Microsoft's Nuance integrates OpenAI's GPT-4 into voice-enabled medical scribe software

Big tech companies are in an artificial intelligence arms race as they rush to integrate the technology, specifically large language models, into their products and services.

This week, Microsoft-owned Nuance Communications unveiled its latest voice-enabled medical scribe application integrated with OpenAI's GPT-4. 

Nuance says the new application, Dragon Ambient eXperience (DAX) Express, is 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.

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.

The solution also is tightly integrated with electronic medical records software and the clinician always has the final "sign-off" on the clinical note, executives said.

The new application aims to build on Nuance’s capabilities in capturing, analyzing and distilling the contents of physician-patient medical visits to reduce doctors' workload, specifically administrative tasks and paperwork.

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

Mark Benjamin, CEO of Nuance, said the Dragon Express solution marks the "next step forward in the ongoing evolution of AI-powered solutions for overburdened care providers."

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

The U.S. also is facing a looming physician shortage as older doctors retire and some are leaving the medical field. The Association of American Medical Colleges projects a shortage between 37,800 and 124,000 physicians by 2034, with the largest disparities being in the area of specialty doctors.

"We've always been focused on this big problem in the industry around physician burnout. Being able to solve that and solve that at scale is really what's important," Diana Nole, executive vice president and general manager of Nuance's healthcare business, said in an interview.

DAX Express combines Nuance's "very deep experience with conversational and ambient AI" with GPT-4 to provide "the most optimized level of accuracy in terms of clinical documentation," Nole said.

"That is what's unique and the first thing that no one else has been able to introduce. The conversational and ambient AI that we've been working on, and we've been the market leader for many years on, has been trained with millions of encounters that have had that physician editing as part of that AI learning loop, so combining the two is what's so unique," she noted.

Microsoft and Nuance started teaming up in 2019 to use technology to solve a big pain point for doctors—too much time spent on documenting and administrative tasks. The two companies began collaborating four years ago to use ambient technology combined with artificial intelligence, automation and cloud computing to create an exam room experience where the clinical documentation "writes itself."

DAX Express takes that a step further with the integration of GPT-4.

"DAX Express is workflow integrated and it creates a clinical summarized document in a standardized format within seconds of the patient-physician visit being concluded. It's available to the clinician for immediate review," Nole said. "During the medical visit, the patient and the physician just focus in on each other and the ambient technology is working in the background. At the end of the visit, [the clinical note] is automatically available within the Dragon Medical One toolbar that physicians are very used to using."

More than half a million physicians use Dragon Medical One, and the technology's trusted position in the market will help DAX Express scale up to more doctors and organizations, Nole said.

DAX Express will be available initially in private preview beginning this summer for select customers. Once that testing is completed, the technology will be generally available to all Dragon Medical One and DAX users, according to the company.

The company directed organizations or physicians interested in being added to the DAX Express list to this site.

Microsoft ramped up its work in speech recognition and ambient AI technology for healthcare when it bought Nuance for $19.7 billion last year. The deal was announced in April 2021 and closed in March 2022. It marked Microsoft's second-largest acquisition, behind the $26.2 billion deal for LinkedIn in 2016.

Considered a pioneer in speech recognition and AI technology used in healthcare, Nuance's technology is used by 77% of U.S. hospitals and more than 75% of Fortune 100 companies worldwide.

With the original DAX product, Nuance uses human reviewers, or documentation specialists, to review the quality and accuracy of the encounter and the clinical notes. The clinical notes are then added to the medical record within four hours, Nole said.

With DAX Express, the draft clinical note is available to the clinician for immediate review. The clinician has the "final sign-off" on the clinical documentation, according to executives.

The capabilities of Dragon Medical One, DAX and DAX Express give physicians more flexibility to use different technologies.

A simple follow-up visit with a patient may be best served by the ease and use of Dragon Medical One, which leverages automation and speech recognition, Nole said.

"Other encounters could be very in-depth, long and complicated and the physician may want a very customized clinical note around that. They may want a human quality review of that. That's what we introduced three years ago with our DAX solution," she added.

In a blog post, Microsoft executives said technologies like AI, in partnership with clinicians, can play a key role in accelerating progress in the industry by strengthening the human interaction in medicine, reducing costs and easing the administrative and cognitive burdens providers face. 

Physicians using Nuance's solutions report up to 70% reduction in feelings of burnout and fatigue, according to the company. The term “pajama time”—physicians sitting at home, in their own time, filling in medical records—has become an accepted concept in healthcare.

"After we introduced DAX three years ago, we had physicians tell us, they would send us messages, and say, 'I got to see my child's soccer game.' Or things like, 'You've saved my marriage.' We understood more fully the massive pressure that they're under personally and professionally, and they just aren't doing the things that they always felt that they should be doing, which is focusing on their patients," Nole said.

There are opportunities to leverage the combination of speech recognition, ambient AI and GPT-4 to quickly get insights to clinicians at the point of care, she noted.

"There's going to be a lot of opportunity to reduce administrative tasks and also getting the insights and the intelligence out to the users, the physicians, nurses and radiologists, in an efficient manner so that they can use it in the course of their workflow," she added.