Another interesting discussion with @techguy (John Lynn) #FreeEHR for HD TV

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Dr Watson Takes on Healthcare

Watson Emerges Champion in Jeopardy

Watson emerged the Jeopardy Champion last night with a resounding $ 77,147, beating both competitors (Ken Jennings:$ 24,000 and Brad Rutter:$21,600) by over 300% ($53,147/$55,547).

Hats off to Ken Jennings and Brad Rutter for taking on the challenge and doing such a great job

This was followed today with the joint Nuance/IBM Press Release: "IBM to Collaborate with Nuance to Apply IBM’s Watson Analytics Technology to Healthcare" (here on IBM and Nuance's site) that recognizes the tremendous value that Watson can bring to healthcare. Watson showed last night the major advances that have been made by IBM's “Deep Question Answering” (QA) research team:

the ability of a computer to understand natural human speech inquiries that pertain to a limitless range of topics, and to make informed judgments about requests

There was plenty of coverage as evidenced by the 15 Million hits in Google for the search (Jeopardy/Watson) with the vast majority highlighting Watson's superiority (Time Magazine: Winner, Dr Watson I presume, ZDNet: Watson's Next Adventure - Healthcare with Nuance, Information Week: IBM Nuance Envision Watson Helping Doctors, NY Times: Computer Wins on Jeopardy, Trivial It's Not andIBM Moving Watson Supercomputer Beyond 'Jeopardy' To Health-Care. Stephen Wolfram of Wolfram Alpha weighed in with this thoughtful post (Jeopardy IBM and Wolfram Alpha) comparing Watson and Wolfram Alpha and this more light hearted post If Google Played Jeopardy: Smartest Search Engine, But It’s No Ken Jennings where he challenged search engines with the simplified task of entering the same Jeopardy Clues

Google showed well

Leading them to suggest that

Either he’s (Ken Jennings) an immediate acquisition candidate in Mountain View and Redmond, or he should just start his own search engine and answer queries as they come in

There were other dissenters including this post Could Google Play Jeopardy Like IBM's Watson. Google has certainly cornered search and access of data but even if the data can be found with a google search and there are certainly some shared concepts in the search technologies I'm not sure that finding the data in a search page is the same as answering the question and really understanding the question. But the summary and analysis of Natural Langauge:

Natural Language Reality Check: The reality is that the technology that Watson demonstrates, while amazing in a game show, is overkill for what most people need. Those behind “natural language” search technologies have long trotted out sentences like the “Who’s in the pajamas” example above to demonstrate how “smart” their search tools are. And yet, most searches people do on search engines are only two or three words long.

Missed the mark and the analogy is flawed on several counts.  I would suggest that our interactions are deliberately simplified when we interact with Google - we work around the lack of understanding of the Google search engine. And while Watson may be overkill for "most people" the potential application in multiple areas dealing with ever increasing volumes of unstructured data it is healthcare that has been struggling with the challenge of overwhelming clinical knowledge and our inability to access and apply this at the time of care delivery. In this discussion on the possible healthcare applications of Wtason/DeepQA


Dr Herbert Chase (Professor of Clinical of Medicine at Columbia University) says:

For at least 30 years it has been impossible for a physician to master all the material to practice medicine at the highest level. Biomedical literature has doubled in size every seven years but patients want those facts at the doctors finger tips when they see him (the doctor)

It is this challenge of data that clinicians face every day as they attempt to deliver the best possible care to each and every patient at the time of the consultation and something their patients expect. Definitely not overkill for patients or doctors and given the Tsunami of medical knowledge and the challenge of sharing clinical data. DeepQA will add a new level of medical intelligence to support to clinicians is with the application of Natural Language Processing taken to a new level of understanding.

Back in June I talked about this technology and the potential for application in healthcare (NLP in Healthcare). In October Nuance announced our strategic partnership with IBM and I covered the news in this post: Clinical Documentation Challenges and then again building towards the Jeopardy challenge NLP in Healthcare Part 2 and most recently this week as part of the potential solution to the challenge of shareable clinical data and clinical data models (The PCAST Opportunity, HL7 CDA, UEL and SAGE)

The announcement today builds on a deep research and technology partnership that already exists in multiple areas between the companies. As one person pointed out in a note to me yesterday

"I cannot understand that Watson cannot 'hear' an opponents wrong answer. They text in the question and then Watson parses the english, algorithms swirl, etc. However, when an opponent speaks it cannot hear. So when a bad answer is spoken it is bound to repeat it.. "

That is part of the innovation and solutions that Nuance will contribute to the partnership which will also include the Clinical Language Understanding (CLU) Technology that will be used create new solutions that provide hospitals, physicians and caregivers access to critical and timely information expanding from recognizing what was said and parsing data to now understanding the intent and providing guidance. This will push us one step closer to intelligent medical analysis real time with the clinician to assist hospitals to utilize facts and knowledge as they migrate toward evidence-based and accountable care models:

Recognizing the tremendous value that Watson can bring to healthcare, Nuance and IBM have teamed to co-develop solutions that will transform vast amounts of clinical data into actionable information across the continuum of care. This endeavor is intended to unlock important medical knowledge and facts buried within huge volumes of data repositories, providing healthcare provider organizations, payers and individual physicians a new level of medical intelligence

It has been yet another exciting day in the world of healthcare technology

If you want to see the Jeopardy games you can watch them below
Part 1:

Part 2:

and Part 3:



And it is not just healthcare:

Computer Assisted Physician Documentation

It was an exciting news day today with the announcement of a Strategic partnership between Nuance and 3M. Lots of coverage and keen interest from the press and healthcare industry as evidenced by the 290,000 search results in Google by 15:30 ET. While many of the news links were picking up 3M's Press Release and Nuance's Press Release it was the interview on HISTalk that provided a detailed look into the tremendous synergies between the two companies and excitement surrounding the concept of Computer-Assisted Physician Documentation. As John Lindekugel said

In a nutshell, we’re taking 3M’s industry-leading Clinical Documentation Improvement approach, which a lot of hospitals rely on today in their HIM and documentation improvement departments, and applying all the technology that Nuance brings and its industry-leading technology to deliver that content to the point of care, to the physician.

Replacing the manual time consuming and painful follow up process today with an automated tool that provides immediate feedback to the clinician at the point of care.....as one CMO put it "that's huge!".

For clinicians CAPD's immediate feedback adds up to

• More accurate and specific documentation that is more effective in assessing and communicating the patient's condition
• Reducing the burden of disruptive follow up questions and queries for Clinical Documentation Improvement (CDI) staff
• Improving the overall quality and detail of the Clinical document without excessive change in behavior or effort
• Achieving appropriate reimbursement with more accurate quality and detailed clinical reporting
• Ease the burden of the ICD10 transition

For any healthcare facility in the US CAPD means there are now automated tools to reduce the administrative burden on clinicians which will have a positive effect on clinician satisfaction and retention. More accurate information flowing through the clinical systems translates to accurate clinical risk and severity, reducing compliance risk and reducing administrative costs

All this will be on show at HIMSS next week in Orlando at 3M's Booth 3547 and Nuance's Booth 2744. If you will be at the show stop by and take a look. It will be a busy few days but there should be plenty of opportunities to talk to the folks involved in developing the solution and we are keen to get feedback from as wide arrange of stakeholders as possible.

Playing Games with ONC Certification - Guest Post

Certification remains one of the basic building blocks of the incentive program from the Government. CMS provides a tool for finding certified EHR technology for practices as part of the EHR incentive program. As Houston Neal Director of Marketing at Software Advice points out "Certified" is the $44,000 buzzword. In this guest posting he drills down into the details of certification and provides a list of 5 key questions to ask to help avoid the pitfalls and make sure you will be eligible to receive the incentive payments:

Playing Games with ONC Certification

“Certified” is the $44,000 buzzword prefixing electronic health records (EHR) software. To qualify for Health Information Technology for Economic and Clincal Health (HITECH) Act incentive payments, you must use an EHR that is certified by the government. Additionally, you must use a system - or systems - that offer 100% of the functional and security capabilities required to meet “Meaningful Use” criteria.

Many EHR vendors are promoting their products as “certified,” but the claim can be misleading. There are three ways they could lead you astray:

Alternative Certifications

Before the HITECH Act, two organizations certified medical software:

●      Certification Commission for Health Information Technology (CCHIT) - CCHIT began certifying EHR software in 2006. Since then they have released 10 certification programs for ambulatory and inpatient EHRs.

●      KLAS - KLAS is a private organization that has gathered ratings on EHRs since 1997. Every year they rank EHR vendors and bestow a “Best in KLAS” award on the top 20.

In an effort to stand out from the other 300+ EHR systems on the market, vendors widely promote their CCHIT or KLAS credentials. They may even tack the word “certified” onto their CCHIT or KLAS approved product. This muddies the water for providers. They have to distinguish between CCHIT, KLAS and certification from an ONC-Authorized Testing and Certification Body (ONC-ATCB). While CCHIT and KLAS are meaningful credentials, they’re not the certifications that qualify for incentive funds.

This is especially confusing because CCHIT is now one of six organizations approved to certify EHRs for the HITECH Act. So, if an EHR vendor claims they have CCHIT certification, you’ll need to clarify which one. Is it ONC-ATCB certification, or one of CCHIT’s independent credentials?

Complete EHR vs EHR Module

Software vendors can receive ONC-ATCB certification for a complete EHR or an EHR module. This means a product doesn’t need to meet all criteria for Meaningful Use - instead, it can be partially certified if one or more functions meet a subset of requirements. For example, a vendor could certify their e-prescribing application or their patient portal.

This under-publicized detail could cost you thousands of dollars; by itself, a certified EHR module won’t make you eligible for incentive payments. You must use two or more modular EHRs that, combined, meet 100% of the ONC criteria. So while vendors can officially promote a module as having ONC-ATCB certification, it may fall short of making you eligible.

Guaranteed Incentive Payments

Be mindful of guaranteed incentive payments. It is reasonable for a vendor to guarantee they’ll meet certification criteria. In fact, you might make it a requirement in your purchase decision.

However, guaranteeing incentive payments is altogether different. Technology alone won’t make you eligible. EHRs are just a means to an end. Ultimately, you are responsible for achieving Meaningful Use status. So be wary of this type of guarantee. Read the fine print and find out how you are reimbursed if you don’t qualify for incentive payments. Does the vendor reimburse you the full amount of lost incentive payments? Or do you just get reimbursed for the cost of the software? You shouldn’t purchase a system based on this guarantee alone.

Five Key Questions to Ask Vendors

To help you avoid thse pitfalls, we put together a list of 5 questions to ask vendors. Answering these will put you in a good position to become eligible for incentive payments.

1.     Which certification does the EHR have: CCHIT, KLAS or ONC-ATCB? You must use an EHR that is ONC-ATCB certified in order to be eligible for incentive payments.

2.     Which product version has been certified? Ask the vendor for complete details of their ONC-ATCB 2011/2012 certification, including: product name and version, date certified, unique product identification number, the criteria for which they are certified, and the clinical quality measures for which they were tested.

3.     Does the vendor have certification for a complete EHR or an EHR module? If module, you will need to use more than one to be eligible for incentive payments. The ONC has created a handy website that allows you to build a list of EHR modules that meet 100% of ONC criteria.

4.     Will the vendor resubmit their EHR for final certification in 2012? The current certification is temporary and only lasts through 2011. Make sure your vendor has plans to reapply in 2012, and find out if they will certify a complete EHR or just a module.

5.     Are you purchasing through a reseller or other business partner that renamed the product? If so, make sure the renamed product has been approved by the ONC-ATCB. Even if it is the same version with identical features and functionality, it won’t make their Certified HIT Products List unless the original vendor reports it to an ONC-ATCB.

This article was written by Houston Neal of Software Advice. To view the original article, visit Playing Games with ONC Certification.

The PCAST Opportunity, HL7 CDA, UEL and SAGE

The recent publication of the PCAST Health Information Technology Report: Realizing the Full Potential of Health Information Technology to Improve Healthcare for Americans: The Path Forward,  published December 8, 2010 (press release and covered in this webcast) and became something of a Piñata for comments. Vince Kuratis did a great job of pulling these comments and responses together in his his blog PCAST HIT Report Becomes a Political Piñata.

But Wes Rishell's post: "PCAST Opportunity: Documents vs. “Atomic Data Elements” that reviews the PCAST recommendations and digs into the details of the development of standards and the basis for the exchange of information (documents vs snippets or Molecules/atoms), exchange formats and Universal ExchangeLanguage (UEL) vs HL7 CDA does an excellent job of dissecting out some of the controversies and homing in on exchange of data and the standards in question as well as highlighting the challenges associated with pre and post coordination of data (read less codes requirements and more code requirements). Interestingly Wes estimates

from 20,000 to 100,000 (data elements) but a number of physicians seem to agree that a very useful collection of molecules and radicals would contain many fewer than 20,000. Stan’s presentation describes several different parallel efforts to enumerate the molecules using siloed methodologies. The one he is working on as identified more than 4,000.

He points to several related posts - this from John Halamka: Detailed Clinical Models that points to multiple other standards in development in other countries (Open EHR in Australia, ISO13972, Tolven's Open Source Clinical Data Definitions  and the National Health Service Logical Record Architecture) which all adds up to a pressing need for a Universal Exchange Language...and in my mind translates to a significant challenge in developing and then keeping up to date.

Both blogs point to an excellent detailed (almost 2 hours) presentation by Stan Huff (CMIO at Intermountain Healthcare): Practical Modeling issues: Representing Coded and Structured Patient Data in EHR Systems

select

And a link to some of the original work "Detailed Clinical Models for Shareable, Excutable Guidelines (pdf from MEDINFO 2004) that detailed the NIST funded multi institutional SAGE research project

sharable, executable clinical guidelines. The project envisions a system that enables the authoring, localization and execution of significant clinical guidelines in a vendor independent manner

One thing is for sure - this is a complex issue requiring much attention and focus since the coordination and sharing of data is a fundamental building block of effective, efficient and safe healthcare. Effective sharing of data appears to require standards and exchange languages. But today is the first of three part episodes of Jeopardy featuring Watson . I talked about this back in June and again in December. Tonight is the first night of the Waston Jeopardy challenge.
In the countdown to Jeopardy


It is clear IBM has pushed the limits of computing technology and "understand" the complex human language which Nuance has partnered to bring this same technology to Healthcare: Clinical Documentation Challenges that will apply a whole new way of looking at clinical documentation that reduces our dependance on codes, structure and defined clinical data models.

If we consider the adeptness of the human mind and our ability to understand the fine nuance detailed of clinical reports without the data being tagged or encoded this suggests that the Watson applied to healthcare concept may hold a critical key to exchange and intelligent use of data. Based on the existing standard of "documents" we can innovate and use these documents that are currently a natural part of clinical care.

So as Wes Rishell stated in his summary:

Documents will continue to be at the heart of information flow for patient care and one primary way of bundling clinical information about people

In conjunction with some form of

• evolving universal exchange language (UEL),
• encoding of data, and 
• reliable and simple ("but only as simple as possible, but not simpler") data representation

In conjunction with machine based understanding that I think we will see tonight has been advanced to new and exciting levels we will have a foundation of sharing data efficiently and intelligently in our healthcare system

EHRs and their Impact on Quality of Care

Headlines this week have provided much confusion in the march towards digitization of healthcare that were based on a Stanford study published in the Archives of Internal Medicine: Electronic Health Records and Clinical Decision Support Systems with a conclusion:

Our findings indicate no consistent association between EHRs and CDS and better quality. These results raise concerns about the ability of health information technology to fundamentally alter outpatient care quality.

Needless to say a strong negative claim from a leading institution attracted a lot fo coverage (Medscape, Reuters, Health Data Management, iHealthBeat,  DotMedNews, Bloomberg.....and the list goes on). The power of the internet and the instantaneous nature of the news allows these stories to rapidly disseminate.

In fact some of this will add fuel to the HR408 Act  Spending Reduction Act of 2011 (the text of this can be found here). It is a far reaching bill attempting to reign in spending to the tune of 2.5 Trillion and includes several elements focusing on repeal of Healthcare IT stimulus spending S:302 which focuses on repealing the HITECH funding and investment - there was a good analysis in Health Data Management GOP Bill Puts Meaningful Use, HITECH Act in Peril that highlights the murky nature of the impact of this legislation.

But the power of the internet works both ways and there are several great articles that apply a sound analytical view on the study and highlight the limitations of the study. In this piece Dr WIlliam Hersh; Electronic Health Records Do Not Impact the Quality of Healthcare takes a long hard look at the study adn as he points out

Like almost all science that gets reported in the general media, there is more to this study than what is described in the headlines and news reports. The study was published in a prestigious medical journal by two Stanford researchers. The implementation of the research methods they used appears to be sound.

But as he points out there are serious limitations to this type of study based on the type of study and the data resources, in particular the study "used a data source collected for other purposes and he highlighted the following limitations:

1. A frequent challenge - the study looks at correlation, which does not mean causality
2. The quality measures used did not provide enough insight into actual quality improvement (process measures vs outcome measures)
3. No detail of the EHR's being used and if they had any decision support in place relative the the quality measures
4. THe care assessed was individual episodes of care and improvements in actual quality occur over multiple episodes of care (the longitudinal medical record)
5. Data analyzed was old (2005 - 2007) and in any field of technology including Healthcare Informatics this is old
6. No indication of the training and skill set of the clinicians being assessed and success and failure fo EHR's goes far beyond the technology and is closely tied to implementation and training

And there was extensive discussion that pointed to other articles and studies highlighting the benefits and in particular emphasize how early we are in this process. I imagine that for several other key inventions there was a similar response:

• The Electric light bulb
• Telephone

This 'telephone' has too many shortcomings to be seriously considered as a means of communication. The device is inherently of no value to us.

Western Union Internal Memo: 1876

• Automobile
• Microprocessor
• And even the internet and the world wide web

THis follow up piece by Clem McDonald: Clinical Decision Support and Rich Clinical Repositories: A Symbiotic Relationship that highlighted a range of other positive studies and identifies significant breakdown in the meta analysis that was carried out. As he states succinctly:

• First, and most important, the current article tells us nothing about which CDS guidelines were implemented in the systems that they studied. Practices and EHRs vary considerably in the number and type of CDS rules that they implement, and we do not know whether the CDS rules implemented by the practicesthat participated in the surveys addressed any of the 20 quality indicators evaluated by Romano and Stafford.
• Second, the current study and Garg and coauthors' review considered very different categories of guidelines. Most of the guidelines (60%) in Romano and Stafford's study concern medication use; none of them deals with immunizations or screening tests, which were the dominant subjects in the studies reviewed by Garg et al.3 Furthermore, in our experience, care providers are less willing to accept and act on automated reminders about initiating long-term drug therapy than about ordering a single test or an immunization.
• The third difference is that the current study examined the outcome of a single visit, while most of the trials reviewed by Garg and colleagues observed the cumulative effect of the CDS system on a patient over many visits.
• Finally, the data available from NAMCS/NHAMCS may be limited compared with what is contained in most of the EHRs used for Garg and coauthors' trials. For example, the NAMCS/NHAMCS instruments have roomto record only 8 medications, even though at least 17% of individuals older than 65 years take 10 or more medications.

The road to digitization of healthcare is long and filled with many ups and downs. This study adds the overall knowledge but should be taken in the context of what was studied and its contribution to guiding us down the correct path and not, as some would believe> halting the journey and returning to the dark ages of pen and paper.

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Excellent Meaningful Use Qualification for Incentive Matrix

Great post from Dr Halamka laying out the details of what is required to qualify for meaningful use incentives

http://mycourses.med.harvard.edu/ec_res/nt/36980CA6-E154-4820-A0ED-8B235138B79F/measures.pdf

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Nuance Self Service Mobile Developer Platform Announced Today

Nuance announced the launch of the Dragon Mobile SDK for iOS and Android via a new self-service website as part of the Nuance Mobile Developer Program.

>>>>Now mobile developers are able to quickly and easily leverage the powerful dictation and voice search capabilities at the core of the successful Dragon Dictationand Dragon Search apps, as well as Nuance’s trusted Vocalizer text-to-speech (TTS). 

In line with the explosion of mobile applications and similar to the model for Apple's Developer Application (XCode) the SDK is available (for both Apple iPhone/iPad/iPod Touch iOS 4.0 and for Android v2.1 and higher. Supporting multiple languages the offering provides instant access to "easy-to-integrate prepackaged wrappers and widgets for rapid inclusion of voice recognition into their applications, all through a self-service website. Developers also have access to an on-line forum for additional support, a variety of code samples and full documentation."

And all for free! Leveling the developer playing field and fostering innovation of speech enabled apps so that as Michael Thompson, SVP and GM of Nuance Mobile Division put it:

"If you can imagine it you can speech enable it"

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Adoption of EHR Likely to be Very High

So a recent survey from the CDC: NCHS Health E-Stat "Electronic Medical Record/Electronic Health Record Systems of Office-based Physicians: United States, 2009 and Preliminary 2010 State Estimates" (pdf version here) and reported on the US Department of Health and Human Services website HHS.gov "Surveys show significant proportions of hospitals and doctors already plan to adopt electronic health records and qualify for federal incentive payments" suggests that

• 80% of hospitals , AND
• 41% of Office based physicians

are intending to take advantage of the federal incentive payments for adoption and meaningful use of certified EHR's
And Dr David Blumenthal posted a video comment on the registration for EHR Incentive programs

This is substantially higher than a recent set of stats that had the rates posted much lower. This is good news all round if the incentive program has stimulated that much interest and desire to move towards the digitization of the medical record which for Stage 7 has barely reached double digits according to the most recent HIMSS Analytics assessment of EHR implementations.

For those wanting more information
Information about the incentive payments program is available on the CMS website and the Regional Extension Centers (RECs) technical assistance is available at the HealthIT web site. So for those still pondering if this is worthwhile investment it seems that healthcare systems and your clinical peers see this as a valuable and positive move. Do you want to watch the train leave the station or be on it?

Docs struggling financially, but new tech makes job easier

Survey: Docs struggling financially, but new tech makes job easier
http://www.healthcareitnews.com/news/survey-docs-struggling-financially-new-tech-makes-job-easier
Technology can actually make your life better...certainly according to doctors

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A national license to practice medicine

This needs to be fixed if telemedicine is ever to take off

A national license to practice medicine
http://www.kevinmd.com/blog/2011/01/national-license-practice-medicine.html

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IVF breakthrough to hit the world market

New innovation improves results in IVF 
IVF breakthrough to hit the world market
http://www.eurekalert.org/pub_releases/2011-01/uoa-ibt010511.php

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Tomatoes found to contain nutrient which prevents vascular diseases

Eat more tomatoes.....
Tomatoes found to contain nutrient which prevents vascular diseases
http://www.eurekalert.org/pub_releases/2011-01/w-tft010611.php

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Nuance eScription Receives 7th Consecutive Best IN KLAS award

Nuance’s eScription Platform Honored with Seventh Consecutive Best-in-KLAS Award

Seven Consecutive Best in KLAS Awards, Market Growth and Continued Delivery of Innovation Reinforces eScription as Leading Solution for Hosted, Background Speech Recognition

BURLINGTON, Mass., – December 20, 2010 – Nuance Communications, Inc. (NASDAQ: NUAN) today announced that its eScription platform has received a Best in KLAS award for the seventh consecutive year. With a score of 89.8, the eScription platform ranked the highest in the speech recognition category, surpassing its score from 2009 even as the platform’s usage has dramatically grown with both new and existing customers. Today, the number of active dictating clinicians who use eScription is up by 24 percent since one year ago.

The Best in KLAS Award is driven solely from customer feedback, a testament to the demonstrated benefits of the eScription platform and the service and support provided to eScription customers. According to Nuance’s review of past Top 20 Best in KLAS Awards reports, Nuance is one of only four other healthcare IT vendors that have achieved a Best in KLAS product award for the past seven consecutive years. As noted in the KLAS report, 98 percent of customers surveyed indicated they would buy eScription again; this high level of customer satisfaction and confidence comes in 12 percentage points higher than the next highest ranked background speech solution.

“Throughout our partnership with Nuance, the eScription platform has never disappointed and in fact, has met or exceeded all expectations,” said Jonathan Bowers, Vice President Information Services, Carolinas HealthCare System.  “eScription’s ranking as the best speech recognition solution does not come as a surprise.  In 2006, we leveraged KLAS’ ratings as part of our speech recognition vendor selection; our diligence and intuition to partner with Nuance was validated. Today, we’ve reduced report turnaround time by an average of 75 percent, realized significant cost savings and as we approach an annual run rate of 100 million lines through the platform, we are confident with eScription as our standard speech recognition solution across all Carolinas HealthCare System sites.”  

Nuance’s focus on customer satisfaction was echoed at the recent annual Conversations Healthcare 2010 user meeting, where 39 healthcare organizations were recognized for saving one million dollars or more on medical transcription costs as a result of implementing eScription. Cumulatively, eScription Million Dollar Award recipients have reported savings of more than $140 million.

“2010 marks the eScription platform’s seventh consecutive Best in KLAS award, a year of growth for the platform and a year of innovation across our portfolio,” said Janet Dillione, executive vice president, Nuance Healthcare. “Nuance is honored to be recognized by KLAS and by our customers. This distinction comes at an exciting time, one in which we are focused on delivering more value to our customer base and the healthcare industry at large.”

Emphasizing Nuance’s commitment to innovation, earlier this month Nuance launched Dragon Medical Mobile Recorder, an iPhone app that offers clinicians a new level of clinical documentation flexibility by enabling mobile point-of-care dictation that is connected to Nuance’s speech-enabled transcription platforms, including eScription.

2010 Top 20 Best in KLAS Awards were determined based on 25 performance criteria in five categories: Sales and Contracting; Implementation and Training; Functionality and Upgrades; Service and Support; and General. KLAS, a market research firm, published its latest findings in the 2010 Top 20 Best in KLAS Awards: Software & Professional Services report (December 2010). The product rankings are derived from product evaluations and confidential interviews with healthcare information technology (HIT) customers, incorporating performance data collected over the past 12 months (November 15, 2009 – November 15, 2010).

eScription is Nuance Healthcare’s leading on-demand, enterprise-wide transcription platform.  Whether a healthcare organization has an in-house staff of medical transcriptionists (MTs) or uses a fully outsourced approach, eScription is proven to help healthcare organizations reduce document turnaround time, improve consistency and quality, and save costs, without impacting clinician workflow.

About KLAS

KLAS is a research firm specializing in monitoring and reporting the performance of healthcare vendors. KLAS’ mission is to improve delivery, by independently measuring vendor performance for the benefit of our healthcare provider partners, consultants, investors, and vendors. Working together with executives from over 4500 hospitals and over 2500 clinics, KLAS delivers timely reports, trends, and statistics, which provide a solid overview of vendor performance in the industry. KLAS measures performance of software, professional services, and medical equipment vendors. For more information, go to www.KLASresearch.com, email marketing@KLASresearch.com, or call 1-800-920-4109 to speak with a KLAS representative. © 2008 KLAS Enterprises, LLC. All rights reserved.

Nuance’s Healthcare Business

Nuance’s healthcare portfolio of proven, speech-enabled clinical documentation and communication solutions enable healthcare provider organizations to improve financial performance, enhance patient care, and increase patient safety. With more than 10,000 healthcare provider organization customers and 450,000 clinician customers worldwide, Nuance has the experience and solutions that meet the individual needs of any size healthcare provider organization.

Nuance Communications, Inc.

Nuance is a leading provider of speech and imaging solutions for businesses and consumers around the world. Its technologies, applications and services make the user experience more compelling by transforming the way people interact with information and how they create, share and use documents. Every day, millions of users and thousands of businesses experience Nuance’s proven applications and professional services. For more information, please visit www.nuance.com.

Nuance and the Nuance logo are trademarks or registered trademarks of Nuance Communications, Inc. or its affiliates in the United States and/or other countries. All other company names or product names may be the trademarks of their respective owners.

The statements in this press release, relating to future plans or future events or services, are forward-looking statements which are subject to specific risks and uncertainties.  There are a number of factors which could cause actual events or results to differ materially from those indicated in such forward looking statements, including fluctuations in demand for the Nuance products, the relationship with the customer or partner and the continued development of Nuance products.  The reader is warned not to rely on these forward-looking statements without reservation, since these are simply reflections of the current situation.  Nuance disclaims any obligation to update any forward-looking statements as a result of developments occurring after the date of this document.

via nuance.com

eScription racks up a 7th consecutive "Best in KLAS" concurrent with a big expansion in the user base up by 24% since last year.
This is a huge testament to the Nuance team who have worked tirelessly to maintain quality and customer service and contributed over $140 Million dollars in savings to multiple healthcare organizations
Thanks to the customers for their vote of confidence and congratulations to the Nuance team who continue to excel at delivering increasing value to the healthcare industry

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Technology helping Physicans Improve their Practice Management

via mdnews.com

The ability to access clinical information while make clinical rounds proved to be especially helpful to Jon Wahrenberger, M.D., a cardiologist at Dartmouth- Hitchcock Medical Center in Lebanon, NH where he was able to access information real time while at the patient's side and used as a collaborative tool with patients reviewing the information with the doctor

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NLP in Healthcare Part 2

Following up from my post back in June (NLP in Health care) the Jeopardy challenge is on - coming to your TV February 14 - 16. There was lots of coverage of the announcement
This from the Washington Post - "'Jeopardy!' to pit humans against IBM machine" and the IBM release
Ken Jennings and Brad Rutter two of the leading Jeopardy winners will go up against Watson. Jennings had the game show's longest winning streak at 74 games in a row and Rutter has won the most money standing at $3.3 million.

What is Watson



But what's important is the possible future applications:

IBM is hoping the technology it exhibits will have some practical uses eventually, for instance helping doctors diagnose illnesses or solving customer problems at technical support centers.

Applying this in healthcare is part of the partnership announced back in October and featured in the posting  "Clinical Documentation Challenges". It will be exciting to see the performance of Watson in Jeopardy on live TV but its the application of this in healthcare that will present some revolutionary opportunities...watch this space

iPad in practice: Applying the apps

via cmio.net

iPad takes healthcare by storm - there are still some difficulties but form factor, battery life and ease of use win users over

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President's Council of Advisors on Science and Technology (PCAST) to Release Health Information Technology Report

President's Council of Advisors on Science and Technology (PCAST) to Release Health Information Technology Report

SPEAKERS:

- Kathleen Sebelius, Secretary, HHS
- Lawrence Summers, Assistant to the President for Economic Policy and Director, National Economic Council
- David Blumenthal, National Coordinator for Health IT
- Eric Lander and Christine Cassel, President's Council of Advisors on Science and Technology
- Private-Sector Discussants

Read the report
http://www.whitehouse.gov/sites/defau...

Read the press release
http://www.whitehouse.gov/sites/defau...

This video is also available at
http://www.hhs.gov/news/imagelibrary/...

We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/com... 

U.S. Department of Health & Human Services (HHS) 
http://www.hhs.gov

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Evidence Based Medicine, Medical Malpractice and Incentives

A recent Dustin Comic like all good comics hit the proverbial nail on the head



Unfortunately the healthcare reform fails to address key aspects to the incentive problem in healthcare. The system remains centered on measuring what we do for patients rather than the end result.

There are moves by employers and the insurance industry to incentives patients towards healthier behavior. This approach is not without problems as highlighted in this piece in the New England Journal of Medicine "Carrots, Sticks, and Health Care Reform — Problems with Wellness Incentives" where the authors highlight the challenges for employers, employees and insurance in creating incentive and how this can introduce inequities that do more harm than good. As they point out

If people could lose weight, stop smoking, or reduce cholesterol simply by deciding to do so, the analogy might be appropriate. But in that case, few would have had weight, smoking, or cholesterol problems in the first place

There is no doubt that patient incentives must be part of the solution but require thoughtful design and implementation to avoid the pitfalls

Incentives for healthy behavior may be part of an effective national response to risk factors for chronic disease. Wrongly implemented, however, they can introduce substantial inequity into the health insurance system. It is a problem if the people who are less likely to benefit from the programs are those who may need them more.

But incentives aligned to the practice of evidence based medicine and in particular the financial challenges facing the ever increasing ordering of tests is where there seems to be significant progress. The announcement of a statewide adoption of Radport by the Institute of Clinical Systems Improvement (ICSI), a nonprofit comprising 60 medical groups, 9,000 physicians, and six payers and health plans was covered extensively at RSNA 2010 in Chicago this year and featured in this piece in Information Week "System Helps Doctors Pick The Right Tests" demonstrating a saving of $27 Million over the preceding year

During the yearlong pilot involving more than 2,300 ICSI-member physicians, ICSI saw no growth in the number of high-tech diagnostic imaging tests ordered. In previous years, the number of tests ordered grew about 8% annually...The lack of growth translates to a savings about $28 million for the year

But any discussion on incentives needs to include the issue of malpractice - liability drives behavior in the same way as incentives do (in some respects its incentive in another from). Peter Orszag opinion in the NY Times Malpractice Methodology makes the point that

The health care legislation that Congress enacted earlier this year, contrary to much of today’s overheated rhetoric, does many things right. But it does almost nothing to reform medical malpractice laws. Lawmakers missed an important opportunity to shield from malpractice liability any doctors who followed evidence-based guidelines in treating their patients.

President Obama weighed in on this issue in June 2009 when he spoke to the American Medical Association when he highlighted the "unnecessary tests and treatments (ordered by doctors) only because they believe it will protect them from a lawsuit" and as he put it

We need to explore a range of ideas about how to put patient safety first, let doctors focus on practicing medicine and encourage broader use of evidence-based guidelines

Medicine remains "more evidence-free" than should be the case:

One estimate suggests that it takes 17 years on average to incorporate new research findings into widespread practice

Addressing the issue of liability can take the traditional approach of limiting punitive damages but as Peter Orszag said "provide safe harbor for doctors who follow evidence-based guidelines" is a much better idea and one that would sit well with patients and doctors alike (I'd be interested to hear from lawyers who agree or disagree on the merits of such an approach).

There are some initial moves in this direction and a need to implement technology to help guide the treatment (as we see with ICSI) and all this would also lead to higher quality of care for everyone and possibly a new system that reimbursed based on the quality of care delivered versus the quantity of care.

8 years on HRT still prescribed in risky high dose format

Despite a Randomized clinical trials (RCT) some eight years ago physicians continue to prescribe hormone replacement therapy (HRT) with regular dosage despite the risks associated with this therapy

High-Dose HRT Still Prevalent (CME/CE)

More evidence for the requirement for clinical support tools and integration of evidence based medicine (EBM) into regular clinical practice. Capturing clinical data at the point of care to enable these tools to provide relevant clinical input and guidance is critical to increasing quality and safety in medicine. The journey begins with capturing clinically actionable data as part of the documentation process without burdening the physician with hunt and click data entry tasks.

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