I would argue a majority of my physician colleagues are not fans of the technology they use in their everyday clinical workflows. However, there is one company that is close to being beloved by physicians — it’s Nuance and their Dragon dictation software. Nuance easily enables physicians to write patient notes and document care in an efficient manner. It doesn’t require a complicated set up, and once it’s part of your workflow, the real-time speech to text transcription allows you to power through your charts with ease.

It’s one of the few forms of software, possibly the only, where I have rarely heard a single physician complaint. From the physician technophile, to the physician who doesn’t even own a smartphone — it’s widely used.

While their strength is in strict transcription services, Nuance hasn’t capitalized on its direct speech to text software, and other digital health companies have done a poor job of recognizing the potential it has to change clinician workflows.

What Nuance does better than other transcription services is the following:

  1. Real time voice to text — You don’t have to record your voice and wait for a transcription service to transcribe your text.
  2. Overlaying with EMRs — Overall, Nuance has done a good job of overlaying its voice to text software with existing EMRs. It works seamlessly with EPIC and other popular medical record platforms.
  3. Accuracy and set up — It doesn’t require a complicated set up, and rarely makes mistakes.

With reports that Samsung and other companies are interested in buying Nuance — I’m uneasy, but also excited. Samsung is reportedly interested in buying Nuance to expand their healthcare wearable market–letting people use their Gear Fit by voice commands.

I’m uneasy because I don’t want the company that buys Nuance to screw up one of the rare pieces of software that physicians actually like, but I’m excited because I feel voice recognition hasn’t truly been exploited by Nuance and others in the healthcare arena.

They showed great promise when they released the Dragon Medical Search app in 2010. The app enabled you to search for prescription drugs and disease pathologies using your voice, but they barely made any updates to it and the app has been orphaned without an update since 2010. It’s not like the app was a failure — it was one of the top downloaded medical apps for several months, and garnered hundreds of solid reviews from physicians.

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They were onto something with the app — but failed to capitalize and broaden the app to a target audience. From there Nuance released a series of enterprise apps, but no revolutionary or game changing ones. In a physician workflow, there are four key elements in regards to information technology during a patient visit.

This is a gross oversimplification, though the following can be broken down into several subsections.

  1. Looking up a patient’s prior history in the medical record, along with the current “chief complaint” and vital signs.
  2. The patient is evaluated, and then ordering the necessary tests occurs.
  3. When tests are back, or if they are still pending (clinic setting), ordering necessary prescriptions.
  4. Once the patient visit is done (or during parts of the patient visit), documenting the visit appropriately.

As I already mentioned, Nuance hits the 4th element well with Dragon Dictation — it’s great for documenting visits, but there are so many other aspects of the clinical workflow it could improve.

Let’s start with Number 1: I should be able to open up a patient’s chart, and verbally say — “Last History and Physician” or “last clinic note” — and get the appropriate note to pull up. Obviously, this would mean Dragon would have to be more integrated with the EMR, and this wouldn’t be the easiest thing for it to do. However, this action alone would save a tremendous amount of time. Imagine key action phrases, such as “Last EKG”, or “Last set of lab results”.