July 28, 2021: Physicians have enough stressors let alone having to worry about the conversations they’re having with patients. How do they document it? How do they make sure they’re connecting? And afterwards, how can they have the confidence that the data is all there? That’s where DAX comes in. Dragon Ambient eXperience is a comprehensive AI-powered voice-enabled solution which uses ambient sensing technology to securely listen to clinician-patient encounter conversations. Nuance, a leader in conversational AI, is fine tuning this technology with Metro Health. Their number one priority is to help solve physician burnout. Our guests are Diana Nole, EVP General Manager at Nuance and Josh Wilda, CIO and Dr. Lance Owens, CMIO for Metro Health.
Nuance Ambient Listening (DAX): A Case Study with Metro Health
Episode 429: Transcript – July 28, 2021
This transcription is provided by artificial intelligence. We believe in technology but understand that even the smartest robots can sometimes get speech recognition wrong.
[00:00:00] Bill Russell: [00:00:00] Thanks for joining us on This Week in Health IT. This is a Solution Showcase. My name is Bill Russell, former healthcare CIO for a 16 hospital system and the creator of This Week in Health IT, a channel dedicated to keeping health IT staff current and engaged.
[00:00:20]Special thanks to our Solution Showcase sponsor Nuance for choosing to invest in our mission to develop the next generation of health IT leaders. If you want to be a part of our mission, [00:00:30] you can become a show sponsor as well. The first step is to send an email to [email protected]
[00:00:36]I ran into someone and they were asking me about my show. They are a new masters in health administration student and we started having a conversation and I said you know we’ve recorded about 350 of these shows and he was shocked. He asked me who I’d spoken with. And I said Oh you know just CEOs of Providence and of Jefferson health. And CIO’s from Cedars Sinai, Mayo Clinic, Cleveland Clinic [00:01:00] and all these phenomenal organizations, all this phenomenal content. And he was just dumbfounded. He’s like I don’t know how I’m going to find time to listen to all these episodes. I have so much to learn. And that was such an exciting moment for me to have that conversation with somebody to realize we have built up such a great amount of content that you can learn from and your team can learn from. We did the COVID series. Talked to so many brilliant people who are actively working in healthcare and in health IT addressing the biggest challenges that we have to face. We [00:01:30] have all of those out on our website and we’ve put a search in there and makes it very easy to find things. All the stuff is curated really well. You can go out on a YouTube as well. You can actually pick out some episodes, share it with your team, have a conversation. We hope you’ll take advantage of our website, take advantage of our YouTube channel as well. And now onto today’s show.
[00:01:49]Today we’re joined by Josh Wilder, CIO for Metro Health, Lance Owen, CMIO for Metro Health and Diane Nole EVP General Manager for the Health Division at Nuance. And we’re [00:02:00] excited to have this conversation. I’ve been really looking for an organization that had pushed the envelope forward on DAX and the use of ambient listening.
[00:02:10]In fact, I was having a conversation this morning with one of my clients and they are starting a pilot. So this will be relevant to them as you guys are farther down the road. So I’m looking forward to that.
[00:02:20] Josh, tell us, before we get started, tell us a little bit about Metro Health and your role at Metro health.
[00:02:26] Josh Wilda: [00:02:26] Sure. So Metro Health is an affiliation with [00:02:30] Michigan Medicine. So our official name is Metro Health, University of Michigan Health. We’re a 208 bed community hospital in the greater grand rapids area.
[00:02:39] Our bread and butter, although we have a great hospital is our outpatient focused where we have about 300 providers in various specialties, but working around 30 different clinics across our region. We are very focused. Very highly intelligent when it comes to being patient centered with a provider focus.
[00:02:59] And what we’ll [00:03:00] talk about today meets that specifically. I myself have been at Metro for 15 years in various roles, mostly in the IT space. But as I’ve mentioned to you, Bill Diana and Lance and I really lead our organization, the IT shop. We are healthcare professionals in the IT space. So hopefully today in our conversation that really comes out of why DAX and what that means to our providers and our patients.
[00:03:22]Bill Russell: [00:03:22] Yeah. And I’m looking, I look forward to getting into that. That’s going to be fun. Diana, tell us a little bit about Nuance what’s going on [00:03:30] and your role at Nuance.
[00:03:31] Diana Nole: [00:03:31] Sure. Thanks Bill. Great to be here. So Nuance’s is a leader in conversational AI. And specifically in healthcare, we’re focused on how that type of technology can really help the solve the problem of physician burnout and physician burnout associated with the heavy administrative duties of clinical documentation.
[00:03:51] So we focus in on whether that’s physicians that have to play that role, radiologists nurses, et cetera, and in whatever setting they [00:04:00] have. And I’ve been here just a little over a year, but I’ve actually known Nuance and have worked with them for close to 15 years. Really a pioneer in this space. Today we’re going to talk about some of the leading innovative things were coming out. As we advanced conversational AI to include the world of ambient. I’m extremely excited. It was one of the key things that brought me to Nuance, because I think with introducing ambient technology, we actually can have a breakthrough with getting the patient back front and center [00:04:30] for the physician and really also enhance the patient experience and build back that trust by the fact that the technology sort of runs in the background and doctors can actually just focus on the patient, really listening to them. And so we’re excited to talk about that today.
[00:04:47] Bill Russell: [00:04:47] Well I’m glad we have a physician on the, on the call. So, so Lance give us an overview of your role and the relationship with Nuance at Metro Health.
[00:04:59] Dr. Lance Owens: [00:04:59] Sure. So I’m [00:05:00] a family doc. I’ve been with Metro for about 20 something years, 25 years minus some time in the military, which is actually where my introduction into clinical IP actually started. You know I’ve kind of been involved in the ITspace at Metro really, since I came back from the military back into the early 2001 and eventually landed up being the Chief Medical [00:05:30] Information Officer. So Josh and I, a working together for about 15 years, we’ve been looking at this kind of ambient AI technology for several years, and I’m just thrilled to death that we are using it now and we’re seeing its impact on healthcare. As far as our, in our relationship with Nuance.
[00:05:49]We started out many years ago with our Dragon integration. When we moved our hospital, literally moved our hospital to a different location and then start [00:06:00] it up using Epic, our EMR. That relationship has been, has deepened and progressed over the last several years. We now use the power scrubs.
[00:06:08]We use dragon medical advisor and of course now we’re using Dax and we have a fairly good adoption of Dragon medical one within our institution. So that’s been an exciting relationship and transition for us. And we’re looking to continue to advance our relationship broadening our use of Dax using the clinical documentation improvement tools that they have within the nuance suite.
[00:06:28] And then also even [00:06:30] reaching out to the patient. That patient engagement piece of all of this technology is really key for me as a provider and a physician executive in the IT space, because at Metro, we really try to focus on using our digital arms to wrap around our patients and hug them with this technology so it’s not intrusive to what we’re doing and DAX and this ambient technology is the embodiment of this idea. I can’t [00:07:00] tell you how exciting it is to just sit back and look, my patients in the eye have a meaningful conversation, not have to worry about the documentation. I’m able to fully focus on the information, synthesize a plan, execute my education and my regimen that’s going to help my patients. And I know that the documentation is not going to miss a beat. And that is just incredible for me as a provider. If I could just also add that when I talked to providers about this, they say, [00:07:30] oh, it’s, we’re going to get back to what it used to be. And I say, no, we are not getting back to what it used to be.
[00:07:36] We are moving forward. We are moving forward because in the past, when I would have to, when I was responsible for the documentation outside of an EMR, I was still the one typing it in Tran, no dictating doing, using drag. And I was the one who was stealing. Now what’s happening as I’m talking to the patient.
[00:07:56] And I know that my note is going to come back to me. I have to prove it [00:08:00] validated and it’s done. And I don’t have to worry about that input. This is moving forward. This is for those providers that are in your audience. This is not about getting back to what we used to be doing. This is moving.
[00:08:09]Bill Russell: [00:08:09] Last week we could spend the entire interviewing ignoring Diana and Josh at this point.
[00:08:15]Are all the physicians, this happy about this? I mean, you, you see pretty, pretty excited about it.
[00:08:21]Dr. Lance Owens: [00:08:21] You know honestly, Bill, I honestly feel that that Nuance has the life preserver for healthcare and I am honored [00:08:30] to be in the hands of throwing it out to our providers. I will tell you that. I mean, I have a whole list of positive comments, but I mean, I walked into a practice and a doctor has literally ran up to me and hugged me and said, you have saved my life.
[00:08:44] I had a doctor tell me that you fixed healthcare in one button because the DAX product is so easy to use. It was really is just pushing a button and letting it all work. I have providers, I have one provider said, my wife thinks I need to be admitted to a new mental institution because when I come home at night I’m [00:09:00] not logging back on to the EMR to finish work and she thinks I’m ignoring my job. So, I mean these comments could just go on and on.
[00:09:07] Josh Wilda: [00:09:07] Bill and I’ll mention, I’ve spoken to folks at Nuance, even Diana, another metric is how many, how many marriages are going to be saved? So I like that you say, my wife is a PA who works underneath Dr. Allens who is also using DAX and she said the same thing as a husband, seeing the stressors of the conversation that we have about [00:09:30] the patients. And then how do I document it? How do I make sure that I’m connecting? And now to see her come home and go, I have the confidence it’s all there. She came back and said it saved me. I’m back into what I needed to do as far as being a clinician, why I wanted to be a clinician. And she’s only been practicing for five to seven years.
[00:09:48] And so now when you talk about burnout? You talk about the burdens that the federal government, or what have you from a documentation standpoint puts on providers to really make sure that they are the data entry specialists, because they had the [00:10:00] conversation. The other ones that need to be synthesizing the information. Getting it all together, reviewing the information and Lance and I talk about that all the time is as how do we, how do we make sure that this technology is really pushing the needle forward? I like to say what you’re getting back to us as a provider is that patient provider connection again, that’s what is coming back, which you’re moving forward with the new technology.
[00:10:27] There’s a lot of patients that have never had the [00:10:30] experience of having this kind of connection with the providers. And that’s a big piece of what we’re hearing too.
[00:10:35] Bill Russell: [00:10:35] All right. So my job here is going to be to break this down so people have an idea of how you move from where you’re at or where you’ve been to, to where you’re going. So Dragon medical 1 was implemented. Is that pretty pervasive across the board for you guys?
[00:10:52] Dr. Lance Owens: [00:10:52] Yes.
[00:10:52] Josh Wilda: [00:10:52] It is. A lot of the providers are using it from a device standpoint. It was interesting. It came along [00:11:00] and Lance mentioned with our EMR implementation with Epic. And the conversation at that point was how do we make sure that providers continue to be progressive and what they’re using so we can get these tools out of the way so they can continue to focus on the patients.
[00:11:14] The key with all of our technologies is how do we make sure the technology gets out of the way? Not in the way. And so with Dragon Medical 1 through the years has really been progressive and we knew it caught fire when our ED physicians, they started to use it. They were early [00:11:30] adopters. And it was cool to see them not only use it for, for the transcription portion of it from speech to text, but we actually had providers that were looking for ways to, to augment their experience.
[00:11:40] We had a couple of providers that had trained their Dragon experience to log themselves in because they were looking for how do I augment what I have to do with the technology and reduce the interaction with the technology. So I can focus more on the patient. So it really was an adoptive model. Not every [00:12:00] provider uses it. Some have found the experience with the technology, with the EMR, just as easy as far as typing. So we used it as a tool as an option, not just as a, you have to use it, but as an option, we see a lot of adoption from our providers.
[00:12:14]Dr. Lance Owens: [00:12:14] We try to provide suite of tools so that a provider can choose the best tool, at the best time, for the best reason to make them efficient and high quality providers. So it, and DAX is just the next [00:12:30] step to that.
[00:12:31]Bill Russell: [00:12:31] So Diana, I want to come back to you. Ambient clinical intelligence, ACI has so much promise. Can you give us an overview of the technology and where we might see it in the clinicals?
[00:12:43] Diana Nole: [00:12:43] Yeah. So we consider our Dragon ambient experience under that umbrella of ambient clinical intelligence. So it’s really, when we think about Ambien, it’s really the nature of our conversational AI, right? It provides a natural way of working by simply [00:13:00] speaking and listening. The technology is sort of in the background and it it really removes the barriers to productivity and patient care. So you sort of, you sort of heard about this, so it kind of unlocks the physician from being at the computer. And it sort of has the ability to sort of just be in the background. As you’ve heard, described here, where the physician can stay deeply focused on listening to the patient.
[00:13:24] And so right now, the technology automatically captures and contextualize. Every word of the [00:13:30] provider patient encounter. So it has to understand who’s the provider, who’s the patient, which is really intriguing and kind of the physician statements and the relevant patient responses. And that’s all added to the clinical note, really eliminating the need to actually type or dictate information into the EHR.
[00:13:47] So the physician speaks nationally and then key information is translated. You can imagine if you sorta think about it, some of the things, and the reason why we want partnerships like with Metro Health is our customers are already [00:14:00] starting to say, well, what if it could do this? And what if it could do that?
[00:14:05] Things such as we do have on the roadmap under the world of Ambient a kind of commanding and control where you can actually actually ask the device to handle, Hey, Dragon, pull up the x-ray Hey, dragon place the order. Now in the case of conversations that we have with customers, they actually almost would would say, Hey, in the future, doesn’t really have to have that sort of even [00:14:30] interaction.
[00:14:30] Can it just listen and understand and interpret. And I think those are some of the futuristic ways that we could think about it. Also right now, the way DAX works is really primarily in an office setting. It’s this physician patient experience. But you could also understand and appreciate in an inpatient room where ambient clinical intelligence could also be sort of something in the background for the patient to interact with the nurse to interact with the physician, interact with other [00:15:00] caregivers.
[00:15:00] So we see a lot of really interesting ways the umbrella of ambient clinical intelligence could come to play over time from where it is today which already sounds like it’s proving out something that’s very valuable to our customers.
[00:15:15] Bill Russell: [00:15:15] Yeah. You must be in an interesting spot with all the, I mean, with all the things that you can do with this. And it’s so early on in the technology. It’s got to be constant where they’re going, Hey, can we do this with it? Can we and it’s, I mean, the, the requests just have to [00:15:30] be coming left and right.
[00:15:32] Diana Nole: [00:15:32] Yeah. And you know by having the conversations different people have different concerns.
[00:15:38] I mean, we still have to have the ability for the physician to feel like they’re ultimately in control of the patients so the whole world of AI has had its issues with, Hey, we don’t want a black box. We have to control. We have to understand what it’s doing. So we’re very sensitive to that. We also were very sensitive to not wanting anybody to feel [00:16:00] uncomfortable in these settings, patient or physician in terms of what is happening in the background. So you’ll get what is very hard probably. But I enjoyed about my job is we have these complex problems to solve, but we also have a very diverse user base of customers using it in family medicine, in specialties, inpatient, outpatient, et cetera.
[00:16:24] So one of the hardest things we have is really to your point, Bill is really prioritizing. That’s why it’s [00:16:30] really important for us to have a users like Metro Health that can help us prioritize what’s most important on the roadmap near term.
[00:16:37]Josh Wilda: [00:16:37] If I could add real quick to that Bill, because I know your listeners you’ve talked about it. I personally don’t like the word disruptor because disruptor, especially in healthcare when somebody hears the technology that’s a disruptor to healthcare people think of, well, now it’s going to change. You’re going to force change on me. To Diana’s point. We are one of those organizations that when we talk with our senior leadership team, then [00:17:00] CNO president of the medical group, we’re all, how can we use it? And so it was, I like to use the word the technologies are catalyst for change, not a disruptor for change. And what Nuance has done with this DAX, I can’t echo that as a customer. That those questions about where else can we use it immediately? So they are seeing the value immediately as opposed to disruptors of having laggards and really I’ll let someone else go first. What our chief nursing officer, who is very dedicated to the patient [00:17:30] provider experience, and he’s always had conversations about bringing devices in the room for nurses to be able to document on what would look like a phone. So immediately we use Vocera for speech recognition was immediately, can we tie it into the Vocera?
[00:17:43] So then when our nurses are talking with our patients about what they’re doing today, it can also just do that charting so they can just move on to the next patient and focus more. And that’s for Diane and her team have been an open arms of going, if you guys want to do it, let’s do it. And we’re an organization that [00:18:00] wants to be at the forefront of that.
[00:18:02] Bill Russell: [00:18:03] So Josh as people are thinking about this, and you talk about the room, is there a special setup for the room? Is there a lot of tweaking to get that room? Right? Is there a lot of equipment to put in place? What does that aspect of it look like from a CIO perspective?
[00:18:15]Josh Wilda: [00:18:15] So so there were opportunities again, you know when we talk about dollars and cents, we also need to make sure that a lot of us who have built bricks and mortar, sometimes it’s hard to flip that bricks and mortar for new technologies. In this instance, [00:18:30] while DAX does provide a nuance, does provide a device that we can put in room. They thought about, well, what are devices that are already going to be in the room, which are tablets and mobile devices.
[00:18:39]So really what we’ve done is instead of just going with the full mounted device, which we plan on doing because of the future. Where it’s not even going to be speech, but also visual recognition. And I know Diana probably wants to talk a little bit about that. But we just decided to say, you know what, we’re just going to put the phone in the room, hit a button, have a conversation with the patient [00:19:00] early on with the concern was the patient’s gonna be concerned about recording.
[00:19:04] It’s surprising how patients are, do they want to be a part of this? They see where healthcare is going, and they’re saying, yes, we want to be a part of this. Today we’re excited because we’re going to have some partners from Michigan Medicine here to see a demo of DAX. And it was funny, our CDO said Lance, Josh just set up a demo nd it was Dr. H, Dr. Peter Hauser or president. We said, it’s really just put the phone on the table and hit a button. And then the [00:19:30] note is there, what do you want demo? And it was kind of that reaction of, again, it’s the technology that’s now not disrupting the experience with the provider. It’s just, there and that’s the goal where we choose our technologies and you speak about a partnership with Nuance. That’s where they hit the sweet spot. They’re not forcing organizations to change how they practice, they’re adapting their technologies, the force, how practices can change. And I think that is key.
[00:19:56]Dr. Lance Owens: [00:19:56] If I could add it. I do know having the DAX [00:20:00] ambient device was certainly an option for us. And and, from our perspective, you know the fact that it is such a relatively new technology, that listening device will probably improve. I suspect that a little, probably have a camera on it at some point to do visual AI. And so that was probably, that was the one piece of the technology that we thought we would not get on the ground floor.
[00:20:22]Just because of how rapidly those changes will probably be. In addition, I just want to say that using the iOS device, which is [00:20:30] currently what we’re using has been wildly successful. I’ve had providers be concerned about the quality of the video or the quality of the audio. And it, it is amazing. I’ve accidentally, I’m so used to not having my phone out in the patient interaction that I’ve turned DAX n oand just instinctively put my phone back in my pocket and it’s listening and it captures everything perfectly.
[00:20:50] I’ve had as many as five people in the room at one time talking and DAX is able to figure out who’s talking and is able to construct that out with [00:21:00] five people. So we we’ve had really good success with simply using a mobile device.
[00:21:05] Bill Russell: [00:21:05] So the technology setup is not all that hard Lance, I want, I want to go to you. And how do you determine what areas or what physicians you’re going to start with? I know that a lot of times there’s champions within the organization that you just naturally go to, who are willing to try things out. Is that, is that typically how you do things at Metro Health as well?
[00:21:25]Dr. Lance Owens: [00:21:25] Well, we did it a little differently because let’s be honest, this technology, [00:21:30] for our size can add up as far as the cost. It can be expensive. And so with our pilot pro what we did is, is we used the data that we typically connect or are collecting on our providers within our EMR. And so we look at things like time and notes per day, time and notes per appointment. How long has the documentation? What is their workload over how many patients they see and their efficiency with Epic?
[00:21:56] What we call pajama time. So anytime they’re [00:22:00] documenting outside of typical work hours. And we look at work that they’re doing on their scheduled days off and work that they’re doing on days, that they have no patients scheduled. So we look at all of those and then I want it to look at okay, who are our providers that are really struggling and give them DAX to see if we can help them. And I really wanted to see what our really efficient providers are doing and how they feel it interacts with their workflows. We at Metro, we are not [00:22:30] touting that this is a time-saver. This is efficiency. Our providers who are, tend to be a little on the slower side with their documentation, we’vedecreased one of our providers five minutes per note in documentation.
[00:22:45] So in this particular case, it was a time-saver for them. The provider that is the couple of providers, one in particular who was very efficient. He spends about two minutes per patient per note, which is, [00:23:00] which is actually pretty good as far as the national average is concerned. And he said to me that this technology DAX doesn’t necessarily make me faster, but I will tell you it makes me much better.
[00:23:11]It works on both ends of the spectrum. And then we have, we have providers who are in the middle. We have providers who were hesitant to use the technology, and I wanted to get their input on them. We have providers that are kind of in the middle that were just kind of ambivalent about using the technology.
[00:23:26] So we kind of chose our providers [00:23:30] based on, can we really what are, what are the use cases? What would the adoption be? We kind of want to use both primary care and some specialty. We attempted to use an entire department. We want it, we wanted to see how it would work just with an indigo provider, just using it.
[00:23:49] We wanted to see what an entire care team would, would do. And then we wanted to see what an entire department. So we kind of chose our providers based on what we were looking for as far as the end game, which is [00:24:00] really an institutional rollout of this technology. So it is available to anyone, like I said, for anyone at the time, they think it is going to make them the best provider.
[00:24:09]Bill Russell: [00:24:09] Are there any lessons learned at this point of things that you would do a little different as you rolled it out.
[00:24:14]Josh Wilda: [00:24:14] That’s I laugh because I go, no. I say that, I say it from the standpoint of the partnership and the implementation we’re making it sound very, very fast and it was to sustain up our pilots. [00:24:30] Nuance wants to make sure that this is successful as well. This isn’t just a we hear about virtual reality and we’re seeing that kind of being starting to creep in, or is it really something that’s gonna have.
[00:24:39] So new ones had a bunch of KPIs. As Lance talked about that we really wanted to manage and maintain. Early on, cause Nuance has had success with other specialties like ortho and some of those others we’re an organization that goes, we knew where this is going to go, Bill. This was something that Lance and I been had our pulse for many years about where ambient was.
[00:24:59] And we said, [00:25:00] listen, let’s try in the hardest areas first, because if that works, the complexity that you see now in primary care, the variation of care. We didn’t want to go down the road of what has already been proven. We wanted to prove this organization that can work in the harder areas.
[00:25:16] And it is. Where Lance mentioned it, this isn’t just tongue in cheek. He actually got a visceral reaction from a provider of being hugged by a provider and saying you’ve saved my life. And we would love to say [00:25:30] yep we developed Nuanc DAX. That’s all on us. It’s our partnerships as well if we brought to the table.
[00:25:35] And so this is where we’re, we’re just talking as an organization, the buzz around DAX around here. Is that of how fast can we get it out there? As Lance mentioned, this is an early technology. And so the cost conversation, and this is where the partnership with Nuance has been great as well to talk about don’t price out the smaller organizations in early technology adoption because we’re ready and willing to roll it out to everyone. [00:26:00] And not just doing these little pilots here and there, that really don’t take, take off. We’ve had conversations with this Nuance, in fact this morning, we had a great conversation about what we want to focus on next, which is we want to stand up primary care.
[00:26:13] We need to get back to our primary care specialists and say, you’re going to get this too. Because many times their course for our organization, we thought that through COVID we see that as we keep going, we want to give back to them and nuances convocation about how do we make that happen for organization [00:26:30] like us.
[00:26:30] You never really tried to find a vendor like that. I’m not going to knock Epic, but we all know early on in the epic career, they only, they only went for whales or they went for large organizations because they thought, well, there was really only ones that could sustain it. Metro was another organization. We were one of the first, mid to small markets to show, no, if you do it as smart sort of way, and you’re really focused. Just like a partnership with Nuance, we can make that work. And that’s again, where this partnership is really the blossoming between the two organizations.
[00:26:58] Dr. Lance Owens: [00:26:58] I wouldn’t say that there was [00:27:00] anything that I would change as far as the rollout, from a global perspective. There are things that I would recommend for providers and for people. Like I’ll give you an example. DAX will create this, this this suite or this, this studio, they call it. That is just for me, so they can teach DAX to construct my notes in the way that I like it.
[00:27:23] And I think, I think one of the things I personally didn’t do was put enough time into that. So once DAX went live, I [00:27:30] had to work with Nuance about creating a more tailored deck studio. So I think that’s important. Making sure that Nuance has your templates. Not that they are just regurgitating your templates, but they’re teaching the system to document how you’d like to document.
[00:27:46] Again, it’s that AI, which then helps everyone else the AI gets better and it gets better for everyone. So that would be one thing that I would really encourage anyone who’s doing this as to, is to put a little more time in than others. When [00:28:00] Nuance asks for your, for your templates, what are your typical notes look like? That would be something I would spend more time on. And then the other piece is, which has been a little uncomfortable for some providers is either talking out or then, or later dictating the physical exam. Because right now it’s hard for the computer to know what your physical exam is.
[00:28:19] And so you really have to kind of dictate that. Other than that, I would agree with Josh. It, it was easy to roll out is easy to use. It’s been a great [00:28:30] experience.
[00:28:30]Bill Russell: [00:28:30] You know, it’s, it’s, it’s interesting. When I talk to people about this, I say it’s another assistant, right? It’s just like hiring an assistant and you have to train that assistant. And if you do that, you just take the time and do that effectively. the assistant is going to give you a better note. It’s going to give you a better outcome. And we’ve seen that in a lot of different areas. Diana, I want to come back to you and talk about, you know what the future is a little bit. So what’s the future of of DAX and of [00:29:00] this technology?
[00:29:01]Diana Nole: [00:29:01] So I think a few things have been discussed. We initially created the device to include something around machine vision. We felt as though the initial customers that are using it actually are really focused on not meeting that yet, but you could conclude that and the physical aspects of machine vision, or more just to help as was just mentioned.
[00:29:23] If somebody says, well where does it hurt? And somebody’s pointing to it. Or how about if I do this, does this hurt? You can speak [00:29:30] a little bit more again in natural conversation versus having to be a bit too medically oriented because the system does have to understand everything that’s going on. But I think more so is just the where we would potentially see it is the structure around the note, how we can make it better. There have been interests levels of, in the situation where you might have other people in the room that are caring for the patient, with the patient. But there are some times situations where family members or other care [00:30:00] providers are not there.
[00:30:01] And they would actually like to see the complete diarized portion of it, including kind of what the patient said so they can understand, appreciate it. So things and tools for the patient may actually be available if they wanted something. That’s a more of a comprehensive note. There are other things relative to certainly we’re trying to cover all of the specialties and we’re trying to cover all of the use settings.
[00:30:22] So again, today, It’s primarily as an office visit, but we have been approached and [00:30:30] had interest in well, what about the aspects of an ambient environment for the inpatient incorporating more of the care providers that take care of a patient within that? Of course, we have a lot of activities going on with the integration of all of this, with the EHR vendors and we have deep relationships with them, which is really critically important from our days with Dragon, because everybody is also very interested in, how do you also potentially have the device help [00:31:00] in terms of clinical decision support and understanding the context of the patient that comes out of the EHR to be coupled with what is actually being in this particular visit?
[00:31:11] So these are all very futuristic. I could not tell you when everything would kind of come to play. But you can kind of see where technology is, sort of unlocking some of these things that we honestly all wanted to have happen when EHR has were adopted. And now we’re kind of bringing it to life in a way that’s [00:31:30] also providing a much better experience for both again, the patient and the physicians.
[00:31:35] So I think there’s the thing that’s going to be, as I mentioned before, so hard deciding what are the near term versus the futuristic priorities. And again, that’s why our customers are so important to us to help us guide that because they will tell us immediately, listen, you don’t need to focus on that right now. I focus on this.
[00:31:54] Bill Russell: [00:31:54] Yeah. And Josh, I’m going to ask you about futures, but Lance, one of the things I wanted to hit on was does this lead to a [00:32:00] more standardized and uniform note? Does it lead to better documentation or is that more of a function of the EHR and the things you put into that?
[00:32:09] Dr. Lance Owens: [00:32:09] Well, I think it’s all how you, how you train your studio. I think that the industry probably could come up with a fairly standardized note. There already is one. But I think that for me, as a, as a practicing provider is not as important to me as the fact that. I just have this device listening to the conversation, [00:32:30] really capturing what was said.
[00:32:32] I mean, there are things I had a provider tell me if it was an ER file with a patient and if he had been typing in the note and looking at all the ER stuff and kind of distracted with all the stuff that’s currently goes on with the visit he probably wouldn’t have heard everything and remembered everything that had gone on or even thought of things that have to happen, like for example, a tetanus shot. So I think that right now, this help of trying to prevent [00:33:00] provider burden and the burnout is really focused around help me make a really good note about of what an account of what happened in this office.
[00:33:10] Josh Wilda: [00:33:10] And I think we’re hearing from providers, and Lance can attest to this too, that we’ve heard providers say it’s documenting better than they would document. And we all know in this industry an EMR risk came out, standardizing notes, problem oriented charting. We try to create those kinds of standard things. And what you hear is that note becomes very robotic or note blokes [00:33:30] or telling the story. And it’s interesting to hear our providers say it feels like a person wrote it.
[00:33:35] It is funny that we joke around with Nuance and Diana and team. My wife was like, Hey coz they do have somebody helping QA to know as the technology gets better to helping somebody QA th enotes. Lance and I are all the time going, dude. Are you sure this is AI? Are you sure it’s just not robust transcription just because of the personality that’s in the notes.
[00:33:56] I know Lance, you can speak more to that because of your [00:34:00] experiences, but that’s what we’re hearing from the providers that it’s not just this robotic piece of transcription. It’s not just the medical piece. Putting things in the patient’s terms. Those terms that I, I slipped and fell and jacked up my knee and they would have the note in quotes, patients that jacked up me, things like that to really tell the story.
[00:34:21] And I think that is also the key about this right documentation. Isn’t just about regulation. It is really about continuum of care. And how do you really get a good [00:34:30] note to transfer onto that care to remind you of that care? And the AI is doing it. The AI is doing Lance, do you want to, you want to talk a little bit about that?
[00:34:38] Dr. Lance Owens: [00:34:38] Yeah. The first week or so of me using it, I’ve been using it now for several months and after the first week or so I said to our account executive, you have to prove to me that this is not a person doing this because the notes are so good. And then I got the luxury and the privilege of being able to kind of see behind the curtain if you will of how it actually functions to kind of prove to me that it’s not a person, [00:35:00] just a fancy transcription service. That it’s a pretty amazing technology. But I think that pro’s part of w it with the EMR people say I will does Dax put the note? Is it my voice? No.
[00:35:15] But that’s okay. I’m willing to trade that a little bit because of the benefits of it. But it’s pretty close. That my medical decision making is, is documented very well. At this point, I’m making very little edits to my notes because there’s a [00:35:30] lot of things that Nuance is doing that just prove that they’re a fantastic company. I’ll give you a quick example. They take my feedback very graciously. They incorporate that into my studio. They do a note. They send that note back to me and then once I’ve signed the note, they then review it. To see if I changed anything they did. And then they add that back into DAX.
[00:35:54] And again, it’s a way of just making the global AI better for everyone. So these [00:36:00] notes, they’re pretty good. And I expect they will continue to improve.
[00:36:03]Bill Russell: [00:36:03] Is that part of the technology, Diana, that it’s taking the learning of all these notes and the feedback from all these notes and just getting better as it goes along?
[00:36:12] Diana Nole: [00:36:12] Absolutely. Absolutely. So we are very transparent that it is in a journey. It is in a process. There are things that are more advanced. Obviously we have all of this technology and learnings that we have from our Dragon days so we’re, we’re far better than we feel anybody else in the [00:36:30] market is.
[00:36:31] And but it does still require as AI does, it needs to get taught. And as you can imagine, the diversity of what is coming in in terms of medical and clinical notes it is very important that we have a human involved in kind of working through to continue to educate and train the system. And so it’s getting better every single day. It takes in all of the information from from all of the diverse customers and really doing quite [00:37:00] well. So it’s great.
[00:37:01] Bill Russell: [00:37:01] So it’s interesting. As your market share grows with the product it gets smarter. That’s sort of the nature of cloud systems of Ai and machine learning.It’s kind of wild. I I normally close these out with a, with a goofy question and I’m going to go ahead and do it here. Is there any question I haven’t asked about this or any area that you guys would like to highlight that maybe we didn’t talk about
[00:37:25] Josh Wilda: [00:37:25] For me the only thing Bill is, like we talked about earlier, trying to find [00:37:30] technologies that really bridge the gap of provider focus but patient centered.
[00:37:35] And what the impact is on the patients with this technology, not only just the feeling of being engaged we’re even talking about how do we monitor it. We’re talking about working with Nuance and potential research papers on some of these things. What about patient compliance?
[00:37:50] Now that I’m engaged with the provider and I see that eye to eye, do I have better patient compliance? We think that’ll come out of it. Information blocking sharing of the note. Now the patient actually [00:38:00] sees their voice in the note, not just an interpretation of what the provider said, that the patient said happened to them.
[00:38:07] The patient actually gets to see their voice in their care. And I think it’s not a goofy question. It’s one of those where it’s that unstuck. It’s the right technology for the right bridging of patient and provider of where it’s going. And I think that that’s a focus too, that we want to continue to work on is, is the patient benefit? Is the patient being more engaged? Is the patient being more involved? [00:38:30] And that’s something that we’re already hearing and seeing from patients. I’ve got some Lance and I lead a, a patient advisory council of our community, patient members. And we have patients that said, what is our doc going to get it?
[00:38:41] And if they’re not going to get it soon, when can I go to a doc that has it? And that’s when you really hear, when the patient is hearing about us doing this, how are we bridging that gap and changing the way care is delivered to what we all expect. And I think that that is something also that we’ve talked a lot about the provider side, that this is really patient centered [00:39:00] care with a provider focus. And it benefits all.
[00:39:03] Dr. Lance Owens: [00:39:03] Yeah.I would echo that. We are now starting to see comments about DAX and our, and our patient satisfaction surveys. Not only as part of our, of our national reporting, but we are also doing a special evaluation with our patients who are experiencing DAX. And we can all joke with the patients, I have a couple patients that now call me Dr. Crusher from Star Trek. So patients are really noticing and appreciating the [00:39:30] technology. I’ve had a couple of patients come back to me and talk about, they actually read the note and they’re pretty amazed about the quality of the note. But we’re asking questions in our survey about did this visit feel more patient focused with the provider, more focused on you? And then we asked that question as if, is this your first visit with this provider or is, or do you know this provider well, and as if you know this provider, well, do you feel this technology has improved [00:40:00] your interactions. And out of five, our institution is ranging at a 4.9 right now. Of our patients saying this interaction with DAX was better than it was without DAX. And so, I mean, this is a really good thing happening right now with this technology. And I, like I said before, I’m proud to be a part of it.
[00:40:21] Because like Josh said, as a provider, I’m on board. I am totally a hundred percent in and excited about it. [00:40:30] And what I’m hearing from my patients is that it is a really good thing for them as well. So this is like this, this checks all the boxes for me.
[00:40:39] Diana Nole: [00:40:39] And Bill, I would just add as a vendor, we sometimes go into these thinking that we have to have, and we still believe we have to have a hard ROI for our customers to engage with it.
[00:40:50] I think one of the best things that has just been commented here is the impact that it has on all aspects of, we call the quadruple aim and we have been [00:41:00] tracking the patient belief around this. And I think that that’s been the most wonderful surprises. Part of this is that patients are also indicating that this helps them feel like they have a more trusted listen to situation. So it definitely has been a wonderful surprise an augmented element of what we think we want to be able to provide from an outcome.
[00:41:23]Bill Russell: [00:41:23] Fantastic. Diana, Josh, Lance, thank you for sharing this. As I said just [00:41:30] talking to people, where are you going next? Because Dragon medical 1 has a lot of market share out there. People are, are, are very familiar with it and very satisfied with it. And they talk about DAX and where they’re going to go. And I think this conversation that we had is going to help people to really understand what they can do with it. Some of the great outcomes that you’ve been able to get with it. So thank you very much for coming on the show. Appreciate it.
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