Using AI to improve interactions between physicians and patients
By Matt Phillion
Generative AI is the talk of the town right now across all industries, including healthcare. As health systems face staffing shortages, physician burnout, and rising financial pressures, finding new tools to help combat these challenges is imperative.
Cooper University Health Care began using Dragon Ambient eXperience (DAX) from Nuance in 2020 as a way to improve the physician/patient experience. DAX Express is an AI-powered solution that automatically documents patient encounters through voice-enabled technology. Clinicians can use the solution to take notes during patient interactions, helping speed up documentation and eliminate administrative burden.
“One of the things that has become pervasive in healthcare is the number of administrative tasks,” says Dr. Anthony Mazzarelli, co-president and CEO of Cooper University Health Care and a practicing emergency department physician. “It is part of what leads to burnout: It takes us away from interacting with patients. And it’s interacting with patients that data shows improves outcomes for those patients, decreases cost, and also decreases burnout.”
Since enabling physicians to use the technology, Cooper reports that 85% of patients found their physician more personable and conversational. Clinicians using DAX have seen a 70% reduction in feelings of burnout and fatigue, as well as up to 50% time saved per patient per clinical note.
“We do a lot of research here, and we’re always looking for ways to increase that interaction and connection between those who provide care and those who receive it,” says Mazzarelli. “Technology seems to be where everyone says we’re not connecting. Everyone blames the EMR, but in reality, it’s how we use it. The industry thought a lot about how we get information in, but not as much about how we get information out.”
People tend to think of technology as the problem, Mazzarelli notes, but the solution is actually different technology: the kind that will allow human practitioners to do less of the administrative tasks and focus more on the patient. “Anything that can take that administrative burden down and automate those tasks puts us in front of the patient more,” he says.
“There’s a saying that physicians see the patients for free and get paid to do the paperwork,” says Mazzarelli. “Technology like DAX is soon going to be everywhere, and there is an opportunity for it to help with the pain point of note-taking and documentation. It can be used to unburden the physician from those administrative tasks, and when you do that, that’s when you’re practicing at the top of your license.”
The gradual weight of administrative burden
The number of hours spent on administrative tasks has steadily grown over the decades, Mazzarelli notes. “One reason is the actual rules and requirements from insurance companies and the federal government of what you have to do to get paid has increased. There are more and more boxes to check,” he says. The second reason is the arrival of EMRs. Both happened simultaneously, and their combined weight has expanded ever since.
“Thirty years ago, the only work a physician could do was the number of charts they could fit under their arm,” says Mazzarelli. “Now, ‘pajama time’ exists because pajama time is possible. We see clinician EMR inboxes filling up; when was the last time you had a truly empty inbox? Now imagine a whole separate inbox where people’s lives depended on you. That’s the increasing burden of documentation—the availability without taming the information coming at us.”
The infinite array of options and choices in today’s medicine necessitates better decision support. Mazzarelli sees using the right technology to ease those pain points as the key to keeping physicians practicing effectively.
“We tend to overestimate the impact of tech when it’s new, but underestimate it long-term,” he says. “We have a responsibility to use it correctly.”
Using it incorrectly is all too easy. For example, you could log onto the web and ask ChatGPT all the reasons you should not go to the hospital for a heart attack, and the technology will give you plenty of answers—all of them wrong, Mazzarelli says.
“We have to think about using AI in a responsible way. I think you’re going to see there’s a light side and a dark side to how it is used, and healthcare will be on the light side of this technology—there’s a lot of good it can do,” he says. “We’re in a field that is getting increasingly more complex. We need ways to deal with that complexity.”
The impact of this technology now
At Cooper, Mazzarelli notes that the clinicians using DAX have reported a 43% decrease in time spent writing notes into the EMR. Others have reported an 80% improvement in documentation quality.
“It’s increased patient interaction quality as well,” he says. “They’re able to look the patient in the eye.”
The solution listens to what the doctor and patient say and do and documents it to the record for the physician to review later. The amount of reviewing required varies from person to person, but consistent users have found they can use DAX to achieve roughly the same quality of notes while only spending half the time.
“How do I compare one doctor’s notes to another? Well, it used to be whichever one I could read their handwriting,” says Mazzarelli. “This technology is really good about picking up the voice, and the ability to record sound has gotten better and better.”
That voice recording allows more of what Mazzarelli calls eyeball time with the patient: actual, meaningful eye contact rather than moving back and forth between the patient and the EMR, for example.
“Connection to the patient is what gives you those better outcomes,” says Mazzarelli. “There’s a famous picture in the Journal of the American Medical Association where a pediatrician’s patient drew a picture of them. The picture had the patient, their mom, and the pediatrician’s head was angled down at a computer screen. The doctor was appalled, because that’s the way they were viewed. And we’re faced with a choice: Do I bury my head in the EMR or hope I hold all the information from the interaction in my head for later?”
With DAX, physicians are less likely to need to bury their faces in a screen. “This way, it’s not just a transaction,” says Mazzarelli. “And that’s where the burnout occurs, when we’re not practicing at the top of our license. It starts to depersonalize things.”
Another benefit has been physicians learning new ways to navigate patient interactions because of the technology. “You have to say the physical exam out loud for the technology to document it,” explains Mazzarelli. “I’ve talked to multiple physicians who say that even if they weren’t using the solution, they would continue to speak the exam out loud, because it helps the patient understand what the doctor is doing. For these physicians, it’s been a change for the positive.”
While Cooper expected its technophile clinicians to most rapidly adopt DAX, surprisingly, it’s helped those who are less tech-savvy even more. “Those who are really into technology had already found shortcuts,” he explains. “Some of our more veteran physicians who struggle with the way they do notes are seeing the biggest benefit of this technology. We have physicians with big panels of patients who are chopping off two or three hours of administrative time a night.”
The patients seem to be responding well, but the organization is compiling data and plans to eventually publish their findings on patient satisfaction with DAX. “Other organizations have found that the patients enjoy it, but we’re still putting that data together,” Mazzarelli says. “When you help connect with patients, though, those scores will go up and important outcomes will improve.”
Looking ahead, Mazzarelli is interested in seeing more groundswell for AI-assisted documentation in the decision support arena. “Ultimately, the physician makes the call, but anything we can do to help interact with those who receive care and address their concerns, it’s all a positive,” he says.
Matt Phillion is a freelance writer covering healthcare, cybersecurity, and more. He can be reached at matthew.phillion@gmail.com. This story first ran on PSQH.