AI in practice

[IMres85]

Just curious if anyone has used any form of Ai in their practice and how? Im always looking to increase efficiency. I’ve seen some new dictation services that maybe will listen to encounter and dictate the note in real time? (Not sure if I read it wrong but that’s what it seemed like). Documentation is probably the only utility for now but I was just curious if anyone has gotten creative

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[gutonc]

Just curious if anyone has used any form of Ai in their practice and how? Im always looking to increase efficiency. I’ve seen some new dictation services that maybe will listen to encounter and dictate the note in real time? (Not sure if I read it wrong but that’s what it seemed like). Documentation is probably the only utility for now but I was just curious if anyone has gotten creative

Insurance appeal letters.

I'm pretty efficient with documentation, and I like it a specific way. I don't see AI making my documentation more efficient enough to make it worth the trouble.

I think the thing you're thinking of is a virtual scribe. I don't like regular scribes, so a fake one is out of the question for me. But I can see it being helpful if you're someone who uses scribes. That said, I'm still not sure what the benefit of a scribe is over Dragon or other dictation software, but I don't use that either.

 

[solidonc2020]

Just curious if anyone has used any form of Ai in their practice and how? Im always looking to increase efficiency. I’ve seen some new dictation services that maybe will listen to encounter and dictate the note in real time? (Not sure if I read it wrong but that’s what it seemed like). Documentation is probably the only utility for now but I was just curious if anyone has gotten creative

I've just come across this website which uses a ChatGPT style query and response while searching medical literature: openevidence.com

I've tested it with a couple of rare diagnoses and it returns a narrative style answer and lists resources. Also allows for follow-up questions. I haven't implemented it for direct patient care yet, but I think it will save time when needing to look through PubMed to get the answer you're looking for much more quickly. It's free but requires a login and NPI.

 

[gutonc]

This is the kind of thing where I can see it being somewhat useful. A more comprehensive answer than just a Google search. The problem to watch out for of course is "AI hallucination" so you need to make sure that the results you get are grounded in reality...which may make it more work than just doing the search and lit review yourself.

 

[solidonc2020]

This is the kind of thing where I can see it being somewhat useful. A more comprehensive answer than just a Google search. The problem to watch out for of course is "AI hallucination" so you need to make sure that the results you get are grounded in reality...which may make it more work than just doing the search and lit review yourself.

Agreed, there’s always possibility for error. Would definitely check the provided pubmed links before making any clinical decision.

 

[dozitgetchahi]

I've just come across this website which uses a ChatGPT style query and response while searching medical literature: openevidence.com

I've tested it with a couple of rare diagnoses and it returns a narrative style answer and lists resources. Also allows for follow-up questions. I haven't implemented it for direct patient care yet, but I think it will save time when needing to look through PubMed to get the answer you're looking for much more quickly. It's free but requires a login and NPI.

I may try this.

At least in rheumatology, I haven’t found chatbots like OpenGPT to be very useful thus far. They can give very generic, basic answers to softball topics like “how do you manage gout?”…but if you ask deeper questions about unusual patient situations with relatively little evidence in the literature, they are lost. It’s obvious that these are basically just next-level Googlers that can string words together, and not really “artificial intelligence”.

I haven’t tried any of the AI scribes like Deepscribe yet, so I don’t know about those.

 

[CatFactorial]

I subscribe to ChatGPT and use it all the time

literature review
Manuscript writing
Helping with differential diagnoses

It requires a lot of healthy skepticism in order to not be hoodwinked by its confabulations. I think docs are more insulated from this than most

The singularity is nearer

 

[gutonc]

A spammer just bumped this thread but it did remind me of it.

Pretty happy with DAX Copilot these days. Definitely not perfect and definitely needs some editing. But it is saving me time on documentation (and I was already pretty efficient), even with review and editing. I would say that, conservatively, it's giving me 30-45 minutes back each day in clinic.

There are supposed to be upgrades coming which will implement AI based ordering and that will be another game changer.

 

[CopaceticOne]

it's giving me 30-45 minutes back each day in clinic.

That's impressive for someone who was efficient already.

 

[IMres85]

Hey @gutonc - what’s your primary EMR? Epic? I think a partner of mine uses the same software as you do but I’m not positive.

It’s almost frustrating that with dragon, epic, or onc based EMR like flatiron hasn’t implemented its own AI directly into the software. I just don’t like taking the extra step needed to drag and drop in appropriate places

 

[gutonc]

Hey @gutonc - what’s your primary EMR? Epic? I think a partner of mine uses the same software as you do but I’m not positive.

Yes, we use Epic which has Nuance/Microsoft's DAX baked in (if you're willing to pay for it).

It’s almost frustrating that with dragon, epic, or onc based EMR like flatiron hasn’t implemented its own AI directly into the software. I just don’t like taking the extra step needed to drag and drop in appropriate places

It will happen eventually as it will become the norm and will be expected. But as of now, of the 7 systems in this region that use Epic, only the two largest (both multi-state "non-profit" systems) have it available.

ETA since I re-read your comment: DAX is directly integrated into Epic (again...if your institution/employer pays for it). It does take 2 extra steps, one of which is automatic (you have to put the DAX shortcut in your note template, that's a "one and done" thing) and you have to pull up the patient's chart in Haiku (the mobile phone version of Epic) and start it listening before you walk in the room. It becomes 2nd nature, but it's not automagic just yet.

 

[IMres85]

Few months later and it seems from talking to colleagues this is starting to become full swing. My EMR (flatiron) hasn’t quite integrated its AI yet (deepscribe). Anyone have a particular AI software they use for dictation ? As gutonc mentioned I’ve seen a popularity of Dax

 

[solidonc2020]

Abridge AI scribing has been built into our Epic/Haiku and it’s awesome.

 

[gutonc]

Dax went down for us yesterday. My day was a total s***show and my documentation was slow.

I realize that 9 months ago I said I was never going to use an AI scribe. Clearly, even I can admit when I was wrong.

 

[Plutarch02]

AI notes we've been using have been generating good notes for billing but terrible notes for between professional communication. It's going to be bad for a doc inheriting a panel from a retired doc who used AI notes, I can hardly tell what happened, why a regimen was selected, why it was changed etc.

 

[gutonc]

AI notes we've been using have been generating good notes for billing but terrible notes for between professional communication. It's going to be bad for a doc inheriting a panel from a retired doc who used AI notes, I can hardly tell what happened, why a regimen was selected, why it was changed etc.

Oh I definitely edit it to make sure it makes sense. As I said, they're not perfect, but it gets me 80% of the way there.

Also, you make it seem like most physician's notes make sense even without AI. That is patently untrue and most notes I see range from stream of consciousness logorrhea to copypasta that hasn't been updated in 10 years. Roughly 10% of the notes I get attached to consults even make sense when I read them. And of those, only 10% even state a reason for the consult.

 

[IMres85]

Oh I definitely edit it to make sure it makes sense. As I said, they're not perfect, but it gets me 80% of the way there.

Also, you make it seem like most physician's notes make sense even without AI. That is patently untrue and most notes I see range from stream of consciousness logorrhea to copypasta that hasn't been updated in 10 years. Roughly 10% of the notes I get attached to consults even make sense when I read them. And of those, only 10% even state a reason for the consult.

Getting an oncology patient transferred from another practice, especially one that’s been there for a while. There is literally nothing that takes longer to decipher. I’ve seen maybe a few patients who can give an accurate story of what happened.