transcription as the accelerator of meaningful clinical ... · transcription as the accelerator of...

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

[email protected]

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


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


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


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

Company ConfidentialLynn Kosegi7

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…


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


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


Speech recognition plus MT editing• Efficiencies and cost savings• Cost avoidance• Comprehensive and complete

documentation• High adoption by physicians• Flexibility and options

Company ConfidentialSpeaker Name

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


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


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

The Myth of the “% Gained”

Company ConfidentialLynn 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


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


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


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


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


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


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


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?


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


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


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?


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

Quest for Semantic Interoperability

Company Confidential31

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


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


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


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


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


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


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

Throw away everything you thinkyou know…

39

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


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


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” …


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?


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


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.


..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”?


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


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.


“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?”


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?


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.


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.


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.


“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!


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

Would you charge the same for a Jetta asyou would for this?


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…”


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?

[email protected]

Or Google…

Management for the Modern MTSO

Excellence in Health Information


[email protected]

Or Google…

Management for the Modern MTSO

Excellence in Health Information

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