A recurring theme across many industries globally is "the new normal." This is especially true in healthcare, and that terminology can be heard on many virtual video conferences that we all now attend daily. The new normal, other than the donning of facemasks in public places and calls for frequent handwashing, is the emergence and push for virtual doctor visits. CMIOs must now add these “new normal” technologies and associated governance challenges to their quiver of informatics skills.

The new normal, other than the donning of facemasks in public places and calls for frequent handwashing, is the spike in virtual doctor visits. At the recent Health Management Academy (HMA) CMIO Virtual Forum, many CMIO’s at various organizations shared their experiences on how they rapidly transitioned to telehealth. Whereas virtual doctor visits cannot immunize our children or provide necessary chemotherapy and radiation therapy for cancer patients, they do provide critically important appointments for those who cannot get to their physicians in-person. CMIOs must now add these new normal technologies and associated governance challenges to their quiver of informatics skills.

I have heard many stories and read many lay and journal articles about the success and satisfaction of virtual appointments with healthcare providers.  During hard times with COVID-19, some healthcare organizations reported tens of thousands of successful video visits in a month. The new normal requires some learning on the part of the patients and the physicians about the various challenges of this growing trend and healthcare. For example, understanding the security, privacy, etiquette, and perhaps more importantly, the documentation of the interaction. Again, CMIO’s must learn, adapt, and help their organizations succeed by adopting and utilizing these new normal technologies.

As more talking takes place and less physical examination and intervention obligate to the new format, many physicians lament at the challenge of capturing the patient’s story. In essence, a 10 to 15-minute conversation via a telehealth platform could encompass some 1500 words or three pages of single-spaced text. Some physicians have complained that using standard EHR tools to document visits can take hours of their day and miss many pertinent details. At Nuance, we’ve introduced a new solution to assist physicians with the challenge of documentation in this new environment – the Nuance Dragon Ambient eXperience, or DAX.

Nuance DAX listens to the doctor-patient interaction and uses voice biometrics to identify the speakers, applying artificial intelligence to place important history and clinical details into the appropriate sections of the visit note in real-time. If this saves just 4 minutes of documentation time – and chances are it is saving much more than that – over the course of 15 video visits, then the physician would save an hour of documentation time each day. Multiply that across an extended physician staff utilizing virtual visits, and the time-saving action of DAX is even more profound. CMIO’s and HIM departments need to grasp this concept and implement these technologies.

The move by the Centers for Medicare and Medicaid Services (CMS) to new documentation rules for reimbursement will hit in January 2021. It will leave many organizations scrambling for new ways to format note templates and develop standards via governance for medical staff to adapt to the changes for compliance and proper payment. This leaves many leaders scratching their heads on how they will shift the culture to meet the new guidelines when they hit. Technological innovation will undoubtedly be necessary to capture the patient’s story and memorialize the decision making of the physicians. Not an easy task after some 20 plus years of the current documentation and payment models.

Reinventing the doctor-patient relationship with virtual visits through telehealth is just a part of the challenge, as will be documentation for proper payment. Adding Nuance DAX to the mix strengthens the doctor-patient interaction by eliminating the documentation burden and allowing the physician to concentrate on the patient’s needs.  This technological innovation and improvement in communication greatly enhance efficiency, productivity, and documentation of the complex visit while greatly supporting satisfaction and crucial healthcare interventions during the current medical crisis and the evolution of the new normal.

Robert Budman, MD MBA

About Robert Budman, MD MBA

Dr. Robert Budman, MD, MBA, and Certified Documentation Improvement Practitioner (CDIP) with AHIMA, is the Chief Medical Information Officer for Nuance Healthcare. He supports the Computer Assisted Physician Documentation (CAPD) product line and develops training and education materials for outbound and internal use. Dr. Budman is Board Certified in Family Med & Informatics. He focuses on efficiency, safety, and quality initiatives with global experience in multi-EHR and service line care delivery. His work involves implementation, workflow adoption, and optimization. Dr. Budman earned multiple clinical awards and speaks extensively on healthcare IT.