Most doctors choose medicine because they want to support patients. Yet today’s health care system requires physicians to spend many hours each day on other work—searching electronic health records (EHRs), writing documentation, coding and billing, prior authorization, and utilization management—often exceeding the time they spend caring for patients. This situation leads to physician burnout, administrative inefficiency, and poorer overall patient care.
Ambience Healthcare is working to change this with an AI-powered platform that automates routine physician tasks before, during and after patient visits.
“We are building co-pilots to give clinicians AI superpowers,” says Ambience CEO Mike Ng MBA ’16, who co-founded the company with Nikhil Buduma ’17. “Our platform is built directly into the EHR to enable physicians to focus on what matters most – providing the best possible patient care.”
The Ambience product suite supports real-time AI pre-charting and recording, and helps you navigate thousands of rules to select the right insurance billing codes. The platform can also send post-visit summaries to patients and their families in various languages to keep everyone informed.
Atmosphere is already used at approximately 40 huge institutions, such as UCSF Health, Memorial Hermann Health System, St. Luke’s Health System, John Muir Health and more. Doctors employ Ambience in dozens of languages and in over 100 specialties and subspecialties, for example in the emergency department, inpatient hospitals and oncology departments.
The founders say clinicians who employ Ambience save two to three hours a day on documentation, report lower levels of burnout, and develop better relationships with their patients.
From the problem, through the product, to the platform
Ng worked in finance until he took a closer look at the healthcare system after breaking his back in 2012. He was initially misdiagnosed and put on the wrong care plan, but in the process he learned a lot about the American health care system, including how most of a doctor’s days are spent documenting visits, selecting billing codes, and performing other administrative tasks. The average physician spends only 27 percent of his or her time on direct patient care.
In 2014, Ng decided to attend MIT Sloan School of Management. In his first week, he attended the “t=0” entrepreneurship celebration organized by the Martin Trust Center for MIT Entrepreneurship, where he met Buduma. The pair became rapid friends and eventually took classes together, including 15.378 (Building an Entrepreneurial Venture) and 15.392 (Scaling Entrepreneurial Ventures).
“MIT was an incredible training ground for assessing what makes a great company and learning the fundamentals of building a successful company,” says Ng.
Buduma went on his own journey to uncover problems in the healthcare system. After immigrating to the United States from India as a child and struggling with lingering health problems, he watched his parents struggle to navigate the American health care system. While earning his bachelor’s degree at MIT, he also became exposed to the artificial intelligence research community and wrote the first textbook on contemporary artificial intelligence and deep learning.
In 2016, Ng and Buduma founded their first company in San Francisco, Remedy Health, which operated their own AI-powered healthcare platform. In the process of hiring clinicians, caring for patients, and implementing technology themselves, they gained an even deeper appreciation of the challenges facing healthcare organizations.
During this time, they were also able to see advances in artificial intelligence. Google’s chief scientist, Jeff Dean, a major investor in Remedy and now Ambience, led a research group at Google Brain to invent the transformer architecture. Ng and Buduma say they were among the first to introduce transformers into production to support their clinicians at Remedy. Then a few of their friends and roommates started a huge language model group within OpenAI. Their friends’ work formed the research foundation that ultimately led to the creation of ChatGPT.
“It was very clear that we were at an inflection point where we were going to have this class of general-purpose models that were going to be exponentially better,” Buduma says. “But I think we also saw a big difference between general-purpose models and what would actually be robust enough to work in the clinic. In 2020, Mike and I decided that there should be a team that would specifically focus on refining these models for healthcare and medicine.”
The founders started Ambience by building an AI-powered script that runs on phones and laptops and records doctor and patient visit details in a HIPAA-compliant system that protects patient privacy. They quickly recognized that the models needed to be adapted to each area of medicine, and over a multi-year process, they slowly, step by step, expanded their scope of specialization.
The founders also realized that their scribes needed to fit in with back-end operations like insurance coding and billing.
“The documentation is not only for the clinician, but also for the revenue cycle team,” Buduma says. “We had to go back and rewrite all of our algorithms to account for coding. There are literally tens of thousands of coding rules that change every year and vary by specialty and contract type.
Based on this, the founders developed models that enable clinicians to make referrals and send comprehensive visit summaries to patients.
“In most care settings before Ambience, when a patient and their family left the clinic, everything the patient and their family wrote down was what they remembered about the visit,” Buduma says. “This is one of the features that physicians love most as they strive to provide the best possible experience for patients and their families. By the time the patient is in the parking lot, they already have a really solid, high-quality summary in their portal of exactly what you talked about and all the shared decisions related to your visit.”
Democratization of health care
The founders believe that by improving physician productivity, they are helping the health care system cope with a chronic physician shortage that is expected to grow in the coming years.
“In healthcare, access is still a huge issue,” says Ng. “In rural America, the risk of preventable hospitalization is 40 percent higher, and half of that is attributed to lack of access to specialty care.”
Because Ambience already helps health systems manage tight margins by streamlining administrative tasks, the founders have a long-term vision to support augment access to the best clinical information across the country.
“There is a really exciting opportunity to increase the democratization of expertise at some of the major academic medical centers across the United States,” Ng says. “Right now, there are simply not enough specialists in the U.S. to support our rural population. We hope to help scale the expertise of the country’s leading specialists through the AI infrastructure layer, especially as these models become more clinically intelligent.”