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Are You Creating a Culture of Unwanted Employees? Twelve Low-Cost Suggestions for Welcoming New Hires
October 5, 2015 2:17 PM by Silas Gossman

[Editor’s Note: this blog was originally written by Kate Zabriskie] 

Statistics and practical experience show it costs time and money to replace an employee, so does it not make sense to new hires off to a good start? For very little money and a modicum of effort, you can set the stage for a new hire’s success.

1.         Send new employees a note (handwritten if possible) before they start work. These aren’t messages about policies or parking passes. Rather, you are writing to say “We are glad you are going to be working with us.” 

2.         Tell new people exactly what to do when they arrive on their first day. Do they park in visitor parking? Should they report to Human Resources first? Eliminating uncertainty will show that you’ve got your act together.   

3.         Make sure the space a new hire is going to occupy is clean and free of the last person’s personal effects and well stocked with supplies. Nothing says “We don’t care” like dirt and clutter do. 

4.         Does the new person get a computer, phone, or other electronics? If so, be sure to have those items in place as soon as possible. Without the proper tools, it’s hard to hit the ground running 

5.         If your organization has coffee mugs, shirts, or other promotional items emblazoned with the company name, gather these together, and present them to the new hire. Most people like a present, and this small gesture is another signal that you are welcoming and excited to have a new team member.  

6.         Avoid doubt and confusion by providing the new person with a written schedule for the first day. The schedule should include lunch with the immediate supervisor, new colleagues, or other people who will contribute to making the new hire’s first days a success. And while you’re at it, provide the firm’s emergency telephone number.

7.         Along those same lines, establish expectations early. Meet with the new person and review what you expect in terms of quantity and quality of work, appearance, hours, and so forth. Much of this could also have been covered by Human Resources or outlines in an employee manual provided by your organization. However, if something is important to you, highlight it verbally. New people have a lot of information to digest, and extra emphasis can’t hurt.

8.         During a new hire’s first few weeks, set up 20-minute informational meetings with key employees throughout your company. This should go without saying, but be sure to choose people who believe in your organization, set a good example, and can provide insight about the business. 

9.         A little background information can help new employees avoid potential landmines. While gossip is obviously not a good idea, insight on the idiosyncrasies of the workplace should be shared if knowing about them will help the new person without hurting anyone else.

10.       Pay attention to distribution lists. New people won’t necessarily see the emails or memos they should if someone isn’t looking out for them.  

11.       If the employee is new to your industry, share trade magazines, websites, and other resources that might be useful.

12.       Finally, check in throughout the week, but don’t be a pest.  

None of these suggestions is difficult to implement, but they all take planning. The good news is, it’s usually worth it. The faster you can get new employees up to speed, the sooner they will produce the work you hired them to do!

Kate Zabriskie is the president of Business Training Works, Inc., a Maryland-based talent development firm. She and her team help businesses establish customer service strategies and train their people to live up to what’s promised.  



Maximizing the Value of ICD-10
September 30, 2015 5:13 PM by Michael Jones

[Editor’s Note: this blog was originally written by Ken Edwards.]

This is a moment in healthcare when we are laying the foundation for new capabilities, new precision and new operational enhancements for healthcare organizations. If you embrace it -- and if you lead your team to focus on maximizing the benefits of it -- you will also be keeping your organization on the crest of the key major changes taking place in healthcare today.

That is true of vendors, providers, large healthcare organizations, payers and every one of us who can benefit from this change -- every one of us who is responsible for making this transition not just seamless, but purposeful.

For context, let’s look ahead.

Value-based Care
Under ICD-10, every claim filed with a payer will contain significant -- and significantly more detailed -- information about the true health of the patient. In aggregate, claims data will paint a richer, more complete picture of the patient’s story. ICD-10 will create an information-rich, nationally standardized system that will help us understand the full picture of the patient when they are receiving care.

Doctors are experts at understanding the patient’s health. Historically, the gap has been one created by data siloes and by large individual data-sets that do not contain -- on their own -- the correct or sufficient contextual information.

That is changing -- and the change is coming along with other major developments in healthcare. As reimbursement becomes more and more closely tied to outcomes, it is incumbent upon all of us to take a leading role in supporting the integrity of the additional wealth of healthcare data we are introducing into the system. Not simply because this is how we will ensure the continued financial stability of healthcare organizations, but because this data will play a crucial role in public- and population-health management efforts. It will be factored into decisions that affect all of us -- not just those who work in healthcare.

ICD-10 will provide additional and more granular detail about chronic diseases, comorbid conditions, disease-management best practices and mental healthcare, just to name a few top-of-mind examples. In aggregate, this detail will become a rich source of insight for evidence-based medicine, and also has the potential to accelerate the research process since historical data (both coding and clinical documentation) will become more comprehensive and specific. The data will underpin newfound abilities to manage population health as it will enable informed, accurate segmentation of patients within existing disease registries or among previously indistinguishable subsets of patients.

Fee-for-service isn’t going away, but as fee-for-value rises, identifying and addressing gaps in care (along with other aspects of population health management) will have greater and greater ability to impact your overall clinical and financial performance.

Fee-for-value requires clinical integration and comprehensive longitudinal records of care. The quality of those records starts with the granularity and quality of your documentation (AKA: the same foundation for coding accurately in ICD-10). Whether you’re striving to meet specific quality measures for a state incentive program or taking on new risk-bearing contracts with payers, documentation will play a significant role in how successful you are under fee-for-value models. Among other things, it will determine how wisely you expend case manager hours and other care intervention resources.

My advice to you is to embrace the change to ICD-10.

Surgeon Scorecards Can Be Cutting
September 22, 2015 2:38 PM by Silas Gossman

[Editor’s Note: this blog was originally written by Dr. Anthony Oliva]

The rise of healthcare consumerism brings with it new ways of evaluating doctors and healthcare organizations, including patient reviews and physician scorecards. This post examines what providers can do to manage their online reputations.

I’m a family medicine physician who has been training residents and medical leaders since President George Bush, Sr. was in office. In that time, I’ve found very few things that get physicians to spring into action or worry outside of a “code blue.” We’re trained to stay calm. And we’re methodical in nature. After all, we are trained in a profession steeped in knowledge, science and statistical proof. And we are a competitive bunch.

When training a group of physicians on the importance of clinical documentation last week, I brought up a screen from an online site that showed “Surgeon Scorecards,” listing specific facilities by location and specialty where I drilled down to show specific physicians’ names. This had a “shock and awe” effect, and left my audience with mouths agape. Immediately, every doctor in the room whipped out their phones and frantically typed their names in search of reviews, uttering a sigh of relief when they discovered this potentially damaging online scorecard site published performance stats for surgeons only. I had their full attention now.

Physician scorecards are a game changer
With online reviews, reputations are at stake, and this transparency of clinical performance is not coming soon, it’s here now. Physicians and healthcare providers alike want (and need) to know what can be done to prepare and get in front of this new, and somewhat scary, development in the world of healthcare consumerism. Knowing what patients are looking for in their healthcare experience1 and what they expect from their providers is key.

The good news is there are methodologies, tools and people on all sides of them that can help them monitor their reputations when data finds its way into the public eye. Here are a few suggestions on how to manage online clinical performance metrics:

  1. Manage information input from the start: Accurate documentation of clinical notes at the point-of-care2 is not only an important part of diagnosing a patient, but also of managing performance metrics. Record the patient story in detail and avoid gaps in information that can make the documentation unclear or unfamiliar, which can cause coding or payment issues, and make you look bad. Carefully input clinical practices, orders and recommendations ensuring missing details in clinical documentation are few and far between.
  2. Do a visual scan: See what online profiles exist today for you and your organization, and how they look. You and your team already have a sense of wait times, complications, mortality rates and patient satisfaction scores. Assess how closely these published metrics compare to what was expected — and what you can do to fix them.
  3. Consider the source: Take a holistic look at your online reviews and feedback3: is it a few grumpy patients commenting on a general site, is it data from claims, or scores from patient satisfaction surveys such as Press Ganey, HCAHPS)?  All of these can be helpful or harmful, so look at the source and quality of these reviews, and plan your attack.
  4. Remember, medicine is a team sport:  Seeing many patients quickly while practicing the Art of Medicine4 is a careful balancing act. A short visit can feel fulfilling and provide a positive experience if it’s combined with eye contact, communication and focused attention. The many people involved in the process from door-to-doctor can positively impact the experience.

I recently heard Hal Baker, senior vice president for Clinical Improvement and CIO, WellSpan Health System say: “Our quality improvement efforts are really driven around the whole care team. The high quality of care that is attributed to me, and that my practice is being measured on, is probably determined more by the other people in my office than by me.”  I couldn’t agree more. We all chose to work in healthcare because we want to achieve a singular goal: to help people to the best of our abilities. And helping starts with listening.

1. http://www.slideshare.net/NuanceInc/how-millennials-shop-for-healthcare-in-a-digital-world?utm_source=millennial-patient-press-release&utm_medium=nuance&utm_campaign=art-of-medicine-2
2. http://www.nuance.com/for-healthcare/clintegrity360/clinical-document-improvement/index.htm
3. http://whatsnext.nuance.com/healthcare/online-physician-reviews-influence-patient-decisions/
4. http://www.nuance.com/for-healthcare/artofmedicine/index.htm

Dr. Anthony Oliva is the Vice President and CMO at Nuance Communications. This post first appeared on What’s Next.

Will There Be a Rotten Tomatoes for Healthcare?
September 15, 2015 12:33 PM by Silas Gossman

[Editor’s Note: this blog was originally written by Dr. Anthony Oliva]

With the increased availability of quality scores and the consumer trend of product ratings and reviews, it won't be long before patients are relying online reviews to select their doctors and hospitals.

The site Rotten Tomatoes has become the trusted source and gold standard for film reviews en masse. The principle is simple: viewers rate movies, television shows, and discuss movie trailers. It’s like a litmus test for public opinion, complete with a “Fresh Picks” section, which showcases newly-rated releases. The site is known for its brutally honest reviews and it’s not easy to score high; in fact, for a feature to be considered a “Fresh Tomato,” it has to have a 60% or higher approval rating — everything below that is considered a “Rotten Tomato.”

So, if we are taking the time to apply that level of scrutiny to review films on a site like Rotten Tomatoes, how long will it be before we begin applying that same critical lens and rating system to physicians or a healthcare system?

The reality is that it’s already happening — just not how one might expect.

Sharing means caring
A recent survey shows that 70% of young Millennials choose their doctors based upon recommendations from family and friends, which means that word of mouth is the primary source of new business for providers among this demographic. However, this group is also less apt to provide feedback to their physicians when they are unhappy with their care; instead, they tell their friends — and this can pose a big problem for healthcare organizations. What happens when Millennials turn to social media and online forums to share negative feedback to the masses unbeknownst to the physician who failed to meet their expectations? With Millennials on the verge of surpassing Baby Boomers as the largest living generation, providers need to come up with strategies to solicit input from their younger patients and communicate more effectively with them in new and different ways.

Physician reputations at risk
Millennials are estimated to spend $200 billion by 2017 and nearly $10 trillion over their lifetime, and they are savvy shoppers. As digital natives, most have grown up with access to online resources, so researching a question or looking up a product review is second nature. In fact, a recent study found that “more than twice as many millennials as non-millennials use mobile devices to research products and read user reviews while shopping,” which means we are fast approaching a new paradigm in healthcare: one where online patient reviews of clinicians will increasingly drive business.

Just like Rotten Tomatoes, new sites culling physician scorecards as well as quality metrics are emerging, and patients will take them into account as they select their care providers. But in addition to changing how people shop for healthcare, having this information available for the first time will also impact physicians’ reputations and the referral system. Physicians won’t recommend specialists who have low scores as it will call their credibility into question, and what provider or payer wants to back the physician at the bottom of online scorecards or with a 20% approval rating? This change is a surprise to most doctors who, until now, have not worried about online profiles because it wasn’t personal, historically they’ve always been associated with hospitals or large groups.

How do you look, Dr. Welby?
This puts good physicians who are poor at clinical documentation1 at risk. They could be treating very ill patients, but if the severity of that patient’s condition isn’t reflected in her record, the numbers will be skewed and they look like bad doctors.

While it may seem daunting, this is really about transparency between physicians and their patients. We are a different society than we were 20, 30 or 50 years ago, and people want and frankly need to become more involved in their own care. Quite literally, they have the most skin in the game. Being able to research and choose physicians based on important criteria such as the amount of quality discussion time, eye contact and other bedside manners, as well as health outcomes is the right of every patient. After all, trust and comfort is at the core of healing and good care. The key to success in this new world of healthcare centers around accuracy: getting credit for the care physicians provide to their patients each and every day, and being appropriately reimbursed for those expected outcomes.

1. http://whatsnext.nuance.com/healthcare/clinical-documentation/

Dr. Anthony Oliva is the National Medical Director at Nuance Communications. This first appeared on Nuance’s blog, What's Next

di-theme-font:minor-bidi;mso-ansi-language:EN-US;mso-fareast-language: EN-US;mso-bidi-language:AR-SA'>Dr. Anthony Oliva is the National Medical Director at Nuance Communications. This first appeared on Nuance’s blog, What's Next

No One Wants To Go To the 5th Worst Cardiologist
September 9, 2015 8:33 AM by Silas Gossman

[Editor’s Note: this blog was originally written by Trace Devanny]

As healthcare consumers increasingly become responsible for shouldering care costs, they will look to personal recommendations and online patient reviews to educate themselves on physicians, specialists, hospitals, and care outcomes. Healthcare providers must understand their patients' preferences, behaviors, and expectations in order to best meet their changing needs. So, what do providers need to know in order to ensure patients have an optimal care experience?

Technology has radically shifted how we approach and solve problems, and this is something I witnessed continually watching my kids grow up.  Younger generations are hard-wired to research online—they don’t know any other way—and they rely on this data for everything, whether they’re looking up NFL stats while drafting their fantasy football teams or buying a car. Peer reviews play an integral role in their decision-making process.

This is a trend that is starting to impact healthcare.  A few short years ago, quality metrics were really only known to the payer and the healthcare organization with very little buy-in or impact on physicians.  That is changing.  As the industry moves toward a value-based reimbursement model, metrics are becoming increasingly refined, and more directly connected to the different specialty groups or individual physicians who are providing that care.  We, as patients, now have access to information we never had before, and this information can shape our decisions.  Today more than ever, reputations of both healthcare organizations and their care teams are front and center.

As healthcare consumers increasingly become responsible for shouldering care costs, they will look to personal recommendations and online patient reviews to educate themselves on physicians1, specialists, hospitals, and care outcomes.  And, this will drastically change the business of healthcare.  The best cardiologist will quickly look like the fifth worst specialist by failing to properly document in the EMR. Something that was not even covered in medical school could be the nail in the coffin for the business of healthcare or professional reputations. Why? Physicians will not refer their patients to a specialist with bad outcomes, patients will not trust that doctor, healthcare organizations will not hire her, and payers will not reimburse her.

Healthcare is no longer just about the physician, it’s about the entire operation—from scheduling and parking availability to ease of prescription refills and surgical recovery times—and it’s about the patient.  As one CIO I recently spoke with noted: “Our quality improvement efforts are really driven around the whole care team.  The quality of care that I’m delivering, and that my practice is being measured on, is probably determined more by the other people in my office than by me.”

The business of the patient care experience
This shift in how people shop for healthcare and greater transparency of information means providers need to understand who their patients are and what they are looking for when it comes to their care experience.  This year, Millennials surpassed Baby Boomers as the largest living generation, and this will have a profound impact on healthcare.  As part of its ongoing research on the changing practice of the Art of Medicine2, Nuance conducted a 3,000 person global survey exploring the evolution of patient behaviors and preferences3.

We found that more than half of young Millennials search for health information online before seeing their doctors, which means they are walking into their appointments as educated healthcare consumers.  It also means they are checking up on their doctors and healthcare facilities, reading reviews about the courtesy of staff members, the cleanliness of facility, and rankings for bedside manners.

The findings also reveal that, as digital natives, Millennials rely heavily on personal recommendations from friends and family when looking for a physician, and they share their negative feedback with their social networks.  This differs considerably from the behavior of patients 65 and older, the majority of whom, when unsatisfied with their care, share their feedback directly with their providers.

This trend indicates a behavioral shift: as more patients rely on online data to assess their physicians and providers, the healthcare industry needs create ways to ensure the integrity of this data.  Review sites that simply function as forums for patients to air grievances will not be seen as credible to physicians or organizations looking to improve their care experiences.  Instead, online healthcare review sites will need to blend clinical outcomes with patient-reported outcomes.  This information can be used to improve the healthcare experience for patients, but it will only work if the data has integrity. Forward-thinking healthcare organizations, such as Swedish Health Services, have made it a priority to consider how their brand and patient experience relates to publicly reported metrics, and uses their survey feedback to improve their care experience as well as their online reputation.

The digital area is changing the healthcare marketplace.  As patients play an increasing role in determining how, when, and where they receive care, organizations that don’t stay closely connected to them won’t be able to survive.  And it all comes down to understanding patient populations; those physicians and providers who do will remain competitive and best manage their patients’ evolving healthcare needs.

Trace Devanny is the President of Nuance Communications’ Healthcare Division. This first appeared on Nuance’s blog, What's Next.

1. http://whatsnext.nuance.com/healthcare/online-physician-reviews-influence-patient-decisions/
2. http://www.nuance.com/for-healthcare/artofmedicine/index.htm
3. http://www.nuance.com/company/news-room/press-releases/Differences-Between-Millennial-and-Baby-Boomer-Healthcare-Consumers.docx

The 3 Secrets to a Better Patient Experience for People Like Me
August 26, 2015 8:38 AM by Silas Gossman

[Editor’s Note: this blog was originally written by Jonathon Dreyer of Nuance]

The overall patient experience is becoming increasingly important, so how can providers ensure they are meeting their patients' needs? Focusing on accessibility to personal health information, preserving the art of medicine and improving communication are three critical ways that can help.

It’s nothing new for businesses – even healthcare organizations – to evaluate how they are doing in the eyes of customers; but in healthcare, the “patient experience” has taken on greater meaning. It’s no longer just the healthcare developer community, user interface (UI) experts or a single healthcare administrator talking about the importance of the patient’s overall experience1. Everyone from the chief quality officer and CFO to front-line caregivers are focused on ways to improve quality and make things better, faster and easier for patients and their families. The reason is clear: patient satisfaction is closely connected to quality of care, and better outcomes improve quality scores, reputations, finances and attract patients and physicians. The challenge is if I don’t feel like I was treated in a good way, even though my medical care may have been technically good, my feedback on a provider or their score will be bad.

Working with mobile and cloud innovations and with many disruptors in the healthcare industry, I have seen more than a glimpse into the different ways to make this experience better2. And as a prosumer of healthcare, and a gadget guy who carries three devices at any given time, I see a path to helping providers deliver not just a medical procedure, but also the experience and services that I (or people like me) expect when it comes to receiving high-quality care.

3 secrets to improving the patient experience
1. Evolve the practice of medicine to recognize that patients want more information, and that interaction needs to come quickly and digitally. For most, information about clinical assessments and recommendations is top of mind, but that’s not all. If you really ask patients what they want, they’ll say the ability to look up information and access their medical records on their smartphone, as well as being able to pay their bills on their mobile devices. It’s about being better connected.

2. Technology can enhance medical care, but not with extra clicks or drop-down menus that replace eye contact with patients. This is a timeless expectation, and striking that balance is getting very hard for physicians (read: “I will not let a computer come between me and my patient”3). A recent patient survey4 commissioned by Nuance reinforces that these two can live harmoniously:  in fact, 69% of people have noticed a difference in the amount of technology used by doctors in the last five years, and 97% are comfortable with it. The problem is with “how” it is used, and this creates great opportunities to incorporate technology in ways that both help deliver better care and keep patients satisfied, for example, showing X-rays on a tablet or YouTube videos to educate patients in the room.

I know that the health information technology (HIT) field exists in order to help physicians interact with technology in intuitive ways, whether that it is a hospital or practice using voice recognition5, mobile EHR apps6, single sign-on, or something else. However, patients like me expect HIT to be an enhancer, something that makes the cumbersome administrative tasks easier, so interacting with technology does not trump the quality connection between patients and physicians.

3. Engage with patients meaningfully outside of the single clinical visit. With stats indicating up to 80% of patients saying they feel engaged7 in managing their own health, most people are not going to expect a ‘one and done’ experience with their physicians. As patients assume more responsibility for paying a portion of their care, and providers assume more risk and accountability for what patients do outside their office or the hospital, the two will need to be more connected and the ability to communicate with physicians outside of an office visit will be a big patient satisfier. Using different members of the healthcare team and new channels to communicate with patients about their care will round out this experience to make it more complete and more rewarding.

Patients are increasingly becoming more informed consumers, that new hip and the multitude of visits and interactions that go with it, all determine the “patient experience.” Helping doctors deliver on those expectations in a system that often seems stacked against them is not as easy as it sounds. It’s time to protect the patient-physician relationship; a foundational element of quality care.

Jonathon Dreyer is the director of cloud and mobile solutions marketing at Nuance Communications, where he is driving a physician-first approach to medicine by bringing cloud-based speech recognition and clinical language understanding technology to a worldwide community of healthcare IT developers and provider organizations. This blog first appeared on What's Next.

1. http://www.fiercehealthcare.com/story/hospitals-work-capture-patient-voices-improve-healthcare-experience/2015-07-20
2. http://whatsnext.nuance.com/healthcare/preserving-the-patient-physician-relationship-with-technology/
3. http://www.kevinmd.com/blog/2015/07/i-will-not-let-a-computer-come-between-me-and-my-patient.html
4. http://www.nuance.com/for-healthcare/artofmedicine/index.htm?utm_source=media-article-referral&utm_medium=press&utm_campaign=art-of-medicine-2#patients
5. http://australia.nuance.com/products/physician-speech-recognition-solutions/index.htm
6. http://www.healthcareitnews.com/video/cio-spotlight-episode-26-eddy-stephens
7. http://www.nuance.com/for-healthcare/artofmedicine/index.htm?utm_source=media-article-referral&utm_medium=press&utm_campaign=art-of-medicine-2#patients
James Bond: An Inspiration for Health IT and the Connected Car
August 10, 2015 8:07 AM by Silas Gossman

[Editor’s Note: this blog was original written by Jonathon Dreyer] 

Inspiration for innovation can be found everywhere — even in the pages of a book. James Bond’s gadgets and sleek cars have been essential to outsmarting villains and wowing audiences for decades, but this cool technology might not be as far off as you think.

I’ll admit it: I’m a James Bond fan. And one of the things I love most is the obligatory scene in every film where Q does a run-down of all the gadgets with which Bond will be outfitted — including the upgrades to his always-impressive car.

Despite having been penned more than 50 years ago, Ian Fleming knew that seamless and intuitive technology would forever change the game. And he was right. As we become increasingly connected, we expect constant access to whatever information we want, whenever we want it, and our cars are no exception. In fact, with innovative in-car systems1, they are becoming increasingly more Bond-like. For instance, when I’m driving home, I can ask a virtual personal assistant to look up movie times and buy tickets, and then send a text to let my friends know where and when to meet. With a simple command, I can check my email, and access my music library so I can listen to whatever I want2. So why does it have to stop there? Why can’t this accessibility apply to my personal health information, as well?

The intersection of health IT and the connected car
In James Bond movies, the Q Branch of MI6 is always coming up with new ways to connect things, such as James’ watch, with other devices and objects, including his car. Because I work in healthcare technology, my question for these types of visions is always the same: how can we make this a reality?

Connected health devices could radically change how we think about the care continuum, from triaging to daily health management. In Casino Royale, Bond, who is going into cardiac arrest, stumbles to his car, runs a diagnostic test that senses he is in distress, and immediately connects him to an MI6 physician who walks him through his condition and tells him to use a defibrillator (which is conveniently located in the glove compartment). Needless to say, the quick response and real-time assistance saves his life, and he goes on to win the poker game and get the girl (albeit only briefly).

From a personal health standpoint, connecting wearables or fitness trackers to your car through smart integrations that do not compromise safety while behind the wheel could yield incredible results. For instance, a diabetic could wear a watch with a sensor that can detect low blood sugar and sync with an intelligent agent in the car that routes him to a nearby restaurant or fruit stand. Or a virtual personal assistant could pull data from a driver’s smart watch and, noticing she is behind in her daily step count, suggest a parking lot located further away from the destination, and even check the weather to make sure her walk is rain-free.

The same level of connectivity could hold true for a physician traveling between facilities. Being able to receive secure text-to-speech (TTS) notifications about a patient who has an elevated potassium levels, and the ability to call or text him simply by giving a verbal command would help physicians address concerns before they become critical issues. And, with the help of a virtual personal assistant, that physician could request a medication order and a follow-up appointment, if needed. All of these interactions, of course, could be logged into the patient’s electronic health record using secure speech-to-text and clinical language understanding and would be immediately available for the next treating clinician, and the structured data fields properly populated for appropriate reimbursement.

Although it seems far-fetched, what is truly remarkable is that independently, these technologies already exist in different form factors — it is up to us to break down the silos, challenge the status quo, find inspiration in the everyday and come up with new use cases. The ability to have immediate access to health data and advice would not only help consumers make more informed health decisions, it has the potential to unlock better population health outcomes. We have entered the age of the connected car, and this may be the very thing that shifts us into high gear and helps drive us toward a healthier future.

This blog first appeared on What's Next. 

1. http://www.nuance.com/for-business/mobile-solutions/dragon-drive/index.htm
2. http://whatsnext.nuance.com/connected-living/car-infotainment-systems-connect-social-media-and-music/
Monitoring and Predicting: The Promise of Digital Health
August 3, 2015 10:47 AM by Silas Gossman

[Editor’s Note: this article was originally written by Eric Venn-Watson MD, MBA, senior vice president - Clinical Transformation, AirStrip]

This is the third in a three-part series looking at how digital health is transforming healthcare.

The Goldman Sachs report1 I mentioned in the first part of this series mentions that remote patient monitoring (RPM)2 enables healthcare providers to better manage high risk patients, potentially decreasing healthcare spending through better chronic disease management. Further, the report notes that most chronic disease spending can be attributed to heart disease, asthma and diabetes-disease states that represent the most fertile ground for digital health.

This is one of the most promising – and limitless – opportunities in healthcare today. Current RPM devices3 allow us to monitor CHF patients from home, providing a real-time assessment of their heart health and decreasing their risk of readmission. In the case of an asthmatic patient, RPM devices can monitor a patient’s respiratory health and provide notifications when factors such as the local air quality puts them at risk for an exacerbation. For diabetic patients, RPM can provide continuous blood glucose levels and help provide a level of glucose control that was previously unachievable. The future of RPM involves combining these tools and the patient’s entire health history with streaming analytics and clinical decision support tools that can detect when a patient’s physiologic parameters are trending outside of the normal range, and send a notification to the patient and potentially the care team when appropriate. As a result, we are able to predict and track diseases before they become acute – and potentially even prevent them from ever happening. In essence, we will be able to shift the management paradigm from reactive care to proactive care, which is mission critical in an environment where caregivers are scarce.

Ultimately, clinicians want to provide the best care possible and make a positive impact on our patients’ quality of life. The digital healthcare revolution is helping us achieve that goal, improving the way we practice and provide medical care, streamlining our clinical workflow, and helping us to make the vast number of patient data sources relevant and actionable. The old ways of doing business are no longer acceptable. The new financial and regulatory models won’t allow for it – and ultimately, the patients won’t stand for it.

The digital healthcare revolution has arrived.

1. http://www.businessinsider.com/goldman-digital-healthcare-is-coming-2015-6
2. http://www.wsj.com/articles/remote-patient-monitoring-comes-to-health-care-1424145642
3. http://www.airstrip.com/airstrip-one
Digital Health and Behavioral Modification
July 29, 2015 8:03 AM by Silas Gossman

[Editor’s Note: this article was originally written by Eric Venn-Watson MD, MBA, senior vice president - Clinical Transformation, AirStrip]

This is the second in a three-part series looking at how digital health is transforming healthcare.

Last time, I talked about how the digital healthcare revolution has arrivedand its potential applications, including telehealth. Another way this digital transformation is changing healthcare is how it affects behavioral modification and adaptation.

Over the past few years, I have noticed a significant culture change in my patients. They are more knowledgeable about their health in general, more informed about management options and more likely to want to work toward an improved level of health. They also tend to be more open about sharing their health profiles and results with family members and friends and more inclined to gradually change their behavior if they can get real-time feedback illustrating the impact of their efforts. Digital health technology provides this feedback and can be as simple as providing daily step counts or charting caloric intake vs. calories burned, or more complex by combining live physiologic monitoring with complete past medical histories to create a real-time health dashboard.

True success, however, can be achieved when patient behaviors are modified using customized health programs based on individual profiles. Digital health applicationsare rapidly evolving as a method for affecting behavior through customized, real-time interventions that can be adapted for each individual based on prior outcomes, previous responses to intervention, current physiologic and psychologic parameters, environmental and social context, as well as a range of other variables that influence the state of an individual’s health. These tools allow us to change our focus from differences between individuals to differences within a single person over time.

As more and more data sources become available and integrated into the feedback loop in a manner that provides value, we will see a continued increase in people intimately engaged and driving their own healthcare.

We’ll be wrapping up this blog series with a look at remote patient monitoring, so be sure to check back.

1. http://mobilehealthmatters.com/2015/07/15/the-digital-health-revolution-has-arrived/#more-690
2. http://www.airstrip.com/airstrip-one 

The Digital Health Revolution Has Arrived
July 20, 2015 2:08 PM by Silas Gossman

This is the first in a three-part series looking at how digital health is transforming healthcare.

[Editor’s Note: this article was originally written by Eric Venn-Watson MD, MBA, senior vice president - Clinical Transformation, AirStrip]

Digital healthcare holds the promise of saving a staggering $305 billion, according to a recently published report from Goldman Sachs1. The report predicts the technology revolution will come from increasing access to diagnostic, treatment and preventative care, coupled with dramatic cost reductions. In particular, they see significant opportunities for digitally-enabled telehealth, behavioral modification and remote patient monitoring, while much of the savings will be generated by the elimination of redundant and wasteful spending in the area of chronic disease management. 

They are right, and here’s why. Digital technology has already transformed a multitude of industries including banking, travel and retail by aligning provider and consumer. Almost every aspect of our lives is being touched by digital technology; we are more ‘connected’ than ever before. Concurrently, a number of factors are driving a similar transformation in healthcare: increased consumer demand for better, more convenient and more cost effective care, changes in reimbursement and the shift to value-based care, and of course, the availability of tools such as smartphones, tablets, wearable sensors and portable diagnostic equipment. Thanks to a digital health ecosystem that brings it all together, the relevant data becomes available through streaming analytics, clinical decision support tools and immediate communication back to patient and provider via mobile devices, when appropriate.

The Goldman Sachs report points to the following three specific opportunities: telehealth, behavioral modification and remote patient monitoring. Today we dive further into this first topic: telehealth. 

Telehealth applications are being driven both by consumers and providers, and are rapidly changing the way healthcare is practiced. I am seeing this with my own patients, who have busy schedules and a desire for convenience. They are asking for easy and efficient alternative methods such as secure texting and videoconferencing to connect with me outside of the traditional office visit and receive medical guidance. This model of care has gained significant traction, as evidenced by Teladoc’s 11 million consumers and its recent, very successful IPO.

There is another important and exciting aspect of telehealth: clinician-to-clinician communication. Telehealth tools enable me to reach out to fellow physicians and specialists rapidly to share and view secured, real-time patient information. This collaboration expedites my workflow and enables me to make quicker, data-driven management decisions. I have no doubt that these models of care will continue to expand and become, as the Goldman Sachs report states, a ‘viable component in daily healthcare practice2.’

1. http://www.businessinsider.com/goldman-digital-healthcare-is-coming-2015-6
2. http://www.businessinsider.com/goldman-digital-healthcare-is-coming-2015-6

Will The Joint Commission’s New Standards Keep You Safe from Unnecessary Medical Imaging?
July 15, 2015 10:39 AM by Silas Gossman

[Editor’s Note: the following blog was written by Karen Holzberger]

The Joint Commission has issued new standards around protocols, documentation and education that are designed to reduce unnecessary medical imaging and improve quality and safety. But is it enough?

The Joint Commission standards1 for diagnostic imaging, which recently went into effect, are designed to help prevent duplicate and unnecessary medical imaging of patients, and reduce potentially harmful exposure to radiation when patients need CT scans, MRI or a combination of these and other diagnostic tests. Beginning July 1, 2015, these standards require protocols, documentation and data collection, staff education and other criteria that raise the bar for quality and safety at ambulatory imaging sites, critical access hospitals and accredited hospitals. What do these standards really mean to the patient?

The new imaging standards focus primarily on the radiation dose index2. There are a number of uncertainties tied to the long-term impact of imaging on patients, but researchers agree it impacts patients differently depending upon sensitivities to radiation, age, body parts being tested, absorption rates and other factors and these are still being studied. In the meantime, to prevent undue risk, The Joint Commission has put a stake in the ground with these specific standards to help improve patient safety. The Joint Commission joins other accredited healthcare organizations, such as the American College of Radiology (ACR) and other clinical associations that are releasing new quality-focused recommendations, enhanced education tools and technologies3 to make it easier for healthcare teams to keep you safe from unintended risks while you receive diagnostic imaging that could shed light on serious health conditions.

As a patient and someone who has worked in healthcare technology for more than 20 years, I believe the combination of diagnostic imaging, evidence-based medicine and expert medical oversight that exists today will help organizations big and small better manage radiation exposure and protect patients today and in the future. These efforts provide great improvements in reducing unnecessary testing and putting safeguards in place to generate important results, while mitigating the long-term risks to patients when they need different exams.

The Joint Commission’s imaging standards were initially intended for release last year, but they were postponed due to lack of detail and clarity. In conjunction with imaging guidelines provided by the American College of Radiology’s4 “Body Imaging Commission” and other clinical associations, they help providers focus on the right testing to do at the right time to improve quality of care when radiologists face a flurry of different kinds of patient cases every day.

The Joint Commission’s report explains that knowledge of a patient’s previous imaging exams helps prevent duplicate imaging examinations and further radiation exposure, and they recommend considering a patient’s age and recent imaging studies when deciding the most appropriate exam. The same precedent exists for surgery today so it makes sense that something similar would apply to diagnostic imaging. The fundamental part of medicine is based on “do no harm.”

Obstacles to accurate and reliable imaging
While The Joint Commission’s standards will ultimately benefit hospitals, there are a few challenges they face in complying with these new regulations based on healthcare delivery today. Compliance becomes difficult when a patient is seen by multiple healthcare providers – especially in different geographic regions – and when the patient’s journey spans different facilities, specialists and time zones as they strive to get well.

Today, many hospitals keep a record of a patient’s medical images in their facility, and they typically provide a CD of relevant images to the patient to take with them when being treated somewhere else. However, too often the CD will end up damaged or unreadable to the next physician, and even if it works, the CD will not contain a complete story of the patient’s health including their medical imaging history. Incomplete or missing information creates doubt and risks that are not welcome in healthcare. The patient is looking for certainty in their diagnosis, the radiologist is looking for certainty in recommending next steps and the referring physician wants to ensure that he or she is providing the right treatment for the best outcome. Without accurate and reliable imaging information, everyone may not have the answers and assurances they need. The result? Repeat medical imaging.

Repeat exams are particularly problematic for patients who are most at risk because of the cumulative effectives of overexposure to radiation, such as the elderly and children. Concerns over unnecessary use of medical imaging and unnecessary costs of these tests have been around for years, but despite concerns, recent statistics show it is still a common practice. A study published in the Journal of Emergency Medicine in March 2015 shows 97% of ED physicians order unnecessary imaging because of worries that they will miss something and be sued5. Half of these physicians identify that improved education on advanced diagnostic testing would help cut down on this practice of over-ordering tests.

This all goes back to certainty. With regulations changing, clinical guidelines evolving, patient volumes growing and information access ranging from hard to get to hit or miss, the implications are clear. When physicians are unfamiliar with the appropriate diagnostic tests or the clinical best practice for a specific symptom, or they can’t see the complete patient story such as prior radiation dosing for the patient, they try to do what’s best and that often leads to repeat medical imaging.

1. http://www.jointcommission.org/assets/1/6/Approved_Revisions_Diagnostic_Imaging.pdf
2. http://www.radiologyinfo.org/en/safety/index.cfm?pg=sfty_hiw_09
3. http://www.nuance.com/ucmprod/groups/healthcare/@web-enus/documents/collateral/nc_037321.pdf
4. http://www.nuance.com/company/news-room/press-releases/NC_035230
5. http://onlinelibrary.wiley.com/doi/10.1111/acem.12625/abstract

Karen Holzberger is the vice president and general manager for Diagnostics at Nuance Communications. This post originally appeared on Nuance’s blog, What's Next.

Let Doctors be Doctors
June 30, 2015 7:25 AM by Silas Gossman
Physicians don't always realize the correlation between their clinical documentation and the level of credit they get for providing quality patient care.
[Editor’s Note: the following blog was written by Jennifer Woodworth]
No one chooses to work in the healthcare industry because it’s easy.  We do it because we want to help others. The mounting frustrations doctors face as the result of an increasingly burdensome healthcare system are not only understandable, they are justifiable. These men and women did not go to medical school to sit through hours of meetings about code sets.  Their primary responsibility is to treat patients.  And for those of us who work with them, it is our role to be the trusted partner of our doctors and clinical care teams — to ensure they share the right information where and when it’s needed. I’ve spent close to a decade working with physicians on clinical documentation to make sure it reflects their intent and they get credit for the level of care they are providing.
Over the years, the doctors have taught me some valuable lessons. When it comes to implementing a successful clinical documentation improvement (CDI) program, start with these three fundamentals:
Skip the catering: meet your doctors where they are
Everyone is busy, especially doctors, and initially, we tried to engage with them by holding early morning meetings where we provided breakfast and information about our CDI program.  We quickly discovered that we were left with not much more than a tray of cold eggs and pancakes.  So we made adjustments and began meeting doctors where they were — in their departments, on grand rounds and within the agenda of a medical staff meeting. This significantly improved physician engagement and helped us better collaborate on capturing the patient’s care in a way that was accurate and complete not just to other doctors. CDI programs are not one-size-fits all, and keeping this in mind as you reach out to your physician teams is very important.
Become a translator for health IT language
Because specialty groups each have their own medical vocabularies, different registries and workflows, they will also face unique challenges and concerns. Swedish Health Services is a multi-hospital health system that includes a heart and neural hospital. When we implemented our CDI program, we realized that we needed to tailor our approach by physician specialty — what was an important quality driver in one clinical area is not necessarily the same in another. Swedish is a “5-star institution,” and we need to uphold that reputation. So, in order to do this, we first had to figure out what each specialty group’s quality scoring was based upon, and then sit down and work with our physicians to show them the impact their documentation was actually having on their scores.
Seeing clinical data is believing
Doctors have analytical minds, after all, that’s how they decide how and when to modify treatment plans — by looking at results and analyzing the data. This holds true for clinical documentation, too.  They don’t always realize that how they document is just as important as how they are providing care; in fact, it’s the proof they are doing the right thing for patients. When we reviewed our clinical data, we found that our ICU patients were typically on ventilators longer than the average, which was negatively impacting our quality scores. Sitting down with our ICU physician team, we conducted a retrospective review and discovered that the majority of these patients had pre-existing respiratory conditions that necessitated an extended time on a mechanical ventilator. It wasn’t that they weren’t receiving good treatment, it was, in fact, our doctors doing the right thing for these patients — keeping them on the ventilator longer because they needed it — that was negatively skewing our numbers.  It was a simple error of omission: our doctors didn’t realize that by not fully documenting their patients’ pre-existing conditions in the clinical record, they were hurting their reputation as great doctors, and ours as an excellent hospital.
While not always easy, changing a culture to support a value-based care model makes sense: hospitals and healthcare organizations get paid, or not, based on how they care for their patients. Our physicians trust us to help them accurately represent the good care they are providing, and, in turn, we use CDI data to identify areas where together we can optimize quality to do what’s best for the patient.
The accurate clinical data that results from an effective CDI program not only helps our doctors earn credit for the good work they do, but also improves patient care and reimbursement for our organization. Accurate clinical data also enables us to get a clear picture of who our patient population is so we can adequately prepare for their future health needs. And, at the end of the day, that is what healthcare and the continuum of care is all about.
Jennifer Woodworth is the Director, Clinical Documentation Integrity Program (CDIP) at Swedish Health Services in Seattle, Washington. This blog originally appeared on Nuance Communications’ blog, What’s Next.

The Eligibility Impact: How and Why Eligibility Data Issues Affect Payment Integrity
June 23, 2015 8:06 AM by Silas Gossman
[Editor’s Note: the following blog was written by Paul Vosters, Discovery Health Partners president and COO]
Organizational and technology structures can keep health plans from recognizing, understanding and resolving their payment integrity challenges. However, another factor may be at the root cause of some of those challenges: eligibility. 
Eligibility issues impact a multitude of payment integrity areas including Coordination of Benefits and Medicare Secondary Payer validation and, to a lesser extent, Workers’ Compensation, Other-Party Liability and Subrogation. In fact, our research indicates that approximately 30% of payment integrity costs are driven by eligibility errors. In addition to the financial cost of payment integrity errors, eligibility issues can also have a direct effect on member satisfaction. Claims that are declined due to inaccurate or out-of-date eligibility data can lead to member abrasion and lost market share as well.
At their core, these issues all stem from the fact that health plans lack a single, definitive resource for making eligibility status determinations prior to paying a claim. This creates tremendous downstream issues as health plans make business decisions and pay claims based on flawed data.
The complex structure of health plans means that member eligibility is updated at multiple points in the claims payment process and is managed by multiple departments across the organization. As a result, it’s often inconsistent, outdated or inaccurate, and leads to improper claims payments. Until plans are able to establish a single source of the truth for eligibility, these inaccuracies can cost plans millions of dollars. Let’s examine a few of these challenges more closely: 
Multiple data sources
The sheer number of data sources feeding the master eligibility file has a significant impact on accuracy. Information comes from the members, providers, CMS, data-match vendors and other data sources. These feeds are all subject to their own timelines, standards and information challenges. In addition, these external feeds to eligibility status have a high rate of change, creating a complex hierarchy of overlapping status updates. Plans are challenged to manage these work processes and make a clear determination of primacy and eligibility that can support all of the transactions that rely on this data. 
Organizational challenges
The eligibility challenge isn’t just technical, it is also frequently organizational. Eligibility is commonly managed by line of business, meaning that status updates made by one group are not necessarily shared across the organization. For example, changes in a member’s eligibility status might not be effectively communicated between the commercial and government lines of business as the member moves from commercial to Medicare Advantage coverage. With no clear owner of the member eligibility status, managing the data across departments adds an additional level of complexity.  
Existing solutions
In addition to being spread out across different departments, responsibility for managing eligibility status is shared by several administrative systems. Plans often make the mistake of addressing eligibility in a single point solution, rather than taking an enterprise view of member eligibility management. Claims and enrollment systems often fail to address eligibility on a consistent transactional basis, and frequently capture crucial updates in notes or text format. Eligibility data is rarely shared between systems, and because there is no single data master, the priority of status changes is unclear. 
Looking to the future…
Health plans have the opportunity to dramatically improve their payment integrity performance and member retention by managing member eligibility as a business asset. The ideal solution will provide a complete and integrated picture of eligibility status across membership types and lines of business, while providing validated data for downstream applications. Doing so will require a shift in culture, as well as new technologies. Nonetheless, there are strategies that let you achieve progress in a staged progression, which we will explore in future posts. Managing eligibility data as a strategic asset is worth the effort, as it will result in millions of dollars in recoveries and cost avoidance.

Why Knowing How to “Speak Doctor” is Important for Population Health
June 16, 2015 8:47 AM by Silas Gossman
[Editor’s Note: The following blog was written by Dr. Anthony Oliva] 
Being able to "speak doctor" ensures that physicians are accurately capturing the level they provide to patients, and enables healthcare organizations to correctly identify their patient populations and predict their future healthcare needs.
I’ve worked as a CMO at hospital systems for much of my career, and one thing that I’ve learned is the importance of knowing how to speak doctor. This means listening for clues one physician shares with another about a patient that are critical to their immediate assessment and delivery of patient care. Physicians can communicate a lot of information very quickly, in very few words, and because other clinicians are trained to understand and to act quickly, the system worked… most of the time. Until recently. Now short written notes or verbal handoffs are a thing of the past and what is being conveyed about patients’ conditions may not be clear or may be buried in charts with note bloat, which is a real problem for money, patients, and predicting risks. Here are the three big problems you need to fix to get ready for population health:
Problem #1: Say what you mean
The way doctors speak is different than the coding language needed for billing and hospital payments. The impact is real, unrealized revenue for a hospital or health system when care is provided, but not documented by a physician in the EMR. The last place I worked realized $9 million of traditional revenue by fixing physician documentation up front, and Swedish Medical Center secured more than $18 million in appropriate reimbursement. Better translation of what doctors say up front through a Clinical Documentation Improvement (CDI) program brings predictable financial improvements.
Problem #2: It’s in the patient story details
When a doctor’s clinical documentation leaves clues everywhere in the chart pointing to a risky condition, but sparse clinical documentation leaves out specific details, good care may not look like it. That carries big risks for physicians and healthcare organizations that need to look good on scorecards and quality outcomes. When clinical speak indicates a potential condition, complication or cause for treatment, but it isn’t translated into co-morbidities or diagnosis codes in a record, a patient receiving healthcare may look much healthier than he or she really is. I can’t tell you how many times I’ve seen a chart when a patient spent three days in the ICU being treated for sepsis, which is a very serious and expensive situation, but the chart classified the patient through codes as having something close to a bladder infection because the diagnosis was not properly identified. In today’s competitive healthcare environment, a doctor cannot afford to look bad to payers or patients.
Problem #3: Know your patient population
Your crystal ball better predict the future correctly. When it comes to population health and accountable care, the rules are changing. If your charts don’t accurately reflect how sick your patients are or the conditions you treat in your community, there will be no path to population health management because you won’t really know your populations.
Healthcare is changing and everyone is assuming more risk ‒ physicians, provider organizations and even patients ‒ and in order to stack your team with the right types of providers, who are resourced to deliver the right services that your patients want and need, you have to know what those needs are and what they will be in the future. Accurate clinical documentation that starts with physicians today is a prerequisite for predictive modeling. No one wants to prepare for one patient population and then look back later wondering why mortality is so high or the level of care and resource drain is so much greater than anticipated. That is a problem we are solving for today.
And it starts with physicians. Hearing and understanding them, and then helping them translate what they do into the appropriate documentation is key. What a physician sees when he looks at a chart may seem completely obvious, but we live in a world where unless the words are documented in that chart, the care being provided won’t count. It’s time to retrain doctors to explain what they do in a language everyone will better understand, and reap the clinical and financial benefits.  We can do this with the basic building block of a clinically-focused CDI program to help with the translation.
Dr. Anthony Oliva, DO, MMM, FACPE, is the National Medical Director at Nuance Communications. This blog first appeared on What’s Next.

Getting the Right *Beeping* Results: Innovations in Radiology
June 1, 2015 9:41 AM by Silas Gossman
There is a culture of certainty in healthcare that is driving unnecessary testing and increasing costs. But some organizations are using the latest technology innovations in radiology to help improve patient care and protect their bottom line.
[Editor’s Note: the following blog was written by Karen Holzberger]

A few years ago, there was a witty car commercial advertising an alert feature that took the guesswork out of filling your tires by gently beeping to signal the appropriate pressure had been reached.  It featured a series of vignettes where the car horn would beep, cautioning the owner to reconsider just as he was about to overdo something (for instance, betting all of his money on one roll of the dice).  The concept of getting a reminder at the point of a decision is a compelling one, particularly if it can save you time or aggravation and guide you to do the right thing. In healthcare, any technology that can provide that level of support will have a profound impact on patient care.
Albeit humorous, that car commercial wasn’t far off the mark with healthcare challenges. Unnecessary medical imaging exposes patients to additional radiation doses and results in approximately $12 billion wasted each year, but it has also had another unintended downstream effect.  It has fueled a culture of medical certainty, where tests are ordered in hopes of shedding light on some of the grey areas of diagnostic imaging, including incidental findings.  The reality is that incidental findings are almost always a given, but not always a problem.  So how do you know what to test further and what to monitor?  And while one radiologist may choose the former option with a patient who has an incidental node finding, another might decide to go with the latter option, so who is right?
Beep! It’s important
This is a jarring situation when so starkly presented, which is why the American College of Radiology (ACR) has released clinical guidelines on incidental findings.  By offering clinical decision support on findings covering eleven organs, the ACR is helping radiologists protect their patients through established best practices for diagnostic testing.
While this is a great step forward for the industry, some hospitals are taking it one step further.  Massachusetts General Hospital (MGH) is using its radiology reporting platform to provide real-time quality guidance at the point-of-care to drive better patient care. Now, when a radiologist is reading a report and notes an incidental finding, the system will automatically ping her with evidence-based recommendations for that finding.  For instance, if the node is a certain size, it should be tested further.  These clinical guidance best practices are updated constantly, which means that radiologists have access to the most up-to-date information when treating their patients and can make the most informed decisions based on industry best practices.
Patients deserve and need to have the best and most thorough care; however, this shouldn’t put them at risk for unneeded radiation exposure.  It is neither safe, nor financially sustainable.  Health IT innovations like these – that can ping clinicians in real-time with the latest in quality guidance – will be the tipping point in the shift to value-based care.  They will forever change the standard of patient care and the landscape of the healthcare industry, and that is exactly what we need.
Karen Holzberger is the Vice President and General Manager for Diagnostics at Nuance Communications. This blog originally appeared on What’s Next.



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