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Speech Recognition—Front-End EMR 2018
Decision Insights Report
Author
Doug Tolley
Author
Sam Eaquinto
Herbert Hoover, 31st President of the United States, said, “Competition is not only the basis of protection to the consumer but is the incentive to progress.” Competition forces vendors to focus on relationships and protects consumers from stagnant development and higher pricing. In the past, Nuance maintained multiple product offerings and had the largest customer base in the market by far. Today, healthcare organizations are typically choosing between two high-quality products in purchasing decisions: Nuance Dragon Medical One and MModal Fluency Direct. This increased competition has been good for customers and led to improvements by both vendors. KLAS conducted 38 interviews in the past 18 months about purchasing decisions for front-end EMR speech recognition solutions. This report analyzes those decisions to determine why healthcare providers choose one product over another and what the perceived strengths and weaknesses of each offering are.
Nuance and MModal Keep Customers and Dominate Mindshare
The A-List: MModal Fluency Direct and Nuance Dragon Medical One
MModal and Nuance each offer a high-quality, easy-to-use product. Very few existing customers have plans to replace either MModal Fluency Direct or Nuance Dragon Medical One.
MModal clients feel the product has the functionality they need and that the vendor keeps their promises. MModal is known by customers as a good partner and is generally viewed as a less-expensive option. A few respondents would like a more responsive support experience and better communication about open support tickets.
Competition from MModal is putting pressure on Nuance to improve the customer experience, and Nuance has responded for their Dragon Medical One users. These clients have seen a decrease in nickel-and-diming. Another strength mentioned by both current and potential customers is Nuance’s ability to integrate their solution with EHRs, particularly Cerner Millennium. Some customers report stability issues with Dragon Medical One.
What Is the A-List?
To qualify for the A-list, a vendor product must demonstrate a track record of high market energy (purchasing considerations), high overall customer satisfaction (overall performance score of 85 or higher out of 100), and high customer retention (no more than 10% of customers planning to replace the product).
Why Are Nuance and MModal Considered?
Nuance Dragon Medical One and MModal Fluency Direct dominate considerations of front-end EMR speech solutions. In 100% of KLAS’ Decision Insights conversations about this market segment, healthcare organization decision-makers mentioned either Nuance or MModal (or both) as being considered.
In 18 of the 38 conversations KLAS conducted, Dragon Medical NE was described as vulnerable to replacement. In these replacement decisions, MModal Fluency Direct is considered slightly more often than Dragon Medical One, suggesting that Nuance could lose some market share to MModal.
Nuance has driven significantly improved customer experiences with Dragon Medical One compared to the older NE product. Relationships (measured by executive involvement and support) show marked improvement. While Dragon Medical NE, Nuance’s legacy product, sees much lower satisfaction, improvements with the go-forward Dragon Medical One highlight Nuance’s efforts to improve customer relationships and deliver needed technology.
As front-end EMR speech recognition becomes more of a commodity, the quality of the vendor/customer relationships, the quality of technical support, and the ability to keep promises become key differentiating factors.
What Drives New Energy?
For decision-makers looking at front-end EMR speech recognition products, the most important decision factors are functionality, integration, and technology, along with consolidation to a single speech vendor—a factor increasingly on health systems’ minds due to M&As and market efforts toward interoperability.
“We like MModal because they are focused. They are also smaller and more nimble than the other vendor we are considering.” —CMIO, large hospital
“Nuance's development space and the things they were doing with multiple points of integration blew me away.” —CIO, large hospital
What about Dolbey?
Despite a high performance score, Dolbey is not receiving many considerations from organizations looking to make a new or replacement purchase. Dolbey was mentioned as a potential candidate in only 2 of the 38 conversations KLAS had for this research; in 4 instances, Dolbey was noted as likely to be replaced by the responding organization. Dolbey has more replacement energy than consideration energy overall.
Provider organizations report solid relationships with Dolbey but rate the vendor lower for cost/value and technology. Some clients have not seen the development they hoped for and feel Dolbey has not kept up with the competition in terms of innovation. Dolbey recently launched Fusion Narrate, their cloud-based front-end EMR speech recognition product; it is yet to be seen whether this will spur higher consideration of Dolbey or convince some who are planning to leave Dolbey to remain instead.
“When we tested Fluency Direct, we did it in the ED for multiple reasons. First, the ED is kind of a noisy place, and we wanted to see what the background noise would do to the voice files. Second, we have one lady who has a very strong accent, and we wanted to see whether the system would recognize her voice and what the error rate would be. It did extremely well. It made only a few errors in a page and a half of dictation.” —CMIO, community hospital
“Right off the bat, the voice recognition is at least 95% accurate, even with heavy accents. We had people here who weren't able to use our previous system because of their accents, and now they are all using Dragon Medical One with exceptional accuracy. Dragon Medical One has improved the accuracy of our documentation. We can still build templates if we want, but it is much easier to use the voice-to-text solution.” —Chief of Staff, large hospital
“We are only replacing Fusion SpeechEMR because we are getting a new EMR. We have loved the Dolbey tool and are sad to be moving away from it. Had Dolbey moved to cloud-based speech recognition a year ago, I think we would have stayed with them.” —IT Analyst, large hospital
Decision Insights help provider organizations understand which vendors have market energy and why organizations are considering these vendors. Decision Insights are not designed to be a comprehensive census or win/loss market share study.
Designer
Natalie Jamison
Project Manager
Robert Ellis
This material is copyrighted. Any organization gaining unauthorized access to this report will be liable to compensate KLAS for the full retail price. Please see the KLAS DATA USE POLICY for information regarding use of this report. © 2024 KLAS Research, LLC. All Rights Reserved. NOTE: Performance scores may change significantly when including newly interviewed provider organizations, especially when added to a smaller sample size like in emerging markets with a small number of live clients. The findings presented are not meant to be conclusive data for an entire client base.