Assisting physicians from the wrist

We’ve all heard the gripe: Physicians are turning into glorified note-takers, as they spend time during patient visits staring at screens and typing frantically into electronic health records, only to revisit the files hours later touching up their notes.

The problem is, in part, the technology that doctors must use. But some providers are now adding even more technology—in the form of virtual assistants, like the one made by Notable—to make things easier.

“Doctors are now the most highly paid professional data-gatherers,” said Notable CEO Pranay Kapadia, whose company makes an AI-powered medical assistant app for the Apple Watch that captures notes and visits digitally and recommends billing codes. “The best part is access to data that had never been available before,” Kapadia said.

Notable isn’t just a digital scribe. Instead, it translates what’s happening in the patient-provider encounter into data points in a form suitable for inclusion in the EHR. It also can take voice dictation from the Apple Watch, turning the provider’s voice-entered notes into the right format—and placing them into the right structured fields—in the EHR.

The software also learns from physicians’ habits, predicting orders and billing codes and proactively inputting certain parts, like where labs should be sent, based on insurance requirements.

And when it has enough information, Notable can also predict billing codes.

Billing automation can only work, though, if the tool is integrated with health systems’ other digital systems. Kapadia and his team aim to make Notable integrate easily into the EHR, with data transfer dependent on either robotic process automation or application programming interfaces, much as happens on Mint.com, the personal finance and budget manager made by Intuit, where Kapadia was head of product for Mint.com and Mint Mobile. Like Mint.com, Notable is relatively easy to set up, requiring at most a few weeks before a health system can start using it.

“We’ve seen enterprise technology be made or broken based on the integration,” he said. “It’s only as good as the integration.”

But as with any technology solution, a certain level of human oversight could still be necessary. “I believe that the workflow would still require revenue integrity and coding professionals to either review the charges caught in the edits or fix any that are not passing edits that are important for specificity and modifier hierarchy,” said Shela Schemel, vice president of operations at Navigant. “Furthermore, the question of how voice recognition will select the procedural device if not spoken by the provider likely remains unanswered at this point. A potential downside could be that the recognition technology from AI could lead to more intervention in the pre-bill process, slowing down claims and billing via volume, as well as reimbursement and revenue-cycle operations.”

There’s the integration into the EHR, and there’s also integration into the provider workflow. The Notable team didn’t know at first that they’d end up making an Apple Watch app. “Initially we didn’t know it would be a wearable—we thought that was impossible,” Kapadia said. He and his team instead considered making the tool for smart speakers or for phones.

But none of those devices were quite right. Most physicians’ work doesn’t happen in the exam room, so a smart speaker wouldn’t be ideal, Kapadia found. Many doctors don’t like carrying phones around, and many women don’t bring their phones into the clinic with them, Kapadia said. “That was a big ‘aha’ moment.”

“The watch is not intrusive,” said Dr. Chris Dolan, an orthopedist at Great Basin Orthopaedics in Reno, Nev., who’s been using Notable for several months. “I can dictate in the watch after I leave the patient room and still do what I need to do with my right hand with the mouse,” he added.

Since Dolan began using Notable’s software, he’s become more productive and has sliced more than an hour off his workday.

The changes in Dolan’s day may look small compared to the eventual changes in scribes’ and transcriptionists’ days.

While scribe work often falls to people in transitional phases of their careers— medical students waiting to go into residency, for instance—transcription is usually more of a career itself, Bain said. Digital tools like Notable’s are “phasing out the transcription position,” she said.

But if billing recommendations like those provided by Notable become more widespread, those jobs could also be in jeopardy.

“Doctors are now the most highly paid professional datagatherers. The best part is access to data that had never been available before.” Pranay Kapadia, Notable CEO whose company makes an AI-powered medical assistant app for the Apple Watch