Magnolia Regional Health Center improves clinician satisfaction and note quality

Cloud-based speech platform and embedded solutions, plus CDI, transform clinical documentation

Embracing a unified speech-driven approach to clinical documentation

Magnolia Regional Health Center (MRHC), located in Corinth, MS, is a 200-bed, acute care community hospital serving Northeast Mississippi and Southern Tennessee. Having successfully deployed MEDITECH’s Web Ambulatory EHR in the hospital and MEDITECH Expanse in its clinics, MRHC wanted to build on this foundation and further improve physician satisfaction and productivity by combining a unified speech-driven documentation workflow with a clinical documentation improvement program designed to ensure every medical record accurately reflected the patient’s course of care.

“We expect major system transitions to be cumbersome and complicated. It’s usually a short-term pain, long-term gain scenario in a quest to increase productivity and reduce costs. However, including Dragon Medical shifted the equation and allowed us to realize immediate gains while setting us up for further enhancements. It was the highlight of the MEDITECH EHR adoption project—a win for both the organization and our physicians.”

David Parker, Chief Information Officer
Magnolia Regional Health Center

MRHC executives turned to Nuance to help create and implement this vision.

Flexible tools address cost and convenience while improving physician satisfaction

As MRHC deployed a major upgrade to its MEDITECH EHR for the acute environment and implemented MEDITECH’s Web Ambulatory EHR in its clinics, the organization sought to further capitalize on its investment by adding complementary voice technology.

MRHC physicians expressed growing frustration with the slow turnaround times associated with transcription but were not universally prepared for the shift to the new EHR. While some physicians required an alternative to typing to maximize their EHR utilization, others were already adept at entering notes directly into the system. However, both groups reportedly longed for the freedom and flexibility to do so without being tethered to their devices.

“It was clear we needed to provide our physicians with as many options as possible to help them quickly capture information in the EHR and standardize their work process,” said David Parker, Chief Information Officer at MRHC. “This was our opportunity to virtually eliminate transcription costs and drastically improve turnaround times—from up to 24 hours to immediate availability. However, success hinged on providing better on-the-go documentation workflow.”

Dragon Medical—accessible when working within both MEDITECH and other Windows desktop applications—and PowerMic Mobile were easily applied in both the acute and ambulatory environments. The cloud-based speech solutions offered a consistent, seamless user experience across devices and locations to improve mobility, speed documentation and streamline the physician workflow.

The journey to cloud-based voice technologies

When MRHC executives began the search for a speech recognition platform, they prioritized speed, accuracy and convenience—all of which correlated to physician satisfaction. They wanted true cloud solutions that would allow their physicians to document the complete patient story using their voice, in real time from anywhere—without the need for on-site servers or hardware refreshes.

The selection process included demos and solution testing by a physician advisory committee, which determined that only Nuance offered both the immediate technical capabilities and the long-term value of a trusted relationship with MEDITECH. As a result of this relationship, Dragon Medical is truly embedded in MEDITECH’s workflow as part of the software’s design.

When MEDITECH spoke about its roadmap and future development, Dragon Medical solutions were an obvious consideration. While platform speed was impressive, ultimately we were sold on the bigger picture and the technology’s ability to grow in sync with our EHR to meet our evolving needs.

David Parker, Chief Information Officer
Magnolia Regional Health Center

Rapid adoption of embedded cloud-based clinical documentation accelerates results

MRHC initially implemented the following solutions to achieve its primary objectives:

• Dragon Medical One for documenting care in MEDITECH and beyond with the only true cloud-based speech platform
• Dragon Medical embedded in MEDITECH Expanse to provide an exclusive speech-enabled workflow designed to accelerate documentation by allowing clinicians to generate content, navigate fields and execute commands with their voice—all with no additional software to install or maintain
• PowerMic Mobile to turn any smartphone into a secure wireless microphone—further supporting mobility and access

Dragon Medical One and Dragon Medical embedded in MEDITECH Expanse allowed MRHC physicians to access their single, cloud-based voice profile at the hospital, in the clinic or from their home office, working seamlessly to create clinical documentation directly in MEDITECH.

“Our physicians rapidly and overwhelmingly embraced Dragon Medical, citing ease of use and improved documentation,” said Parker. “It was the highlight of the project—a win for both the organization and our physicians.”

Understanding the potential for reducing documentation costs, MRHC executives opted to move forward immediately with implementation and prematurely end its existing transcription contract with a competing vendor—despite being hit with a hefty cancellation penalty. Once live with Dragon Medical, they succeeded in reducing traditional medical transcription by 100%.

Currently, nearly 200 clinicians are actively using Dragon Medical, and MRHC has begun adding additional licenses to meet the growing need and popularity of the system among its physician community.

“We expect major system transitions to be cumbersome and complicated. It’s usually a short-term pain, long-term gain scenario in a quest to increase productivity and reduce costs,” said Parker. “However, Dragon Medical shifted the equation and allowed us to realize immediate gains while setting us up for further enhancements.”

Documentation transformation continues with Nuance CACDI

Encouraged by the positive physician response and results from Dragon Medical, MRHC expanded its investment in Nuance and took the next step in its note quality improvement initiative by deploying Nuance Computer-Assisted Clinical Documentation Improvement (CACDI).

“We understood the correlation between a strong CDI program and quality ratings and public satisfaction scores,” said Parker. “These ratings are based on severity of illness and risk-adjusted mortality. Our documentation did not tell the complete patient story. Our patients were much sicker than our notes revealed, and we needed to do a better job of showing the level of care we were providing.”

MRHC believed its incomplete documentation was causing poor quality scores and was having a negative impact on hospital and physician quality ratings. By employing Nuance CACDI technology, MRHC knew artificial intelligence would allow CDI teams to review queries with in-workflow physician follow-up. Evidence is automatically collated and presented to the CDI team for consideration and to help prioritize their workload. Automating this process allows CDI teams to cover more cases, expand payer coverage and gain time to focus their clinical expertise on more complex cases.

Nuance CACDI also contains a library of proven clinical strategies to better support the team’s clinical decision-making, a worksheet area for working up the DRG with integrated APR and MS DRG grouping, extensive clinical and coding reference materials, peer benchmarking, and outcomes analysis.

“We considered other vendors during the selection process, but felt the Nuance CACDI technology and overall CDI services were a better fit, especially from a data and analytics perspective. Plus, just as with the original Dragon Medical project, we appreciated the long-term advantages of Nuance’s strong relationship with MEDITECH,” said Parker. “We had a difficult experience with a previous CDI vendor due to poor implementation and lack of training. Knowing Nuance was going to be there with implementation support and ongoing professional education—coupled with the success of our Dragon Medical deployment—gave us confidence that we were making the right decision.”

During the bidding process, Parker noted that MRHC turned down the opportunity to be forgiven on its multiyear transcription contract if it selected the same competitive vendor for CDI.

“The fact that we went with Nuance despite the extra cost speaks volumes about Nuance CACDI and the value we believe it will ultimately offer us in the long run,” he said.

MRHC has identified opportunities with CACDI and CDI services, and estimates the solutions will help realize notable improvement in its Case Mix Index (CMI). According to Parker, that shift would represent an increase of over $1 million in appropriate reimbursement in the first year alone.

The right method for optimizing documentation

By partnering with Nuance, MRHC was able to increase physician productivity, improve documentation quality, decrease transcription spend and drive appropriate reimbursement. Nuance cloud-based solutions make it easier for clinicians to capture the complete patient story and deliver time and money savings to healthcare facilities.

---

Copyright © 2018 Nuance Communications, Inc. All rights reserved. Nuance and the Nuance logo are trademarks and/or registered trademarks of Nuance Communications, Inc., or its affiliates in the United States and/or other countries.
All other brand and product names are trademarks or registered trademarks of their respective companies.