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“Building great tech for doctors is no different from ventilator technology. In some scenarios, you will want to talk to the EMR like you talk to Siri, rather than poring over a screen littered with boxes and lists. In other cases, you will want elegant graphs intuitively laid out to show how your ICU patient is progressing. Other solutions will go unnoticed aside from the time they save by eliminating double work in the background.
A great technology team builds products with all the attention to detail that we devote to our patients. This is how we will liberate doctors from EMRs.”
Erin Palm is a general surgeon and head of product, Suki.
She shares her story and discusses her KevinMD article, “How to liberate doctors from EMRs.”
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Hosted by Kevin Pho, MD, The Podcast by KevinMD shares the stories of the many who intersect with our health care system but are rarely heard from.
Transcript
Kevin Pho: Hi, and welcome to the show, where we share the stories of the many who intersect with our health care system but are rarely heard from. My name is Kevin Pho, founder and editor of KevinMD. Today on the show, we have Erin Palm. She’s a general surgeon, and she is head of product at Suki, which is an AI-powered, voice-enabled digital assistant for doctors. She wrote the KevinMD article “How to liberate doctors from EMRs.” Erin, welcome to the show.
Erin Palm: Thanks for having me, Kevin.
Kevin Pho: So we’ll get into your article in a little bit, but first off, can you share your story and your journey to where you are today?
Erin Palm: Absolutely. I’m a Stanford-trained general surgeon. During my time at Stanford, I had the good fortune to build a clinical product in the health system in India, actually. And that was my first foray into product development with a team of mobile engineers. I then did a fellowship in trauma and surgical critical care at LA County, and I really appreciated that experience to see some high-volume trauma.
And from there, I decided that while I love clinical practice with a passion, and actually still practice general surgery and critical care part-time, actually up here in Northern California, I wanted to build something that would help all of my physician colleagues. And the problem that I decided to tackle, in collaboration with some Silicon Valley technology veterans, is the problem of documentation burden for physicians.
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Kevin Pho: Excellent. And I’m sure we’re going to get into that, because as a primary care doctor, that is something that I am sorely interested in hearing more about. So let’s get right into your KevinMD article, “How to liberate doctors from EMRs.” Now, for the audience who haven’t read your article, can you walk them through it and share the story of why you decided to write it?
Erin Palm: Absolutely. I think what happens is, as physicians, and I was thinking about this most in the ICU, we are so obsessive about taking great care of our patients. We will go to such great lengths, to the extent that we’re very self-denying in our work and in the care that we provide. In my dual role as somebody who thinks about how to take better care of doctors by building better technology for them, I thought, why not try to articulate what that care and attention would look like if we could turn that caretaking lens toward ourselves?
So I wanted to outline the analogy. We use these ventilator weaning protocols to make sure our patients are only vent-assisted for the minimum amount of time that they need to be, because there are side effects and consequences to being on a vent too long. Similarly, we should, or someone should, for us, pay attention to how the toll of clicking into all these boxes and doing all this documentation affects us in our work. So that was the motivation for writing the article.
Kevin Pho: That is one of the downsides of EMRs, the amount of clicking, the amount of checkboxes we have to do. And we’re reading a study saying that for every hour we see patients, we spend another two hours on a computer documenting that visit. Now, what are some of the technologies out there that can help us with this problem?
Erin Palm: One technology is voice. And actually, I saw this opportunity with my colleagues to bring the power of consumer voice assistants to medical workflows. Imagine just being able to interact with a voice assistant and say, “Create a note for my patient in room three. They got a spontaneous awakening trial this morning. They passed, and we plan to extubate.” If all that documentation could get created, the orders get created, and then all I have to do is supervise and sign off, as if I have an intelligent assistant helping me do my work. That’s the vision for building a digital voice assistant to help doctors with these tasks.
Kevin Pho: And where are we with that technology? Because I use Siri on my iPhone, and sometimes Siri doesn’t understand what I’m saying. So how good is the voice recognition technology currently?
Erin Palm: It’s definitely not a silver bullet. And I think doctors have really high expectations, in that a lot of doctors think that AI will be able to act just like a human. I think that that is a very laudable objective over time, that I could have an AI that’s just like my senior resident. They’re so good at everything; they can put in the post-op orders.
Today, I mean, at home, if I ask Alexa to play a song, some small percentage of the time, it doesn’t quite understand me, and I have to make sure I can interact with tech in an effective way. But folks still want to use Alexa and Siri because they make our lives so much better and hands-free and automated. So that’s the push.
We actually have some evidence that even these early tech-enabled voice assistants are saving a lot of time for physicians. We have some internal evidence that we’re saving 76 percent of the time doctors were previously taking on their notes in clinic. So there are definitely some early promising signs. We have to expect to teach the technology and have it evolve and learn with us. It’s not going to be a silver bullet right out of the gate.
Kevin Pho: So walk us through a sample workflow, especially in the outpatient setting, because I’m very interested in hearing about this as a primary care doctor. So if I’m seeing a patient and I’m interested in using this technology, can you walk me through how that would work?
Erin Palm: One of the very important things is that the digital assistant integrates with your existing electronic medical records system. So at the time of onboarding, when you first start using the product, it should know your schedule, ingest prior information about your practice, and know something about the patients you’re seeing today. So you can go and, you know, see your first patient, and maybe during some parts of the visit, or maybe afterwards, depending on the style of interaction you like to have with the patient, use the voice assistant to quickly create a clinical note.
It recognizes, you know, direct speech-to-text and a kind of command-and-control mode, and then you can also say things like, “I did a normal physical exam,” and it knows what that means for you and what you like to add into your note when you say that. Other things are adding in diagnosis codes. So if you create a note in a problem-based fashion, and you’re addressing stage 2 chronic kidney disease and diabetes, you can just say those things, and the coding can happen in the background.
Other things that digital assistants can do is help you quickly query lab results: “What were the last three hemoglobin A1C results for my diabetic patient?” Rather than doing, you know, 17 clicks up and down the medical record to find that information, it should make that information quickly available at your fingertips.
Kevin Pho: Are digital assistants able to create a history of present illness by recording what the patient is saying and having that transcribed into the note?
Erin Palm: You know, any of the digital assistants or virtual scribes available on the market today that are doing that kind of summarization of a conversation are truly using human scribes behind the scenes to create that HPI. Some of that is our interpretation, and our construction of that narrative is really something we use our judgment and training as physicians to create: to know what was relevant in, you know, what Mrs. Jones was saying about the parakeets she keeps at home, right? For some people, it’s super relevant. For other people, it doesn’t belong in the note.
Ambient AI is not something that exists on the market today in a pure technology fashion. Most of the companies that are marketing ambient AI are truly using remote human scribes. That said, there is a roadmap to making that possible with a powerful enough machine learning system that understands your preferences and practices and has access to a tremendous amount of data is something that will be a journey over time.
Kevin Pho: With these digital AI systems, in terms of cost, how much do they cost relative to a typical EMR?
Erin Palm: Yeah, interestingly, if you compare to these virtual scribes that are on the market, you can imagine that anytime there’s a human listening in on an interaction, you have to be able to pay the cost of a human. If it’s a solution that’s built on pure technology, more akin to a Siri or an Alexa, then the pricing is much more, you know, tech-enabled, pure software as a service. So it can actually be an order of magnitude cheaper than a virtual scribe powered by a human.
Kevin Pho: Do you see more penetration within the outpatient setting or within the hospital?
Erin Palm: We’ve done both, and there actually are virtual scribes and digital assistants present in both settings. A lot of our experience to date has been in ambulatory settings, across more than two dozen specialties, spanning from orthopedic surgery to cardiology to quite a bit of family practice and primary care. I think the documentation burden in primary care is so extreme that the demand is tremendous, and it’s really a privilege to serve those folks.
Kevin Pho: We’re talking to Erin Palm. She’s a general surgeon, and she’s the head of product of Suki, which is an AI-powered, voice-enabled digital assistant for doctors. She wrote the KevinMD article “How to liberate doctors from EMRs.” Erin, where do we stand in terms of it being fully realized, in terms of where you want it to be?
Erin Palm: I would say we’re about 30 percent of the way there. We have done a pretty exceptional job of handling clinical documentation, notes, and coding, but I think that doctors have really high standards for the technology that they’re using. And as I said, they have this expectation that it can be like my senior resident. You know, replace a person with a technology: Every community doc can have the support that we have in these academic settings where I’m privileged to practice too.
And we have something. The technology is there to have something that, out of the gate, is useful and saves time. As I said, 76 percent time savings over prior documentation methods. That said, on the horizon is so much more: being able to ping us with just the right information at the right time, to have seamless end-to-end ordering, to communicate with other team members, and, of course, to help with making complex medical decisions.
Starting with the technology that does simple, automatable tasks in a way that unburdens the doctor has been the early focus. And further down the line, as we get smarter and understand clinical practice more, we can do the higher-order things, like helping with clinical decisions, which is not something that most of these digital assistant technologies have tackled to date.
Kevin Pho: And my final question, Erin: Do you have a take-home message that you want to share with the KevinMD audience?
Erin Palm: Really, that tech can do so much more for doctors, and that we shouldn’t be settling for less. Doctors deserve better. They’re burning out under the weight of administration burden, and we should be expecting more for ourselves as we fight hard and dedicate so much of ourselves to taking care of patients.
Kevin Pho: Erin, thank you so much for sharing your time and insight, and thanks again for being on the show.
Erin Palm: Thanks for having me.
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