Saturday, June 28, 2008

Healthcare driving speech recognition technology growth

No big surprise here - healthcare is deriving huge benefits from speech recognition and a new report from DataMonitor just reaffirms this. You can see the press release here
Healthcare currently represents 85% of the market for PC- and server-based speech recognition technologies.
Good news for the providers of speech recognition and speech understanding:
Datamonitor estimates in its report, Automating and Enhancing Processes through Voice in Desktop and Back Office Environments, that the global market for speech recognition in healthcare is currently worth an estimated $170 million. It projects that between 2008 and 2013 the market will more than double in size.
Which seems very conservative when you consider the current size of transcription market estimated anywhere from 6 - 12 Billion dollars. And that industry and content is currently pouring documents into the Electronic Medicals Records (EMR) filling some 60% or more of the content in these systems today. The problem with documents is they are only really human readable (it is possible to apply some level of Natural Language Processing (NLP) to them but that process remains difficult and is not happening with any significant amount of market penetration today). What these systems need and are crying out for is data that is machine readable and therein lies the real opportunity for speech and in particular speech understanding to deliver clinical data directly into the EMR from the dictation process....

Wednesday, June 25, 2008

Political Comparisons of 2008 Presidential Candidates Heathcare Proposals

Now we are down to two candidates (or at least today we are down to two presumptive candidates) it is good to see where they stand on healthcare (props to Mr HisTalk for the pickup)

You can see a side by side comparison here

Both contain good ideas but the cost containment concepts make for interesting reading and will be important as the industry starts to address the soaring costs associated with delivering healthcare to our existing population and the burgeoning number of over 60's.....
Invest $50 billion toward adoption of electronic medical records and other health information technology.
Good to see some level of realism of investment needs to make this happen
Promote competition among providers by paying them only for quality and promote use of alternative providers (e.g., nurse practitioners) and treatment settings (e.g., walk-in clinics in retail outlets).

Provide consumers with more information on treatment options and require provider transparency regarding medical outcomes.

Require hospitals and providers to publicly report measures of health care costs and quality.
And for the cost and quality measures it will be essential to build in the collection, capture and reporting of this information as part of the normal clinical work flow, not as some after thought or adjunct process. Once again the concept of capturing clinical data directly from the clinician represents an efficient method of gathering data especially if this can be done in real time or near real time without any additional burden on the already over stressed and time pressured clinician. Once this information is captured it needs to be held in a form that can be transmitted to other systems in both human readable form as well as computer readable data that requires little or no human intervention to populate clinical database that can then use and report on this data.....Clinical Document Architecture for Common Document Types (CDA4CDT) does just that.

Monday, June 23, 2008

Consumerism and Clinical Knowledge

Providing the population with the right information at the right time to help them navigate the murky waters of health care delivery, insurance, hospitals, payors, denials, quality indicators and pay for performance statistics is going to be a key facet to the success or failure of any consumer driven revolution in health care.

The recent study by McKinsey “What Consumers Want in Health Care“ - summary here
Faced with health care decisions, consumers are concerned, confused, and unprepared. They rely heavily on personal recommendations and brand recognition, according to a recent McKinsey study
No big surprise here but if this is to change and the consumer is really to become informed and help drive change in health care delivery they need to have access to the right information
...48 percent report being prepared for common medical problems but only 15 percent for more disruptive medical scenarios...
To help satisfy this need consumers are already turning to the web in increasing numbers and estimates range from 50% to as high as 75/80% of patients use the web before and after visiting their physician. But much of the information available comes from a range of sources some less qualified than others. By providing structured data output as part of the clinical documentation process and delivering documents in a standard form that can be read but also imported into computer systems it should be possible to support this burgeoning need for clinical data as a natural part of the process - this is exactly what Clinical Document Architecture for Clinical
Clinical Documentation Architecture for Common Document Types (CDA4CDT) is intended to provide directly from dictation.

You can read more about the process and the concept in these articles
Guidelines Will Standardize Dictated Documents
HL7's first ballot in expected series under way
HL7 CDA: The Missing Link in Healthcare IT

As the McKinsey study revealed
Most people need additional guidance, education, and advice to make decisions
Innovative, cross-industry products that assist with the complex decision making will be highly valued by an influx of consumers eager for options but unsure where to turn
That's going to be difficult until we can standardize the clinical information coming out of clinicians offices and hospitals and make it available in machine readable form to consumers to aid their voyage of discovery in the new health care world of consumer driven choice

Sunday, June 22, 2008

Most Doctors Aren’t Using Electronic Health Records

Most Doctors Aren’t Using Electronic Health Records

Laura Pedrick for The New York Times

Dr. Paul Feldan, one of three doctors in a New Jersey practice, said switching to electronic records did not make economic sense.


Published: June 19, 2008

A government-sponsored survey of the use of computerized patient records by doctors points to two seemingly contradictory conclusions, and a health care system at odds with itself.

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Robert Spencer for The New York Times

Dr. Peter Masucci, a pediatrician in Massachusetts, said shifting to computerized records helped improve his patient care.

The report, published online on Wednesday in The New England Journal of Medicine, found that doctors who use electronic health records say overwhelmingly that such records have helped improve the quality and timeliness of care. Yet fewer than one in five of the nation’s doctors has started using such records.

Bringing patient records into the computer age, experts say, is crucial to improving care, reducing errors and containing costs in the American health care system. The slow adoption of the technology is mainly economic. Most doctors in private practice, especially those in small practices, lack the financial incentive to invest in computerized records.

The national survey found that electronic records were used in less than 9 percent of small offices with one to three doctors, where nearly half of the country’s doctors practice medicine.

Dr. Paul Feldan, one of three doctors in a primary care practice in Mount Laurel, N.J., considered investing in electronic health records, and decided against it. The initial cost of upgrading the office’s personal computers, buying new software and obtaining technical support to make the shift would be $15,000 to $20,000 a doctor, he estimated. Then, during the time-consuming conversion from paper to computer records, the practice would be able to see far fewer patients, perhaps doubling the cost.

“Certainly, the idea of electronic records is terrific,” Dr. Feldan said. “But if we don’t see patients, we don’t get paid. The economics of it just seem so daunting.”

Private and government insurers and hospitals can save money as a result of less paper handling, lower administration expenses and fewer unnecessary lab tests when they are connected to electronic health records in doctors’ offices. Still, it is mainly doctors who bear the burden making the initial investment.

“We have a broken market for electronic health record adoption because the people who gain financially are not the people who pay,” said Dr. Blackford Middleton, a health technology expert at Partners Healthcare, a nonprofit medical group that includes Massachusetts General Hospital in Boston.

To fix the market, Dr. Middleton, like others, recommends that the government play a role in providing incentives or subsidies to speed the use of computerized patient records in the United States, whose adoption rate trails most developed nations.

The government took a step in that direction last week, announcing a $150 million Medicare project that will offer doctors incentives to move from paper to electronic patient records. The program is intended to help up to 1,200 small practices in 12 cities and states make the conversion.

Individual doctors will be offered up to $58,000 over the five-year span of the project, which is intended to test the impact of incentives on the spread of electronic health records. Further programs across the country are planned.

The report published in the journal also found that electronic health records were used by 51 percent of larger practices, with 50 or more doctors.

Indeed, electronic health records are pervasive in the largest integrated medical groups like Kaiser Permanente, the Mayo Clinic, the Cleveland Clinic, University of Pittsburgh Medical Center and others. These integrated groups not only have deep pockets. By combining doctors, clinics, hospitals and often some insurance they can also capture the financial savings from electronic health records.

The findings of the study, which was paid for by the Department of Health and Human Services and a grant from the Robert Wood Johnson Foundation, broadly echo previous research on the adoption of electronic health records. Large medical groups have long been the early adopters, and small practices have struggled.

But the new study is based on a large sampling — more than 2,600 doctors across the country — and a detailed survey, making it more definitive than past research, experts say. The results, they say, also show a strong endorsement of electronic health records by doctors who have them, especially for what the report termed “fully functional” records, which include reminders of care guidelines, based on a patient’s age, gender or medical history.

For example, 82 percent of those using such electronic records said they improved the quality of clinical decisions, 86 percent said they helped in avoiding medication errors and 85 percent said they improved the delivery of preventative care.

“Those numbers are huge and very encouraging,” said Dr. David J. Brailer, the former health information technology coordinator in the Bush administration.

Dr. Brailer also pointed to the 54 percent of doctors without electronic health records who said that not finding an electronic health record that met their needs was a “major barrier” to adoption. In short, they are not satisfied with the existing products, which tend to be designed for hospitals — big customers — instead of small practices.

“What we see is a deficit in innovation, and that is something innovators and the capital markets can address,” said Dr. Brailer, who leads a firm that invests in medical ventures, Health Evolution Partners.

One wave of innovation is coming from big technology companies, like Microsoft and Google, which recently have begun services that offer consumer-controlled personal health records over the Web, which are stored in the companies’ data centers. These consumer-controlled health records are intended to link up and exchange information with electronic patient records in doctors’ offices and hospitals.

Dr. Peter Masucci, a pediatrician with his own office in Everett, Mass., embraced electronic health records to “try to get our practice into the 21st century.”

He could not afford conventional software, and chose a Web-based service from Athenahealth, a company supplying online financial and electronic health record services to doctors’ offices.

Dr. Masucci was already using Athenahealth’s outsourced financial service, and less than two years ago adopted the online medical record.

Today, Dr. Masucci is an enthusiast, talking about the wealth of patient information, drug interaction warnings and guidelines for care, all in the Web-based records.

“Do I see more patients because of this technology? Probably no,” Dr. Masucci said. “But I am doing a better job with the patients I am seeing. It almost forces you to be a better doctor.”

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