The internet is buzzing with news about ChatGPT, an artificial intelligence large language model developed by OpenAI, and its potential uses in medical practice and education.
Doximity, a digital platform for medical professionals, rolled out a beta version of a ChatGPT tool for doctors that helps streamline some of their time-consuming administrative tasks, such as drafting and faxing preauthorization and appeal letters to insurers.
The open beta site, called DocsGPT.com, is an integration with ChatGPT that works with Doximity’s free fax service, said Jeffrey Tangney, Doximity co-founder and CEO, during the company's fiscal 2023 third-quarter earnings call Thursday.
The company worked with doctors to fine-tune the product, he said.
Doximity engineers began working on the beta site over the holidays, Tangney said, and the tool was announced this week during the earnings call.
"Like many others, we are very excited about the potential applications of generative AI in health care. We know how busy physicians are and recognize that administrative burden is a leading contributor to burnout. Our mission is to help physicians be more productive so they can focus on what matters the most—spending more time with their patients," Nate Gross, M.D., co-founder and chief strategy officer at Doximity, told Fierce Healthcare via email.
"We had an opportunity to speak with a number of physicians and a very familiar use case quickly bubbled up: doctors still handle a lot of paperwork and much of it is still sent via fax machines," he said.
At least 70% of healthcare providers still exchange medical information by fax, according to federal officials.
Using the free open beta site, doctors who are Doximity members can fax letters directly to insurers with the company's digital fax service. The site features a growing library of best medical prompts where the AI-based writing assistant has been trained on healthcare-specific prose.
Examples of medical prompts on the site include drafts of letters to insurance companies to get prior authorization for medications and other services, appeal denials, medical disability letters, post-procedure instructions for patients and even treatment instructions for children with asthma written as a rhyme in the style of Dr. Seuss.
The library of prompts ranges from clinical correspondence to progress notes to patient education to help doctors with charting and to draft communications to colleagues and patients.
Many of the initial prompts available on DocsGPT.com are based on real-world feedback from Doximity's physician members, Gross said.
"From appealing an insurance denial for a patient with a chronic condition to referring a patient to a specialist for further evaluation, there are many tasks that DocsGPT can help streamline with fewer disruptions to physicians’ clinical workflow," he said.
Doximity, which claims to have more than 80% of doctors on its network, has been working on a number of innovations to assist physicians. The company announced it is integrating with scheduling automation leader Calendly to help physicians schedule appointments with colleagues.
The company posted strong third-quarter results despite macroeconomic headwinds. But the company's stock slumped Friday, dropping 14% as investors were disappointed in Doximity's forecast. For the quarter, Doximity's revenue grew 18% to reach $115.3 million. The company reported quarterly earnings of 22 cents per share, beating Wall Street estimates of 17 cents per share.
However, Doximity executives said the company encountered unexpected delays in the approval of some of its vertical video products, which are subject to medical legal reviews. This will result in a 2% hit to its full-year revenue guidance.
The company reined in its full-year revenue guidance. For fiscal 2023, Doximity now expects revenue in a range of $417.7 million to $418.7 million, down from $424 million to $432 million. For the fourth quarter, the company expects revenue to reach $109.6 million to $110.6 million revenue, and, for fiscal year 2024, its revenue outlook stands at more than $500 million compared to $122.2 million and $523.6 million estimated by analysts, respectively.
Testing out ChatGPT in healthcare
At the end of November, Clifford Stermer, M.D., a rheumatologist, demonstrated in a TikTok video how ChatGPT could save time with insurance denials, and the video went viral as it was widely shared on other social media sites.
However, many physicians and researchers have cautioned that the technology has major limitations, specifically that medical citations are often inaccurate, as Stermer explains in this updated TikTok video. ChatGPT can pull primary and secondary references from the medical literature and include these in letters to insurance companies, but the bot has been known to make up references, doctors say.
On the DocsGPT beta site, Doximity notes to physician users that "the letter content is AI-generated" and suggests that doctors "make sure to review and ensure accuracy" of the letter before it is submitted.
To use the fax service, Doximity members draft a letter using ChatGPT and then log into the company's HIPAA-compliant portal where they can review and edit AI-generated responses before they send the digital fax, Gross said.
"This means they can adjust the response to ensure accuracy and even add in patient information securely," Gross said via email.
Gross called the technology "very promising," but noted it's not without errors and "should still be approached judiciously."
"We aim to enable physicians to test and use this technology, so they can ultimately help ensure the best applications in a healthcare context," he noted.
David Canes, M.D., a urologist with Lahey Hospital and Medical Center in Burlington, Massachusetts, has tweeted and blogged about how he's used ChatGPT. He noted in his blog that time is a doctor's most valuable asset.
"The crux of the burnout problem, in my view, is that doctors have lost control over their time," he wrote, while providing extensive examples of how using the AI chatbot can help with day-to-day tasks.
Doctors still handle a lot of actual paperwork, and, in today’s healthcare system, much of it is still sent via fax and doctors often call this "scut work."
"By integrating DocsGPT with our free fax service, we hope to help medical professionals 'cut the scut'," Gross said.
During the earnings call, Tangney said early use of DocsGPT has been "promising."
"An oncologist from Ohio called DocsGPT a 'game changer' after it drafted an appeal letter for a cancer patient with a heart condition. The insurer got the fax and approved within the hour, allowing the patient to receive a non-generic medication with fewer cardiac side effects," the CEO told investors during the earnings call.
"Obviously, DocsGPT is just a small test project. But more broadly, we're enthused about AI's potential to streamline workflows across our entire platform," Tangney said.
Future of ChatGPT in medicine
With an eye toward accelerating breakthroughs in AI, tech giant Microsoft announced in January a “multiyear, multibillion dollar” investment into ChatGPT maker OpenAI. The investment is rumored to be as much as $10 billion.
Microsoft executives have hinted about potential uses for artificial-intelligence-powered language models in healthcare. Junaid Bajwa, chief medical scientist at Microsoft Research, told Analytics India Magazine that he sees ChatGPT as an answer to "solving various challenges in healthcare, offering more specific, personalized, and result-backed healthcare solutions, treatments, and consultations."
Last year, Microsoft bought voice technology company Nuance Communications for $19.7 billion. Nuance is considered a pioneer in speech recognition and artificial intelligence technology used in healthcare.
The hype about ChatGPT and its future in healthcare reached a fever pitch in December when an paper, published on medRxiv, found that the chatbot was capable of passing the U.S. Medical Licensing Exam. The peer-reviewed study published on Feb. 9 in the journal PLOS Digital Health. While no one is expecting the technology to replace doctors or nurses, it does demonstrate the potential for a tool like ChatGPT to help with administrative tasks or with diagnostics and treatment plans.
Gross emphasized that Doximity is developing DocsGPT with extensive input from physicians.
"DocsGPT is still in its very early stages, and that is by design. Too often physicians are not given a seat at the table in product development and new technologies designed to help them simply miss the mark. We know from over a decade of working side-by-side with physicians that our best ideas often come directly from them," he said.
He added, "We can’t wait to see where this technology leads us, but we still have a long way to go. As you might expect, the 'AI bar' is even higher in healthcare than it is in many other fields. To get this right, we must have the right partners and that includes physicians."
According to Doximity executives, several physicians have suggested that DocsGPT could save them and their staff up to two hours a day by streamlining administrative work they would otherwise have to do manually. "With a growing physician shortage issue and an aging population, we think the longer-term implications here could be significant. This type of feedback is very consistent with Doximity’s overarching goal—helping doctors be more productive so they can provide better care for their patients," Gross said.
In addition to insurance approvals, DocsGPT could be used to quickly generate templates for common administrative and documentation tasks, summarize and analyze medical articles or prepare study materials for medical students, Gross noted.
In response to a question from an investor about potentially monetizing the DocsGPT service, Tangney said it was a possibility down the road.
"You just think of all of those letters that need to be sent back and forth between insurers and providers, and we'd really love to help them out with that. It's really had a lot of warm accolades in a pretty short period of time," he said.