What’s next:
In the Labs

×

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.

By

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.

 

 

Read full article

More from the editor

“Customized voices are a great way to enhance and distinguish a brand”
Nuance offers system voices that sound more human-like and enhance the user experience
Not a trust fall, but a trust rise to the occasion
Drive Lab Study investigates how voice-system transparency fosters trust
Q&A: How our latest internal hackathon brought innovation to non-profits
The SS11 Innovation Challenge for Social Good
Sorry, Team “Yanny” – AI says it’s “Laurel”
An audio clip is at the center of the latest viral debate
A tribute to Stephen Hawking and his iconic voice
Celebrating the life – and voice – of the renowned scientist
How the machines will adjust to us: A short story about “conversational AI” growing up
The evolution of conversational artificial intelligence
Multimodal interaction – How machines learn to understand pointing
Smart assistants combine speech, gesture and hand writing for human-like user experience
Buffalo buffalo Buffalo buffalo buffalo buffalo Buffalo buffalo: Part 1 of What’s left to tackle in voice technology
Automatically generating dialog for conversations is a complex problem to solve.
Beyond the algorithms: Shaping the future of the Automotive Assistant for autonomous cars
New study reveals how drivers want to get notifications in the cars of the future
Dragon celebrates its 20th anniversary
Two decades later, we’re still talking to our computers – and much more
Nuance Research Conference 2017: Reflections on Deep Learning and AI innovation
Keynotes from John Searle & Barbara Grosz inspire Nuance’s global voice, AI research teams
1,000 years of emoji history and what Machine Learning means for its future
A look at emoji: how they’ve changed over time and where they are going
Dragon, do you speak my dialect?
Once divisive, now unifying, dialects play an important role in defining who we are
Nuance’s inaugural engineering conference, Ncode, rocks it in Montreal
Q&A with Nuance Mobile R&D from the event
How the technology transcribing your meetings actually works
Simple isn’t always as simple as it seems
Why we’re using Deep Learning for our Dragon speech recognition engine
Unique application of Neural Nets results in greater productivity
Winograd Schema Challenge: Can computers reason like humans?
Results from the inaugural Winograd Schema Challenge unveiled at the IJCAI-16 in New York
Hearing is like seeing – for our brains and for machines
How CNNs developed for image recognition help with ASR and NLU, too
Part 1: How to avoid 5 common automotive HMI usability pitfalls
Audio and touch input are at the core of a powerful automotive HMI system
Part 3 – AI for customer care: Using Machine Learning to solve customer requests
Turning big data into big knowledge for better customer service
Part 2 – AI for customer care: Turning ‘bags of words’ into meaning with machine learning
Machine learning and AI turn big data into big knowledge for a better customer experience
Nuance and DFKI help students create interactive appliances of the future with speech tools
Providing easy to use speech tech helps usher forth tomorrow’s interactive appliances
Part 1 – AI for customer care: Human assisted virtual agents get smart with big knowledge
Machine learning and AI turn big data into big knowledge for a better customer experience
Mercedes-Benz’s Margarete Wies discusses the future of the connected car
Extending digital living with infotainment systems, autonomous vehicles, and more
In a galaxy (not so) far, far away
Star Wars and the relationship between man and machine
Then and NAO: Bringing conversational robots to homes, hotels, and hospitals
Aldebaran's NAO and Pepper show the power of specialized voice experiences for robotics
How many Neural Nets does it take to catch the big fish in Machine Learning?
NLU and AI innovation goes deeper so machines can understand human language
KITT – Please open the garage
How talking cars that talk to "things" make life simpler, smarter
Meet Lisa, a world championship robot with a lot to say
How this student-built social robot can lend a helpful hand to our aging society
Just be yourself: More on variation, voice biometrics, and the science of voice technology
Using Deep Neural Networks to add variation and improve accuracy
Taking a pause to discuss speaker variation… and Machine Learning
New research observes variation in communication to abstract meaning
Innovating dialog: How machines use and make sense of ellipses
Building speech systems that naturally use ellipses in human-machine interaction
Innovating dialogue: How machines make sense of anaphora
Building speech systems that naturally use anaphora in human-machine interaction
#iLookLikeAnEngineer: Breaking down gender stereotypes in tech
An inside look at Nuance and how diversity fuels innovation
Lost in translation: A solo trip abroad and discovering the art of language
Sunrises in Spain and machines you can talk to
Innovating dialogue: How machines make sense of paraphrasing and adult language
Building speech systems that naturally use paraphrases in human-machine interaction
Innovating machine dialog: Brush up on your Greek and read Aristotle
Building systems that can make sense of Rhetoric and nuanced speech
Deep learning, coming to a car near you
Computing systems inspired by the human brain change the way we interact with cars
Getting “deep” about “deep learning”
A detailed exploration of deep machine learning, a concept rooted in metaphors
The personality of Science: The traits that help define an industry
Nuance researchers answer, “What qualities does a good researcher possess?”
Technology inspired by humans – A look back at NRC 2015
Reflections from Nuance Research Conference 2015
The intersection of Science Fiction, super-pi, and technology innovation
An ode to Mr. Spock and to chasing the impossible
Star Trek, Mr. Spock, and a highly sought-after future
How a vision for the future helped allay the anxieties of the time.
It’s time to take off your tinfoil hats: AI is safe for human consumption
Exploring the effects of artificial intelligence on our daily lives
Nuance senior research scientist David Martin receives AAAI Senior Member status
Leading Artificial Intelligence industry group recognizes Martin for career achievements
Can machines think?
Nuance to host annual Winograd Schema Challenge, an alternative to the Turing Test
Humanizing technology through Cognitive Computing and Artificial Intelligence
Nuance furthers AI investment with DFKI research center
Why “innovation” doesn’t always have to be new (or at least on first sight)
Decades old concepts give light to revolutionary innovations
Ethics and design: Doing the right thing
The importance of design stretches far beyond basic appeal
Will machine language bring about the demise of voice actors?
The science behind creating next-generation synthetic voices
Can we build ‘Her’?: What Samantha tells us about the future of AI
The journey to making virtual assistants more humanlike
Innovation and design: The coolness (and unusability) of our rich friends’ houses
The challenges of designing for fanfare vs. usability
The never-ending evolution of natural language understanding
Rapid development in natural language understanding creates new possibilities
Nuance’s Ron Kaplan awarded honorary doctorate from University of Copenhagen
Award recognizes significant contributions to linguistics and natural language
Video: Innovating a relationship between people and technology
Making technology that works *for* us - not against us
Nuance’s Peter Patel-Schneider receives prestigious SWSA Ten-Year Award
SWSA award honors most impactful research
Beyond the GUI: It’s time for a conversational user interface
Conversational user interface promoting new interactions between people and devices
Voice recognition and the dawn of intelligent systems
Examining the rapid progress of voice recognition and natural language understanding
Nuance opens new Mobile Innovation Center in Cambridge’s Central Square
The new mobile innovation center is home to the expanding segment of Nuance’s R&D.
Nuance Chief Technology Officer Vlad Sejnoha named 2013 CTO of the year
Nuance CTO presented with the CTO of the Year Award at Mass TLC Awards
Smart watches need intelligent systems
Here's how you deliver intelligent systems for the evolving wearables ecosystem
Nuance and Intel keep their heads in the cloud
Collaborating on cloud computing to advance intelligent NLU systems
Got GPUs? Nuance puts groundbreaking NVIDIA GPUs to work to accelerate voice innovation
Ushering a new era in Machine Learning
Customized voices are a great way to enhance and distinguish a brand
“Customized voices are a great way to enhance and distinguish a brand”
Nuance offers system voices that sound more human-like and enhance the user experience
yanny-laurel-audio-clip-headphones
Sorry, Team “Yanny” – AI says it’s “Laurel”
An audio clip is at the center of the latest viral debate
Smart multimodal assistants, such as Nuance Dragon Drive, now also include gaze detection based on eye-tracking
Multimodal interaction – How machines learn to understand pointing
Smart assistants combine speech, gesture and hand writing for human-like user experience
Dragon speech recognition software celebrates its 20 year anniversary
Dragon celebrates its 20th anniversary
Two decades later, we’re still talking to our computers – and much more
Nuance speech technology can understand over 80 languages and their dialects
Dragon, do you speak my dialect?
Once divisive, now unifying, dialects play an important role in defining who we are
Dragon uses deep learning for more accurate speech recognition.
Why we’re using Deep Learning for our Dragon speech recognition engine
Unique application of Neural Nets results in greater productivity
How to get the key foundation right for automotive HMI with audio and touch input
Part 1: How to avoid 5 common automotive HMI usability pitfalls
Audio and touch input are at the core of a powerful automotive HMI system
DFKI students use nuance speech tools to create interactive IoT applications
Nuance and DFKI help students create interactive appliances of the future with speech tools
Providing easy to use speech tech helps usher forth tomorrow’s interactive appliances
Star Wars’ portrayal of relationships between robots and humans is becoming today’s reality with new technological advancements
In a galaxy (not so) far, far away
Star Wars and the relationship between man and machine
Connected cars are becoming more connected to the IoT and more useful, employing ubiquitous personal assistants that exist across devices and experiences
KITT – Please open the garage
How talking cars that talk to "things" make life simpler, smarter
Speech systems need to observe and deal with pauses and other variation to elicit more natural communication between man and machine
Taking a pause to discuss speaker variation… and Machine Learning
New research observes variation in communication to abstract meaning
Female Nuance engineers share stories about combatting gender stereotypes in the tech industry
#iLookLikeAnEngineer: Breaking down gender stereotypes in tech
An inside look at Nuance and how diversity fuels innovation
The ancient Greeks discovered rhetorical devices which are now common in everyday language - something we need to specially design speech systems to accommodate
Innovating machine dialog: Brush up on your Greek and read Aristotle
Building systems that can make sense of Rhetoric and nuanced speech
Childlike curiosity, being comfortable with a blank page... Nuance researchers share what qualities they think a good researcher possesses
The personality of Science: The traits that help define an industry
Nuance researchers answer, “What qualities does a good researcher possess?”
Star Trek, Mr. Spock, and the future of patient care
Star Trek, Mr. Spock, and a highly sought-after future
How a vision for the future helped allay the anxieties of the time.
winograd-schema-challenge
Can machines think?
Nuance to host annual Winograd Schema Challenge, an alternative to the Turing Test
Ethics and design: Doing the right thing
The importance of design stretches far beyond basic appeal
Innovation and design: The coolness (and unusability) of our rich friends’ houses
The challenges of designing for fanfare vs. usability
Video: Innovating a relationship between people and technology
Making technology that works *for* us - not against us
Voice recognition and the dawn of intelligent systems
Examining the rapid progress of voice recognition and natural language understanding
Wearables like smart watches need intelligent systems to enable a meaningful human-device interaction
Smart watches need intelligent systems
Here's how you deliver intelligent systems for the evolving wearables ecosystem
When it comes to autonomous vehicles it is not enough to simply strive for innovative, but instead achieve ideal interactions
Not a trust fall, but a trust rise to the occasion
Drive Lab Study investigates how voice-system transparency fosters trust
Stephen Hawking speaks famous words with his computer-generated text-to-speech voice
A tribute to Stephen Hawking and his iconic voice
Celebrating the life – and voice – of the renowned scientist
Buffalo buffalo Buffalo buffalo buffalo buffalo Buffalo buffalo: Part 1 of What’s left to tackle in voice technology
Automatically generating dialog for conversations is a complex problem to solve.
bringing together leading minds to tackle advancements in AI
Nuance Research Conference 2017: Reflections on Deep Learning and AI innovation
Keynotes from John Searle & Barbara Grosz inspire Nuance’s global voice, AI research teams
Nuance engineers gather at Ncode
Nuance’s inaugural engineering conference, Ncode, rocks it in Montreal
Q&A with Nuance Mobile R&D from the event
Contestants for the Winograd Schema Challenge build intelligent systems to test natural language and reasoning capabilities.
Winograd Schema Challenge: Can computers reason like humans?
Results from the inaugural Winograd Schema Challenge unveiled at the IJCAI-16 in New York
How you can use machine learning and natural language methods to accurately answer customer service questions
Part 3 – AI for customer care: Using Machine Learning to solve customer requests
Turning big data into big knowledge for better customer service
An agent in a call center supports virtual agents
Part 1 – AI for customer care: Human assisted virtual agents get smart with big knowledge
Machine learning and AI turn big data into big knowledge for a better customer experience
Machine Learning, Neural Nets, and advanced voice technology are making the robots for homes, banks, hotels, and more, even smarter
Then and NAO: Bringing conversational robots to homes, hotels, and hospitals
Aldebaran's NAO and Pepper show the power of specialized voice experiences for robotics
Students from the University of Koblenz-Landau built Lisa, a helpful social robot who can communicate with humans and perform daily tasks.
Meet Lisa, a world championship robot with a lot to say
How this student-built social robot can lend a helpful hand to our aging society
How machine speech systems use and make sense of ellipses rhetorical devices
Innovating dialog: How machines use and make sense of ellipses
Building speech systems that naturally use ellipses in human-machine interaction
Traveling alone in Spain, I formed a new appreciation for language as an art and the technology we’ve built to interpret and interact with people
Lost in translation: A solo trip abroad and discovering the art of language
Sunrises in Spain and machines you can talk to
deep learning connected car echnology
Deep learning, coming to a car near you
Computing systems inspired by the human brain change the way we interact with cars
Nuance Research Conference 2015 explored R&D topics like Deep Neural Nets, Artificial Intelligence, Natural Language Understanding, Anaphora, and more
Technology inspired by humans – A look back at NRC 2015
Reflections from Nuance Research Conference 2015
Two things so different can live in harmony - these are the positive effects of artificial intelligence on humanity
It’s time to take off your tinfoil hats: AI is safe for human consumption
Exploring the effects of artificial intelligence on our daily lives
artificial-intelligence
Humanizing technology through Cognitive Computing and Artificial Intelligence
Nuance furthers AI investment with DFKI research center
Will machine language bring about the demise of voice actors?
The science behind creating next-generation synthetic voices
The never-ending evolution of natural language understanding
Rapid development in natural language understanding creates new possibilities
Nuance’s Peter Patel-Schneider receives prestigious SWSA Ten-Year Award
SWSA award honors most impactful research
Nuance opens new Mobile Innovation Center in Cambridge’s Central Square
The new mobile innovation center is home to the expanding segment of Nuance’s R&D.
Nuance and Intel keep their heads in the cloud
Collaborating on cloud computing to advance intelligent NLU systems
Nuance SS11 Innovation Challenge
Q&A: How our latest internal hackathon brought innovation to non-profits
The SS11 Innovation Challenge for Social Good
How the machines will adjust to us: A short story about “conversational AI” growing up
The evolution of conversational artificial intelligence
Beyond the algorithms: Shaping the future of the Automotive Assistant for autonomous cars
New study reveals how drivers want to get notifications in the cars of the future
The history of emoji and its future with Machine Learning
1,000 years of emoji history and what Machine Learning means for its future
A look at emoji: how they’ve changed over time and where they are going
New technology can transcribe meetings between colleagues
How the technology transcribing your meetings actually works
Simple isn’t always as simple as it seems
Seeing is like hearing for machines and human brains
Hearing is like seeing – for our brains and for machines
How CNNs developed for image recognition help with ASR and NLU, too
Machine learning turns bags of words from big data into big knowledge for customer care
Part 2 – AI for customer care: Turning ‘bags of words’ into meaning with machine learning
Machine learning and AI turn big data into big knowledge for a better customer experience
The Future Mobility vehicle becomes a contextual and highly personalized digital living space.
Mercedes-Benz’s Margarete Wies discusses the future of the connected car
Extending digital living with infotainment systems, autonomous vehicles, and more
How many Neural Nets does it take to catch the big fish in Machine Learning?
How many Neural Nets does it take to catch the big fish in Machine Learning?
NLU and AI innovation goes deeper so machines can understand human language
Variation can improve accuracy of speaker verification for voice biometrics
Just be yourself: More on variation, voice biometrics, and the science of voice technology
Using Deep Neural Networks to add variation and improve accuracy
in communication, speech systems are built to interpret and use rhetorical devices like anaphora
Innovating dialogue: How machines make sense of anaphora
Building speech systems that naturally use anaphora in human-machine interaction
in communication, speech systems are built to make sense of and use rhetorical devices like paraphrase
Innovating dialogue: How machines make sense of paraphrasing and adult language
Building speech systems that naturally use paraphrases in human-machine interaction
Getting “deep” about “deep learning”
A detailed exploration of deep machine learning, a concept rooted in metaphors
On Super Pi Day, we celebrate those who dare to chase the impossible and innovate a futuristic world full of things even Mr. Spock couldn't imagine
The intersection of Science Fiction, super-pi, and technology innovation
An ode to Mr. Spock and to chasing the impossible
aaai-senior-member-david-martin
Nuance senior research scientist David Martin receives AAAI Senior Member status
Leading Artificial Intelligence industry group recognizes Martin for career achievements
Why “innovation” doesn’t always have to be new (or at least on first sight)
Decades old concepts give light to revolutionary innovations
Can we build ‘Her’?: What Samantha tells us about the future of AI
The journey to making virtual assistants more humanlike
Nuance’s Ron Kaplan awarded honorary doctorate from University of Copenhagen
Award recognizes significant contributions to linguistics and natural language
Beyond the GUI: It’s time for a conversational user interface
Conversational user interface promoting new interactions between people and devices
Nuance Chief Technology Officer Vlad Sejnoha named 2013 CTO of the year
Nuance CTO presented with the CTO of the Year Award at Mass TLC Awards
Got GPUs? Nuance puts groundbreaking NVIDIA GPUs to work to accelerate voice innovation
Ushering a new era in Machine Learning
Show more articles