Using AI to Remove Cognitive Burdens From Healthcare Providers

By Matt Phillion

As AI gains traction in every industry, the question needs to be asked: What does it add to healthcare, and what problems does it solve? For the University of Michigan Health West, AI has become a method of focusing healthcare back onto the patient and improving the patient experience. Using Nuance DAX (Dragon Ambient eXperience) to capture physician-patient conversations and automate the clinical documentation process, the organization has enabled providers to deliver more attentive, more meaningful care to their patients.

“My passion is bringing technology to our providers to allow them to provide better, safer, higher-quality care,” says Lance Owens, DO, chief medical information officer with the University of Michigan Health West. “That’s where we focus our guiding principles.”

When the industry talks about providers practicing at the top of their license, the conversation often turns to the need to remove administrative barriers or issues that put another entity between the provider and the patient. EMRs played an important role in addressing documentation necessities, but brought burdens that hindered providers’ focus.

“How do we still maintain that provider-patient relationship, that level of intimacy between them?” asks Owens. “Providers became the highest-paid data clerks in the world overnight. There are many documented advantages to the EMR, but it is not a time saver. It increases the cognitive burden as physicians add notes in the patient’s medical history.”

Once EMRs emerged, it didn’t take long to see where time crunches and burdens on physicians began to pile up: note creation, phone calls and emails, a loss of autonomy. “We looked in the IT space at how to really eliminate some of that burden, reducing the time physicians are at their computer in the exam room, between patients, or after hours—both in the office and at home,” he says. “Something had to happen.”

The emergence of AI

When it came to clinical documentation integrity, Owens and his team looked at a number of options that didn’t seem ready for prime time. “We believed certain solutions added a burden to the provider’s workload, particularly for inpatient providers,” he says. “A lot of these products offered a better end result for documentation but did add a significant burden.”

Teaming up with Nuance offered a chance to pursue some of the team’s principal goals. “We were early adopters,” says Owens. “The idea was to remove the burden, time, and distraction out of our provider’s workflows to allow them to really connect with patients in ways they never were able to before.”

The solution records the interaction between the provider and patient and populates the record—all steps that had previously fallen to the physicians themselves, even when using the EMR.

“I’ve had older physicians saying DAX allowed them to get back to what they used to do, and that’s not all. No matter what they did before, whether it was dictation or typing up notes or recording notes by voice, it was still their responsibility to get that information into the note,” says Owens. “With a product like DAX, that burden is gone. I cannot tell you how much this has altered, changed, and improved our workflows.”

Practitioners know the cognitive burden of note taking well—striving to remember everything from the patient interaction and making sure it’s all entered into the record—but removing that burden changes the interaction with the patient as well, Owens says.

“Removing the administrative burden on top of the cognitive burden, that alone changes the visit,” he says. “I can sit back, be in a relaxed pose, look the patient in the eye, ask probing questions, garner more information, and come up with a differential, diagnosis, and treatment plan, and all of that time I know that in the background everything is being captured and entered into a note that is better than I could have done myself.”

During the pilot stage, the results had to be undeniable, he explains. “If this did not work, if the key performance indicators didn’t show positive results, we’d jettison,” Owens says. “These notes had to be right. We can’t afford to be muddling around with notes that have to be heavily rewritten. We have to follow all billing, coding, and compliance regulations.”

Owens was the first person in the organization to give the solution a shot, and it only took him a few hours to want to push it out to others. “We knew who among us are relatively technologically savvy, so we reached out to those folks first, but we also wanted to involve people who were doing great, who were struggling, who were in the middle—a broad range of experiences.”

Specialists weren’t immediately hooked, but primary care physicians were on board right away, Owens says. “If something can capture the complexity of a primary care office, it can capture anything,” he says.

The lightbulb moment for him was when he received the first note back from the solution. “When I saw the first note, my jaw hit the desk. It was a real tear-jerker of a moment,” he says. “When people ask how this changes how you can treat patients, I say I can go into some very complex visits now, medically, behaviorally, and emotionally. A visit that would have been almost taxing before, you can now go into further because you know you’re free of the burden of the note taking and just have to go in and edit it.”

Providers say that they’re able to pay more attention and be more astute to details because they don’t feel rushed or have the weight of note creation hanging over their heads, Owens says.

“Being able to get deeper into some of these conversations just happens more naturally when you’re not consumed by getting the data into the computer while the patient is telling you what they’re experiencing,” he observes. “It’s always a question of do I touch the computer while I’m in the room with the patient or do I enter the information after? When a family practitioner is seeing 20 or 25 patients a day, and you have all those notes to do afterward, it’s a lot.”

It’s difficult to address all patient needs in one 15-minute appointment, even with technological assistance. “I’ve never been the kind of doctor who says ‘one complaint per visit,’ particularly when they’ve waited a few weeks to see me. That’s unfair to the patient. But I can tell you those of us who review multiple, unrelated complaints, there’s a lot of care or ‘oh, by the way’ complaints that can be uncaptured,” says Owens. “From an ROI perspective, they’re not revenue producing; they’re unbillable. That’s another advantage of being able to address more than one complaint per visit. You can get much deeper with the patient and address more of their concerns knowing it’s being documented.”
Plus, allowing the patient to fully express what’s on their mind in the moment improves the rapport all healthcare providers strive for. “When the patient doesn’t feel rushed or that they can’t talk about their issues, that right there improves the relationship, the trust, the empathy,” he says.

The organization has seen a positive response from patients as well, with higher patient satisfaction ratings and anecdotal surveys that offer insight into the patients’ reactions. “I’ve had patients say it reminds them of Dr. Crusher from Star Trek,” says Owens.

AI involvement in note taking and patient records has only scratched the surface, Owens says. Right now, there’s a bit of a turnaround time, but that is constantly improving. The potential for AI to be involved in orders or recall test results could further reduce cognitive burdens on providers. He says making this opportunity available to nurses as well would be a huge step forward.

“Talk about folks who have a burden,” says Owens. “In nursing, their responsibilities are up, their numbers are down, and their patients are up. They’re doing heroic things, and anything we can give them to provide a sense of relief would be truly awesome.”

Other anecdotal soft ROIs rise up all the time, Owens says. “Imagine someone came to you and asked what the worst, most burdensome part of your job is and said, ‘I have a tool that can take 90% of that away,’ ” he says. “It’s amazing, but I also feel like I’m doing a better job: The notes are better, I’m communicating with my future self better and communicating with the patients better. Not only am I happier with my job, I’m doing a better job of it as well.”

Matt Phillion is a freelance writer covering healthcare, cybersecurity, and more. He can be reached at matthew.phillion@gmail.com.