Epic, Nuance bring ambient listening, GPT-4 tools to the exam room to help save doctors time

Microsoft and Nuance Communications are building on their long-standing partnerships with Epic to broaden the availability of generative AI tools for medical note-taking.

Nuance, Microsoft's speech recognition subsidiary, is integrating its Dragon Ambient eXperience (DAX) Express into Epic's electronic health record software. The integration of DAX Express into Epic workflows will act as a copilot for Dragon Medical users to help cut down on clinicians' administrative workloads, the companies said.

DAX Express for Epic will be available to early adopter customers this summer and generally available later this year, the companies said.

In March, Nuance unveiled its latest voice-enabled medical scribe application integrated with OpenAI's GPT-4. The company touted its new solution, called Dragon Ambient eXperience (DAX) Express, as the first fully automated clinical documentation application to combine conversational and ambient AI with the advanced reasoning and natural language capabilities of OpenAI's GPT-4 model.

Nuance's ambient AI technology aims to automate clinical documentation by "listening" to the physician-patient medical visit and taking notes. With the addition of GPT-4, DAX Express automatically creates draft clinical notes in seconds after the patient visit and is available to the clinician for immediate review so they can make note corrections, executives said.

Providers that use DAX Express for Epic will be able to create draft clinical notes automatically and securely from the exam room or via a telehealth encounter for immediate clinical review and completion after each patient visit, according to the company.

DAX Express for Epic will be included for users of DAX and available as an addition to Dragon Medical One. 

Nuance's Dragon Medical One speech recognition solution is used by more than 550,000 physicians. DAX Express builds on the DAX solution Nuance launched in 2020. That solution is currently deployed across hundreds of healthcare systems, the company said.

DAX Express is the next milestone in Nuance's work to use technology to reduce administrative burden and help clinicians to spend more time taking care of patients and less time on paperwork, executives said.

Epic, for its part, is going all-in on generative AI. The company made a big splash at the Healthcare Information and Management Systems Society Conference in Chicago when it announced a partnership with as Microsoft to integrate large language model tools and AI into its electronic health record software. The health IT vendor and the tech giant are collaborating to combine the Azure OpenAI Service with Epic’s EHR software with an initial focus on drafting message responses.

A handful of health systems, including UC San Diego Health, UW Health in Madison, Wisconsin, UNC Health and Stanford Health Care, signed up to be early adopters.

One study by the American Medical Association found that for every hour physicians spend in exam room visits with patients, they spend nearly two hours on electronic health record and desk work during office hours. Health systems are eager to adopt technology that will help to ease this burden.

Josh Wilda, chief digital and information officer at the University of Michigan Health-West, said DAX Express for Epic will spark a "transformational shift" in healthcare.

"We've already seen first-hand how ambient AI from Nuance has transformed the provider-patient experience using the DAX ambient solution, but now with the augmentation of generative AI, we're going to give our providers more options to use technology in a way that delivers even greater outcomes to them and their patients," Wilda said in a statement. "DAX is already reducing what used to be hours of time for clinical documentation to mere seconds—while improving the quality of patient care and provider experiences. It's truly life-changing."

Epic and Nuance Communications teamed up back in 2018 to integrate voice assistance technology into Epic’s EHR apps.

Nuance's first ambient solution, DAX, is currently used by hundreds of healthcare organizations using the Epic EHR and thousands of their physicians, according to the two companies. The tech has helped ease burdensome clerical work. Clinicians who use DAX reported that it has helped them achieve a better work-life balance (79%), experience higher job satisfaction (67%) and reduce feelings of burnout and fatigue (70%). Additionally, three out of four physicians state that DAX improves documentation quality while patients say their physician spent less time on their computer during the patient encounter.

Clinicians who use the tech report saving seven minutes per encounter, adding five additional appointments on average per clinic day and achieving a 40% increase in first-time approval of prior authorizations. 

"For both patients and providers, quality care experiences start with meaningful conversations and mutual understanding," said Sean Bina, vice president of patient experience at Epic, in a statement. "For the first time, we can see how conversational understanding, generative AI, and clinical context can together generate high-quality documentation."