The May 2008 acquisition of eScription by Nuance Communications brought two formidable companies together, both with a strong healthcare presence. The eScription platform, named Best in KLAS in December 2008 for the fifth year in a row, provides computer aided medical transcription using background speech recognition. Nuance is the world’s leading speech solution vendor. The eScription solution turns clinician dictations into formatted draft documents, requiring only a quick transcriptionist review and edit. The product has been proven to work in large enterprise deployments, reducing transcription costs, turning dictation into EMR-ready data, and improving report turnaround time to ensure efficient patient management. We spoke with John Shagoury, co-president of Nuance’s healthcare division.

What are your responsibilities at Nuance?

I am co-president of the Healthcare Division of Nuance Communications. Nuance Healthcare provides roughly half of the company’s revenue, in excess of $400 million. I’ve been with the company for four and a half years and have been involved in the healthcare division for part of that time.

What attracted Nuance to acquire eScription in May 2008 and what has changed with its products and operations since then?

As you probably know, Nuance is focused on speech recognition technology and the use of speech technology in many different areas to lower costs for organizations, improve customer/user satisfaction, and drive strong ROI. Nuance has been in the healthcare business for about three years now.

We were attracted to eScription because of its strong business model, wonderful product offering, and very satisfied customer base. We have never lost a customer on the eScription platform. I can’t remember the last time I have been able to say that.

Today, eScription is operating as a virtual business unit within Nuance Healthcare. The eScription software for computer aided medical transcription (CAMT) is our on-demand platform.

You mentioned customer satisfaction. eScription has constantly been at the top of KLAS rankings for transcription and background speech recognition systems, winning Best in KLAS yet again this past December. How have you been able to sustain such high level customer satisfaction year after year?

We’ve had a passionate focus on customer satisfaction, which is driven by really outstanding, responsive relationships throughout the eScription organization with customers, from Sales to Installations to Technical Support.

I think we continue to do a wonderful job of setting appropriate expectations. The theme is to over-deliver on any promise and to make sure we talk to our customers about what we can do, and in turn, what they should expect of us. The concept of being upfront allows the eScription customer never to be surprised in a negative way, to always understand what is going on.

Organizationally, we are set up to ensure the right kind of customer care, from the time a healthcare organization first signs the contact to long after it is up and running on the eScription platform.

Nuance speech processing acquisitions have created a broad healthcare portfolio. How do you differentiate your offerings for healthcare decision-makers?

Nuance Healthcare provides speech-driven clinical documentation and communication products in three areas. The first area, Transcription Platforms with EMR Integration, includes the eScription on-demand platform and the Dictaphone Enterprise Speech System on-premise platform.

Second, in Radiology, we are a market leader with our PowerScribe for Radiology and RadWhere for Radiology speech recognition reporting solutions, as well as with order entry decision support, business intelligence, and critical test results communication.

Third, in the EMR and in the small physician space, it’s our real-time speech recognition product, Dragon Medical.

As a team, we work to ensure health information professionals in each segment understand our product offerings, as well as the robust benefits they provide.

Will the company do anything different in a weaker economy?

A weaker economy challenges healthcare organizations to increase efficiencies and cut costs. The eScription platform has been proven to do just that for its customers.

Because the eScription ASP model does not involve a capital sale, healthcare organizations can move to the platform and very quickly start saving money on medical transcription.

Each May, at the eScription User Meeting, we announce our new Million Dollar Club members. To date, 23 major healthcare organizations have demonstrated savings of $1 million or more since they’ve ‘gone live’ with eScription. The Club includes Brigham and Women’s Hospital, which has saved more than $9 million, Beth Israel Deaconess Medical Center, with more than $5 million saved, and a long list of others.

In a tough economy, solutions that have demonstrable ROI like the eScription platform become more attractive and are considered strategic investments to drive operational efficiency and savings.

How easy it is to make a business case for eScription? How is that ROI determined?
As we like to say, eScription is based on the simple premise that it is faster to edit than to type. The physician is dictating the same way, so there is little to no change to physician behavior at all.

The ROI is determined pretty simply by first sitting down with a prospective customer and understanding the transcription process they are currently using. Typically, this is a type of voice capture system that sends dictation to medical transcriptionists (MTs) who transcribe the audio into text.

What happens with eScription is that the MT actually becomes an editor. Where the MT would previously start with a blank page and an audio recording, now the dictation first runs through our speech recognition engine and is automatically processed into a highly accurate, formatted draft document.

MTs review and edit the drafts while listening to the original audio, a process that is typically twice as fast as typing from scratch. The MTs might be employed by the healthcare organization or they might work for a medical transcription service organization (MTSO).

To make the business case, we can look at what a healthcare organization is paying today for both technology and transcription services, and show them how it can save costs as a result of increased MT productivity.
For example, as in-house MTs become more productive, the organization may be able to reduce or eliminate overflow outsourced work. Organizations that solely outsource reduce their cost per line because the MTSOs will charge less per line to edit than for traditional transcription.

It is important to remember that the healthcare organizations that use eScription pay separately for the software platform and for the transcription/editing services they use.

The eScription platform also helps healthcare organizations reduce document turnaround time. Customers report that with their previous systems, turnaround time for certain work types could take days or even weeks, whereas with eScription CAMT, turnaround time is now being reduced to hours.

It’s a win-win, not only in direct cost savings, but also in all the other benefits that improve patient care, improve report quality, and even improve reimbursement.

A not uncommon concern with outsourcing is the risk of data breach. How do you weigh the risks of that versus the benefits you get with eScription?

In the eScription model, Nuance provides the technology platform. Should an organization use outsourced services, it is welcome to choose whichever medical transcription organization it wants. We don’t make that decision for them and we don’t control it.

Our MTSO Alliance members are the most experienced on the eScription platform and do a significant volume. What we do is give the customer a list and say, “Here are some people we know who have the experience to do a good job,” but it’s really up to the hospital to decide who they want to go forward with. It’s up to each healthcare organization to get comfortable on the security and whether they want to keep all the work on shore, which is typically more expensive, or whether they want a lower cost solution, which may be offshore.

Although we cannot guarantee the security of the transcription company chosen for labor, we understand this concern and have built the software to protect patient safety and security as much as possible. The transcription administrator’s console has settings that managers can adjust to create security levels to protect patient information.

For example, administrators can create password settings that require users to change their passwords regularly, and permission-specific security groups to restrict user access to certain dictations, documents, and patient information. They are also able to review audit trails showing which users have touched documents.

The editing client by default prevents MTs from saving documents to local disks, ensuring that private information remains only on the secure network that encrypts all customer data to and from the ASP servers. These features among others help HIM departments manage the security of confidential patient information.

Do you see many new opportunities coming about now that the front-end and the back-end are both so much more accurate? What are the effects down the road?

At Nuance Healthcare, we continue to invest in our speech-driven solutions and look for ways to leverage the increased accuracy gains in both real-time and background speech recognition.

The more we can continue to improve the quality of our draft documents, the less time it takes an MT to complete a final document. The less time it takes, the more documents an MTSO or in-house transcription team can handle per hour, which helps drive costs down to deliver stronger ROI.

One way we get input from the market is through our Product Advisory Meeting that takes place in May in conjunction with the annual eScription User Meeting. During the Product Advisory Meeting, one representative from each of our customers participates in facilitated discussions with our senior product development leaders to let us know the challenges they are facing and to give us input on how we can help meet them. At the end of the meeting, everyone votes on development priorities for the coming year.

In addition, we continue to invest in improvements to our clinician dictation interfaces – via phone, digital recording device, or directly into an EMR – and to our document distribution and electronic signature components.

Have any key new clients come on board that you’d like to mention?

There’s a significant list of clients that have gone live on the eScription platform recently. Kaiser Permanente Northwest is now using eScription. Aurora Health Care in Wisconsin is another prominent customer that is expanding its use of the platform for an enterprise-wide solution.

Back in 2006, Aurora Metro Region adopted the platform, and since then, four other regions and the Aurora Medical Group have gone live, representing more than 50 facilities including hospitals and clinics using the eScription solution. Orlando Regional Healthcare in Florida is another recent eScription customer, processing more than 23 million lines of transcription per year.

Any final thoughts?

As the pressure for cost saving continues to mount, there’s not a lot of places a hospital can look for a quick return of demonstrable savings. Most of the time, when you can deliver demonstrable savings within in an organization, the savings come at some expense, at some pain, such as a decrease in customer satisfaction.

That’s not the case here. We have so many valid proof points and so many referenceable eScription customers that will talk on and on about how happy they are with the decisions they have made and the successes that have come as a result. Across the organization, from clinicians to HIM directors, eScription customers are achieving significant financial results and appreciate many other benefits of CAMT. These include streamlined and standardized processes, more consistent documents, and faster turnaround time, all which support their efforts to provide quality patient care.

Fast Facts

Products
eScription Computer Aided Medical Transcription

Company
Nuance Communications, Inc.
1 Wayside Road
Burlington, MA 01803
781.565-5000
www.nuance.com/healthcare/

Notable Customers
Beth Israel Deaconess Medical Center, Brigham and Women’s Hospital, Carle Clinic, Maine Medical Center, Poudre Valley Health System, Aurora Health Care, Orlando Health.

The Bottom Line

* eScription CAMT changes time-consuming transcription into skilled reviewing and editing, often doubling the productivity of transcriptionists.

* Faster report turnaround improves patient care and can simultaneously help make patient throughput more efficient.

* CAMT can help move handwritten or unstructured notes into the electronic format usable by electronic medical records systems.

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