val9000 conversational interfaces for clinical information systems
TRANSCRIPT
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VAL9000, Inc.
Richard Koffler [email protected] (310) 807-5786
Dr. Val Nenov [email protected]
January 2011
Conversational interfaces for
clinical information systems
Simplifying the practice of medicine SM
1. Intuitive, unobtrusive, easy, without training hassles
2. Quick: In, out, done!
3. Accessible everywhere: At point of care, on the road, between offices, at home, etc.
4. Available immediately when needed, no delays
5. Always accurate: No follow-up human proofing
Anything else is unproductive, and takes time from seeing patients and practicing medicine
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Is this a productive use of the doctor’s time?
Five keys to doctor-friendly electronic medical records
Mobile apps nice but very imperfect Ja
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Low-productivity user interfaces
• Cramped screens; cumbersome to navigate, find, retrieve Click-swipe-type-click-swipe-click-swipe-…
• Every app behaves differently, training headaches
• User can’t multitask: Distractive to use while doing other things
One more thing to carry
• Cramped-screen smartphones fit in pocket, but tablets don’t
• Prone to forgetting, losing, dropping in sink, etc.
• And useless when battery dies
Endless chasing after platform obsolescence
• Explosion of operating systems, hardware, apps, etc.
• Impossible to get all doctors and nurses to carry the same device
Our piece of the solution Ja
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EMR
HIS
PHR
etc.
No apps. No keyboards. No screens.
Just pick up any phone and talk.
From anywhere at any time.
For example Ja
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Anything need my attention?
Order an MRI of the brain
Yes
Patient had a CT of the brain in May. Proceed anyway?
Mary Smith presents headaches
Patient is allergic to ionic contrast. Non-ionic requires authorization.
Proceed anyway?
Nursing
documentation
system
Bedside monitor
Radiology
information
system
Personal health
records
Insurance records
Care protocols
What are her vitals?
BP 140 over 95. Temp 101. RR 22.
Real-time
data exchange
Conversation snippets Ja
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• MD What patients require my immediate attention?
• VAL 9000 John Doe, 55, stroke patient, room 1413, …
• MD Do you have his latest test results?
• VAL 9000 Yes, except for radiology. Would you like to order an MRI?
• MD No, thanks. Order full blood test and consultation with neurology
• VAL 9000 Would you like me to notify you when the results are available?
• MD Yes please
Patient follow-up
• MD Order an MR of the brain
• VAL 9000 With contrast?
• MD Yes
• VAL 9000 Patient appears to be allergic. Non-ionic contrast requires insurance authorization. Do you want to order contrast anyway?
Order tests
• MD When was last blood test and what was abnormal?
• VAL 9000 July 21 8am non-HDL C was 145, normal is 50 to 130
Review results
Conversation snippets Ja
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• MD Prescribe Zocor 20 milligrams
• VAL 9000 May I substitute with generic simvastatin?
• MD Yes, go ahead
Prescribe meds
• MD Dictate note
• VAL 9000 Ready for dictation
• MD Patient presented with severe abdominal pain…
Dictate notes
• MD Order infectious-disease consult
• VAL 9000 Done. Want to add notes or instructions?
• MD Yes. Patient presented with abdominal pain…
Schedule consults
• VAL 9000 You have a message from Dr Brown
• MD What is it?
• VAL 9000 Hi. I examined patient for a possible infectious disease…
Collaborate with other doctors, nurses, assistants
Why voice? Ja
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No special training: Users already know how to talk “medical”
Quick, targeted data access: No click-click-type-click-click-swipe-type-type…
Ubiquitous: Phones everywhere, but keyboards & screens not always available
Multi-tasking: Use while giving care, walking, driving, operating, etc.
VAL9000’s key features Ja
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Complements existing clinical information systems
•Spoken conversations replace keyboards and displays
•Doesn’t store data: Retrieves from and saves to existing systems
•Knows which systems to read from and write to
•Tasks: Timely & complete charting, submission of care plans, order entry, e-prescribing, insurance approvals, workflows, alarms, alerts, etc.
Natural to use, quick, accurate, unobtrusive, polite
•Eliminates burden of learning multiple clinical systems: just ask
•Plain English: Speak normally, no training needed
•Understands meaning, intent, jargon, acronyms, abbreviations, etc.
•Handles accents, enunciation, pronunciation, etc.
•Anticipates requests and suggests actions
Conveniently ubiquitous and secure
• Just pick up any phone & talk anywhere any time
•100% voice driven using any phone: Landline, cell, VoIP, SIP
•No keyboards, displays, mobile apps
•Server-based intrinsically secure: Like two people having a conversation
How is VAL9000 different from Nuance Dragon Solutions Ja
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• Action: Dictate instead of typing
• Limited to one-way task of dictating text reports
• Doesn’t:
• Handle clinical workflows
• Retrieve data
• Save structured data
• Primary metric: Speech-recognition accuracy ‒ and still needs human proofing
• Requires software on computer or mobile + high-quality microphones
NUANCE’s goal: Produce text documents
• One-way speech-to-text dictation
• Requires human proofing for 100% accuracy
• Offline (not real-time) tools to extract some structured data from text reports
How is VAL9000 different from Nuance Dragon Solutions Ja
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• Action: Workflow optimization with two-way spoken interactions with clinical information systems
• Replace keyboards & displays with speech recognition + artificial intelligence + clinical workflows
• Finds & saves structured clinical data: results, notes, orders, etc.
• Automatically assembles text documents from structured data
• Manages alarms, alerts, follow-ups
• Primary metric: Correctly understand and respond to user’s intent
• No equipment or installable software needed: Call & talk from any phone
VAL9000’s goal: Simplify practice of medicine
• Automatic report creation only when needed
• Two-way spoken conversations: find & save structured data
• Self-proofing throughout conversations
SYMPTOM CONSTIPATION
SYMPTOM NO DIARRHEA
ON MEDICATION MONOPRIL 10MG
FAMILY HISTORY DIABETES MELLITUS
INTAKE BP 112 70
INTAKE RR 18 CLI
NIC
AL
SYST
EMS
It’s working at Ja
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• Bedside data capture
• Verbal order entry
• Care-coordination and patient rounds phone service
• Assets & personnel tracking via hospital-wide WiFi network
Four piloted applications since 2006
• Radiology, oncology, pathology, lab, pharmacy (HL7, SOAP)
• Bedside monitors (Unity Network)
• Nursing documentation system (Essentris, Clinicomp)
• Cisco Wireless Location Manager
Eight system interfaces
Benefits: Efficient, convenient, immediate turnaround
• No paper charts or click-click-type-click-type-type-click-click…
• No paper scribbling or remembering for later: Immediate entry of care plans, orders, Rx
• Real-time compliance with workflow & care protocols
Productive on-the-go data retrieval and entry
• Communication “through medical record” instead of interruptive phone calls, voicemail, “phone tag”
Collaboration among providers (and patients)
Less time learning new systems
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ROI: Hard-dollar savings Ja
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Gives MD’s and RN’s more time to see patients
Eliminates or reduces data-entry clerks and scribes
Reduces need for multi-system portals, mobile apps
SaaS: No CapX or added infrastructure
Helps comply with meaningful-use requirements
Keeps logs for productivity & efficiency assessment
System architecture Ja
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EMR
HIS
PHR
UCS
etc.
• ASR
• NLP (CLP)
• TTS
• Telephony
CONVERSATION ENGINE
• User profiles
• Workflows
• Templates
• Care protocols
• Alerts
RULES ENGINE
• HL7
• Web services
• Custom
DATA INTERFACE ENGINE
• Uses off-the-shelf speech-recognition and speech-synthesis components
• Artificial-intelligence technology incorporated in all engines
• HIPAA compliance shared by all engines
System interfaces Ja
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• HL7
• Web services
• Custom
Interoperates using standard interface protocols
• Automatically routes data to/from data repositories (e.g., EMR, RIS, HIS, LIS) and real-time devices (e.g., bedside monitors)
Interoperates with multiple systems
Voice user interface Ja
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• Users speak as they always do: No retraining required
• Automatically handles accents, enunciation, pronunciation, etc.
• Understands meaning, intent, jargon, acronyms, abbreviations, etc.
• Verbal algebra, unit conversions, clinical calculators, date algebra
“Free form”, natural conversations
• Smart, silent, audio, verbose
Adaptable “verbosity” and hand-holding
• Could understand 4 (EN, ES, FR, DE); speaks 7 (+ CN, IT, JP)
Multiple languages
• Voice-print, name & PIN, caller ID
User identification and authentication
Frictionless implementation Ja
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Customer selects initial application(s)
We take care of the rest
• Rules & profiles
• Data-exchange interfaces
• Telephony interfaces
• Test and tweak
• Go live
• Analyze, tweak, optimize
When ready, customer adds applications
Price Ja
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Per session
• Cents to dollars per session
Per port
• $100 to $1000 per month
Per minute
• 10¢ ‒ 20¢ per minute
Hosted, in the cloud = No CapX or additional IT infrastructure
Implementation fee + three SaaS options
MedVox: Consumer version of VAL 9000 Ja
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SECURE ACCESS OF PERSONAL
HEALTH RECORDS
Patients
Caregivers
Doctors & nurses
Emergency response medics
Emergency room staff
Three to five years from now Ja
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INTELLIGENT MEDICAL
ASSISTANTS
More intelligent, versatile
conversations
Smarter rules, workflows, templates
More medical applications
Deeper real-time integration with
clinical information systems
About us Ja
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• Computer science (MS UC Berkeley, BS MIT)
• Career launching and growing IT startups
• Co-founder of highly successful healthcare IT & telemedicine venture
Richard Koffler CEO
• Inventor: VAL 9000
• Micro-electronics (MS Prague Polytechnic), computer science, neuroscience (PhDs UCLA)
• Research: clinical information systems, clinical trials, neural networks, artificial intelligence, natural language processing
• Founder and CTO of highly successful provider of EMR portals on handheld devices
Dr. Val Nenov CTO
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VAL9000, Inc.
Richard Koffler [email protected] (310) 807-5786
Dr. Val Nenov [email protected]
January 2011
Conversational interfaces for
clinical information systems
Simplifying the practice of medicine SM