Nuance’s Karen Holzberger: Fostering innovation through collaboration

The transition from volume- to value-based care is underway in the U.S., but a tremendous amount of uncertainty—and anxiety—continues to plague the providers who deliver that care.

It is precisely that uncertainty that inspired speech recognition vendor Nuance to disrupt its own business model by opening its source code to collaborators, reimagine its cloud network and enter into partnerships with others interested in providing support to physicians on that journey.

Clinical Innovation & Technology sat down with Karen Holzberger, vice president and general manager, diagnostics, Nuance, Burlington, Mass., to discuss the changing dynamics of healthcare, the evolution of its speech-generated reporting platform and how partnerships are helping Nuance to innovate the solutions providers need to succeed in the new healthcare paradigm.

Q. What do you see as the greatest challenges providers will have to meet in the next five years?

Holzberger: With the dynamics of healthcare changing to a patient-centered system, it’s challenging—and exciting—to see providers at the forefront of the quality movement, driving better outcomes for their patients.  That’s really the heart of this.

We’re still in a gap period between pure fee for service and value-based payment structures in which providers must quantify and report on the quality aspects that drive outcomes. This gap period is a real struggle: How can they make the same income that they’ve had over the past 20 years? How do they manage through this gap period to drive quality reporting and get to value-based healthcare?

Q. As a developer of health IT, where do you think vendors should be focusing to assist providers in moving to value-based care?

Holzberger: One of the markets that Nuance serves centers around radiology, with our PowerScribe speech recognition reporting system. We’ve been at the forefront of clinical accuracy in voice-to-text reporting, with one out of every two radiologists in the U.S. using our systems.

Five, six, seven years ago, clinical accuracy centered on the challenges of voice to text. Utilizing clinical language understanding, we can now take the report through a quality check with our Assure product. You are not going to get laterality incorrect, you’re not going to get gender incorrect, you are going to find those mistakes in an easy, simple way.

With vendors like Nuance—Massachusetts General Hospital (MGH) likes to call us the toolmaker—we had to move from supporting clinical accuracy in voice-to- text interpretations to helping the consumer—the ordering physician—get to the next care pathway for that patient. We knew we had to start building toolsets to support clinical accuracy and less variability in reporting, to make that report actionable.

Through collaboration with the American College of Radiology (ACR) and MGH, we just launched point-of-care access to electronic clinical guidelines.   We help the radiologist to send a more robust and actionable report back to the ordering physician, who can identify a clearer care pathway for the patient.  Equally as exciting, is that we have leveraged our PowerShare network to make these guidelines accessible regardless of whether or not the provider uses PowerScribe.  

That’s where healthcare IT vendors, as a whole, come into play.

Q. You recently launched an Innovation Program to open up your software platform to developers. Who do you envision using the platform and how has it changed your relationship with providers and other vendors?

Holzberger: It has been phenomenal; it has opened us up so that we are looking outside the walls of radiology. We are working with other visible light vendors that generate imaging around the patient journey but have difficulty connecting with the patient. Tools are under development, such as APIs and other technologies, that enable non-radiologists to be connected on our network to drive better outcomes and better care pathways for their patients.

We are thinking about our network beyond the ability to share images and reports: It’s about information at the point of decision.

For instance, radiologists are starved for information. They can’t get the information they need out of the EMR, it’s buried in there. We are using innovation partners to help drive information availability, whether its DICOM images, visible light images, information, education services or clinical guidance to make better decisions.

Many of the early innovators in imaging informatics have their own development shops. It’s been really exciting to open up this innovation program so that they can develop the things they need.

Q. What role do partnerships play in your overall development strategy, and what kind of partners are you looking for?

Holzberger: Within and outside of the imaging space, we are looking for partnerships with healthcare providers themselves, as we continue to work with the ACR. We are assuming a new model, where we are the platform-enabler versus being the toolmaker itself.  

We have this framework for partners to be able to innovate and build things much faster, sometimes more so than we can ourselves, being a large, multinational corporation. We’re providing the platform and the ability to share in the monetization of those tools.

Q. Nuance touches a lot of healthcare organizations through the widespread use of its voice recognition software.  How many hospitals are you in and how did the idea of building a communications network come about?

Holzberger: Approximately 70% of U.S. hospitals rely on Nuance healthcare solutions.  In the Diagnostic market, the PowerScribe 360 footprint is in 55% of radiology reports in North America. From a facilities perspective, just over 1,600 utilize PowerScribe. In the area of image sharing, more than 2,200 facilities are networked in via the PowerShare Network.

In fact, a number of people were quite perplexed when we moved into image sharing, and  we’ve actually had to do a lot of education over the past year articulating the reasons why: It’s the need for radiologists to have information, the need to connect them (with the referrers or with each other), and enable them to collaborate together.

The network begins with image sharing, but it boils down to information and providing a consultation workflow where they may make a decision not to image because there are already existing relevant images, information, and reports available. This can lead to overreads or double-blind reads that impact their quality measure scores and improve care quality by having the ability to “not” re-image, which reduces radiation dose to the patient.  According to a recent report conducted by Peer60, somewhere between $7.47 billion and $11.95 billion dollars is spent on unnecessary imaging. 

They need each other and we are the conduit, or fabric, that connects them. Image sharing was our first app on the PowerShare Network, clinical guidance based on ACR guidelines, is a second. You’ll hear us talk further away from Phase 1 and image sharing to focus on information sharing, insights and collaboration, all on our network.

Q. How do you envision the PowerShare Network assisting providers in the transition to value-based care?

Holzberger: In moving to value-based care, the network effect is about being able to do quality reporting. Most quality activities today, whether strictly clinical or related to required quality reporting for CMS or others, are heavily dependent on registries. 

Nuance has the ability to leverage its PowerShare Network to automate the extraction and transmission of data to registries, such as the ACR’s Physican’s Quality Reporting System (PQRS) and General Radiology Improvement Database (GRID) registries.  A registry for Lung Cancer Screening is expected to be available shortly, which will positively impact both quality and revenue generation.

However, it really comes down to providing tools for better patient care and making images and information available at the point of decision. We’ve improved the availability of the information that radiologists need to make better decisions through our interoperability strategies with the EMR vendors as well as the ACR. From that perspective, the network makes radiologists more efficient and able to fulfill their role as consultants.

If you think about our network effect, of making PowerScribe a node on the PowerShare Network, you can envision how powerful it is for radiologists to be able to collaborate amongst themselves to get to the highest quality diagnostic report, which is their output.

At the end of the day, though, it is about the benefit to the patient. In addition to the 2,200 facilities networked for the sharing of images and reports, we have 12,000 patients registered on the PowerShare Network: They can go in and see and share their images and reports. Having that ability to link into their patient portal through the EMR is a real testament to the network’s reach outside the walls of radiology.