December 9, 2020: Diana Nole with Nuance and Dr. Amy Compton-Phillips with Providence discuss their partnership to improve the clinician experience through voice and AI using ambient clinical intelligence technology. How much time do doctors and nurses spend typing data versus doing their real job which is caring for people? Dragon Ambient eXperience (DAX) allows physicians to focus solely on their patients during visits thus helping with clinician burden and burnout. Is there a learning curve to this technology? Is there a significant capital expense? Do you have to set up special rooms? Is it cloud-based? What are the plans for rollout and educating the physicians? Carer to distance is a huge deal during this pandemic. What kinds of things are they doing with voice to help reduce the number of touchpoints and conserve PPE? One silver lining of COVID is that the government allowed regulatory burdens to go away. They allowed us to put up payment models that allowed care to be provided for differently. And once that burden was lifted, innovation was unleashed. It’s a very good lesson for us to remember in the future.
Putting Clinicians and Tech on Speaking Terms with Amy Compton-Phillips and Diana Nole
Episode 339: Transcript - December 9, 2020
This transcription is provided by artificial intelligence. We believe in technology but understand that even the smartest robots can sometimes get speech recognition wrong.
[00:00:00] Bill Russell: [00:00:00] Welcome to this week in Health IT influence where we discuss the influence of technology on health, with the people who are making it happen today, we're going to hear from two fantastic leaders, Diana Nole with Nuance and Dr. Amy Compton-Phillips with Providence. We're going to talk about improving the clinician experience through voice and AI. And towards the end we discussed some of the silver linings that have come about as a result of our COVID journey [00:00:30] as an industry. My name is Bill Russell, former healthcare CIO, CIO, coach consultant, and creator of this week in health IT. As we approach 250,000 downloads for the year. I want to thank Sirius Healthcare for supporting the mission of our show to develop the next generation of health leaders, their weekly support of the show and our channel sponsors as well, has allowed us to expand and develop our services to the community.
[00:00:53] And for that, we are incredibly grateful now onto our show. All right, today we [00:01:00] have Diana Nole the GM of Nuance health division, and Dr. Amy Compton Phillips the Chief Clinical Officer for Providence joining us, good morning and welcome to the show.
[00:01:11] Amy Compton-Phillips: [00:01:11] Thanks so much for having me
[00:01:12] Diana Nole: [00:01:12] Thanks Bill.
[00:01:13] Bill Russell: [00:01:13] Yeah. I'm looking forward to this conversation. I've talked to a handful of people at both organizations talk to the CTO at Nuance and you guys are doing some really cool things around the Ambien clinical intelligence. We're going to talk a little bit about that. Talk to [00:01:30] Providence, talk to, a couple of people at Providence. So, a really innovative company, you guys are doing a lot of really fun things.
[00:01:39] So we're going to explore this, this partnership but before we do that, Amy let's, let's really start from the beginning. Tell us a little bit about the partnership, between Nuance and Providence. And I actually, as you're doing that, give us a little background. I think a lot of people know who Providence is, but give us a little background and then talk about the partnership.
[00:02:01] [00:02:00] Amy Compton-Phillips: [00:02:01] Sure. Well, Providence is a large healthcare system based up and down the West coast. So we go from Alaska down as far South is orange County and as far East, as Texas, and we have 51 hospitals over a thousand medical clinics, 120,000 total employees. So a pretty big footprint over a big geography. And one of the big guiding principles that we have is we're really focused on delivering on the quadruple aim, right?
[00:02:25] So better health outcomes on more affordable care, but also changing the [00:02:30] experience of care. And that experience, the reason it's quadrupling up the triple aim has to be for both patients as well as for clinicians. As we've gotten going with, the digitization of healthcare, bringing it in electronic medical record is moving services to the cloud being able to do things like book appointments online, we've actually added complexity to the physician's day. And what always had been the primary element of healthcare that visit between a patient and their doctor, whether [00:03:00] that's online or whether that's, whether they call, click or come in, whether it's in the virtual world, the railroad that focus that conversation yeah.
[00:03:08] Should be a person with a caregiver, right. A nurse, a doctor. And so instead, what, has happened with the advent of EMRs is we now have a third element in the room. We have a, a computer that actually changes it, interrupts, that relationship between the doctor and the person, because the [00:03:30] doctor's sitting there typing on a computer instead of looking at that person. And so what the partnership with Nuance is really doing is, is helping us on our quest to simplify health, to actually make great care with great compassion, easy and available to, to perform. And so with nuance, with particularly the ambient technology, if we can somehow take out that third element in the room, start making that about the doctor and the patient again, having the [00:04:00] documentation as well. That's what goes on to our EMR. Be simplified and streamlined. We'll have a real win in our quest towards health for a better world.
[00:04:08] Bill Russell: [00:04:08] So, Diana, give us an idea from a technology perspective back when we did HIMSS, I think the last HIMSS we actually did, we, we got to see your ambient clinical intelligence in action in this booth. It was really impressive. I mean, it was essentially a physician seeing a patient, having a conversation. You had a [00:04:30] camera's in the room, you had audio in the room and it was actually documenting it was doing the note. It was the whole thing. And then the doctor just went over and approves the note in a way it went now that was, and they said, it's like, this is, this is the vision. but is that what we're talking about here and how far along are we?
[00:04:50] Diana Nole: [00:04:50] Yeah, so that is, that is the vision that we brought to market. We actually were ready to kind of GA that product did that right the HIMSS right [00:05:00] in March of this year. And it is live out in the market. It is being used in exactly the environment that you saw it in. and through patient consent, we accurately do capture and appropriately contextualize every word of the patient encounter. So we really are targeted at what Amy has described to really make sure that the conversation can go on between the patient and doctor and in the background, the ambient device is listening, [00:05:30] capturing it and then certainly proving it up to serving it up to the doctors so that they can review it, make any final changes, and certainly feed that back into the AI learning loop. And that's the evolution of that solution. It's referred to is the Nuance DAES or Dragon Ambient Experience Solutions. So it is out in the market.
[00:05:50] Bill Russell: [00:05:50] DAX. So does it work also in a telehealth setting? Is that, another area you're looking at?
[00:05:58] Diana Nole: [00:05:58] Yeah, so definitely with COVID [00:06:00] arriving, it definitely works within a telehealth environment, so you can automatically use it in a telehealth environment and then it has varying levels of deep integration with various types of providers. And that certainly, I think not only in COVID, but post COVID is going to be extremely important. And I think even more so in a telehealth environment, you can even imagine even more. So it's really critical to kind of develop that relationship through the video between the patient and the doctor. And you don't want to have the doctor having to be burdened [00:06:30] again by, the administrative aspects of the conversation.
[00:06:35] Bill Russell: [00:06:35] Yeah. So Amy, I want to talk to you about really what are the desired outcomes for Providence from this, from the Nuance partnership and the technologies that you're looking to deploy? Do you have some metrics that you're looking at?
[00:06:51] Amy Compton-Phillips: [00:06:51] We do. And several of the metrics are really related to the fact that as I mentioned before, healthcare has gotten more complicated for physicians, particularly as you start [00:07:00] doing things like typing. And so what we're finding is that rather than back in the, when I first started practice, right, I would just jot a note down in a chart and that I would have it for my chart. With typing, we spend a lot more time on nights and on weekends, and we can actually track how much time people spend outside of a work day working. Right. The other thing we are tracking is, how much time and how much burden physicians feel from the administrative data that comes along with practicing medicine and also [00:07:30] nurses by the way, and same thing, right? That how much time do you spend typing versus doing your real job, which is caring for people. So there's the actual time that we can monitor there's the perception of time. And then there's overall burnout scores and, and participation with EMR is one of the big drivers of burnout. So those three things are easy ones for us to shoot to improve in the near term.
[00:07:53] Bill Russell: [00:07:53] Is there a learning curve to this technology? And is there a [00:08:00] significant capital expense? Do you have to set up rooms and set up technology or exist? Is this more of a cloud-based type thing that you're going to be able to roll out and educate the physicians as you go.
[00:08:10] Amy Compton-Phillips: [00:08:10] Yeah, both ends, right? So there's always a learning curve to, how do you use technology? Think about how you use your iPhone when you first got it, versus how you use it now. Right? There's, there's always, always things that you can do, but, and I'll let Diana talk about the background of the technology but there is definitely a individual learning [00:08:30] curve of how physicians can speak and have it be interpreted in a way that's useful for their ongoing use of that information.
[00:08:38] Diana Nole: [00:08:38] Yeah. And if I can just add it is a cloud based, it is not, extensive to get it up and running. You can actually start with a mobile app, but then we also have the, what you had seen before is the device. So you can do either setting. so it's very easy to get started, but as Amy mentioned, usually what we see in these pilots, early [00:09:00] adopters, the installations that we've had this far as there is work that goes on between Nuance and the customer around what is the specific situation that the physician would like to have in terms of their particular structure of their notes.
[00:09:14] And so we work with them to get the template set up. We kind of do a couple revisions of that and then we're sort of off and running and then make sure that the solution is adaptable to what the physician would like to see. And certainly there's that element of learning curve. And then in the background scene, [00:09:30] obviously I think one of your questions is likely what is the learning curve of the actual technology? So we can touch on that now or in the future.
[00:09:39] Bill Russell: [00:09:39] So let me ask you this with, with the, Dragon solutions that we used to have, we, the physician used to have to train it, right. So they'd have to sit down and they'd have to put their voice in and train the system to understand them. Is that, or are we still doing that kind of process with it?
[00:09:58] Diana Nole: [00:09:58] No, no, we are [00:10:00] not. So I've actually, I'm smiling because I've seen and heard of stories where people bought like the biggest computer they could get. So they could use the initial version of dragon because it did have such, kind of learning curves and you had to teach it and train it. We're beyond that for sure. It is not in that regard. what we're really talking about now is the AI learning, ongoing learning of the conversational and the aspects of what's most important for dropping into the node and what is maybe sort of background information. [00:10:30] So, the AI learning is much different than what you would have experienced in the dragon adoption.
[00:10:36] Bill Russell: [00:10:36] So, so Diana helped me to understand that you guys are, you guys have announcements coming out pretty often. You guys are right squarely in the middle of, of this, clinician experience and even the patient experience as well. I mean, you guys are, we're voice interacts with the, with the medical record and the medical establishment.
[00:10:55] You guys are right there helping me to understand you have an announcement with Microsoft. [00:11:00] around Azure. Is that part of this as well of the partnership you're doing with Providence?
[00:11:05] Diana Nole: [00:11:05] Yeah. So Nuance DAX was innovated as you noted with Microsoft, we leveraged their Azure platform and our AI technology. And that's securely capturing and contextualizing every word of the patient encounter. So certainly the deployment of Nuance DAX will be certainly supported by Microsoft, beyond direct integration. I think Microsoft is also shares that this collaboration is a [00:11:30] prime example of how you can have multiple parties really bringing together the technical and domain expertise that each of us have.
[00:11:38] Obviously Providence is bringing significant clinical domain expertise. We're bringing aspects of the technology. And I think we're all going to learn and hopefully, kind of, really accelerate sort of our adoption curves here.
[00:11:53] Bill Russell: [00:11:53] Yeah. So Amy, let's talk about this. You have a fairly large organization. Some of your physicians right now [00:12:00] are hearing this and they're going, okay, when am I getting this? When is it going to come out? What kind of approach are you taking to introducing these technologies across the entire organization?
[00:12:11] Amy Compton-Phillips: [00:12:11] Yeah, well, it's, we have to do it as a phased approach because we have to learn. Right. And you, you don't start everywhere all at once and do anything, badly everywhere all at the same time. Right? So you, you, you. and that's what we're doing right now. And so we're really starting with, the [00:12:30] PowerScribe and radiology. We're starting in a couple of clinics. We're really learning how to implement it. We're learning how to train on it. We're learning how we can actually make it work to, to. make the promise of making lives better for our clinicians and our patients. And then we'll roll it out. And as Diana mentioned, because it is a cloud-based solution if it works really readily and easily, we can roll it out really quickly, but we know that there's, it was a learning curve. And so we're taking it slow with initially starting with these few clinics and a few specific applications in both surgery, radiology, as well as medical.
[00:12:59] Bill Russell: [00:12:59] Yeah. [00:13:00] So Diana would, the clinical terminology has been one of the challenges, and really integrating into the workflow and how important that is. You guys are also using AI technology, just a lot of technologies coming together. Let's talk about that terminology though. It's, it's really understanding oncology, cardiology, all those different things. How is, is this solution really targeted [00:13:30] to certain practices at this point, or are you starting to expand to more practices as you go through because of the use of AI?
[00:13:40] Diana Nole: [00:13:40] Yeah. So you've really touched on, I think, a deep piece of how AI has to kind of progress and we have the benefit of having that. The experience from Dragon and the years and years of kind of boys, but you're right. AI is going to, look at the medical field and look at [00:14:00] each of these specialties. And as we know each patient encounter in each specialty situation, As different levels of complexity. And so like, you would imagine just like Amy said, they're going to roll it out. We also did really focus on specific areas to start. Now we cover all specialties, but we really guide that the most mature ones right now are in orthopedics, podiatry other areas.
[00:14:23] And we are coming out with additional we're kind of coming up that learning curve in many areas, cardiology, urology. [00:14:30] ENT primary care there. these are all on the roadmap and they are at various levels of degrees of complexity and therefore at different degrees of kind of their AI powered solutions are at a different stage in each of these with some of them as you mentioned, further along.
[00:14:48] Bill Russell: [00:14:48] Yeah. So Amy, coming back to you, Providence is really known. They have the innovation group that, that has a portfolio of companies and things coming out. Is there [00:15:00] any intention to develop new products as products, as a result of this, or take anything to market as a result of this?
[00:15:06] Amy Compton-Phillips: [00:15:06] Well, let me just go back to one real quick thing. Is that Providence? Firmly believes that data digital information technologies will change the future of healthcare. We also know that when. When tech companies tried going into healthcare all by themselves a decade ago, nobody succeeded. And so we believe that this partnership between [00:15:30] organizations like Nuance and with Microsoft, with healthcare experts.
[00:15:33] So we have technology experts, innovation experts together with healthcare experts, and those partnerships are going to be the ones that launched the tools of the future. and so this is one of the things that. That Providence is so excited about in this partnership with Nuance is that we absolutely believe this is going to be something that helps transform healthcare in is one of many that we hope that both the, the capacity to understand spoken language, distill, spoken [00:16:00] language, use AI to help us actually advance on, on not just, understanding, but starting to process and suggest.
[00:16:08] So I think the future is incredibly bright and it's partnerships like this that are going to help actually turn that from idea into reality.
[00:16:17] Bill Russell: [00:16:17] Fantastic. So, if I could get off the beaten path a little bit here, I have, you two are phenomenal. And I just want to ask you some questions. So we're we're carer to distance is such a huge deal during [00:16:30] this pandemic and, I just wanna hear from you, what kind of solutions have you seen? What kind of things are we doing, today at maybe at Providence? What kinds of things are we doing with voice that is, helping to, reduce number of touchpoints, conserve PPE and those kinds of things? What kinds of things is technology playing a role in, in how we're delivering care? Maybe I'm using the term care at a distance where we're creating that [00:17:00] separation for, protecting the clinicians.
[00:17:03] Amy Compton-Phillips: [00:17:03] Yeah. So, I'll start on this one. Diana, if you don't mind, but something that Providence did early on when COVID first hit was we realized that if our, all of our algorithms and all of our thinking was bring everybody in for an evaluation, we were going to drown, right. That healthcare couldn't handle the concerns. And so we started with the premise is if I were a patient and I Googled on, do I have [00:17:30] COVID, what information would I want to find? Let's do that. Okay. and so we worked in this case with Microsoft as a partner and built a chat bot. That helped triage patients to going from?
[00:17:40] No, you don't have any symptoms to, yes. You potentially have it. Would you like to have a go to a telehealth consult or would you like a visit? And so we were able to very rapidly and in the course of a week, go from not having anything to having automated technologies on the web available for anybody to use. And in fact, we then gave Microsoft and Providence gave [00:18:00] that chatbot to the CDC. And since that time it's been used, I believe hundreds of millions of times. so that was one thing, one way that we could use it and that, that isn't voice, but you can adapt it for voice. Right. But, but you start with where you are, which was, was go through the algorithm.
[00:18:15] The other, the other thing we've been able to do since then is continuing mostly adapt that chat bot. So now we're okay at the point where you're worried you have COVID, we're working with another partner LabCorp to FedEx tests kits at home [00:18:30] to patients so that they can actually self administer their own tests and nasal swab that they FedEx back and within 48 hours, they can actually get a test done with care. Another thing we've done is to make sure patients that if they're at risk, like they have, they do come up positive for COVID and we're worried about them but we don't want to put them into a hospital bed. We're now doing at home monitoring with nurses, monitoring banks of information, that come from patients being monitored at home.
[00:18:58] And we're up over 15,000 [00:19:00] patients that we've monitored at home care. being able to use this kind of moving knowledge, not people letting patients have minimally disruptive medicine, getting care in their home without having to be in an uncomfortable hospital bed, isolated from their family. All of those things, allowing patients to get care where they live, work and play, rather than an art facilities in our bricks and mortar have been hugely impactful, lowering the cost, improving the experience of care and really improving the outcomes of the people that we serve. And all of that's been totally [00:19:30] enabled by technology.
[00:19:31] Bill Russell: [00:19:31] That's fantastic. Diana, where's Nuance been, asked to really play a role in the, in the pandemic at this point?
[00:19:39] Diana Nole: [00:19:39] Yeah. So similarly to what Amy outlined, I think one we already touched on was people said immediately, do you have tool sets that we could use for telehealth? Also how do we get our clinicians to be able to work at home? So we've been asked around that. We also have been asked, how can we keep these deployments going of your necessary tools, but do it remotely? I think [00:20:00] the other thing that's been really exciting since I've joined in June of this year is really around taking technology that is used in other parts of nuance, not in healthcare, really around exactly what Amy was mentioning.
[00:20:12] Around, how do you just handle the increasing in overwhelming volume of frequently asked questions and where do I go for this and how do I get this started? And, and can you remind me of what I'm supposed to do? And there's all kinds of technology, both voice and interactive. Types of [00:20:30] technologies on our enterprise side that are used with airlines, banks, insurance companies, to handle those, extremely high volumes of calls and other elements.
[00:20:41] And so we're really introducing those at the request of many of our provider customers around how to just further enhance that sort of patient digital front door. so I think, COVID is certainly kind of heightened. The need to kind of do some of these basic things to just keep that interaction going. [00:21:00] I think those are here to stay, obviously. So some of those are, are things that certainly were asked of us to sort of accelerate. We're very happy. We have some of those out in the market already.
[00:21:10] Last question, for you guys, we've heard a lot about silver linings. We go through this and it really has changed health care and how we do a lot of different things and maybe even how we design buildings, how we utilize technology and where we utilize technology.
[00:21:26] And I guess the question I'd love for both of you to answer is. [00:21:30] What do you think the lasting impact the, the lasting positive impact of this pandemic will be on healthcare or healthcare at your system? Amy we'll we'll start with you.
[00:21:44] Amy Compton-Phillips: [00:21:44] Well, I absolutely think telehealth is here to stay. in 2019, we did 70,000 tele-health visits in 2020 we're on par to get 1.6 million telehealth visits. So I think, I think that's not going away. The other thing is the pace of [00:22:00] learning and healthcare has been astounding. The remarkable breakthroughs from the science there, our ability to go from not knowing this germ existed in January of 2020 to having a vaccine ready for deployment. Broadly by December of 2020 is unbelievable that pace of learning that pace of being able to adapt everything from genomic information into new therapeutics, I think is absolutely here to stay.
[00:22:25] So we're going to continue to see breathtaking advancements in the science. And last but not [00:22:30] least. I think that we're finally having to break through on how to equalize and equilibrate, the inequities we have in healthcare. The fact that we can move knowledge, not people. Now, the fact that we can get care using different tools from urban centers, where expertise exists into rural areas, where they have more need be through tele-health solutions, through different kinds of technologic infrastructure. I think that's going to be a huge bonus. Any anything we can do to reduce the health inequities in the country as a positive. And [00:23:00] I, I started to see glimmers for the first time in my career that were going in that direction.
[00:23:04] Bill Russell: [00:23:04] Fantastic. Diana, we'll give you the last word lasting impact of the pandemic on healthcare.
[00:23:11] Diana Nole: [00:23:11] Unfortunately, I think it's even heightened the worsen aspect of physician burnout, clinician burnout, but I am so encouraged by the fact that our customers who are handling all of this have really pushed forward and kind of said, technology has got to help us. And I'm encouraged by the early adopters that [00:23:30] have adopted DAX saying, hey, it reduces my documentation time. By six minutes, my patients are scoring me higher. it's, nine minutes less wait time for my patients. And so I'm just thrilled that the technology is helping because, I really, I do believe that this has just put even more burden on the physician burnout, but our clinicians and our customers are really finding a way to really push through it. So I'm encouraged by that.
[00:23:58] Bill Russell: [00:23:58] Yeah. It's, it's amazing. When I came [00:24:00] into healthcare, we talked about how slow healthcare moves. I don't think anyone can say that in December of 2020, healthcare moves amazingly quick. This year, people were very, flexible. They were very adaptive and utilizing technology, utilizing each other, collaborating across the industry. It's really been amazing.
[00:24:20] Amy Compton-Phillips: [00:24:20] Something that allowed that to happen is, and we realized was holding us back is the regulatory burden went away. That the government [00:24:30] allowed us to innovate the government, put up payment models that allowed care to be provided for differently. That kept both facilities intact as well as clinicians in intact. And once that regulatory burden was lifted, innovation was unleashed. So I think it's just a good lesson for us to remember in the future.
[00:24:47] Bill Russell: [00:24:47] Yeah, it will be interesting. And we're we're and that's continuing, we just saw, I think last week, they're opening up some more flexibilities for, for home care as well. So telehealth really took [00:25:00] off as a result of this as. A result of reducing the regulatory burdens. Now we're seeing the regulatory burdens and really the acknowledgement of the value of setting up the home for a potentially acute care settings, as well as, some of the more normalized already remote patient monitoring. It's pretty exciting.
[00:25:20] Diana Nole: [00:25:20] I think it is a, it really is exciting that it's been able to be something that's sort of a bright shining star out of a very challenging
[00:25:27] Bill Russell: [00:25:27] time
[00:25:28] I want to thank the two of you for, for coming [00:25:30] on the show. Thanks.
[00:25:31] Amy Compton-Phillips: [00:25:31] I really appreciate it. And thanks Diana. It was great seeing you.
[00:25:33] Diana Nole: [00:25:33] Oh I agree Amy great to see you.
[00:25:36] Bill Russell: [00:25:36] What a great conversation. That's all for this week. Don't forget to sign up for clip notes. It's a great way to support the show. It's also a great way for you to stay current. if you're not familiar, clip notes is an email that we send out, immediately following the shows actually 24 hours after the show airs and it'll have a summary of the show, bullet points. Key moments from the show and also one to four video clips that you can just watch. Great way to stay [00:26:00] current, to know who was on the show and what was said. Special thanks to our sponsors, VMware, Starbridge Advisors, Galen Healthcare, Health lLyrics, Sirius Healthcare, Pro Talent Advisors, HealthNXT, McAfee and Hill-Rom digital, our newest sponsor for choosing to invest in developing the next generation of health leaders. This show is a production of This week in health IT. For more great content, you can check out our website this week, health.com or the YouTube channel as well. We continue to modify that for you to make it a better resource for you. [00:26:30] Please check back every while. when to check back, we publish three shows a week. We have the news day episode on Tuesday. we usually have solution showcase every Wednesday and then an influencer show on Friday but right now we don't have any solution showcases. So we are doing multiple, we were dropping multiple, influenced episodes. So a lot of content being dropped, between now and the end of the year. Hopefully you'll like that. And also we have the end of the year episodes coming up and I'm looking forward to those. We have the best [00:27:00] of the new stay show. So we take 10 news stories that we covered this year and, give you some clips, give you an idea of what we went through this year. Obviously COVID was the big story, but a lot of other things happen this year in the world of felt it, we're also doing a best of the, of the COVID series itself.
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