The experience of going to the hospital is well-known to most of us. We check in, sit in a waiting room until the clock on the wall runs out of batteries and stops ticking, the paint cracks and falls off, and we miss our own birthday, twice. Finally our names are called, and someone takes our blood pressure, and then we again sit in a room by ourselves for a second eternity. When the doctor finally comes in, it’s like being admitted to see a monarch. We exchange formalities, discuss our issue for approximately 7 minutes, take our script, and are on our way. In all those moments of impatient isolation, one thought inescapably recurs over and over: What does that doctor or nurse actually do outside of the 7 minutes he or she spent actually talking to us?
Unbeknownst to most, doctors and nurses actually spend an inordinate amount of time manually documenting our care. After every appointment, our healthcare professionals must annotate our ailments, write up our treatment plans, cross-check drug interactions and the latest medical literature, and ensure that a defensible record of care is intact should it be needed for future follow-ups or malpractice suits. This laborious process takes a tremendous amount of their time, which in turn reduces patient throughput, increases the time it takes to get appointments, and often results in the endless wait times we all have experienced.
Nuance Communications is on a mission to change that. Under present conditions, more than 50% of a doctor’s time is spent on clinical documentation, an hour a day is spent searching for relevant information, 73% stay at work late to finish their documentation, and 58% indicate that their notes would be more complete if they had more time to spend on them. Using cutting edge AI and machine learning, Nuance is attacking the systemic time-sink problems in healthcare to reduce the burden on physicians and improve patient care through a number of innovative product offerings.
One frontline product under this initiative is Dragon Medical One, a cloud-based speech-recognition platform. This product allows medical professionals to verbally transpose their narrative thoughts on patient care into an Electronic Health Record (EHR). Due to high accuracy rates, tight integration with existing systems, and user-friendly interfaces, this innovative software has the ability to drastically reduce time spent typing (or worse, handwriting) medical documentation. Further expanding on this innovation, Nuance also offers Dragon Medical Advisor, which takes this “basic” speech software and integrates learning algorithms to analyze distinctive patterns, suggest questions to ask the patient, or request additional evidence to strengthen a given diagnosis. This analysis occurs in real-time, and even goes as far as recommending improvements to the specificity and strength of a given narrative. Another product, PowerScribe, provides voice-enabled immediate access to clinical guidelines at the point of documentation, further improving the quality of care and reducing or eliminating laborious research. The value these products create in provider time saved alone is tremendous. Further, this modern integrated system secondarily improves diagnosis specificity and outpatient risk-adjusted payment models, resulting in both improved patient care and lower risk to the patient, the hospital, and insurance companies. These tools can be stacked with modern data analytics as well. Nuance has pioneered a product known as CDE Triage which reads and analyzes patient documents and EHR’s in real-time, providing advanced statistics and recommendations, even recognizing opportunities for improvements in diagnoses and clinical indicators.
In addition to its focus on documentation process improvements and analytics, Nuance offers an open platform for AI algorithms to assist and augment radiology physicians. This use of AI brings together coders and doctors in a time-saving and care-enhancing two-sided platform with network effects, effectively “expanding human intelligence” in the radiology space. Doctors are able to do their jobs better and patients receive better and more accurate care in less time.
Nuance captures value from these products by licensing to hospitals and clinics for subscription fees and by charging royalties from developers for algorithm deployment or charging doctors a small use fee. Thus, the main challenge they face going forward is simply competition and market penetration. Fully integrated product suites using advanced technology like AI need to simultaneously be value-adding, up-to-date, and widely adopted to maximize their ongoing value to providers. However, Nuance appears to have found a largely untapped domain in which to create value—healthcare providers have been swamped in mundane and inefficient swaths of time-wasting work, and Nuance is leveraging innovative technology to save the most precious clinical resource of all: time. Given their market pioneering positioning of innovative products that truly create value, I believe they are in an excellent position to continue succeeding.