When senior managers introduce new workplace technologies, the cognitive burden on the end user deserves primary consideration. Organization-wide technological upgrades often come with a similar assumption from leadership: If everyone can get on board with the new system, the new software or gizmo, our whole operation will be more powerful and efficient. But how can management monitor the human impact of these transitions, and is there any recourse when the costs outweigh the benefits?

The University of Michigan Health-West recently reached a similar inflection point decades after making the transition to electronic health records (EHRs). The growing prevalence of EHRs birthed a generation of doctors, nurses, and others who rose in the professional ranks assuming the dual roles of clinician and data entry clerk. Inputting the details of each visit into a patient’s electronic file was a necessary task with little or no time available for it in the clinician’s schedule. They effectively had two options: take notes on a computer while meeting with patients, or update the EHR later, often at the end of their workday.

The transition to EHRs was a net positive with well-documented benefits to patients and clinicians. EHRs centralize patient records within a health system and make data accessible to clinicians more readily than paper records. They ease the process of tracking changes in a patient’s health over time, and integrate with related digital tools, such as those that flag potentially dangerous drug interactions or automatically calculate a patient’s body mass index.

More recently, the cost of all that record-keeping on clinician’s workloads has come into sharp focus. Physician and nurse shortages anticipated prior to the COVID-19 pandemic worsened due to burnout. Earlier this year, a group of experts collaborated with the National Academy of Medicine to issue a Healthcare Workforce Rescue Package, including a list of recommendations. High on their list: “Reduce EHR clicks for common workflows.”

This was a key focus for the University of Michigan Health-West. They found a solution with AI-powered ambient clinical intelligence technology, which uses advanced machine learning to understand and document both the content and clinical context of multi-party conversations.

Since its introduction in early 2020, the technology has been used by health systems, clinics, and practices. University of Michigan Health-West was an early adopter and began an institution-wide rollout of Nuance’s Dragon Ambient Experience (DAX) in 2021-22 and first applied it in primary care settings.

A secure application, running on the clinician’s smartphone, captures the conversation between the clinician, patient, and other visit participants, which is then converted and consolidated into comprehensive medical documentation. Before the note is presented to the clinician in the EHR, a trained specialist validates the quality of the note, which also helps the AI learn over time.

More productive, less stressed, more personal

Across the board, this technology predictably reduced the amount of time clinicians spent taking notes during patient visits. Before DAX, one clinician estimated spending 75 percent of his time on the computer while with patients. Once he started using DAX, the rate fell to roughly 25 percent. Clinicians polled at every doctor’s office DAX was utilized in, reported that they saved an average of 7 minutes per encounter, while patients reported significantly more personable interactions with clinicians who were more focused on them and less focused on the computer.

The qualitative data points added further insights:

1. Several clinicians described feeling less stressed and having more time to focus on the needs of the patient during appointments instead of typing notes. One family practice clinician said that eliminating the mental burden of note-taking improved his ability to ask better questions during patient visits.
2. Several clinicians said implementing the solution increased their productivity. Others added patient slots to their schedules. Another used his newfound time to “formulate a strategy and plan with the patient, discuss treatment, therapy, and educate.” Dr. Owens noted that his time between appointments became less rushed and more productive, enabling him to fill prescriptions and reply to emails and phone calls. That in turn helped the rest of his office function more smoothly.
3. A survey asked 232 patients who saw their clinician both before and after the DAX implementation to rate on a scale of 1-5 their agreement with statements such as “my visit felt more like a personal conversation” (average: 4.7), “the clinician seemed to be more focused on me during the visit” (4.6), and “the clinician spent less time typing on their computer” (4.7). In addition to the productivity and other benefits, the greatest promise of this technology may be its ability to restore the human aspects of healthcare that were lost with the adoption of the EHR.

Looking to the future

An EHR augmented by AI-powered ambient clinical intelligence enables clinicians to provide high quality care, improve the patient experience, and expand access to care. The technology is delivering time savings by documenting care automatically — and that time savings is having a significant impact on operational efficiencies and improved experiences for all.

Beyond the medical profession, the use of more complete and accurate transcripts of quality-checked multi-party conversations has improved basic processes for restaurateurs, journalists, and customer service organizations that employ an automated call center.

The University of Michigan Health-West’s adoption of ambient clinical intelligence technology highlights its potential benefits for other professionals engaged in high-stakes, face-to-face meetings. A detailed summarization of each patient-clinician conversation captured in real-time can reduce cognitive distractions so meeting participants can focus on key points, access pertinent background and historical data, and ultimately produce a more complete and accurate record of the interaction efficiently, saving time for all.