In the age of artificial intelligence, things are moving at warp speed, noted UNC Health CIO Brent Lamm.
Back in late August, Epic announced it was tapping into Microsoft's AI expertise to roll out more tools to help clinicians save time with clerical work and medical notetaking. The two organizations laid out plans to integrate a generative AI-powered tool, called DAX Copilot, into Epic's electronic health record software to automatically draft clinical notes during patient exams.
The tech companies think that copilot tool is now ready for prime time. Epic recently announced the general availability of Nuance Dragon Ambient eXperience Copilot (DAX Copilot) embedded in its EHR. Nuance Communications is Microsoft's speech recognition subsidiary.
Four months after piloting that technology among a small group of clinicians, Chapel Hill, North Carolina-based UNC Health plans to roll out the AI-based clinical scribe technology to more providers.
The health system is among 150 health systems, hospitals and medical centers set to deploy DAX Copilot embedded in Epic at scale, according to Nuance.
The AI-based tool marks an industry-first integration stemming from a larger partnership between Microsoft, Nuance and Epic aimed at accelerating the innovation of conversational, ambient and generative AI solutions for Epic users, according to the companies.
UNC Health began working with Epic, Microsoft and Nuance back in September to pilot the AI-based tool for clinical documentation, initially testing out the technology with 20 physicians, Lamm said. The health system then expanded the pilot to 35 physicians.
UNC Health is not shy about being an early adopter of AI technology to reduce physicians' administrative workloads. Last May, the health system, which as been an Epic customer for 10 years, was tapped to test-drive the EHR company's generative AI tools to help overworked clinicians respond to a deluge of patient messages.
During the COVID-19 pandemic, as the use of virtual care boomed, doctors also saw a spike in digital messages from patients ranging from requests for medication refills to more complicated medical questions.
“We saw a 650% increase in the number of MyChart messages that our providers were getting. So in addition to a busy clinic day, they needed to go home and respond to those messages. We've got some other Microsoft and Epic work we've been involved in around that problem specifically. But that has led to a huge provider wellbeing challenge for us, making sure our providers are not burned out. We want to remove as much administrative burden from them as we can,” Lamm said.
“We have been very aggressive over the past 12 to 18 months at UNC Health to seek out any and every opportunity to try to remove or reduce the administrative burden for our provider teams. When we had the opportunity to talk with Microsoft and Epic and Nuance about this opportunity, we jumped on it," he added.
Back in April, Epic announced it was working with Microsoft to integrate large language model tools and AI into its EHR software. The health IT company also is collaborating with Nuance Communications, a company Microsoft acquired in 2022, to integrate its Dragon Ambient eXperience (DAX) Express into its EHR software.
The DAX Copilot solution is the next step in that three-way collaboration.
During an in-office or telehealth patient visit, the solution records the patient-physician conversation, with patient consent, and then uses ambient listening technology, speech recognition and natural language processing to securely draft a clinical note directly in Haiku—Epic's mobile application. The solution then immediately produces a draft note for physician review and completion, the companies said.
Clinicians using DAX Copilot for Epic in private preview reported a significant reduction in documentation time, cutting time spent on documentation by 50% and a decrease in cognitive burden, reducing feelings of burnout and fatigue by 70%, according to Nuance.
Clinicians also reported an increase in the number of patients seen per day with five additional appointments on average, and seven minutes saved per encounter, the company said.
"Even by the high standards and strong results established over our years-long collaboration, our pioneering partnership to integrate DAX Copilot with the Epic ecosystem stands out," Peter Durlach, executive vice president and chief strategy officer at Microsoft Health and Life Sciences, said in a statement.
"Our commitment to deliver a robust solution for some of healthcare's most pressing issues in less than six months signals a new era in accelerated innovation driven by leaders like Epic and using the combined expertise, resources, and responsible AI development capabilities of Nuance and Microsoft," Durlach said.
AI-based tools are a 'shot in the arm' for providers
UNC Health physicians who have tested out the technology have reported encouraging results so far, Lamm said.
"What I hear overwhelmingly from the providers that are involved in this directly and using it is they really feel like they now can focus on the patient," he said. "There's efficiencies in this and there are workflow improvements, all of the sort of traditional healthcare operational metrics that we can talk about. But for our providers, they're really getting a shot in the arm and a boost from the fact that they feel like, 'I got into healthcare because I wanted to take care of my patients and I wanted to work with people and help people and I can now really focus exclusively on the patient and not worry about the computer.' For them, it makes that patient-provider engagement and experience so much more rich."
The health system is conducting one-on-one interviews with physicians who have tested the technology to get their feedback but plans to collect data on to quantify the impact on physicians, such as a reduction in documentation time, he noted.
UNC Health also plans to eventually survey patients to evaluate how the technology impacts the patient experience.
"We're trying to use this initial pilot phase to figure out what are the right questions to ask patients. We want to do a rigorous evaluation of this, but we don't want to do that before we have all this sorted out," he said.
Physicians have become accustomed to taking medical notes during patient visits, which often requires focusing on a computer screen rather than being 100% engaged with patients.
Using technology like DAX Copilot, which is essentially "hands-free," requires doctors to change their behavior and conversational style, Lamm noted.
"It's new to our providers so it requires a bit of additional training. It requires the providers to think a little bit differently about that encounter with the patient. They've been so used to having their hands on that laptop or pivoting back and forth," he said. "Now, they're just talking to the patient and they need to verbalize some things to take advantage of the ambient listening and AI" rather than just typing in the medical notes.
He added, "One of the things that I've heard from a couple of our providers is that they're getting positive feedback from the patients just because they're behaving differently as a provider. Providers will tell you to take a deep breath or 'Open up and say, Ah,' but as a patient, you may not always know what's going on in the provider's minds. With ambient listening technology, one of the side effects we've seen, in a positive way, is the providers are actually verbalizing more of what they're doing to the patient. The patient is walking away feeling more informed feeling that it was an instructive and helpful examination."
Providers also find it helpful to use active listening techniques like playing back what they just heard in order to capture accurate information in the clinical note, Lamm noted.
"Providers will say to patients, 'What I'm hearing you say is this' or 'What I'm sensing is this' and that helps make that conversation between the patient and the provider just richer and more robust," he said.
UNC Health's initial pilot with DAX Copilot was among internal medicine, family medicine, orthopedic and pediatric physicians. The health system has since added other specialists to the pilot project, including gastroenterology, cardiology and oncology doctors.
"We've got a lot of internal demand from our providers who are not in the pilot. They are standing on the side, looking over the fence saying, 'I want this technology.' We are looking forward to growing this," Lamm said. "We view this as step one. We think there is so much more opportunity, and we're excited to see what Microsoft and Nuance do to develop more and more capabilities with this technology for our providers. My vision is that providers will be able to talk to the computer exclusively for everything that they're doing eventually."
As other health systems look to deploy AI-based tools in EHR systems, Lamm stressed the importance of provider training to use the technology.
"It's not nearly the level of training time or investment as an EHR but you do need to be proactive about making sure that the providers are trained because the last thing you want to do is just turn them loose on this technology. If they don't know how to use it then they might have a bad experience or the patient has a bad experience," he noted.
UNC Health adopted a policy to be transparent with patients about the use of AI and ambient listening technology during provider visits. There were initial concerns that patients would be turned off by the technology but that has not proven to be the case as patients have voiced positive reactions
"The results we're seeing from our providers that are in the pilot have been overwhelming that patients have said, 'This is awesome. I like that you're able to talk to me, focus on me and look at me instead of having to look at the computer," he noted. "I would encourage people to be open, honest and transparent with patients about the use of this technology, why you're using it and here's why we think it's going to be a great thing for you."