Nebraska Medicine pilots ambient clinical intelligence to streamline physician workflow and improve provider satisfaction with EHR technology.
While EHR technology has streamlined clinical documentation and integrated patient’s disparate medical history, physicians find it unintuitive to use. The click-heavy nature of EHR system leaves many physicians frustrated. To deliver timely care to their overloaded patient panel, providers often must sacrifice their free time and complete medical charts after clinic hours.
Streamlining the charting process would drastically improve provider satisfaction.
In order to do this, Nebraska Medicine is pilot testing ambient clinical intelligence (ACI) technology among a handful of their specialists. At the point of care, artificial intelligence technology securely listens to the provider-patient interaction and automatically modifies the EHR.
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Using an incremental approach to improve natural language processing, virtual scribes review the conversation and physically update the EHR.
“Information is captured in the visit. That raw data is going through the natural language processing engine. That then goes to a human who’s not in Nebraska. That person then updates the chart with the information they found, and this helps calibrate the engine,” explained Brian Lancaster, vice president of information technology at Nebraska Medicine. “Over time, that human will be removed from the equation.”
Rolling this new technology out slowly was a best practice learned from their previous work, Lancaster noted. In 2012 when Nebraska Medicine rolled out the electronic medical record, they introduced a three-day documentation turnaround time. While they succeeded in hitting that metric, physicians were frustrated by requirements to use the EHR system so quickly without proper training.
“We did everything at such a rapid rate of change and put physicians in a bad spot,” Lancaster said. “We didn’t optimize the workflow. We didn’t give physicians enough training. We didn’t do enough customization and personalization. Physicians were not happy with us.”
When Nebraska Medicine decided to roll out new workflow processes, they learned from this experience and slowly rolled out the technology beginning with only a handful of specialists. The goal is to grow the use across the system slowly.
“This is the kind of workflow change that we needed to talk to physicians about upfront, teach them how to do it, and then monitor their first day or two to make sure it’s working,” Lancaster emphasized.
A slow rollout has also allowed Nebraska Medicine to fine-tune the technology, considering provider critiques and adjusting accordingly.
In earlier notes, physicians expressed concern with the professionalism of the language.
“If a physician is talking to a patient, he’s going to use not as much medical lingo as he would if he were talking to another physician,” Lancaster explained. “In some of the early notes, there was a level of professionalism that physicians were concerned with. If one of their colleagues read the note, he would be alarmed that the physician is not using the appropriate medical terminology.”
To address this problem, the users implemented pre- and post-conversations into the ACI workflow. Physicians would make comments to the recorder before entering and leaving the patient room, so the machine and virtual scribe could understand the template and general terminology the physician would use in the patient room.
“This helped with some of the learning of the machine and some of the instructions to the virtual scribes,” Lancaster explained.
Another significant challenge Nebraska Medicine had to overcome was concern about patient privacy. Sending patient information from Nebraska Medicine to a virtual scribe for review could make some patients feel uneasy about the security of their health information.
Only after patient consent is the ambient clinical intelligence technology enabled. The technology works with a HITRUST CSF-certified vendor to ensure HIPAA compliance.
“We have multiple interactions scripted from the time the patient checks in to the time a nurse is rooming them to the time the physician comes in to make sure the patient clearly understands what’s going on,” Lancaster explained. “This is scripted to create awareness for what’s occurring as well as why it’s important.”
Lancaster noted that this technology also helps enhance the information available to the patients on their patient portal, making it more accurate and up to date.
“It’s done in a way that is supposed to help transition knowledge from the physician to the patient. By explaining that, patients have been extremely understanding and actually excited about the technology,” he noted.
To measure the success of ACI’s integration, Nebraska Medicine has several key performance indicators: the timeliness of the note, the speed with which the note is updated and ready for viewing compare, and quality of the note.
“We’ve also been looking at physician satisfaction and productivity,” Lancaster said. “Are they able to complete the document more on time? Are they generally satisfied with the process both in terms of quality of the note and their satisfaction with the scribe process?”
Preliminary results demonstrate quicker turnover times, improved satisfaction, and maintained quality of notes.
“We’re more efficient, more productive, and note quality has maintained the same level,” Lancaster explained. “Over time, as we start to introduce some of the more advanced workflows, quality will start to really improve.”
About 90 percent of their patients have authorized the use of ambient clinical intelligence during their visit.
The other ten percent of patients who have not opted in is mostly the result of language barriers, challenges understanding consent, and general concerns about privacy, Lancaster noted.
Many patients see the use of the technology as a net positive. The recording device on the physician’s phone means they do not need to have a laptop or workstation on wheels in the patient room.
“A lot of the patients had seen their physicians in the room, documenting with the computer,” Lancaster said. “Now, physicians can make eye contact. Patients can have a conversation, and they can see the results in their patient portal.”
In the future, Lancaster hopes this technology will be incorporated into the patient room, so the use of smartphones in front of the patient becomes less common.
“We are working to put in smart speakers and smart devices that will add video cameras and audio microphone speakers to the room,” he explained.
Incorporating this technology into the room would enable the physician to be more visible to patients, no longer being blocked behind a screen.
“By doing this, we can heighten the physician-patient relationship because no longer is technology the wall between them,” Lancaster noted.
He hopes the smart room technology will provide reminders and guardrails to providers moving forward.
“As the physician is wrapping up the visit, they can start to see some suggestions that say the patient might need a flu shot or smoking cessation. It can identify real patient-safety issues like ordering medication the patient is allergic to,” Lancaster noted.
“With this technology, you’ve removed most of the clicks,” he concluded. “Now, you have a true warning that physicians will be more apt to be mindful of because they haven’t had to interact with the computer up until that point.”
Source: EHR Intelligence