“Just to make sure I’m not missing anything, it sounds like your child has been having worsening cold symptoms and fever for the past three days. Is that right?”
That sounds like a physician checking in with a patient and their parents—but it’s also a signal to a smartphone app.
For the past year and a half, Dr. Matthew Fradkin, a pediatrician with Swedish Medical Group in Seattle, has been using Saykara, a virtual assistant that “listens” in the background during patient visits and automatically documents notes in the electronic health record system. He began using the app as part of a pilot project with Swedish Medical’s parent organization, Renton, Wash.-based Providence St. Joseph Health, to help address provider burnout, but since then, he’s continued to use it.
Virtual assistants like Saykara are part of a growing market of software solutions working to reduce the documentation burden on providers. Primary-care physicians now spend more time in the EHR than on face-to-face time with patients, with most physicians completing documentation in the EHR after hours, according to a study published in the journal Family Medicine last year.
“It’s very natural,” Fradkin said of the Saykara system, even though it requires him to vocalize all notes he wants recorded during the visit. “As a pediatrician, I’m always saying what I think I’m hearing to the patient’s family and calling out things I see on the physical exam so parents know what I’m looking at.”
At the start of each appointment, Fradkin asks the patient and their family if it’s OK to use the Saykara app. The virtual assistant then listens to the entire visit, using artificial-intelligence techniques like natural language processing and machine learning to interpret what the physician is saying, helped by listening for key terms such as “just to make sure I’m not missing anything,” “in summary” or “let me get this straight.”
It then inputs notes, diagnoses and orders directly into the EHR, structuring the patient note by analyzing Fradkin’s previous documentation.
That helps Fradkin spend more time face-to-face with a patient, rather than having to look at a computer screen to take notes during the visit, he said.
Fradkin still reviews and signs off on each patient note, but said most require no editing. During Fradkin’s pilot with the app, he found the system helped cut the time he spends in patient charts by roughly half, allowing him to increase the average number of patients he sees per day to 25 to 30, up from 18 to 22.
As the pilot case, Fradkin is still the only physician using Saykara at Swedish Medical. But he said Providence St. Joseph is working to expand the pilot project to physicians at several other clinics in the health system.
Saykara charges a monthly subscription fee of roughly one-third what a human scribe would be paid for that time, according to Ryan Plasch, the company’s vice president of growth and strategy. He gauges the average cost for an in-person scribe at $3,500 to $4,000 per provider per month. PayScale estimates the average medical scribe’s annual salary at $31,055, while Glassdoor pegs it closer to $24,857.
EHR giant Epic Systems Corp. demoed a prototype of its own virtual assistant at its annual User Group Meeting last month. “We’re seeing some early advances in technology to move toward this … conversation-driven documentation,” said Seth Howard, Epic’s vice president of research and development.
Epic’s system, which would listen in on a patient encounter and complete a note after a physician says “Hey, Epic, write my note,” is still an experimental project, though Howard estimated it will be released in three to five years.
Hospitals are just beginning to adopt voice technology to address documentation issues, said Susan Irby, managing director for business intelligence and analytics at Maestro Strategies. “The potential for this is huge,” she said, adding it’s too early to assess some of the benefits and challenges.
To evaluate return on investment, Irby suggested hospitals considering this type of service track changes in coding accuracy, patient volume and physician satisfaction. There’s also the possibility of revenue growth by increasing the number of patients that a physician can see in a given day, she said.