Electronic Health Reporter

Joe Petro is senior vice president of healthcare research and development, where he provides leadership for all of the research and development required to bring Nuance Healthcare products to market, including: Dragon Naturally Speaking, eScription, Dictaphone (Enterprise Express/iChart), Radiology Platform, Radiology Reporting & Decision Support, SpeechMagic, Critical Test Results Reporting and innovations such as cloud offerings, CLU, and CAPD. Prior to joining Nuance, Joe was SVP of product development at Eclipsys Corporation. While at Eclipsys, he also served on the executive staff and was a reporting officer, where he was responsible for the development of more than 30 products from ADT, departmental, inpatient, ancillaries, patient financial management and outpatient products. Petro received a Bachelor of Science in Mechanical Engineering from University of New Hampshire and a Master’s Degree in Mechanical Engineering from Kettering, graduating both with Summa Cum Laude accolades.

Here he discusses Nuance, the evolution of technology in health IT, trends and changes, the patient response, meaningful use’s hamstringing and the biggest obstacles patients face.

Describe Nuance Communications and your role.

Nuance is the market leader in creating clinical understanding solutions that drive smart, efficient decisions across the health information technology industry. More than 500,000 clinicians and 10,000 healthcare facilities worldwide use our technology and solutions.  Nuance clinical speech and understanding products are deeply embedded in EHR solutions, such as Cerner, Epic, Meditech, etc., enabling them to deliver innovations that provide a seamless user experience to their clinicians.

I’m the senior vice president of engineering, Research and Development, for Nuance’s healthcare division. I am responsible for the research and development of the entire Nuance Healthcare product portfolio. When not leading the engineering teams, I spend time with clients trying to understand how to improve existing products and devise brand new ideas that someday will become part of our extensive product portfolio.

How is Nuance changing healthcare today and in the future? Where do you see the company, and health IT going?

I think the health IT industry is approaching an inflection point where technology shifts from being viewed as a mandated requirement to more of a ”necessity that I must have in order to get my job done.” We are finally reaching a point where the cloud is enabling the kind of form-factor agnostic experience that we all thought made a lot of sense from the very beginning, but which was challenging to deliver because all of our “things” were not connected.

When it comes to tech adoption, particularly in healthcare, there needs to be a catalyst—we saw that with CMS regulations and meaningful use. Now, we are starting to see perspectives shift: Physicians are asking seemingly obvious questions like “Why can’t I access this data on my smart phone…?” or “Why can’t I do the same things on my phone as I can using the computer on wheels in the hospital?” This kind of shift is creating massive opportunities for a company like Nuance because the ability to get data into the mobile device (and easily access it) can be profoundly impacted by the technologies that we build. And sure there are plenty of challenges, but the industry is becoming more adroit and agile, creating solutions that serve the specific needs of the individual physician – and not just the technology to address government imposed regulations.

At Nuance, we are re-imagining the clinical documentation process by seeking to change the status quo and rethinking how technology can be leveraged to improve clinical workflows.  We consider the way it was done in the past and introduce state-of-the-art technology to create a new normal. In this respect, we work hand-in- hand with our EHR solution providers. From a user standpoint, we work with physicians to develop clinically-focused solutions that are minimally-disruptive to the physician-patient relationship and that ensure documentation accuracy and integrity.

How do you see technology evolving the way care is delivered? How is it impacting the physician and patient relationship?

When I was an application engineer many years ago, I used to talk with my clients about how natural or unnatural a tool feels. For instance, when you work on your car and you grab a favorite wrench it feels like a natural extension of your hand. Despite the good intentions of government regulations, they did have unintended consequences—including tools that don’t feel so natural.

As the industry gets over the initial mountains of achieving regulatory compliance, technology providers are starting to focus more on the user experience. The cool part about being in R&D at Nuance is we have always focused on the experience, and our history with making physicians more productive is overlapping into facilitating the patient-physician relationship using technology such as natural language processing and intelligent agents. For instance, Nuance Speech Anywhere services has more than 1,000 development partners who are building applications for physicians and patients alike. Preserving this relationship and the Art of Medicine is central to what we do. We to “turn the chair around” and get the physician focused back on the patient and not staring at a computer screen, hunting and pecking his or her way through documentation.

Are patients reacting and how can they take a greater role in their care?

Patients and physicians, alike, are consumers: they are used to interconnected devices and information always at their fingertips, so they are very interested in technology, but it needs to provide health insights in a thoughtful way. Right now, I think the rise in wearable technology supports a movement toward the engaged patient, a greater awareness of being healthier, and metrics that help drive behavior changes. This is an interesting step toward population health. In the end, the patient is going to be far more connected to the care giver and accountable care is driving towards this. We, as patients, are going to wake up years from now and will not even have realized that technology has slowly, but deeply, connected us into our own healthcare experience. Our own “health management” will be, in large part, enabled through the devices we all carry.

What are some of the trends and biggest changes that are facing healthcare leaders today?

Security is obviously a very big deal today, particularly the extent to which its concerns extend across the technology. Hosting and deployment footprints make security management extremely complicated, and the media’s reactions to these issues have not been disproportionate.  Every technology leader has a stack of security initiatives on his or her desk.

The cloud, in general, is another big bet the industry is making, and everyone is trying to figure out how deep to go and how fast. There is so much opportunity with the cloud in terms of creating form-factor-agnostic experiences, in addition to making information more ubiquitous in different workflows—so much so that the reward far outweighs the risk we will need to overcome. For Nuance, the cloud is a phenomenally powerful enabler for all kinds of technology and product initiatives that were extremely challenging to deliver just a few short years ago.

How are healthcare leaders rising to the occasion? How are they failing?

Healthcare leaders are rising to the security challenge as a necessity—the ramifications of a breach are far too costly to ignore.

The cloud is a more interesting question. Some leaders are slowly rolling out cloud solutions, while others are charging headlong into the void. I think this is a classic technology adoption curve where there will be a mix of early adopters and folks who wait to see the proof before they move. The good news is that the cloud offers such compelling functionality that the value will be (and is) undeniable.

It comes down to comfort levels and knowing that failure avoidance hinges on understanding the strengths and weaknesses of these technology initiatives, and trying to thread the needle in such a way that risk and reward is balanced for your organization.

Healthcare providers are still working on many different regulatory challenges. What do you think are the top regulatory challenges for providers? How can they meet them? What is hampering Meaningful Use of EHRs for real users?

In terms of impact, providers are obviously concerned with meeting meaningful use Stage 2 and Stage 3, along with a number of other things such as the shift to ICD-10, ACA payment shifts, and ONC activity around data integration and availability. And this is just the short list.

One of the important things to realize is that achieving Meaningful Use is only partly about installing compliant software and “attesting.” Actually using the software, day-in and day-out, is an altogether different story and, in the end, this is more about classic change management than it is about technology. The technology will make the change management a lot harder (or a little easier) depending on the implementation, but it is important to realize that meaningful use is forcing stressed out physicians, who are attempting to deliver high-quality care, to do things much differently from a workflow standpoint. Yes, there is real money involved, but in the end it is too painful to achieve, physicians will push back all the way. So there is an important soft science dimension to this problem. Part of what hampers meaningful use is not recognizing it as a classic change management problem and incorrectly assuming it ends when the software installs.

As technologists, we are trying to make the change management process easier by creating systems that providers WANT to use. I capitalize “WANT” because if a provider really wants to use the system, the change will not feel so foreign and the adoption will be more frictionless. I was an R& D executive at an EMR company in a past life, and I used to have a spreadsheet with 2,500 CCHIT items on it, and the budget to address only 500 of them. How the systems made someone feel or “ease of use” was sometimes barely a consideration. As we get to the “other side” of these regulations, the technology companies that were so hampered by the regulations will have more time to smooth the user experience, and this will put wind in the sails of adoption.

What about some of the other regulations? What are your peers drawn to? What are they running from?

From a technology standpoint, these regulations have created huge opportunities for innovation and draw in lots of competition. Whether it’s the shift to value-based purchasing, the transition to ICD-10, or meeting meaningful use requirements, there are opportunities to apply core technology such as speech or natural language processing, exercise new deployment models such as the cloud, and employ product delivery mechanisms such as web-services. These are exciting times because core technology is evolving in a way that is almost keeping pace with the requirements flowing from the market. This means that instead of running away from the chaos, we are meeting and addressing it.

What role does mobility and speech recognition play in addressing critical issues and supporting quality patient care? How are you advancing this mission or meeting this goal?

Our mobile clinical speech-recognition allows clinicians to document their patient notes in real-time, directly into the EHR. This means that important patient information can be accessed from anywhere, at any time— leading to more informed and timely treatment decisions. There is also an opportunity for intelligent agents to help create a streamlined physician experience, particularly when it comes to data input and navigating complex workflows. For instance, instead of hunched over a laptop, clicking through screen after screen, a physician can simply say: “Pull up my next patient” and “Let’s give him 250 milligrams, Amoxycillin, by mouth, daily.”  Using clinical speech recognition and having intelligent systems available to assist with filling in the workflow gaps is one way Nuance is bringing real value to physicians.

What are the overwhelming issues patients face and are we on the verge of tackling them?

In the end, patients just want to get better. Making healthcare manageable, accessible, and simple to consume, is at the center of this challenge.  Unfortunately, I think we will be “on the verge” of tackling the various issues found within the patient’s world for a very long time. The good news, however, is that very soon patients are not going to need to look much further than their phones to gain access to their own personalized healthcare experience. And this is what is needed to begin the behavior change evolution.  For those of us in health technology, this makes for very exciting times to come because we are starting to really make both the physicians’ and patients’ lives better with our work.