Hospital uses intelligent virtual assistant for more accurate order entry

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

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.

"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

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.