In this Business Profile, Paul Weygandt, MD, JD, vice president of physician services, talks about the importance of integrating clinical documentation improvement (CDI) with patient care in real time, and how Nuance is turning the EHR into a tool valued by physicians. 

Nuance Paul Weygandt

Tell me a little bit about your organization.

Nuance is the market leader in creating clinical understanding solutions that drive smart, efficient decisions across health care. More than 500,000 clinicians and 10,000 healthcare facilities worldwide leverage Nuance’s award-winning, voice-enabled clinical documentation and analytics programs to support any clinical workflow on any device.

Nuance’s healthcare division is reinventing the healthcare experience. Through our voice, language, and CDI powered by J.A. Thomas & Associates (JATA) offerings, we create a more human conversation with many systems, devices, electronics, apps, and services. That translates to more satisfied physicians, healthier patients, and a better bottom line. 

What are some of the biggest challenges affecting healthcare organizations?

Engaging physicians to support appropriate reimbursement remains one of the toughest challenges. CDI offers an opportunity to enhance both reimbursement and patient care through better coordination and real-time access to data. However, surveys show that disruption of physician workflow is the biggest barrier to CDI, followed closely by difficulty working with EHRs and other technologies. Historically, the EHR has been data-rich but information-poor, as far as many caregivers are concerned.

We are now at the tipping point, where the EHR begins to make physicians more efficient in both information entry and information extraction—if organizations can engage physicians to use these solutions. The best way to garner this engagement is to integrate CDI with clinical quality and let physicians lead the way. 

Real-time identification of clinical patterns—at the point of care—allows physicians to improve clinical documentation from the start, rather than through the traditional retrospective system where physicians are asked to clarify a diagnosis for billing purposes alone. Physicians are trained to dictate their clinical impressions in their own words, and natural language processing allows those words to be instantly converted into structured text.

The next big step is then making that text readily available to others as actionable information and applying intelligent systems to that information.

How do your solutions help address these needs?

Nuance uniquely supports clinical workflow and physician-patient interaction while enhancing the quality of information entered into the EHR, which we believe is the key to future success.

The clinical language understanding (CLU) technology developed by Nuance allows physicians to express the subtleties of a clinical opinion—perhaps the most essential component of a physician’s professionalism—easily within their natural workflow and within a patient’s record. This opinion can then be instantly analyzed and its content used to support clinical care at the time of service.

By seamlessly integrating essential clinical processes that used to be sequentially addressed, Nuance brings together capture of the physician’s clinical impression with all the downstream uses of that information that are vital to the success of healthcare organizations and meeting regulatory compliance. Real-time, computer-assisted physician documentation at the point of care naturally integrates elements of CDI, coding, quality monitoring, and analytics, offloading extensive rework from clinicians. The impact on physician workflow and professional satisfaction is profound, allowing physicians more time with patients and providing accurate clinical information in a manner long expected by the profession.

Specifically, CLU converts the patient care narrative from text (which physicians need to describe clinical conditions that vary from patient to patient) into discrete data elements that can be measured and mapped—something that back-end users need for conducting epidemiology, clinical research, coding, compliance, analytics, and billing—thus, bringing together two disparate worlds.

What other advice would you offer to healthcare leaders when choosing among vendors?

The ideal vendor should:

Focus on clinical care, not just the revenue cycle. You want a vendor that understands clinical quality, physician workflow, and how to engage physicians in a collaborative process to improve patient care. This perspective becomes particularly important as we move toward accountable care.

Have a long history of engaging physician leadership and practicing physicians in accurate documentation and CDI. This unique capability provides far greater impact, because it breaks down the traditional barriers between the clinical and revenue cycle functions.

Nuance graphic

Introduce CDI programs to physicians not as part of revenue cycle improvement, but as part of patient care and outcomes-oriented solutions. One great example: Physicians judged on quality are often very concerned that outcomes are severity adjusted. How do you do that? By accurately documenting acuity in the medical record. 

Bring physicians in early in the process, to identify their needs and help them make the connection between proper terminology and better patient care. Nuance—through its clinically focused Dragon Medical 360 documentation solutions and more than 20 years of clinical documentation expertise from Nuance’s JATA—not only gains support of physicians but also typically spurs 4 to 8 percent improvement in one key revenue cycle metric: case-mix index. 

How can healthcare organizations implementing Nuance’s intelligent solutions best set themselves up for success? 

Selecting CDI or coding solutions should always begin with a high-level discussion of desired clinical outcomes and workflow considerations, with a focus on ultimate benefit to patients.

Are there any educational materials you would like to share to help healthcare providers in these efforts? 

Visitors to our website can download two HFMA reports, HFMA’s Executive Survey: Clinical Documentation Meets Financial Performance and HFMA’s Educational Update: Navigating Today’s CDI Landscape: 10 Strategies for Success, that speak directly to the importance of CDI and its vital links to both clinical quality and revenue cycle enhancement. Go to

Nuance   JATA

HFMA is the nation’s leading membership organization for more than 40,000 healthcare financial management professionals. This Business Profile is funded through advertising with leading solution providers. 

This published piece is provided for advertisement purposes. HFMA does not endorse the published material or warrant or guarantee its accuracy. The statements and opinions of those profiled are those of the individual and not those of HFMA. References to commercial manufacturers, vendors, products, or services that appear do not constitute endorsement by HFMA. 


Publication Date: Sunday, June 01, 2014