HITN: COVID-19 has further exposed employee stress and burnout as major challenges for healthcare. Tell us how we can stop digital transformation technologies from simply adding to them.

Wallace: By making sure that they are adopted for the right reasons – meeting clinician’s needs without adding more stress or time pressures to already hectic workflows. For example, Covid-19 being a new disease meant that clinicians had to document their findings in detail and quickly without the process slowing them down – often while wearing PPE. I think speech recognition technology has been helpful in this respect, not just because of speed but also because it allows the clinician time to provide more quality clinical detail in the content of a note.

In a recent HIMSS/Nuance survey, 82% of doctors and 73% of nurses felt that clinical documentation contributed significantly to healthcare professional overload. It has been estimated that clinicians spend around 11 hours a week creating clinical documentation, and up to two thirds of that can be narrative.

HITN: How do you think speech recognition technology can be adapted into clinical tasks and workflow to help lower workload and stress levels?

Wallace: One solution is cloud-based AI-powered speech recognition: instead of either typing in the EPR or EHR or dictating a letter for transcription, clinicians can use their voice and see the text appear in real time on the screen. Using your voice is a more natural and efficient way to capture the complete patient story. It can also speed up navigation in the EPR system, helping to avoid multiple clicks and scrolling. The entire care team can benefit – not just in acute hospitals but across primary and community care and mental health services.

HITN: Can you give some examples where speech recognition has helped to reduce the pressure on clinicians?

Wallace: In hospitals where clinicians have created their outpatient letters using speech recognition, reduction in turnaround times from several weeks down to two or three days have been achieved across a wide range of clinical specialties. In some cases where no lab results are involved, patients can now leave the clinic with their completed outpatient letter.

In the Emergency Department setting, an independent study found that speech recognition was 40% faster than typing notes and has now become the preferred method for capturing ED records. The average time saving in documenting care is around 3.5 mins per patient – in this particular hospital, that is equivalent to 389 days a year, or two full-time ED doctors!

HITN: How do you see the future panning out for clinicians in the documentation space when it comes to automation and AI technologies?

Wallace: I think we are looking at what we call the Clinic Room of the Future, built around conversational intelligence. No more typing for the clinician, no more clicks, no more back turned to the patient hunched over a computer.

The desktop computer is replaced by a smart device with microphones and movement sensors. Voice biometrics allow the clinician to sign in to the EPR verbally and securely (My Voice is my Password), with a virtual assistant responding to voice commands. The technology recognises non-verbal cues – for example, when a patient points to her left knee but only actually states it is her knee. The conversation between the patient and the clinician is fully diarised, while in the background, Natural Language Processing (using Nuance’s Clinical Language Understanding engine) is working to create a structured clinical note that summarises the consultation, and codes the clinical terms eg. with SNOMED CT.

No more typing for the clinician, no more clicks, no more back turned to the patient hunched over a computer, resulting in a more professional and interactive clinician/patient consultation. 

Healthcare IT News spoke to Dr Simon Wallace, CCIO of Nuance’s healthcare division, as part of the 'Summer Conversations' series.