[7 MIN READ]

In this article:

• DAX Copilot picks up on ambient conversation and turns it into clinical documentation within seconds. 

• Providence physicians call the technology “life-changing,” with 62% spending less time on the computer in the exam room, 57% spending less time on clinical documentation overall and 85% reporting a better experience documenting care. 

• Providence has been an industry leader in adopting this technology, effectively reducing caregiver burnout and improving patient care. 

DAX Copilot: “Life-changing” technology

Electronic medical records have long been heralded for improving efficiency, accuracy and care coordination. But nothing’s perfect. For many physicians, electronic records have meant more administrative work, often when the workday is long over, at home or after everyone else in their family has gone to bed. For many patients, electronic records have meant conversations with physicians looking at a screen, not them.

DAX Copilot is a new technology developed by Microsoft. It allows physicians to converse face-to-face with their patients without writing notes or typing. While talking, DAX Copilot picks up on ambient conversation and turns it into clinical documentation within seconds. Physicians can skip extensive typing and dictating and review and edit the documentation quickly.

“And that’s what we’ve been pushing here at Providence,” says J. Scott Smitherman, M.D., MBA, associate vice president and chief medical information officer of Providence Clinical Network. “Letting physicians be physicians, treating patients like humans and using technology to get the administrative burden off of physicians’ plates — using the technology to let doctors do the things doctors are trained to do and to form those great human connections.”

Life before DAX Copilot

“In the era of medical records, all of us had gotten a little too used to looking at the back of the doctor’s head as they had their nose in the computer, looking up data about you as a patient, putting in orders and typing to write the narrative of what’s happening in your visit so they know themselves what happened later to justify their billing to your insurance company,” Smitherman says. “But we were finding that for every minute the doctor spent looking at you, there was at least another 50% of that time they spent outside of that visit to finish their documentation. And that’s to say nothing of the fact that while you’re in the room, they’re not looking you in the eye, they’re typing.”

Smitherman says some doctors could get some of their notes done while they talked to you, but at the expense of looking at you. And then they still had a lot of homework to do after talking to you. 

“To business people, I describe it as this: Imagine you had 20 business meetings a day, and after every one of them, you had to generate a two-page note about everything that happened in that visit,” Smitherman says. “And if you got anything wrong, you would get in trouble. That’s a physician's life. They’ve got 20 or 30 meetings a day, and they’re generating a high-school essay about every one of those. And it was a tremendous burden.”

Life after DAX Copilot

Now, DAX Copilot converts natural conversations into accurate, specialty-specific summaries within seconds.

Providence physicians always ask the patient for permission to use the technology first.

“I walk in and explain clearly what I’m going to do,” Smitherman says. “I say, ‘Hey, I’m using some new technology that records our conversation and helps me write my notes.’ Only once they’ve consented do I start the recording. I set my phone on the exam table or the countertop in the exam room, and then I have a conversation with the patient. I can look them in the eye and talk to them as a person.”

Of course, physicians can still use the computer to look up old test results, for example.

“But that’s a normal thing,” Smitherman says. “I have information I need to review, but I do not need to sit there and type and try to take notes while talking to the patient.”

Also, some doctors aren’t great typists. 

“If this is not what they’re good at, they often wait till the end of the day to make their notes, at which point they’ve forgotten a lot of what’s happened, or maybe they don’t get all the details,” Smitherman says. “The beauty of this system is with the recording happening and the AI, you’re capturing the patient’s voice and what was said in the encounter. So even if I have to rush off to another patient and I don’t get a chance to totally button up all my documentation, I’m not starting from a blank page when I return to it later. I’m starting from a remarkably complete note that only needs mild editing and review for accuracy. So it’s really wonderful.”

A learning curve

“The technology is still evolving,” Smitherman says. “We physicians make sure everything is accurate. I can use most of the notes with very minimal editing. Most of the time, it’s not AI’s fault if I need to add to it. I want to add more thoughts to something that I didn’t verbalize. AI can’t read my mind. So you do have to verbalize certain things that maybe you weren’t used to verbalizing before. If you want the exam findings to be in your notes, you have to say them out loud. Or when I tap on a knee reflex, if I don’t say that reflex is normal, AI has no way of knowing that. But overall, the accuracy has been great.”

And while this is not necessarily accuracy-related, Smitherman says physicians have had to be more flexible. 

“You’ve got a bunch of highly trained people used to getting As on all their papers through all of school,” Smitherman says. “And now that AI will be writing their notes for them, and it won’t look exactly like they would write it.” 

Companies have improved at providing more options so doctors can customize their output.

“But that’s an evolving space,” he says. “It still doesn't look exactly the same as a note I would’ve written five years ago. Doctors do have to adjust. It’s an amazing thing that takes off this huge burden. But many of our doctors have been practicing for decades and are used to using their notes as part of their thinking and workflow. It can take some doctors a little time to adjust to a new workflow. And that’s probably the biggest reason we don't have 100% of our doctors using it yet, though about half of our primary care physicians are using it for the majority of their visits. It’s not right for every visit, and we’re not here to make doctors make a change, but it certainly is an amazing tool.”

Of note: Thanks to DAX Copilot, 62% of Providence physicians report spending less time on the computer in the exam room, 57% spend less time on clinical documentation overall and 85% report a better experience documenting care.

Preventing caregiver burnout

Smitherman says he’s never been involved in anything that has garnered so much positive feedback. Physicians have told Smitherman that DAX CoPilot is “life-changing,” and they use it with all their patients now. 

Another physician said, “I’ve ended every week with everything finished except the last few notes of the day and I’ve not touched Epic [the system used to write and store electronic medical records] on the weekends — such sweet freedom.”

“I’ve long thought that was one of the biggest markers of burnout,” Smitherman says. “We use some great reporting in Epic to tell when doctors are logged in, and the doctor that is logged in at 10 p.m. to 1 in the morning after they’ve put their kids to bed, that’s the doctor that's not sustainable. They’re going to burn out, or they’re going to find a different career or they’re going to ask to lower their FTE [how many hours they work].” 

Doctors have told Smitherman and his team that they used to spend Saturdays doing their notes from the week, and now they don’t.

“That’s amazing,” Smitherman says. “Another doctor said, ‘I’ve used it on every patient, all my charts are done. This is unheard of. My family will thank you.’”

Looking ahead

Microsoft continues to modify DAX Copilot, giving Providence more options. These may be basic in nature, such as the option to have a note written in bullet points rather than a more narrative style.

“There’s definitely room for more individual development right now,” Smitherman says. “I think they’re mostly concentrating on making it better as quickly as possible for everybody. But they have continued to offer more customizations and more things they can do. Certainly, the technology has that ability to both learn what I want and then use that to write more notes that sound more like I would’ve written them.” 

In the future, DAX Copilot will also connect recordings and ambient experiences in ways that go beyond just generating a note. For example, if you and your physician start talking about your heart failure, a virtual assistant will bring up relevant information from your chart, such as your echocardiogram result, without your doctor even having to look for it. Or, if you talk about back pain, a virtual assistant will pop up an MRI you had two years ago.

“I could do that, but it would take me 30 seconds to go find it in the chart and in our time-limited visits, how great would it be if I have something helping me out or serving me up the latest recommendations,” Smitherman says. 

But even as the technology stands now, Smitherman says it’s been game-changing.

“This is one of the few things that’s come around that has been so universally positive and is really changing some doctors’ lives for the better in terms of removing a burden,” he says. “It’s been an exciting thing to be involved in. Providence has been a leader in this space, and that’s been a lot of fun.”

Contributing caregiver

J. Scott Smitherman, M.D., MBA, is associate vice president and chief medical information officer of Providence Clinical Network.

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