Are AI scribes the answer to doctors' documentation woes?

Dr. Matthew Fradkin, a pediatrician at Swedish Primary Care and Providence St. Joseph, discusses his work implementing an ambient scribe in his workflow at HIMSS20 Digital.
By Laura Lovett
03:16 pm
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Before Dr. Matthew Fradkin was a pediatrician he played in a punk rock band. Aside from the years of training to become a physician, he said there were actually some similarities to the two – namely the search for human connection.

“They have the same core, the in-the-moment human connection is really important to both. Bringing back the human connection in medicine is where I see digital and AI advancing in helping to turn back the clock in terms of the patient provider experience,” Fradkin, a pediatric and Swedish Primary Care and Providence St. Joseph’s, said during a HIMSS20 Digital event

With more and more documentation piling up in the medical world, Fradkin said that connection with the patient is in jeopardy – and so is provider burnout. 

“I want to find ways to make caregiving easier for our providers, and by finding ways for our providers to care for patients the way they want to in a large healthcare system, pushing towards standardization for population health advances. Or basically how do we prevent provider burnout using various digital tools and technology.”

Physician burnout is associated with work, personal life balance, and organizational factors, he said. 

“The only thing I can really make an impact on are the work factors. I’m probably not going to change a 50-year old primary care doctor’s personality, and I’m not on the C-suite, so I’m pretty sure I can’t make structural change overnight … so work factors for me is the obvious category to start addressing.”

He decided to start with a notorious pain point in care—the documentation. He noted that, while EMRs provide doctors with a plethora of data points, they shoulder the bulk of the input burden. That was when he began to look at AI and machine learning scribes to help ease this issue. 

“We want ambient technology to provide an accurate note where providers don’t change a thing in how they deal with patients in the clinical room or in their head,” he said. 

He started to work with the digital innovation team at his health system to look into pilots for fixing this issue.

“Part of the digital innovation core of Swedish and Providence St. Joe's is the accelerated pilot process. This is a set framework that allows providers to investigate possible new technologies to help with their clinic experience,” he said. “This pilot allowed us to follow that framework and to evaluate possible vendors in a virtual arena, come up with KPIs or key performance indicators and streamlining the path through IT, security, legal or any other red tape that prevents pilots from occurring in large health system.”

The tech that Fradkin decided to pilot was an AI-based medical scribe that is able to train and learn a provider’s individual style and preferences over time.

“Initially, so the provider does not have to do heavy lifting in training the ML, there is a real-person reviewer offsite, reviewing what the ML is coming up with after a visit, and correcting it and making adjustments in the background based on my personal and organization-wide templates already in the system,” he said. 

The system lets providers choose how they would like to use it. Some just used it for the simple transaction notes. Others use the “snip-it” mode, where they say a phrase that helps the system choose a certain path. Lastly there was an ambient mode, which listens to the whole encounter and is able to do the bulk of the charting.

“During and after the pilot I was able to go from seeing 16 to 17 patients a day to 23, with a range of 22 to 30 with the entirety of the pilot – where, for return on investment with the particular product we used, I would have to see one patient extra a week, four extra patients a month, to pay for the product,” he said. 

But Fradkin said that this type of system would do more than just boost the number of patients he could see. It would also help burnout. 

“Venturing into this new realm of AI-driven scribes is an exciting one, and one that needs to provide caregivers flexibility and responsiveness – the same factors parents expect from their providers in this new digital age of medicine,” he said. “Yes, there is a cost to this, never mind the fact that most of these solutions pay for themselves in the short run. But, if we have the same urgency to finding an answer to 'the cost of losing physician to burnout' from the EMR as we do to any other disease, we wouldn’t even be having this discussion about cost. It makes care better for the providers and patients.”

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