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| Name | Class |
|---|---|
| Hieu Nguyen, MS - Biostatician | UNKNOWN |
| McKenzie Isreal, MPH - project manager | UNKNOWN |
| Casey Stephens, MPH - Health services researcher | UNKNOWN |
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AI solutions like, Dragon Ambient eXperience (DAX) Copilot (Nuance/Microsoft), hold the potential to significantly enhance provider and patient interactions and alleviate pain points that contribute to burn out. Atrium Health was the first healthcare system in the world to pilot Nuance's DAX Copilot intelligence (AI) enabled scribe software, which synthesizes a draft clinic note by "listening" to the conversation between a provider and patient. After 180 days of use by primary care clinicians and advanced practice providers (APPs), along with a control group, the investigators assess provider satisfaction, patient experience, and provider efficiency through qualitative and quantitative methods.
In this non-randomized stepped-wedge trial, clinicians (including physicians and advanced practice providers [APP]) specializing in family medicine, internal medicine, and general pediatrics were recruited from outpatient clinics located in North Carolina and Georgia. The intervention group was divided into 5 waves between June and August 2023 based on clinic locations. Prior to the activation of accounts, clinicians underwent a one-hour training session on DAX Copilot. Meanwhile, a comparison group comprising clinicians not utilizing DAX was recruited in five waves from locations and specialties similar to those of the intervention group. Two types of primary outcomes, electronic health record (EHR) metrics and financial metrics, were assessed after 180 days of intervention. EHR metrics include time in EHR (EHR8), work time outside of work (WOW8), time in documentation (Note8), completed appointment rate, same day closure rate, and note length. Financial metrics include gross revenue per visit and work relative value units (wRVU) per visit. Secondary outcome include provider satisfaction survey, provider interview, and patient satisfaction survey.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Intervention - Dragon Ambient eXperience (DAX) | Active Comparator | Clinicians interacted with DAX Copilot |
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| No Intervention - Control group | No Intervention | Clinicians with standard care |
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Dragon Ambient eXperience (DAX) Copilot | Other | The tool (DAX) listens to the conversation between a clinician and patient/caregiver during their visit, provides transcriptions between different speakers for the clinician to review, edit, and included in the final EHR notes. |
| Measure | Description | Time Frame |
|---|---|---|
| Total EHR time | Total time on EHR (during and outside of clinic sessions) per 8 hour of patient scheduled time. | Month 10 |
| Work outside of work | Time on EHR outside of scheduled patient hours per 8 hour of patient scheduled time. | Month 10 |
| Time on encounter note documentation | Hours on documentation (note writing) per 8 hour of scheduled patient time | Month 10 |
| Completed appointment rate | Total completed visits over scheduled visits | Month 10 |
| Same day closure rate | Number of visits closed on the same day over total scheduled visits | Month 10 |
| Note length | Length of note in EPIC for each visit | Month 10 |
| Gross revenue per visit | Total charged amount in each day over total completed visits on the same day | Month 10 |
| wRVU per visit | Total work relative value units (wRVU) in each day over total completed visits on the same day | Month 10 |
| Measure | Description | Time Frame |
|---|---|---|
| Provider satisfaction | REDCap survey to clinicians in both groups (intervention and control) and assess their satisfaction of the new tool. | Month 4 |
| Provider interview | 12 semi-structured interview on clinicians in the intervention group. Each interview was facilitated using an interview guide with a semi-structured list of questions to help guide the conversation and answer the learning objectives. |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Tsai-Ling Liu, PhD | Wake Forest University Health Sciences | Principal Investigator |
| Timothy C Hetherington, MS | Wake Forest University Health Sciences | Principal Investigator |
| Jeffrey A. Cleveland, MD, FAAP | Wake Forest University Health Sciences | Study Chair |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Atrium Health Navicent | Macon | Georgia | 31201 | United States | ||
| Atrium Health Floyd |
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|
| Month 1 |
| Patient satisfaction | Patient satisfaction on the visit - patient satisfaction surveys are collected as part of routine care, which will be accessed through Medallia. Scores range between 0 (worst) to 10 (best) with one decimal point. | Month 6 |
| Rome |
| Georgia |
| 30165 |
| United States |
| Atrium Health | Charlotte | North Carolina | 28203 | United States |
| Scotland Health Care System | Laurinburg | North Carolina | 28352 | United States |
| Atrium Health Wake Forest Baptist | Winston-Salem | North Carolina | 27157 | United States |