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March 22: In this Interview in Action at HIMSS 2024, Bill Russell interviews Kenneth Harper, VP and GM from Nuance Communications. Harper discusses the revolutionary impact of DAX Copilot in healthcare documentation, highlighting its seamless integration into Epic and its ability to save clinicians valuable time. But with the democratization of technology, how do we ensure quality and accuracy? As organizations rush to adopt similar solutions, what distinguishes true innovation from mere imitation? Moreover, as AI continues to evolve, what new frontiers lie ahead in healthcare augmentation and automation?


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  Welcome to This Week Health. My name is Bill Russell. I'm a former CIO for a 16 hospital system and creator of This Week Health, where we are dedicated to transforming healthcare, one connection at a time. Today, we have an interview in action from the 2024 conferences, the spring conferences, VIVE in LA, HIMSS in Orlando.

Special thanks to our sponsors, Quantum Health, Gordian, Dr. First, CDW, Gozeo Health, Artisite, and Zscaler. You can check them out on our website, thisweekhealth. com. Now, onto our interview

(Interview 1)   Here we are from HIMSS 2024 in Orlando, and we are at the Nuance Microsoft booth. That's right. With Kenn Harper who runs DAX Copilot. A fair amount of activity at this booth. Now, there's usually a lot of activity at this booth, but it's really active, and I think that speaks to all the things that are going on.

Talk a little bit about where we're at with DAX Copilot.

Yeah, tons of activity at the booth. Energy is very high. Excitement is very high because DAX Co Pilot isn't just an idea. It's something that we've built over the last year. We've deployed it. We had a number of customers, over 200 customers, that are now signed up.

Over 10, 000 users are signed up. We've had some really exciting deployments. You saw this week Stanford announced they're rolling this across all their ambulatory practice based on the outcomes. They're measuring wall span is also rolling this out quite widely, so it's been a really exciting 12 months to get DAX compiled out there and see the impact that it's having on care teams.

This was not

a small deal, because for years we struggled to scale this, and then we went to a different backend. The backend used to be essentially Scribes, and this is a completely different model that allows us to scale using technology. But there's also that quality aspect that we had to work through.

Talk about, clearly, Stanford's moving forward, WellSpan's moving forward. The quality's there.

the quality is there, and this has always been the vision of DAX. The ambient, in general, that you walk in, you have a conversation with a patient, and a note comes back within five seconds.

Technology's doing all the work, and that's always been the goal that we've been getting to, but now we're there. Technology can now support the creation of clinical documentation from a conversation without having to have that quality reviewer. In the process. And with a clinician getting a note back, it's really convenient.

You can look at it, make a couple of quick tweaks to the clinical document and get it signed off on. That's still saving you significant time in your day, as well as reducing that burden that you have in having to remember those minute details of what you need to document.

I'm going to take it a little different direction now when I come back, which is essentially, talk about the Microsoft partnership and what this has meant for


Well, if you think about what Microsoft's doing, they're building copilots across all industries. This is a shared technology platform. The technology that we're using it in specific ways for healthcare. What Microsoft is doing is using generative AI to power a number of different copilots across all industries.

All the various industries. So that's something we're reusing in healthcare. Which is accelerating how do we solve these problems. Because we're not reinventing the wheel. We're making it very specific to a use case in healthcare. But we're leveraging the Microsoft platform to do all this.

I assume this whole thing is cloud based, correct?

Yes. It's amazing because at this booth there used to be like a line in the theater and you'd go in. Is that still here? It's here, you gotta check it out. Oh, it is, okay. But, when I saw a doctor using this it was essentially, hey, I'm going to record this, and he drops his phone down, and it would be no different than you and I recording this conversation in front of me.

And there were certain times where he would say things that were specifically to co pilot, and that's still the case where he's trying to document

correctly. Yeah, you still need to vocalize, it's still a natural conversation. You're looking at the patient in the eyes, like you and I are looking at each other now.

And it's freeform, but you still need to vocalize what you're doing. You can call out certain exam findings, or talk about where in the body you might be doing an exam. So there is certain aspects that you have to make sure is being called out, so technology knows what to do. But it is in the context of a freeform conversation.

It's interesting, because when we were looking at Ambient before, We were talking about setting up rooms and I remember like people sort of recoiling oh my gosh Are we really gonna have to do this? And this really changes the game.

We had an idea several years ago, like maybe we would have to have specialized hardware to really capture quality conversation with multiple folks that might be treating a patient and we've actually proven with this technology and how advanced technology has come that just You know, on a simple mobile phone, two microphones, the quality is there.

We don't have to require healthcare organizations to have a hardware program or do installation of anything physical. It's all software. You download a mobile app and you're off and running.

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from decision to sign a contract to pilot to implementation. How long does that usually take?

Weeks at most. We've had some organizations, and actually this is another thing I should mention. Bill is We've actually integrated DaxcoPilot natively into Epic. That's what Stanford's using, that's what WorldSpan's using. We have over 60 clients that have to have native Epic integration. So this is the first time, end to end, inside of Epic, where you can use your Haiku application.

Same thing on mobile, you pick your patient that you're going to see, you directly in hyperspace. And in five seconds, this is just yet another game changing experience. And to tie that back to your question on speed, because it's native inside of Epic, this can be turned on in some cases in a matter of days, depending on how quickly the healthcare organization wants to move


What are the conversations you're having with healthcare leadership? When you're talking to clinician leadership, you're talking to IT leadership. What are the kind of things they're looking for that they're saying, yeah the timing's right. This is moving

forward. Yeah. I think part of it is.

The conversations around, how do we bring this to all of our clinicians?

not a select class

that gets it, but the others don't. Yeah, you really, they're now thinking about, this should be a tool. Very similar to Dragon Medical One. In that journey that we took DMO, this is now a tool that every clinician should have the right to use.

Cause it's that game changing from an outcome perspective. And so that's a big part of the conversation, and Stanford is one of the first to really recognize very early on this is something everyone. can benefit from Let's really put together a plan to roll this out broadly as more of an enterprise tool. So that's a big part of the conversation today.

What kind of results can they expect in terms of productivity, in terms of satisfaction, and those kinds of things?

We see minutes. being saved per encounter. Mileage will vary a little bit, depending on the practice, depending on how you as an individual clinician practice, but on average, minutes saved per encounter, so you can really look at saving an hour or two in the course of a week for a full time provider.

The satisfaction and to bring back the joy to medicine, we have clinicians telling us verbatim, I now want to stay in the profession for another five years because I actually can focus on my patient And those are real visceral feelings from clinicians where they feel they like practicing medicine again.

Because they now have a co pilot, that tool on their side that's doing the clinical work for them.

Yeah, that terminology is interesting. Satya talking about that the whole idea of coming alongside. And not only in our industry, but in our industry, coming alongside the nurse, coming alongside the doctor, and taking some of the load.

Not making the decisions, not changing the decisions. They're still going to review the note before it goes in. But it's there to assist and

help. That's right. Co Pilot is a deliberate name for Microsoft. It does espouse, What it is, and how it's there to help, but not replace. That's an important aspect.

We bring copilots to physicians with Axe Copilot. We're also working on a nursing initiative. We have very similar technology. Help nurses with their documentation. We're doing copilot work for radiologists. The through line across all the different care personas is the copilot is there to augment. But fundamentally not replace the decision making that those physicians are making for their patients.

That's a really important distinction in our philosophy at Microsoft on how to do

this. Let me ask you this. A lot of organizations are sort of popping up out of nowhere. It's hey, we can do this too. Yeah. The technology is becoming democratized, more accessible, and those kind of things.

curious, as I hear CIOs talk about that, my immediate radar goes up for Really, they can generate a good clinical note here. How much experience do they actually have doing that? How good is the quality? How much has it been tested? That's my initial concern. I'm sure you're hearing the same thing.

Oh, we found something that's 10 cheaper. Yeah.

Listen, with the technology where it's at today, anyone can put together a compelling demo. But that's very different from how this actually runs in In healthcare, the final mile matters. And you're driving up the accuracy of what's in the node.

And how this runs natively inside of Epic is part of that integration. that is the final mile. To make this successful and drive those outcomes, that's something that we're maniacal at Microsoft. The nuance in that will

always bend. Does it continually get better as it gets more and more conversations in it?

It does. Yeah. So skill

does matter. Absolutely matters. what makes these technologies perform the way they do is That's how AI works. That's how you see more patterns, variations, and how medicine is being practiced and what goes into clinical documentation. And we have that footprint and scale where this is a living, breathing system in the cloud.

It's not a static point in time where you're stuck with something for six months. Every couple weeks, every month, the system's getting better based on that data that's

coming in. So we used to have conversations around vocabularies. Is that going away or is there still a vocabulary challenge

That problem's been solved.

The vocabularies in medicine, they're well known ontologies of the types of things that clinicians are talking about that are unique to their specialty. As a well solved problem in this technology, it's really about Extracting from the conversation the most important elements that are needed for documentation.

That's fantastic. What's the question I didn't ask?

Well, maybe one question is where we're going. Yeah, where are we? You think about everything that a copilot could do. I feel like we've arrived. We've arrived. It's like, where are we going? It's I like where we're at right now. Every time you arrive, though, you're still at the first inning of other problems you could look to solve in healthcare.

And so if you think about, if you've used Microsoft Copilot, this is a consumer application, you talk to it, A world of possibility limitless possibility of what this technology can do. And ahead of us, looking at more task automation, other clerical tasks we can help solve for clinicians, giving them a tool where they can get information, that might help them with some of that decision making, on behalf of the patient.

There's so much potential here,

like to see it in the center. could see it capturing conversations and Extracting the key elements out of it. Maybe taking some of the tasks away from some of the clinical administration that has to be done.

If you ever have a surgery and you get that call the day before, you go through the checklist of sort of asking you everything for your admission.

That sort of thing could be automated and there's just a ton of potential here.

Fantastic. Kenn Harper, thank you for your time. Thank you very much, Bill. Appreciate


for listening to this Interview in Action episode. If you found value in this, share it with a peer. It's a great chance to discuss and in some cases start a mentoring relationship. One way you can support the show is to subscribe and leave us a rating. If you could do that would be great, and we want to give a big thanks to our partners who make this possible.

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