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HIStalk Interviews Janet Dillione and Jon Lindekugel

February 15, 2011 Interviews 5 Comments

Janet Dillione is executive vice president and general manager of the healthcare division of Nuance. Jon Lindekugel is president of 3M Health Information Systems.

2-15-2011 5-27-57 PM 2-15-2011 5-29-55 PM

Nuance and 3M Health Information Systems announced this morning a broad, strategic partnership to deliver ICD-10-ready clinical documentation and coding solutions, starting with Computer-Assisted Physician Documentation, which combines Nuance’s speech recognition technology with 3M’s Clinical Documentation Improvement content.

CAPD allows physicians to dictate encounters in their own words while prompting them for any additional information needed for proper ICD-9 and ICD-10 coding, enabling clinical documentation improvement a the point of dictation. It was designed to accelerate the implementation of ICD-10.

I interviewed Janet Dillione and Jon Lindekugel Tuesday afternoon before the announcement.


Tell me what the announcement means in simple terms.

Janet: Nuance and 3M have decided to partner to go after very deep innovations around clinical documentation, specifically targeted at the physician. Both companies saw the same thing happening with the coming of ICD-10. We had similar ideas of how to blend the strengths of both companies together. We viewed each other’s strengths as very complimentary and several months ago, initiated conversations.

We think with our Computer-Assisted Physician Documentation, we are able to bring an incredible piece of innovation and a really time-saving, ground-breaking change to physicians and the way they will document with ICD-10.

Jon: The partnership combines 3M’s core strengths in coding and Clinical Documentation Improvement with Nuance’s advanced speech recognition and Clinical Language Understanding technology. With the combination, we think we’ll be able to make a step change in helping physicians capture accurate documentation, especially with the coming ICD-10 transition, and do so in a way that will leave the physician more time for patient care. And in the process, help facilities achieve full and appropriate reimbursement, accurate quality reporting, and ultimately, successfully make the transition to ICD-10.

In a nutshell, we’re taking 3M’s industry-leading Clinical Documentation Improvement approach, which a lot of hospitals rely on today in their HIM and documentation improvement departments, and applying all the technology that Nuance brings and its industry-leading technology to deliver that content to the point of care, to the physician.


Describe how Computer-Assisted Physician Documentation works and how it looks to the physician as they’re dictating.

Janet: If you’re a physician in your classic workflow, you can be using Dragon. We have several hundred thousand physicians using Dragon. Physicians like the dictation technical workflow. You’ll be dictating through Dragon and will be able to take both unstructured data from the narrative, apply Clinical Language Understanding to it, as well as bring in any data that may have come in through a template that’s up in that EHR. We will grab that data and pass it into the 3M CDIS clinical knowledge environment, where we will have an environment with Clinical Language Understanding.

Essentially, we will be able to send back out of that engine to the physician, “Did you mean CHF unspecified, or did you mean an acute MI? Did you mean this, or did you intend to say something else?” Really trying to replace what happens today, with manual follow-up, where the next day, hours later, or even post-discharge there’s a lot of manual intervention going on with these charts and people poring through the narrative as well as what’s coming through the templates to try to get accurate documentation, both for the patient quality and the reporting that’s required as well as reimbursement. They’ll be able to automate that entire work flow and do it at the moment that physician is there inside that work flow.

Jon: We believe we’ll be able to drive physician-sensitive prompts, a limited set of prompts, directly to the physician to improve the accuracy of documentation right at the point that documentation is occurring.


Is your sense that there will be an overall time savings for the physician compared to dictation and then follow-up questions?

Jon: Yes.

Janet: Absolutely. There should be time savings for the physician, not to mention the efficiency and savings for the overall delivery system. We should be able to reduce this manual back-end intervention that’s happening now.

Who’s the ideal prospect?

Janet: Any delivery system that needs to deliver patient care with physicians as ICD-10 is being implemented. I guess that means the US delivery system. [laughs]

Jon: Every hospital in the United States healthcare system will significantly benefit from CAPD, be it their physician community through CMIOs who are interested in automated tools to reduce administrative burden on physicians to the financial community, CFOs concerned about receiving accurate and full reimbursement, reducing compliance risk, and getting cost out of the system. From an IT perspective, CIOs who need to ensure accuracy and completeness of the information flowing through the EHR.


ICD-10 has caused people to seek alternatives to manual physician lookup of codes, especially since there will be so many more of them. How do you think this approach will be accepted by the market compared to lookups or other on-screen prompting?

Janet: I think you’re exactly right. That’s what was interesting as we began to talk to each other. The industry to date had been predominantly focused on the back side, trying to help the coders with a lot of tools, and 3M has some fantastic innovation there.

But when you began to really understand what happens with documentation and how that stuff gets clarified, you really find how many queries and pings and e-mails are hitting the physicians, some of which get answered and some of which don’t. That’s where we thought that we could really bring the efficiency and the real breakthrough. We have had the opportunity to validate this. We have shown a mock-up to some physicians and we’re typically getting an a-ha reaction of, “That’s what we needed.”

Jon: On the very specific topic of customer reaction, we were able to show it to seven customers, large delivery systems, last week. The feedback was unanimously positive and they immediately jump into a detailed design mode because, “This is exactly what we need, and here’s the 15 additional things you need to make this do.” It was pretty exciting to see.

The other thing that gets validated as we review it with customers is that the value of this as a passive ICD-10 training tool, frankly. By deploying this long before the actual October 2013 date, physicians, in effect, are being trained on the level of granularity that their documentation needs to include as we move to ICD-10. As we deploy this as an ICD-10 solution, it’s going to drive that education surrounding what’s needed in documentation, framing it in a passive way that isn’t a classroom lecture. It’s a real, live, on-the-job learning exercise for the physicians that will make the transition much smoother when we get to 2013.


For organizations that haven’t given as much thought to ICD-10 as they should have, what are the opportunities that it brings to them, assuming that CAPD makes it easier to capture the codes accurately and quickly?

Janet: ICD-10, because of the sheer scale of it, is forcing just about everybody to question how they do what they do today. There are estimates of almost a 50% reduction in efficiency on the coding side. That’s stunning. Even if you could afford the budget to increment your staff, there isn’t enough talent in the market.

Folks who have not started to look at it, when we make this announcement, I think it will show them a way to not only start to look where they had typically been looking, but also to really look for process innovation. How can we do things differently here? How can we do things more intelligently? How can we bring more of the intelligence up to the front part of the process?

Jon: On the cost side, we view this is as a direct means of driving training and accurate documentation upfront and we will take some cost out of the ICD-10 transition by deploying the solution upfront. On the other side of it, our computer-assisted coding will now be powered by the Nuance Clinical Language Understanding natural language processing module, which will take cost out of the back end for sure, offsetting some of the increased coding resource requirements surrounding ICD-10.

When we lay all that out, we really hope to offset the increased cost during the transition for the provider networks in a way that enables all of the advanced analytic work longer term that should be able to be done from the much more granular view of medical transactions and the delivery of healthcare.


Any concluding thoughts?

Janet: I think the industry will be a little bit surprised to see these two partners coming together. People will see how quickly this came together and how amazingly aligned the vision was with both companies. Jon and I actually met a matter of months ago and we started to see the synergies between these two companies. The teamwork has been fantastic and I can tell you that the organizations — the R&D folks, people who meet with customers every day — are positively pumped to get this out there and get this in front of the customers. We really think we’ve got something unique here.

Jon: It’s really just taking two great brands in the healthcare IT space that deliver great best-of-breed solutions and combining them in a way that really is going to solve some significant client problems and pain points. We’re just thrilled, both companies. Everybody involved is really excited about the opportunity. We just can’t wait to get the announcement out and get going on it.

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Currently there are "5 comments" on this Article:

  1. I think the potential here between 3M and Nuance is really quite amazing. There is no question that automation will become an absolute necessity as ICD10 gears up. Furthermore coupling the Clinical Language Understanding (NLP) with Clinical Documentation Improvement (CDI) offers tremendous value to both clincians and hospitals. Smart alignment.

  2. Neither has an engine that has specific rulesets here that are needed for suggesting appropriate codes during the documentation process.

    Nuance has a speech recognition engine . . . . FAR DIFFERENT than what is needed here in this spot . . . .

    3M has ZERO NLP other than the pattern matching they get from CodeRyte who is oddly missing here as at least they have Coding specific NLP although only applicable in outpatient and specifically radiology settings.

    They will fool some HIM Directors into buying this approach. But they are getting their clocks cleaned in true NLP for coding and physician documentation and this is like and IBM release in the 80’s . . . “we are the market leader so listen to the almighty IBM . . er Nuance and 3M” . . . .

    CALP is innovative thinking no doubt but this combination cannot deliver it as the key is NLP that is specific to the specialty task required . . . . neither has it . . . period . .

  3. This sounds like the release put out in a hurry before HIMMS to slow the momentum of all the NLP providers who have beaten them to market. Despite Nuance buying a “NLP” company, L&C, no mention of that here. This is old CDA tagging brought over by Nick Van Terheyden from his move from MModal to Nuance.

    Showing Dr’s “mock ups” and promising Late Fall 2011 is pretty suspect. The other issue is the best NLP engines can “search” and “recognize” free text. This does neither and true NLP is agnostic towards using a particular source (i.e. Nuance Transcription or Speech).

  4. when will Sorian clinicals be converted from the press release, mock-up and ppt to a working version?? oops last employer . . .

    when will the 3M Coderyte partnership result in real CAC and not just a search engine google search of a stagnant database . . . oops last partner . . .

  5. Two great organizations working together to provide a much needed solution. It will be interesting to see how they will be able to help physician documentation without leading to alert fatigue.







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