Patient intake, and the associated manual tasks that come upfront before a medical visit, represents a key component of a health system’s operational efficiency and clinical quality.
As a result, some hospitals and primary care clinics are experimenting with artificial intelligence and large language models to focus on note-taking and scribe work.
With physicians burnt out by spending more and more time in the electronic health record (EHR), can this technology be applied to other departments outside of the exam room?
Dr. Josh Reischer is CEO of Health Note, a vendor of a platform that can automate pre-visit documentation and help optimize time spent in the exam room by limiting EHR time. We talked with him about the role of AI in the patient intake process and other workflow efficiency efforts.
Q. You deal with ways to automate patient intake and the manual tasks that come upfront before a medical visit. Why is this area important to the overall performance of a health system?
A. Pre-appointment interactions set the tone for the entire healthcare experience. If done right, patients and physicians can have a better encounter, administrative staff can be more efficient, and organizations are best prepared to get paid for the care they deliver. If done poorly, you get the system we have today.
You wouldn’t walk into an interview unprepared, but for physicians, that’s the norm, and patients can tell when they have to reshare the exact information they filled out at home or in the waiting room. Physicians don’t have much of a choice in the matter, and the demands on them are overwhelming.
The goal should be driving efficiency for patients, staff and physicians. That means having everyone freed up from phone tag, paper surveys, repeat questionnaires and other unnecessary medical minutiae. What’s more, when doctors are well-informed about their patients, it has the capacity to improve the visit. They can ask prescriptive, non-redundant questions that put the patient at ease and lead to a better diagnosis.
We are seeing physicians spending more time in the EHR. This is compounded by the endless notes and “pajama time” I used to struggle with late at night, as physicians are required to code and summarize patient interactions into the EHR.
Only one in five physicians say they have enough time to document. In this same study, 42% feel they have little control over their workloads, and more than one in two spend excessive time at home completing documentation.
Revenue integrity and compliance is another group within health systems that can benefit from a streamlined, automated intake and outtake process. Depending on the billing, there are different documentation requirements and patient-reported outcomes that need to be collected for each.
The solution is to collect the appropriate patient-reported outcomes before the appointment begins. That way, a physician has the reminder to confirm and doesn’t need to worry about forgetting to add them. Traditionally, updates like this take training, and there is lag time. However, automating the workflow can help integrate these updates across all their physicians and patients at once.
Q. Health systems increasingly are experimenting with AI and large language models for note-taking and scribe matters. Does this technology translate into places outside of the exam room or is it a one-trick pony?
A. Generative AI is an incredible technology because it’s so adaptable. I think that AI will uproot several areas of our industry, but I don’t believe it should displace humans in the loop. Most importantly, AI will help healthcare to become more human than it is today.
It almost feels like healthcare technology is in the awkward teenage years – still figuring out its purpose. Today’s healthcare technology is gangly and goofy, and doesn’t always do what’s expected. Generative AI feels like the beginning of the next phase of maturity.
Scribes are a good first step for generative AI, but there are a number of use cases along the patient and physician journey that would be improved with the technology outside of the visit. Yes, it starts with simple manual tasks and chores that are antiquated and unnecessary in healthcare today, but I’m excited about how healthcare could be better for everyone.
When AI is applied to the front-end experience of healthcare, there are some significant benefits. For example, during intake, a chatbot or intelligent engine can work with a patient to discern pain levels, previous medical history, social determinants that flare up past conditions, or just recall a past medical visit.
Generative AI can communicate in many different languages, translate medical shorthand, and empathize with a patient’s condition. This is a huge win for organizations that serve diverse and underserved populations.
Even in my career as a medical professional, I’ve seen the industry move from paper templates and keyboards to buttons and touch screens. I believe AI will unlock new, more intuitive ways for us to communicate with each other and the technology that supports us.
Q. Doctors are spending more time working in the EHR, and this is contributing to clinician burnout. What are some ways technology can be made better to ensure doctors are more efficient and prescriptive with their time?
A. It was found that clinician time spent on EHRs increased by 28 minutes between 2019 and 2023. That just cannot happen, especially at a time when more medical professionals are signaling they want to leave the industry. Technology makes the mundane better and allows doctors to practice at the top of their license.
As cliche as that sounds, it’s true. Today’s tools would have encouraged me to stay in the patient care setting. I left internal medicine in 2018 to cofound Health Note. We all want to see the eradication of paper notes; we are constantly rehashing every minute of our patient interactions – the good, the bad and the ugly – for accountability and an antiquated billing model.
Artificial intelligence is already changing that, with documentation companies handling that part. We need to expand this to the intake process, and other areas, to allow doctors to spend more time with patients and sleep better at night. The bottom line: Doctors can depend on technology to increase personalization and get to know patients before exam room interactions.
Q. Are there other ways health IT design has failed? If so, how can these things be fixed?
A. In this first wave of innovation, doctors, nurses and clinicians have been completely left out of the design stage. I’ve seen a lot of incompatibility and misunderstanding on technology uses. It’s why I believe there are now more physicians like myself who are developing much more practical tools.
We’ll have to interface with the EHR for the foreseeable future – but it can evolve. Point solutions will disappear in the near future. It’s now about enterprise platforms that can penetrate various sites of care and specialties, from urology to musculoskeletal. Healthcare has so many layers, and you can’t just design with one use case in mind.
It has to be versatile enough to apply to this wide range of settings and populations, from Rural Appalachia to New York City. As we prepare for the Silver Tsunami of an aging Boomer generation, where 10,000 people turn 65 each day, we all expect healthcare utilization to increase. So, it’s urgent we build a sustainable workflow for the doctor and enable an experience that is personalized to meet the volume strain.
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