How Ambient Clinical Intelligence Reduces Provider Burnout

February 24, 2020 - The explosion of value-based care has triggered a need for high-quality patient data to identify gaps in care and inform many shared savings payments.

Patient data is also used by payers for reimbursement of patient care received and even to help identify fraud.   

The majority of this information comes from a patient’s medical record, so providers are pressed to document their patient interactions thoroughly, incorporating everything discussed. Poor documentation can result in denied patient claims for value-based care reimbursement and impede payments. 

Both patients and providers are at risk if documentation is not complete or precise. To ensure accuracy, many providers spend approximately the same amount of time face-to-face with patients as they do with the EHR.

As a result, providers must master using the EHR. But discrete fields, incomplete data, and lack of interoperability make using the EHR efficiently nearly impossible. Many providers report EHR utilization is one of the biggest causes of burnout.

Nearly 70 percent of these providers reported health information technology (HIT) related stress, including reduced time for documentation. 

To help, health systems can increase the amount of time providers have to document by extending their hours or reducing the number of patients they see. To maintain performance levels, neither option is viable. The other option is to make documentation easier for providers.

For this, health systems are turning to ambient clinical intelligence (ACI) technology. Using artificial intelligence, ACI listens to patient-provider interactions and automatically completes the EHR documentation.

“The very first time I transitioned to ACI, I finished my last patient at 4:30 and had nothing else to do except review the notes and sign off on them,” said William Silver, MD, Medical Director EmergeOrtho Triangle Division. “I have been able to add extra slots into my day. I’ve been able to see more patients by virtue of not having to worry about documentation.”

Silver’s organization is an early adopter of Nuance’s Dragon Ambient eXperience (DAX) solution. Currently, DAX records the conversation in the patient room. This information is sent through a quality review process to ensure accuracy before it is sent back to the provider to review.

“The notes are more detailed, more accurate, and certainly more in the patient’s voice in terms of what they’re complaining about or what their medical issue is,” Silver explained. "It's more thorough, more complete documentation of what problems the patient is actually having."

Rather than using dictation software to fill in the open fields of the provider’s note, DAX fills discrete fields and completes the medical chart entirely. Providers do not have to go back through the free text and parse out where in the EHR information should be placed.

Physicians used to spend valuable time transferring information from intake documents into the EHR. Now, the physician can discuss the information with the patient and DAX fills out the appropriate EHR fields.

“It was a much bigger onus on the physician to do the documentation themselves,” insisted Silver. "That's where machine learning and AI come in to generate an identical and seamless product. Having a computer do it is going to be much cheaper and more efficient than having a live human being." 

Some patients might be hesitant to use the technology in the exam room. It can feel like an invasion of privacy, and many are concerned about the security of their private health information.

Throughout the initial roll-out, though, there has only been one patient who did not consent, Silvers pointed out.

"People are used to having digital interfaces at this point, even elderly patients who may not be nearly as computer-savvy as some of the younger patient populations," he noted.

In fact, the use of ambient clinical technology has improved patient engagement.

“I’m not scribbling notes on a piece of paper. I’m paying full attention to what my patients are saying. I’m looking at them directly in the eye while we’re having discussions,” Silver said. “It frees me up to do all the things I could not do before.”

With the computer screen is completely removed from the interaction, providers no longer have their backs to a patient. Conversations flow easily and the patient feels acknowledged.

"It's life-changing and truly liberating to be able to document in a much cleaner fashion. I can actually interact with a patient," Silver emphasized.

Ultimately, smart exam rooms will display the patient’s chart in real-time so the doctor and patient can review the information together. This transparency will prompt patients to ask further questions and, hopefully, better understand their treatment options.

Continued development and integration of ambient clinical technology promises to bolster patient engagement.