Natural language processing, AI, and machine learning travel in the same space. The breakthrough is a result of the collaboration of several technology giants, Google, Amazon, and commercialized by Nuance, is a long-standing player in dictation and transcription. Nuance is a player in the consumer market place, as well in the health care market. Their offerings have expanded considerably and Nuance is in full marketing mode.
Products often appear to be useful when introduced, but the real test is in clinical use. The small things often make a product a winner or a lackluster performance when caring for patients.
Dr. Tarik Alkasab demonstrates PowerScribe 360 Clinical Guidance at Mass General Hospital
Workflow and data entry are key components and individual physicians accomplish their own tasks in different ways from each other. When electronic health records came into existence workflow and computer data entry did not get along. This markedly reduced clinician efficiency less time with face-to-face interaction with patients, and longer work hours. It led to substantial physician burnout and early retirement for many physicians.
NLP has advanced with time and usage. Algorithms require huge amounts of data, text, charts, or images to 'learn'. There is really nothing intelligent about machine learning. The algorithm must be fed, like the robot in the movie, Short Circuit, where a 1986 American comic science fiction film was directed by John Badham and written by S. S. Wilson and Brent Maddock. The film's plot centers upon an experimental military robot that is struck by lightning and gains human-like intelligence, which it embarks to explore.
"Johnny" or Number Five from "Short Circuit"
The robot earns the name 'Number Five', apparently, his serial number given to him by its builders. "Number Five is alive" becomes a trademark announcement by the misguided robot shocked into life by an errant lightning bolt. The lightning bolt reprogrammed Number Five with an algorithm again to machine learning.
Number Five had a consummate thirst for knowledge. When queried his response would often be 'need more data'. He had the unique ability to recognize when he could not compute the answer.
NLP and machine learning also needs to be given data and learns. NLP is not a static program, it will learn, the more it hears the more it can translate into written language. The process is autonomous and should not require manual reprogramming.
Nuance is marketing an expanded set of NLP and artificial intelligence applications:
Robust integrations with third party vendors streamline workflows to improve efficiency, reduce data entry errors and share data across systems.
Advanced Data Integration
Auto-import data and map to custom fields to minimize redundant steps and streamline reporting
Advance Data Integration with ModLink
Import, manage and normalize measurement, dose, DICOM-SR and other data to improve accuracy
EHR Follow-up Delivery
Capture and codify data elements critical to patient follow-up, and automate their delivery directly to EHR
A unified worklist platform that optimizes workload management and prioritization, consolidating access to imaging and patient information across multiple sources.
An industry-leading, end-to-end solution that simplifies creating and managing lung cancer screening programs, tracking high-risk patients from eligibility through follow-up and reporting.
Automated identification and proactive management of incidental findings recommendations and follow-up compliance, closing the loop on patient follow-up for improved outcomes.
NUANCE and Microsoft Teams are Integrating DAX to be used in telehealth and clinical encounters. Nuance promises the integration of their NLP into the EHR and is embarked on that goal with Epic EHR systems. It is in limited use at several health facilities. This is a work in progress and will be expensive to perfect.
The Exam of the Future using DAX
This first version of DAX is merely a cut and paste version and does not form fill in the correct fields of the EHR. In essence, it is a marketing tool to develop an interest in a later version.
Nuance Dragon Ambient eXperience for Microsoft Teams
In much the same manner DAX Telehealth records in real time as the examination proceeds with little to no action on the part of the examiner.
All these improvements are early renditions, and much more will come swiftly. It is a step by step process. Good things are coming.
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