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Google, Stanford Pilot “Digital Scribe” As Human Alternative

Posted on November 29, 2017 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

Without a doubt, doctors benefit from the face-to-face contact with patients restored to them by scribe use; also, patients seem to like that they can talk freely without waiting for doctors to catch up with their typing. Unfortunately, though, putting scribes in place to gather EMR information can be pricey.

But what if human scribes could be replaced by digital versions, ones which interpreted the content of office visits using speech recognition and machine learning tools which automatically entered that data into an EHR system? Could this be done effectively, safely and affordably? (Side Note: John proposed something similar happening with what he called the Video EHR back in 2006.)

We don’t know the answer yet, but we may find out soon. Working with Google, a Stanford University doctor is piloting the use of digital scribes at the family medicine clinic where he works. Dr. Steven Lin is conducting a 9-month long study of the concept at the clinic, which will include all nine doctors currently working there.

Patients can choose whether to participate or not. If they do opt in, researchers plan to protect their privacy by removing their protected health information from any data used in the study.

To capture the visit information, doctors will wear a microphone and record the session. Once the session is recorded, team members plan to use machine learning algorithms to detect patterns in the recordings that can be used to complete progress notes automatically.

As one might imagine, the purpose of the pilot is to see what challenges doctors face in using digital scribes. Not surprisingly, Dr. Lin (and doubtless, Google as well), hope to develop a digital scribe tool that can be used widely if the test goes well.

While the information Stanford is sharing on the pilot is intriguing in and of itself, there are a few questions I’d hope to see project leaders answer in the future:

  • Will the use of digital scribes save money over the cost of human scribes? How much?
  • How much human technical involvement will be necessary to make this work? If the answer is “a lot” can this approach scale up to widespread use?
  • How will providers do quality control? After all, even the best voice recognition software isn’t perfect. Unless there’s some form of human content oversight, mis-translated words could end up in patient records indefinitely – and that could lead to major problems.

Don’t get me wrong: I think this is a super idea, and if this approach works it could conceivably change EHR information gathering for the better. I just think it’s important that we consider some of the tradeoffs that we’ll inevitably face if it takes off after the pilot has come and gone.

New EHR Virtual Assistant: Samantha from NoteSwift

Posted on November 14, 2017 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Sometimes in a blog post, it’s much easier to show something than it is to write about something. That’s definitely the case with the recently announced EHR Virtual Assistant from NoteSwift called Samantha. That’s why I asked NoteSwift to create a demo video of Samantha at work so you could see what they’re doing. Check out the video demo of Samantha working with Allscripts Professional below.

Samantha currently works with Allscripts Professional EHR and athenaClinicals EHR and they’re looking at integrating with other EHRs in the future.

When NoteSwift first reached out to me with this tool I told them that it sounded a lot like the voice recognition and NLP solutions that I’d seen previously. I remember one EMR a long time ago that had really deeply integrated voice navigation that got pretty close to this type of interface. Plus, I’d seen demos of NLP that would pull out the granular data elements from a narrative text before.

The key question for me was how tightly integrated the voice recognition and NLP technology was with the EHR software. As you can see from the demo above it’s quite integrated. I do still have some questions on what the learning curve for some of the specific voice commands will be for the NLP to work properly and document the visit the right way. Plus, similar to voice recognition I’m interested to know if the mistakes you have to correct are as time intensive as just clicking the boxes yourself. I’m sure there will be the full spectrum of experiences.

One thing that really impressed me about NoteSwift’s implementation of Samantha was the verification process that the doctor goes through near the end of the video (about 2 min and 12 seconds in for those keeping track at home). I’ve always thought that, at least for now, this was an essential part of using NLP in the medical world. The doctor still needs to verify that everything is accurate before moving on. The way NoteSwift has implemented this is quite slick.

In talking with Wayne Crandall, the President and CEO of NoteSwift, he also told me that Samantha can work with any input mechanism including voice recognition from Nuance or MModal. He even told me that some doctors believe they can type faster than they can do speech recognition which isn’t a problem for Samantha either. The real magic of Samantha is in taking a narrative text, however it’s produced, parsing the structured data, assigning the coding and entering it into the correct areas of the EHR.

Pretty slick solution and one that I think many doctors would like to try so they can stop their slow death by a million clicks.

Solution for “Too Many Clicks” Problem in EHR?

Posted on January 27, 2016 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

I’ve long been intrigued by the complaint I hear from doctors about “too many clicks” in the EHR. Long time readers may even remember my piano analogy which looks at the issue of too many mouseclicks and keystrokes in EHR software. I still think that largely applies today.

With that said, I’ve been fascinated to watch the evolution of click free solutions like what Note Swift is offering. Many are familiar with Dragon Naturally speaking an in particular the Dragon Medical product. It does amazing voice recognition. What I love about NoteSwift is that it takes Dragon’s voice recognition and integrates it naturally into the EHR interface.

Here’s a demo video that was all done by voice using NoteSwift to illustrate how it works:

I think it’s fascinating to see the evolution of these products. Plus, with things like Siri. “Ok Google”, and even Amazon Echo,we’re creating a culture of people who are use to using their voice to do things. So, that will help efforts like the one above.

No doubt doctors are blown away by the concept of documenting a patient visit with 1, 3, or 5 clicks. Now let me leave what’s available today and think into the future. Imagine a video EHR which was voice enabled. The doctor could literally go into the room and using video, voice recognition, NLP, technologies like NoteSwift, connected devices, etc they could easily chart a note with no clicks. While that’s not happening tomorrow, it’s not as far fetched as you might imagine.

The Future of Physician – Patient Interaction

Posted on December 17, 2012 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

I’m hearing more and more people cry foul about the physician patient interaction trend. The obvious complaint is that more and more physicians are spending time in the exam room focused on the computer as opposed to the patient. There are a number of people doing really interesting things to try and solve this problem. In the following video Dr. Nick van Terheyden, CMIO of Nuance, discusses one view of how the future physician – patient interaction will happen.

101 Tips to Make Your EMR and EHR More Useful – EHR Tips 41-45

Posted on September 20, 2011 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Time for the next entry covering Shawn Riley’s list of 101 Tips to Make your EMR and EHR More Useful. I hope you’re enjoying the series.

45. Think about ICD-10 compliance sooner than later
ICD-10 goes into effect October 1, 2013. (barring them postponing it again). Can you imagine if you’ve implemented an EHR and then find out that the EHR isn’t ready to support ICD-10? Sure, we’re still a little ways out, but ICD-10 has been on the docket for a long time coming.

44. Make sure your revenue cycle process is as clean as possible
Cleaner processes are easier to implement. Your revenue is going to take a hit when you first implement an EHR in your office just based on the learning curve of EHR. You don’t want to add to the changes by having to change any issues with revenue cycle at the same time.

43. Don’t underestimate the time necessary to be compliant with 5010
This won’t be as bad as ICD-10 for most practices, but you want to be ready for it.

42. Keep transcription in mind
Make sure you have a good understanding of the costs associated with cutting out transcription. Notice that I said costs and not savings. I already know that you’re aware of the savings of cutting transcription. What you might not have taken into account is the costs of ending transcription. If you’re doing voice recognition then you’re going to need the software, a great microphone, and possibly faster/newer computers. If you’re doing voice recognition there will be more manual corrections that you’ll have to do than in transcription. If you’re cutting out all voice input of data, then just be aware that you may hate “all the clicks” and want to go back to transcription in some form. Is your EMR conducive with that change if you decide to go back to transcription?

41. Watch your insurance claim denials
Of course, most clinics are doing this already. However, a whole new set of claim denials will happen because of how your EMR files those claims. You don’t want to miss out on the insurance money because you can’t handle the claim denials in a timely manner.

If you want to see my analysis of the other 101 EMR and EHR tips, I’ll be updating this page with my 101 EMR and EHR tips analysis. So, click on that link to see the other EMR tips.