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 Welcome to this Week in Health, it influence where we discuss the influence of technology on health with the people who are making it happen. Today we're going to hear from two fantastic leaders, Diana Noel with Nuance, and Dr. Amy Compton Phillips with Providence. We're gonna talk about improving the clinician experience through voice and ai.

And, uh, towards the end we discussed some of the silver linings, uh, that have come about as a result of our covid journey as an industry. My name is Bill Russell, former healthcare, C-I-O-C-I-O, coach, consultant, and creator of this week in health. It as we approach 250,000 downloads for the year. I want to thank Sirius Healthcare for supporting the mission of our show to develop the next generation of health leaders.

Their weekly support of the show and our channel sponsors as well has allowed us to expand and develop our services to the community. And for that we are incredibly grateful. I. Now onto our show. All right. Today we have Diana Noel, the GM of Nuance Health Division, and Dr. Amy Compton Phillips, the Chief Clinical Officer for Providence joining us.

Good morning and welcome to the show. Thanks so much for having us. Thanks, bill. Yeah, I'm, I'm looking forward to this conversation. I've, I've talked to a handful of people at both organizations, talked to the CTO at Nuance, and you guys are doing some really cool things around the, uh, ambient. Clinical intelligence.

We're gonna talk a little bit about that. Talked to Providence, talked to a couple people at Providence. So, and, and really innovative company. You guys are doing a lot of really fun things. So we're gonna explore this, this partnership. But before we do that, Amy, let's, let's really start from the beginning.

Tell us a little bit about the partnership between Nuance and Providence. And, uh, actually as you're doing that, give us a little background. I think a lot of people know who, uh, Providence is, but give us a little background and then talk about the partnership. Sure. Well, Providence is a large healthcare system based up and down the west coast.

So we go from Alaska down far as far south as Orange County and as far east as Texas. And uh, we have 51 hospitals, over a thousand medical clinics, 120,000 total employees. So a pretty big footprint over a big geography. And one of the big guiding principles that we have is we're really focused on delivering on the quadruple aim, right?

So better health outcomes on more affordable care, but also changing the experience of care. And that experience, the reason it's quadruple aim, not the triple aim, has to be for both patients as well as for clinicians. As we've gotten going with the digitization of healthcare, bringing in electronic medical records, moving services to the cloud, being able to do things like book appointments online, we've actually added complexity to the physician's day and what always had been the primary.

Element of healthcare that visit between a patient and their doctor, whether that's online or whether that's, whether they call, click or come in, whether it's it's in the virtual world or in the real world, that focus, that conversation should be a person with a clin, a caregiver, right? A nurse, a doctor. I.

And so instead, what what has happened with the advent of EMRs is we now have a third element in the room. We have a, a computer that actually changes and interrupts that, that relationship between the doctor and the person because the doctor's sitting there typing on a computer instead of looking at that person.

Okay. And so what the partnership with Nuance is really doing is, is helping us on our quest to simplify health, to actually make great care with great compassion, easy and available to, to perform. And so with nuance, with particularly the ambient technology, if we can somehow take out that third element in the room, start making that about the doctor and the patient again.

And having the documentation aspects of what goes onto our EMR be simplified and streamlined, we'll have a real win in our quest towards help for a better world. So, Diana, give us an idea from a technology, uh, perspective. Back when we did himss, I think the last HIMSS we actually did. We, we got to see your ambient clinical intelligence in action in this booth.

It was really impressive. I mean, it was essentially a physician seeing a patient having a conversation. You had, uh, cameras in the room, you had audio in the room, and it was actually documenting, it was doing the note. It was the whole thing, and then the doctor just went over and approved the note and away it went.

Now that was. And they said it's like this is, this is the vision, but is, is that what we're talking about here? And, and how far along are we? Yeah, so that is, that is the vision that we brought to market. We actually we're ready to kind of ga that product, did that right at the hys right in March of this year.

And it is live out in the market. It is being used in exactly the, the environment that you saw it in. Uh, it through patient consent. Uh, we accurately do capture and appropriately contextualize every word of the patient encounter. So we really are targeted at what Amy has described to really make sure that the conversation can go on between the patient and doctor and in the background, the ambient device is listening, capturing it, and, and then certainly proving it up to serving it up to the doctor so that they can review it.

Make any final changes and certainly feed that back into the AI learning loop, and that's the evolution of that solution. It's referred to as the Nuanced DAX or Dragon Ambient Experience Solutions. So it is out in the market. Dax. So does it work also in a telehealth setting? Is that another area you're looking at?

Yeah, so definitely with Covid arriving, it definitely works within a Telehealth environment, so you can automatically use it in a telehealth environment. And then it has varying levels of deep integration with various types of providers. And that's certainly, I think not only in Covid, but post Covid is gonna be extremely important.

And I think even more so . In a telehealth environment, you can even imagine even more. So it's really critical to kind of develop that relationship through the video between the patient and the doctor, and you don't wanna have the doctor having to be burdened again by the administrative aspects of the conversation.

Yeah. So, Amy, I, I, I wanna talk to you about really what, what are the desired outcomes for Providence from this, from the nuance. Partnership and the technologies that you're looking to, to, to deploy. Do you have some metrics that you're looking at? We do, and, and several of the metrics are really related to the fact that, as I mentioned before, healthcare's gotten more complicated for physicians, particularly as you start doing things like typing.

And so what we're finding is that rather than back in the, when I first started practice, right, I would just jot a note down in a chart and then I would have it in my chart. With typing. We spend a lot more time on nights and on weekends, and we can actually track how much time people spend outside of a workday working.

Right? The other thing we are tracking is how much time and how much burden physicians feel from the administra. That comes along with pri. Practicing medicine and also nurses, by the way, same thing, right? That, that how much time do you spend typing versus doing your real job, which is caring for people.

So there's the actual time that we can monitor. There's the perception of time and then there's overall burnout scores and, and participation with the EMR is one of the big drivers of burnout. So those three things are easy ones for us to to shoot, to improve in the near term. Is, is there, is there a learning curve to this technology and is there, is there a.

A significant capital expense. Do you have to set up rooms and set up technology or is this, is this more of a cloud-based type thing that you're gonna be able to roll out and educate the physicians as you go? Yeah, both and, right. So there's always a learning curve to how do you use technology, think about how you use your iPhone when you first got it versus how you use it now.

Right? There's, there's always, always things that you can do, but, and I'll let Diana talk about the background of the technology. But there is definitely a, a individual learning curve of how physicians can speak and, and have it be interpreted in a way that's useful for their ongoing use of that information.

Yeah. And if I can just add, it is a cloud-based. It is not. Extensive to get it up and running. You can actually start with a mobile app. Uh, but then we also have the, what you had seen before is the device, uh, so you can do either setting. So it's very easy to get started. But as Amy mentioned, usually what we see in these

Pilots, early adopters. The installations that we've had thus far is there is work that goes on between nuance and the customer around what is the specific situation that the physician would like to have in terms of their particular, um, structure of their notes. And so we work with them to get the template set up.

We kind of do a couple revisions of that, and then we're sort of off and running, and then make sure that the solution is adaptable to what the physician would like to see. And certainly there's that element of learning curve. And then in the background scene, obviously I think one of your questions is likely, what is the learning curve of the actual technology?

So we can touch on that now or in the future. Well, uh, so let me ask you this. So with, with the Dragon solutions that we used to have, we, the physician used to have, right?

Put their voice in and train the system to understand them. It it is that, are we still doing that kind of process with it? No. No, we are not. So, I've actually, I'm smiling because I've seen and heard of stories where people bought, like the biggest computer they could get so they could use the initial, uh, version of Dragon because it did have such.

Kind of learning curves and you had to teach it and train it. We're beyond that for sure. It is not in that regard. What we're really talking about now is the AI learning, ongoing learning of the conversational and the aspects of what's most important for dropping into the note and what is maybe sort of background information.

So . The AI learning is much, much different than what you would've experienced in the Dragon adoption. So, so Diana, help me to understand, you guys are, you guys have announcements coming out pretty often. You guys are right squarely in the middle of. Of this clinician experience and even the patient experience as well.

I mean, you guys are where voice interacts with the, with the medical record and the medical establishment. You guys are, are right there. Help me to understand, you have an announcement with Microsoft around Azure. Is that part of this as well, that uh, of the partnership you're doing with Providence?

Providence? Yeah, so Nuanced Acts was innovated as you noted with Microsoft. Uh, we leveraged their Azure platform and our AI technology and that's . Securely capturing and contextualizing every word of the patient encounter. So certainly the deployment of Nuanced Dask Dax will be certainly supported by Microsoft.

Beyond direct integration, I think Microsoft also shares that this collaboration is a prime example. Of how you can have multiple parties really bringing together the technical and domain expertise that each of us have. Obviously, uh, Providence is bringing significant clinical domain expertise. We're bringing aspects of the technology and I think we're all gonna learn and hopefully kind of really accelerate sort of our adoption curves here.

Yeah. So Amy, let's talk about this. You have a fairly large organization. Some of your physicians right now are, are hearing this and they're going, okay, when am I getting this? When is it gonna gonna come out? Uh, what kind of approach are you taking to introducing these technologies? A across the, the entire organization?

Yeah. Well, it's, we have to do it as a phased approach because we have to learn. Right. And you, you don't start everywhere all at once and do anything badly everywhere, all at the same time. Right? So you, you, you. And that's what we're doing right now is, so we're really starting with the PowerScribe and radiology.

We're starting in a couple clinics. We're really learning how to implement it. We're learning how to train on it. We're learning how we can actually make it work to. Make the promise of making lives better for our clinicians and for our patients. And then we'll roll it out. And as Diana mentioned, because it is a cloud-based solution, if it, if it works really readily and easily, we can roll it out really quickly.

But we know that there's always a learning curve and so we're taking it slow with initially starting with these few clinics in a few specific applications in both surgery, radiology, as well as medical fields. Yeah. So.

And really integrating into the workflow and how important that is. You guys are also using AI technology. Just a lot of technologies coming to, uh, together. Let, let's talk about that terminology though. It, it's, it's really understanding oncology, cardiology, all those different things. How. Is, is, is this solution really targeted, uh, to certain practices at this point?

Or are you starting to expand to, to more practices as you go through because of the use of ai? Yeah. So you've really touched on, I think, a deep piece of how AI has to kind of progress. And we have the benefit of having that experience from Dragon and the years and years of kind of voice. But you're right, AI is going to look at the medical field and look at each of these specialties and as we know, each patient encounter and each.

Specialty situation has different levels of complexity and so like you would imagine, just like Amy said, they're gonna roll it out. We also did really focus on specific areas to start. Now we cover all specialties, but we really guide that. The most mature ones right now are in orthopedics, podiatry, other areas, and we are coming out with additional, we're kind of coming up that learning curve in many areas.

Cardiology, urology, ENT, primary care there, . These are all on the roadmap and they are at various levels of degrees of complexity and therefore at different degrees of kind of their ai, uh, powered solutions or at a different stage in each of these, with some of 'em, as you mentioned further along. Yeah. So Amy coming back to you, Providence is really known.

They have the innovation group that. That, uh, has a portfolio of companies and things coming out. Is there any intention to develop new product as, uh, products as a result of this, or take anything to market as a result of this? Well, it, let me just go back to one real quick thing is that Providence firmly believes that data, digital information technologies will change the future of healthcare.

We also know that when. When tech companies tried going into healthcare all by themselves a decade ago, nobody succeeded. And so we believe that this partnership between organizations like Nuance and with Microsoft, with healthcare experts, so we have technology experts, innovation experts together with healthcare experts, and those partnerships are going to be the ones that launch the tools of the future.

And so this is one of the things that, that Providence is so excited about in this partnership with Nuance is that we absolutely believe this is going to be something that helps transform healthcare and is one of many that we hope that both the, the capacity to understand spoken language, distill spoken language, use AI to help us actually advance on, on not just understanding, but starting to process and suggest.

So I think the future is incredibly bright and it's partnerships like this that are help, going to help actually turn that from idea into reality. Fantastic. So if I could get off the beaten path a little bit here, I, I have, you two are phenomenal and I just wanna ask you some questions. So we're, we're.

Care at a distance is such a huge deal during, during this pandemic. And I, I just wanna hear from you, what kind of solutions have you seen, what kind of things are we doing today at, at maybe at Providence? What kind of things are we doing with voice that is helping to reduce the number of touch points, conserve, PPE and those kind of things.

What kind of things is technology playing a role in, in how we're delivering care? Maybe, uh, I, I'm using the term care at a distance where we're, we're creating that separation for protecting the clinicians. Yeah. So I'll, I'll start on this one, Diana, if you don't mind. Something that Providence did early on when Covid first hit was we realized that if, if our, all of our algorithms and all of our, our thinking was bring everybody in for an evaluation, we were gonna drown, right?

That healthcare couldn't handle the concerns. And so we started with the premise is, if I were a patient and I Googled on do I have Covid, what information would I wanna find? Let's do that. And so we worked in this case with Microsoft as a partner in built a chatbot. That helped triage patients to going from, um, no, you don't have any symptoms to, yes, you potentially have it.

Would you like to a, go to a telehealth consult or would you like a visit? And so we were able to very rapidly in, in the course of a week, go from not having anything to having automated technologies on the web available for anybody to use. And in fact, we then gave Microsoft and Providence gave that chat bot to the CDC.

And since that time it's been used, I believe hundreds of. So that was one thing, one way that we could use it. And that that isn't voice, but you can adapt it for voice. Right? But, but you start with where you are, which was, was go through the algorithm. The other, the other thing we've been able to do since then is continuously adapt that chat bot.

So now we're at the point where you, you're worried you have covid. We're working with another partner, LabCorp. FedEx tests hits home to patients so that they can actually self-administer their own test, a nasal swab that they FedEx back and within 48 hours they can actually get a test done with with care.

Another thing we've done is to make sure patients that if they're at risk like they have, they do come up positive for covid and we're worried about them, but we don't wanna put them into a hospital bed. We're now doing home monitoring with nurses, monitoring facts of information. That come from patients being monitored at home and we're up over 15,000 patients that we've monitored at home care.

Being able to use this kind of moving knowledge, not people letting patients have minimally disruptive medicine, getting care in their home without having to be in an uncomfortable hospital bed, isolated from their family. All of those things, allowing patients to get care where they live, work, and play, rather than in our facilities, in our bricks and.

Have been hugely impactful, lowering the cost, improving the experience of care, and really improving the outcomes of the people that we serve. And all of that's been totally enabled by technology. That's fantastic. Diana, where, where's Nuance been asked to really play a role in, in the pandemic at this point?

Yeah. So similarly to what Amy outlined, I think one we already touched on was people said immediately, do you have tool sets that we could use for telehealth? Also, how do we get our clinicians to be able to work at home? So we've been asked around that. We also have been asked, how can we keep these deployments going of your necessary tools, but do it remotely?

I think the other thing that's . Been really exciting since I've joined in June of this year is really around taking technology that is used in other parts of nuance, not in healthcare. Really around exactly what Amy was mentioning around how do you just handle the increasing and overwhelming volume of

Frequently asked questions and where do I go for this and how do I get this started and, and can you remind me of what I'm supposed to do? And there's all kinds of technology, both voice and interactive types of technologies on our enterprise side that are used with airlines, banks, insurance companies, to handle those.

Extremely high volumes of calls and other elements. And so we're really introducing those at the request of many of our provider, uh, customers around how to just further enhance that sort of patient digital front door. So I think I. Covid has certainly kind of heightened the need to kind of do some of these basic things to just keep that interaction going.

I think those are here to stay, obviously. So some of those are, are things that certainly were asked of us to sort of accelerate. We're very happy we, we have some of those out in the market already. Uh, last, last question for you guys. We've heard a lot about silver linings. We, we go through this and it really has changed healthcare and how we, we do a lot of different things and maybe even how we design buildings, how we utilize technology, and where we utilize technology.

That pace of learning, that pace of being able to adapt everything from genomic information into new, new therapeutics, I think is absolutely here to stay. So we're gonna continue to see breathtaking advancements in the science. Last but not least, I think that we're finally having a breakthrough on how to equalize and equilibrate the, the inequities we have in healthcare.

The fact that we can move knowledge, not people. Now, the fact that we can get care using different tools from urban centers where expertise exists into rural areas where they have more need through telehealth solutions, through different kinds of . Technologic infrastructure. I think that's going to be a huge boon.

Any, anything we can do to reduce the health inequities in the country is a positive and I, I started to see glimmers for the first time in my career that we're going in that direction. Fantastic. Diana, we'll give you the last word, lasting impact of the pandemic on healthcare. Unfortunately, I think it's even heightened the worsen aspect of physician burnout.

Clinician burnout, but I am so encouraged by the fact that our customers who are handling all of this have really pushed forward and kind of said, technology's gotta help us. And I'm encouraged by the early adopters that have adopted Dax saying, Hey, it reduces my, um, documentation time by six minutes. My patients are scoring me higher.

It's. Nine minutes, less wait time for my patients. And so I'm just thrilled that the technology is helping because I really, I do believe that this has just put even more burden on the physician burnout, but our clinicians and our customers are really finding a way to really push through it. So I'm encouraged by that.

It's really been amazing. Something that allowed that to happen and, and we realized was holding us back is the regulatory burden went away. That the government allowed us to innovate. The government put up payment models that allowed care to be provided for differently. That kept both facilities intact as well as clinicians intact.

And once that regulatory burden was lifted, innovation was unleashed. So I think it's just a good lesson for us to remember in the future. Yeah, it will be interesting. And we're we're, and that's continuing. We just saw, I think last week they're opening up, uh, some more flexibilities for, for home care.

Telehealth really took off. A result of reducing the regulatory burdens, now we're seeing the regulatory burdens and really the acknowledgement of the value of setting up the home for, uh, potentially acute care settings as well as some of the, uh, more normalized already remote patient monitoring. It's pretty exciting.

It's really exciting. I think it is. I, it really is exciting that it's been able to be something that's sort of a bright, shining star out of a very challenging time. I wanna thank the two of you for, for coming on the show. Thanks. Really appreciate it. And thanks Diana. It was great seeing you. Oh, I agree.

Amy. Great to see you. What a great conversation. That's all for this week. Don't forget to sign up for CliffNotes. It's a great way to support the show. It's also a great way for you to stay current. If you're not familiar, CliffNotes is an email that we send out immediately following the show, actually 24 hours after the show airs, and it'll have a summary of the show, bullet points, key moments from the show, and also one to four video clips that you could just watch.

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