The transition from volume- to value-based care is underway in the U.S., but a tremendous amount of uncertainty—and anxiety—continues to plague the providers who deliver that care.
It is precisely that uncertainty that inspired speech recognition vendor Nuance to disrupt its own business model by opening its source code to collaborators, reimagine its cloud network and enter into partnerships with others interested in providing support to physicians on that journey.
Clinical Innovation & Technology sat down with Karen Holzberger, vice president and general manager, diagnostics, Nuance, Burlington, Mass., to discuss the changing dynamics of healthcare, the evolution of its speech-generated reporting platform and how partnerships are helping Nuance to innovate the solutions providers need to succeed in the new healthcare paradigm.
Q. What do you see as the greatest challenges providers will have to meet in the next five years?
Holzberger: With the dynamics of healthcare changing to a patient-centered system, it’s challenging—and exciting—to see providers at the forefront of the quality movement, driving better outcomes for their patients. That’s really the heart of this.
We’re still in a gap period between pure fee for service and value-based payment structures in which providers must quantify and report on the quality aspects that drive outcomes. This gap period is a real struggle: How can they make the same income that they’ve had over the past 20 years? How do they manage through this gap period to drive quality reporting and get to value-based healthcare?
Q. As a developer of health IT, where do you think vendors should be focusing to assist providers in moving to value-based care?
Holzberger: One of the markets that Nuance serves centers around radiology, with our PowerScribe speech recognition reporting system. We’ve been at the forefront of clinical accuracy in voice-to-text reporting, with one out of every two radiologists in the U.S. using our systems.
Five, six, seven years ago, clinical accuracy centered on the challenges of voice to text. Utilizing clinical language understanding, we can now take the report through a quality check with our Assure product. You are not going to get laterality incorrect, you’re not going to get gender incorrect, you are going to find those mistakes in an easy, simple way.
With vendors like Nuance—Massachusetts General Hospital (MGH) likes to call us the toolmaker—we had to move from supporting clinical accuracy in voice-to- text interpretations to helping the consumer—the ordering physician—get to the next care pathway for that patient. We knew we had to start building toolsets to support clinical accuracy and less variability in reporting, to make that report actionable.
Through collaboration with the American College of Radiology (ACR) and MGH, we just launched point-of-care access to electronic clinical guidelines. We help the radiologist to send a more robust and actionable report back to the ordering physician, who can identify a clearer care pathway for the patient. Equally as exciting, is that we have leveraged our PowerShare network to make these guidelines accessible regardless of whether or not the provider uses PowerScribe.
That’s where healthcare IT vendors, as a whole, come into play.
Q. You recently launched an Innovation Program to open up your software platform to developers. Who do you envision using the platform and how has it changed your relationship with providers and other vendors?
Holzberger: It has been phenomenal; it has opened us up so that we are looking outside the walls of radiology. We are working with other visible light vendors that generate imaging around the patient journey but have difficulty connecting with the patient. Tools are under development, such as APIs and other technologies, that enable non-radiologists to be connected on our network to drive better outcomes and better care pathways for their patients.
We are thinking about our network beyond the ability to share images and reports: It’s about information at the point of decision.
For instance, radiologists are starved for information. They can’t get the information they need out of the EMR, it’s buried in there. We are using innovation partners to help drive information availability, whether its DICOM images, visible light images, information, education services or clinical guidance to make better decisions.
Many of the early innovators in imaging informatics have their