Category
🤖
TechTranscript
00:00 You know, when you go to your doctor's office,
00:01 you've probably noticed that your doctor spends a lot of time
00:04 during your visit typing into the computer,
00:06 documenting your symptoms
00:08 into your electronic health records.
00:10 Well, those EHRs are really the bane of doctors' lives.
00:14 A lot of them actually end up finishing those notes later,
00:17 often at home, in what's become known as
00:20 pajama time in the business.
00:23 Microsoft's Nuance Technology Unit
00:24 has an AI-enabled app called Dax Express
00:27 that just could put pajama time to bed.
00:30 To see how it works, I did a simulated doctor's appointment
00:33 with Nuance's Dr. Julie O'Connor,
00:35 and she didn't type at all during our visit.
00:39 - I'm actually on my phone, and I'm inside our Dax app,
00:41 is actually can record the conversation
00:45 and use that ambient AI to automatically create
00:48 a draft clinical document from our conversation.
00:51 So I'm with Bertha, who's a 50-year-old female
00:54 here today for foot pain.
00:55 So tell me, Bertha, what's going on?
00:57 - I love to run for last 15 years until about 2017.
01:02 - Okay. - It was great.
01:04 It was a great stress reliever.
01:06 I really enjoyed doing it.
01:07 And then around 2016, 2017, I developed plantar fasciitis.
01:12 - Okay. - So I had to
01:14 literally step back, and I wasn't running much anymore.
01:18 - But recently, it's become worse, is that correct?
01:21 - It's become worse, particularly in the morning,
01:23 regardless of whether I've run or,
01:26 well, if I've walked a lot,
01:28 so I like to go hiking as well.
01:29 - Okay. - So if I do that,
01:32 it, like the next day, I will feel some aches,
01:35 more aches in my feet. - Okay.
01:37 - It's like you're walking on marbles.
01:40 And now also my ankles sort of feel a little crunchy as well.
01:43 I don't know if it might be arthritis.
01:46 My grandmother had arthritis.
01:47 - I think the MA told me that you're going on a vacation,
01:50 you're hoping to hike.
01:51 - Yeah. - It's up in the Adirondacks.
01:52 My in-laws, they have a place in Lake Placid,
01:55 and so we usually go up in the wintertime.
01:57 - This year, the black flies and deer fly are really vicious.
02:02 Fourth of July, I was up there, I got bitten on,
02:04 I had everything covered, but got bitten on my finger,
02:06 got infected, and I wound up having to take antibiotics.
02:10 - So next, I would really like to do an exam,
02:13 if that's okay with you. - Okay.
02:14 - So when I press the outside of your ankle,
02:16 does that hurt at all? - No.
02:17 - There's no focal tenderness
02:19 over the medial or lateral malleoli.
02:22 Normal range of motion in both ankles.
02:24 Your exam is normal,
02:26 but your symptoms are consistent with platar fasciitis.
02:29 What I typically recommend patients do
02:32 is they actually stretch their foot out
02:34 before they even step out of bed in the morning.
02:36 I would actually wear shoes with orthotics.
02:39 I'm also gonna do x-rays of your ankles bilaterally,
02:42 so x-rays of both ankles
02:43 to evaluate for possible arthritis.
02:46 In addition, I would recommend you do ibuprofen,
02:49 600 milligrams, three times a day.
02:52 So I stopped the recording,
02:53 and so what happens is that audio file
02:56 of our conversation goes up to the Microsoft Azure Cloud,
02:59 gets run through the engine,
03:01 and we automatically receive a note back.
03:03 And as a clinician, I'd be able to reference this
03:06 on the phone, review it on the phone,
03:08 or review it from the computer.
03:09 I can make edits from either of those locations as well.
03:13 So this is the part of the medical documentation
03:15 that actually tells the patient's story
03:17 of what brought them in.
03:18 So you love to run, you've been doing it for 15 years,
03:21 until 2017, it was a stress reliever,
03:25 and you were developed plantar fasciitis.
03:27 You're running less, instead you're doing walking
03:31 or the elliptical, but it's not the same for you.
03:33 The bottom of your feet's hurt, your ankles feel crunchy,
03:37 and honestly, this part of the note
03:40 is really taking your own words,
03:42 and it included the walking on marbles as well.
03:44 You've done the therapy in the past,
03:46 you'd like to go hiking.
03:47 Supplemental information, you had an infection
03:51 from July on your hand that got treated with antibiotics,
03:56 which is important medical history.
03:58 Taking a medication like that can set you up
04:00 for other things down the road,
04:02 but it did take out the banter about me--
04:04 - And the Adirondacks. - And the Adirondacks,
04:06 me having family that lived in Lake Placid,
04:08 and so that's not medically relevant.
04:10 So with DAX Express, anything that I verbalize out loud
04:15 will be incorporated into the output.
04:18 I focused really on the foot exam,
04:21 and so looking at the left foot,
04:23 there's no focal tenderness.
04:25 Now coming down to the assessment and plan,
04:27 so this is where we document our diagnosis
04:31 and the medical decision-making.
04:32 So I recommend stretching, orthotics,
04:35 taking the ibuprofen, 600 milligrams three times a day.
04:38 I don't see the x-ray specifically,
04:40 so I would add that back in as I'm reviewing the note
04:43 before I sign off.
04:44 - When I've seen my doctor notes,
04:46 I never see a narrative like that.
04:48 I see basically bullet points.
04:50 - So they're trying to do the fastest thing they can do,
04:53 and this allows them to really just focus on you,
04:56 focus on the medicine of what's bringing you in.
04:59 - As a doctor yourself, where do you see this going?
05:03 - 40 to 60% of clinicians are, you know,
05:07 identifying with feeling burnt out,
05:10 and we are facing this huge shortage
05:13 in physicians in the US.
05:15 You know, by 2025, I think they estimate
05:17 90,000 physician shortage in the US alone.
05:21 And so we need to combat that administrative burden,
05:25 and these tools, this technology,
05:27 is really serving a huge pain point in the workflow.