There's Gold in Healthcare Mandates

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Ask everyday consumers what government healthcare mandates mean and they are likely to respond with salty language. Ask healthcare providers the same question and they might say, "A big headache."

Speech technology companies are looking to change that sentiment for the healthcare industry, offering solutions so that physicians and hospitals can deliver great patient care while lessening the onus of adhering to myriad rules.

Added to that is the burden of skyrocketing costs that have hit both patients and providers where it hurts the most--their pocketbooks.

"Speech for healthcare is an area where technology has wanted to be and is trying to be," says Judith Markowitz, president and founder of J. Markowitz Consultants. "It's a growing area, but there are issues. Healthcare is highly regulated. The money for healthcare is being squeezed, and healthcare service providers are being squeezed even more as Congress gets its way."

Healthcare Mandates: Meaningful Use

The healthcare industry is faced with sifting through various pieces of U.S. legislation, many of which stem from the Health Information Technology for Economic and Clinical Health (HITECH) Act, which falls under the American Recovery and Reinvestment Act of 2009. Part of that mandate calls for healthcare providers to use electronic medical records (EMRs), also known as electronic health records (EHRs).

EMRs are used to comply with "meaningful use," which is, according to the Department of Health and Human Services, a "set of standards defined by the Centers for Medicare & Medicaid Services Incentive Programs that governs the use of electronic health records and allows eligible providers and hospitals to earn incentive payments by meeting specific criteria."

Dr. Nick van Terheyden, chief medical information officer at Nuance, explains that the underlying requirement is that healthcare providers need to have granular data, but at the same time must be able to create discrete data without entering and generating it through a manual process.

"An analogy I have is that you don't ask the CEO of Bank of America to enter stock data," Dr. van Terheyden says. "Likewise, we shouldn't ask clinicians to enter discrete data. We should be able to capture that from their narrative. Now we can actually generate discrete data that will drive systems that will help measure it and deliver quality care."

Meaningful use has three stages and is aimed at clinicians and hospitals. Stage one, which was implemented during 2011-2012, called for healthcare organizations to electronically capture information in a standardized form, among other criteria.

Stage two goes into effect in 2014, and covers advanced clinical processes, including more rigorous health information exchange, in addition to other criteria. Stage three goes into effect in 2016, and focuses on issues such as improved quality, safety, and efficiencies that can lead to better health outcomes.

EMRs Are Seeing Explosive Growth

Meaningful use has been front and center for speech technology providers who have been keen to offer solutions.

"Meaningful use has driven broader adoption of medical systems like EMRs," says Ben Brown, senior research director for medical and imaging equipment at KLAS Research, a health information research company. "Because EMR adoption has increased so much over the last couple of years with meaningful use, it has opened up a big opportunity for growth in the speech recognition sector."

The largest player in this arena is Nuance, which has several products, including those under its Dragon Medical 360 umbrella. The solution uses front-end speech recognition and back-end computer-aided medical transcription, while also analyzing physician narratives and translating them into clinical and quality indicators.

"Dragon Medical focuses on converting spoken word to text, and in between that is an editor who checks the correctness of [the information] and feeds it back," Dr. van Terheyden says. "[For example], one of our back-end solutions, Dragon Medical 360 eScription, bundles up a voice file, sends it to a machine, and transcribes it. We've now layered on top of that a number of unique pieces of technology that essentially takes the narrative and extracts the meaning."

Nuance solutions include combining speech recognition with Clinical Language Understanding (CLU). "CLU is our version of natural language processing, what I would call natural language on steroids," Dr. van Terheyden says. "It allows us to extract from the narrative the discrete data that is absolutely essential for the meaningful use criteria, but it doesn't ask clinicians to enter that data using the keyboard or mouse."

Hot on the heels of Nuance is M*Modal, whose products span coding, imaging, transcription, practices, radiology, and transcription through its Fluency offerings. The company uses proprietary automatic speech recognition in all its solutions, and believes that the answer to EMR constraints is to create better documentation.

"We really do believe that most problems, whether it's EMR adoption or EMR's ability to actually report on quality measures or coding, [are] a documentation issue at the time a record is created," says Aaron Brauser, director of Catalyst products at M*Modal. "So if we can get it right, then it makes everything else go that much better. If it's a mobile user talking into an EMR, it's about taking that quality of captured information and being able to reuse it so that it's not just putting it in some sort of static file, but putting it into a consumable way for other downstream events."

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