’t fun anymore. But I think that is because in order to meet someone where they are, we have to realize where we are. My parents have paid for my college education and comfortable housing. I have had to focus on nothing but my school experience.  I am a white woman living in the south. My community was well off, so the public schools offered a good education. There was guilt and frustration. I wanted to think that I got to where I am because I was a hard worker.  If I was given an upper hand, then how did I not feel guilty about that? I will experience less adversity in my life because I was born with things that our system has decided to allow me. I didn’t know how to handle that. But I always remembered one thing my professor said, “We are most blind where our privilege is greatest.” I realized that I had to accept where I stood and understand that every journey is different.

 My experience with BPSS helped me establish where I stand in the world and accept that for what it is. I learned where I stand to help myself better understand where others are standing. I will forever be grateful for the worldview it helped me develop. 

Congratulations to all 2019 grads!

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At the end of the day… is an expression meaning an assessment of essential facts and truths. It’s a summation of the pros and cons of any situation and a straightforward statement of what really matters. It’s also the title of this blog series by Brenda Hodge, Nuance Healthcare’s Chief Marketing Officer, with insights about leadership, empathetic customer relationships, and marketing techniques.

 

At the end of the day… we need each other

Statistics show that loneliness and isolation can take a toll on our overall health. Communities can be formed through shared interests in sports, work, hobbies, or religion. In many cases, having a shared interest gives you the opportunity to create a true social connection.    
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I recently saw statistics on what contributes to our health and was surprised to see that individual behaviors contributed 40% while genetics were only 30%.

I also recently had the pleasure of hearing a keynote from Dr. Vivek Murthy, former U.S. Surgeon General. Given his vast knowledge and experience, I expected to hear an in-depth technical talk about how to improve healthcare in the U.S. The talk was not technical at all but rather an incredibly motivating talk about the importance of protecting one’s emotional well-being. Dr. Murthy believes strongly in the 40% of individual behaviors that contribute to our health. Dr. Murthy talked about the impact of living with positive emotions and that one of the best tools is social connection. Isolation and loneliness can be extremely damaging to emotional well-being and 20% of adults suffer from loneliness.

Individuals can suffer from isolation and loneliness even when surrounded by people. Feelings of isolation can happen to people from all backgrounds, ages, and income levels.  Some of us get so busy working we forget to make true connections. Some of us lose someone we love and need more community support. So, it’s important that we take the time to create true social connections.

My neighbor recently lost her husband of 56 years. Obviously, she struggles with the loss, but I was struck this weekend when talking with her that what she needs most right now, 3 months after his death, is social connection.  She needs someone to chat with, to just ask how she’s doing.  She needs to not feel isolated and know she has a community that cares.

The fact is, we are better when we have connections – friends, family, or community members with whom to socialize.  I call my closest friends my 3 a.m. people.  I know that at 3 a.m. I can call any of the ladies I lovingly call my ‘YaYas’ and any of them would answer and help. I believe that everyone needs 3 a.m. people – and communities with which you relate.  For example, communities can be formed through shared interests in sports, work, hobbies, or religion. In many cases, having a shared interest gives you the opportunity to create a true social connection.

Dr. Murthy passionately declared, “we need each other” – and I completely agree. I encourage you to take the time to make true social connections. Don’t go it alone. Participate. Connect and be there for each other.

At the end of the day… is an expression meaning an assessment of essential facts and truths. It’s a summation of the pros and cons of any situation and a straightforward statement of what really matters. It’s also the title of this blog series by Brenda Hodge, Nuance Healthcare’s Chief Marketing Officer, with insights about leadership, empathetic customer relationships, and marketing techniques.

 

 

 

At the end of the day … bring more joy to work

Leaders and influencers have a responsibility to recognize our teams for doing great things.
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Have you ever thought about what makes for a good day at work?

Is it if you had a chance to generate new ideas?  Is it completing a project?  Working with a fabulous team is certainly a part of my everyday joy. I believe the majority of people take pride in their work and want to do a great job. That is certainly true at Nuance. I also believe part of our responsibility as leaders and influencers is to catch people doing great things and let them know.

At a previous company, I worked for a CEO who never complimented anyone. The CEO was on a board of CEOs who met with the White House annually in Washington D.C.  I was asking him about his trip when he returned, and he was surprised that the other CEOs knew who our company was. He looked at me and said, “Brenda that’s because of the work you and your team have been doing over the last two years.”  I slowly started backing out of his office. He gave me a funny look and I said, “I need to leave now because this day isn’t going to get any better.”

Catch your teammate doing something well; catch your colleagues doing something well; catch your boss doing something well; and we will bring more joy to the work environment.

At the end of the day… is an expression meaning an assessment of essential facts and truths. It’s a summation of the pros and cons of any situation and a straightforward statement of what really matters. It’s also the title of this blog series by Brenda Hodge, Nuance Healthcare’s Chief Marketing Officer, with insights about leadership, empathetic customer relationships, and marketing techniques.

International Women’s Day is about… You and Your Story

Our attitudes and actions toward improving gender equity affect all of us – men and women – and make a difference in our business and personal lives.
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At the end of the day…balance for better

On International Women's Day 2019, Nuance Healthcare Chief Marketing Officer Brenda Hodge discusses how better gender balance across industries makes for a better economies and communities.
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Today is International Women’s Day.   The theme for International Women’s Day is #BalanceforBetter because a gender balanced world is a better world.

Balance is not a women’s issue, it’s a business issue.  Gender balance is essential for economies and communities to thrive.

According to Fortune magazine, when a minimum of 30% of women are represented at the C-Suite level, profitability jumps by up to 15%. For economies and communities to thrive we need more gender balance in the boardroom, the government, our teams, and in Healthcare.

I work in Healthcare Information Technology and I care deeply about this industry. Healthcare as an industry represents one-sixth of the U.S. economy.  According to Fast Company magazine:

  • Women account for 80% of healthcare workers
  • Women account for 50% of medical school applicants

But there’s a significant drop when you look at leadership:

  • Only 11% of Healthcare CEOs are women
  • There isn’t a single woman at the helm of a Fortune 500 Healthcare company
  • None of the Healthcare companies in the Fortune 500 have gender parity on their boards or executive teams
  • Just 9% of Health Tech companies are founded by women
  • 30% of women physicians have experienced sexual harassment in the workplace, while 33% of nurses have been subject to physical violence and bullying
  • About half of female medical students report being harassed while still in school

Let’s make this not just an International Women’s Day, but International Women’s year and decade. Let’s build a gender-balanced world together. Time to act.

At the end of the day… is an expression meaning an assessment of essential facts and truths. It’s a summation of the pros and cons of any situation and a straightforward statement of what really matters. It’s also the title of this blog series by Brenda Hodge, Nuance Healthcare’s Chief Marketing Officer, with insights about leadership, empathetic customer relationships, and marketing techniques.

 

 

Re-imagining radiology workflows with language understanding and AI

The cloud, context-aware language understanding and AI help to advance the practice of radiology and improve the quality, outcomes, and costs of healthcare.
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This content was also published in Health Data Management on November 28, 2018 and is co-authored with Dr. William Boonn, CMIO, Nuance Healthcare.

As healthcare’s technology pioneers, radiologists are following the ongoing development and design of artificial intelligence (AI) models to detect abnormalities in diagnostic images with a mix of anticipation and uncertainty. It’s increasingly clear what AI can do to improve patient outcomes and healthcare costs. What’s less well understood is how radiologists will be able to use the technology in ways that complement, rather than complicate, their existing workflows.

While published results have demonstrated the high degree of accuracy and specificity of various AI image characterization algorithms, behind-the-scenes work has focused on integrating a range of AI-powered capabilities into radiology workflows. That’s crucial in order to realize the benefits that radiologists envision for the technology.

For example, widely used speech recognition technology with nearly 100% accuracy is indispensable for reporting findings and follow-up recommendations, but how can radiologists use it to improve workflow efficiency and reporting accuracy? How can care teams easily access the wealth of diagnostic information and follow-up recommendations contained in the unstructured text within radiology reports? While AI shows tremendous potential to manage workloads, act as a diagnostic assistant, and automate reporting, how can those algorithms become a seamless part of the workflow without adding more screens and mouse clicks?

Adding urgency to those questions is an increase in workload and a simultaneous shift in reimbursements from the volume of radiology services to the value of the documented outcomes of those services. That’s led to a dramatic increase in physician burnout caused by the billing and reporting burdens that take doctors away from patient care.

The cloud, context-aware language understanding and AI

A combination of cloud connectivity, significant advances in speech recognition, and mechanisms that enable uncomplicated access to diagnostic algorithms and clinical decision support information is making it possible to integrate AI into radiology workflows.

Today’s speech recognition systems have a very high rate of accuracy in converting speech into text for radiology reports. But the text is unstructured narrative – just words and numbers on a screen or printed page – that doctors must manually read to extract relevant clinical information. By using computational analysis within the cloud, it’s now possible to train speech recognition algorithms using continuous, real-time input from thousands of radiology users. The result is a context-aware language-understanding system that converts the radiologist’s previously unstructured narrative into a layer of structured data, essentially pairing the words with their clinical meaning. It does that as the radiologist speaks without any extra steps or input.

Instead of being confined to a standalone textual report, the radiologist’s findings and recommendations become discrete data that can be integrated with related clinical intelligence and shared with the patient’s electronic medical record (EMR). For example,

Because the system understands a radiologist’s finding of the location, size, and surface characteristics of lung nodules on a CT, it can match those findings to current clinical best practices for consistent, evidence-based follow-up recommendations. That combined structured information also can be shared with the EMR system, making it readily accessible to primary care physicians monitoring a patient’s condition.

That same data enables quality checking to ensure report accuracy and consistency. For example, it can highlight errors in laterality or gender, or prompt for required information such as the Hounsfield Units value in a CT scan.

Workflow efficiency, report automation and improved patient outcomes

Image characterization algorithms and structured data can be leveraged throughout the radiology workflow for worklist triage, efficient communication of findings to care teams, and to improve patient outcomes.

For example, an AI model identifies a potential pulmonary embolism on a CT angiogram and prioritizes the study on the worklist. The doctor begins dictating the report using visualization tools to validate the algorithm’s findings. Instead of requiring the radiologist to fill in a blank template, the algorithm prebuilds the report with findings, measurements, and evidence-based recommendations for review and expedited forwarding to the care team.

Accessibility Is key

While there are a growing number of radiology algorithms in development, there needs to be a mechanism to ensure straightforward access to them from within the normal workflow. One approach now in operation creates the equivalent of an App Store for radiology with an expanding library of workflow, detection, and other models contributed by commercial vendors, data scientists, and physicians. Hospitals and radiology practices can purchase and subscribe to specific AI models to improve the accuracy and efficiency of many common image interpretation and reporting tasks.

One such example comes from Aidoc, an Israeli developer of AI-based radiology workflow optimization solutions. The company recently received U.S. Food and Drug Administration (FDA) clearance for an AI triage model that identifies acute intracranial hemorrhages in head CTs and flags those studies for immediate attention. The University of Rochester (NY) Medical Center has successfully used Aidoc’s AI models for worklist prioritization.

A path to greater value & information sharing

Using language understanding to generate structured narrative data opens up entirely new opportunities for intelligent information exchange with EMR systems, picture archiving and communication systems (PACS), imaging modalities, and other systems. This will require standards for consistent language and terms used in radiology reports. There is ongoing collaboration between healthcare technology vendors, the American College of Radiology, the American Society of Neuroradiology, the Radiological Society of North America, and other governing bodies to develop Common Data Elements (CDE), essentially a dictionary of terms, data types (e.g, number or text), allowable values, and other attributes used in reporting. As described by the RSNA, CDE can standardize the recording of findings such as anatomic location, shape, and dimensions to create reports that contain “not only words, but also context, meaning, and relationships.”

AI offers tremendous promise to advance the practice of radiology, and improve the quality, outcomes, and costs of healthcare. Cloud-powered, context-aware language understanding to structure the narrative data in radiology reports, and the integration of powerful AI-powered diagnostic and clinical intelligence tools within radiology workflows provide the essential technical and practical means to realize those benefits.

For more information, visit nuance.com/go/aimarketplace.

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At the end of the day…. innovation is a necessity

Our world has gotten so complex and our day-to-day lives so busy that innovation to help simplify our lives is a necessity. But the goal of innovation must be to make our lives, the lives of our customers, or the lives of our team easier.  Innovation should streamline what we already need to do, not make life more cumbersome. 
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What is your favorite innovation? My husband and my oldest daughter love gadgets. My daughter’s latest love is her Echo. I laughed when I visited her in Los Angeles, and she was excited to show me that she could tell Echo “lights out” at bedtime. I kept thinking she could just turn the lamp off, but she may have considered that medieval of me.

My husband’s latest gadgets are remote-controlled security cameras at our beach house. Given we are often not there, it a great way to keep an eye on things.  We have a pull-up bar for his workouts under the house.  You would be amazed how many people walk by our house and decide to try pull-ups.  We have it all on film and it’s quite entertaining.

One of the most profound marketing innovations was digital advertising. I’ve been in marketing a long time, and my company was one of the first to purchase Google ad words. We spent millions on print advertising, so Google ad words were a bargain at the time, as well as something that could be executed much more quickly – so, well worth the experiment.  It was an innovation that not only paid off for my company, but the population at large in the years to follow.

Our world has gotten so complex and our day-to-day lives so busy that innovation to help simplify our lives is a necessity. But the goal of innovation must be to make our lives, the lives of our customers, or the lives of our team easier.  Innovation should streamline what we already need to do, not make life more cumbersome.

Keep asking yourself what process or approach you can innovate? Where can you make the complex simpler for your customers? For yourself? For your team? Innovation can be incremental or big bang and comes in many forms including technology, process, and ideas. One of the best ways to be an innovator with customers is to bring them new ideas.   We can all be innovators so keep thinking about how to make the complex…easier.

At the end of the day… is an expression meaning an assessment of essential facts and truths. It’s a summation of the pros and cons of any situation and a straightforward statement of what really matters. It’s also the title of this blog series by Brenda Hodge, Nuance Healthcare’s Chief Marketing Officer, with insights about leadership, empathetic customer relationships, and marketing techniques.

 

At the end of the day…show your respect

Lessons learned about what it means to show respect and, in return, earn the respect of others.
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When you read the title, did you think this blog would be about respecting your elders?  When we hear the phrase, “show your respect,” it’s usually in that context. I want to challenge us all to think more broadly about respect, because respect is simply treating people in a way that makes them feel cared for and important. I got this simple definition of respect from Sesame Street.

I believe every individual has something to contribute whether it’s knowledge, perspective, expertise, talent, or skill they can share with others.  And we are all more likely to contribute when someone is treating our opinion or contribution as if it matters, because in fact it does matter. When someone is giving us the admiration we deserve, we feel valued and do better work.

Showing respect also is helpful in conflict situations.  Did you give someone the benefit of the doubt?  Did you ask them what happened before you assumed they did something wrong?  Did you get both sides of the story? Treating people in a way that makes them feel cared for is another way of showing respect.

I had the honor and privilege years ago of working for Mike Etue who showed respect for everyone. He listened intently, sought to learn from everyone, and showed people they mattered. I learned a tremendous amount from watching Mike, but I certainly fall short of his example.

Interestingly enough, the best way to earn respect is by first giving it to other people. Sometimes I think we act as if we give respect away, there won’t be any left for ourselves. People will trust you more when you respect them, and trust earns respect in return.

If respect is something that can multiply when shared, why were we primarily taught to respect our elders? Everyone deserves to be respected.

At the end of the day… is an expression meaning an assessment of essential facts and truths. It’s a summation of the pros and cons of any situation and a straightforward statement of what really matters. It’s also the title of this blog series by Brenda Hodge, Nuance Healthcare’s Chief Marketing Officer, with insights about leadership, empathetic customer relationships, and marketing techniques.

At the end of the day…there’s power in taking a break

Why do some of us, especially us type A personalities (that would be me), not take enough breaks?  I believe like with many things in life, we need to understand the science combined with our own experiences. And sometimes maybe a reminder of what we know to be true, but have gotten so busy, we have forgotten to practice. 
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There are many scientific studies that show the power of taking a break. Whether it’s a quick break during the day to clear your head, taking a day off on the weekend to relax, or taking a vacation to re-energize, the science shows that breaks provide better focus, clarity, productivity, and even increased happiness.

In my 20’s, I got a sage piece of advice from an older woman who was listening to me discuss my hectic life. I am one of those people who squeezes in everything I can in the day, the week, and the month. This wise woman suggested that I needed a day each week that wasn’t time-based. Her simple advice was for me to not wear a watch (this was before cell phones) on Saturday.  The advice served as a simple reminder to take the day as it came and not to be worried if I had gotten enough done or what was next to accomplish (again, remember I’m type A).  I haven’t worn a watch on a Saturdays in decades, and I make it a habit not to wear a watch when I go on vacation. It’s a good reminder to take a break, slow my pace, and re-energize a bit.

Before my daughter went away to college, when I was puzzled by an issue I had been working on in my home office that I just couldn’t solve, I would ask my daughter to walk the neighborhood with me. She was a wonderful sounding board, and usually by the end of the walk, a decision was made on what to do. The change of scenery, the physical exercise, and her being a good listener all helped to bring clarity.

This year my husband and I decided to take a New Year’s trip as our holiday present to each other. We spent seven days on a small ship, anchoring off a different Caribbean island each day. Most of the trip, I had no cell service, so I completely took a break from work and my normal responsibilities at home.

It was incredibly energizing to spend my days doing something completely different. I came back from our trip rejuvenated. The science proved true.

I encourage you all to take a short break during the day to clear your mind and allow you to refocus, take at least a day off during the week to relax, take a vacation to re-energize yourself. I am confident your experiences will support the science.

At the end of the day… is an expression meaning an assessment of essential facts and truths. It’s a summation of the pros and cons of any situation and a straightforward statement of what really matters. It’s also the title of this blog series by Brenda Hodge, Nuance Healthcare’s Chief Marketing Officer, with insights about leadership, empathetic customer relationships, and marketing techniques.

 

 

 

 

A Backstop that reduces risk of delayed diagnosis

Nuance Healthcare Diagnostics Vice President and General Manager Karen Holzberger and University of Rochester Medical Center's Dr. Ben Wandtke discuss his ongoing research into improving healthcare outcomes by coupling tools like mPower Clinical Analytics with practical use of existing technology and effective communications to ensure that vital follow-up recommendations don’t “fall through the cracks.”
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There are two things that have long been true about incidental findings and follow-up recommendations in radiology reports. First, they are exceedingly common. Second, they are often not completed: 30% to 70% of follow-up recommendations are “lost” or never completed for reasons unrelated to physician skill, but from a mix of systemic and technology limitations. Fortunately, work is advancing to “close the loop” using clinical analytics and practical methods that significantly improve healthcare outcomes and radiologists’ value. I spoke with Dr. Ben Wandtke to get a real view of the work they’re doing at the University of Rochester to create those advances.

KH: You’ve been doing some important work at the University of Rochester Medical Center for the past few years to understand and address the problem of non-compliance with radiology follow-up recommendations. Can you give us an overview of the issue?

Dr. Wandtke: Thank you, Karen, and yes, it’s an issue that’s certainly captured my attention and that of radiologists and healthcare administrators in systems across the country. Like many radiology departments, we noticed a disconnect in follow-up for patients that come through the ED. They may have a CT for example, and the radiologist reports an incidental finding of a lung nodule or a lesion lower in the abdomen. But the emergency physician was understandably focused on addressing the primary reason for the visit to the ED. That means that the patient’s PCP often doesn’t get notified and the patient might not learn about that finding until much later when the condition has become difficult to treat.

In our study, we found that only 43% of follow-up recommendations contained in radiology reports were completed while 57% were never performed. The negative impact in terms of patient outcomes, physician satisfaction, and healthcare costs is profound. On the other hand, the positive effects from the steps we’ve implemented to date have been transformative for patient experiences and in improving the costs and value of healthcare delivery.

We initially started with a home-grown database and a manual process at one of our community hospitals. We had a system of communication backstops and tracked outcomes data associated with our interventions to bring patients back. At a small scale, we were able to demonstrate the need and the efficacy for this type of program, but we quickly discovered that we were going to need additional automated functionality to make this viable on a larger scale.

KH: Let’s get into some of the specifics of your program.

Dr. Wandtke: We initially looked through radiology reports for exams with follow-up recommendations and loaded them into our home-grown database. For exams with overdue follow-up imaging recommendations, we implemented a three-stage communication protocol for ensuring compliance. Stage 1 consists of resending the radiology report to the patient’s PCP, requesting attention to overdue recommendations, or a letter to patients’ without a PCP. Stage 2 involves a call from a dedicated staff follow-up person to the PCP’s office. In Stage 3, the radiologist contacts the PCP directly. We realize that not every program may implement all these steps, but it worked well for our group.

The initial implementation of PowerScribe Follow-up Manager (initially part of the Primordial suite) helped automate many steps in this process. Through an integration with the radiologists’ reading environment, radiologists could easily designate exams with a recommended follow-up. It automated the building of a worklist, the collection of data from the RIS/EMR, and it also automatically escalated the patients who were overdue at each stage of the process. When it was time to send a letter, it would merge the patient, exam and appropriate physician information into a pre-defined letter template for printing.

KH: How did you scale it up from that first facility?

Dr. Wandtke: A year and a half ago we scaled the system to six hospitals and five outpatient imaging centers. When we expanded the scope to a larger, less centralized group, we quickly realized that not every radiologist would remember to take the extra step to designate a finding, even though the capability was integrated into the reading environment. Nuance was given the opportunity to analyze the cohort of reports using mPower, their clinical analytics engine, to see if the radiologists failed to flag any follow-up recommendations. mPower simply scanned the free text of the report and extracted out relevant follow up recommendations that met the inclusion criteria. Integration of mPower allows for more efficient recommendation entry into a tracking system without additional manual effort by the radiologist to flag follow up recommendations and without modification to the radiologists existing dictation style. Simply dictating recommendations into the report is sufficient.  mPower-automated recommendation capture nearly tripled the number of recommendations tracked and increase the cost-effectiveness of the program dramatically.

KH: The results have been impressive. I’m also struck by the importance of the program on multiple levels because it’s much, much more than taking a measure of improvements in costs and healthcare benefits.

Dr. Wandtke: Overall, our program is now able to confirm satisfactory follow-up for 91% of our patients. The remaining 9% are primarily “lost” due to patient non-compliance. The tracking system resulted in an 80% increase in our ability to “close the loop.” Beyond generating additional examinations, often with higher-reimbursing imaging modalities, the program improves patient care through earlier diagnoses and reduces medical legal risk. Preliminary analysis suggests a positive annual return on investment in addition to the quality gains demonstrated.

That said, it’s more than just tracking follow-up compliance. Programs like these reinforce the use of evidence-based guidelines and consistent application of high-quality care. They address the fragmentation of healthcare delivery and prioritize the patient and clinical outcomes.

KH: Thank you, Dr. Wandtke. Those are excellent insights. In any profession, follow-up and follow-through are essential. That’s especially true in medicine where it can have such far-reaching, literally life-saving, effects. Each of us has the capacity to create lasting good just by following up. It’s the people who follow through who excel. As we’ve seen from the continuing work by Dr. Wandtke, mPower Clinical Analytics and PowerScribe Follow-Up Manager can greatly enhance our abilities to follow up – and make a difference in healthcare every day.

The Real View is a Q&A blog series with Karen Holzberger, Vice President and General Manager of Nuance Healthcare’s Diagnostic Division. The Real View cuts through the hype and gets to what’s real, here, and now. The blog series features interviews and insights from health IT movers and shakers – and uncovers disruptive technologies that solve challenges, optimize workflow, and increase efficiencies to improve patient care.

 

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A 2019 prediction: Radiologists accelerate the adoption of workflow-integrated AI solutions

The coming year will see radiologists continue their long-standing role as technology pioneers as they increasingly adopt workflow-integrated AI, the Nuance AI Marketplace, and context-aware language understanding to extract structured data from narrative text.
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I have a prediction for the adoption of AI in radiology in 2019: radiologists not only will adopt workflow-integrated AI solutions in increasing numbers, they will accelerate development and application of these solutions throughout the healthcare value chain.

I base that on three observations from last month’s RSNA conference in Chicago:

  • There’s been a sea change in radiologists’ views of AI. Practical understanding and a grounded sense of curiosity and excitement are dispelling the concern, confusion, and hype that has surrounded the technology.
  • The top three factors that will drive widespread adoption of AI-driven diagnostic and report automation tools in radiology are — workflow, workflow and workflow.
  • Radiologists are doing with AI now what they have done so well over the past 30 years with RIS and PACS, speech recognition, and every other new disruptive healthcare technology – leading the way forward by exploring, adapting, and adopting it to advance patient care.

Each of those three observations is notable by itself, and I mentioned them in the RSNA recap in my last blog post. But what’s remarkable is how they coalesced at this year’s conference in a virtual circle — each supporting and propelling the other two. You could see it in the exhibits, on social media, and in the news coverage, and hear it in the presentations and in conversations with attendees. You could feel the energy and optimism that the show produced.

The change in attitude is a product of increased understanding, partly from the results of studies exploring the promising performance of image characterization algorithms as well as the real-world challenges of using them. Radiologists also are seeing FDA clearance for a growing number of diagnostic algorithms from developers and healthcare organizations including from more than 40 distributing their AI models via the Nuance AI Marketplace for Diagnostic Imaging.

That leads to the second observation and the recognition of the radiology workflow as the linchpin for AI adoption. PowerScribe One is designed specifically to integrate the practical use of AI into radiologists’ trusted and familiar workflows. It embeds powerful AI tools within the workflow in ways that naturally extend and enhance a radiologist’s own experience and expertise.

That includes seamless access to the Nuance AI Marketplace where radiologists can subscribe to, use and refine continuously learning algorithms in a collaborative feedback loop with developers. Instead of trying to work with countless developers one-by-one, radiologists have one-stop, integrated access to a range of AI models. Current use cases include worklist prioritization and workflow automation, specifically:

  • Aidoc, Nuance, and the University of Rochester are collaborating on a potentially life-saving worklist prioritization application. The FDA-cleared application analyzes CT exams indicating a suspected intracranial hemorrhage, then prioritizes them on the PowerScribe Workflow Orchestration worklist for a radiologist’s immediate attention in cases when time-to-treatment is critical.
  • Aidence, eUnity, Nuance, and the University of Pennsylvania are collaborating on the development of an application to assist radiologists in the time-consuming task of detecting and characterizing pulmonary nodules for reporting and follow-up comparisons. The Aidence Veye Chest algorithm can detect, measure, and characterize lung nodules in CT exams. It also can compare lung nodules in follow-up exams to assess changes. The accuracy of Aidence’s automated nodule diameter and volume measurement, growth rate, and composition have been validated in a clinical study at NHS Lothian and the University of Edinburgh. Aidence’s Veye Chest application has received a CE mark but is not yet cleared by the FDA for clinical use.
  • Zebra Med’s Coronary Calcium Scoring application checks for calcium buildup in the coronary arteries. Calcium in these arteries may be a sign of heart disease. Zebra has developed several algorithms that are designed to help institutions uncover incidental findings across a patient population that have meaning and potential impact on risk stratification. The Coronary Calcium Scoring application is intended for value-based institutions that hold preventative methodologies as a priority.
  • Densitas’ FDA-cleared densitasdensity™ application automatically assesses breast density, an important predictor of breast cancer risk, while radiologists focus their time and attention on finding breast cancer. The densitasdensity algorithm can analyze images to provide consistent and reproducible breast density grades that align with the ACR’s 4th or 5th edition breast density scales. The application is intended for use with compatible full-field digital mammography systems.

These algorithms also can work hand-in-hand with the advanced context-aware language understanding platform integrated into PowerScribe One. The language understanding platform converts unstructured narrative text into structured data and derives its meaning in a clinical context. That enables the content of the spoken narrative to be used alongside the results of AI algorithms, matched with current and applicable decision-support tools, checked for consistency and accuracy, and shared with PACS, EMR, and other systems.

As you can see, the focus is not on AI technology per se, but on using AI to support and enhance workflow. That’s absolutely essential for making it relevant and practical. That leads to the final observation. When it comes to exploring new technology, seeing ways to use it to assist in the diagnosis and treatment of disease, and then adopting it in daily practice, radiologists have repeatedly “been there and done that.”

So, it is now with AI. Radiologists are not seeing AI as a threatening abstract technology. Instead, they are coming to understand it as an incredibly powerful tool they can use in practical, everyday ways to address physician burnout, meet the growing demand for radiological services, advance the state-of-the-art in radiology, and improve the quality and outcomes of patient care. As we witnessed at the RSNA conference, radiologists are energized by this change because it comes from a how-to “playbook” of technology empowerment and achievement that they know well.

Which brings us back to the first observation, then to workflow integration and the practical application of AI, which leads to more excitement and innovations. And the cycle continues.

I do not consider my prediction bold; rather, it’s the most sensible and likely path ahead. Any uncertainty I have is not about if AI adoption will accelerate, but how rapidly and widely it will. Time will tell, of course, but I suspect that when we look back after the 2019 RSNA conference we are going to be talking even more about radiology’s contributions to improving healthcare costs and outcomes using AI.


 

 

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4 factors health systems need to consider when protecting PHI

When thinking of security including cybersecurity most organizations focus on their perimeter security -- to stop outside threats from entering. The reality is however, that our biggest risk is already inside from employees either through accidental or malicious attacks. Healthcare organizations must focus on internal and external threats to protect PHI.
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4 factors health systems need to consider when protecting PHI

Evolving technologies such as artificial intelligence, connected devices, and virtual assistants are continually simplifying our lives. While they simplify our lives however, they make our technological environments much more complex and difficult to manage and secure. CIO’s have the daunting task of implementing agile cybersecurity and privacy strategies to protect not just their networks but their rich customer data as well. Healthcare CIOs have an even greater burden since experts insist that the cost of a healthcare data breach is still the highest of any industry.

Interestingly, recent reports from Verizon’s 2018 Protected Health Information Data Breach Report (PHIDBR) indicate that 58% of all healthcare breaches involve insiders. This is disturbing especially when many healthcare organizations have repeatedly told us at Nuance, “our devices are only accessible by staff.” The report goes on to show that healthcare is the only industry where insider threats exceed external threats. Further to that HealthcareInfoSecurity reports that there have been 229 data breaches affecting 6.1 million individuals since the start of 2018. It’s imperative that health systems implement the right solutions and best practices to establish security for PHI.

When thinking of security including cybersecurity most organizations focus on their perimeter security — to stop outside threats from entering.  The reality is however, that our biggest risk is already inside from employees either through accidental or malicious attacks. As a result, best-in-breed healthcare systems are rethinking their security strategies including managing and monitoring what applications and devices their staff access. Printers and multi-function devices are high on the list given the recent chatter of how vulnerable they are to cyber security breaches.

Shahid Shah, Chief Technology Officer at Citus Health, Inc explained that “security teams spend a lot of their time looking at external threats because we’ve all been taught – across industries – to ensure that proper firewalls are installed, IDS’s are enabled, and that phishing is something we have to care about. What security professionals are not taught about regularly is how insiders, such as those who can escalate account privileges in their EHRs or who have access to lots of Microsoft Office documents with PHI, can be just as more dangerous.” Shah is correct.

Now to tighten their network strategies, many health systems are turning to frameworks such as HITRUST CSF to help guide their security strategies. HITRUST incorporates key elements from a multitude of standards organizations like NIST & ISO among others, in addition to regulatory statutes like HIPAA and agencies such as CMS to name just a few to provide an overarching program that provides governance over technical, administrative, business operations and human capital.

The problem however with insider threat, Shah explained further “is that they are hard to mitigate with just installation of tools – we have to consider all the different ways privileged staff can do damage. While almost any security professional can help with general externally facing threats, we need to train special healthcare security professionals focused on medical, administrative, and clinical workflows that general security personnel cannot catch. If you’re not spending at least 1/3rd of your time and budget on protecting from insider threats, you’re probably more susceptible than you could be.”

 

Along with the right strategy and frameworks here are 4 factors health systems need to implement when protecting PHI:

 

Control access across devices

One of the key elements of being able to secure information and the network begins with access controls at the device level. There are many solutions in the market that can provide access controls at an individual function level, like print or scan or fax or copy or maybe a combination of 2 or 3. However healthcare organizations need solutions that control and manage access at the device level across all functions.

 

Custom and personalized authorization

 Healthcare systems need to implement solutions that are not only able to control and manage access to functions of an MFP, but also provide another unique capability such as custom and personalized authorization. Based on a user’s profile and the policies of the organizations, solutions must be able to authorize a user’s access to some or all of the functions of the device. For example, some users may only be allowed to make copies. Others may be able to make copies and pick up print, but not able to scan or fax information.

 

Mandatory Document Encryption

Health systems must be able to manage the all printed, scanned and faxed documents. These documents hide a wealth of patient information that needs to be protected from deliberate or accidental exposure.  Employing solutions that ensure these documents are properly encrypted, recorded for audits, inspected for content restrictions, retained for legal review, and prevented from being sent to undesirable or unintended destinations is critical.

 

Security and Usability Balance

The best security is a balance between protection and usability. At Nuance we’ve focused on providing an enterprise platform that can secure and optimize document workflows, but in a way that’s also intuitive, flexible and easy to adopt for end users. Change management in healthcare is critical and being able to deploy a solution that accomplishes the technical, administrative and operational goals while also being quickly and easily adopted by the employees, staff and clinicians is what defines a successful project.

To protect their PHI data from externals and especially internal threats healthcare executives must take steps to protect their health systems.

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4 factors health systems need to consider when protecting PHI

At the end of the day…create value

By focusing on delivering value, we create customer loyalty, competitive differentiation, a more consistent customer experience, and deeper relationships with our customers.
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I was asked this week by an analyst firm, “How do you create value for your customers?”

Value is defined in both tangibles and intangibles.

The tangibles are dollars, time, and quality. Dollars are measured with cost savings, additional revenue or profit. Improved efficiency is measured in time savings. And quality is typically measured with quality scores and reputation.

The intangibles are customers’ personal motivators, ideas you bring to the table for your customer, and trust that you build with them. Personal motivators could be how you improve someone’s reputation in the organization or industry, bring ideas to your customers to improve their business, or build trust over time through a variety of interactions with your customers.

It’s important to understand and quantify the value you bring to your clients. The only way to ensure your company is delivering value is to measure it.

Know what problem you are solving for your customers and measure the return.  Leverage your industry experts to define the quantifiable outcomes as a part of the solutions definition. Make sure your implementation team knows the metrics and outcomes to measure and take good baselines before you get started. For the customer loyalty and experience, leverage best practices like the Net Promoter Score to measure how you are doing.

By focusing on delivering value, we create customer loyalty, competitive differentiation, a more consistent customer experience, and deeper relationships with our customers. The more value you create, the more you can maintain your price point or even charge a premium, because quite simply, there’s more value.

By focusing on creating value for your customers, you ultimately create value for your company and shareholders.

At the end of the day… is an expression meaning an assessment of essential facts and truths. It’s a summation of the pros and cons of any situation and a straightforward statement of what really matters. It’s also the title of this blog series by Brenda Hodge, Nuance Healthcare’s Chief Marketing Officer, with insights about leadership, empathetic customer relationships, and marketing techniques.

 

Winning game-changers for really “doing AI” in radiology

Context-aware language understanding and workflow-integrated access to a growing marketplace for AI diagnostic and decision-support tools signal a new generation in radiology reporting
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The annual meeting of the Radiological Society of North America (RSNA) reliably produces a lot of important radiology news, and it would be fair to say that this year’s conference was no exception.

In fact, it’s more accurate to call the news from this year’s conference – game-changing. RSNA 2018 was exceptional for the marked shift in how radiologists are energized by the practical and easily accessible ways to use AI to boost workflow productivity, reduce burnout, address healthcare costs and improve patient outcomes.

In fact, our introduction of PowerScribe One and our update on the vibrant first-year growth of the Nuance AI Marketplace for Diagnostic Imaging are at the vanguard of that shift. Specifically, our RSNA announcements demonstrate how AI – after a lot of fear, uncertainty, doubt and hype – is now both useful and usable. PowerScribe One and the AI Marketplace together represent a new generation of radiology reporting systems that specifically address workflows and collaborative, interoperable solutions. Nuance is, as UPMC Chief Innovation Officer Dr. Rasu Shrestha tweeted on the rainy first day of the show, one of the “winners” really “doing AI.”

The innovations in PowerScribe One begin with a cloud-powered, continuously learning, and context-aware language understanding platform that converts unstructured speech-to-text input into structured clinical data while the radiologist speaks and without any additional steps or input. PowerScribe One uses the cloud and real-time input from thousands of Nuance users to continuously train machine learning algorithms that improve accuracy and specificity. That transforms the value of radiology with a wealth of actionable data that can be shared and used throughout the healthcare value chain. Structured narrative data also opens a path to expanded interoperability and a new generation of data-driven applications.

Workflow integration is the key

PowerScribe One is designed from the ground up with workflow-integrated access to AI tools for assisted diagnosis, clinical guidance, quality-checking, and report automation. That includes integrated access to the Nuance AI Marketplace for Diagnostic Imaging and its expanding library of workflow, diagnostic, and other radiology algorithms. Images are automatically routed through PowerShare, where algorithms from the AI Marketplace analyze them and send results back into PowerScribe One. The radiologist then reviews each AI finding, and accepted results and recommendations are automatically included in the report with no additional steps.

The practical benefits of workflow-integrated AI are as clear and accessible as the tools themselves. Radiologists are seeing:

  • 94% reductions in report turnaround time
  • 87% fewer phone call interruptions
  • 31% productivity increases through analytics
  • 95-100% critical findings message closure compliance
  • 10% increases in workflow efficiencies

Those benefits cascade through the healthcare value chain with:

  • 44+ hours saved per week managing lung cancer screening programs
  • Cost savings equal to 1 FTE per 200K studies with automated patient reconciliation and order creation.
  • 40% reductions in duplicate imaging and unnecessary repeat scans
  • Optimized IR scheduling and length-of-stay reductions of up to 3 days

A collaborative, workflow-integrated AI marketplace

In less than a year since we introduced it, the AI Marketplace for Diagnostic Imaging has mobilized a community of developers, researchers and technology leaders building, testing, validating and sharing algorithms for radiology. The AI Marketplace now has more than 40 developers and healthcare organizations including the Center for Clinical Data Science at Massachusetts General Hospital and Brigham and Women’s Hospital. We’re also working with the American College of Radiology (ACR) and other professional societies to establish standards for AI within radiology workflows, EHRs, PACS, and other areas.

A few examples of workflow-integrated algorithms available through the AI Marketplace are:

  • Aidoc, Nuance, and the University of Rochester are collaborating on a potentially life-saving worklist prioritization application. The FDA-cleared application analyzes CT exams indicating a suspected intracranial hemorrhage, then prioritizes them on the PowerScribe Workflow Orchestration worklist for a radiologist’s immediate attention in cases when time-to-treatment is critical.
  • Aidence, eUnity, Nuance, and the University of Pennsylvania are collaborating on the development of an application to assist radiologists in the time-consuming task of detecting and characterizing pulmonary nodules for reporting and follow-up comparisons. The Aidence Veye Chest algorithm can detect, measure, and characterize lung nodules in CT exams. It also can compare lung nodules in follow-up exams to assess changes. The accuracy of Aidence’s automated nodule diameter and volume measurement, growth rate, and composition have been validated in a clinical study at NHS Lothian and the University of Edinburgh. Aidence’s Veye Chest application has received a CE mark but is not yet cleared by the FDA for clinical use.
  • Zebra Med’s Coronary Calcium Scoring application checks for calcium buildup in the coronary arteries. Calcium in these arteries may be a sign of heart disease. Zebra has developed several algorithms that are designed to help institutions uncover incidental findings across a patient population that have meaning and potential impact on risk stratification. The Coronary Calcium Scoring application is intended for value-based institutions that hold preventative methodologies as a priority.
  • Densitas’ FDA-cleared densitasdensity™ application automatically assesses breast density, an important predictor of breast cancer risk, while radiologists focus their time and attention on finding breast cancer. The densitasdensity algorithm can analyze images to provide consistent and reproducible breast density grades that align with the ACR’s 4th or 5th edition breast density scales. The application is intended for use with compatible full-field digital mammography systems.

Unlike other imaging AI marketplaces and exchanges, the Nuance AI Marketplace gives developers access to 70 percent of all radiologists across 5,500 healthcare facilities, continuous algorithm training using real-world data, and automated access to required registries. For subscribers, the AI Marketplace offers one-stop-shopping for imaging algorithms integrated into the radiology reporting workflow, with a collaborative feedback channel for continuous improvement.

It’s gratifying and incredibly encouraging for us to see the radiology community share in our vision for AI. It’s also inspiring to see the growing commitment to AI among radiologists as they begin to realize the benefits and explore further advances.

One thing is for sure: PowerScribe One and the AI Marketplace are winning game-changers for really “doing AI” in radiology.

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At the end of the day…be thankful

Thanksgiving is a great time to take stock of your many blessings.
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The first Thanksgiving was a harvest feast celebrated by a diverse group. Puritans who had come to the “New World” seeking religious freedom, and Native Americans who banded with them to protect themselves from other tribes, celebrated the fall harvest together. The Puritans had much to celebrate since they survived the long journey across the ocean. These Puritans made it through that first winter, and with the help of the local Wampanoag tribe, they had a hearty supply of food to sustain them through the next winter.  Great reasons to be thankful.

I started a tradition many years ago that right before Thanksgiving I make a list of all the things for which I’m grateful.  I started this tradition one year when I felt I was taking too many blessings in my life for granted.

I am a list maker by nature, so my tradition is to make a list of blessings, big and small.  The list includes people in my life, places I’ve been, laughter shared with friends, and moments in my life that stand out.   Several years ago, I remember reflecting that I was grateful to be healthy, but that if I were to ever get sick, I would make sure to write my husband and daughters letters about all their wonderful qualities. However, I realized that I should not wait for some unfortunate situation, so I wrote and gave them the letters.

Sometimes I get so busy I forget to take stock of what matters, and this tradition helps me to remember.

What’s your list?

At the end of the day… is an expression meaning an assessment of essential facts and truths. It’s a summation of the pros and cons of any situation and a straightforward statement of what really matters. It’s also the title of this blog series by Brenda Hodge, Nuance Healthcare’s Chief Marketing Officer, with insights about leadership, empathetic customer relationships, and marketing techniques.

Hunting for the “easy” button: Finding balance and minimizing radiology overhead

Nuance Healthcare Diagnostics Vice President and General Manager Karen Holzberger and Senior Manager, Product Management, Andy Stahl discuss the challenge of workload distribution and explore considerations for redesigning a system that supports the unique needs across radiology departments and private practices. With varying organizational cultures, processes, and competing priorities, how are these groups dealing with these challenges and implementing effective solutions in an evolving imaging ecosystem?
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The workplace dynamics of radiology reading “rooms” have changed dramatically in the last few decades. It’s less common for radiologists to sit in a single reading room and have the option to talk directly with each other about how to manage the daily workload. In addition to the physical separation, today’s radiology workloads have become more compartmentalized as specialization has increased. Many groups still rely on email, phone calls, multiple worklists, and manual work assignments. With these methods, groups struggle to scale and meet quality and cost goals.

As new technical solutions have emerged to address these challenges, it has become increasingly more difficult to separate marketing hype and unnecessary complexity from practical solutions. In order to separate signal from noise, I sat down with Andy Stahl, to get his perspective on the history of these concepts, the current state, and where these solutions are headed.

KH: Andy, you have been working with radiology departments and private practices for more than a decade.  You have listened to their challenges, their goals – and have a first-hand view of what matters most. Can you share your view of the current status of workload distribution?

There is a spectrum of needs and solutions for workload distribution, so I would initially separate the discussion into two distinct categories: systems integration and operational optimization. First, there is the most basic need to integrate data and workflow from multiple disparate sources into a cohesive system. Data can be interfaced into central systems or disparate applications can be integrated through a workflow orchestration platform. Requirements may vary based on governance, architecture, and integration challenges. Some data sharing between systems will inevitably be required, even if it is only to build a universal reading worklist. With the public push for interoperability and the decades-old teleradiology precedent, it’s surprising to still see some data owners reluctant to share information. That is still present, but thankfully a receding trend.

When governance and data access issues can be addressed, a true vendor neutral workflow orchestration platform should be able to integrate with multiple disparate systems using open, standards-based technologies. Vendor-neutral workflow orchestration platforms have proven their ability to integrate with multiple systems —multiple viewers, multiple RIS/EMR applications, multiple dictation/VR systems. Yet, they will always be dependent on the level of compatibility of other systems. The reality is that we see most groups try to consolidate the reading work into as few core systems as possible, for example, workflow manager, viewer, and reporting — and one of each. Consolidation not only reduces technical points of failures and complexity, but it also greatly improves the efficiency of end users. Imagine doing any daily computer work constantly switching between Mac and Windows OS at any given moment. Short-cuts, menu options, and other UI elements are all basic ergonomic examples of where efficiency is lost with technology context switching. Then, there are multiple inactivity time-outs, hardware compatibility, memory shortages, and other performance killers. Even in practices juggling multiple systems, we see a strong user preference to batch work in one application to avoid the context switch, as opposed to batching by clinical priority, which should be the goal.

The second and more interesting category of workload distribution addresses the issues of optimizing supply, all types of personnel, and the clinical demand. Culture, staffing levels, and specialization can vary widely by group. Therefore, one group may have a very different set of optimization challenges than another.

KH: Is it currently possible for an intelligent radiology workflow management system to fairly distribute work on any and every given day? How much of this is reality and how much is science fiction?

Fairness may always be a matter of perspective. There are ways to evenly distribute exams based on counts or weighted values such as RVUs. There are ways to adjust RVU values. There are ways to incorporate non-dictation events, like tumor boards, into an individual’s overall work effort. Those concepts are current realities. If fairness is assigning the same number or same weighted total or designated proportion to each user, then fairness is an achievable reality.

The idea that a workload balancing system can make all these decisions independently, or that work will always be evenly distributed without human oversight, may still be more myth, or marketing hype, than reality. A system can be designed around the average or expected scenarios, but it should also be able to handle fluctuations in demand and unexpected changes in supply. If volume is unexpectedly high, then work can still be evenly shared. If a user is pulled away unexpectedly, then work may need to be re-allocated. Although the technology can handle these exceptions, these override scenarios need to be specified and then monitored for effectiveness. A system that optimizes workload distribution must deal with dynamic inputs and constraints and sometimes competing priorities, like fairness and clinical urgency. Good technology design may allow for easier and more practical approaches to achieving fairness then turning over all decision making to a computer algorithm. Using a component-based design that allows for flexibility has been key to helping our customers strike the right balance.

Distribution concepts solely focused on counting exams may also discourage other value-added work, such as clinician consults, patient communication, peer collaboration, and interdisciplinary team work. Radiology departments and private practices should be sure to explore solutions that facilitate and measure other quality-oriented activities in addition to counting load-balanced exam assignment.

KH: How do groups justify investing in new technology and new systems when so much has been spent on existing systems, like PACS and EHRs?

ROI calculations and a business case for a workflow management system should be oriented around value, which is a function of both quality and cost. The system should enable the provider group to deliver and quantify a higher value service while it lowers the overall cost of supporting the service line. It’s not just about one type of output – the number of reports. It’s not about one type of user – rads, techs, system admins, or rad assistants. The number and type of units should increase while the overall cost per unit decreases. Workflow management systems can add more depth and value than a PACS or EHR that is oriented around image management or a comprehensive medical record.

KH: What is your sense of the cherry-picking problem? What are the best methods to address these concerns?

Cherry-picking can be a real problem and it can be minimized and monitored. Look at the different types of potential cherry-picking. When working off a shared worklist, a user could choose high RVU exams with a low actual degree of difficulty. By placing exams onto individual worklists, the system could avoid the problem altogether. The system could know when that assignment was ignored and forced into someone else’s queue by exception. Poor behavior might be intentionally avoiding plain films or avoiding specific exams, like bone age and scoliosis exams. These exams could be pooled and distributed, but the trends can be easily spotted with analytics tools that show RVU, modality and exam code mix by user and by shift. Cherry-picking could also mean leaving before a worklist is cleared. Analytics tools can identify a pool of unread exams at a point in time and would quickly confirm whether these suspected behaviors are realities.

Some approaches advocate a break-the-glass approach, where users must explain their behavior before reading or skipping exams. Our experience has been that users find this to be a nuisance and that it’s counterproductive. In general, customer experience has pushed us towards designing systems that facilitate positive behavior rather than ones that prevent negative behavior, especially when negative behavior is elusive and hard to prevent but easier to track.

KH: Is there an “easy button” or “one-size-fits-all” approach for helping groups that don’t have much time to spend on this?

There really isn’t a one-size-fits-all approach. We work with groups that have different perspectives even between their own sections. Neuro likes reading off shared worklists, but the body section wants workload distribution. Or, weekends and night shifts may have a different preference than day shifts. We believe that we need to be flexible to serve the customer base. We need to support shared worklists, automated assignment to a shift, manual assignment to a shift, automated assignment to a user, manual assignment to a user, and semi-automated assignment. We encounter new use cases constantly. One group might want to just distribute the undesirable plain films. Another group may have a body section in which some users don’t read certain types of exams. Another group may want to accommodate ordering MD preferences for radiologists. All these adjustments in worklist design should consider the schedule and its flexibility to match demand.

The truth is, you’re dealing with sophisticated and intelligent users. If you can give them do-it-yourself tools to work off individualized worklists with fewer rules, minimal overhead and better analytics, then you may be able to hit the “easier” button. Historically, the problem has mostly been that native PACS or RIS/EMR based worklists haven’t supported the sophisticated logic required to build the right worklist and allow dynamic adjustments for users. With better worklist technology, you could solve most of your workload distribution issues without adding unnecessary management overhead and complexity. That worklist technology better be sophisticated enough to tie your brain in knots with the flexibility of its logic.

A step-wise and iterative approach to solving these problems has typically been most effective. Use analytics to confirm suspected inefficiencies in scheduling, worklists, and personnel. Build new worklists that more precisely distribute the work to the appropriate shifts and people. Back-test these worklists against historical data. Edit the worklists. Edit the schedule. Consider the other value-added work and the whole picture.

KH: Andy, thank you for sharing. Your insights will give our readers much to consider as they evaluate solutions to help optimize their workloads.

The Real View is a Q&A blog series with Karen Holzberger, Vice President and General Manager of Nuance Healthcare’s Diagnostic Division. The Real View cuts through the hype and gets to what’s real, here, and now. The blog series features interviews and insights from health IT movers and shakers – and uncovers disruptive technologies that solve challenges, optimize workflow, and increase efficiencies to improve patient care.

 

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A real view of lung cancer screening programs

In recognition of Lung Cancer Awareness Month, Nuance Healthcare Diagnostics Vice President and General Manager Karen Holzberger sat down with Baptist Health South Florida’s Dr. Juan Batlle to discuss how they’re working to catch and treat more cancers at their earliest stages.
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According to the Lung Cancer Foundation of America, 433 Americans die every day from lung cancer—that’s one person about every three minutes. Despite its position as the leading cancer to cause death, routine screening programs have only just been established in recent years. I had the chance to talk recently with Dr. Juan Batlle, whose work with the Lung Cancer Screening Program at Baptist Health South Florida’s Miami Cancer Institute (MCI) is having a profound impact on patients.

KH: Tell me about why you established your lung cancer screening program.

Dr. Batlle: We have, for a long time, had routine screenings established for breast, colon, and prostate cancers. But lung cancer, which is a leading cause of death, really didn’t have a similar screening program. In 2010, a national research trial came out and showed a significant mortality benefit to annual screenings, and more recently a European companion trial demonstrated similar results. So, we were interested in establishing our own program, and got the project started rather quickly. We knew from talking with other lung cancer screening programs that the combination of screening plus cessation support was the right way to go.

KH: I understand you ramped up fast and quickly became one of the top five sites in the U.S. in terms of volume. How did you do that?

Dr. Batlle: We started by setting clear objectives for the program. First, we had to catch cancers early enough to have a positive impact on patient outcomes. Second, we had to achieve year-over-year program growth. Third, we had to find a way to make sure no one would fall through the cracks. We then designed the program around CMS-specific parameters for eligibility, and made sure that the cost to patients was affordable. It wouldn’t make sense to set up a program and then not have any patients who could rely on it.

KH: How does the program work then, on a day-to-day basis?

Dr. Batlle: When a patient meets the eligibility requirements—that is, they’re between the ages of 55 and 80, have a 30-pack per year smoking history, and have not quit in the last 15 years—the first step is to make them aware of the screening program. Once they have made an appointment, they speak with one of our nurse navigators, who ask additional questions to verify eligibility, offer a cessation program, and get their information into our database for the program. After that, they receive their scan, and our radiology team issues the report. The nurse navigators send them a letter that advises them of the follow-up process. The reports go to the referring physicians, or with suspicious cases, we convene the team to talk about next steps. Patients aren’t waiting for months for our conclusions; they’re getting our recommendations within a week of their scan.

KH: You mentioned that you needed to make sure no patient would fall through the cracks. Explain that to me—how do you do it?

Dr. Batlle: Technology is the backbone of our program. We have a range of Nuance solutions to create the radiology reports, track patient results, send letters to patients, communicate with referring physicians, manage our workflows, and more. Tracking patients is not something you can do with sticky notes and spreadsheets, and you have to handle the cancer registry reporting requirements. You need a real system that’s HIPAA-compliant, can talk to the EMR, accurately renders the radiologist’s narrative, and keeps all reports and imaging together. Nuance is the glue that keeps this all together for us.

KH: How has the program progressed since it launched?

Dr. Batlle: We’re proud of how quickly we have ramped up. In the first few years, we have found and treated 26 proven cancers after scanning nearly 2,500 eligible, qualified patients. The vast majority of these cancers were in their earliest stages, which inverts the therapy dynamic in favor of the patient. Most of these cancers have been caught early enough to be surgically cured, which is not typical of lung cancers.

KH: Impressive results. Thank you, Dr. Batlle, for sharing your story.

Dr. Batlle also recommended a few best practices for other organizations that are interested in establishing their own Lung Cancer Screening programs. For example, he mentioned that it’s tempting to think that one radiologist could manage the program, but the all-in support and multi-disciplined approach from the Baptist Health South Florida health system has been a critical component to their program’s success. You can read more about Dr. Batlle’s story in our recent case study, which you can download here.

The Real View is a Q&A blog series with Karen Holzberger, Vice President and General Manager of Nuance Healthcare’s Diagnostic Division. The Real View cuts through the hype and gets to what’s real, here, and now. The blog series features interviews and insights from health IT movers and shakers – and uncovers disruptive technologies that solve challenges, optimize workflow, and increase efficiencies to improve patient care.

 

 

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At the end of the day…YOU define success

Sometimes we start down a path of success defined by others and not ourselves. It takes courage to make a switch.
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In high school, I was nominated to participate in a “Calendar Girl” contest which meant if I won, I would have my photo on one month of the high school’s calendar. At the time, this was important to me because I was known as the “smart girl”, not a “pretty girl” because in high school the two unfortunately were mutually exclusive.  I remember I had to walk out in a long dress and do a turn that tripped me up most of the time.  I also had to answer a question in front of a large audience. Now, this was the 1980’s, so the question I received was, “Is a woman’s place in the home?”

At the age of 17, I replied, “The answer is – it is up to the woman to decide. What does she want? What would make her happy? Not what someone defined for her.”

And then because I couldn’t resist, as I liked to push the limits, I said, “For me personally, my place is in the house… (dramatic pause) …or the senate.”

Decades later, I still agree with my answer. Success is defined by being happy doing something you love. It is not defined by social status or financial status or what someone else defines for you.  I’ve known successful stay-at-home moms and successful CEOs. What they have in common is that their job makes them happy and they are both contributing to making something or someone else better.

Sometimes we start down a path of success defined by others and not ourselves. It takes courage to make a switch.

Who are the most successful people you know? I am dedicating this post to my daughter Jordyn. She just made a brave move to start down a new path and define her own success.  I have no doubt she will be wildly successful!

At the end of the day… is an expression meaning an assessment of essential facts and truths. It’s a summation of the pros and cons of any situation and a straightforward statement of what really matters. It’s also the title of this blog series by Brenda Hodge, Nuance Healthcare’s Chief Marketing Officer, with insights about leadership, empathetic customer relationships, and marketing techniques.

At the end of the day…. get on the balcony

To be a good leader, a good employee, a good friend, or even a good parent you need to be willing to see things from a different perspective.
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It’s important in business and in life to fully participate. Sometimes I think of this as being on the dance floor, fully participating. There’s also an adage, that sometimes you also need to get on the balcony to see the world from a different perspective.

I admire people who are willing to fully participate. They are engaged, involved, and present in the moment. We can all think of people in our lives or on our work teams who fit this description. They are all in, but sometimes they are so focused on their own dance move, they miss the bigger choreography or the bigger picture.

To be a good leader, a good employee, a good friend, or even a good parent you need to be willing to see things from a different perspective. You need to be willing to get off the dance floor and get on the balcony. Try to think not from your vantage point, but from the next level up, so you can spot patterns, trends or potential problems.  In business this often means, backing away from the detail to go back to guiding principles, or reconsidering what you are trying to achieve to find a more holistic viewpoint.

In one’s personal life this also can mean finding a different perspective, most likely seeing the world or a situation through someone else’s eyes. Considering an issue or challenge from a different, more holistic vantage point, can only improve your chances of making more progress.

I remember a story about a tourist attraction in the California red woods – there was a tree so big a hole was cut in it so cars could drive through. A car with a luggage carrier on top got stuck while driving through the tree. Dozens of people were trying to help by prying, pushing and removing luggage. Finally, a small child suggested they take air out of the tires.

Sometimes, you need a different perspective.

So, as much as it’s great to be fully engaged on the dance floor, it’s as important to get on the balcony from time to time.

At the end of the day… is an expression meaning an assessment of essential facts and truths. It’s a summation of the pros and cons of any situation and a straightforward statement of what really matters. It’s also the title of this blog series by Brenda Hodge, Nuance Healthcare’s Chief Marketing Officer, with insights about leadership, empathetic customer relationships, and marketing techniques.

At the end of the day…diversity is powerful

Seek to add diversity to your team and to your company. You will see the power of bringing that mixture of life experiences together.
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I have always believed that an idea shared is an idea improved. There is power in gaining the perspectives of those that are different from us in examining and improving on an idea. Companies at their essence are a collection of ideas that get implemented, ultimately leading to a growing client base. The better the idea, the stronger the company.

As one study from the University of Illinois at Chicago found, when compared to companies with a less diverse workforce, companies with a highly diverse workforce  have significantly higher revenue, more customers, higher than average market share, and higher than average profitability. Seeking out a diversity of thinking impacts the bottom line.  

And where do these diverse perspectives come from? Perspectives come from your life experiences.   What were the life events that impacted the person you have become? Whether you had siblings, whether you had a single parent, what cultural norms surrounded you, your gender, your work experience, your education, your age which ties to world events you’ve experienced, your economic status, your race, your sexual orientation, your hobbies, your disabilities – and the list goes on.  At Splunk, they call this “A Million Data Points” and have a great video of their diverse team. Splunk believes that diversity not only makes Splunk a great place to work, but it also drives the success of the business.

Did you know that dyslexics have a special talent for IT security? Dyslexic people see things differently from the majority, so they spot patterns that most people won’t.  Which is why GCHQ in the U.K. employs at least a hundred dyslexics and dyspraxics. Their neuro-diversity gives them a special talent for processing and analyzing complex data.

Next time you have an idea, seek some diverse perspectives. Seek to add diversity to your team and to your company. You will see the power of bringing that mixture of life experiences together.

At the end of the day… is an expression meaning an assessment of essential facts and truths. It’s a summation of the pros and cons of any situation and a straightforward statement of what really matters. It’s also the title of this blog series by Brenda Hodge, Nuance Healthcare’s Chief Marketing Officer, with insights about leadership, empathetic customer relationships, and marketing techniques.

 

 

 

 

 

Engaging surgeons for better documentation

A perspective on the importance of complete, accurate and compliant surgical documentation.
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When it comes to documenting procedures, too many surgeons are dissatisfied with the status quo: documentation requirements add to surgeons’ daily burden, coding of procedures is complex and dynamic, and busy days with long procedures can have a negative impact on documentation accuracy. But it doesn’t have to be this way.

Our newest white paper, “How Artificial Intelligence engages surgeons for better documentation,” explores the ways in which smarter technology can help overcome these—and other—points of dissatisfaction. I’ve invited Dr. Lucian Newman III, CMO of Vincari, to introduce you to this white paper.

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Accurate documentation of Current Procedural Terminology (CPT) has always been a topic of conversation within physician groups. A large amount of the focus has been on the E/M category used to document history and physical consults, whether inpatient or outpatient. Third-party payers have been augmenting primary care reimbursement in this area, but little attention has been directed to procedural reimbursement with respect to the accuracy of recording by proceduralists.

Each year there are “tweaks” to the value assigned to CPT services, ostensibly to recognize the complexity and value these services deliver. The Relative Value Update Committee (RUC) is made up of 31 physicians who review the presumed value created by services—commonly known as the wRVU, or “work relative value unit,” which has substantial impact on individual reimbursement for physicians. Before 1992, adoption of the Medicare fee schedule changed the model of reference for payment away from the “usual and customary charges” basis for charges. This narrowed the gap between specialist and primary care reimbursement. The RUC sets the value for the wRVU that is used to calculate Medicare reimbursement for CPT services. The payment is a product of wRVU (work) + peRVU (practice expense) + mpRVU x conversion factor where “pe” reflects the costs of maintaining a practice in the area and “mp” reflects the malpractice insurance expense in your specialty and area, and the conversion factor changes yearly based on usage and budget impact. If you are a specialist where minor changes in reporting can change the wRVU substantially, it begs the question: am I missing something?

All physicians are subject to an increasing battery of measurements meant to drive quality, satisfaction, and efficiency. Additionally, protection against fraudulent usage of CPT coding is important. Recovery Audit Contractors (RAC) are directed at curtailing incorrect usage of the CPT reporting for financial gain, and so greater attention is on improving the accuracy and quality of reporting. The focus of procedural reporting should be open and visible to physicians and their complete treatment team to mitigate errors in reporting.

Let’s look at some examples. The excision of skin lesions is among the most mundane of procedures done by primary care and specialists alike. The correct coding of excision is a product of the size of the lesion excised plus the margins on each side required. Waiting for the pathology report (although required to document malignancy) will undersize the correct measurement due to drying artifact – human tissue is roughly 60 percent to 80 percent water by weight. Additionally, there are changes in CPT based on size, and < 5mm, 6 to 10 mm, 11 to 20mm, 21 to 30 mm, 31 to 40 mm and greater than 40 mm. Missing the size by 1mm changes the CPT wRVU!

Similarly, there are 11 different thyroidectomy codes with differing complexity that change the wRVU by more than 100 percent. There are 8 different codes for pericardial intervention with substantially different wRVU values. There are 10 different approaches to prostatectomy. There are 11 different approaches to hysterectomy. The list of variations seems endless, but they are meant to reward physicians performing more involved and complex procedures with better reimbursement.

Those who are interpreting the dictated information – often after a tedious procedure or when your mind has moved on to your next task – are challenged with translating what you did into the correct CPT to get you paid accurately. How often does the surgeon revisit the note after code assignment to assess whether the code and information is reflective of what they did? The nature of most physicians would be to underbill which is also incorrect and unfair to them. Therefore, the question remains: am I missing something?

Check our new white paper,  “How Artificial Intelligence engages surgeons for better documentation,” to find out why surgeons need smarter technology to ensure coding accuracy, enhanced revenue capture, and improved quality ratings.

Dr. Lucian Newman, III is a practicing general surgeon in Gadsden, AL, specializing in minimally invasive surgery. He is a graduate of the University of Alabama’s School of Medicine in Birmingham, and completed a surgery residency at Georgia Baptist in Atlanta in 1993. Dr. Newman practices with his father and brother who are also surgeons; his family has practiced medicine for a total of 119 years.

Over his career, Dr. Newman has given lectures and operated in over 20 countries, published over 100 articles and 6 textbook chapters dealing with minimally invasive surgery, and is currently focused on documentation and coding issues faced by physicians and hospitals alike. Dr. Newman is passionate about creating a more user-friendly environment for physicians to deliver more accurate and complete documentation. Dr. Newman is the current Chairman of Blue Cross Blue Shield of Alabama, Past Chief of Staff at Riverview Regional Medical Center, Past Advisory Board Member at Gadsden Regional Medical Center, Chairman of the Advisory Board for SCA, and Chief Medical Officer of Vincari.

 

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At the end of the day…build your brand equity

Keeping your promise and delivering consistently at every touch point is what builds brand equity. It’s what builds trust.
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An industry analyst recently asked me, “What is a brand?” My response: a brand is quite simply the promise you make combined with your personality traits that are displayed in interactions with you. In the case of a company brand, it’s the promise you make to the market combined with the personality or the characteristics or values you want to portray.

There are many similarities between a personal brand and a company brand.

Companies who are concerned with building long-term value, are concerned with the customer experience. The best place to start is by defining your brand promise. What are you ultimately doing for your customers?   When Domino’s Pizza first started, their promise wasn’t about great food, it was about food delivery in a timely manner.  For my company, our promise is about making it easier for the care team to take care of patients.  The ultimate customer experience begins with delivering on your brand promise – each and every day. This is also true for individuals. Did you promise to be a good wife or husband? A good mother or father? A good friend? A good son or daughter?

Building a brand begins and ends by delivering on the promise you make, but it’s also reinforced every day by the traits we exhibit. For a company, these traits are exhibited through every customer touch point. If you want to be known for being innovative, compassionate and transparent, then you must reflect these traits – when a customer calls support, or when they get their bill. If not, the customer experience is inconsistent with brand characteristics.

The same is true for individuals. Let’s use an example of being a good friend. Friendship may mean you are reliable, willing to listen, or loving despite a friend’s flaws.

I’ve seen companies through the years spend millions of dollars to define their logo, color palette, and brand attributes – investing very little energy to keep that promise and make the customer experience consistent.

I’ve also realized as a person, it’s important to have a set of values that I consistently work to portray. It’s important to me to be there for others, to keep my promises and to be as consistent as possible acting upon my values.

Keeping your promise and delivering consistently at every touch point is what builds brand equity. It’s what builds trust. It’s what makes you uniquely… you.

What promise did you make to your customers, your employer, your family, your friends? What characteristics do you want to exhibit?

At the end of the day… is an expression meaning an assessment of essential facts and truths. It’s a summation of the pros and cons of any situation and a straightforward statement of what really matters. It’s also the title of this blog series by Brenda Hodge, Nuance Healthcare’s Chief Marketing Officer, with insights about leadership, empathetic customer relationships, and marketing techniques.

 

Are you using secure speech recognition in your mobile messaging app?

Healthcare providers are no different than any other smartphone user: they rely on their mobile devices to send and receive timely messages that make work and life easier. But unsecured communications can present a problem for healthcare organizations. Now, Nuance has collaborated with TruliaCare to grant Dragon Medical One subscribers access to AI-powered speech recognition within this clinical collaboration platform.
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Adding speech to secure clinical communications benefits doctors and patients

Every day, Americans send billions of text and mobile messages—and the “just text me” movement has spilled over from our personal lives to the workplace. Likewise, healthcare providers also have come to rely on text messaging to communicate with care teams and get quick answers to questions about patient care.

A problem arises, however, if any of those text messages contain patients’ protected health information. It’s a clear violation of HIPAA, and even if clinicians are using their own personal devices, they expose their employer, themselves and the patient to significant risks.

The answer is not to discourage texting as a form of communication. On the contrary, healthcare organizations need secure messaging platforms that maintain the convenience of sending a quick text while managing risk. TruliaCare is one such mobile application that allows clinicians to collaborate with each other; it enables encrypted, HIPAA-compliant text messaging and professional communication, and integrates with health IT systems for a custom, unified provider experience.

And now, Nuance has collaborated with TruliaCare to grant Dragon Medical One subscribers access to AI-powered speech recognition within the TruliaCare secure messaging platform. Every Dragon Medical One user has a unique Nuance Healthcare ID, which can be used to access their personal profile within TruliaCare for a familiar Dragon Medical experience—reliable, accurate speech recognition; custom vocabulary; and time-saving AutoTexts—within the secure communication and collaboration environment.

Today’s physicians are more mobile than ever—and that’s not changing any time soon—and so to begin enjoying the real-time, intelligent speech-enabled workflows within TruliaCare, Dragon Medical One subscribers can learn how to register their Nuance Healthcare ID and begin reaping the benefits of speech-enabled workflows in a growing catalog of mobile productivity apps as well as gain immediate access to new tools, such as Dragon Medical Clinical Calculators, all within Dragon Medical One.

 

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Adding speech to secure clinical communications benefits doctors and patients

At the end of the day…the little things matter

All the little things we do send messages of who we are and what we care about.
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Years ago, I remember reading my annual employee feedback, and there was a comment about me being anti-social in an elevator. At the time, I was floored that someone would take the time to write down that I had not spoken to them in an elevator.  My defensive reaction was to wonder why they didn’t understand I was probably deep in thought on some issue?  It was a great lesson on the fact that the little things matter.

All the little things we do send messages of who we are and what we care about. Did you sit at the table or take a side chair?  Were you being present in the moment or was your mind somewhere else? Did you make eye contact? Did you listen or were you thinking about what you wanted to say?  Did you reply all when it wasn’t needed?  Did you say thank you?  Did you silence your phone?

A company I used to work for planned to spend a significant amount of money with a firm to help better understand our client base and our brand strategy. The firm had their CEO present the initial findings.  The CEO mis-pronounced our company name over and over in his comments. No one heard anything else he said, and we did not proceed with that firm.  Their research may have been terrific, but the detail of knowing the pronunciation of our company name mattered.  After all, if they couldn’t bother to get our name correct, how could we trust them with a project of this size?

The little things communicate messages. Are you distracted?  Are you genuine?  Are you caring? Are you focused?  Are you prepared?  The little things really do matter.

At the end of the day… is an expression meaning an assessment of essential facts and truths. It’s a summation of the pros and cons of any situation and a straightforward statement of what really matters. It’s also the title of this blog series by Brenda Hodge, Nuance Healthcare’s Chief Marketing Officer, with insights about leadership, empathetic customer relationships, and marketing techniques.

Innovation in action speaks louder than words

As Nuance showcases a vision for how ambient clinical documentation can make conversational AI-powered virtual assistant capabilities widely available, we explore how collaborative innovation is pushing the healthcare industry forward.
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Brown University published research that uncovered an alarming trend among healthcare providers: physicians are spending less time with patients and more time on the computer. This study isn’t an outlier, unfortunately, but clearly illustrates how the people at the heart of medicine—patients and providers alike—need healthcare technology to quicken the pace of innovation.

In many ways, healthcare has failed to keep pace with innovators in other segments – but several healthcare organizations are leading the way and demonstrating real innovation in action.

For example, at Epic’s 2018 User Group Meeting (UGM), Nuance and Epic showcased a vision for how ambient clinical documentation can make conversational AI-powered virtual assistant capabilities widely available through Epic apps. Now as part of Nuance’s rapidly expanding virtual assistant portfolio, and delivering on commitments made earlier this year including the first commercial availability of voice-enabled workflows through Epic Rover, the 100+ healthcare organizations that already have access to Dragon Medical through Epic Haiku, and the thousands of physicians that use it every day to create voice-driven clinical documentation, will be the first to benefit from commercial availability of advanced virtual assistant-enabled workflows. The new capabilities will enable physicians using the most widely adopted and highest performing speech solution for Epic mobile apps to conversationally retrieve schedules, lookup patient information, laboratory results, medication lists, and visit summaries.

Nuance and Epic also are working closely with joint clients like Vanderbilt University Medical Center (VUMC) who is leveraging Nuance’s Dragon Medical virtual assistant technology integrated into Epic. These solutions make it easier for physicians at VUMC to retrieve information from the EHR more efficiently and conveniently, as well as enter data, manage tasks, use computerized physician order entry (CPOE), and communicate with other providers. Yaa Kumah-Crystal, MD, MPH, MS, Assistant Professor of Biomedical Informatics and Pediatric Endocrinology at VUMC said, “We have worked closely with Nuance and Epic and have found that using Nuance’s voice assistant with Epic not only helps us empower our physicians through voice, but enables us to leverage virtual assistants to assist with tasks while supporting HIPAA-compliance. We believe the incorporation of voice assistants in the provider workflow can enhance the delivery of care and we will continue to team with leaders in health IT to deliver on this commitment. One of our physicians described the platform like a helpful intern always ready with an answer.”

Innovating isn’t easy, nor should it be. It requires more than just a desire to grow by developing leading-edge products or features; it takes a deep understanding of the problems people face and an unwavering commitment to solving them.

And, when innovation is put into action, it can push an entire industry forward. Consider innovations such as virtual assistants that are designed to join forces between humans and AI, complementing and enhancing each other’s strengths – amplifying our own intelligence, and leaving us humans free to focus on the most important tasks that machines simply cannot do – like caring for patients.

When organizations such as Nuance, Epic, Vanderbilt and others collaborate to innovate—with very specific, problem-solving purpose—future innovations can become reality today and every day.

How is your organization putting innovation into action?

 

 

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At the end of the day…earn your money

After he was picked by the Indianapolis Colts, Peyton was asked, "What are you going to do with all that money?" Peyton's answer was...
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I often talk about people with a strong work ethic. Have you ever really thought about what work ethic truly means?  Do you think you have work ethic?

I recently attended a keynote presentation by former NFL quarterback Peyton Manning. A great storyteller, Peyton kept the audience fully engaged, but what stayed with me most was a story he told about an experience at the NFL draft. After he was picked by the Indianapolis Colts, Peyton was asked, “What are you going to do with all that money?” Peyton’s answer was, “I’m going to earn it.”

We all know people who are willing to work for “it” and those that think they are just deserving of “it” whatever “it” maybe. Success comes from a mixture of skills and knowledge – but how do you get more of both?  By working at “it”, of course.

In the book “Outliers” Malcolm Gladwell describes many stories of success, and at the root of many of those success stories is what he describes as the 10,000-hour rule. Those that want to succeed, spend at least 10,000 hours practicing – whether it’s computer programming or playing the piano, or the fundamentals of football.

Peyton also highlighted that even with or without a winning record in the NFL, every summer he and his brother would return to his college coach to practice the fundamentals. Peyton always wanted to be the one most prepared.  He wanted to earn his money.

Striving to always be better no matter how good you already are…that’s earning your money. Even after you’ve accomplished something great, you don’t stop there.  You keep learning; you keep stretching; and you keep earning “it”.

At the end of the day… is an expression meaning an assessment of essential facts and truths. It’s a summation of the pros and cons of any situation and a straightforward statement of what really matters. It’s also the title of this blog series by Brenda Hodge, Nuance Healthcare’s Chief Marketing Officer, with insights about leadership, empathetic customer relationships, and marketing techniques.

 

 

Time on Capitol Hill

On July 26, ACT | The App Association’s Connected Health Initiative hosted a panel of experts on Capitol Hill for a congressional briefing to help policymakers and the Artificial Intelligence Caucus better understand AI for healthcare, its role in the future of clinical care, and the potential to improve lives.
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I arrived at the Rayburn House Office Building on Independence Avenue ready to seize the day. My flight to Washington, DC had landed early, and there was no line at the security checkpoint. I was grateful for the opportunity to take it all in and walk about the impressive building that’s home-away-from-home for many of our U.S. representatives.

Just days earlier I had received an invitation from Graham Dufault of Connected Health Initiative to participate in a panel discussion about the role of artificial intelligence (AI) in healthcare—for the Artificial Intelligence Caucus on Capitol Hill. I remain humbled by the invitation and was honored to accept.

The panel opened with remarks from Congressman Pete Olson from the 22nd district Texas. I was joined on the panel by Graham Dufault as moderator, Betsy Furler of Communication Circles, Joshua New from the Center for Data Innovation, and Dr. Akane Sano from Rice University. Betsy presented mobile applications that are  helping people with visual and verbal impairments better navigate the world around them using AI. Joshua brought expertise in the areas of policy and government affairs. Dr. Sano shared her work in the areas of depression and AI.

And me? Well, I got to speak about the very things I’m most passionate about – the ways in which AI will have a positive impact on the future of healthcare; unburdening physicians with real-world solutions to documentation challenges; and how, ultimately, AI can help doctors do what they do best: care for patients.

The people in the room—mostly Congressional staffers and policy experts—asked engaging, in-depth, technical questions that kept me on my toes. It was clear that these are people who clearly care about what they do and how it will affect people and populations.

I took the time to explain that the impact AI will have on healthcare will come from a new and expanded use of AI-powered solutions, such as conversational virtual assistants combined with mobility. It’s in this area that we will begin to see highly intelligent systems that can act in partnership with human intelligence in powerful ways.

I highlighted that Nuance Healthcare, for example, focuses on augmenting a physician’s capabilities with data and intelligence that were previously unavailable or hard to access. What’s key here is that the interaction is natural and an integrated part of a physician’s regular workflow. So, AI in healthcare will not only solve problems but also open avenues for improved diagnoses and treatments.

Although my time on Capitol Hill was a new experience for me and for Nuance, it opened my eyes to a realm of possibilities – a place where Nuance continues this work of advocacy and guidance from a policy perspective. For me personally, I’m looking forward to using this briefing as a springboard to continue conversations and find new platform to emphasize the need to create a data information highway in a free, open, interoperable way, where the exchange of information will facilitate technologies like AI, but more importantly, it will generate greater human benefits from the wider availability of information and conversation.

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Look beyond the numbers to achieve a state of growth

Business growth is primarily understood through the indicators that we use to measure it like revenue, headcount, or geographic expansion. But growth is the outcome of a range of tangible and intangible steps that are more broadly based than numerical goals or quotas. It’s a top-to-bottom company mindset that embodies a way of thinking, being, and innovating.
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The topic of business growth is often viewed in terms of tangible, measurable things—revenue; headcount; or investments in engineering, product development, sales, and so on. But it’s the intangible factors, from employee mindset to the quality of customer relationships, that truly drive a company toward a state of growth.

Consider how Apple achieved a historic milestone – a market valuation of over one trillion dollars. According to CEO Tim Cook, this growth has been driven by the organization’s commitment to innovation and its principles. He wrote to the employees: “It’s you, our team, that makes Apple great and our success is due to your hard work, dedication, and passion. I am deeply humbled by what you do, and it’s the privilege of a lifetime to work alongside you.”

Indeed, when teams are not merely responding to market demand or internal goals but are creating and fostering growth by continuously thinking about and looking for purpose, insights, and opportunities, that state of growth becomes far more achievable. Leaders should consider it a privilege to work with customers and employees in ways that go much deeper than selling products or closing deals. After all, when we listen to customers and employees at all levels to help them grow, we expand our own knowledge and opportunities along the way.

Therefore, growth is about innovating with purpose – it’s about going beyond technology to look at the entire value chain, creating and delivering offerings that understand and anticipate customer needs and problems, and solving those problems from start to finish.

For example, our Nuance healthcare division is actively expanding internationally as demand for cloud-based clinical documentation platforms powered by artificial intelligence (AI) grows around the globe. We are uncovering a broader base of geographies to find new customers whose problems echo those of our current customers. In fact, we are honored to now play central roles in national initiatives in the UK and Canada. By helping national healthcare systems ease the burden of clinical documentation and free providers to spend more time caring for patients, we are enabling a digital transformation – start to finish – as the use of our cloud-based, AI-powered solutions expand.

When in a state of growth, teams are empowered to experiment, to do what they believe are the right things to do, and even to fail on the way to creating larger successes. There are many practical steps to achieving a state of growth, and they are all guided by the mindset of doing ordinary things extraordinarily well – but most of all, doing so with purpose.

Look beyond the numbers to achieve a state of growth – and discover that business growth comes from a way of thinking and a way of being, as well as a way of operating.

 

 

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A real view of cloud-based data analytics and insights for clinical excellence

With cloud-based access to powerful analytics and data-driven insights, radiologists have more power than ever to shape the quality of patient care, remove the pitfalls of failed patient follow-up, drive more revenue, and simply work more efficiently.
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Nuance Healthcare Diagnostics Vice President and General Manager Karen Holzberger sat down with Dr. William Boonn to get a clinician’s view of why the new mPower Clinical Analytics offering – part of the mPower suite of clinical excellence solutions – represents such a significant step forward for radiologists and for healthcare professionals everywhere.

In nearly every aspect of healthcare from diagnosis, to treatment, follow-up, healthcare services delivery, population health and beyond, clinicians look to the data. So, you would think that the constant flow of data from today’s health IT systems would be a good thing. It is, but it’s actually too much of a good thing. Clinicians are deluged with data but without any easy or intelligent way to access, analyze, and apply that data to create clinical insights. Until now, that is. I sat down with Dr. William Boonn to get his real view of one of the most important breakthroughs in clinical analytics today, the new mPower Clinical Analytics (“Clinical Analytics”) solution that puts practical tools for data exploration and insight into hands of clinicians.

KH: The new Clinical Analytics solution for radiology comes at a critical time for radiologists and represents a number of important practical and technology breakthroughs. Can you unpack it for us?

Dr. Boonn: Yes, there are many significant developments. The mPower Clinical Analytics solution is driven by the combination of increasing professional, technical, and financial pressures that radiologists and healthcare professionals are facing, and the cost and deployment benefits that the cloud brings to address those pressures. The solution also is influenced by the opportunity to make a fundamental step forward in healthcare outcomes and economics.

KH: We talk to physicians, administrators, and health IT managers about those pressures every day. How does the new Clinical Analytics solution intersect with those issues?

Dr. Boonn: A perfect storm of factors have affected radiology during the past few years. The shift from service-based to outcomes-based reimbursements is a big factor. Along with that are pressures on controlling costs while increasing productivity and generating new revenue flows. At the same time, demand for radiology services is growing, which in turn creates a greater need for reporting and follow-up recommendations. And finally, there is a massive amount of image and report data being generated daily, but no simple way for clinicians to access it for analysis and insight. The new cloud-based mPower Clinical Analytics solution is built specifically to solve those problems. It’s not enough to address those issues with limited, selective deployments of data analytics. They need to be tackled in a coordinated and comprehensive way, and that’s what this new solution does.

For example, radiologists must find, extract, and interpret patient information from reports—it’s a time-consuming and difficult process when done manually. Analytical algorithms, on the other hand, can do that both automatically and on-demand according to a clinician’s specific needs and areas of inquiry. In this way, this clinical excellence solution helps radiologists reduce care delays, evaluate MIPS measures, and strengthen quality improvement efforts directly. It gives them a lot of very practical power to create positive change.

KH: You mentioned the important role of making Clinical Analytics cloud-based. How does that factor in?

Dr. Boonn: Radiologists need instant access to the structured and unstructured data common in radiology reports, as well as the analytical algorithms to incorporate into their workflows with best practices, clinical intelligence, and actionable insights. The cloud makes it possible to do that on a large scale without the need for expensive or new IT infrastructure. It makes the analytics scalable and accessible when and where the physician needs those tools. It’s what makes the widespread and practical use of analytics possible.

KH: What are some of the specific use cases and benefits that radiologists can expect from this cloud-powered clinical analytics solution?

Dr. Boonn: We’re directly addressing the top half-dozen challenges facing radiologists today. These are hard problems that also have been among the most frustrating. Most of these issues can be remediated by using the data generated by thousands of imaging studies and reports daily. The problem is that there has been no good way to access, analyze, report on, and use that data. It’s virtually been a case of “data, data everywhere and not an insight to be had.”

The first benefit is to reduce the length of patient stays. By modeling industry best practices, mPower Clinical Analytics has been shown to decrease length of stay by up to three days for patients needing interventional procedures. It does that by tracking data on inpatient recommendations and facilitating care coordination. Data makes that easier and far more accurate.

The second is to improve regulatory and billing compliance by analyzing the data to facilitate MIPS and other reporting requirements. Radiologists can use that data to optimize billing and reimbursement, and document clinical outcomes. The trick is to use the analytics to remove the complexity and automate the billing and compliance requirements as part of the radiologist’s normal workflow.

The third area is to reduce variability in follow-up recommendations and compliance based on documented best practices and outcomes. mPower Clinical Analytics automatically extracts follow-up recommendations from reports and creates detailed, consistent profiles. That gives radiologists a way to make and track follow-up recommendations and identify overdue examinations. Several studies have shown a greater than 60% failure rate for follow-up recommendations. That can lead to delays in patient care, increased medicolegal risk, as well as lost revenue opportunities for radiology practices. mPower Clinical Analytics can identify and track overdue follow-up recommendations to ensure that patient receives appropriate and timely care based on their imaging findings. That’s very powerful.

Next is to use the data to identify ways to increase revenues. Physicians and administrators can explore underserved or at-risk populations based on industry benchmarks and clinical results from across the industry. mPower Clinical Analytics helps practice managers deliver effective and important clinical care when and where it’s needed.

The fifth is to reduce inappropriate or unnecessary imaging, which is much better for patients. The data mining algorithms can identify outliers, guide quality improvement efforts, and reduce unnecessary ordering of images, all based on documented outcomes and industry best practices. In a way, it’s the flipside of identifying revenue opportunities by using radiology resources productively and profitably.

Finally, you have greatly improved security and IT costs and deployments. mPower Clinical Analytics is hosted in Microsoft Azure, a HITRUST CSF certified infrastructure, which makes upgrades easier and minimizes service disruptions. Single sign-on, password policies, user management, and multi-factor authentication all contribute to enhance security and usability. You eliminate the security lapses that come from something as simple as weak passwords. Those are the little things that can make a big difference.

KH: What’s the big-picture takeaway for radiologists, administrators, and C-level healthcare executives?

Dr. Boonn: First, clinical excellence solutions for the most pressing problems for radiology and for healthcare at large are available – now. It’s a giant step forward in overcoming the practical issues that tie up valuable resources and get in the way of what physicians want to do in the first place, and that’s to care for patients.

Second is the empowering and freeing role that the cloud and AI are playing in advancing the state of radiology. I know there have been concerns among some radiologists that AI was a long-term threat to their professions. But mPower Clinical Analytics is a great example of how these technical advances can augment and improve their ability to apply their skill and expertise, and reduce the administrative burdens they deal with now. It also will open new areas for research and treatment in radiology and other areas of healthcare.

Finally, I think it’s appropriate that radiologists are the ones leading the way ahead just as they did with the first PACS systems more than 20 years ago. Radiologists have always been the technology trailblazers. Now they’re going to lead the way with cloud and AI technologies.

KH: Thank you, Dr. Boonn.

Author Paulo Coelho wrote, “Beautiful sunsets need cloudy skies.” It’s a phrase that means something to me in the context of this discussion with Dr. Boonn. We need cloud-based infrastructure to make the best, most beautiful things happen. With access to data-driven analytical insights, radiologists have more power than ever to innovate and influence quality patient care, remove the pitfalls of failed patient follow-up, drive more revenue, and simply work more efficiently – in the cloud.

The Real View is a Q&A blog series with Karen Holzberger, Vice President and General Manager of Nuance Healthcare’s Diagnostic Division. The Real View cuts through the hype and gets to what’s real, here, and now. The blog series features interviews and insights from health IT movers and shakers – and uncovers disruptive technologies that solve challenges, optimize workflow, and increase efficiencies to improve patient care.

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Minimizing the costs and risks of prescription printing with plain paper

Research dictates that hospitals must cut costs by 2022 just to break even. Forward thinking hospitals are finding innovative ways to do just this including employing cutting-edge prescription printing software. These innovative solutions combine CMS Tamper Resistant security features with information they receive from the electronic health record (EHR) directly onto plain paper. Thus, cutting costs and minimizing risks while retaining security compliance.
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Nuance solutions can help minimize the risks of prescription printing with plain paper

Savvy hospitals are turning to new innovations in printing to help them cut costs and minimize risks using plain paper prescription printing.

According to Black Book Research “in order to break even, average hospital costs will have to be reduced by 24 percent by 2022.” That percentage seems almost insurmountable with the mounting costs associated with managing a hospital. In recent years, regulatory compliance demands and pressures from HIPAA and the Centers for Medicare and Medicaid Services (CMS) have added to their responsibilities.  Researchers from Harvard’s TH Chan School of Public Health indicate that while other nations spend between 1%-3% to administer their health plans;  administrative costs are 8% of total health spending in the US. Chipping away at some of this administrative spend is imperative.

The Cost of Compliance

A recent report from the Centers for Disease Control and Prevention (CDC), indicated that “drug overdoses killed 63,632 Americans in 2016. Nearly two-thirds of these deaths (66%) involved a prescription or illicit opioid.” A quick scan of the news highlights the gravity of this problem. To stem this epidemic CMS mandates that all computer generated, and hand-written prescriptions have at least one industry recognized security feature in each of three categories.

  • Copy Resistance: to prevent copying of a completed or blank prescription
  • Erasure/Modification Resistance: to prevent the erasure or modification of information written on the prescription
  • Counterfeit Resistance: to prevent the use of counterfeit prescriptions

As such, when physical prescriptions are needed, hospitals must ensure they adhere to these guidelines. Compliance for many means using costly tamper resistant paper and special printing devices.

As you can imagine, tamper resistant paper and the special devices required to print them can be costly not just to obtain but to maintain as well. Hospitals must bear the burden and risks associated with retaining tight custody of the paper as it moves from delivery all the way to becoming an actual prescription. Often this requires the use of security guards to protect the shipment of the paper, having the printers in locked rooms, having printers with special locked trays, and tightly monitoring reloading the printers. With prescription fraud as rampant as it is, hospitals cannot afford to have their prescription paper stolen.

 

Make it plain – plain paper printing

With the need to cut costs yet maintain excellence several hospitals are now employing cutting edge prescription printing software to do the heavy lifting for their prescription printing. These innovative solutions combine CMS Tamper Resistant security features with information they receive from the electronic health record (EHR) directly onto plain paper.  Yes, plain paper! This vendor-agnostic approach allows for industry-recognized security features to be printed on a broad range of printers. Hospitals can then leverage existing technology and equipment. Hospitals then get a panto-graph background that states “VOID” if copied, and the original document has microprint that renders the text unreadable if copied all on their plain paper. Added to this, variable printing on the back of each prescription adds an extra layer of security. They also can Include a security warning box at the bottom of the page that lists all the security features included so pharmacists can know what to look for to check for authenticity

In addition to these CMS Tamper Resistant security features, some print features, such as those found in Nuance’s print management solutions, offer secure printing workflows that record all key details about a job including who released/printed it, even on single- function printers equipped with a card reader.

 

Benefits of Secure Plain Paper Prescription Printing:

 

When you remove the cost of special paper, special printing devices, and the additional personnel to protect the paper hospitals can realize significant savings. Some of these benefits include:

  • Works with a broad range of print
  • Eliminates the cost and management of pre-printed form
  • Removes need for special printers or locking t
  • Provides secure print release with complete chain-of-custody track
  • Supports MFDs and single-function printers via POE reader.
  • Offers a centralized enterprise-level output management syst
  • Enables failover printing and audit t

 

The cost and risks savings from prescription printing software is significant! By using innovative prescription printing software hospitals can write secure prescriptions without the large overhead costs all while remaining secure and compliant.

Nuance Healthcare Solutions Can Help

Visit our healthcare solutions page to learn more about how we can help secure your print environment

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Nuance solutions can help minimize the risks of prescription printing with plain paper

At the end of the day…you can’t win holding the Queen of Clubs

Building trust is not only about making the right decision, it's about sharing your decision with your team and providing insight on what led you to that decision.
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I learned an important lesson in a leadership class many years ago that I’ve never forgotten. There are times in leadership to get opinions and gain consensus, and there are circumstances where the leader just needs to decide.  The lesson years ago was: if you’ve made the decision, communicate clearly that you have and why. Don’t portray that your people have choices to make or influence a decision if they really do not. They will always be frustrated when they realize you already had the answer.  A mentor of mine used to call this having “the Queen of Clubs” in your pocket.  If you have the answer, just share it.  Just say, ”I have decided…and here’s why…”  How many times in your career have you heard yourself say, “If they had just told me, it would have saved me a lot of time.”  I’ll bet we’ve all experienced this. You build trust and save everyone time and frustration by just sharing your decision

At the end of the day… is an expression meaning an assessment of essential facts and truths. It’s a summation of the pros and cons of any situation and a straightforward statement of what really matters. It’s also the title of this blog series by Brenda Hodge, Nuance Healthcare’s Chief Marketing Officer, with insights about leadership, empathetic customer relationships, and marketing techniques.

Teamwork, purpose-built technology, and the responsibility to care for those who care for us

New peer-reviewed research with Health Quest reveals that the implementation of speech recognition technology within the electronic health record (EHR) significantly improves provider satisfaction and efficiency, as well as documentation quality, and costs.
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Provider burnout is a major issue for the healthcare industry, as a whole – and it’s a human issue at its heart. The people caring for all of us are suffering day-to-day, and that’s a problem worth solving. But it’s more than that. Provider burnout has real and frankly frightening implications for patient safety and quality of care.

As technology leans toward serving protocols and regulations, caregivers are now serving the technology. As a result, caregivers are reliving their day – to finish documentation, resolve coding queries, and reorganize their personal lives to make it all happen. Incomplete documentation is causing queries, denials, rework, and costs. More importantly, though, in some cases, the right diagnosis may not be captured or followed up on.

To change this, the clinical documentation and decision support solutions relied upon must have a solid foundation, so physicians and care teams can trust them. They must be built by clinicians who understand care – not solely by people who understand codes. They must be complete and provide choice to match any use case while being deeply embedded into the EHR systems – and match the way caregivers think, talk, and work. They must drive mobile effectiveness letting physicians and care teams use their device of choice – and use it anywhere and at any time. They must be supported 24/7 because technology must always serve the caregiver and their patients – and not the other way around. They must be smart and surround caregivers with intelligence at every turn. Because technologies that provide real-time intelligence paired with decision support not only dramatically improve the patient story – but the caregiver story as well.

We recently had the opportunity to team with Health Quest to take a closer look at these challenges and realities by conducting a comprehensive, multi-year study about how speech recognition technology could have an impact on provider burnout, satisfaction, and other clinical documentation issues. The peer-reviewed study examined more than 1 million patient notes in the EHR, and here’s what we learned: As providers increasingly relied on speech recognition technology, satisfaction with documentation technology increased. Documentation quality and completeness improved. And providers spent less time documenting patient encounters—or, they spent the same amount of time capturing more robust patient stories that presumably had a real impact on the quality of patient care.

I encourage you to read the research in full on PubMed Central. Provider Adoption of Speech Recognition and its impact on Satisfaction, Documentation Quality, Efficiency, and Cost in an Inpatient EHR was initially presented at the AMIA 2018 Informatics Summit in March, and subsequently at the AMDIS symposium in June 2018.

We thank Health Quest for their time, efforts, and dedication to the health and care of their providers and patients. We are honored to have the opportunity to partner with Health Quest on these important initiatives.

In healthcare, it’s up to all of us to prioritize and care for the people who care for us. To do so, technology must be purpose-built for healthcare’s unique realities, and the caregivers that use them.

 

 

 

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GDPR enforcement in healthcare

Enforcement of the GDPR is looming and healthcare organizations face new requirements. Healthcare organizations must be in compliance with the new regulation in order to avoid facing steep penalties. As a result, they will need to assess key security components and processes like data breach detection and notification, data controller and data processing procedures and training to ensure they meet the mandates of the GDPR. The "right to personal data" and "right to be forgotten" are additional measures that organizations must be prepared for.
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GDPR is a call to healthcare industry to improve paper problem

 

After four years of extensive preparation and debate, the European Union’s General Data Protection Regulation (GDPR) will go into effect on May 25, 2018. U.S. healthcare systems globally expanded or actively marketing and delivering care to EU patients will need to comply. While few U.S. healthcare providers have expanded globally, those that have include prominent organizations such as Johns Hopkins Medicine, Cleveland Clinic Foundation, Mayo Clinic and UPMC. Other healthcare systems are likely to follow suit in the coming years as demand for U.S. healthcare expertise grows worldwide, and the EU emerges as a prime target market.

Healthcare systems needing to comply with GDPR are likely focused on the two most pressing requirements – securing patient consent to use their personal data for business purposes not directly related to care and ensuring the ability to erase all instances of personal patient data upon a patient’s request. While that may sound reasonable, GDPR is a large, complex bill with vines reaching into often overlooked corners of the healthcare enterprise, specifically paper documents. What are the top document management priorities for healthcare providers striving to become GDPR compliant?

Digitize paper

More than 40 percent of healthcare organizations report having paper reduction initiatives in place, according to research from IDC. Despite this, paper remains prevalent in the healthcare enterprise. Even hospitals that have achieved late-stage Meaningful Use continue to process high paper volumes. In many cases, paper and print volumes have increased. One reason for this is because people naturally prefer absorbing long, complex information from paper as opposed to on a screen.

Many hospitals have accumulated filing cabinets full of paper and the prospect of digitizing it all is daunting. However, digital documents are inherently more secure and support greater levels of consumer data protection and privacy than paper – giving them the advantage in a GDPR world.

Automate Workflows

Hospitals continue to rely on paper to support a wide range of work processes, including admissions, prescriptions and discharges. When workflows are paper-based, they are less secure and more time-consuming than digital processes. Advantages of automated workflows include the ability to access a complete, verifiable audit trail of what data is sent to whom, and where it resides in the funnel at any given point in time. This augments a hospital’s ability to locate personally identifiable information quickly and accurately, even within in-transit data, and ensure data is not being routed for any business purpose other than patient care.

Secure the Printer

Information security initiatives are often focused on mitigating cyber security threats, server hacks and database vulnerabilities, ensuring data both at rest and in flight is protected. Numerous industry sources have found that paper documents are often overlooked. However, with the GDPR’s intense focus on data privacy, paper documents represent a newly rediscovered security risk.

The multifunction printer (MFP) is a standard piece of office equipment but is a hub for sensitive personal data as it transitions from digital to paper and back again. If it is not properly addressed, it has the potential to become a major data security and GDPR compliance blind spot. To alleviate the security risk at the MFP, healthcare organizations can apply a variety of device-level controls. Two examples include user authorization, which releases print jobs only when an authorized worker validates at the device; and file destination control, which restricts scanned documents to pre-approved destinations.

GDPR Opens the Door

Improved document management – particularly efforts to reduce paper – offers many benefits. These include greater data security aligning with the governing rules of GDPR (and HIPAA), and improved operational efficiency. Whether or not U.S. healthcare organizations find themselves reckoning with GDPR compliance, the bill’s mandates present a valuable opportunity for all healthcare systems to digitize and automate their document management processes.

Gain control over your paper problem

Nuance solutions help healthcare organizations gain control over their paper problem. Visit this page to learn more.

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GDPR is a call to healthcare industry to improve paper problem

A Tuesday to remember

Have you ever had one of those days that you never want to forget? Tuesday was one of those days.
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Tuesday morning, I attended the HealthTrust University Conference in Nashville, where the theme was amplifying your influence. HealthTrust is a large industry organization with thousands of hospitals, health systems, and ambulatory members like HCA and Trinity. Their mission is to strengthen provider performance and clinical excellence.

The HealthTrust event featured a fireside chat with former NFL quarterback Peyton Manning. I listened with great interest as Peyton shared his career lessons. One question asked of Peyton was how he distinguished the good from the great players. Peyton responded with the following traits: natural ability, work ethic, passion, and accountability. As I sat back and processed Peyton’s answer, I was reminded of my own leadership team, and the greatness that they portray each day.

Following Peyton’s fireside chat, I was called to the stage. HealthTrust awarded our Nuance team with the first annual Cybersecurity Excellence Award. Again, I listened with interest as a HealthTrust executive shared with the audience that Nuance was receiving this award for our transparency, the collaborative spirit we demonstrated in working with our customers, and our willingness to share lessons learned and influence health systems preparedness. I was humbled, and to say that I was honored would be an absolute understatement.

Later in the day I had the pleasure of a conversation with Steve Long, CEO of Hancock Health. Earlier this year, Steve’s organization suffered from a cyberattack in which patient data was hijacked. Steve offered to share his story with our customers via a webinar on Tuesday. Steve shared that the type of ransomware Hancock Health was impacted by is unfortunately becoming commonplace, and hospitals remain a target. So, he shared approaches for hospitals to protect against similar cybercrime.

Once Hancock Health’s recovery efforts were complete, Steve could have simply shored up his own boundaries and gotten back to business as usual. But that’s not what Steve chose to do. Instead, Steve is doing what I believe is the most important thing a leader can do – he’s going above and beyond to share his story and influence people.

The notion of a leader that influences others is one that I hold dear, in large part because when we do this well, we inspire trust in our teams and in our customers. Creating a culture of trust is essential to an organization that’s poised for growth. That is, employees who work in high-trust organizations report 74% less stress, 106% more energy at work, 40% less burnout—among other benefits for employees and organizations alike. There’s neuroscience behind this culture of trust, writes Harvard Business Review, but ultimately leaders, like Steve Long, that influence people are at the heart of a high-trust culture.

Leadership and teams are tested in times of adversity and Tuesday was an opportunity for me to reflect on the great leaders that I work with that ultimately delivered a Tuesday to remember.

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At the end of the day…may we all have more optimism

Successful people tend to be both optimistic and self-confident. Even when the outcome is uncertain, they take action, usually with positive results.
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While flying last week I observed the ultimate level of optimism – a woman who had a roller bag that was going to fit into the overhead bin.  For those that fly often, you’ve all seen it; these optimistic souls…if I place it wheels first, if I turn it around, if I try it sideways, if I try it upside down, if I try it further down the aisle (because the bin is going to magically get bigger) – it’s going to fit.  I watched skeptically, and on the fifth try, with another passenger helping her shove the bag, much to my surprise, the bag went into the overhead bin. 

Optimism is a form of determination with confidence.  If you are determined and confident enough to want to make it work, it often does. How often do we approach projects with optimism?  How often do we approach relationships with optimism?  Do we start skeptically or with confidence?  Are we determined to make it work well or are we holding back?    

May we all have more optimism. 

At the end of the day… is an expression meaning an assessment of essential facts and truths. It’s a summation of the pros and cons of any situation and a straightforward statement of what really matters. It’s also the title of this blog series by Brenda Hodge, Nuance Healthcare’s Chief Marketing Officer, with insights about leadership, empathetic customer relationships, and marketing techniques. 

 

At the end of the day…never stop growing

Growth is a lifelong process. And while we may have reservations about what that process will require, or what the future holds, we must never stop growing our bodies, our minds, our hearts.
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A small boy was walking slowly with his grandmother as she carefully navigated her cane on the pavement, when suddenly he asked her, “Grandma, do I have to grow up?”

The grandma stopped and turned with a smile on her face and said, “Honey, you wouldn’t want to miss it.

Growing your body helps you reach for the stars!

Growing your mind helps you gain wisdom which will lead to more happiness each day of your life.

Growing your heart by learning more about people means you will always have love.”

The little boy looked thoughtful for a moment and then the grandma leaned down and whispered in his ear, “I’ll tell you a secret. I’m not done growing yet either.”

At the end of the day… is an expression meaning an assessment of essential facts and truths. It’s a summation of the pros and cons of any situation and a straightforward statement of what really matters. It’s also the title of this blog series by Brenda Hodge, Nuance Healthcare’s Chief Marketing Officer, with insights about leadership, empathetic customer relationships, and marketing techniques.

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At the end of the day…take time to prioritize your values.

Knowing which values are most important to you and discussing them with your team are hallmarks of exceptional leaders. It’s a starting point that builds trust. And as I have learned, whether you want someone to follow you as a leader or simply be your friend, you must start with trust.
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Throughout my career I’ve had the opportunity to learn from some exceptional teachers on leadership; two of them being Ken Blanchard and Ed Ruggero. They stressed the importance of knowing what values are most important to you and discussing these with your team. The hardest part of doing this work is narrowing it down to what’s most important to you and why. The list of values I decided years ago were most important to me are teamwork, open communication, respect for the individual, having some fun along the way, and building trust.

My leadership philosophy has always been that a strong leader aligns their head, heart, hands, and habits. That means you determine the right strategies (head), you and your team execute those strategies (hands), you articulate what values are most important to you (heart), and then you do your best to show those values in action each and every day (habits). There will be days that you fall short; I know I do. But at the end of the day…when your head, heart, hands, and habits are aligned, you gain the trust of those with whom you work and play. And I learned many years ago, whether you want someone to follow you as a leader in business or to just be your friend, they must trust you. It’s that simple.

What are the values that matter most to you?

At the end of the day… is an expression meaning an assessment of essential facts and truths. It’s a summation of the pros and cons of any situation and a straightforward statement of what really matters. It’s also the title of this blog series by Brenda Hodge, Nuance Healthcare’s Chief Marketing Officer, with insights about leadership, empathetic customer relationships, and marketing techniques.

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Use your voice to solve problems worth solving

Harvard Business Review wrote recently that, despite companies’ investments of time, money, and effort, organic growth “remains elusive,” which is especially troublesome in a global market that’s more dynamic and unpredictable than ever. One solution, they write, is to find a problem worth solving.
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We’re inspired by the power of voice to multiply the impact of everything we do. We’re helping providers use their voices to do their jobs better, improve reimbursements, capture better patient stories, and advance compliance efforts. Today’s innovative solutions mean we can have a positive impact on patient care as well as imagine the next generation of problem-solving solutions.

We do this by harnessing the precision of machine learning and conversational artificial intelligence—both of which are driven, in large part, by a convergence of big data, computing power, and cloud resources. That is, these factors combine in a way to create highly intelligent systems that allow us to expose new approaches to solving problems in healthcare (e.g., physician burnout).

This commitment to solving these problems is not only what’s best for our customers and their patients, it’s driving our own growth and having a substantial impact on the healthcare market as a whole. In fact, this week, Nuance Healthcare was placed in a top spot on the Healthcare Informatics 100 list. Published for two decades, the Healthcare Informatics 100 list is a compilation of those “who are propelling to the top of the market.”

As we look toward the future and see the continuously changing healthcare landscape, we will continue to solve the problems in healthcare that are worth solving, and for the opportunities to bring new solutions to light.

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At the end of the day…just because you can, doesn’t mean you should

It’s important to not only consider the subject matter that interests you, but also the right match to your personality and your passions. Consider all aspects as you make that career choice. And, allow yourself to make some mistakes or change your mind along the way.
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People that know me well would never guess that I was a computer science/math double major in college. I enjoyed my studies. Math always came easy for me and computer programming was a welcomed challenge. When I started interviewing my senior year, I considered many types of positions: sales, marketing, software engineer — all for high tech companies. I took a position as a software engineer at Data General. It was the most responsibility I could find right out of school, and that appealed to me. Within months, I was close to miserable, spending 8 to 10 hours a day programming at my desk. I am an extrovert and enjoy people. Just because I could do the job, didn’t mean I should do the job. After the first year I moved into technical support, more toward people interaction. Within two more years, I moved into marketing and sales which is when I really started to thrive.

What role did you take or major did you select that was a bad match for you?

At the end of the day… is an expression meaning an assessment of essential facts and truths. It’s a summation of the pros and cons of any situation and a straightforward statement of what really matters. It’s also the title of this blog series by Brenda Hodge, Nuance Healthcare’s Chief Marketing Officer, with insights about leadership, empathetic customer relationships, and marketing techniques.

The power of you. Multiplied.

Solving for healthcare’s toughest challenges requires more than technological innovation. This type of problem solving requires a deep understanding of our customers’ goals and the ability to combine that knowledge with technical expertise, innovation, and industry-wide partnerships. Across the care continuum, providers and healthcare executives are looking for new ways to amplify their efforts to make an even greater impact.
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Late last year, KLAS Research wrote about the three biggest challenges in healthcare IT: (1) interoperability and data acquisition; (2) provider engagement and burnout; and (3) the financial pressures of the cost of care. We all know there are many challenges that healthcare organizations struggle with every day.

At Nuance, we are working to reduce transcription costs by 100%, help providers spend 45% less time in clinical documentation and remove 80% of the clicks to retrieve EHR information. We are helping radiologists improve their productivity by 31%, and CFOs increase appropriate reimbursements by $45 million annually.

We listen closely to our customers, and then merge that input with engineering, product innovation, and implementation design. For us, it’s a synergistic, virtuous cycle in which technological advances emerge from solving problems. For example, 94% of users say Nuance technology helps them do their jobs better by improving the quality of their documentation, and helps them save more than 30 minutes every day. Radiologists are sharing their stories about how they’re reducing turnaround times and improving compliance efforts.

As we’ve envisioned a world where technology enhances the ability for clinicians to take care of their patients and doesn’t get in the way — we wanted and needed to find a powerful way to share these insights with you. And so, it’s no coincidence that we are launching our newest campaign: The power of you. Multiplied.

When you put our industry-leading technology and teams on your side, you can and will multiply your effectiveness, accuracy, efficiency, compliance, profitability, and patient outcomes. This campaign sheds light on how we are arming our customers with the right technological advancements and support to empower people to do more…to get more out of every patient encounter, every interaction with the EHR, and every day of life.

 

 

 

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A turning point in healthcare

As the pace of technological innovation continues to accelerate, a POLITICO Health Live panel evaluates how new healthcare IT tools are delivering on their promises.
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I had the privilege of participating in the POLITICO Health Live panel discussion titled “Health Care Innovators: A Turning Point in Health IT?” It was a lively discussion and excellent opportunity to engage with policy and technology experts as we examined how health IT tools are delivering on their promise to improve how providers communicate with each other, treat patients and shape the health of patients outside the exam room.

Additionally, we explored a tremendous burden today’s providers face: they’re spending 45% of their time on documentation. Requirements for documentation mean that, too often, they’re turning their backs on patients to enter data into the EHR. This administrative burden is contributing to the physician burnout crisis in the American healthcare system.

And that’s where Nuance comes in. The technology to alleviate this burden is available today. Nuance’s AI-powered healthcare Virtual Assistant is one example of how the pace of innovation continues to accelerate, faster even than just five years ago. The assistant is designed to do far more than simply capture what is said in the exam room; it harnesses the power of natural language processing and augments physician intelligence with advice, feedback and support. In the end, it’s building documentation within the context of the patient-physician conversation, entirely eliminating the keyboard from the exam room.

Because that’s really the ultimate goal—a world where technology enhances the ability for clinicians to take care of their patients and doesn’t get in the way. That’s the tipping point we’ve been waiting for…and we’re there now. Of course, there was far more to this lively panel discussion than I can share here, but I encourage you to listen in to the conversation as a whole, and follow the hashtag #POLITICOHealth on Twitter for further insights.

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Achieving interoperability for radiology requires a holistic approach and long-term vision

Network roaming equivalents are not true interoperability for radiologists. True interoperability in radiology must integrate with workflow and reporting systems, and tie into wider healthcare system initiatives. While well-intentioned, simply interconnecting image archives falls short of interoperability goals and is comparable to the early days of cell phone roaming.
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Interoperability for healthcare IT and radiology is a tough, yet important challenge that healthcare systems, providers and patients face. The goals for interoperability as defined by the U.S. Office of the National Coordinator for Health IT (ONC) include:

1. the vision of a learning health system where individuals are at the center of their care and providers have a seamless ability to securely access and use health information from different sources.

2. to provide access to individuals health information, which is stored in electronic health records (EHRs) but includes information from many different sources and portrays a longitudinal picture of their health.

3. helping public health agencies and researchers rapidly learn, develop, and deliver cutting-edge treatments.

Achieving those goals within a complex and diverse healthcare IT environment involves multiple, carefully considered steps along the way. For example, interoperability can include interconnection of radiology image networks. But solutions limited to simple network connectivity without addressing workflow and reporting fall short of the ONC’s goals. Connectivity alone imposes added layers of IT infrastructure for limited functionality and requires physicians to take additional steps outside of their normal workflow to access and use the images.

Radiologists should be aware that a connectivity-only approach is being compared to the early days of cell phone roaming.

Food for thought: today, we use our phones worldwide without a second thought. But the early days of mobile phones weren’t nearly as well-designed. “Roaming” happened when you entered another mobile provider’s service area and wanted to use their network. You had to register your phone on their network usually by entering strings of access codes and account numbers to use that network. It was not seamless or optimal.

Achieving seamless interoperability is critical to Nuance and our customers – it is the reason why we invest in building, supporting, and protecting the robust PowerShare Network with images from more than 5,200 facilities and why more than 1,000,000 studies are exchanged per month. It’s also why we launched the AI Marketplace for Diagnostic Imaging to propagate via the network the development, validation and adoption of diagnostic algorithms integrated into a radiologist’s preferred workflow. Further, the network is the vehicle for delivering future radiology innovations. All of that integrates with our other initiatives in structured radiology reports, embedded clinical guidance, and EHR optimization. Each of those areas represents progress on the multiple fronts required to achieve the benefits of interoperability.

The days of cell phone roaming are gone, and a broader, long-term vision of true mobile interoperability has prevailed. We all are enjoying the benefits of that vision, not the least of which is the continuing integration of mobile devices into healthcare IT. It’s important to learn from the lessons of the past, and keep them in sight, for ourselves and our customers to achieve true interoperability for radiology and outcomes-based healthcare.

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At the end of the day…you will never regret being kind

When we care for and are kind to people, we feel more connected and generous with each other and our time. But our first instinct, when facing a tough situation, can be to act out of anger. Given the choice between being angry and being kind, however, I’m making an effort to choose kind.
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showing kindness

I was traveling recently and had a frustrating experience at the hotel. My first inclination—like so many of us, I’m sure—was to head straight to the front desk and make my complaint known. But I paused, took a breath, and reminded myself of a simple axiom: I will never regret being kind.

Instead of angrily approaching the desk, I stayed calm and, honestly, had a much better outcome with the hotel than I think I would have if I’d acted on that first instinct.

Kindness is not a word you often hear in business or marketing, but the truth is that, just as it did in the hotel and in every other aspect of my life, kindness creates a more positive outcome for everyone involved. . When we care for and are kind to people, we feel more connected, more generous with each other and our time.  Practicing kindness is contagious and it is good for business. Did you know that people who are happy at work are 12% more productive?

I’m not talking about grand gestures here. Simple acts of kindness pay huge dividends. Remembering to say thank you, making the next pot of coffee, greeting people, checking on people to make sure they are doing well… all of these are simple, everyday things everyone can do to show kindness and have a positive impact on the people and world around us.

Because at the end of the day, when given the choice between being disengaged, frustrated, angry or being kind, you’ll never regret choosing kind.

At The End of the Day… is an expression meaning an assessment of essential facts and truths. It’s a summation of the pros and cons of any situation and a straightforward statement of what really matters. It’s also the title of this blog series by Brenda Hodge, Nuance Healthcare’s Chief Marketing Officer, with insights about leadership, empathetic customer relationships, and marketing techniques.

 

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showing kindness

“Nurses: Inspire, Innovate and Influence” – Nuance celebrates National Nurses Week

On behalf of Nuance and the nurses that are part of our organization, we would like to recognize National Nurses Week (May 6-12) and Nursing Informatics Day (May 12) and show our appreciation for the 19.3 million nurses providing healthcare services around the world. It’s also an opportunity for us to reflect on what it means to leverage nursing and nursing informatics expertise at Nuance to inspire, innovate and influence the role technology plays in improving clinical and financial outcomes while maintaining a keen focus on improving the lives of clinicians, patients and communities.
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We, at Nuance, join the American Nurses Association, the Alliance for Nursing Informatics, the American Nursing Informatics Association and numerous others in celebrating National Nurses Week (May 6-12) and Nursing Informatics Day (May 12). This year’s theme, Nurses: Inspire, Innovate, Influence is most fitting as we celebrate the impact nurses have on patient care, clinical transformation and the evolution of Healthcare Information Technology.

First and foremost, I am honored to work in a profession that Americans have rated most honest and ethical for 16 consecutive years. From the bedside to the boardroom, nurses continue to be a trusted resource and vital part of the healthcare system and transformation initiatives.

As a Registered Nurse and Nurse Informaticist, I am inspired by the role nurses play in research, innovation and leveraging clinical knowledge, skills and expertise to influence the way technology is developed and deployed across the continuum of care to enhance care delivery, clinical outcomes and drive cost savings. Nurses and Nurse Informaticists are leveraging their expertise to innovate and enable improved quality, cost savings and productivity in a variety of roles to impact population health, patient and family engagement, decreased variations in care, enhanced care coordination, and Meaningful Use for the organization and populations served.

Some believe Nurse Informaticists focus solely on nursing related care, documentation, technology and workflows, but that is not the case. Nurse Informaticists support nurses, patients, the interprofessional care team, consumers and other stakeholders in their decision-making in all roles and settings to achieve desired outcomes. Nurse Informaticists facilitate the strategic and cross-organizational vision as instrumental liaisons between Information Technology, care teams, administrative teams and patient care. The application of Nursing Informatics knowledge is empowering for all healthcare practitioners in achieving patient and family-centered care while improving clinical and financial outcomes for the organization. Nurse Informaticists work as developers of communication and information technologies, chief nursing/nursing informatics officers, researchers, educators, chief information officers, software engineers, implementation or optimization consultants, policy developers, and business owners to advance healthcare technology, deployment, optimization and adoption.

Through my role at Nuance, I have the privilege to collaborate with many key internal and external stakeholders to facilitate research and development that contributes to new solutions, methodologies, best practices and creates new baselines, to enhance current technology-enabled solutions and to innovate on longer-term visions to ensure technology improves care delivery, clinical and financial outcomes while mitigating clinician burnout in alignment with key industry transformation initiatives. Technology should facilitate what clinicians seek to do best – take care of patients and the communities they serve. Stay tuned, as we’ll be sharing some first-of-its kind research with you soon that was facilitated collaboratively by both nursing and medical informaticists.

I was asked many years ago if I missed direct patient care and impacting their health and well-being. Without a second thought, I responded, “My goal is to impact the lives of millions of patients, family caregivers, and clinicians through technology-enabled solutions while alleviating the pain points I felt as a nurse, member of the care team and family member of the patient many years ago. My passion to make a positive impact on healthcare delivery on a global level for clinicians, patients, and families by leveraging technology is what drives me each day as I collaborate with my colleagues and our clients.”

The Nuance team wishes you continued success as you harness your expertise and passion to inspire, innovate and influence the transformation of healthcare and impact the patients and communities you serve each day.

From our Nuance healthcare family to yours,

Happy Nurses Week and Nursing Informatics Day!

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At the end of the day…everything we do either helps or hurts our health.

Even the smallest decisions you make every day have the power to affect your health. Whether you’re skipping breakfast, staying up late to catch up on work emails, getting to yoga after work, or loading up on lean protein… everything we do either helps or hurts our health. Take a moment to consider how every decision you make has an impact on your wellbeing.
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While attending the CHIME conference last month, one of the keynote speakers shared a statistic that struck me: “80% of healthcare costs are self-inflicted. We are contributing to chronic disease by what we eat, drink, and smoke.”

That really got my attention. Not only did I realize that we as individuals can help curb chronic disease, but at that point, I was also about 30 days into an anti-inflammatory diet . I’d been struggling with back pain and my doctor suggested this approach to food would help.  On this anti-inflammatory diet, there are a number of restrictions on what I can eat. I cannot eat dairy or sugar or soy or wheat or gluten or anything highly processed. I have always enjoyed sweets and junk food as a form of entertainment, so this was a major mind shift for me. But I had also read a book that gave me one simple axiom: Everything you eat either helps your health or hurts it. I’d never thought of food as that binary. Surely, I thought, some foods would be neutral? But, indeed, food either makes you stronger or it interferes with your body’s ability to process the nutrients you need.

And then there’s sleep…or the lack thereof. Sleep is fundamental to our health  and yet most of us don’t get enough sleep. My husband and I have been having a disagreement for 30 years on whether I can make up on the weekends for the sleep I missed during the week. That’s my optimism coming through; I think I can catch up, but in fact, regularly getting only five or six hours of sleep is hurting my health.

At the end of the day…everything we do either helps or hurts our health, and I am learning that all of these seemingly small decisions matter. I never want to take my health for granted, and so I am taking better care of myself in recent months—and I’m encouraging all of us to take a moment to consider how every decision we make has a positive or negative effect on our health.

 

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Three reasons to be positive about AI’s changes to medicine and healthcare

This year’s World Medical Innovation Forum is shaping and influencing how artificial intelligence (AI) and healthcare are converging to improve R&D, care delivery, patient engagement, population health and administration. A key takeaway from the Forum is that the power to realize the benefits of AI will come from in-workflow technology and our own individual engagement.
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artificial intelligence in healthcare

This week, I had the privilege of attending the World Medical Innovation Forum. This year’s Forum, of course, focused heavily on the advancements and opportunities of AI in healthcare, something in which we at Nuance are deeply invested.

From discussions around how ambient intelligence with real-time, AI-driven information and analytical recommendations offer an opportunity to improve clinical documentation, to the necessity that AI technology must fit into the everyday physician workflow, I walked away from the Forum with heightened optimism and an excitement borne of a deeper understanding for how we will realize the benefits of AI.

That excitement comes from seeing AI and healthcare not as an incomprehensible, complex mix of technology, science and market forces, but as something that is very much in our power to create, shape, use and direct.

AI gives us power; it amplifies our abilities to accomplish more.

The ultimate success of AI, however, will come from shifting our thinking – realizing that AI is not an abstraction happening to us, but instead something that is as personal, tangible and as much in our control as driving a car. Because the reality is that AI will be as regular and integral to our daily workflows and personal lives as a laptop, a phone or even a coffee maker are today. And, it will be driven by our needs and expectations for what we want it to do for us.

Overall, presenters at the Forum made it abundantly clear that AI already is changing medicine and healthcare—and that’s something we should be aware of and positive about. Here are three reasons why:

1. Population health management – Society wants to consume more healthcare than it wants to pay for, which has created cost pressures on the system that have the potential to constrain innovation. And yet, because AI depends on vast amounts of data, which healthcare institutions certainly have available, we can seize the opportunity to harness the power of this data and, with the right data training strategies, apply it to population health management.

2. Physicians can do more with less – Nuance has always focused on making clinicians more productive, getting more time back in the day to focus on patient care. Our AI-powered virtual assistant already features conversational capabilities that are a catalyst for change and advancement. But because AI is the greatest technology force of our time with the ability to help individuals achieve super-human results, even writing software that humans cannot write ourselves, (as NVIDIA’s Jensen Huang stated during his Fireside chat), so much more can be done. Another way to put it is that each of us can and will do so much more with AI.

3. A decade of advancement – We have only just begun to scratch the surface of what’s possible when we infuse AI-driven solutions. The next decade is an opportunity for extraordinary advancement. Dedicated research teams will not only reveal incremental innovation in this space, they have the responsibility to properly guide AI to do the right things, and great things. And when you consider the important work already happening with open, democratic AI platforms, as well as academic institutions, we all can look forward to what’s coming next, and how we can partner with these organizations to deliver on the promise of AI.

The future of AI is happening now. In healthcare, we can choose to ignore it, or we can adopt a bold ambition, focus on it and invest in it — today.

artificial intelligence in healthcare

A top place to work in an age of accelerating disruption

As Nuance is recognized by Becker’s Healthcare as a top place to work in healthcare, we reflect on the management practices that influenced this honor.
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Becker's healthcare top 150 places to work

Nuance recently earned a place on the Becker’s Healthcare 2018 list of the “150 Top Places to Work in Healthcare.” We are proud to be recognized by Becker’s, and believe it affirms the steps we’ve taken to create a culture that supports, enables and empowers our employees to achieve their professional and personal goals. It also underscores our employees’ work and dedication during a time of continuous and accelerating industry change.

A recent McKinsey article states: “We live in an age of accelerating disruption. Every company is facing up to the profound changes wrought by digitization. Industry boundaries have become permeable. Data, algorithms and artificial intelligence are changing the nature of forecasting, decision making and the workplace itself. All this is happening at once, and established companies are responding by rethinking their business models, redesigning their organizations, adopting novel agile-management practices and embracing design thinking.”

Workplaces around the globe are transforming; successful leaders will embrace the uncertainty and see what they don’t know as an opportunity for learning and growth. They will question themselves and set a direction for journey vs. dictate steps to an objective. Above all, they will listen to employees and customers, and be open to what McKinsey calls ‘emergent possibilities’.

Creating and maintaining a great workplace in this age of transformation relies on many different factors, but when we reflect on what makes us a top place to work in healthcare, we consider and share the following management practices:

  1. Have a clear vision: Ensure that employees throughout the organization understand the company’s vision and, more importantly, believe in it, commit to it and make it happen.
  2. Listen: Listen to employees, customers, and shareholders to learn, build trust and strengthen relationships.
  3. Seek to understand: Know and understand the market and the products — understand they affect customers’ lives, practices and success.
  4. Measure growth along the way: Organizations and people that aren’t growing will not succeed. Be mindful of key performance indicators – every day – and grow.
  5. Be resilient: Disruption is happening all around us. “Inner agility,” as McKinsey describes, is a requirement. Resiliency steadies and energizes us to tackle new problems, uncover new paths and lead through change.

We remain dedicated to creating a working environment that delivers happy employees, customers, and business success during continuous and accelerating industry change. And, we are honored by Becker’s Healthcare recognition.

 

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Becker's healthcare top 150 places to work

AI in Action at Vanderbilt University Medical Center

Providers at Vanderbilt University Medical Center can now rely on their virtual assistant to ask questions and get answers from the EHR. It’s more than a technical advancement; it’s one that can have a profound, personal effect on healthcare delivery.
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Vanderbilt_university_medical_center

Healthcare IT News reported last week on a new and exciting development in healthcare AI: Vanderbilt University Medical Center has collaborated with Nuance to create an AI-powered voice assistant for providers to navigate their Epic EHR.

Much like the AI in Action experience room we hosted at HIMSS 2018, Vanderbilt caregivers now can rely on a natural language, conversational interface to query the EHR, even asking general questions of the voice assistant. For example, a caregiver can say, “Dragon, how much does the patient weigh?” or “Dragon, show me the latest chest x-ray.” In response, the EHR will provide the caregiver with the necessary summary or images, eliminating the typical, manual keyboard-and-mouse navigation.

AI in Action is all about making it easier to not only efficiently and conveniently retrieve information from the EHR, but also to enter data, manage tasks, use computerized physician order entry, and communicate with other providers. With this collaboration, we’re beginning to see and implement considerable steps toward fully automated clinical documentation, where one day a virtual assistant will be able to listen to a conversation and automatically build the documentation in real time.

Technologically speaking, these strides represent significant advances that demonstrate how far we have come in terms of building AI platforms and development toolkits in the cloud. But healthcare is personal, and these advances are far more than technical marvels. They’re enabling physicians to minimize the documentation burden and free up more time to focus on patients — improving the delivery of patient care and outcomes.

 

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Going the distance for continuous improvement and excellence in radiology

A new way of thinking about radiology workflows focuses on using imaging systems to respond to the increasing emphasis on outcomes-based revenue models and the integration of radiology expertise into overall patient care.
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Triathletes running to bicycles on beach

If you want to understand where radiology and radiology workflows are heading, just listen to your colleagues, friends or family members talk about fitness routines. Gone are the days when getting fit was mainly about pumping iron, working the weight machine circuit or getting on a cardio machine. People still do those things, of course, but now in the context of functional training for an activity, sport or event. They have broader goals beyond losing weight or building muscle. They are working toward practical results and overall improvement, and they aren’t confined to workouts and motions defined by the equipment.

I’m currently doing that myself while training for my second triathlon later this year. My first one taught me a couple of important things. First, I discovered that my performance had a lot of room for improvement. Second, I needed to adapt my training to target specific improvements to help me attain my overall goals. It’s hard work, to put it mildly, because my push to do better must be continuous.

The radiology workflow version of functional training is a shift from the traditional models of the RIS- or PACS-driven workflow. Those are roughly the equivalent of the old-school gym debates about the relative advantages of free weights vs. machines. The RIS (and now EMR) models argue that they provide more clinical context and data. The PACS position focuses on the use and capabilities of the viewer and the radiologist’s ability to derive maximum insight.

Those models grew from the requirements of the healthcare system and the imaging technologies at the time. But the economics, technologies and practices of the healthcare system have changed. Health systems are emphasizing operations, workflows and efficiencies. Revenue doesn’t come from utilization, but instead, from outcomes. An added pressure is that radiologists have found themselves tied more to legacy RIS or PACS systems and further removed from patient care.

In comparison, Nuance Healthcare’s radiology equivalent of functional fitness training places radiologists in broad control of workflow to deliver results producing the diagnostic report, communicating critical findings, managing peer review workflows, identifying, and increasing operational efficiencies, and orchestrating workflow across specialists and subspecialists. This includes optimizing resource utilization and improving turnaround times. The results-driven model unties the workflow from the PACS and the RIS and lets users build a process that supports the desired results.

A results-driven workflow also facilitates and improves patient care. As with functional training it focuses on practical everyday benefits. For example, PowerScribe 360 Workflow Orchestration ensures that the right exams are read by the right specialist at the right time, and that various levels of priorities are optimally managed. It recognizes that not all STAT exams are the same, and that workflow seamlessly continues when interruptions happen. It’s responsive because it’s designed functionally for the real-life radiology workflow.

So instead of free weights vs. machine, treadmill vs. roadwork in fitness, the shift in thinking about radiology workflow from RIS- or PACS-driven to results-driven workflow is about the desired outcomes for the hospital, the patient and the radiologists. It’s about training for continuous improvement and overall excellence.

As for my triathlon training, suffice it to say that I won’t have any sponsors bidding for my product endorsements. However, I will consider continuing improvements and achieving personal goals my very own version of excellence.

 

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Triathletes running to bicycles on beach

At the end of the day…it’s about growing and thriving by embracing change

It may feel natural to resist change, but it creates opportunities for growth.
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penguin jumping off an iceberg

We live and work in an industry experiencing continuous and accelerating change. It is through these transitions that we must recognize that change is good for us—personally, professionally, culturally. Yet many of us fear change, and do so for a variety of reasons. Perhaps we’re afraid to fail, afraid of criticism, afraid of the uncertainty new leadership can mean.

When I think about change management, I’m reminded of the fable John Kotter, long-time faculty member of Harvard Business School, presents in Our Iceberg is Melting. In this story, we meet a colony of Antarctic penguins; one curious member discovers that their iceberg is in danger, but none of the other penguins is ready to believe him. They’re satisfied with the status quo and resistant to the changes that are suddenly foisted onto the group. The story progresses through the actions and reactions of the various characters – you may recognize yourself and your colleagues in there – as they struggle, argue, resist, explore, and finally adopt the changes necessary for their continued success. In fact, embracing change becomes an essential part of their culture and belief system.

Relatable? Definitely.

We all have had a melting iceberg in our lives, and whether we’ve been on the penguin leadership council, a middle iceberg manager, or a front-line fish, one truth prevails. When we all remain true to our shared values and beliefs, change leads to transformation and growth. It generates its own opportunities for looking at things anew and for considering and achieving goals that we previously didn’t even know were possible.

At the end of the day…it’s about growing and thriving by embracing change.

At the end of the day… is an expression meaning an assessment of essential facts and truths. It’s a summation of the pros and cons of any situation and a straightforward statement of what really matters. It’s also the title of this blog series by Brenda Hodge, Nuance Healthcare’s Chief Marketing Officer, with insights about leadership, empathetic customer relationships, and marketing techniques.

 

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penguin jumping off an iceberg

AI cloud: A pivotal moment for innovation

As the cloud wars wage on, we see evidence that the “AI cloud” will supplant “the cloud” as innovators continue to harness the power of AI. Patient outcomes, physician satisfaction, and organizational growth all stand to gain from novel ideas and developments.
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artificial intelligence cloud representing the internet-of-things

Last fall, Gartner issued its inaugural report on the state of the infrastructure-as-a-service market—this is the space that provides cloud computing and storage. In this IaaS research, Amazon sat (predictably) at the top in terms of revenue and share. Microsoft and Alibaba rounded out the top three providers, but when combined with Google, the report indicated some level of erosion in terms of Amazon’s market share as demand for these services continues to climb in the coming years. Welcome to the cloud wars.

At the same time, leading organizations are “in a headlong rush to…create AI-based platforms”—platforms that build on existing and essential capabilities: facial recognition, turning speech into text, and the natural-language processing that enables us to engage with virtual assistants.

In short, “the cloud” is likely to be superseded by “the AI cloud.”

Because most of our interactions with AI will occur within the cloud, this is an important tipping point in IaaS innovation. AI-driven technologies are already enabling organizations and individuals alike to “do things they’ve never been able to do.” And, for us at Nuance, we are harnessing the power of AI to improve patient outcomes, alleviate the burden documentation plays in terms of physician burnout, and drive innovations that help executives find new ways to affect top and bottom line growth.

These innovations are coming at an optimal moment as calls for “fixing the EHR” abound. One way to help is to eliminate the keyboard and mouse with voice commands—making clinical systems more intelligent, efficient, and effective with AI.

 

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artificial intelligence cloud representing the internet-of-things

How to combat regulatory overload

A new report from the American Hospital Association (AHA) reveals that hospitals spend nearly $40 million annually to report on 692 different quality indicators required by CMS, TJC, payers, and other industry influencers. As this number grows, it adds to clinicians’ administrative burden of tracking, managing and reporting—and providers are ready for relief.
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administrative office worker holding overloaded paperwork stack

If you think that the burden of capturing, improving and reporting on Quality Measures and Indicators has grown, you’re not imagining things. With nearly 700 available Quality Indicators, many of which are mandated, it’s clear that providers are struggling with regulatory overload.

Let’s look at some numbers. In an average-sized hospital:

  • 59 full-time equivalents (FTEs) are dedicated to regulatory compliance
  • About 25% of these FTEs are doctors, nurses and allied health staff
  • Administrative aspects of quality reporting costs about $709,000 annually
  • It costs approximately $760,000 per year to meet meaningful use administrative requirements

Furthermore, according to a new American Hospital Association (AHA) report, a 161-bed hospital spends an estimated $7.6 million on administrative activities related to compliance—or about $1,200 per patient hospital admission.

This same report—which analyzed requirements from CMS, the Office of Inspector General (OIG), Office for Civil Rights and the Office of the National Coordinator for Health Information Technology—revealed that providers spend nearly $39 million annually to comply with 692 requirements across nine domains.

The costs are clear, and so the question then becomes: how do we combat the regulatory burden placed on providers?

The AHA report makes a number of recommendations, including:

  • Reduce redundancy across requirements
  • Evaluate current measures for effectiveness
  • Use only evidence-based measures
  • Provide clear guidance accompanying new measures

At Nuance, we are likewise committed to reducing the regulatory overload; our vision is to develop technology-enabled solutions that fit seamlessly into the clinical workflow, allowing clinical staff to remain focused on core responsibilities to deliver quality, cost-effective and safe patient care. Our clinician-lead product teams have forged partnerships with providers to tackle this issue as well.

Through these partnerships, we are exploring ways to improve patient care and outcomes while decreasing the burden of identifying, acting upon and documenting quality measures. Additionally, we are working to discover and understand not only the process of capturing PSI and other quality indicators, but also the effectiveness of those process. Finally, we are committed to building solutions to capture exactly what’s needed, right at the point of care, so we can get it “first time right.”

Satish Maripuri, Executive Vice President and General Manager of Nuance Healthcare, recently was interviewed by Forbes contributor Ben Kerschberg about the burdens on providers, and gave several examples of broader initiatives in healthcare. I invite you to give the Forbes Q&A a read.

Based on your experience, what are the top five most challenging quality indicators to capture? Please share your comments below.

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administrative office worker holding overloaded paperwork stack

Leading with change

As we find ourselves in a period of transition, we remember how change and transformation are good for us – personally and professionally. Our own experiences in creating and implementing change for the healthcare industry offer insights and lessons.
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leadership management change

It is fitting that Nuance, a company leading change and growth in healthcare IT, experience our own change and transition. Our change comes with the planned retirement of Paul Ricci, who for the past 18 years as Nuance CEO led the company’s growth from a $50 million software publisher to a multi-billion-dollar leader in Conversational AI, with 14,000 employees worldwide. The vision, established during Paul’s tenure, of using speech technology to let people interact with computers and data easily and naturally, has brought us to a pivotal moment in time – with ownership of some of the most impactful technologies known today.

We thank Paul for his contributions and welcome the leadership of incoming CEO Mark Benjamin to embrace this moment and drive new levels of growth across our organization.

Mark’s decades of experience and recognized expertise in directly relevant technology and market segments create an exciting and compelling synergy with our core values, competencies, and priorities. Mark is stepping forward to lead Nuance in a position of strength as we follow our growth trajectory. Based on discussions with Mark, it’s clear he shares our commitment to keeping the customer first, to fostering trust, to focusing on growth, and to personal and organizational resilience. Mark’s own vision and skills honed through his extensive experiences in industries that also have shifted and evolved will complement and build upon our success.

The overall pace of change in technology – especially in healthcare – is accelerating. As such, the very nature of our work in healthcare places us squarely in the business of creating and enduring change. Our skill comes into play in directing and leading that change to produce the greatest good. In our case, it’s nothing less than to fundamentally transform the quality, economics, and outcomes of healthcare.

At Nuance Healthcare, we all share and remain focused on a vision for the future; understand the importance of our work; and embrace successful change.

 

 

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leadership management change

At the end of the day….it’s about the patients.

A newborn with a life-threatening condition required urgent care. Connecting this baby with his care team via Nuance’s cloud-enabled medical imaging exchange meant connecting him with the resources he needed to save his life.
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There was a newborn baby who had an abnormal x-ray; we’ll call this newborn baby Christian. The medical team at the hospital where baby Christian was being seen, urgently sought assistance from the Chief Quality Officer of their healthcare system. Upon getting a call from the neonatal team, this physician asked them to share the medical image with him by uploading baby Christian’s x-ray to the Nuance cloud network. The doctor was en route to another hospital, but he was able to pull up the image on his iPhone.

As a radiologist reviewed Christian’s x-ray and registered concern, he requested an upper GI series from the team at Christian’s hospital, again asking that the images be shared with the entire care team. At one point, there were as many as four different doctors at four sites reviewing baby Christian’s x-rays via the cloud image exchange. Together, they arrived at a diagnosis: a life-threatening condition where the bowel twists, often leading to death.

A helicopter was dispatched. Christian was airlifted to the main hospital and sent directly to the operating room. No detours to the emergency room. No delays in going to another neonatal unit. The team had the diagnosis and could act quickly and appropriately.

Baby Christian survived and, of course, his parents were grateful beyond words.

I share this story because the ability to impact care is what drives us each and every day. We extract clinical facts, the science of life and death — and give care teams a voice and a way to connect with purpose. We are helping save lives with technology-enabled care and collaboration.

Behind every technology, every set of actions, you’ll find a family, a baby, an aging parent—a patient who relies on a team to care for them — and the patient’s health and well-being are at the center of what we do.

At the end of the day…it’s about the patients.

 

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Asking “Why not?” instead of “Why?”

If you had to identify the most significant challenge the healthcare industry must address before it can fully realize the benefits of artificial intelligence (AI), what would you say? Image recognition? Algorithm development? Conversational interfaces? Compute power? Cost?
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The single biggest obstacle that we collectively face is how we think about AI and what might be possible. Asking “Why not?” instead of “Why?”

Our version of “Why not?” at Nuance Healthcare is driven by envisioning “a world where technology enhances the ability for clinicians to take care of their patients and doesn’t get in the way.”

For example, we are focused on an area of augmented intelligence called conversational AI, which powers natural spoken or text interaction with computers and instantaneous access to highly actionable data and information in ways that were previously too difficult or cumbersome. Virtual Assistants are an example.

We are actively building real-time AI solutions that give doctors, nurses, radiologists, and anybody delivering care easy and instantaneous access to intelligence in any care setting from any device – so they can focus on caring for patients instead of tending to technology.

I recently had the privilege to talk with Forbes contributor Ben Kerschberg about real-time AI in healthcare. I gave several examples how providers and patients can expect to use and benefit from real-time AI as well as broader initiatives in healthcare including EHR usability.

I invite you to give the Forbes Q&A a read.

To quote George Bernard Shaw: “You see things; and you say ‘Why?’ But I dream things that never were; and I say, ‘Why not?’

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AI Marketplace is open for business! Developers create deep learning algorithms for radiology.

Algorithm developers, publishers, data scientists, and radiologists can successfully code to Nuance’s radiology API’s and distribute countless AI applications to over 2000 PowerScribe 360 Reporting and Workflow clinical users.
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Here’s a bit of news followed by a little history. First, the news:  The Nuance AI Marketplace for Diagnostic Imaging is officially open for business!

After finalizing logistics and implementing the details, the AI Marketplace officially welcomed its first 34 AI software developers, since its ‘doors opened’ at the HIMSS18 conference earlier this month. These AI development partners will be among the first to offer a wide range of machine learning and deep learning algorithms for image analysis, workflow optimization, clinical decision support, and other radiology applications and use cases.

We look forward to seeing radiologists access the AI Marketplace to download and subscribe to algorithms, then incorporate those algorithms into their regular PowerScribe desktop workflow. To see this come to fruition in less than 6 months since our RSNA announcement, and to watch the initial reception is truly exciting. It feels to me like a “Field of Dreams” experience — when a big change happens so quietly at first that many people don’t notice it until later. But it is happening, and it is profound.

That brings me to the history. Not quite 10 years ago – July 10, 2008 – Apple launched the iOS App Store with a modest 500 apps. There was skepticism at first, but now it’s an integral part of our daily lives with more than 2.2 million apps of every description available. It propelled the app store concept to where it is now covering smartphones, computers, and other devices and markets. The other notable aspect of the Apple App Store was how quickly it caught on. Those first 500 apps grew to 50,000 in the App Store’s first year of operation driven by Apple’s support for third-party developers, a published software development kit (SDK), and a large base of tech-savvy iPhone users hungry for apps.

When you combine the news and the history, you can see why we are so excited about the potential for the AI Marketplace. Algorithm developers, publishers, data scientists, and radiologists can successfully code to Nuance’s radiology API’s and distribute countless AI applications to over 2000 PowerScribe 360 Reporting and Workflow clinical users.
More than just a place to offer and access radiology algorithms, and unlike other AI development platforms, the AI Marketplace offers subscribers a feedback channel to developers and publishers to enable continuous learning and refinement of their algorithms. It’s a simple but incredibly effective way to develop, test, validate, and refine imaging algorithms, then seamlessly connect them to the radiologist’s existing workflow.

Since 70 percent of radiologists use Nuance diagnostic solutions in the United States, the widespread development, adoption, and rapid deployment of imaging AI algorithms are easily integrated into the existing workflow of thousands of radiologists. As a result, we are augmenting the practice of radiology with AI algorithms that are useful, usable, and used – at scale.

On top of creating and using radiology algorithms, the entire radiology and development community can discover and share new and improved ways of managing workflows, interpreting images, and reporting findings. As we witnessed with Apple, there’s a certain serendipity that creates its own growth, finds innovative use cases, and opens new lines of thought and exploration. That’s truly exciting.

Developers, radiologists, and other members of the healthcare community interested in playing a part in transforming and improving the practice of medicine with AI can get in touch with us for more information or to get started in the AI Marketplace.

Attendees at NVIDIA’s GPU Technology Conference in San Jose, CA, March 26-29, can get detailed practical info about the AI Marketplace directly from two of the industry’s top AI in radiology experts. Nuance’s Chief Medical Officer Dr. Woojin Kim and Engineering Director Arman Sharafshahi will talk about the importance of clinical domain expertise in algorithm and model development. They’ll demonstrate how AI can augment radiologists in image interpretation and in the overall workflow. They’ll also cover the critical difference between developing a great AI model in isolation and having it become part of daily medical practice.
AI in radiology is not futuristic, foreboding, or frightening. It’s happening now — and offers incredible promise and immediate and ongoing benefits. We invite you to experience it for yourself. Just as the iOS App Store changed how we used and viewed smartphones, the AI Marketplace can deliver a similar transformation to the quality of care.

Join us and “go the distance” – register in the AI Marketplace today.

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A powerful vision can accelerate innovation more than one can imagine

We joined more than 40,000 attendees in Las Vegas for this year’s HIMSS conference. In response to the event, one HIMSS-veteran reviewer wrote, the HIMSS announcements are “…waking people up to the fact that there is a better way of doing things and that if they don’t innovate, someone else will.” Moreover, he wrote that health practitioners are getting “pretty practical about using technology to really make a difference in how they deliver care.”
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Image of Dragon Medical virtual assistant in action

We’ve long been focused on reimagining the way things are done in healthcare. At Nuance Healthcare, our vision is: “A world where technology enhances the ability for clinicians to take care of their patients and doesn’t get in the way.” During the conference, we made a key announcement that continues to support this vision with a new AI-powered virtual assistant platform embedded in the Epic EHR for physicians, nurses, and schedulers.

This remarkable step forward means care teams can conversationally engage with the EHR, never touch a keyboard, and focus on the patient. This is not 5 years out – it is available now. A powerful vision can accelerate innovation more than one can imagine.

Adding to the buzz, our AI in Action room at HIMSS delivered a unique opportunity to experience what ‘a better way of doing things’ means.

The featured scenario in the AI in Action experience room began with the physician at home, fielding a call from a patient’s mother. Right from her mobile device, the physician could use her voice to log in, order medications, schedule follow up appointments, create tasks, and access key patient information. And without a click, the physician was able to get critical data in and out of the EHR with ease. These simple conversations continued throughout the care process from the clinic and ED to the radiology reading room—supporting nursing flowsheets and notes entry and radiology workflows. The scenario concluded with examples of automated documentation and in-workflow guidance to support better clinical decision making—and all of this happened while the physician held the patient’s hand instead of a computer mouse.

Following these standing-room-only sessions, hundreds of CMIOs, CIOs, and others tried our AI-powered technology for themselves. The response to and energy in the AI in Action experience room was palpable. And, the impressions we overheard were, frankly, humbling.

Carl Dvorak, president of Epic said: “Nuance’s AI-powered virtual assistants with conversational AI functionality expand the ways that physicians and care teams can instantly capture and retrieve patient information. These advancements represent a growing need for next-level conversational AI capabilities and we expect them to be a catalyst for changing how and what physicians are required to document in progress notes.”

Unburdening care teams in this way has been our vision, so the AI in Action experience at HIMSS was a dream come true to see the concept come to life for our team, partners, and customers.

As David Y. Ting, MD, CMIO, Massachusetts General Physicians Organization stated: “Technology needs to be unobtrusive and support the process of providing high quality patient care. Having Nuance’s AI-powered virtual assistant technology embedded into Epic will help make a new generation of patient care a reality – for both clinicians and patients.”

We can certainly do our part in leaving the world a better place than we found it, and disruptive innovation will help us in that quest.

 

 

 

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Image of Dragon Medical virtual assistant in action

At the end of the day…it’s about listening to your customers

At The End of the Day… is an expression meaning an assessment of essential facts and truths. It’s a summation of the pros and cons of any situation and a straightforward statement of what really matters. It’s also the title of this blog series by Brenda Hodge, Nuance Healthcare’s Chief Marketing Officer, with insights about leadership, empathetic customer relationships, and marketing techniques.
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Last month in Florida, I was absorbing some great discussions with our Executive Client Council (ECC), a group of C-level executives from the nation’s leading health systems. I was closely following a dialog rich in insight when I was struck by two simultaneous thoughts: (1) we should do this more often, and (2) why don’t more marketers do this more often?

“Listen to your customers” is unquestionable for any marketer. Most make at least some attempt to do it. Some do it well, and others not so well.

So that leaves my second thought: Why don’t more marketers do this more often? If you ask the question, the common reply will be “we can’t find the time”.  If you push beyond the surface answer, you would also find an unease about what you will hear and an uncertainty if you want to hear it.

If it’s about time, think of the time and resources spent developing products and services that weren’t quite right or were just plain wrong. Then think about the time and money spent digging out of the resulting hole. Can you afford not to take the time? If it’s about being afraid of what you’ll hear because it might disrupt some major product development, then be prepared for the results you get in return — knowing that what you don’t know can hurt you.

We meet with our ECC regularly and it’s fantastic every time. We’ve learned a lot from this group of executives, and adjusted direction on product and technology development based on their coaching. We are committed to making this a more frequent dialog. Our intensive focus on clinical virtual assistant development is one direct outcome from listening to our customers.

Successful businesses are designed around what customers need. So, at the end of the day go beyond just thinking that you’re listening to your customers no matter how well you think you’re doing it. Instead, honestly ask why you aren’t spending more time with them.

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Trust is more than a 5-letter word

As cybercrimes become more prevalent and organizations strive to earn—and keep—their customers’ trust, we must find new ways to confront and mitigate against these risks.
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Since The Trusted Advisor was first published some 17 years ago, many organizations have worked hard to cultivate trust-based organizations. The authors remind us that trust is a two-way street: one entity must be trusted, and one entity must do the trusting. Unfortunately, in more recent years, cyberattacks have become a proverbial roadblock on that two-way street. For example, hackers have found healthcare organizations to be a “lucrative target,” affecting millions of patients in 2017 alone, and experts expect healthcare data breaches to continue to increase throughout 2018. In fact, in an Accenture-AMA survey of 1,300 physicians, 83% reported that their practices have experienced some type of cyberattack. The attacks led to system downtime; increased operational expenses; and, perhaps most alarmingly, patient safety risks. Looking ahead, across all sectors, cybersecurity remains a top priority for many organizations, and spending in this category is expected to reach $96 billion in 2018.

The AMA-Accenture survey also revealed that physicians trust their third-party providers to provide the HIPAA and security training they need to protect their practices — perhaps due to the facts — cybersecurity threats constantly are changing; hackers are getting smarter; and devices can easily be lost or stolen. As cybercrimes become more prevalent and organizations strive to earn—and keep—their customers’ trust, we must find new ways to confront and mitigate against these risks.

At Nuance, we strive to employ the most effective policies, procedures, tools, techniques, and experts to help us on our journey. For example, this week, Dragon Medical One achieved HITRUST Common Security Framework (CSF®) Certified status from the HITRUST Alliance. This achievement places Nuance in an elite group of organizations worldwide that have earned this certification.

We also firmly believe that knowledge is power, and we continue to put our knowledge into action with and for our customers. Later this month, our Provider Solutions General Manager, Michael Clark, will share a presentation entitled Cyber Protection Planning for Healthcare Systems at the California Health Information Association EHR Governance Symposium. During this session, Michael will discuss the increasing severity of incidents and the evolving skillset to defend health systems in the new cyber reality.

The lessons we, at Nuance, have learned from living through a difficult experience remain with us. They’ve made us stronger and better prepared when new challenges arise. These new challenges may not be easier, but with our hardwired resilience we can and will approach them with greater wisdom and perspective

Our customers have faithfully placed their trust in us, and we endeavor to maintain that confidence every day.

To us, trust is more than a five-letter word; it is the heart of our business.

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The radiology quality & value Olympics

Imagining radiology as a sport at the Winter Olympics helps us to understand the ways in which radiologists must synthesize their skills and diagnostic expertise with available technologies to achieve quality, value, and improved patient outcomes. At the heart of this synthesis lies the radiologist’s workstation—and the innovations we pioneer in partnership with Primordial to extend and expand the capabilities of PowerScribe 360.
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What if radiology were a sport at the Winter Olympics? Would it be the giant slalom, moving at high speed through a series of gates in constantly changing conditions? Or would it be the biathlon, requiring a rapid cross-country pace with stops for precision shooting? Or maybe it would be figure skating, blending technical and interpretive skill with a panel of judges scoring the performance?

Radiology would actually be all three — at the same time.

That’s impossible of course, but the thought of simultaneously combining those sports captures the multiple pressures radiologists face with the shift from fee-for-service billing to value-based reimbursements for demonstrated outcomes. Radiologists must interpret more cases in less time with greater accuracy while proving the value and results of the work. It’s competitive in the sense that it requires meeting or exceeding demanding standards under constant and increasing time and financial pressures.

Instead of skis, skates, and rifles, radiologists rely on their workstations to apply their training and diagnostic expertise. Just as athletes refine and personalize their gear to maximize performance, radiologists can add capabilities and automation to their workstations to improve the efficiency, quality, and value of their work. The key is to fit the solution to the radiologist’s day-to-day workflow and preferences rather than the other way around.

Take for instance how emerging artificial intelligence (AI) and machine learning technologies are driving new automation and efficiencies in the radiology workflow. The Journal of the American College of Radiology’s recently published article on AI’s criteria for success cites better patient outcomes and improved work life for radiologists, noting that AI can also address practical issues to include optimizing worklists, prioritizing cases (like in the instance of potential pulmonary embolism), pre-analyzing cases in high-volume, and extracting information from images that may not be apparent to the naked eye.

The central role of the radiologist’s workstation is why we continue to invest in extending and expanding the capabilities of PowerScribe 360. It’s why we pioneer innovations from Primordial to create customizable radiology solutions like PowerScribe Workflow Orchestration and PowerScribe Lung Cancer Screening. PowerScribe solutions give radiologists worklist prioritization, automated and intuitive guidance, and speech recognition tools for completing reports efficiently and accurately. It also includes integrated access to published clinical best practices for citation in their reports and recommendations to fellow clinicians.

The Nuance AI Marketplace for Diagnostic Imaging is another example of expanding capabilities at the time of reporting. The Marketplace delivers access to powerful new cloud-based AI tools for handling the huge amount of x-ray, CT scan, and other imaging data as part of a radiologist’s regular workflow.

Just as Olympic athletes leverage their training and skills with the right equipment, radiologists can optimize their medical expertise with the systems and tools they prefer, right at the point of interpretation and documentation. Instead of medals, radiologists can gain something even more important to themselves and their patients: demonstrable quality, value, and improved outcomes across the care continuum.

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Pushing the innovation envelope: the value of automation

Although economists note that productivity growth has declined over the last decade, automation is expected to give the “global economy a much-needed productivity boost, even as it enables us to tackle societal ‘moonshots’ such as curing disease.”
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We are on the cusp, as McKinsey writes, of a new automation age. With the latest developments in robotics, artificial intelligence, and machine learning, automation is changing how we work—across the spectrum of industries. Automating aspects of work can enable reduced errors, improved quality and speed, and the ability to achieve greater outcomes.

Although economists note that productivity growth has declined over the last decade, automation is expected to give the “global economy a much-needed productivity boost, even as it enables us to tackle societal ‘moonshots’ such as curing disease.”

Of course, automation creates disruption, but keep in mind that disruption—particularly the disruption we’re seeing from digitalization—can bring enormous benefits to healthcare organizations. Consider how Dragon Medical One took speech recognition technology, already itself a disrupter, from the desktop to the cloud, further changing how physicians and care teams capture patient stories. And today, we’re celebrating a new milestone with Dragon Medical One.

As of last month, we surpassed 100,000 active cloud users of our speech recognition solution. If we break it down by the numbers, that means:

  • 10.7 billion distinct words were dictated last year. The 20-volume Oxford English Dictionary contains full entries for 171,476 words in current use. It would take 62,538 copies of the Oxford dictionary to hold the 10.7 billion words recognized by Dragon Medical One last year. Standing upright, cover-to-cover, the volumes would reach over 20 miles.
  • 103 million minutes of audio were recognized last year. A physician who started dictating on Sunday, September 2, 1821 would complete a dictation of this length on March 1, 2018, after 196 years and 228 days.

Additionally, in an analysis of client usage data, we find that automating documentation workflows means clinicians have been able to reduce the amount of time they spend on documentation by 45%—a boost to productivity that, as one health system executive explains, “has created more efficient workflows, which have led us to being able to see more patients.”

This is kind of feedback we love and motivates us to continue pushing the innovation envelope. Where can we go from here?

We will be sharing our new innovations at HIMSS next week.  Join us at booth 1143 to discover what’s next.

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Is artificial intelligence healthcare’s new nervous system?

Faced with continued cost pressures, today’s healthcare executives need new ways to drive top- and bottom-line growth. Clinical documentation solutions, powered by artificial intelligence, can contribute to cost-reduction efforts, while having a positive impact on revenue generation, provider satisfaction, and burnout.
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The topic of cutting costs from the U.S. healthcare system rightfully garners a lot of attention. American consumers continue to grow concerned about the affordability of healthcare and health insurance—while healthcare spending is expected to grow 5.5% annually over the next decade as the population continues to age. From the provider perspective, healthcare systems face shrinking reimbursements, business transformation, and legislative uncertainty that are driving a relentless focus on cost reduction and the ability to generate additional revenue.

In fact, according to a recent survey from The Health Management Academy (“The Academy”), 90% of executives rank cost reduction as a “high or very high priority.” Moreover, almost all of the responding executives indicated that the priority level of cost reduction has increased in the last year. Respondents indicate that system-wide, they are focusing cost reduction efforts in the areas of labor, such as holding off on new hires and new positions; supply chain; and pharmacy, while remaining hesitant to cut costs in cybersecurity and IT including electronic medical records (EMR) implementations.

In addition, about one-third of respondents to The Academy’s survey indicate that generating additional revenue will have the greatest impact on their organization’s finances over the next five years.

As healthcare organizations face continued cost pressures, they are turning to the newest generation of clinical documentation technologies that rely on artificial intelligence (AI) and machine learning to help them realize financial improvements.

Let me give you some statistics: Nuance’s AI-powered solutions adapt to existing, natural workflows to improve productivity by up to 54%, and to free up about two hours per clinician, per shift. Productivity improvements certainly contribute to cost-reduction efforts. But more importantly, the extra time in a clinician’s day means spending more time with patients and less time on documentation, a combination that leads to greater satisfaction and potentially a positive impact on the mounting problem of provider burnout.

AI-powered solutions also make a more secure path to reimbursement achievable—from guaranteed case mix index (CMI) improvements to significant increases in Medicare admission reimbursement. For example, AI enables real-time clinical guidance to help providers capture patient stories more fully and accurately, and with this higher-quality documentation, it becomes much easier to receive appropriate reimbursements for the care provided.

We at Nuance expect AI-powered solutions to be among those strategies that produce the most value for health systems in the coming years—and we’re not alone. In a research report entitled “Artificial Intelligence: Healthcare’s New Nervous System,” Accenture indicates that the AI market is not only seeing “explosive growth,” but is estimated to generate $150 billion in annual savings for the U.S. healthcare economy by 2026.

It is truly an exciting time to be working in this space, and the conditions are right to make big moves that position the health systems for long-term success.

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Creating change with awareness, resilience, and strength

It was not long ago that you might have found a typical healthcare IT department relegated to the hospital basement, largely charged with installing and supporting medical devices and productivity-centric computer systems. But the role of healthcare IT has changed as profoundly as healthcare delivery itself.
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Sheryl Sandberg quote about change

Today’s healthcare models now prioritize patient care and population health, along with a new emphasis on quality measurement and payments based on value and outcomes as opposed to quantity and system utilization. CIOs must assume new roles: agent of change and IT implementer. They are rolling out tools and devices for clinicians to use across care settings while driving strategy and innovation alongside C-level executives at the boardroom table.

It’s not enough to know that change is occurring; rather, we must be aware at a granular level of the many factors influencing it. It’s the difference between knowledge and understanding, and between reacting and effective action. Understanding healthcare CIOs’ goals and priorities is a vital and ongoing part of aligning our organizational priorities with our customers’ issues and concerns.

Last week, we had the honor to meet over two days with our Executive Client Council (ECC), a group of C-level executives from the nation’s leading healthcare systems, to continue to build and refine our awareness and understanding. We learned quite a bit about their priorities and goals – and how we can continue to build the ‘must-have’ technologies to support them.

Earlier this year we also we engaged in a survey of CIO priorities and goals with the College of Healthcare Information Management Executives (CHIME). This effort uncovered the following key priorities:

Cybersecurity and malware prevention: With healthcare data breaches happening daily in 2017, cybersecurity is overwhelmingly the top priority for CHIME CIOs. System security is a prerequisite for achieving their other goals in cloud-based system optimization, patient engagement, satisfying regulatory requirements, and driving growth. Likewise, ensuring customer trust and confidence through the security, privacy, and resiliency of our solutions also remains a top priority for Nuance. You can view cybersecurity as much of an enabling technology as speech recognition, deep-learning AI algorithms, and cloud connectivity.

Optimizing IT systems: CHIME CIOs view IT system and electronic health record (EHR) optimization, usability, and ROI as a way to both increase the value of these solutions and mitigate provider burnout. Related concerns include finding and retaining qualified IT talent, data analytics, and patient engagement platforms. EHR optimization is a key area of outreach for Nuance as well, including the recent completion of a pilot program at Brigham Health.

Physician Burnout: The heavy administrative and reporting requirements on physicians – with as much as two hours of computer time needed for every hour spent on patient care – is a serious industry-wide concern. CHIME CIOs cite EHR optimization, speech recognition, and mobile device use as the three most effective technologies for addressing burnout.

Artificial Intelligence: Two-thirds of CIOs plan to deploy AI-based solutions over the next three to five years. The remaining CIOs intend to focus first on other organizational priorities. Nuance initiatives, including the cloud-based Nuance AI Marketplace for Diagnostic Imaging, lay the groundwork for widespread AI adoption going forward.

Data Governance: Healthcare data governance is still a work in progress at many healthcare organizations — and understandably so, as it relies on and affects the success of other priority areas. Managing health information throughout its lifecycle is vital to treatment documentation, payment, research, outcomes improvement, and government reporting. It’s also central to accomplishing the broader goals of improving patient experiences and population health, as well as reducing healthcare costs.

Healthcare Consumerism: As consumers become more involved in their own medical choices, they will have the same expectations for healthcare as they do for their shopping, financial, and other day-to-day decisions. This shift brings a corresponding focus on patient experiences and demonstrated outcomes.

The March to the Cloud: With more than 70 percent of hospital IT systems now cloud-based, two-thirds of CIO budgets are going to cloud-based solutions to drive EHR optimization, patient experiences, and other areas. In fact, one CIO who responded to the survey highlighted his organization’s plans to converge all devices into the EHR, and then migrate the EHR to the cloud.

At Nuance, we are committed to continuing our focus on these priorities and goals, as we believe they are vital to our customers’ success. We recognize, of course, that CIOs face a variety of challenges in this transformative era. From tech challenges and aligning IT with business goals and outcomes to managing relationships, skills, resources, and budgets, we know that in partnership with the CIO, we can have a profound impact on the future — together.

Building and maintaining awareness and understanding through our regular discussions with the ECC and the CHIME survey truly make the difference between being changed through passive reaction, and creating change with awareness, resilience, and strength.

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Sheryl Sandberg quote about change

Driving outcomes through innovation

Many people have the understandable tendency to think “innovation” means technology. They reflexively associate the word with new IT systems, new capabilities, and hoped-for benefits. This association is valid in healthcare and many other areas of life and work. But no matter how innovative or inspired technology is, meaningful innovation requires holistic thinking that considers a multitude of factors and effects.
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New idea, innovation, Incandescent lightbulbs laying next to one glowing, energy efficient lightbulb.

Innovation requires you to think about how people and organizations will use and adapt to new technologies, sometimes in unexpected ways. In other words, innovation is technology-based but not just about the technology.

A current example of technology-driven innovation comes from our ongoing work in optimizing the use of certified electronic health record (EHR) systems. EHRs are used by 96 percent of acute care hospitals in the US for accessing medical records, documenting treatment, and coordinating billing. EHRs are essential to the operation of the healthcare system, especially as it shifts from fee-for-service billing to value-based reimbursements. But they impose a heavy time burden on physicians simply to access or enter EHR data. For every hour they spend with patients, doctors can spend 2 hours on the EHR, often outside of clinic hours, “contributing to work–life imbalance, dissatisfaction, high rates of attrition, and a burnout rate exceeding 50%.”

Voice recognition and other technologies can do a lot to speed and simplify routine interactions with EHRs, but technology alone can’t address the greater impacts on physician burnout and patient care. Instead, KLAS Enterprises found in a survey of more than 7,600 physicians that strong initial training, personalization, and responsiveness to needs and preferences significantly improve physician satisfaction with EHRs.

Nuance last year launched an EHR optimization pilot program to improve the effectiveness and value of current EHRs. A Nuance team, led by Dr. Bret Shillingstad and Dr. Rizwan Pasha, worked on the pilot with Brigham Health Outpatient Services’ CMIO Dr. Michael J. Healey. As part of Partners HealthCare, Brigham Health has approximately 1,500 physicians using its Epic EHR and included about 180 of them in the two-month pilot. They first reported the results of the pilot last week in a Scottsdale Institute webinar titled, “Optimizing the EHR to Prevent Burnout and Obtain Better Outcomes.”

The pilot looked at EHR usability in fine detail. It examined the specific needs of different departments and medical specialties and which tasks could be completed by physicians or by administrative staff. It counted the numbers of clicks and screens it would take a physician to access or enter required data and how templates could be used for entry of narrative data using speech recognition. The pilot showed that physician satisfaction and efficiency rose through simple changes such as:

  • ensuring that EHR tasks were handled by appropriate department physicians or staff;
  • consolidating multiple data screens into one and eliminating 31,000 EHR clicks each day across 20 physicians in a single gastroenterology clinic; and
  • using speech recognition and personalized note templates for after-hours chart completion to save physicians 40 minutes each evening.

The pilot even determined when and in which settings EHR coaching and support sessions were preferred and most effective. That ranged from groups of nurses during regular shifts, to small groups of physicians in the same area of medicine, or to individual doctors during one-on-one “Genius Bar” type sessions. The initial results from the program at Brigham Health are very promising.

Nuance is leading healthcare technology development for EHR usability, AI, and speech recognition. We’re also using that technology to think holistically – driving innovations that create meaningful improvements in physician- and patient-centered outcomes across the care continuum.

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New idea, innovation, Incandescent lightbulbs laying next to one glowing, energy efficient lightbulb.