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.

Benefits

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.'"

Challenges

Accuracy

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."

Details

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)