As the Chief Medical Officer for Landmark Hospitals, I’m responsible for seven long-term acute care (LTAC) environments, where we primarily treat high acuity medical patients. I am also the CMIO for Chartpad, a cloud-based EMR with Technomad based out of Bonita Springs, FL. In this type of setting our patients are very sick; they are often transferred from other hospitals and may come to us with 12 diagnoses and 20 medications. It’s our responsibility to make sure we are giving them the very best care possible.
One of the things I’ve seen in my 15 years of practice is the increasing number of requirements being placed on physicians. We’re seeing more patients every day, and with an aging population those patients are sicker. With Medicare cuts, we need to see more patients in order to break even financially. One of the ways we can combat these pressures is to look at the time-consuming processes in our day, and see how we can improve them.
Ideally, I’d like to get rid of my keyboard and mouse altogether. I want to be able to sit down at my Electronic Medical Record (EMR) and create all of my notes and place all of my orders quickly and easily, and then get back to my patients’ bedsides or to family meetings. To me, it’s all about interacting with people and spending less time at the computer.
That’s why I was excited to meet Florence. To set the record straight, Florence lives inside my computer. Named after Florence Nightingale, the pioneer of public health, Florence is a virtual assistant created by Nuance that uses artificial intelligence (AI) to help lighten the load of clinicians. Florence not only helps me to update the EMR more quickly, but it actually takes things a step further and thinks ahead to do things like create orders for me.
When I had the opportunity to try Florence, I jumped at the chance. Florence is now omnipresent and built into our EMR. I don’t have to type in the order, I can just speak it. No matter where I am in the record I can turn to Florence and have a conversation without touching the keyboard or mouse.
I’ve always found that one of the biggest problems of everyone moving so quickly is that doctors will put a recommendation in the plan of a patient’s medical record, but they might not place all the orders to activate that plan either because they get interrupted or are so busy that it doesn’t get done. Computer Physician Order Entry (CPOE) is very time consuming especially in a LTAC setting like ours which is why I felt that Florence was a perfect complement for our workflow.
The real benefit to me is as I think of something, I can order it immediately. If I’m creating progress notes and creating my plan, Florence can extract all those orders from my plan, create orders on its own and confirm them with me. This is a tremendous help in eliminating that error rate of stating something in your notes, but not actually completing all the steps to get it done.
I participated in a 6-month pilot with Nuance where Florence was integrated with our system, Over that period of time, we completed about 3,000 orders. I was truly impressed with the results. Florence reduced my time entering orders using CPOE by 35% and reduced my keystrokes to 0. Now that I’m even more familiar with Florence, I would estimate that I reduce my average input time by up to 50% on complex orders. You can see my side-by-side video comparison here.
I’ve found that Florence really guides you through the process. It’s a “conversational agent” using speech recognition and language understanding, but the beauty is that you don’t even notice it. As I enter notes or orders, Florence makes suggestions or asks questions when appropriate. That’s the built-in intelligence to assist the clinician for that error-free rate we are all striving for when we provide care.
Teenagers are not the only ones who use technology. I believe that most doctors want and need this kind of innovation. For example, if I rattle off an order I might not notice I missed something, but Florence will see what I forgot, and will ask me for it. Busy doctors need that help.
Artificial intelligence technology has come a long way in the last couple of years. I believe that AI-enabled solutions with this type of real time intelligence will help us shift our time back to our patients, while Florence can help handle all the important, yet time consuming clinical documentation and medical orders.
Publish Date: March 29, 2017 5:00 AM
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