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Nuance Communications, Inc. [NASDAQGS:NUAN]: Access, Share, and Interpret Medical Images Anytime

 Peter Durlach, SVP Healthcare Marketing & Product Strategy , Healthcare Radiology has come a long way since its invention by Wilhelm Röntgen in the 19th century. The digital era has further accelerated its growth. Diagnostic imaging that earlier took days and months to process are now done in minutes. Meanwhile, the rapid rise in demand for diagnostic imaging, spurred-on by disease screening programs, an aging population and more advanced techniques and solutions, has involuntarily created a situation: the reduced interaction between radiologists, patients and the referring physicians. Today, radiologists are often termed as “the dark investigator”—married to their work lists, separated from physicians and divorced from the multi-disciplinary teams that provide patient care. Nuance Communications [NASDAQGS:NUAN] is solving the intricacies in this equation by providing a robust platform that ensures that radiologists can demonstrate and quantify the value and quality of their work product—the diagnostic report—and allow them to move beyond their current status as a diagnostic report production line and be both interpreter and ‘data-tician.’ It’s a paradigm shift.

“The rapid reduction in interactions between radiologists and the care team paves the way to two important queries—how aligned they feel to the delivery of care and how much value the organizations are receiving for their expertise,” explains Peter Durlach, Senior Vice President, Healthcare Marketing & Product Strategy, Nuance. Headquartered in Burlington, MA, Nuance solutions help radiologists effectively manage clinical documentation, drive standardization and better integrate radiologists with the care team to drive improved clinical and patient outcomes—“with access to industry based guidelines to support care recommendations and better follow-up management—the radiologist has never been in a better position to drive clinical, business and patient outcomes.”

To accomplish this, Nuance enables radiologists to access the complete clinical picture and recommend the best course of action by amalgamating radiology information systems (RIS) and picture archive and communication systems (PACS), as well as the hospital electronic medical records (EMR). “We believe that the integration of the radiologist and care team will improve patient outcomes dramatically and the care delivered would be more precise, cost effective and actionable,” Durlach adds. “Radiologists will then be able to demonstrate the quality outcome of their work by first proving the necessity of the imaging study through to the structured actions of the patient’s care team.”

Discussing on the current market challenges, Durlach brings in the declining reimbursements scenario in the radiology space that, in turn, is further getting complicated. “The demand to deliver accurate and actionable patient reports is exerting huge pressure on radiologists,” he points out. Having won a strong following among radiologists, Nuance makes the radiology process intuitive, with its structured information format, real-time access to clinical guidelines and the ability to mine and leverage the data to drive tangible outcomes. “Making the radiologist central to the care team and the patient’s care-pathway by providing actionable recommendations for the care team is only the first step,” remarks Karen Holzberger, Vice President & General Manager Diagnostics, Nuance. She also brings in the importance of having clinical guidance, at the radiologists’ fingertips.
“We know that when these clinical guidelines are built into the radiologist’s existing workflow, alignment and adoption is more than 90 percent over alternative methods. And all of this data is analyzed and used to drive industry benchmarks—the right test, at the right time for the right follow-up - that is when the health enterprise will realize the true value of radiology.”

Advanced Radiology Platform

Nuance solutions are built to drive clinical and financial outcomes for healthcare organizations. PowerScribe® 360 stands out as their core radiology reporting platform, supporting rapid turnaround times and ensuring reports are accurate, consistent and highly actionable. The standardized templates and structured reports make the pre-report, in-report and post-report process consistent and made ready for further clinical and business analysis. “Used by over 20,000 radiologists on a daily basis, PowerScribe 360 and the integrated PowerShare® platform allow access to critical information—including reference images and deeper patient data—and help radiologists not only to create and turnaround diagnostic imaging interpretations faster than ever before, but takes it ten steps further in the data’s ability to direct and improve patient and clinical outcomes,” states Holzberger. Additionally, within PowerScribe, the extended Clinical Guidance ability brings real-time clinical evidence to the interpretation and recommendation process—for instance, incidental findings on lung scoring. Another interesting feature is its Clinical Test Result Management through which an important finding can be immediately communicated to the physician to ensure utmost care delivery to patients. Closing the data loop is the Nuance clinical analytics solution, made possible through its recent acquisition of Montage Healthcare Solutions and deeply integrated into the PowerScribe 360 platform, to manage and track overdue recommendations for follow-up care and minimizing the risk of follow-up care “falling through the cracks”.

Many radiologists use PowerScribe 360 in the production of their reports, and with the deeply integrated PowerShare Network solution, the diagnostic images and imaging data can be made available through their secure cloud-based network, as easily as clicking a link during the interpretation process. The image sharing network offers the ability to share relevant diagnostic images and imaging data across organizational and regional boundaries.

Durlach brings in an interesting example to elaborate on the functionality and efficiency of the PowerShare Network. “Patients don’t stay within the walls of one health system—and neither does their health data. The radiologist requires a level of workflow efficiency, irrespective of the data’s originating EMR, VNA or PACS. For instance, in mammography screening cases, if prior images are not available at the time of the impression, reports will most certainly be incomplete and will require time-consuming addendums,” he narrates. “Not having to deal with undependable CD transport or time consuming CD uploads means no longer worrying about accessing the patient studies and instead focusing on the impression and recommendation for better patient treatment.” Today, the PowerShare Network connects more than 4,000 health care provider sites that includes more than 12,000 physicians and has facilitated the exchange of more than 6 billion medical images.

Leveraging Technology for Better Patient and Clinical Outcomes

Nuance also has a stronghold in the area of clinical analytics, moving beyond the operational reporting systems to measure staff productivity, compare findings, follow-up recommendation rates, analyze radiologist report variance, monitor ordering patterns, and calculate turnaround time based on a variety of parameters. “Our industry has never had the ability to track quality of reports—like follow-up, no-follow-up or hedge statements—and our operational analytics helps in recording the success rates of the radiology reports as well as in conducting detailed analytics on the process to understand the clinical symptoms and findings,” says Holzberger.
“When up to 30 percent of follow-ups never actually occur—concerns over potential liability and financial leakage become top of mind.”

A best example to showcase the expertise of clinical analytics would be its success at Elkhart General Hospital, which was looking for a solution and partner that could help its physicians unlock actionable information and clinical data. Within just 90 days of implementing the Nuance clinical analytics solution, Elkhart completed 14 radiology analytic assessments that benefited its facility, including improving workflow efficiencies and becoming more proactive. Most importantly, these improvements not only had an impact on the facility but are helping Elkhart physicians provide better quality care to its patients—their priority from the start.

"Used by over 20,000 radiologists on a daily basis, PowerScribe 360 and the integrated PowerShare® platform allow access to critical information"

Set to Tackle the Future of Medical Imaging

To validate its innovation strategy and remain focused on being an open platform, Nuance has established a strong strategic partnership with the Radiological Society of North America (RSNA), American College of Radiology (ACR) and National Decision Support Company (NDSC), integrating their best practices and guidelines into delivered solutions. “We recently entered into a new partnership with Stryker to support the sharing of surgical images. It’s a great example of how Nuance is enlisting partners from every corner of the medical space to create the future of data sharing and collaboration,” says Durlach.

We believe that the integration of the radiologist and care team will improve patient outcomes dramatically and the care delivered would be more precise, cost effective and actionable


On its futuristic vision, the company will strive to add more innovative features that deliver demonstrable clinical and patient outcomes. “There is a new radiology paradigm emerging,” said Durlach. Radiologists are poised to leverage their professional experience and marry it to the role of 􀇰data-tician􀇱 interpreting the information that is being used for future data mining. “Our key focus will be to make the process of diagnostic image interpretation, quality of reporting and creation and delivery of actionable data available at the radiologist’s fingertips.” “Finally, on the image sharing area, we are making the platform supportive of all types of images, workflows, integrations— making the capability more robust for a wider future.” “With a strong customer base of 4,000 facilities, Nuance is poised to support this new paradigm of radiology productivity that started as just speech to text and today focuses on image driven structured reporting.”