Microsoft was wise to acquire Nuance as a way to reach physicians where they are. It opens a path to bring advanced technologies to the most important aspect of our healthcare system: physicians providing care to patients. This is also a space that desperately needs innovation- EHR systems are reported as a top source of clinician burnout and have failed to deliver their promised efficiency improvements. But is voice the right approach to addressing the shortcomings of EHR systems?
There is compelling evidence that ambient voice technology is an important part of the future of healthcare delivery. When done well, it can make an awfully burdensome component of physician workflow, note writing, nearly effortless. Efficiencies brought by such functionality will enable better care at lower cost and can be an effective tool in the fight to address clinician burnout.
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However, voice-based interactions are and always will be only useful for a limited set of the activities required of clinicians. While documentation is a huge source of frustration for physicians, it is not the majority of the work that they need to do in the EHR, and voice is of limited use in other areas. Voice is not the right medium to help clinicians quickly review a complex patient’s medical history, identify gaps in care, or handoff from one care team member to the next.
For many heavy utilizers of the EHR, chart review takes more time than documentation. A better visual experience interacting with that data can help save a tremendous amount of time for those physicians and make a meaningful impact. Health systems today are reducing the amount of time their physicians spending in the EHR by over 40% as a result of deploying predictive workflow systems that summarize the key information physicians need to see for a particular patient. Thousands of physicians across the country are conducting their chart review with these workflow platforms that sit on top of the existing EHR.
There are no industry corollaries to speak of where voice became the primary way that people interact with complex information. Voice-based interaction paradigms can be useful to answer specific questions and quickly enter information or take a particular action. But visual displays of data tend to be a much more efficient way to consume complex information, and you’d be hard pressed to find an industry with more complex data and under more pressure today than healthcare. This isn’t a limitation of voice technology as it stands; it is a permanent limitation of voice as a medium.
An ostensible appeal of ambient voice technology is the perception that physicians are technology averse, that introducing new technology into physician workflow is an uphill battle. After all, the promise of ambient voice is that it can be leveraged without the physician needing to change anything that they do; simply add a smart device into the patient room and let the AI work its magic.
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This simplicity is alluring, but also short-sighted. Physicians are not technology averse; they are just averse to bad technology, as anyone would be if they had to deal with the software physicians are required to use today. Ask any physician entering the workforce and she/he will tell you that they are craving better software, if only it were available to them. The need for new technology to be ambient is a workaround to allow for it to reach users without disruption, but solving the real root causes of the inefficiencies that exist in the software that drives physician workflow requires some disruption.
One particularly glaring deficiency of EHR systems is their inability to integrate across multiple sources effectively for physician workflow. Patient data is incredibly fragmented across a wide variety of EHR systems, payer systems, HIE systems and so on. It is, sadly, routine for physicians to make decisions with significant blind spots in patients’ medical histories. This fragmentation is arguably the single biggest issue with these individual systems, and voice does not directly do anything to address those challenges. A better way to visualize content contextually, however, can aggregate those data points across sources and intelligently surface that data and insights to users prioritized by what is most relevant.
To resolve the root causes of the frustrations physicians face with EHR systems, there needs to be a more comprehensive redesign of the experience of interacting with clinical information for treatment decisions. Voice technologies, which have so much promise, should integrate harmoniously into advanced user interfaces that display data in a more intelligent and contextualized fashion to clinician users, tailored to their needs. AI can predict what information to include in the documentation for an encounter based on ambient voice analysis and what information to display visually to the clinician. These joint solutions should drastically reduce the time users need to spend on documentation and other key inefficiencies with EHR systems. Microsoft investing in physician-facing voice technologies like Nuance is an initial step in that direction.
Craig Limoli is CEO and co-founder of Wellsheet, which is transforming the physician experience in the EHR with a predictive workflow platform. Wellsheet is used by thousands of physicians for more efficient chart review, care team collaboration, and decision support, and has an NPS score of 57. Learn more about how to reduce time in the EHR and physician burnout at www.wellsheet.com
