AI solutions like, Dragon Ambient eXperience (DAX) Copilot (Nuance/Microsoft), hold the potential to significantly enhance provider and patient interactions and alleviate pain points that contribute to burn out. Atrium Health was the first healthcare system in the world to pilot Nuance's DAX Copilot intelligence (AI) enabled scribe software, which synthesizes a draft clinic note by "listening" to the conversation between a provider and patient. After 180 days of use by primary care clinicians and advanced practice providers (APPs), along with a control group, the investigators assess provider satisfaction, patient experience, and provider efficiency through qualitative and quantitative methods.
In this non-randomized stepped-wedge trial, clinicians (including physicians and advanced practice providers \[APP\]) specializing in family medicine, internal medicine, and general pediatrics were recruited from outpatient clinics located in North Carolina and Georgia. The intervention group was divided into 5 waves between June and August 2023 based on clinic locations. Prior to the activation of accounts, clinicians underwent a one-hour training session on DAX Copilot. Meanwhile, a comparison group comprising clinicians not utilizing DAX was recruited in five waves from locations and specialties similar to those of the intervention group. Two types of primary outcomes, electronic health record (EHR) metrics and financial metrics, were assessed after 180 days of intervention. EHR metrics include time in EHR (EHR8), work time outside of work (WOW8), time in documentation (Note8), completed appointment rate, same day closure rate, and note length. Financial metrics include gross revenue per visit and work relative value units (wRVU) per visit. Secondary outcome include provider satisfaction survey, provider interview, and patient satisfaction survey.
Study Type
INTERVENTIONAL
Allocation
NON_RANDOMIZED
Purpose
HEALTH_SERVICES_RESEARCH
Masking
NONE
Enrollment
238
The tool (DAX) listens to the conversation between a clinician and patient/caregiver during their visit, provides transcriptions between different speakers for the clinician to review, edit, and included in the final EHR notes.
Atrium Health Navicent
Macon, Georgia, United States
Atrium Health Floyd
Rome, Georgia, United States
Atrium Health
Charlotte, North Carolina, United States
Scotland Health Care System
Laurinburg, North Carolina, United States
Atrium Health Wake Forest Baptist
Winston-Salem, North Carolina, United States
Total EHR time
Total time on EHR (during and outside of clinic sessions) per 8 hour of patient scheduled time.
Time frame: Month 10
Work outside of work
Time on EHR outside of scheduled patient hours per 8 hour of patient scheduled time.
Time frame: Month 10
Time on encounter note documentation
Hours on documentation (note writing) per 8 hour of scheduled patient time
Time frame: Month 10
Completed appointment rate
Total completed visits over scheduled visits
Time frame: Month 10
Same day closure rate
Number of visits closed on the same day over total scheduled visits
Time frame: Month 10
Note length
Length of note in EPIC for each visit
Time frame: Month 10
Gross revenue per visit
Total charged amount in each day over total completed visits on the same day
Time frame: Month 10
wRVU per visit
Total work relative value units (wRVU) in each day over total completed visits on the same day
Time frame: Month 10
Provider satisfaction
REDCap survey to clinicians in both groups (intervention and control) and assess their satisfaction of the new tool.
Time frame: Month 4
Provider interview
12 semi-structured interview on clinicians in the intervention group. Each interview was facilitated using an interview guide with a semi-structured list of questions to help guide the conversation and answer the learning objectives.
Time frame: Month 1
Patient satisfaction
Patient satisfaction on the visit - patient satisfaction surveys are collected as part of routine care, which will be accessed through Medallia. Scores range between 0 (worst) to 10 (best) with one decimal point.
Time frame: Month 6
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