Daily Briefing

Ambient AI: A new way to save clinician time

Ambient intelligence tools like Nuance's Dragon Ambient eXperience (DAX) can help physicians save time by recording patient visits and generating a detailed clinical summary. And while this technology has some limitations, early adopters are "hopeful" about its potential. Advisory Board's Jordan Peterson highlights how one health system used DAX to reduce documentation and cognitive burden — and shares three steps to help organizations implement and scale these tools. 

How clinicians are using ambient intelligence tools

Several health systems are employing a new tool to help clinicians boost efficiency and reduce administrative burden. Clinicians at these health systems are experimenting with ambient intelligence tools, which record conversations with patients, identify key information, and produce a clinical summary.

Once the program produces a summary, clinicians can review the output, make any necessary changes, then upload the summary to the EHR. According to Kenneth Harper, VP of Nuance, these tools can be thought of as "augmented intelligence."

"It can't replace a clinician, but it can help them do their jobs more efficiently and reduce the burden they face," Harper said.

Early adopters are currently testing different ambient intelligence tools on EHR platforms, including DAX, Oracle Digital Assistant, Meditech and Google's ED app, and sunoh.ai. Several health systems have already seen promising results using ambient tools, including University of Michigan Health-West (UMHW), Atrium Health, Duke Health, UNC Health, and Stanford Health Care (SHC).

Overall, physicians using the tools have noticed an improvement in the quality of patient visits, spent less time on documentation, and experienced a reduction in feelings of burnout, according to the Association of American Medical Colleges (AAMC).

"I am finalizing my notes much more quickly," said Eric Poon, a physician at Duke Primary Care. "It's not perfect, but it beats having to type while I talk to patients or recreate the whole [conversation] from my chicken scratch."

What early adopters are saying about ambient intelligence tools

Early adopters of ambient tools have already identified several benefits and challenges.


Doctor-patient conversations

Tools like DAX give clinicians the ability to focus more on patient conversations, rather than taking notes.

"It's difficult for clinicians to juggle so many aspects of the patient encounter at once — trying to document [the conversation] at the same time that they're listening to the patient and thinking about the patient's problem," said S. David McSwain, chief medical informatics officer at UNC.

"Our clinicians feel that it helps them to declutter their mind during the visit, to stay focused on the patient rather than focusing on the computer," McSwain said. "And I don't think we can understate the value of that."

Saving time and reducing burnout

Overall, clinicians claim that revising an artificial intelligence-generated summary takes a lot less time than writing and editing their own notes.

According to Nuance, clinicians using DAX spend between two and seven minutes less on every patient visit and 50% less time on documentation. They are also experiencing a reduction in burnout and fatigue.

"We have [doctors] who have said, 'I have freed up more time to provide better access for patients,'" said Matthew Anderson, a clinician at Atrium Health. "And we've had people who said, 'Now I'm able to cook dinner, spend more time with my family.'"



According to AAMC, clinicians have found that the notes are typically factually accurate, but there are sometimes errors when the tool misunderstands words or omits key information.

"The technology is not at a point where it can function independently," McSwain noted. "You have to have that engagement of the clinician in ensuring the accuracy of the documentation."


According to AAMC, a key challenge for the tools is identifying what should be included or excluded from the summary. "Nobody wants a full transcript," said Patricia Garcia, associate chief medical information officer for ambulatory healthcare at SHC.

While some clinicians prefer extremely detailed notes, others want the tools to include fewer details from the visit. Some clinicians have even said that the tools include so many details that they must spend a significant amount of time revising the summary.

However, clinicians have also said that the tools sometimes omit important information that could be medically relevant. According to Garcia, the tool can also struggle with complexity. One of Garcia's colleagues at SHC wrote that the tool, "works for quick easy visits, but not for visits with multiple medical issues."

Privacy concerns 

Some patients are hesitant to have their private conversations with their doctor recorded, citing concerns about who can access the recordings and how they could be used.

Patients have also raised concerns about where the recordings ultimately end up. As a patient, "having a voice recording of that conversation attached to my health record, where maybe my family history and even DNA information are, is a much greater risk for me," said Vardit Ravitsky, president of the Hastings Center, which addresses social and ethical issues in health, science, and technology.

Will these become 'go-to tools?'

As adjustments are made to improve ambient tools, Garcia believes tools like DAX will become "go-to tools" for many clinicians. "It still has a few kinks to work out, but it makes my days (and evenings) SO much better," said a doctor who provided feedback at SHC.

"We're not at a place where I would say you should absolutely give this to every doctor," Garcia said.

However, when asked how she feels about DAX's potential, Garcia said, "If I had to describe it in one word, I would say, 'Hopeful.'" (Bruce, Becker's Health IT, 1/31; Boyle, AAMC News, 1/30)

Advisory Board's take

3 ways to implement and scale ambient tools 

By Jordan Peterson

There's clearly an opportunity for leaders to tap into this technology to offload documentation and other burnout-inducing responsibilities that take clinicians away from direct patient care. But organizations must be principled and specific about how this technology will support their clinicians to deliver high-quality care and top-notch patient experiences.

Too often we hear leaders vaguely reference "giving clinicians back time" without outlining a plan for what clinicians will (or won't) do with that extra time. That oversight brings the risk of making clinicians more efficient at the expense of their overall well-being and experience.

Advisory Board recently published a case study highlighting UMHW's experience with DAX. Their approach included three steps that helped them successfully implement and scale DAX to reduce documentation burden and promote clinician well-being.

1. Connect to the organization's mission of clinician well-being

Clinician well-being is a priority at UMHW. That mindset helped drive clinician adoption because they recognized that DAX was a solution meant to work for them. UMHW leaders were very clear that DAX's primary purpose was not to increase the number of patient visits or increase clinicians' workload.

Instead, leaders were firm that the primary purpose of introducing DAX was to make clinicians' lives easier. Leaders found that this mindset not only improved well-being, but naturally resulted in increased productivity and financial returns for the organization.

2. Start with clinicians who could readily benefit from DAX

Rather than starting with widespread implementation, UMHW launched DAX with a group of clinicians who were most open to the tool. They started with primary care clinicians because they've seen an increase in complex, less "templated" visits. Because these visits aren't easily documented in standard EHR templates, DAX helped simplify the documentation process by creating a structed note on its own, eliminating the need for a template.

UMHW also tapped into its culture of innovation. As they scaled DAX across their organization, they used a top-down approach where clinician leaders modeled how to be comfortable embracing change and approaching new technology. As a result, many of UMHW's primary care clinicians were willing to start using DAX because they self-identify as "technologists" and "early adopters."

3. Support clinicians through the change curve

Most importantly, UMHW took change management very seriously. Change is hard, even among the most innovative organizations. To help with adoption, UMHW enlisted provider champions to frequently check in with clinicians and aid them through the adoption process. They also shared key performance indicators from their initial DAX cohort to help clinicians see the benefits of DAX. 

With this careful change management, clinicians who used DAX consistently started to see improvements in their workflow, including decreased cognitive load, improved patient care, and stronger patient relationships.

If you want to learn more about how UMHW successfully implemented and scaled DAX, read our recent case study






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