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Mckesson Pacs Viewer Free' title='Mckesson Pacs Viewer Free' />Healthcare IT News and Opinion. Satish Maripuri, MS is EVPGM of the healthcare division of Nuance Communications of Burlington, MA. Tell me about yourself and the company. I came to the US in 1. Ive been a Boston based executive for quite some time. Ive dealt with a lot of global businesses. Ive traveled quite a bit, 7 or 8 million miles around the globe. Ive been with Nuance for six years. Ive essentially made my career here leading the healthcare business, of which Im very passionate about. Im personally driven from a mission standpoint in healthcare. What has been the business impact of the malware caused extended system outageThe business impact was primarily to the production days that we missed in the transcription business. How To Install Google Market On Archos 59. For the most part, in July and early to mid August. That was the direct impact to our direct revenue. From an ongoing impact, we dont have a predicted run rate tail off from a go forward standpoint. From our investors perspective,  we have this year, of which our fiscal year ended September 3. We have the fourth quarter roughly four to six weeks worth, depending on which clients of production impact downtime. We have a few clients who have transitioned away from us during the downtime, as we had given them counsel to seek other solutions. Most of them have come back. A few have stayed with their existing temporary provider. Those we expect as clients we would lose that part of the business going into next year. One of the things Ive seen is that clients have been very gracious in giving us an opportunity to earn their trust back. The one thing we have focused through the entire recovery process is transparency and regaining their trust. The downtime led me to wonder how the clinician voice dictation business is divided among front end speech recognition, back end speech recognition, and manual audio transcription and how thats changed over the past few years. We transcribe about five billion lines of transcription a year for US hospitals. Thats typically what we call the back end transcription capabilities. The front end, which is essentially the Dragon driven dictation, is being used by about a half a million physicians in the US. We see usage of front end speech continue to grow and the back end dictation continue to erode due to phenomena that the industry is already aware of. I dont see that trend reversing. In fact, in the last year or year and a half, weve seen the front end speech capabilities accelerate in adoption. We have, in fact, been a big part of that adoption by driving front end speech into the cloud. Dragon is now, for the most part, in the cloud. With that, our physicians get ubiquitous access no matter which setting at home, in the car, in the clinic, and in the inpatient setting with a single profile that is always available in the cloud. Even through the downtime we had, its the transcription part of the business that was down, but the front end speech Dragon capability was up and secure. Thats where we see the adoption going. In the last three or four months, weve added something like 2. We only see that accelerating. Speech recognition has reached consumer appliance status, with the Amazon Echo, Apple Siri, and other products moving conversational user interfaces to the mainstream. How do you see that changing If you wouldnt mind, if you would indulge me a little bit in where we see the vision and the next generational landscape going in clinical documentation, that might just be a little bit of context thats going to clarify a bit of your question. We see a world where a clinician is having a conversation with a patient. The two of them conversing is automatically generating clinical documentation that is also annotated and improved on the inside. Then as it goes into the final resting place of the EMR with the capability of being transcribed, being converted to medication lists and into other lab reports, etc. We truly see an ambient clinical documentation world coming to fruition. Intersect that today with todays burden of the clinician. Roughly 4. 3 percent of an average clinicians time today is being spent in front of a computer, dictating and documenting things. You intersect these two and an ongoing increased demand in knowing multiple things to improve clinical documentation. You only see this leading to one thing, which is the more we can take off their plate and the ability to make their life a little bit easier by dealing with the patients which is what they took the oath for the better it is for them. Thats essentially our mission. Thats what we at Nuance Healthcare are putting all our investments into. Every step weve taken in speech NLP and now the capability of conversational AI that were bringing to the table is geared toward that next step. We have effectively delivered a highly scalable, secure Dragon Medical speech solution. The next frontier for us in that step is to bring Dragon Medical Virtual Assistant to the table. Our view is that the next paradigm shift in this Virtual Assistant is the ability to have navigational access and conversational interactions with the EMRs in the multi modality setting. Then of course the question becomes, how do you actually intersect that with the actual device and the form factorWe believe that the complexity of clinical documentation use cases that are in todays physicians setting require a level of capabilities that require a unique device to solve that problem. Hence the prototype of an innovation that we announced around the smart speaker as well that goes along with our Virtual Assistant that addresses these needs. You may already be aware that Nuance as a company has addressed several Virtual Assistant use cases already. Our Virtual Assistant platform is being used at Audi, American Airlines, BMW and I can keep going in both the automotive and the consumer sector. Were bringing this capability to the clinical documentation problem, as we just announced, by taking all that Virtual Assistant capability and IP and specializing that for healthcare, just like we did for Dragon Medical in the cloud. We think that is much needed. Weve had a prototype out there for about two and a half, three years now. Our providers have given us really solid feedback on that. Were now going to that next level of actually launching that, integrating with the EMRs, and taking some of the early adopters to market. Now, your question specifically on consumer entrants. Theyre not to be ignored. In healthcare in general, there are a couple of different use cases. There are patient driven use cases and there are physician driven use cases. Eventually those might blend, but we think that today, theres a natural extension of the consumer devices into the patient centric use cases. They may be in an outpatient setting or an inpatient setting, but theres a big barrier from that point to cross over to clinical documentation and actually being the Virtual Assistant for a physician. Thats the setting in which we have years of experience and that what we are driving to at this point as well. How will you get clinicians to try something new with the Virtual Assistant and how will you develop and maintain its EHR integration You touched on a couple of things that we believe are critical. In terms of the physician adoption question, we can automate tasks that are repetitive and mundane in a very conversational sense. That would be a huge win, because today they go out of their way to document by doing something unnatural speaking into certain boxes and into certain dialogue frames to be able to capture documentation. If you can eliminate those and make those navigational style control and command open Tims record, dictate all of these labs, all the medications, prescribe this, check that these are all things that are natural command and control navigational style. Thats a huge step for us in getting that addressed for our clinicians.