Dragon Medical One Implementation and Adoption Marios Loizou Trina

Dragon Medical One Implementation and Adoption Marios Loizou Trina Glover 1

Introductions Marios Loizou – Application Analyst DMNE (Dragon Network Edition) DMO (Dragon Medical One) Trina Glover – Application Analyst M-Modal, DMNE and DMO 2

Outline Organization DMO Overview Pros and Cons with DMO compared to our previous dictation services Goals Implementation, Adoption and Education strategy Roadblocks/Lessons Learned 3

Organization Overview Comprised of Sinai, Northwest and Carroll Hospitals, Levindale Nursing Facility, and over 80 Multi-Specialty Ambulatory Practices. – Carroll – Sinai: – Northwest: – Levindale: 579 1616 1030 309 4

What is DMO? DMO (Dragon Medical One) is a cloud based speech recognition software that allows users to securely dictate directly into the EMR Designed to increase provider efficiency and reduce provider documentation times. 5

How to access DMO At Lifebridge, we embedded Dragon Medical One in citrix. We utilized and created active directory groups to control access to the various icons. Providers are able to launch a “combined” icon labeled Powerchart – Dragon or Firstnet – Dragon to access both applications at once. 6

Basic Functions of Dragon Medical One Push to talk functionality Ability to adjust Powermic button settings Create user level autotexts, commands and add/modify vocabulary Auto Formatting designed to incorporate punctuation needs. 7

Autotexts Allows users to insert prespecified text using “hot keys” or saying the designated autotext title 8

Autotexts with Variables Providers have the ability to create autotexts with variable fields ([ ]). Once inserted, Dragon will prompt the user to complete the fields or accept defaults Example Head: [ ] [Normocephalic.] [Atraumatic.] Eyes: [PERRLA. Pupils fixed and dilated. Pupils] 9

Commands leveraging Cerner Global Autotexts 10

Dictation Model prior to DMO Nuance Dragon Network Edition – Local Install on each device linked to an onsite server Nuance E- scription – Hospital based phone dictation service Nuance Accentus (Emdat) – Office Based dictation scattered throughout the ambulatory locations M-Modal (Fluency Direct) – Primary dictation service used by Carroll Hospital and Carroll Health Group 11

Benefits/enhancements compared to DMNE Increased voice recognition Dynamic vocabulary Virtually no profile training Limited profile corruption No local server maintenance Command/Autotext integration for Powerchart Touch 12

DMO versus Accentus/E- scription Notes are available immediately which increases provider compliance Dramatic cost savings Fewer mistakes within patient notes Eliminate interface issues between Nuance and Cerner. More efficient onboarding and offboarding process 13

Goals Establish a standard dictation method Streamline support and training models to accommodate our dictation needs across the enterprise Reduce transcription costs for both the hospital and our physician practices Increase efficiency, accuracy and compliance 14

Deployment Preparation Provisioned all current, non-DMNE providers (MD,PA,NP,DO) with DMO Equipped Nuance Powermic III strategically throughout the hospital (Physician Lounges, Dictation Rooms) Implementation of Powermic Mobile Upgrade Citrix receivers to v.4.8 across the enterprise. – Created a script to run the client extension files in succession of the citrix update. 15

Powermic Mobile Mobile application that enables providers to dictate directly into the EMR Eliminates the need for client extension files and reduces microphone(USB) connection issues Available on IOS and Android Devices Additional license required 16

Spreading the Word Identified and informed department managers and directors of our new initiative Conducted presentations and live demonstrations to each department Created a group of pilot providers and identified workflow gaps 17

Leadership Buy In Physician Leaders worked side by side with department leaders and physicians to help drive adoption Utilized reports to identify providers requiring assistance and encouragement during transition. Worked directly with IT and vendors (Cerner/Nuance) for troubleshooting issues 18

Profile Migration from DMNE to DMO Migrated over 600 profiles in an effort to transition the following elements from DMNE to DMO – Commands – Autotext – Words – Groups/Specialties 19

Nuance Management Center Built “Sites” (Facilities) which are comprised of our different specialties at each facility Categorized each provider profile into a specific group – Enabled us to easily track and report by specialty and facility Created a suffix ( Life) for usernames that already existed within the Nuance cloud. – Added a log in token to profile to be AD Aware 20

Implement Global Commands Through the NMC (Nuance Management Console), we distributed commands and autotexts either by facility or specialty. – Assisted in streamlining documentation for multiple providers at once – Increased efficiency for provider documentation time – Standardize documentation across the enterprise 21

Education/Communication Created Quick Tip Sheets for commonly used phrases – New Line – New Paragraph – CAP that – Delete that – Select commands “Favorite Fairs” Directly targeted department leaders for awareness and communication Created Med Power Videos 22

MedPower Videos Worked closely with our education team to develop training videos. – Videos are generally less than 2 minutes long, outlining key concepts Assigned videos to all providers. Classroom sessions are available if additional assistance is needed. 23

Roadblocks DMO is unable to dictate within any application. – Installed the stand alone DMO application for providers who dictate outside of Cerner Broken Client/Audio Extension files due to Windows and Citrix Updates Microphone recognition – USB Host Controller, High Performance Mode, Disable sleep setting. Delays in launching application Microphone response time. 24

Virtual Machine (VM) Utilizing both a local and embedded version of DMO within the VDI. – Local access is provided for use with Paragon EMR – Citrix access is provided for use with Cerner applications. Client/Audio Extension files require install on the VDI for Citrix use. 25

Reporting/Adoption Decrease of 500,000 transcription lines per month! Over 3 million words a month – Autotexts and commands are not categorized into the “word” count Over 500 active providers per month and increasing 26

Words versus Transcription lines LBH Dragon Words vs. Transcription Lines 3,000,000 2,500,000 800,000 710,155 695,982 677,664 658,782 649,019 617,909 613,773 602,609 564,978 Words Dictated 2,000,000 1,500,000 3,220,568 3,155,580 3,054,386 3,033,235 2,993,080 2,903,617 2,771,474 2,767,247 2,766,903 2,547,266 2,384,104 2,377,585 2,248,055 600,000 2,536,867 555,527 700,000 2,115,726 512,000 1,578,010 462,982 448,764 457,488 500,000 405,000 1,200,808 1,139,105 388,745 1,123,775 1,090,464 400,000 372,600 369,845 381,796 1,019,927 366,762 365,946 981,609 973,554 1,000,000 347,286 345,473 852,918 336,346 723,900 643,572 571,010 286,016 280,309 300,000 500,000 399,074 254,358 269,379 235,357 0 1 6 16 16 16 16 1 6 16 17 17 1 7 17 1 7 17 17 17 17 1 7 17 17 18 18 1 8 18 1 8 18 18 18 18 1 8 2 0 l 2 0 g 2 0 2 0 t 2 0 v 2 0 c 2 0 2 0 2 0 r 2 0 r 2 0 y 20 2 0 l 2 0 g 2 0 2 0 t 2 0 v 2 0 c 2 0 2 0 2 0 r 2 0 r 2 0 y 2 0 2 0 l 2 0 g 2 0 2 0 t 2 0 p p n n p n n b n b Ju Ju Au Se Oc No De Ja Fe Ma Ap Ma Ju Ju Au Se Oc No De Ja Fe Ma Ap Ma Ju Ju Au Se Oc Total POC Dragon Use Transcription Lines 3,500,000 750,200 200,000 Transctiption Volume 27

Future Enhancements Coherence Mode – Ability to place cursor in any application and dictate Rapid Navigation – Ability to move from one variable field to another without errors NMC updates to allow site specific usernames without utilizing tokens 28

Questions? 29