While future research could further explore the utility of Nuance’s voice-based, generative artificial intelligence documentation tool for physician subgroups and alternative clinical implementations, researchers found that the overall availability of Nuance’s Dragon Ambient Experience second pilot in Atrium Health electronic health records did not show significant improvement in key indicators for the organization.
WHY IT’S IMPORTANT
Last year, Charlotte, North Carolina-based Atrium Health, which connected and became a health advocate in 2022, he advertised himself as the first US health care system to implement artificial intelligence-based clinical documentation of the environment to automate the creation of clinical documentation during patient visits.
For a post-DAX implementation study published in the Modern England Journal of Medicine AI, researchers from Atrium and Wake Forest University School of Medicine assessed participating clinicians’ performance after a health system implemented Nuance’s DAX Copilot system.
The study initially enrolled 238 family medicine, internal medicine, and general pediatrics clinicians from practices in North Carolina and Georgia in five waves, from June to August 2023.
Those in the DAX testing group received an hour of training and set up an account through their Epic EHR.
Researchers assessed EHR-related outcomes over a 180-day period, including time spent in the EHR, off-work time, time worked on the note, meeting completion rate, same-day appointment closure rate and note length, and financial metrics such as unit workload values per visit.
The final analytic sample that the researchers evaluated included 112 clinicians in the software user group and 103 clinicians in the non-DAX user control group.
They found that three-quarters of “active DAX users” (84/112) migrated more than 25% of their DAX notes to Epic, and approximately 60% of “high-level DAX users” (67/112) migrated more than 60% of their DAX notes to their EHRs .
After controlling for age, gender, provider type, years in practice and baseline scores, researchers said they found few “statistically significant differences” between DAX users and the control group – saving time on notes.
“High DAX users experienced an overall reduction in documentation work hours compared to the control group,” they wrote in their report.
“The exploratory results suggest that small reductions in note taking time may be due to using DAX at high utilization levels or implementing DAX to select subgroups of physicians,” they added.
The study was funded by Wake Forest University Health Sciences, part of the medical school that forms the academic core of Advocate Health.
A BIGGER TREND
Over the past year, many organizations have expanded their operate of DAX Copilot, including Intermountain Health, Pennsylvania-based WellSpan Health and others.
EHR vendors have also formed partnerships to integrate documentation pools to reduce physician burnout. In January, Epic fully deployed the second Nuance AI pilot, and in March, Meditech Expanse EHR announced its integration.
Meanwhile, in October, Microsoft reported that DAX was gaining momentum after a year of availability and emphasized that the AI tool was used in at least 50% of patient encounters at Northwestern Medicine in Chicago. According to the tech giant, health system physicians spent an average of 24% less time taking notes and increased their patient intake by an average of 11.3 times.
ON RECORDING
“Taken as a whole, these findings suggest that AI-driven documentation efficiencies could translate into reduced burnout rates for some physicians, and perhaps more broadly as DAX implementation reaches higher levels of adoption,” the researchers said in their NEJM AI Report.
“However, widespread adoption of DAX in its current form is unlikely to provide noticeable benefits to health systems looking to increase productivity.”