Wednesday, November 10, 2010

Nuanced Physician-Friendly and Physician-Useful Data

Because doctors in droves have failed to install EMRs in the numbers government expected, critics accuse doctors of being Luddites, of being opposed to information technologies to preserve their place in the medical sun and to control the flow of medical dollars.

I have found the opposite to be true. Physicians know EMRs are inevitable. They are just waiting for useful, cost-effective, doctor and patient friendly, and efficient models, to arrive. Clinicians are skeptical of data for its own sake - data created at remote sites that slows their work and inappropriately judges their performance.

Physicians are not Luddites. They simply view information technologies as evolutionary rather than revolutionary. At this stage, data-driven decisions have not proven to be better than human-driven decisions.

Making EMRs More Useful Through Speech Recognition

Evolutionary medical advances take time, testing, thoughtfulness, and an understanding of human nuance. In the course of writing these blogs, I came across a Massachusetts IT company – Nuance Communications, Inc.
I describeed their speech recognition software as follows:

“This Massachusetts-based company has developed improved speech recognition software. It allows physicians to talk their progress notes, clinical findings, and clinical updates into an electronic health record without typing, clicking, or handwriting. Physicians speak their patients’ stories directly into an electronic health record. This electronic tweak makes existing EHRs more clinically useful and efficient. ”

The nuance here, of course, is that doctors are more comfortable dictating or speaking their findings rather than typing in their findings and being glued to a computer screen. Doctors, like the rest of humankind, are narrative creatures.

Making Decision-Support Systems More Collaborative, Convenient, and Useful

Now Nuance has come up with another evolutionary step - Radport . It uses a communication technique, e-ordering, to judge clinical appropriateness for ordering of CT scans, MRIs, PET scans, and nuclear heart scans.

Radport was developed with 60 medical groups in Minnesota and surrounding states as an initiative of the Institute for Clinical Systems Improvement (ICSI). Radport is a collaboration between the medical groups, radiologists, consumers, and private and government payers.

The idea is to pick the right scan, or to select alternative approaches, to arrive at the right diagnosis without exposing the patient to unnecessary radiation or needless waiting and without wasting the clinician’s time.

Imaging procedures now cost the nation over $100 billion and are rising at 15% to 17% per year, among the fasting growing costs among all medical procedures.

The Radport approach is called e-ordering. It occurs at the point of care. The clinician enter patient-specific data in the office. On the spot, the e-ordering system, based on a clinical appropriateness score, either verifies the order or suggests alternative procedures. The physician can select the recommended procedure or override the systems’ suggestion and order the originally suggested procedure. Feedback is immediate, can be shared with the patient, and incurs no additional expense.

In Minnesota, Radport has stopped cold the growth of ordering of the number of imaging procedures, and it is expected to save $28 million in health costs. It has been accepted with satisfaction by coalition of clinicians, medical societies, radiology groups, imaging equipment manufacturers payers, and patient groups.

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