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Ambient AI Technology at Cleveland Clinic: Reducing Physician Burnout and Enhancing Patient Care
AI voice-enabled solutions are reducing physician burnout, enhancing patient interactions and transforming workflows across health care. In this conversation, Cleveland Clinic's Eric Boose, M.D., family medicine physician and associate chief medical information officer, and Rohit Chandra, Ph.D., executive vice president and chief digital officer, discuss the Clinic's initial pilot of ambient listening technology, lessons learned from implementation and what's on the horizon for AI in health care.
Transcript
Tom Haederle
Welcome to Advancing Health. Ambient listening technology is coming into wider use as a way to keep accurate records of the conversations between doctors and their patients. In today's podcast, we hear from two senior executives with the Cleveland Clinic about how their integration of this new application of artificial intelligence makes for better clinical notes and leads to a better experience for everyone.
::Chris DeRienzo, M.D.
Hi, this is Dr. Chris DeRienzo, AHA’s chief physician executive, and I am very excited for today's podcast. We get to have a conversation about AI enabled solutions in health care, and we get to have that conversation with two individuals who are leading the way at the Cleveland Clinic. We have both Rohit Chandra, PhD, executive vice president and chief digital officer for the clinic, as well as Dr. Eric Boose, he's a family medicine physician and the associate CMIO for Cleveland Clinic.
::Chris DeRienzo, M.D.
We're going to have a broad ranging conversation today. But, folks, just before we get started, I've been out on the road a lot. And I have heard from health system after health system who is implementing this ambient listening technology about the kinds of transformative outcomes that they're experiencing. And now we get to talk to folks who are seeing that firsthand.
::Chris DeRienzo, M.D.
And so, Rohit, perhaps the first question is to you, as the clinic begin to think about this universe of AI enabled solutions and ambient technology, what drew you to that as an offering that you wanted to get integrated into practice, you know, as quickly as possible?
::Rohit Chandra, Ph.D.
So thanks, Chris, for the question. I think that our belief is that over time, AI has the potential to impact multiple aspects of health care all the way from clinical to back office and everything in between.
::Rohit Chandra, Ph.D.
The thing that is particularly intriguing about ambient solutions is that they hit a critical pain point for physicians, and they have the potential to do it in a way that is safe. So ambient listening hits a pain point where physicians often spend multiple hours a day in documentation tasks. Those are obviously necessary from a regulatory and patient care perspective, but they take a lot of time. And the technology is almost perfectly suited at streamlining that burden.
::Rohit Chandra, Ph.D.
The second part of it is it can be done safely and make sure that there is human oversight so that there is no risk of any patient harm.
::Chris DeRienzo, M.D.
Let's talk about implementing this kind of a solution a little bit, because I couldn't agree more of the potential for safe, and better experience is huge. But this isn't the kind of thing that you can just turn on.
::Chris DeRienzo, M.D.
And so, Eric, perhaps this one to you. When you made the decision, yes, we want to pursue this technology, we want to get it into the documentation arms of our clinicians. How did you begin that evaluation process?
::Eric Boose, M.D.
Yeah, we know that there's quite a few of these software companies that are out there on the marketplace now. And so we want to make sure we found the right one for us. Isro had said we want to make sure it's safe, the content is appropriate. It's really helping the physicians and not being a hindrance to their day or some new technology that's being imposed on them.
::Eric Boose, M.D.
So we actually took the route of doing several pilots. We actually worked with five different ambient vendors to see which one would work well for us. We had about 50 physicians in each of those. We kind of jokingly called it like a "British Bake Off," because we were kind of having comparisons going on between five different softwares, but we thought it was important to make sure that we chose the right one for us.
::Eric Boose, M.D.
And just like choosing a car, you could go with that first one. It seems to work pretty good and you'll take it. Or you want to look at a variety and really make sure that the choice you're making is a good one, because it's going to be a major decision going forward. So we actually had a lot of fun with that.
::Eric Boose, M.D.
We saw a lot of different aspects of ambient software. What's available out there on the marketplace, which ones worked well? And got a lot of feedback from our pilot users. And everybody was just so excited about this technology. The idea of going from being a lot of data entry, which was a big disruptor when the HRs came on the marketplace, to having something actually doing the work for you and doing it well was super exciting.
::Eric Boose, M.D.
And to your point, you know, thinking about the idea of not having to spend the extra hours and all this documentation and focusing on other patient care we'd like to do.
::Chris DeRienzo, M.D.
Amen. I imagine so five different solutions, 50-ish clinicians per solution. How did you pick where to go and who to work with and which sites to do?
::Eric Boose, M.D.
Yeah, I mean, we had a whole evaluation process. A lot of the things you might think of when you're trying to determine if a tool like this would be appropriate for your organization. And one of them is, you know, around documentation, we want to make sure, first of all, they're not having to spend as much time documenting or getting that documentation done in a more timely fashion, getting home better, you know, in the sense of like less time after work hours or spending more time with our family or things that you want to do rather than doing all this extra work after hours.
::Eric Boose, M.D.
But we want to make sure the quality was there. So we worked with our, you know, audit folks to make sure that the notes were looking good. We were tracking what the physicians were doing, how often they were using it, what they recommended. We did some surveys around, before and after, you know, do you feel like your cognitive load is less?
::Eric Boose, M.D.
Do you feel a little less burnout? Basically, do you feel more comfortable and kind of enjoying medicine again, being able to sit there, not be worried about taking notes through the whole visit, but just having that face to face conversation that we all enjoy, including the patient. The patient certainly notices, too. Everybody seems more relaxed and it's just been going so much more smoothly.
::Chris DeRienzo, M.D.
That really hits home. I remember I had this spectacular family practice physician when I was, in western North Carolina, and he could, stay totally engaged in the entire visit while continually typing away at structure documentation. And he's sort of a unicorn. There are obviously other doctors who can do that, but most of us can't do that.
::Chris DeRienzo, M.D.
And so, you know, hearing that you walk through this very purposeful and intentional evaluation process. Rohit, I'm curious. How did you ultimately decide on which solution to implement? And then, what approach are you taking the implemented?
::Rohit Chandra, Ph.D.
So, a couple of comments. One, I think that traditionally humans have to overextend themselves to adapt to technology and that was sort of the journey with the EHR.
::Rohit Chandra, Ph.D.
The thing that's intriguing about these ambient solutions is that the technology increasingly adapts to the human interaction, and that's the appeal. So just wanted to sort of get that out there. In terms of actually piloting and then deciding what technology to go forward with, we feel that this capability is the start of a transformation journey, and we hope that this is a big decision that if you make a good decision will be transformative over time.
::Rohit Chandra, Ph.D.
What that translated into was a little bit of an approach that I have in bringing technology into the organization is "try before you buy." So that's what led us to say, hey, it's important for us to pilot something as opposed to just pick a partner based on sort of a superficial assessment. So I look back and say, I'm glad we did the pilot.
::Rohit Chandra, Ph.D.
We got a chance to test drive multiple technologies by hand and there's no substitute for that. And at the end of it, then you're far more confident in your solution and the capability and the potential that it has. In terms of actually piloting five vendors, we piloted with what we thought were sort of key players in the space.
::Rohit Chandra, Ph.D.
I am told that there are more than 100 different companies doing it, so. Goodness! Exactly. How many survive? How many find different variations? Time will tell. But at least we try to apply some judgment on which are the prominent ones that we should test drive. Like Eric alluded to, we looked at a few different criteria.
::Rohit Chandra, Ph.D.
First and foremost is the product capabilities, the quality of the transcriptions, the ability to deal with multiple languages, the ability to attribute the right conversation to the right person in the room. All of that is technology capability that needs to be done right. The second part of it is the quality of the summaries that are generated, whether for the patient, whether for the physician, all of those. You need revisions...
::Rohit Chandra, Ph.D.
how accurate and how complete is it? is a second consideration. Integration with the EMR so that the workflows are relatively smooth and not cumbersome is essential.
::Chris DeRienzo, M.D.
Let's pause there for a second, because I know there are many different possible solutions. But as we get into sort of the next part of our conversation, which solution did you ultimately go with?
::Chris DeRienzo, M.D.
And then what is the EMR platform that sits on top of just so listeners can have sort of a sense of, okay, this is what their environment looks like.
::Rohit Chandra, Ph.D.
I can get some of the basics, and then I'll defer to Eric to speak to the experience. So we're an EPIC house. Our EMR is EPIC. And it was obviously essential for us that the workflows that the physicians encounter are as seamless as possible.
::Rohit Chandra, Ph.D.
And I'll defer to Eric to speak to that part of it. But that was obviously an important part of our assessment.
::Eric Boose, M.D.
Yeah. So in the end, when we went through our different assessments, we ended up with ambiance as our solution for our ambient AI software. I do think there's something about ease of use for the user, right? Just like any other technology, if you throw in too many barriers or make it too complicated the uptake is much lower.
::Eric Boose, M.D.
All of these softwares in general are pretty elegant in their solutions in the sense that the listening of the visit all tends to occur on a phone that's listening through an app. But how it gets into the EPIC or whatever your EHR might be, the ease of use of having it there as a draft so that at that point can be reviewed, edited, added, subtracted before it's obviously accepted in the medical record was very important to us.
::Eric Boose, M.D.
And so ease of use in the integration doesn't have to be fully, deeply integrated. I wouldn't say, but it has to be nice and elegant so that things go through so quickly and smoothly that the uptake is done. And it's very easy to use.
::Chris DeRienzo, M.D.
And from the integration perspective, it's not just free text getting ported in. There are structured components to it that also have to get completed. Is that right?
::Eric Boose, M.D.
Correct. I mean, as the recording is in the AI software is working, it will bring back the note and all the different sections that you would need. So the HPI, API and results and erroneous systems is also as patient instructions, which actually turned out to be one of the surprises that we found very valuable was that as soon as the AI was done, it created the note.
::Eric Boose, M.D.
You could have the patient structures ready for them before they even left the exam room. Wow. And to have kind of like that written record of all the things I asked them to do, it was so nice for them as they left, having those instructions with them.
::Chris DeRienzo, M.D.
You're about a month since announcing partnership in the move forward. How's it going? What kind of outcomes are you seeing? Well, you know, what do you what are you focusing on now that it's going live across the clinic?
::Eric Boose, M.D.
I mean, it's been very exciting. We just started the implementation on March 10th. We did listen to our vendor ambiance a little bit, guiding us the way, you know, what's been successful for implementation across a large enterprise to start. And we work together also with our Cleveland Clinic culture to make sure how was accepted and brought forth to all of our providers.
::Eric Boose, M.D.
There are several thousand in scope to be using the product, and so we decided to do things in waves. Ambiance gave us some advice about which they felt which specialty models were ready to go out of the box, which ones they might need about, you know, 4 to 6 weeks to get really tuned up and some other ones that took about 12 weeks.
::Eric Boose, M.D.
y within two weeks have about: ::Chris DeRienzo, M.D.
Oh my goodness.
::Eric Boose, M.D.
We can all attest that it's been a struggle these days, right? We have a lot of information coming to us. We have a lot of patient expectations about getting back to them as quickly as possible. All this electronic health record and patient portals and just, you know, it's expected to be very quickly going through information and getting back to them.
::Eric Boose, M.D.
So this really helps us in our day in the sense of things happened so quickly with it that it's really unloading the other processes that we have to do during the day. And we're feeling that relief and we're seeing some of the docs saying, you know, I don't know if I'm going to cut back my time like I thought it was going to, or I may postpone retirement for a couple more years.
::Eric Boose, M.D.
I mean, things you would never think you would hear from physicians, right? This is like a technology they're asking for and begging for. Like, it was so interesting during the pilots. If there was a person that was in the office using it, yet three others weren't, they're all like, I want it. When can I get it? So that kind of energy has been building.
::Eric Boose, M.D.
And so when we launched it and advertised it, everybody was very, very excited about it. So it's been it's been going very well.
::Rohit Chandra, Ph.D.
Chris, I'll add a quick comment, which is most times technology is a little bit clunky to adopt and integrate, and understandably so. That's true for all of us as consumers. The nice thing was this technology's the integration and the ability to use it is pretty seamless. And the appetite and the enthusiasm for adopting it is unprecedented.
::Chris DeRienzo, M.D.
It's pretty rare for me to hear a positive, life changing story from a technology implementation.
::Chris DeRienzo, M.D.
But you've got it. And to be clear, like, this is the story I'm hearing everywhere. Health care is and will always be a uniquely human experience. And the more opportunities we have to thread our humanity back into the practice of medicine using this needle of technology, the better. We are just about out of time. As expected, this has been a fantastic conversation.
::Chris DeRienzo, M.D.
I am curious, though, as your ambient rollout continues through its the thousands of providers who are pulling to try to get to use it. What else do you see on the horizon with this kind of potential impact? And where are you sort of looking down the road towards other potential AI enabled use cases?
::Rohit Chandra, Ph.D.
I'll touch on a couple of things, which is we are currently rolling out ambient listening in outpatient settings. I think there's an opportunity to look at other scenarios and use cases in different settings where ambient technology can help streamline the documentation burden.
::Rohit Chandra, Ph.D.
I think the second part of it is while today we are leading with transcription and summarization, I think there's an opportunity to bring greater clinical knowledge to bear that can perhaps serve as a physician's assistant at their elbow, helping streamline more and more mundane tasks as we go forward.
::Eric Boose, M.D.
Yeah. And I think just to echo that, I kind of picture that as well - as sort of having this kind of copilot, you know, with you. Again, we have so much information we're trying to gather before we see a patient and deal with after we see a patient with testing, that I almost see it as like, could the AI bring everything together, like do a chart review?
::Eric Boose, M.D.
What care gaps do they have? What are actionable findings that may need to be promoted to make sure they follow up on? Almost like a patient briefing that when I open that record, tell me what I really need to know going into this visit to make sure that I take care of that patient very well. It's personalized to their care, and we make sure that the proper follow up and everything is sort of set up before they even leave the office.
::Eric Boose, M.D.
So I feel like there's a lot of those tasks that I think that as the AI products get better and they do a little more deep dive into the charts and help us with all that context is where I see this going next.
::Chris DeRienzo, M.D.
Well, if that is where we are going, then to all of the young folks out there who are studying medicine and nursing and respiratory therapy at an APP school, the future that awaits you is much better than the present that the folks on this call have lived through. We've gone through the challenging ages of early stage implementation and hopefully through the work that you all are doing leading the way at Cleveland Clinic,
::Chris DeRienzo, M.D.
we will help bring some humanity back into the practice of medicine for all those who get to follow us. It has been a real privilege to get to speak with both of you. Thank you so much for joining us today.
::Eric Boose, M.D.
Thank you for having us.
::Rohit Chandra, Ph.D.
Thanks, Chris.
::Tom Haederle
Thanks for listening to Advancing Health. Please subscribe and rate us five stars on Apple Podcasts, Spotify or wherever you get your podcasts.
