Health care company tests using AI to create notes on patients to help reduce physician burnout

When Dr. David Wallace graduated from medical school in 1995, every visit note, prescription and lab request had to be written by hand.

Now, artificial intelligence writes visit notes for him before he can walk the 20 feet from an exam room to his office.

"AI is actually bringing back the human component," Wallace said. "Now, I can actually put the phone down and, getting the history, I can look at you. I don't have to sit here and type and try to keep up."

Wallace is one of about 200 Sentara primary care physicians testing DAX Copilot, a generative AI program that can filter through conversations with patients to compose a narrative summary of their visits. Health system administrators hope the technology can help address problems from provider burnout to a massive physician shortage.

"It's the 'pajama time,' as they say," Wallace said. "If my notes aren't finished, I either stay after work and finish up my notes, or now I've got to go home and take time away from my family to finish up my notes or I come back into work on the weekends. I think that can increase burnout for providers."

An app on providers' phones records the session, then automatically writes the visit note. Doctors who are part of the pilot program disclose the technology's use to patients, who are able to opt out, said Stephen Payne, Sentara's regional director of operations.

In over 20,000 visits, only one patient has objected, he said.

Payne has been looking for ways to reduce the paperwork burden on Sentara's providers for years, he said. The health care network first experimented with using human medical scribes, hiring extra medical assistants to fill the roles, but had trouble keeping the positions staffed, he said.

Sentara then considered remote human scribe services, like one Wallace used in private practice before coming to Sentara. The former Army doctor's scribe was based in India and attended his appointments virtually. But those programs didn't meet Sentara's privacy standards, Payne said.

Next, Sentara tried a full-service transcription program from Nuance Communications, the Microsoft-owned company behind DAX Copilot. That program involved having a human review transcriptions, then compose the notes from the visit, which Wallace and other providers didn't like because it put them about a day behind on their paperwork.

Information technology staff, Sentara's legal team and a dedicated working group are among those that reviewed the AI program, especially in regard to privacy concerns, Payne said. Although a secure app on doctors' phones records the visit, that recording bypasses phone storage and goes directly to Nuance's servers.

"Physicians aren't walking around with patient information on their phones," Payne said.

Depersonalized data is used to continue to train Nuance's AI programs, and uses may grow to provide highlights to doctors before a patient's visit, suggesting what they should follow up on. The program may be able to write prescriptions and lab orders, too, Sentara leaders said. In all cases, though, the provider's review and signature is vital.

Doctors may need to make small edits before signing off on the AI note, just as they might when reviewing a human scribe's documentation, said Dr. Steven Pearman, Sentara's vice president and chief medical officer for primary care. But AI may also catch things mentioned in passing that a doctor could miss.

"AI is augmenting humans, not replacing them," Pearman said. "You should never take the human out of the delivery care model."

Pearman also doesn't feel AI in medicine is likely to replace humans anytime soon because of the existing primary care crisis. The Health Resources and Services Administration estimates that the U.S. needs more than 17,000 primary care physicians to fill current gaps and will need more than 68,000 by 2036.

"There's going to be a huge shortage of primary care physicians, and if we don't do something different, there's going to be a large percentage of Americans who don't have any primary care at all," Pearman said. "Part of the solution is to produce more doctors. Part of it is to pay primary care better … and part of it is to make the work more manageable."

DAX Copilot can have a "phenomenal" impact in that regard, Wallace, Payne and Pearman said.

After it became available last fall, Payne said, the support and excitement from doctors was immediate.

"The feedback from our providers, it's been unbelievable," he said. "I've never worked on a project and seen results like this, where you're changing the lives of people you're working with."

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