“Pajama time” is a term used by medical care providers — usually physicians — that describes the hours they spend at home in the evening doing tasks like reports and documentation.
A new artificial intelligence (AI) tool being rolled out by the Elliot Health Systems could greatly reduce “pajama time,” as well as improve the quality of face-to-face time spent between clinicians and their patients.
The tool is DAX — Dragon Ambient eXperience — a product of Burlington, Mass.,-based Nuance, a Microsoft company.
Nuance describes DAX as an AI-powered, voice-enabled solution that automatically documents patient encounters during in-person and telehealth visits. DAX uses conversational, ambient and generative AI to help physicians create clinical documentation, which can improve the patient experience and clinical efficiency.
“I think this will really benefit our teams and our people and our patients,” said Dr. Holly Mintz, a pediatrician and chief medical officer of ambulatory services for Elliot Health Systems.
Elliot Health Systems, a part of Solution Health, offers health services at Elliot Hospital and at many outpatient centers, physician practices, and other sites throughout the greater Manchester region.
Mintz has been in medicine for 28 years. “I’ve seen, over my years both as a practicing pediatrician and also in my administrative position, how documentation has impacted the interactions between providers and patients, and also how it’s impacted the lives of providers,” she said.
For patients during an office visit, a clinician is often eyes down, taking notes on a clipboard or laptop or handheld device such as an iPad. The documentation is important not only for the clinician’s direct care of the patient but for ongoing care by the patient’s medical team and to meet regulatory and insurance requirements.
“The medical documentation has become so onerous that we actually have a term for when providers are accessing it from home, and it’s called pajama time,” said Mintz.
That time spent at home doing documentation can have a big impact on a clinician’s work-life balance, according to Mintz, contributing to burnout.
“Nobody went into medicine to type on a computer all day, that I can guarantee,” said Mintz. “We want people to either rediscover or continue their joy of work.”
The need for documentation “has really made it very difficult for providers, not only to enjoy their work, but actually have some type of a work-life balance,” added Mintz. “If I have one provider who is able to have dinner with their family, to me that’s a huge win.”
The DAX software resides on a provider’s iPhone. Once permission is granted by the patient, DAX is enabled and it securely captures the conversation as clinicians engage in a natural conversation with patients and, if necessary, with other family members, allowing more eye-to-eye contact and less eye-to-screen contact.
According to Nuance, DAX automatically converts multi-party conversations into specialty-specific, structured, clinical summaries immediately after a patient encounter, becoming a part of the patient’s electronic health record.
Upon hearing about DAX, Mintz reached out to the health system’s chief information officer, telling him: “We need to do this.”
They met with Nuance, ultimately agreeing to a roll out of the platform in the fall of 2022 to 50 providers at Elliot Hospital and 50 providers at Foundation Medical Partners, part of Southern NH Health, which is also affiliated with Solution Health.
The newest iteration of the software provides almost immediately completed documentation. The roll-out has had some positive responses and some negative responses.
“Some people have gotten so used to their notes looking a particular way that they are challenged by us having missed this kind of resource formulate the note, so it is my goal in my position to help our providers get over that,” she said.
“Obviously, change is hard,” she added. “I think a lot of providers who would really benefit from utilizing this technology are somewhat resistant, but I also know that we at the Elliot are on the tip of the iceberg with the technology and that it will just continue to get better and better.”
DAX is built on Microsoft Azure, a cloud computing platform, and its generative AI, a form of artificial intelligence in which models are trained to generate new original content based on natural language input.
Mintz was a guest of Microsoft at a seminar held in Seattle in June. She was invited to speak at one of the breakout sessions to Microsoft’s health AI developers about why the platform is important and about Elliot’s real-world experiences.
“I was really excited to be invited from the Elliot in New Hampshire to go and speak about this and honestly represent the impact that this could have on a community hospital,” she said.
Elliot wants to put DAX in the hands of more providers. Mintz said it has 150 licenses and she hopes to see DAX roll out to other specialties — for the emergency room, for example, and for the nursing staff.
While AI is a helpful tool, it will never replace the human aspect of medical care, according to Mintz.
“I don’t ever see AI taking over as your provider or your nurse. Everything still needs eyes on it,” she said. “But if we’re able to improve the experience for patients and providers and staff, especially in this day and age where we’re all really needing a workforce, to me that will be worth its weight in gold.”
