There's Gold in Healthcare Mandates

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Getting on Board with ICD-10 and HIPAA

More changes are coming in the form of International Statistical Classification of Diseases (ICD) codes, which are overseen by the National Center for Health Statistics (NCHS), and fall under the Centers for Medicare and Medicaid Services. These statistical codes classify diseases, diagnoses, and causes of death. Currently, ICD-9 codes are being used, but they will be updated to include additional diagnostic information in October 2014, affecting doctors who are covered under the Health Insurance Portability and Accountability Act (HIPAA). With these changes, the healthcare industry has been scrambling for solutions to make the transition as painless and seamless as possible. Enter speech technology.

M*Modal has a number of coding solutions, and recently struck a deal with 3M Health Information Systems that enables its clinical documentation platform to work with the 3M 360 Encompass System. The union marries metrics, analytics, clinical documentation improvement (CDI), computer-assisted coding, and cloud-based speech understanding into a unified data workflow.

"For health IT companies to make a meaningful impact on CDI and the ICD-10 conversion, they need to provide physicians with tools that facilitate more timely and accurate coding at the front end, during the patient encounter, not days or even weeks later," Brauser says. "By using speech recognition to prompt physicians for additional clarity, and creating structure out of patient narratives, healthcare professionals can drive back-end processes such as billing and ICD-10 compliance. And that translates to more accurate reimbursements and patient information."

Nuance also has several speech-enabled coding solutions, including Clintegrity 360, which was released in March. The solution blends CDI and clinical coding with Nuance's voice-enabled CLU. Nuance maintains that ICD-10 is not so much a coding challenge, but a clinical documentation issue, and rather than focusing just on the back end of the process, clinicians should concentrate on the importance of care.

"Organizations need to start with high-quality electronic documentation from the beginning of the care," said Janet Dillione, executive vice president and general manager of Nuance Healthcare, in a statement. "Clintegrity 360 is an end-to-end computer-assisted solution that both helps physicians improve documentation in real time at the point of care within the EHR while providing downstream coding, quality, and case management teams with a set of computer-assisted coding and reporting tools."

Voice Biometrics to the Rescue

Another part of HIPAA covers security and the disclosure of protected health information. These rules went into effect in March 2013, and now cover not only clinicians and hospitals, but also business associates of healthcare providers and healthcare plans. Penalties for breaching privacy can be hefty, ranging from $25,000 to $1.5 million per occurrence.

However, speech technology companies are ready to combat these potentially substantial fines in the form of voice biometrics.

"We see a lot of new opportunities for insurance companies to incorporate voice biometrics e-signatures into their sales process to make these initiatives as painless and frictionless as possible," says Nik Stanbridge, director of product marketing at VoiceVault, whose customers include Blue Cross/Blue Shield, Aetna, and WellPoint. "What we see every day are the risks associated with providing the wrong person with access to data. Voice biometrics is very well placed to provide a tiered level of security where the confidence threshold is a consideration."

Another voice biometrics provider, Voxeo, provides technology for SkyePass, a start-up by Jay Bolton, founder of Integrated Voice Solutions, that works to reduce caller fraud, including in the healthcare industry. SkyePass uses Voxeo's Security Suite (for voice biometrics and location-based services) and Voxeo's Prophecy platform, on which the application resides. SkyePass is scheduled to release its biometrics solution in the third quarter of this year.

"People can enroll in SkyePass and have their biometrics, some of which will be voice, as well as location and device information, create a unique representation [that they can use] when they interact with organizations," Bolton explains. "It all comes down to 'How can you make sure someone is who they say they are?' [It verifies] where you are, who you are, and what you know."

Bolton points to the "Third Annual Benchmark Study on Patient Privacy & Data Security," conducted by the Ponemon Institute and sponsored by ID Experts in 2012, which found that 94 percent of healthcare organizations have suffered data breaches, costing the healthcare industry an average of $7 billion a year.

Using SkyePass, patients, doctors, and administrative staff will be the only people who have access to medical records. "

"A lot of that mandate is about how fast can you warn someone that a medical record has been breached, and how fast can you take action on that," Bolton says.

The Future of Virtual Assistants

Fueled by government mandates, patient satisfaction, and ease of use for clinicians, speech solutions are just what the doctor ordered, especially thanks to the Siri effect. Virtual assistants may be well known for guiding customers on the Internet, but now they are poised to make a foray into healthcare too.

According to a Nuance survey released in February, 80 percent of 10,000 doctors polled believe that within five years, virtual assistants will dramatically change their interactions with EMRs. Sixty-five percent felt that virtual assistants could deliver more precise and timely data that could boost care and notify them of missing information.

Enter Florence, a virtual assistant from Nuance that can actively listen and take directions from a user--in this case, a clinician--and engage in conversational, humanlike dialogues to fulfill specific requests. Nuance's virtual assistant prototype is fueled by speech recognition and natural language understanding. The overarching goal of a virtual assistant for healthcare is to simplify how clinicians interact with technology, Dr. van Terheyden explains, adding that the key is to allow clinicians to work with tools easily, and be able to simply voice commands such as "Show me the lab results."

"Our expectation is that Florence will be integrated into EMRs and other healthcare applications to further streamline usability and increase productivity so that physicians first and foremost focus on patient care," Dr. van Terheyden explains. "As we build out the Florence prototype, we're exploring myriad ways that virtual assistants can be used, from password security processes by leveraging voice authentication to accessing timely, accurate information to support care to assisting with patient medication and health adherence."

M*Modal's Brauser is also optimistic about speech technology's future in healthcare. "As speech solutions become more embedded, there will be growth," Brauser predicts. "[As little as] four or five years ago, you really didn't hear about speech recognition, and now it's in phones, TVs, and cars--all creating this environment where people are getting very comfortable in using it as an interaction tool. Speech is going to become more and more prevalent in healthcare as it is able to be more interactive and responsive, and give instantaneous feedback."

Staff Writer Michele Masterson can be reached at mmasterson@infotoday.com.

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