Future-Proof Your Cash Practice: EMR Secrets for the Coming AI Tidal Wave (S1E21)

Do you feel like you’re somehow living in the Dark ages because you’re not an expert with ambient AI? Are your charts not writing themselves during bathroom breaks? Do you still have staff answering phones instead of an AI chat bot?

And you’re a sophisticated, up to date health care expert, Well, listen up, because I’ve got some surprises that don’t have to do with selling you, the latest, greatest package. But how AI can really help you be a much better diagnostician without getting washed away in the tidal wave of widgets and APIs and high pressure sales nonsense.

Hello. Welcome to the Cash Practice Solution podcast. I’m your host, Doctor J. This week I’m playing role of the lifeguard on the beach during the approach of the AI tidal wave.

Today we’re going to examine AI from our own practical cash practice perspective. Let’s get going.

Let’s start with some basic concepts about AI in a real practice setting. What you need to know is that seeing patients in an AI world is really what’s called a wicked environment. There are “kind” environments, simple things like two and two is four. Or would you like an apple or an orange? That’s a kind environment. A wicked environment is what do you think the family is going to discuss over dinner at Christmas with all 13 of us who will get in an argument.

There’s so many variables, you can’t possibly imagine what could happen. So diagnosing a patient who’s got a complicated situation or diagnosing a patient where maybe their situation isn’t complicated, but they’re complicated, that’s a wicked environment. We live in a wicked environment and AI is promising. I promise you, it’s promising. It’s going to be amazing when we really get it to the point where it’s really worked out.

It’s going to be great. It’s going to be a big help, but it will never exceed your ability to connect with a patient and decipher what the patient really needs. I’ll give you the example that I use for a really good, kind environment that AI is excellent for.

I use Grammarly. I got it a few years ago before we integrated other products into my EMR. But I still use it. It’s 12 bucks a month on an annual deal and it takes care of punctuation and grammar and checks all sorts of stuff for me. And it makes me look really smart because I don’t make grammatical errors.

I’m sure you’re probably using that kind of software. That is called a kind AI environment. It’s easy to punctuate. It’s easy to correct grammar. Those are very simple things. I use them all the time. My emails look great because of it. Now, I don’t use it as much because I have the Esprē system and the system takes care of a lot of that.

Diagnostic software is incredibly “wicked” AI environment. It has so many variables that are involved and for you to get into diagnostic software, if you’re a radiologist, maybe that’s a good spot. AI is getting really pretty good there. But in terms of a primary care practice with a diverse set of patients with a diverse set of problems, it’s years off.

Expert systems for single problems like menopause or ADD or depression or prostate, they’re not integrated into the whole big picture. And they can be pretty good. They can nail down how bad is the prostate, how bad is the ADD, is this patient truly depressed. Those instruments are good.But the problem with them is cost. If you’re going to buy a AI system that’s going to take care of an online questionnaire and provide you with the data integrated into your record, you’re looking at anything from $200 per an assessment, all the way down to stuff that’s worthless and it’s free. Not surprisingly, it’s not real good, but it’s free.

They’re accurate for the single question you might be asking, but they require a lot of practitioner input. So if I do an ADD questionnaire, the patient may ask or may answer questions in a way that says, okay, they’re pretty clearly ADD I still have to spend time with that patient and work with them and pay the $150 for the AI system to be accessed, and that’s a lot of money.

So those systems are not really there yet. There are systems that cost $4.50 if you buy a bundle of 100. And, in my practice, I would never use 100. So I don’t really see the use for it. But everything needs to be reviewed by a licensed professional, I don’t care what system you’re using. I don’t care how good your AI is. Everything needs to be reviewed by a licensed professional.

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Ambient AI is another type of AI. It’s unbelievably promising and unbelievably difficult to use appropriately. A patient that I see generally has a pretty good story, and I need to listen to their story. It takes a while. Ambient AI loses accuracy over time. So as the story gets longer, it starts to drop issues and forget things.

And maybe not even pick up the language because there’s an accent issue. And on top of that, with my patients, I like them to know that if they have issues that are important to them, but they don’t want to be part of the medical record, they’re able to share them with me without being concerned that that’s going to necessarily go into the record.

Privacy issues are a gigantic problem, because if that ambient AI records that it’s part of the medical record, you don’t just eliminate it, you can edit it out, but that original copy is part of the medical record.

If your patients are like mine, my patients are very concerned about listening systems that listen to them instead of caring practitioners that have the discretion to really work through a problem and say, okay, I don’t need to write that down, that’s unimportant.

It doesn’t affect their clinical care, and they might not want everybody to know about that, but they feel you might need to know. A great example. I have a patient this week. I saw, elderly gentleman with some, hormonal issues and some sexual issues he wanted to discuss. So my nursing staff comes with me and sits in the room frequently to just be there to help make sure that ideas don’t get dropped or they have suggestions to make.

But in that moment, I looked over at my staff and she looks at me and without a word, she gets up and walks out of the room because we know that there’s just things that you don’t want everybody to be in on the discussion. That’s just normal, healthy human behavior. And ambient AI doesn’t know about that.

It doesn’t know when to not listen. So it’s going to listen its going to write stuff down. And if you ask a legal person, they’re going to tell you that original documentation is part of the medical record. And it will always be asked for. But you need to be aware.

And then there’s automation bias, which is the system deciding what’s essential, what you really need to be listening for or writing down, because ambient AI is going to leave some things out, or it would be an enormous document, right?

In a normal conversation for 15 minutes. That’s a lot of words. So it’s going to leave some stuff out. It’s going to decide what’s important. And that automation bias can leave some of the things that you think are actually important out. So it’s not the solution necessarily to the entire problem. What I like to do is get the big picture. So I know the patient well enough to separate noise from signal.

Some people, they’re just always anxious. So adding that into each discussion is really unnecessary. I know the patient really well. Some patients with that level of anxiety would absolutely record every detail, because it’s unusual for them or it’s atypical or I’m going to do something to treat it.

For many patients with anxiety, that’s just their state of mind. That’s how they are. Manageable. They’re doing fine, but they’re just a little anxious. I don’t have to record all of that. Automation bias will leave the ambient AI writing it all down.

Medical record law assumes that every part of the patient’s encounter is part of the medical record.

So anything recorded before editing the transcription is part of the record. In some states, it’s required. You have to have it. In many states, it’s going to come up in a proceeding, like if you go to court, the question will be asked, was this done with software? And they’ll say, where’s the original? And they have the right to ask for it.

You may not have it. You’re going to be in trouble. It won’t look good. Even if you don’t get in trouble legally. At that point, you’re not going to look good in front of a jury. So the best way to do it, and this has been done forever, and we all know about it. The old school with the paper record you would put a  line through it and initial.Get rid of it. Addenda or addendum adding it’s perfect. It keeps the record intact. It reduces looking like you changed the record, or that you made a decision later that you don’t want anybody to know about. So you just need to be aware that ambient AI it’s just it’s got immense promise. And I think as it gets better, it’s going to be part of everybody’s day and it’s going to be great. So if you’re not an expert today. It doesn’t matter. You’re fine. You’ll become an expert at it when you need to become an expert at it. But if you want to be great today, I want to tell you about Esprē Health. Esprē Health is our software system, which is the ultimate operating system for cash practice.

If you want to run a cash practice seamlessly with none of the hassles or headaches of insurance companies, government intervention, absolute privacy and an amazing AI that’s been in use and developing and improving and blossoming over 20 years. An expert system that will give you all the data that you need to actually make great decisions based on your particular position with the patient and, just get great results and save you 80 to 90% of the time it would take to do that depth of interview.

Next time we’re going to move on to the more spiritual side of this, this discussion and ways to provide better care through elevation of the doctor patient relationship. So thanks for tuning in to the Cash Practice Solution podcast. I’m Doctor J, and I’m here to remind you that a fulfilling cash practice is within reach, and we can help you get there.

If you want to optimize your current cash practice or start a new cash practice on the right foot, check out all of our resources at the CashPracticeSolution.com. So until next time, listen to your patients, learn their stories and love them with all of your heart. You will be unstoppable.

Thanks for joining us.

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Keep raising the bar and patient care.

We’ll reconnect in the next episode with more ways to help you succeed.