Virtual Assistant Eases EHR Distractions for Physicians

AI-powered smartphone app can reduce physician burnout, enhance patient experience.

Yaa Kumah-Crystal, MD, envisions a day when a voice-enabled, AI-powered virtual assistant summarizes a patient's recent history via a smartphone before each encounter. During the visit, the Siri-like assistant will respond to her queries about information stored in the electronic health record (EHR); it will provide trending or comparative data and context; and the system will help order medication, labs, and diagnostic tests.

Kumah-Crystal's eyes will be focused on the patient instead of a computer screen, her hands will be free to conduct the exam, she won't have to click through multiple interfaces to find information, and her day will be freer of administrative tasks.

The doctor won't have to wait long before science catches up. Some of these technological advances are already available thanks to a commercial venture between Nuance Healthcare, a division of Nuance Communications Inc., and Epic Systems Corporation. The remainder are in development by those entities or at Vanderbilt University Medical Center (VUMC) in Nashville where Kumah-Crystal works as an assistant professor of biomedical informatics and pediatric endocrinology.

For health systems, a virtual assistant with these capabilities could make significant inroads into the challenge of physician burnout by reducing administrative tasks, as well as enhance the patient experience by delivering a better connection with providers.

"We spent a ton of time with Epic combining our different capabilities within an integrated workflow to help health systems achieve that dual goal of helping physicians spend more time with patients and also freeing up time for the clinicians," says Peter Durlach, senior vice president, strategy and new business development for Nuance.

"These virtual agent capabilities not only allow them to complete the work faster," says Durlach, "a highly productive physician can save upwards of two hours a day using this technology." It also contributes to better documentation to meet regulatory requirements. "There are a number of big challenges that we help address," he says.

A Phenomenon That Finally Reaches Healthcare
 

Virtual assistants are a fast-growing phenomenon, not only with the use of consumer products such as Amazon's Alexa, Google Assistant, and Apple's Siri, but as part of automated communications with many industries, such as airlines and banking. Market intelligence firm Research and Markets released a report earlier this year forecasting:

• Unique active consumer VDA [virtual digital assistant] users will grow from 390 million in 2015 to 1.8 billion worldwide by the end of 2021
   
• During the same period, unique active enterprise VDA users will rise from 155 million in 2015 to 843 million by 2021
   
• Total VDA revenue will grow from $1.6 billion in 2015 to $15.8 billion in 2021

The healthcare market has lagged behind, but in September, Nuance and Epic released the first version of a conversational virtual assistant. It operates on Nuance's Dragon Medical cloud-based platform and is available through Epic Haiku, a mobile app for physicians that interfaces with the Epic EHR. The assistant is an upgrade to the app, used by physicians, which provides secure access to clinic schedules, hospital patient lists, health summaries, test results, and notes, while supporting dictation.

Vanderbilt was one of the sites that tested an earlier version of the product. Soon, a similar upgrade will be released for Epic Rover, a mobile app for nurses and other healthcare providers.

At least one start-up, Redwood, California–based Suki, aims to create something similar, and has raised $20 million to fuel an artificial intelligence-powered, voice-enabled digital assistant for doctors, but has not yet released a product.

How Virtual Assistants Will Change Healthcare Short Term
 

According to Sean Bina, vice president of access applications for Epic, the assistant can answer questions such as:

• What are the patient's A1c test results?
• What medication is the patient taking?
• What's my schedule for today?
• Has the patient had a colonoscopy?

"We've been working with physicians to identify the most common types of queries they have that they would want supported in a virtual assistant workflow," says Bina. "Then, just like the virtual assistants that people already use at home and on their phones today, the list of commands, and the natural language that it supports, will grow very rapidly over time."

The immediate impact has the potential to reduce provider burnout, diminish difficulty locating information in the EHR, and change the physician-patient dynamic.

"We're hearing more and more about [providers] feeling like their time is not well spent and is not as directed at patient care," says Kumah-Crystal. "A lot of [effort] goes into documentation and data retrieval, and you're just clickety-clacking on the computer all day."

"Voice has the potential to humanize the workflow," she says. "It can really make you feel more connected to the work you're doing, and also [enhance] the patient experience because you're not having to break away from the patient just to look up something in the EHR. It's as if you had a scribe in the room with you or a really useful medical student or resident. You can just ask for the information you need and not have to break away from your patient to get the content delivered."

"The use case for this is going to shine when the provider uses it [during a patient encounter]," Kumah-Crystal says. "Right now we're kind of forced to be at a computer, simultaneously typing our notes and doing orders while the patient is there with us in the room. If we're able to disconnect from the computer, that will add so much more to the patient-provider interaction that we've lost by introducing the computer as a third party that pulls the provider away from having eye contact and being able to speak directly with a patient."

What the Future Holds
 

VUMC is taking the virtual assistant another step further and developing contextually useful summaries to provide an overview of relevant patient information for the physician to listen to before entering the exam room.

"Currently, we spend a lot of time just clicking through different notes, different tabs in the chart just to put together this information ourselves," she explains. The goal is to create a spoken summary like a medical student or resident would provide to an attending physician.

These capabilities are in development in VUMC's biomedical informatics department where Kumah-Crystal spends 80% of her time. "We consider ourselves kind of like the R&D [research and development] shop for voice user interfaces in health," she says.

In addition to building contextually useful patient summaries, the department is working on delivering trending data via the virtual assistant. They want to provide, through voice cues, information about a patient's height or weight over time, for example, and compare such data to norms.

Among the other capabilities in development:

• Medication and test ordering. While Dragon Medical currently has these capabilities built into its system, Epic has not yet activated this feature. During testing with Vanderbilt, the mean time for ordering medications via the virtual assistant was 17 seconds, compared to 50 seconds using the mobile app without voice assistance.
   
• Decision support tools that could issue alerts, for example, if a patient has adverse reactions or allergies to medications the doctor orders.
   
• A desktop version of the virtual assistant is planned by Nuance and Epic.