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Hospital uses intelligent virtual assistant for more accurate order entry

When physicians juggle a lot of tasks, they can forget to place a necessary order. Artificial intelligence is helping one hospital system remedy this and avoid medical mistakes.

Typically, very sick patients seek care at Landmark Hospitals, which has seven long-term acute care facilities in various states, including Georgia, Florida and Missouri.

"A majority of our patients are Medicare patients," said Anthony Sagel, chief medical officer at Landmark Hospitals. "They're high-acuity Medicare patients coming from basically lateral transfers from other large ICU settings to our hospital, oftentimes on a ventilator … in other words, very sick patients."

Anthony Sagel, chief medical officer, Landmark HospitalsAnthony Sagel

Because these patients are very sick, physicians need to order multiple medications and lab tests, Sagel said. For a physician, this juggling act can be a challenge and, he added, often, physicians don't remember to order all the necessary medications and lab tests a patient needs. To remedy this problem, Landmark decided to use an intelligent virtual assistant.

"Part of the problem that I've seen over the years practicing medicine is physicians will say that they're doing something in their progress notes and then they just forget to order it," Sagel said. "That creates a lot of medical mistakes." This is especially challenging when physicians are caring for patients such as Landmark sees who are very sick and need a lot done for them, Sagel said.

Part of the problem that I've seen over the years practicing medicine is physicians will say that they're doing something in their progress notes and then they just forget to order it.
Anthony Sagelchief medical officer at Landmark Hospitals

"If you look at the high-acuity Medicare patient, they're coming in with at least 20 medications … the physician has to order on admission," Sagel said. "They're coming in with multiple diagnoses, requiring probably 10 labs that we have to order, coming in with issues, with a tracheal tube that requires a portable chest X-ray today and then a follow-up one in the morning."

With the help of Nuance's intelligent virtual assistant, Florence, Landmark is working to ensure patient medications and lab tests are not forgotten. And progress is being made: With the help of Florence, over the course of 18 months Landmark has been able to reduce physician order entry errors by about 30%.

Speech recognition key to intelligent virtual assistant

Jon Dreyer, senior director of solutions marketing for healthcare, NuanceJon Dreyer

Florence is a cloud-based application that utilizes artificial intelligence and natural language processing to help physicians track and follow through with orders as well as make sure the physician is ordering the correct medication for the patient, said Jon Dreyer, senior director of solutions marketing for healthcare at Nuance, a software company, based in Burlington, Mass, that provides speech and imaging applications.

Dragon Medical, speech recognition technology developed by Nuance, is a part of Florence and allows a physician to speak into a microphone and have that information be entered directly into the EHR.

"Dragon Medical is right in that core speech experience of translating the user's voice into text and also facilitating interaction with the EMR," Dreyer said. "What Florence is doing is targeted [at] different, specific use cases."

In the case of Landmark, the use case is physician order entry.

Intelligent virtual assistant improves order entry

"[The  intelligent virtual assistant] creates a conversational interface between the physician and the technology," Dreyer said. "Very much like a human would, it's looking to collect certain information in order to complete a task."

Landmark's Sagel explained that Florence guides the physician making the order. For example, a physician may order a certain medication for a patient and stop there. If they stop there, Florence knows that isn't enough to complete the order and will ask for more information: "What's the dose? What route? How frequent do you want it?" Sagel asked. "It's prompting you … it's thinking for you."

A Florence product demo.

This is where the intelligence part of Florence comes in, Sagel said. It assists the physician and makes sure everything is correct. Once all the order criteria are fulfilled, then the intelligent virtual assistant places the order automatically. Sagel added that Florence is present throughout their EHR, which is homegrown and called Chart Pad. This means that wherever a physician is within the EHR, he can talk to Florence, tell the software what is needed and Florence will make sure all the information needed is not only present and entered into the EHR, but will actually put it into action and place the order for the physician.

"Florence recognizes those as fields within that order that you have to state," Sagel said. "If you don't state it, it's not a complete order."

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