The 2017 Speech Industry Implementation Awards: Nebraska Medicine

Customer: Nebraska Medicine

Vendor: Nuance Communications

Products: Dragon Medical One, PowerMic Mobile, Dragon Medical Advisor

Nebraska Medicine, which operates two hospitals and 40 specialty and primary-care clinics in the Omaha, Neb., area, has been using Epic’s electronic medical records system since 2009. Though the system has brought in a healthy return on investment through reduced transcription costs, Brian Lancaster, executive director of information management at Nebraska Medicine, says it wasn’t enough.

The EMR system greatly simplified the process of creating and managing patient files, but Nebraska Medicine physicians still spent a good deal of their time adding patient information to the EMR records. That was partly because doctors needed to be located at workstations to manually input patient notes. They wanted the freedom to dictate notes into mobile devices as they moved around, Lancaster says.

With that in mind, Lancaster in April 2016 began introducing doctors to Nuance Communications’ Dragon Medical One, an enterprise-wide, cloud-enabled voice recognition platform; PowerMic Mobile, which enables physicians to use their mobile devices to dictate notes; and Dragon Medical Advisor, which analyzes physician notes in real time and suggests specific additions to help ensure compliance and completeness of the records.

Today, more than 350 of the 1,000 doctors who staff Nebraska Medicine’s facilities are using Nuance’s cloud-based speech recognition software tied to its Epic electronic medical record software. As a result, they are saving more than half an hour per day, while Nebraska Medicine benefits from better records and a 23 percent reduction in transcription costs.

With the Nuance software, physicians speak their notes aloud into a range of devices, including standard smartphones, anytime from anywhere using a single voice profile, capturing the complete patient narrative and entering it directly into the EMR in real time. Other care team members have immediate access to the clinical documentation, including the full context and detail needed to deliver more personalized, higher-quality patient care.

These notes are also able to help guide future medical actions, Lancaster says. “If a patient has the potential to become septic, based on clinical documentation notes, this solution will help physicians be mindful of that for both documentation aspects and care guidelines,” he says.

“Physicians access the last notes, medication list, care plan, and so on, and while they review that information, PowerMic Mobile allows for dictation without any cognitive disruption,” Lancaster adds.

Dragon Medical Advisor gives immediate feedback to doctors whose notes might be missing critical information needed for billing or other departments downstream and to ensure compliance with federal regulatory requirements. If an issue is flagged, doctors can immediately add to or amend their notes as needed.

Ultimately, Nebraska Medicine will benefit from improved coding compliance, Lancaster says.

Physicians also tend to enter notes into the system much sooner after meeting with patients, leading to notes that are more extensive and complete.

Each doctor creates his own profile within Dragon Medical One, which takes into account and learns his accent and preferred microphone and background-noise-reduction settings. The settings automatically adjust when the profile is called up, before the user begins speaking.

One month after implementation, Lancaster again partnered with Nuance, this time to conduct a study of the 350 physicians who’d adopted the speech recognition technology and to convert the ones who haven’t been taking advantage of the systems into Dragon Medical One users. Dragon Medical One analytics give Nebraska Medicine real-time information about who is using the voice recognition platform and how they’re using it.

“This allows us to be proactive with our IT support, targeting those physicians who may be struggling and aligning our training and support efforts to help address their concerns,” Lancaster says. “It’s helped us become a trusted adviser to our staff.” 

The Results

Since implementing Nuance Communications’ Dragon One Medical, PowerMic Mobile, and Dragon Medical Advisor, Nebraska Medicine has seen:

• a 23 percent reduction in transcription costs;

• 94 percent of users report that the software is enabling them to do their jobs better;

• 71 percent of users report that the quality of their documentation has improved significantly; and

• 50 percent of users report that the software saves them more than 30 minutes a day.