Nuance prescribes voice cure for doctors' notes

Nuance Communications is one of those companies that the average person on the street mightn’t know much about, but it makes products that same person probably has used. Nuance’s speech recognition engine is very likely the force behind Apple’s Siri service on the iPhone, for example, although neither party will comment on the matter. If you’ve talked to your connected car via an app that might well have been Nuance at the wheel, and if you’ve tried voice dictation to compose a document there’s a good chance you used a Nuance product. But, more critically, if you’ve been hospitalised or have sought medical treatment there’s also a fair chance that your medics used this Burlington, Massachusetts company’s dictation software.

Nuance’s healthcare division contributed about $942m in 2014 revenue as organisations such as Hamad Medical Corporation in Qatar, the Children’s Hospital of Orange County and the NHS Wirral University Teaching Hospital in England, rely on it to improve the documentation workflow at their organisations by speech-enabling applications so that information can be accurately captured and shared with appropriate people. At a recent conference in Tenerife, Spain the company gave a wide-ranging view of how healthcare is changing and what ICT can do to help with those changes.

The situation is pretty stark. Peter Durlach, Nuance VP of marketing and strategy, outlined the situation thus: “The costs of providing care are getting out of control and quality is flat or getting worse. The results are that people die prematurely and all the governments are struggling with this one way or the other.”

He’s surely correct. As we get older the chances of our health failing grow and 70-80% of healthcare costs are bound up in chronic disease. At the same time, 20% of patients suffer from avoidable mistakes in care. So, whether you’re in a massive state-supported system like the UK’s National Health Service responding to the Nicholson challenge for mandatory efficiency improvements or a private provider, the need to automate more, improve services and manage costs is, well, acute.

One aspect of trying to improve services is the effort to go paperless and to change the fundamental thinking behind healthcare.

As Durlach put it, “The culture is ‘just take the drug’ rather than focus on preventative medicine. We need to move from moving the patient through the system to quality of care – from volume-based to value-based. US physicians in primary care are quitting because they want to take care of the patient but they have all these other pressures on them. Most patients say they care about their health but they don’t act on it and unless you change that you can’t bend the curve.

“We don’t see ourselves as a speech company but as a clinical documentation company. We help [medics] reimagine the clinical documentation process to drive better outcomes in patient care, financial integrity and compliance. We need to fix the supply chain because it’s garbage in, garbage out and paper is no longer fit for purpose.”

Of course, documentation and the move towards paperless is just one part of the challenge but it’s not a small part. Thirty per cent of a medic’s working day is spent on documentation in Germany and moves to electronic patient records will make it more, it was suggested at the conference. And a new report suggests that clinicians in the UK spend more than 50% of their days working on clinical documentation and 52 minutes per day just searching for information.

“Doctors would spend more time with patients if the chore of paperwork was removed,” said Frederick Brabant, chief medical information officer at Nuance Healthcare EMEA. “But today in a 12-minute consultation the doctor has to listen, examine, sympathise, diagnose, understand, treat and document.”

By speeding up the documentation aspect, doctors will have more time to practise “the art of medicine”, he added.

In his presentation, biotech entrepreneur Professor Koen Kas examined some technology-enabled approaches to improving medical practice and cited Voltaire who wrote: that “Doctors are men who prescribe medicines of which they know little, to cure diseases of which they know less, to human beings of whom they know nothing.”

However, Kas argued, access to our personal genomes, understanding likely risks to our health, using technology such as wearables to monitor pulse, heart rates body temperature, sleep patterns and blood pressure can identify warning signs can help us reduce our risk profiles.

“Having access to knowledge makes people change behaviour,” he said. “Health is my biology, my environment and my lifestyle. That’s exciting because I can play a little with my environment and a lot with my lifestyle.”

Regular self-testing will help us understand what causes us anxiety or migraines and in future might be used to reward people who behave responsibly, for example in qualifying for lower-cost insurance.

We can use sensors and smart devices almost as Bones, the doctor in Star Trek, used his tricorder and we can tap sources of open information to choose hospitals that will be best suited to treating us, he added.

“Doctors will still be there but they will be our coach saying ‘come on, you can do it better’. There are a lot of ways you can interact. Screens will disappear and speech is a layer that brings humanity into the interface.”


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Martin Veitch

Martin Veitch is Contributing Editor for IDG Connect

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