The race to bring artificial intelligence (AI) into the examining room may now have a new leader. A small Berkeley, California-based firm has introduced what might best be called a smart assistant (like, for example, Alexa or Siri) for electronic health record (EHR) keeping and note taking.
The new technology sits unobtrusively between physician and patient, listening (and viewing, if necessary, using its video option) to every word. It applies a series of advanced AI-style algorithms to what it “hears” and transcribes the interaction into medical notes. It then links to the EHR system and third-party sources, reviews for accuracy, automates the codes, and posts to the physician’s EHR system within 24 hours.
According to its developer, Berkeley-based Robin Healthcare, the AI device can save up to 90 minutes per day of physician time. For a single work week, that translate into 7.5 hours—literally an additional day, per week. And, importantly, cuts the burden of administrative work for the orthopedic physician.
If you attended this past American Academy of Orthopaedic Surgeons (AAOS) meeting, you may have seen Robin Healthcare’s booth. In an attempt to build awareness for their system, the company sponsored a survey of 300 U.S. physicians—all members of either the AAOS or the American Board of Orthopaedic Surgery (ABOS).
The survey was conducted by Kantar Profiles Healthcare Panel, the self-described world’s leading evidence-based insights and consulting company.
It asked orthopedic physicians about the hassles of medical note taking. According to the company, four out of five (80%) orthopedic physicians believe that medical note taking interferes with their interactions with patients and 71% believe that medical coding brings friction to the effective practice of medicine.
Furthermore, according to Robin Healthcare’s study, orthopedic surgeons are concerned about mounting documentation and coding requirements and the likelihood that they will impede physicians’ ability to focus on delivering the highest quality patient care. When asked if medical note taking involves more time than they would like, 90% answered either “strongly agree” or “agree.”
The Robin Healthhcare survey also found that 83% of respondents believe that dictation services are helpful; for scribe services the number was 68%. The physicians did emphasize, however, that the trustworthiness of such services is paramount, indicating that the accuracy and timeliness of the notes are fundamental considerations.
The last thing a harried doctor needs at the end of the day is additional work. Yet, the Robin Healthcare study revealed that more than 73% of orthopedic physicians do indeed take work home in order to complete notes and documentation.
Here’s a link to the study.
Automating and Digitizing Medical Note Taking
Today, anyone can record a conversation and upload it to an inexpensive transcription service. One of personal favorites is rev.com—which will take an audio or video recording and return a pretty good, not perfect, transcription for less than $20.
Medical note taking, however, is a logarithmically more difficult challenge. Medical notes can be messy, ambiguous, complex, and peppered with non-standard terminology, grammatical errors and, most frustrating, acronyms in a narrative form.
Just over three years ago, Amazon Web Services announced a cloud based-service to extract EHR data from clinical notes. That has evolved into a partnership with Stanford Health Care, the Texas Medical Center, Hartford HealthCare, and the University of California at Berkeley and is now a company called DeepScribe.
Like Robin Healthcare, DeepScribe provides ambient listening, speech recognition and EHR integration.
According to DeepScribe’s website, “We build custom integrations that can transfer your notes into discrete fields in your EHR. DeepScribe can be set up and integrated with your EHR in only a couple of hours. From there, it’s ready to go when you are. It’s an on-demand medical scribe you can count on to accurately summarize your patient encounters from your iPhone, Apple Watch, or our special hardware.”
A lot has been thrown at solving this problem—AI and natural language voice recognition software, neural network algorithms and advanced text mining systems.
What is intriguing about Robin Healthcare is its focus on orthopedics and…importantly…its additional commitment to incorporating coding into the Robin AI system.
“Hey, Robin,” More Than One Million Times
The phrase “Hey, Robin,” turns the system on. Robin ambiently gathers all audio (also video, if desired) that passes between doctor and patient.
Robin then aggregates that information, links to the EHR system and third-party sources, reviews everything for accuracy, automates the various codes and posts all of this output (100% HIPAA compliant) to the physician’s EHR files within 24 hours.
The Robin AI-based transcribing assistant features military-grade encryption and ensures that physicians are meeting all of the requirements for insurance, compliance, and liability.
To date, the Robin Healthcare technology has created notes and codes for more than one million orthopedic visits in the United States. The company maintains that the Robin assistant will deliver more accurate reimbursement based on the complete data captured at the time of the patient visit. And the company also points out that such a transcription service could prove invaluable in the event of an audit—ensuring accurate support for codes.
11 Seconds per Patient?
One study found that doctors allow a mere 11 seconds for a patient to explain their issues before interrupting them. That statistic, while not particularly surprising, is cause for concern as it affects the doctor-patient interactions—the bedrock of a hopefully solid and enduring relationship. If more is not done to reduce the paperwork burden on physicians and their teams, that 11 seconds could go even lower.
Automated medical note transcribing systems like Robin promise to unburden orthopedic physicians in significant ways—not the least of which is to allow for a more relaxed, unhurried listening session.
Robin devotee Benjamin Jacobs, M.D., an orthopedic surgeon at Rebound Orthopedics and Neurosurgery in Oregon and Washington, reported, “I focus on patients and Robin handles the charting and everything else needed for billing. This is the future.”
Robin Healthcare CEO Emilio Galán said, “Since starting our company in 2017 our goal has been to reduce the strain on physicians by simplifying the labyrinthine process of data collection. Robin allows doctors to exhale and return to a face-to-face focus on their patients, all the while knowing that the data being collected is accurate, in line with laws/regulations, and secure.”
Stephen Southerland, M.D., an orthopedic surgeon at Rebound Orthopedics and Neurosurgery, says, “For 30 years, I took home charts every single night. I don’t take charts home anymore. Robin has changed my life.”
Reducing EHR Stress and Time
Finally, it is worth noting the connection between electronic health record keeping and the rising rates of physician stress and burnout.
Many, many studies have linked the rise of EHR systems to the rise of physician burnout. In 2017, 11 chief executives of U.S.-based medical centers wrote an open letter saying that EHR systems had “radically altered and disrupted established workflows and patient interactions” for physicians and had become a main contributor to the growing problem of physician burnout.
In the race to put AI systems to work on behalf of orthopedic physicians and surgeons, Robin Healthcare may be the new frontrunner and certainly worth checking out. For more information: https://www.robinhealthcare.com/homepage
