transcription as the accelerator of meaningful clinical ... · transcription as the accelerator of...
TRANSCRIPT
Transcriptionas the Accelerator of
Meaningful Clinical Documentation
All information methods and concepts contained in or disclosed by this documentare proprietary to Multimodal Technologies Inc. By accepting this material the
recipient agrees that this material as well as the information and conceptscontained therein will not be reproduced in whole or in part without expresswritten permission from Multimodal Technologies, Inc. Use of M*Modal toolsor information is subject to the terms of a legal agreement between the user
and M*Modal.
OR…Throw Away Everything You Thought You
Knew about Speech Recognition…
All information methods and concepts contained in or disclosed by this documentare proprietary to Multimodal Technologies Inc. By accepting this material the
recipient agrees that this material as well as the information and conceptscontained therein will not be reproduced in whole or in part without expresswritten permission from Multimodal Technologies, Inc. Use of M*Modal toolsor information is subject to the terms of a legal agreement between the user
and M*Modal.
Lynn [email protected]
Management for the Modern MTSOhttp://mmodal2.wordpress.com
Excellence in Health Informationhttp://community.advanceweb.com
/blogs/hi_18/default.aspx
Company Confidential
Management for the Modern MTSOhttp://mmodal2.wordpress.com
Excellence in Health Informationhttp://community.advanceweb.com
/blogs/hi_18/default.aspx
Agenda The state of speech recognition today The new best practices for adoption and use Measuring success - Using the right metrics at the right time for
the right purpose A comparison of a 2006 AHIMA presentation given by this
speaker with what her message is today.
Dictation as the Key to Adoption and Acceleration Narrative documentation in an electronic world. Technology Realities
Company Confidential
The state of speech recognition today The new best practices for adoption and use Measuring success - Using the right metrics at the right time for
the right purpose A comparison of a 2006 AHIMA presentation given by this
speaker with what her message is today.
Dictation as the Key to Adoption and Acceleration Narrative documentation in an electronic world. Technology Realities
Lynn Kosegi
What I’ve Learned…2006… Carefully Select
physicians Carefully Select MTs Low to mid producers No high producers
“As Dictated” Physicians must
change habits
Now… Bring ‘em on – let the
technology select thephysician All MTs – Editing IS
transcription Requirements per
meaningfuldocumentation
Company Confidential
2006… Carefully Select
physicians Carefully Select MTs Low to mid producers No high producers
“As Dictated” Physicians must
change habits
Now… Bring ‘em on – let the
technology select thephysician All MTs – Editing IS
transcription Requirements per
meaningfuldocumentation
Opposing needs
Enterprise need for structured andencoded data Physician’s need for a fast and easy way
to capture information Care givers’ need for context,
communication, and collaboration
Company Confidential
Enterprise need for structured andencoded data Physician’s need for a fast and easy way
to capture information Care givers’ need for context,
communication, and collaboration
Lynn Kosegi
Changing Face of DocumentationMedical Transcription is competing with:• Front-end speech recognition• EHR – Direct entry• Front-end speech rec• Templating• Direct data entry
Hospitals are looking for the most cost-effective solution…
Company Confidential
Medical Transcription is competing with:• Front-end speech recognition• EHR – Direct entry• Front-end speech rec• Templating• Direct data entry
Hospitals are looking for the most cost-effective solution…
Lynn Kosegi
Industry Stressors
Increased demand for information ICD-10 Meaningful Use Core measures, PQRS
More difficult methods of informationcapture Direct data entry Front-end speech recognition
Company Confidential
Increased demand for information ICD-10 Meaningful Use Core measures, PQRS
More difficult methods of informationcapture Direct data entry Front-end speech recognition
Lynn Kosegi
Road to Adoption
Speech recognition plus MT editing• Efficiencies and cost savings• Cost avoidance• Comprehensive and complete
documentation• High adoption by physicians• Flexibility and options
Company Confidential
Speech recognition plus MT editing• Efficiencies and cost savings• Cost avoidance• Comprehensive and complete
documentation• High adoption by physicians• Flexibility and options
Beyond Speech Rec…Old Way ICs and home-based
workers Flexible scheduling Over staffing Avon-lady MTs Pay by productivity
New Way Employees Assigned schedules Appropriate staffing Career-minded MTs Pay for committed
time and quality
Company Confidential
Old Way ICs and home-based
workers Flexible scheduling Over staffing Avon-lady MTs Pay by productivity
New Way Employees Assigned schedules Appropriate staffing Career-minded MTs Pay for committed
time and quality
Most importantly..
It’s not just about productivity
It’s about high-quality, comprehensivedocumentation to support increasingdemands for information….produced in away that happens to be cost-effective
Company Confidential
It’s not just about productivity
It’s about high-quality, comprehensivedocumentation to support increasingdemands for information….produced in away that happens to be cost-effective
Lynn Kosegi
Hospital versus Service MTs
Employee versus IC FT versus PT Enforced schedule vs “Oprah Effect” Training vs “throw it over the fence” Management vs 100 MTs/supervisor Optimization vs invisibility Doctors forced to accept change vs
invisible to doctors
Company Confidential
Employee versus IC FT versus PT Enforced schedule vs “Oprah Effect” Training vs “throw it over the fence” Management vs 100 MTs/supervisor Optimization vs invisibility Doctors forced to accept change vs
invisible to doctors
Information Demands
ICD-10: Specificity ~5 times the number of codes From 2011 CAC summit: One ICD-9 code with >7,500 ICD-10 mappings!
Impact on direct-data entry
Company Confidential
ICD-10: Specificity ~5 times the number of codes From 2011 CAC summit: One ICD-9 code with >7,500 ICD-10 mappings!
Impact on direct-data entry
Lynn Kosegi
Information Demands Meaningful Use Problem list “Problems” versus billable diagnoses Medications
Quality Core measures PQRS – CMS integration into MU reporting
Clinical Decision Support Patient-facing summary
Company Confidential
Meaningful Use Problem list “Problems” versus billable diagnoses Medications
Quality Core measures PQRS – CMS integration into MU reporting
Clinical Decision Support Patient-facing summary
Lynn Kosegi
Key to Adoption
Ease of use for physician Flexibility Options
Comprehensive information Timely Accurate Useful
Company Confidential
Ease of use for physician Flexibility Options
Comprehensive information Timely Accurate Useful
Lynn Kosegi
The Health Story Perfect foundation for CAC, quality
reporting, clinical decision support HL7/IHE Health Story Consolidation Health Level 7 Integrating the Healthcare Enterprise CDA4CDT HITSP C32/83 CCD Meaningful Use http://www.healthstory.com/pdf/HealthStoryC
onsolidation.pdfCompany Confidential
Perfect foundation for CAC, qualityreporting, clinical decision support HL7/IHE Health Story Consolidation Health Level 7 Integrating the Healthcare Enterprise CDA4CDT HITSP C32/83 CCD Meaningful Use http://www.healthstory.com/pdf/HealthStoryC
onsolidation.pdfLynn Kosegi
CCD Combines ASTM CCR and HL7 CDA XML-based, CDA Specifies encoding and structure for
exchange of patient summary Mandatory narrative – Human interpretation
Encoded data elements
Company Confidential
Combines ASTM CCR and HL7 CDA XML-based, CDA Specifies encoding and structure for
exchange of patient summary Mandatory narrative – Human interpretation
Encoded data elements
24
Discrete Data Elements
Discrete data points are not enough Narrative documentation provides – Ease of use for physicians Cost efficiency for facility Comprehensive information for HIM Expressiveness required for communication Encoded data for reporting
Company Confidential
Discrete data points are not enough Narrative documentation provides – Ease of use for physicians Cost efficiency for facility Comprehensive information for HIM Expressiveness required for communication Encoded data for reporting
Lynn Kosegi
Narrative DocumentationEnables… Ease of human understanding Quality and compliance Usefulness Enterprise-wide efficiency
……across the continuum of care
Company Confidential
Enables… Ease of human understanding Quality and compliance Usefulness Enterprise-wide efficiency
……across the continuum of care
Lynn Kosegi
Meaningful Use
The promise…
The EHR will – Improve patient care Reduce costs Improve population health
How?
Company Confidential
The promise…
The EHR will – Improve patient care Reduce costs Improve population health
How?
Speaker Name
Reality Difficult to get information into the EHR More difficult to get it to the PHR Text is of no use Adoption of physician self entry is low Systems designed for the clinician at
point-of-care are not useful for HIM LOTS of paper
Company Confidential
Difficult to get information into the EHR More difficult to get it to the PHR Text is of no use Adoption of physician self entry is low Systems designed for the clinician at
point-of-care are not useful for HIM LOTS of paper
Speaker Name
Dictation and Transcription..
In a new light… The Road to Meaningful Use Ideal capture method for physicians Human understandable information Options, flexibility, and scale Actionable information
Company Confidential
In a new light… The Road to Meaningful Use Ideal capture method for physicians Human understandable information Options, flexibility, and scale Actionable information
Lynn Kosegi
Actionable Information
Question…..How does any user of clinical information… Generate Find Share…and use the information they need in a
way that makes sense to them?
Company Confidential
Question…..How does any user of clinical information… Generate Find Share…and use the information they need in a
way that makes sense to them?
Lynn Kosegi
Discrete Data is not enough…
Limited to specific vocabularies - uses Many “standards” – link ICD-9, ICD-10 CPT LOINC RxNorm Radlex SNOMED Accepted standard for interoperability
Company Confidential
Limited to specific vocabularies - uses Many “standards” – link ICD-9, ICD-10 CPT LOINC RxNorm Radlex SNOMED Accepted standard for interoperability
ICD-10
More specificity Extensive training Decreased productivity – 50% Learning curve Hybrid phase
Loss of “super bills” Loss of staff – attrition
Company Confidential
More specificity Extensive training Decreased productivity – 50% Learning curve Hybrid phase
Loss of “super bills” Loss of staff – attrition
Speaker Name
GEMsGeneral Equivalence Mappings No direct mappings From SNOMED to ICD-9 Many to one relationship
ICD-9 to SNOMED – Not semantically equal; One to many
From SNOMED to ICD-10 More granular but still not one-to-one
Specificity requirements
Company Confidential
General Equivalence Mappings No direct mappings From SNOMED to ICD-9 Many to one relationship
ICD-9 to SNOMED – Not semantically equal; One to many
From SNOMED to ICD-10 More granular but still not one-to-one
Specificity requirements
Lynn Kosegi
Company Confidential35
AHIMA. "Putting the ICD-10-CM/PCS GEMs into Practice." Journal ofAHIMA 81, no.3 (March 2010): 46-52.
Lessons from the SummitSpeech Recognition Eliminate MTs Decrease MT pay Use lesser-skilled,
lower paid MTs “As dictated” It’s all about the $$$
CAC CAC for “mundane”
coding Elevate lower-skilled
coders Retain highly-skilled
coders It’s all about useful
Documentation
Company Confidential
Speech Recognition Eliminate MTs Decrease MT pay Use lesser-skilled,
lower paid MTs “As dictated” It’s all about the $$$
CAC CAC for “mundane”
coding Elevate lower-skilled
coders Retain highly-skilled
coders It’s all about useful
Documentation
Lynn Kosegi
Retain the Narrative
Availability of context and concepts Application of rules for coding Retain use of encoders Retain and improve familiar workflow Increase ease of use Decrease learning curve Increase adoption
Company Confidential
Availability of context and concepts Application of rules for coding Retain use of encoders Retain and improve familiar workflow Increase ease of use Decrease learning curve Increase adoption
Lynn Kosegi
Technology Reality # 1Speech recognition will not compensate for Poor work habits Inefficient management practices Insufficient training Poor quality Illogical pricing practices Unfair MT compensation Weaknesses in the transcription platform
Company Confidential
Speech recognition will not compensate for Poor work habits Inefficient management practices Insufficient training Poor quality Illogical pricing practices Unfair MT compensation Weaknesses in the transcription platform
40
Cost of the IC Linda Yaniszewski from ExecuScribeAfter changing from IC to employees –
“Results were communicated back to the entire team:• Morale improved.• There was a new sense of company loyalty.• MTs began “fighting” for work.• Company profits increased.• Everyone was able to do more with less”
http://bit.ly/e7YiQICompany Confidential
Linda Yaniszewski from ExecuScribeAfter changing from IC to employees –
“Results were communicated back to the entire team:• Morale improved.• There was a new sense of company loyalty.• MTs began “fighting” for work.• Company profits increased.• Everyone was able to do more with less”
http://bit.ly/e7YiQI41
Technology Reality # 2Assuming you can use speech recognition to
hire unskilled MTs at lower line rates will Increase head count and expense Decrease quality Increase expenses… Decrease your value proposition
even if “percent productivity increase” betweentyping and editing goes through the ceiling
Company Confidential
Assuming you can use speech recognition tohire unskilled MTs at lower line rates will Increase head count and expense Decrease quality Increase expenses… Decrease your value proposition
even if “percent productivity increase” betweentyping and editing goes through the ceiling
42
Technology Reality # 3Average “% productivity gained” is not – The correct metric to use to measure MT
success. The correct metric to use to determine MT
compensation.
You get paid for increased output, not for ahigh “percent gain” …
Company Confidential
Average “% productivity gained” is not – The correct metric to use to measure MT
success. The correct metric to use to determine MT
compensation.
You get paid for increased output, not for ahigh “percent gain” …
43
Technology Reality # 4The highest producing MTs will see lower
productivity PERCENT gains.BUT - Keeping highest producing typists out of
speech does not benefit you It does not benefit the MT Who does it benefit? Why are most case studies for inhouse
MTs?
Company Confidential
The highest producing MTs will see lowerproductivity PERCENT gains.
BUT - Keeping highest producing typists out of
speech does not benefit you It does not benefit the MT Who does it benefit? Why are most case studies for inhouse
MTs?
44
Technology Reality # 5Global workforce: do not compare – Productivity for MTs delivering to the
customer to Productivity for MTs sending to QA What benefit is a 200% gain for work that Requires 3 levels of QA? Results in quality or TAT penalties? Results in lost business? Results in a document that diminishes the
value of your product
Company Confidential
Global workforce: do not compare – Productivity for MTs delivering to the
customer to Productivity for MTs sending to QA What benefit is a 200% gain for work that Requires 3 levels of QA? Results in quality or TAT penalties? Results in lost business? Results in a document that diminishes the
value of your product
45
From a Physician at RSNA..after reviewing draft text produced by
M*Modal’s front-end speech using an un-trained profile…
“this is better quality than I’m getting from<unnamed MTSO> MTs…”
If you are not delivering quality, none ofthe other arguments matter.
Company Confidential
..after reviewing draft text produced byM*Modal’s front-end speech using an un-trained profile…
“this is better quality than I’m getting from<unnamed MTSO> MTs…”
If you are not delivering quality, none ofthe other arguments matter.
46
Technology Reality # 6High productivity means nothing if utilization
(how much of your total volume you areediting) is low
Where is the “sweet spot”?
Company Confidential
High productivity means nothing if utilization(how much of your total volume you areediting) is low
Where is the “sweet spot”?
47
Technology Reality # 7
Don’t lose your best MTs! Without them, you’re just a commodity
Company Confidential48
Commoditization“I’ll do the same thing cheaper” vs“I’ll add value to your documentation”
Given a choice, would you pay more toone electric company than to another? Who cares about the electric company as
long as the lights are on? You all know which companies(y) will
survive if you all become the electriccompany.
Company Confidential
“I’ll do the same thing cheaper” vs“I’ll add value to your documentation”
Given a choice, would you pay more toone electric company than to another? Who cares about the electric company as
long as the lights are on? You all know which companies(y) will
survive if you all become the electriccompany.
49
Technology Reality # 8Speech recognition will never be perfect.
Never.Never.
Never.It will always require human review – even if
only to check for dictation errorsAlways.
Always.Always.
Never expect to finalize a draft without human review.Company Confidential
Speech recognition will never be perfect.Never.
Never.Never.
It will always require human review – even ifonly to check for dictation errorsAlways.
Always.Always.
Never expect to finalize a draft without human review.50
Technology Reality # 9It is incorrect to measure effectiveness of
speech recognition by using a “wordaccuracy” score. A draft that is 100% word accurate can
require a lot of editing! Ask any MT –
“Would you feel comfortable delivering a100% verbatim accurate document?”
Company Confidential
It is incorrect to measure effectiveness ofspeech recognition by using a “wordaccuracy” score. A draft that is 100% word accurate can
require a lot of editing! Ask any MT –
“Would you feel comfortable delivering a100% verbatim accurate document?”
51
Technology Reality # 10Errors in final documents are not the result
of speech recognition! These are MT errors. Addressing quality problems by removing
work from speech recognition is silly! If an MT typing from scratch produces
errors, do you remove the work fromtranscription?
Company Confidential
Errors in final documents are not the resultof speech recognition! These are MT errors. Addressing quality problems by removing
work from speech recognition is silly! If an MT typing from scratch produces
errors, do you remove the work fromtranscription?
52
Technology Reality # 11Willingness to fulfill every individual
preference for format and style is not adifferentiation point! If your value proposition is providing
custom formats, you will lose customers tothe next company offering the same at alower price. Anyone can manipulate document format. Not everyone understands how to deliver
valuable documentation.
Company Confidential
Willingness to fulfill every individualpreference for format and style is not adifferentiation point! If your value proposition is providing
custom formats, you will lose customers tothe next company offering the same at alower price. Anyone can manipulate document format. Not everyone understands how to deliver
valuable documentation.
53
Technology Reality # 12You will not see the same results when
speech recognition is kept invisible as youdo when processes are changed toaccommodate speech Do not pay your MTs the same line rates
for the two scenarios Do not charge your customers the same
line rates for these two scenarios.
Company Confidential
You will not see the same results whenspeech recognition is kept invisible as youdo when processes are changed toaccommodate speech Do not pay your MTs the same line rates
for the two scenarios Do not charge your customers the same
line rates for these two scenarios.
54
Technology Reality # 13“You get what you say” - “type what you
hear” is not “standardization” or“optimization” for documentation! It is optimization for the speech
recognition technology! It is the furthest thing there is from useful
standards that will drive quality,compliance, and usability.
Company Confidential
“You get what you say” - “type what youhear” is not “standardization” or“optimization” for documentation! It is optimization for the speech
recognition technology! It is the furthest thing there is from useful
standards that will drive quality,compliance, and usability.
55
Technology Reality # 14 Know what your customer wants Know what you want to sell Price accordingly Pay MTs accordingly
Every other industry in the worldunderstands this concept!
Company Confidential
Know what your customer wants Know what you want to sell Price accordingly Pay MTs accordingly
Every other industry in the worldunderstands this concept!
56
From Detlef Koll, CTO and VP of Research andDevelopment, M*Modal
“We already have semantic interoperability inhealth information today. Narrative notes arethe one form of documentation that can beunderstood by every human in the patientcare team, including the patient himself…”
Company Confidential
From Detlef Koll, CTO and VP of Research andDevelopment, M*Modal
“We already have semantic interoperability inhealth information today. Narrative notes arethe one form of documentation that can beunderstood by every human in the patientcare team, including the patient himself…”
58
Questions?
Or Google…
Management for the Modern MTSO
Excellence in Health Information
Company Confidential
Or Google…
Management for the Modern MTSO
Excellence in Health Information