Orthopedic surgeon Dr. Marcus Cook has never gotten used to looking down at a keyboard or at a computer screen while he’s seeing a patient.

“I like to look at my patients when I’m talking to them,” said the surgeon at Novant Health Orthopedics & Sports Medicine – who also happens to be the NBA Charlotte Hornets’ team doctor. “I’d really rather not spend 90% of my attention on the computer and 10% on a patient.”

So, Cook was enthusiastic about being part of a pilot program that has provided select doctors’ offices with something called “ambient intelligence.” It’s a high-tech concept that eliminates the awkward and somewhat impersonal experience of a patient talking to her doctor while the doctor is looking at a computer and entering his notes.

The technology was developed by Nuance Communications, based in suburban Boston, which specializes in speech recognition and artificial intelligence.

Nuance Ambient Room technology is currently being piloted in with five Novant Health orthopedic surgeons. It creates an audio recording of an office visit and generates a transcript of that visit that gets placed into a patient’s electronic medical record (EMR).

“When I go into a room, I'll tell my patient that we’ll be recording our conversation, grab the pertinent medical information out of that conversation and make notes that get input into the electronic medical record (EMR)," Cook said,

“I can then go back and review that note and change things that need to be changed or add things that weren't in the note,” he continued. “It takes a lot of the time-consuming portion of electronic medical records off the physician.” And gives that time back to the patient.

The patient can always opt out of having the conversation recorded. But Cook said 100% of his patients have seen the benefit of having their doctor entirely focused on them – and not on a computer.

Adapting to electronic medical records

Dr. Bryan Edwards

What has become front and center in an office visit – the physician’s typing – can now happen in the background. “This technology is the next evolution of how Novant Health has continued to improve the patient/provider experience with electronic medical records,” said Dr. Bryan Edwards, orthopedic surgeon and senior vice president of the Orthopedics & Sports Medicine Institute.

Mandating that medical records be electronic, rather than paper-based, was an important step the federal government took in 2009. Benefits include quick access to medical records, the ability for different health care organizations to share information when treating the same patient and keeping records up to date.

 But one of the unintended consequences of bringing health records into the digital age was that it suddenly put a potential barrier between patient and provider.

The physician could no longer look at patients while they were telling their story. A physician was hearing the words – but possibly missing nonverbal cues. It’s been an impersonal way to do something designed to feel highly personal.

“With Nuance, I can examine a patient, and as I talk to them, I can speak my physical exam so it gets input, as well,” Cook said. “It's been a very good system and very accurate.”  

Currently, there is a scribe – an actual human – reviewing the information  as a backup to the computer. This scribe is a Nuance employee and has signed confidentiality agreements. “Software engineers are trying to come up with ways to automate that completely,” Cook said.

Eventually, the computer won’t need the human scribe. At the moment, it’s working as an app on an iPhone. But as the program expands across the Novant Health system, plans call for devices to be mounted on the wall or otherwise blend into the surroundings as a natural part of the care environment. (Hence the word, ambient.)

And looking ahead, there’s a potential for pairing it with artificial intelligence applications to help diagnose patients. For instance, the program could start analyzing the patient’s symptoms and suggest possible diagnoses based on information from the patient’s medical records and the latest in medical research and information. That may be a ways off, but the potential is promising.

Development of the program is part of a core strategy of Novant Health to employ innovative technology solutions to advance care and meet the individual needs of patients. Other recent examples include instantaneous expansion of virtual visits at the arrival of COVID-19, stroke care that harnesses artificial intelligence for faster care, and approval for use of drones to deliver medical supplies.

More personalized interaction

When it comes to the current pilot program, “The results so far are extremely exciting,” said Zack Landry, vice president of Orthopedics & Sports Medicine Institute. “Our patients are happy with a more personalized and direct interaction with their physician. Our surgeons are thrilled because they can focus more on the patient and less on the computer.” By automating the clinical documentation process, he said, surgeons have less administrative burden and more time back at the end of the day to spend with their families.

Zack Photo
Zack Landry

“We’re excited to introduce this to more clinics soon,” Landry added. “This is really a starting point for a much more engaging, thorough and transparent patient interaction, and we look forward to the evolution of this technology.”

Cook appreciates that he’s now spending less time at night and on the weekends dictating or writing notes and completing charts. But patients are equal beneficiaries of the new technology. There’s no computer to come between patient and physician. Office visits feel like they did pre-EMR. The patient and provider can have an actual conversation – one free of distractions.

Photo caption: Dr. Marcus Cook discusses treatment with patient Carl McLamb. The phone on the edge of the exam table contains the Nuance technology.