The Dragon Medical Solution

Presentation Summary
The Challenge: Documenting Care in an EMR The Solution: Speech Enable Your EMR Dragon Medical: Overview / Demonstration Dragon Medical: Case Studies

The Challenge: Documenting Care in an EMR Becoming a Near - Requirement

1. Clinical documentation Rapid Adoption of EMRs
Market demanding electronic documentation instantly available US Government 10 year plan for an EMR for every American 100% EMR adoption by 2014

2. Remuneration evolving from fee for service to pay for performance

Reimbursement levels flat / declining from 2008 on You dont get paid for what you dobut what you document.

More documentation is neededbut created in a more cumbersome way just to maintain reimbursement levels.

= HIGHER DOCUMENTATION COSTS = LOWER PRODUCTIVITY

The Challenge: Documenting Care in an EMR Requires Using Point and Click Templates
Template-based notes in an EMR are lower quality
dont support ability to personalize for each specific patient encounter Point and click interface lacks patient narrative and medical decision-making Generate cookie-cutter reports

and EMRs impact productivity and profitability

Point and click slows physicians down Studies have shown that EMRs do not in themselves lead to higher reimbursement Physicians didnt go to medical school to become typists Transcription prohibitively costly oftentimes eliminated to pay for EMR

The Solution: Use Dragon Medical 10 to Speech Enable Your EMR

Hands-free Use of EMRs
Dictation Navigation

The Market Leader

80,000+ clinicians All Windows-based EMRs

Increase Physician Productivity Improve Patient Care Eliminate Transcription Maximize Reimbursement Faster Adoption of EMR

Provider PC with Dragon Medical & PowerMic II EMR System

Dragon Medical Lets Physicians Dictate in their Own Words, Complementing the Rigid Structure of an EMR
Dragon-driven navigation command/control Structured point and click data entry

Dragon-dictated narrative: History of Present Illness, Assessment and Treatment Plan

Dragon Medicals Impact on EMR Use Survey Results1

It significantly improves or improves EMR use and facilitates the practice of medicine (80%) it speeds my EMR use up so much I see the same or more patients prior to going live with the EMR (80%) Thanks to Dragon, theres been no increase in patient backlog (75%) Im coding at higher RVU / billing levels using Dragon... (75%)

1 Source: Survey of AHLTA EMR and Dragon Medical Physician Users,

Telemedicine and Advanced Technology Research Center (TATRC), U.S. Army Medical Research and Materiel Command,

Speech Recognition Helps Clinicians Regain Productivity Lost When Adopting an EMR

Productivity Loss
Productivity

Phone dictation

Speech driven EMR

Typing in EMR New point of reference for self-edit speech Compare self-edit speech with the speed and accuracy of typing.
Documentation method

Dragon Medical 10 Demonstration

Proven Value Proposition

Increase Physician Productivity 25% faster Using an EMR Improve Patient Care Higher-Quality, More Complete Notes Eliminate Transcription Save $10,000+ / Year Per Physician Higher Reimbursement Increase $10,000+/ Year Per Physician Faster Adoption of EMR

Return on Investment in 1-2 Months

Dragon Medical: Case Studies

Community Medical Center University of Rochester Med Center Group Health Cooperative Fallon Clinic

Dragon Medical Case Study Community Medical Center

Challenge: Automate the creation of medical records in the organizations Emergency department EDIM application to improve patient care and increase the use of the EMR system Solution: Deploy a 20-user Dragon Medical software license to eliminate the need to hand type information into the EMR application Results: A reduction of over $500,000 in transcription costs in the first year, with the software paying for itself in the first few months of use; reduced malpractice liability and a measurable improvement in patient care

Case Study: Group Health Cooperative

Overview:
900 Physician, Multi-Specialty Clinic (Seattle, WA) 100% Commitment to EpicCare EMR
I often use my voice to trigger a command in Epic which pulls in labs infowith a single command Its fun! It makes a tedious task more enjoyable.
Dr. John Kaschko Primary Care Physician

Challenge:
Enhance Epic Adoption: Offering a Way to Dictate Narrative into EMR

Solution:
Roll Out Dragon Medical on System-Wide Basis

Results:
Accelerated Physician adoption of Epic Reduced Time Spent Documenting Care Achieved Higher Quality of Patient Care Enhanced Provider Satisfaction Improved Quality of Documentation Raised Confidence of Higher Coding Levels Eliminated 80+% Transcription Costs

Dragon has really shortened the process of creating notes. It shortens my day by 11.5 hours because I no longer have to log in from home to complete charts.
Dr. Dean Carr Primary Care Physician

The complete documentation facilitated by Dragon allows me to now code more at a level 4 as opposed to level 3
Dr. John Kaschko Primary Care Physician

Case Study: University of Rochester Medical Center

Overview:
Leading Academic Medical Center 2 Acute Care Hospitals, Primary care network of 100 providers Lower Physician Productivity Post EMR Go-Live (Allscripts)
An asynchronous process becomes synchronous with DragonWhen I close the note, Im done, period.

Challenge:

Dr. David Krusch Chief Medical Information Officer URMC

Solution:

Deploy Dragon Medical 10 Across Primary Care Network Easily Allows Individuals to Create and Modify Templates Lets Physicians Document Unique Narrative per Encounter Seamlessly Integrated with Allscripts EMR On-Site Training
100% of All Primary Care Physicians Using Dragon Medical An Additional 100 Physicians Have Gone Live Physicians Report Higher Patient and Clinician Satisfaction Saving Over $1 Million Annually in Transcription Costs. Return On Investment in < 3 Months

The software works outstandingly. It interfaces smoothly with the EHR. It is affordable, replacing highly expensive transcription services use Dragons success is inevitable. Dr. Betty Rabinowitz Primary Care Internist URMC

Results:

Case Study: Fallon Workflow Impact Study

Spring 2008 Fallon Clinic proposed a funded study to evaluate the impact of Dragon Medical V9.5 on:
Note quality Provider satisfaction Productivity/cost Implemented with 10 diverse providers:

Real-World Setting Specialty Computer and typing skills Age and gender Baseline use of dictation
1-2 hours of formal 1-on-1 training Limited customization with macros Limited support as needed

1Preliminary results.

Case Study: Fallon Workflow Impact Study

Fallon reported that Dragon Medical generated:
17 % reduction in the average # of minutes after patient left that the visit was closed so bill could be sent (55 minutes 46 minutes, P<0.1) 99% reduction in the average # of minutes after patient left for note to be available in the Epic EMR (3.8 days 46 minutes, P<0.001) 94% reduction in the average % of visits using standard dictation/transcription service (62% 4%, P<0.001) 90% reduction in the average monthly lines of paid transcription/MD (4807 503, P<0.001) 57% improvement in the average provider satisfaction with generating notes (2.8 4.4, on ratings scale, P<0.001)

26% Improvement in the average peer-reviewed medico-legal note quality (3.2 4.1 on ratings scale, P<0.001)
57% Improvement in the variance between what was billed and what could have been billed (P<0.2)

Case Study: Fallon Workflow Impact Study

Financial Analysis
Installation Cost for first 3 years: $3,435/MD
License Annual Maintenance Professional Tech Support Professional Training Handheld Philips Speech Mike Pro USB 5280 2 GB RAM Upgrade

3-Yr Cost of ~8 minutes/day/MD: $25,476

0.11 RVUs/minute at CMS rate of $38.09/RVU

Total Cost for first 3 years: $28,911/MD

Case Study: Fallon Workflow Impact Study

Financial Analysis - Savings

Reduced Transcription Costs for first 3 years: $15,492/MD Increased billing from correct coding for first 3 years: $34,762/MD Total Hard Savings for first 3 years: $50,254/MD Net savings of $7,114/year/MD Savings from faster and better communication, as well as happier Physicians.

Priceless!

Announcing Dragon Medical 10 The Fastest, Most Accurate Dragon Medical Ever
20% Accuracy Improvement over Dragon Medical 9 38% More Accurate than Dragon NaturallySpeaking Professional in Clinical Settings 50% Faster Response Time than Dragon Medical 9

Regional Accent Support for Non-Native Speakers

Contains Medical Vocabularies Covering More Than 75 Disciplines.

MyCommands Window Personal Commands in Browser

Configurable PowerMic Buttons

Announcing Dragon Medical 10 Did You Know that

Dragon Medical 10 Includes Vocabularies for All Specialties Dragon Medical 10 supports a range of regional accents Powerful Templates and Marcos can be used to optimize workflow See Demo Quick Voice Formatting Demo

Dragon Medical 10: Increased Number of Medical Specialty Vocabularies

Includes Vocabularies for Essentially All Specialties

Dragon Medical 10: Improved Regional Accent Performance

Nuance has collected data from many speakers and enriched its models. More people will get better accuracy quickly. For the US product: US regions British, Indian, Australian, SE Asian Spanish

New User Wizard offers Accent list If in doubt, pick General. During Optimization, Dragon may automatically select what accent it identifies as matching your data

Dragon Medical 10: More Powerful Macros and Templates

Powerful Customized Templates and Macros streamline workflows

Dragon Medical 10: Macros and Templates

Macros and Template Demo

Summary and Review

Documenting Care in an EMR is a Challenge Speech-Enabling Your EMR with Dragon Medical is a Proven Solution

Dragon Medicals Value: A Return on Your Investment in 1-2 Months

Dragon Medical 10 is the Fastest, More Accurate Speech Recognition Solution Ever:
20% more accurate than version 9

50% faster
Contains Full Range of Specialty Vocabularies Now Has Regional Accent Wizards to Assist Non-Native US Speakers Can Be Customized for Greater Efficiency Using Macros and Templates

Contact Information
Company: Telephone Number: Website:

Backup Slides

Trends Impacting you

Trend 1: Clinical documentation moving to EMR
Driving the demand for better patient health documentation via EMRs US Government 10 year plan for an EMR for every American 100% EMR adoption by 2014 Clinical documentation will move from paper files and MS Word documents to centralized EMRs 25,000 to 30,000 physicians move to EMR per year EMR use requires clinicians to enter structured data in fields and discourages narrative dictation Physicians need to do their own data entry and typing Lower transcription costs, but reduced productivity as the physician starts typing Physicians are less productive

Trends Impacting you

Trend 2: Remuneration moved from fee for service to pay for performance
The way physicians are paid has changed dramatically.
In the past you were paid by patient contact; now you are paid based on the level of complexity of the patient contact (level 1 to 5).

More complex -> higher paid

Doctors need to prove service level with documentation. Physicians are paid based on what they document.

What Do Physicians Say?

What is a clinical narrative?
A first person "story" written by a clinician that describes a specific clinical event or situation. Writing the narrative allows a clinician to describe and illustrate her/his current clinical practice in a way that can be easily shared and discussed with professional colleagues. In addition, the narrative can help clinicians examine and reflect on their clinical practice or analyze a particular clinical situation. Describing Practice through Clinical Narratives: Guide for Clinicians, MGH
Narrative allows us to share complex ideas in an efficient and often seemingly effortless manner. Its use in the medical record is extremely important for clinicians because it allows them to synthesize disparate facts and data elements and to paint a picture rich with meaning that is easily interpreted by other clinicians. Jason S. Shapiro, MD, Department of Bioinformatics, Columbia University Studies have shown that EMRs do not in themselves lead to higher care Template-based systems lack a narrative Patient notes generated by EMRs all look the same

The Speech Enabled EMR

Cost and Time Documentation
Traditional Dictation + MT Increased cost

Manual Driven EMR - Typing

EMR

Speech driven EMR

HIGH COST

LOW COST

Speech Enable EMR: Increases $/Visit

Full freedom to document observations and plans in physicians own words not constrained by structure

More complete documentation in History, Physical Exam and Medical Decision-Making Aspects of Record

At point of charge capture, additional detail gives physician ammunition to code at a higher rate than structured note

Speech Enable EMR: Increases $/Visit

RBRVS (Resource-Based Relative Value Scale) January 1992 Fee Schedule Maintained by CMS Input from AMA/Specialty Society RVS Update Committee 23 Medical Specialties Represented 80+% of Private Insurers Use! Reimbursement Calculation 5 Levels of Service Codes for New / Repeat Patients Fee = relative value of service + amount of resources consumed = amount of Doc Time + Practice Expense + Liability Expense Adjusted by Geographic Practice Cost Index 2008: reimbursement 10% lower than 2007

Reimbursement requires adequate documentation to support level of service billed.

The Solution: Speech-Enable Your EMR Using Dragon Medical 10

DNS EMR
Structured Data input

Speech

The Speech driven EMR

Dragon Medical is perfectly positioned to solve the problem of: 1. Lower productivity due to EMR data entry 2. Higher documentation costs 3. Loss of reimbursement due to less-complete notes The combination of Dragon Medical + an EMR gives the highest productivity and financial benefits for the hospital and provider.