From the library of What’s next: archives from From the editor

NHS Digital: time to do its homework on clinical documentation

The newly-launched NHS Digital Academy has plenty of potential to transform the NHS through digital innovation. However, the training programme must acknowledge the challenge of clinical documentation and the impact it is having on frontline staff. One technology that the new cadre of Digital Academy trainees should be aware of is speech recognition software, which is already being used inside and widely outside the NHS.
NHS Digital must do its homework on clinical documentation

The NHS Digital Academy, launched in Manchester August 2017, is the fruition of another Robert Wachter recommendation. Over the next three years it will train up to 300 digital leaders starting with chief clinical information officers (CCIOs) and chief information officers (CIOs). Rachel Dunscombe, CIO at Salford Royal NHS Foundation Trust has become its chief executive and describes it as the ‘beginning of a profession’.

Understandably there is a lot of excitement and attention on the Academy. Its chair Lord Ara Darzi, former health minister and head of Imperial’s Health Innovation Unit wants CCIOs and CIOs to be sitting as executive members of boards. He says this is because ‘these leaders are the only way we are going to drive digital implementation and transformation’.

Technology needs to support the healthcare transformation

    Professor Keith McNeill, the can-do Aussie leaving his post of NHS CCIO, believes the Academy has the opportunity to ‘provide people on the ground with the skills to understand tech and have transformational leadership capabilities – transform from the ground root and branch’.

    The curriculum will be an interesting starting point and there certainly is a lot of ground to cover. It could easily span health informatics, systems design, clinical decision support, data interventions for service improvement, health information technology implementation to management and leadership.

    The clinical documentation challenge

      Sadly, one area I fear it may not cover in detail is how we overcome the challenge of clinical documentation. In a previous blog post I have highlighted how the ease of entering quality data by whatever method will play a key role in realising the benefits of big data.

      One often overlooked but proven tool for data entry is speech recognition software. You can find out more about the role that speech recognition is playing in reducing the burned of clinical documentation here.

      I have made bold predictions that this simple to use universal tool will quickly surpass other forms of data entry such as typing – we have no choice because in the consumer world, the likes of Alexa are making this happen in front of our very eyes. Our healthcare professionals will be coming to work asking why this technology cannot be harnessed in their day to day working and of course they are right.

      As we know, this is another technology that we should not adopt just for technology’s sake. It must work for the end user. It has to be accurate and address tricky medical terms taking the clicks and clunk out of the all-important electronic patient record. Finally, it needs to be linked with intelligence around decision support and remove the arduous task of coding by seamlessly doing it in the backgroun

      There is plenty of potential for NHS Digital Academy, but if it is to fulfil the ambition then the art of digital clinical documentation has to be a key part of the agenda.

      Why you should speech-enable your clinical documentation now?

      Read our e-paper and find out how to make it quick and easy for clinicians to capture the patient story in your clinical IT systems. Usability is key to clinical engagement!

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      Are you ready for your digital patients?

      From September 2017 NHS patients in England can access their GP record online via the revamped This is just the latest in a suite of online healthcare information services rolling out this year and next that, says Secretary of State for Health, Jeremy Hunt, will deliver a ‘patient powered generation’ over the next ten years.
      Speech recognition can ensure clinical data is recorded accurately and in a timely manner


      Patient online access

        Granting online access to medical records and care plans is one of the most effective ways to engage patients. The revamped now gives all of us the opportunity to:

        • book or cancel appointments online with a GP or nurse
        • order repeat prescriptions online
        • view parts of the GP record, including information about medication, allergies, vaccinations, previous illnesses and test results
        • view clinical correspondence such as hospital discharge summaries, outpatient appointment letters and referral letters

        Curiosity eventually got the better of me and recently I had a second go at accessing my patient record through the newly available GP online services via My first attempt twelve months ago seemed overly lengthy and confusing and I abandoned. This time, once I’d received log in details from my GP surgery, the registration process seemed easier. Now I have an app on my phone ready to go should I ever need it.


        Patient empowerment

          Eagerly I selected ‘view your medical record’. Perhaps I should not have been disappointed by the empty content. After all, I have visited my surgery (excluding age/gender-appropriate screenings) only three times in the last twenty-five years and have difficulty remembering the name of my GP.  However, I am sure my time will come. When it does, I am already more empowered and can readily foresee the benefit of being able to check the accuracy of my own patient record, see and book/cancel an appointment, order prescriptions online and perhaps most importantly choose who else is able to view my record. Meanwhile the GP online services website includes some short videos of real patients, with complex health needs, describing how they’ve already benefited from the service.


          Documentation exacts a heavy toll

            Granting online access to medical records and care plans via and other emerging solutions must be one of the most effective ways to engage patients. However, the quality of data in many patient records and the EPR is poor and therefore may sometimes not be relied upon to give accurate clinical advice to patients without some considerable effort. This adds yet another burden of administration for already hard-pressed GPs, allied healthcare professionals and other members of practice teams who will need to pay greater attention to writing accurate, contemporaneous notes with their patients in mind. Already, the challenges relating to general practice clinical documentation—accurately recording the patient consultation, writing referral letters and reports, meeting medico-legal requirements etc. can seem overwhelming.


            Proven technology to help make the leap to online

              GPs are rising to the challenge and continue to raise their game and by leading investments in technology to help keep them ahead of the workload. Speech recognition integrated into clinical documentation is a mature, proven technology. It supports the quick, easy capture of not just the structured data but also the more detailed and descriptive elements of the patient consultation (narrative) to provide context and rationale within the patient record. Speech recognition technology leads to better outcomes and a more consistent experience for patients. It also eases the administrative burden of clinical documentation, freeing the practice team to devote time and energy to matters more essential to the practice and the well-being of all its patients however those same patients choose to access services – on or offline.

              Download a recently released primary care e-paper

              Find out how a speech-enabled clinical documentation supports patient access to GP online services


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              Is your data in?

              Healthcare data analytics is a hot topic and an essential new way to turn existing information into usable data supporting clinicians in their daily decision making and treatment plans, use resources meaningfully, reduce costs, avoid errors, and on and on it goes. And whilst everybody is really into getting “the” data out of the system, shouldn’t we be worried of “if and how” the data gets into the system in the first place?

              Working at Nuance for many years, whilst maintaining my contact to medicine, as a practicing doctor in Belgium, I believe to understand both sides of the coin: IT providers thinking ahead, trying to modernize healthcare systems all over the globe, whilst as a doctor, you sometimes struggle with something as simple as a lack of tools to write down, aka document, your observations, findings and conclusions.

              Is your EPR ready to receive your data input?

                If you are in the lucky position to be working at a practice or hospital that already counts on a certain degree of digitisation with clinical IT systems in place, you are probably familiar with the pain of switching from hand written or tape-based note taking – essentially someone else is doing the clinical documentation fit to template, form and standards for you – to a digital form presented to you on a screen. Al of sudden you need to start fiddling around with the keyboard, turning your attention from the patient or medical case to trying to be a data clerk. But does it need to be this way? Why can we talk to our mobile phones, send text messages based on voice input, but in our daily professional environment doctors, nurses and clinicians are burdened with data input issues? And just like text editors highlight spelling- or grammar mistakes, why can’t clinical software systems spot medical inconsistencies?  Doctors create a medical note in a once-and-done way. It better be done correctly. Smart clinical systems should be able to prompt the physician with additional questions to create an as complete as possible note.

                Dream with me

                  Our community, healthcare providers world-wide, and healthcare IT companies too, know that there is a reasonable amount of work still undone to let professionals easily input into their electronic records. The path to analyzing this data is even more difficult.

                  If there would be an option to share and compare the treatment outcomes for similar diagnosis within a region, would that benefit significantly the understanding of therapeutic options? What if we would be able to share the chemotherapy outcomes for lung cancer for all patients in Brussels? Or all combined for Belgium? Or Europe?

                  This ‘big data’ would be able to offer to medical professionals and researches an enormous amount of information. We would learn much faster about side effects, medication interaction, most effective treatments…. Well, guess what? This data is available! In each of the record of individual physicians. It is just not shared and linked. Interoperability of data might be the largest breakthrough in medical science for the next decade!

                  We make it easy and fast to update your electronic patient records

                  Find out how health data management is more efficient with speech recognition technology

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                  Pathology finds its voice

                  A recent meeting of Pathologists held at the Royal Chemistry Society, London and hosted by Nuance & Talking Point highlighted how pathologists are rising to the challenges of a worldwide shortage of pathologists and growing demand for their services with investments in new technology.
                  Male doctor pointing at different medical features


                  The challenge for today´s pathologists

                    ‘We’re working in an era where, worldwide, there is a shortage of qualified pathologists and in the UK we are also facing austerity’ challenged Dr Fred Mayall, Consultant Histopathologist at Taunton and Somerset NHS Foundation Trust when speaking to a group of NHS pathologists who had come together at the invitation of Nuance partner Talking Point to share their experience of digitizing their departments. His colleague Dr Pedro Oliveira Consultant Histopathologist at The Christe NHS Foundation Trust also struck a warning note describing the increasing demand and workload for pathologists as a result of having to process more specimens, more samples, more tests

                    Dr Mayall and Dr Oliveira went on to describe how they are developing and using technology solutions, including speech recognition embedded into pathology workflow to improve the quality of reporting, increase throughput and regain work-life balance.

                    5 things busy pathologists love about speech recognition

                      Dr Mayall and Dr Oliveira describe how the use of speech recognition embedded in their digital pathology workflow changes their working lives for the better

                       1. Speed – ‘Speech Recognition is so good it is faster even than canned reports’ declared Dr Mayall. ‘I dictate whilst I am viewing a specimen.  I’ve found that for me this is faster even than calling up a standard template’

                      2. Adaptability – ‘You don’t need to say stuff very clearly.’ Once you’ve set up your individual voice profile the speech recognition software will learn the way you speak and adapt to your accent and dictation style’

                      3. Accuracy – ‘The speech recognition software just doesn’t make mistakes. Once you’ve said a regular phrase a couple of times the software will never get it wrong’ A dictionary of medical words, terms and body system normals from over 60 specialties ensures complex medical terms are always accurately and completely captured.

                      4. Simplicity – ‘A single voice command cuts out the need to use the keyboard and the multiple clicks and keystrokes required to move between screens and between the Laboratory Information Management System (LIMS) and my pathology system’ – Standard and customised voice commands are built into speech recognition

                      5. Quality – ‘The combined effect of faster, easier capture of the notes combined with greater accuracy enables me to focus on reporting the sample or specimen rather than the admin’

                      Streamline the data entry process

                      No need to wait for your dictations to be transcribed, or type and click yourself. Discover how speech recognition productivity tools from Nuance including templates, macros and medical commands to shorten report turnaround time, enrich your patient record and can work for you!

                      Learn more

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                      Make it digital and smart: what NHS nurses need from healthcare IT

                      A roundtable discussion on 20th June, 2017 at the King's Fund in London sponsored by Nuance and supported by the Royal College of Nursing (RCN) discussed ‘Nursing Documentation - the challenges, opportunities and the role of technology’.
                      Female nurse taking an old woman's blood pressure

                      Anne Cooper, Director of Clinical Safety and Chief Nurse at NHS Digital chaired the roundtable discussion which was attended by 15 senior nurses from acute, primary, community and mental health who shared their experiences, frustrations and their future ‘fantasies’ nursing clinical documentation.

                      The discussion began with recent headline statistics about the burden of nursing documentation gathered from a WeNurses Tweet chat in December 2016:

                      • 73% of nurses said they go home late because of clinical documentation
                      • 15% of nurses said they rushed clinical documentation
                      • 36% of nurses said clinical documentation took 40-60% of their time

                      Reference to other research sponsored by Nuance highlighted that nurses spend nearly 11 hours per week adding to clinical documentation.

                      Eight key themes identified in the nursing patient record keeping


                      1. Nursing documentation is complex, laborious to complete, not always shared amongst the right teams, sometimes ignored and does not always contribute to improved clinical outcomes and patient safety
                      2. Nursing documentation needs to be high quality, timely and standardised with inbuilt levels of security, governance and control as appropriate for each patient scenario
                      3. On the journey to a paperless NHS, attempts to digitise the clinical documentation process has led to a ‘digital mountain of documentation’
                      4. One nurse characterised the challenge of balancing patient care versus the burden of documentation that sometimes it feels that everyone is “so busy writing about doing it, but NOT doing it”.
                      5. Anne Cooper suggested, “we need time to think”. Instead of re-engineering current paper workflow, “nurses need to reimagine the process of clinical documentation” and that if smart 21st-century documentation is going to work, then the output needs to be a natural byproduct of the nursing process.
                      6. Everyone was invited to share their ‘fantasy’ of the future for clinical documentation out of which arose discussion of technologies that could be deployed to help ranging from Apps that automatically capture therapeutic observations and feed into the patient record, to the use of biometrics for identification and authentication of individuals, the power of ‘the cloud’ for capture, access to and sharing of data, the use of speech recognition as a natural user interface and prospect of digital assistants removing the grind of administration.
                      7. It was suggested that ‘smart creative technologists ’from leading digital technology companies from, industry and for the consumer space could shadow the nursing fraternity and help them ‘re-imagine’ but that technology must support the nurse, not the other way around.
                      8. Finally, all agreed there was a real opportunity to involve the patient in being involved in patient record keeping and sharing; particularly those with long-term conditions.

                      A whitepaper to be released later this summer will feature a more in-depth review of the roundtable discussion and some suggestions for how to go about addressing the challenge of making nursing documentation and making it ‘digital and smart’

                      Find out more about digital tools for nursing documentation

                      Pre-register for the Summer Nursing Documentation ePaper and find out more about our dictation and voice recognition solutions here

                      Learn more

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                      Law firms move away from billable hours

                      As more legal firms move away from billable hours towards negotiated pricing models, cost efficiency and streamlined document management processes are tantamount to critical business functions.
                      Law student sat at a library desk considering whether he should charge by the hour

                      Do billable hours still exist in law?

                        In short, yes, however, clients now, more often than not, insist on an initial quote so that the responsibility lies with the legal firm to maintain low costs.

                        For decades, billable hours was the traditional pricing model for most law firms, but the Great Recession in the early 2000s forced many legal organisations to find an alternative pricing model in order to remain competitive and retain clients in an increasingly cost-sensitive economy.

                        Although the term “billable hour” still exists, the underlying concept is no longer the same. Clients now demand agreements that determine the budget up front, putting responsibility squarely on the legal firm to control costs in order to maintain profits.

                        Gone is the traditional approach that allowed firms to record time and pass the cost of billable hours on to the client. The pressure is on law firms to accurately forecast profitability and to price and negotiate with clients accordingly. This change in approach has even resulted in the emergence of a relatively new profession in the legal industry: senior pricing executives.

                        A new paradigm

                          Though the concept of a senior pricing executive is relatively new to legal firms, it has become an established function within many professional services institutions and business consulting firms. The responsibilities of these executives are often two-fold: serve as the engagement lead and frontline negotiator on new business, and work collaboratively with client-facing partners to understand the forces and inefficiencies that can impact profitability.

                          Document-related activities are changing as well. For example, clients are growing increasingly resistant to invoices for printed materials, especially if these documents were merely looked at and then recycled.

                          Yet law firms have a lot to lose if they don’t get it right. One estimate suggests firms lose up to £12 per day per lawyer in unrecovered costs such as these. For a firm with 50 staff, that’s nearly £160,000 per year. In Conscious’ top 200 UK law firms, some of which have 150-2,000 members of staff – the unbilled costs could be staggering.

                          A better solution

                            For organisations making the shift to negotiated pricing models, especially related to document management, Nuance legal document solutions are an optimal means to create cost efficiency and preserve profitability. Some of the cost-saving benefits Nuance solutions can deliver include:

                            • Improved workflowsYou can optimise legal workflows simplifying complex tasks and making life easier for your mobile workforce. For example, a centralised print, capture and cost recovery system reduces IT spend while providing a single view into cost recovery opportunities.
                            • Expense management and trackingWhether your clients are on billable hours or negotiated pricing, Nuance seamlessly and accurately tracks all client expenses, exposing your true costs. You have the detailed insight required to control expenses and optimise profits with efficiency.
                            • System consolidation: Separate cost recovery and document workflow solutions erode productivity, erase profitability and cost more to maintain. Nuance’s single platform blends these critical functions to consolidate your systems and centralise administration.
                            • Intuitive solutions for maximum productivity: Nuance solutions offer a consistent user interface that encourages user adoption, helps enforce the application of the firm’s policies and enhances productivity.

                            Stradley Ronon, a leading law firm, recently reduced its annual costs with Nuance cost recovery and expense management solutions. The firm successfully consolidated too many decentralised scanning and cost recovery solutions and gained a single solution capable of providing cost recovery, scan routeing, print management more. As a result, Stradley Ronon significantly reduced annual support costs and increased recovery – all for a stronger bottom line.

                            Gain a new advantage

                              As more legal firms shift from billable hours to negotiated pricing models, executives charged with maintaining profitability will focus on ways to reduce expenses and integrate cost efficiency throughout the legal process including document workflow management. Nuance has the solutions to help.

                              Nuance Legal solutions

                              Learn more about Nuance’s legal solutions to see how you can save your annual costs

                              Learn more

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                              How artificial intelligence can transform NHS patient services

                              Artificial intelligence (AI) could easily be defined as the technology industry buzzword for 2017, with almost every vendor trying to attach themselves in some way to this rapidly developing trend. Once purely the splendor of sci-fi - with films such as Terminator and I, Robot predicting the demise of the human race - AI is now actively transforming our daily lives, from helping us pay bills to supporting doctors to determine patient ailments.
                              scientist using interactive board

                              Intelligent investments 

                              Nearly half of NHS trusts (43%; obtained from a Freedom of Information (FoI) request) are investing in artificial intelligence (AI) enabling patients to ‘self-help’ when accessing services. The trusts are harnessing technology such as virtual assistants, speech recognition technology and chat bots to ease the pressure on healthcare workers across their organisations.

                              These vital investments are geared up to primarily provide access to information and services all-day, every-day, but they also play a key role in reducing the numbers of patients queuing to see their GP for information they can now access through a virtual assistant.

                              Reducing the documentation deluge 

                              Research commissioned by Nuance in 2015 into the impact of clinical documentation in NHS acute care trusts revealed that clinicians spend over half of their work day on clinical documentation. In a more recent Nuance study of UK GP practices, over nine in 10 reported that patient documentation was a considerable burden for their practice and that in 49 per cent of the practices, over half their patient documentation is paper versus electronic format.

                              By deploying technology – such as speech recognition and artificial intelligence – clinicians can process clinical documents quickly and accurately, reducing the need to outsource transcriptions or hire additional secretarial support. Alongside improving the speed and efficiency in terms of the process of building clinical documents, Artificial Intelligence can support the development of more accurate and intuitive clinical documentation, including patient records.

                              With staff across the NHS already under enormous pressure to deliver first-class services, access to supporting technology to ease this pressure will be key. Yet many doctors are still forced to spend half of their time documenting patient care. While it is encouraging that some departments within trusts are using tools like speech recognition, with nearly all of them still reliant on pen and paper in some form, there is a significant opportunity to drive up this usage across the board.

                              Our goal is to bridge the gap between patients, doctors and technology, putting patients in a position where they have access to vital information and support anywhere and at any time, and freeing doctors up to focus on the patients most in need. The combination of these two aspects working in tandem should see a far more resourceful NHS, with delays on the decline and healthier, happier and more informed patients on the rise.

                              Read the full article here

                              Make it easy and fast to update your electronic patient records

                              Download our Clinical Documentation ePaper and find out why it makes sense to give clinicians a voice.

                              Learn more

                              AI is spawning new models of care, not just cars

                              AI is making it possible for people to interact with smart devices and tools that anticipate needs and share knowledge in ways that save time, improve the experience or enhance decisions. We may not realize it’s all around us whether we’re searching the internet or being offered articles specific to our interests. In healthcare, AI shows great promise in helping physicians deliver better and more personalized patient care.
                              Young boy throwing a paper airplane

                              Machine learning and artificial intelligence (AI) have already seen some successes in self-driving cars, smart homes and manufacturing that we used to believe could only happen in our fantasies. These technologies are pushing the limits of innovation and raising expectations with every passing day. It’s exciting to think of the potential AI holds for empowering patients to manage their health more actively and successfully outside of a hospital, and for bringing physicians closer to their patients.

                              According to a poll taken after HIMSS17, 34% of HIT respondents are researching AI and 20% are either actively planning or deploying these technologies right now. Working at Nuance, I see breakthroughs in this technology every day, from giant leaps in the accuracy of speech recognition and language understanding to proactive consumer engagement or conversational assistants that provide communication, critical thinking and support for physicians providing patient care, charting or placing orders. AI powered computer-assisted physician documentation (CAPD) went from being relatively unknown or understood to something physicians are seeking as a tool to help give them back time in their busy days.

                              I believe in the next two years, AI will follow the same path as the cloud in the healthcare industry. Once feared particularly by healthcare administrators, cloud technology is now widely accepted and sought after because cloud-based solutions are light and easy to deploy, and offer clear benefits to both IT staff and end users. It helps caregivers and information move with patients while adhering to tight requirements for security and privacy of personal health information (PHI) of patients. AI in medicine has its own hurdles to overcome, but nobody really believes that machines will replace physicians. A self-service model where patients are more actively involved in their own care is on the horizon, and physicians need more visibility to patients’ adherence and health to support it.

                              AI technologies, which are helping physicians with difficult or repetitive tasks today, are poised to do much more and deliver even greater clinical decision support in the exam room and in the patient’s home where information needs to flow to close the loop of care.

                              What does the future hold for machine learning and AI?

                              Wondering what the impact for these technologies will be on patients and physicians?  Read more of my thoughts in CIO Review, “Machine Learning and AI: Revolutionizing the Physician/Patient Relationship.”

                              Explore AI-powered solutions for healthcare

                              Learn how Nuance is helping physicians and patients reshape models of care with AI-powered solutions

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