AI plays a role during the patient intake process
Patient intake and the associated manual tasks that precede a medical visit are an important part of the operational efficiency and clinical quality of a healthcare system.
That’s why some hospitals and primary care clinics are experimenting with artificial intelligence and large language models to focus on note-taking and note-writing.
As physicians spend more and more time in the electronic patient record (EHR) and become exhausted, the question arises whether this technology can also be applied to departments other than the consulting room?
Dr. Josh Reischer is CEO of Health Note, a provider of a platform that can automate pre-visit documentation and help optimize time spent in the exam room by reducing EHR time. We spoke with him about the role of AI in the patient intake process and other efforts to improve workflow.
Q. You are focused on ways to automate patient intake and the manual tasks that precede 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. When done well, patients and physicians have a better encounter, administrators can be more efficient, and organizations are best prepared to get paid for the care they provide. When done poorly, you get the system we have today.
You wouldn’t walk into a job interview unprepared, but for doctors that’s the norm, and patients know when to re-share the exact information they entered at home or in the waiting room. Doctors don’t have much choice in this area and the demands placed on them are overwhelming.
The goal should be to increase efficiency for patients, staff and physicians. That means freeing everyone from phone calls, paper surveys, repeated questionnaires and other unnecessary medical details. Furthermore, visits can be improved if physicians are well informed about their patients. They can ask prescriptive, non-redundant questions that put the patient at ease and lead to a better diagnosis.
We see that doctors spend more time in the EPD. This is made worse by the Endless notes and “pajama time” that I used to struggle with late at night as doctors would code and summarize patient interactions in the EHR.
Only one in five doctors say they have enough time to document. The same research shows that 42% feel they have little control over their workload, and more than one in two spend an excessive amount of time at home completing documentation.
Revenue integrity and compliance is another group within healthcare 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 must be collected for each.
The solution is to collect the correct patient-reported results before the appointment begins. That way, a physician has the reminder to confirm and doesn’t have to worry about forgetting to add them. Traditionally, these updates require training and are time-consuming. However, automating the workflow can help ensure that these updates are integrated for all their physicians and patients at once.
Q. Healthcare systems are increasingly experimenting with AI and large language models for note-taking and writing. Does this technology translate to places outside the exam room or is it a one-trick pony?
A. Generative AI is an incredible technology because it is so adaptable. I think AI will uproot several parts of our industry, but I don’t believe it should displace humans in the loop. Most importantly, AI will help healthcare become more human than it is today.
It almost feels like healthcare technology is in its awkward teenage years and still figuring out its purpose. Today’s healthcare technology is clunky and idiotic, and does not always do what is expected. Generative AI feels like the beginning of the next stage of maturity.
Scribes are a good first step for generative AI, but there are a number of use cases in the patient and physician journey that could be improved with the technology beyond the visit. Yes, it starts with simple manual tasks and chores that are outdated and unnecessary in today’s healthcare, but I’m excited about how healthcare could be better for everyone.
When AI is applied to the front-end healthcare experience, there are a number of key benefits. For example, during intake, a chatbot or intelligent engine can work with a patient to discern pain levels, medical history, social determinants that fuel previous conditions, or simply recall a previous 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 serving diverse and underserved populations.
Even in my career as a medical professional, I have seen the industry evolve from paper templates and keyboards to buttons and touch screens. I believe AI will unlock new, more intuitive ways for us to interact with each other and the technology that supports us.
Q. Physicians are spending more time working in the EHR, and this is contributing to physician burnout. In what ways can technology be improved to help doctors manage their time more efficiently and prescriptively?
A. It has been noted that The time physicians spend on EHRs increased by 28 minutes between 2019 and 2023. That simply cannot happen, especially at a time when more and more medical professionals are indicating they want to leave the field. Technology is making the mundane better and enabling doctors to perform at their best.
As cliché as that sounds, it’s true. Today’s tools would have encouraged me to stay in patient care. I left internal medicine in 2018 to co-found Health Note. We all want to see the eradication of paper notes; we rehash every minute of our patient interactions—the good, the bad, and the ugly—for accountability and an outdated billing model.
Artificial intelligence is already changing that, with documentation companies handling that part. We need to extend this to the intake process and other areas so that doctors can spend more time with patients and sleep better at night. The bottom line: Doctors can rely on technology to increase personalization and get to know patients before interacting in the exam room.
Q. Are there other ways health IT design has failed? If so, how can these things be resolved?
A. In this first wave of innovation, doctors, nurses and physicians have been completely left out of the design phase. I have seen a lot of incompatibility and misunderstandings about the use of technology. That is why I believe that there are now more doctors like me who are developing much more practical tools.
We will need to interface with the EPD in the near future, but this may evolve. Point solutions will disappear in the near future. It is now about enterprise platforms that can penetrate different healthcare areas and specialties, from urology to the musculoskeletal system. Healthcare has so many layers and you can’t simply design with one use case in mind.
It must be versatile enough to be applicable to this wide range of environments 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 every daywe all expect healthcare utilization to increase, so it is imperative that we build a sustainable workflow for the physician and enable an experience that is personalized to meet volume pressures.
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