Melanie Cole, MS (Host): Welcome to Women's Health Perspectives, a podcast from Unified Women's Healthcare. I'm Melanie Cole. And artificial intelligence is generating a lot of buzz, including for OB-GYNs. AI tools promise to give busy clinicians time back in their day and alleviate cognitive load. Today, we're talking with a physician who's implemented two different solutions in her practice, Ambient dictation for notes and Elise Voice AI for calls and scheduling. We'll discuss the benefits and challenges and the impact on staff and patients, AI solutions in the OB-GYN practice.

Joining me is Dr. Erin Schlueter. She's an obstetrician-gynecologist and a physician partner affiliated with Genesis OB-GYN. Dr. Schlueter, thank you so much for joining us today. Let's start with ambient dictation. Can you walk us through it a little bit and tell us what it is and how it works?

Erin Schlueter, MD, FACOG: Yeah. So, it is a tool that's built into Athena, which is our electronic medical record that we use. And it's essentially a virtual scribe. So, the ambient dictation runs in the background while I'm interviewing my patient. And then, at the conclusion of the visit, I'm able to finalize their assessment, and it uploads a preformed note into the chart that it generates based on the conversation that the patient and I have had.

Melanie Cole, MS: Wow. Isn't that amazing? And, you know, I'd like to talk about how these tools are benefiting the physicians and, as you say, that transfer into electronic medical records. Tell us a little bit about that. And the accuracy is an important question that I think many people have. So, speak a little bit about what you've personally experienced

Erin Schlueter, MD, FACOG: I found it to be, for the most part, fairly accurate. You know, like any technology, there's hiccups and there's sort of a learning curve to using it. You know, it doesn't entirely replace interacting with the chart at all. So, you know, I still look at the note that it generates. And I would say one or two times a day, I have to make pretty significant edits.

Usually, the edits that I make are fairly minor. It has evolved over the course of the time I've been using it, and the note summaries have gotten more and more accurate over time. And so, you know, I expect going forward that we're going to see more accuracy with the note-taking that it does.

Melanie Cole, MS: How has it helped you?

Erin Schlueter, MD, FACOG: I mean, the biggest thing that I think it has helped with was it takes away a lot of the, like you mentioned earlier, the load of remembering what we're talking about with the patient and the load of kind of transcribing and recording the documentation after the fact. I think having the ambient dictation running in the background allows me to connect better with my patients, because you can have a normal conversation, and it sort of allows for, I think, a better and more natural flow of conversation between you and the patient.

Melanie Cole, MS: Well, so that leads well into my next question. How has Ambient Notes had an impact on your patients and how you interact with them? Is it distracting? Are you, like, noting that it's going on in the background? Tell us how it's been with you and your patients.

Erin Schlueter, MD, FACOG: I think it's been fantastic. So my workflow typically is when my medical assistant is rooming the patient, she'll get the general history from the patient. She asks if they want a chaperone, and she gets consent for the virtual scribe. And so, when I go into the room, I'll start the scribe, and I just set it on the counter next to me, and then I talk to my patient.

It allows me to just sit there and have a normal human conversation. And so, I find that since I've been using the ambient dictation, I feel like I have more of a connection with my patients. I think we all go to medical school, because we want to connect with people, we want to help people, and I think it allows me to focus more on really what the patient's saying and listening to them without worrying about remembering all the details of everything that they're telling me, because the scribe is doing that in the background.

So, we have our conversation, I'll do my exam, and then I'll go over the plan with the patient, which is another thing that I feel like the ambient dictation has really helped is, when I first started using it, I was sort of thinking about it in the background. And so, I wanted to make sure it was going to capture everything that I was explaining to the patient and everything that I was recommending to her.

And so, I sort of evolved my counseling to match someone else listening. So, I feel like I do a better job of not only summarizing what the patient's saying, but also summarizing what my recommendations are and what the next step is going to be at the end of every visit.

Melanie Cole, MS: Yeah, that sounds so much more efficient. And I also imagine doing what you do and working in some of the most really intimate moments in a woman's life that that maybe makes them feel just a little bit safer. It's almost like an additional layer of protection on that. So, I think that that's awesome. And how do you review the AI-generated documentation? And you just mentioned a little bit, so I'd like you to expand on how it helps you with your clinical judgment.

Erin Schlueter, MD, FACOG: Yeah. So once you finish the encounter, you can click a button and it, it'll generate the note and it'll put it into Athena for you. So then, I just go through and I read each page of the clinical note. So, it'll generate a summary of the history of present illness, and I'll read through that and make sure that I think that matches my memory and matches what we talked about.

It does make comments on the physical exam. And typically, I use my own note template for the physical exam. If there's any edits or anything like that, I'll change those. And then, I'll look at the assessment and plan and look at the, you know, the different topics that we talked about and make sure that the summary matches up. And so, you know, it takes maybe two or three minutes to read through the note at the end of the encounter. But then, I can put in the orders that we talked about and whatever follow-up that we discussed, and then my notes are done.

Melanie Cole, MS: Wow. That really is awesome and helps streamline that whole situation. Now, Dr. Schlueter, let's talk about Elise AI, the voice automation tool that answers patients' phone calls. What type of calls or requests can it manage well? Tell us about this, because it sounds fascinating.

Erin Schlueter, MD, FACOG: It's been great so far. So, we implemented it, I would say a few months ago. The team at Elise was really great about working with our office practice manager to get a really granular detail on what we want Elise to do, what we don't want Elise to do. And so, through the training, they were able to provide kind of a phased in onboarding of Elise taking our phone calls, and they've always been really responsive to feedback as well.

So, the easiest thing that I've found Elise to schedule is simple visits like a well woman exam or a specific problem. I think patients always have the option when they call of getting directed directly to a human. So, if somebody is uncomfortable talking to the AI or they find that it's not meeting their needs in some way, they can always still talk to one of our in-person schedulers.

But Elise has really taken the load off of our schedulers by ensuring that the patients have access to just getting a checkup or just getting, you know, STI screening or evaluation for a problem that they're having.

Melanie Cole, MS: So, I think the big question is how have patients responded? It's great that you told us that they do have the option to opt out and ask for human, you know, discussion. So, how has the tool affected the front desk and scheduling staff? Have there been challenges? What are patients saying?

Erin Schlueter, MD, FACOG: I think overall the response from patients has been pretty good. I think, you know, the people that are willing to talk to the AI and get their appointments scheduled are happy with it. It definitely has served to take a load off the front desk and our scheduling team, and I think that's where it really shines, is that there's so many appointments that Elise can schedule, that it allows our scheduling team to focus on the more complex issues and make sure that the patients are scheduled in a timely fashion and appropriately for the issue that they're having.

Melanie Cole, MS: What's the voice like?

Erin Schlueter, MD, FACOG: You can pick a couple different ones. It sounds like a person, a little bit of a robotic person, but it still sounds like a person. It's not, you know, the voice has come a long way from, you know, what I remember 15 or 20 years ago of sort of the prerecorded telephone line kind of thing. But yeah, I mean, it sounds like a person mostly.

Melanie Cole, MS: Give it an English accent and I'm sure people will even like better, right? We always like to do that kind of thing. So, Dr. Schlueter, this is really so interesting. And as we look to all of the advancements and things are moving so quickly, for your unified physician peers who are considering some of these AI solutions, what practical advice would you offer based on your own personal opinions and experiences? And I'm going to add a little to the question, as you look to the next five years, do see? What would you like to see? So, offer your physician peers some of your own personal experiences and opinions and then give us a little blueprint.

Erin Schlueter, MD, FACOG: Oh, man. Okay. That's a big question. I would say in my own experience, the role of AI and the role of, you know, machine learning, I feel like it's best used in a clinical setting to facilitate my connection with my patients. So, the role of ambient AI is that it takes notes and it allows me to focus entirely on my patient and not trying to record or be distracted by something in the medical record that comes up. And I think that's really where in the healthcare setting that I see AI having the most benefit, is facilitating that human connection.

Similarly with Elise and scheduling, it allows people access to healthcare by allowing them to schedule appointments at our clinic in a little bit more efficient manner, and then still preserving the ability for people who have more complicated questions or who have more of an urgent need maybe to talk to a scheduler and get put in appropriately. And so, it also allows our office staff to connect better with patients and connect them with what they need from our clinic.

In terms of where I see it going over the next couple years, I think the ambient notes are improving every time. You know, every couple weeks when there's an update, I see the note-taking a little bit better. And I think it's really good now. So, you know, I think moving more over the next five years, I think that I'd like to see a little bit more help with clinical decision support making. So, you having a tool that can look at the information in the chart and maybe suggest patient is due for, you know, pap screening next year or, you know, patient has a gap in mammography, so we need to make sure that she's getting scheduled for that.

And then, I think potentially proactively reaching out to patients to schedule them when they're due for their next annual exam or especially with pregnancy care and prenatal care, making sure that patients are getting scheduled appropriately for that and that people aren't getting lost to follow up when they get confused about when their next appointment is supposed to be or something comes up and they cancel and then maybe forget to call back for a week or two, having something that can reach out to them, make sure that they're still getting care.

And then, your final question about my advice to my colleagues. I think be flexible and be willing to try something new. And I think be open-minded if it's not perfect right away. Both Elise and the ambient note-taking were really responsive to feedback and to comments. And so, I think that there is a little bit of a, not only a learning curve to using the note-taking, but also if you're going to implement something like Elise to help take calls from the front desk, there's going to be a little bit of back and forth, of saying, you know, this person got scheduled. It really didn't meet the needs of what the patient needed or what made sense with our schedule, and then feeding that back so they can improve and they can make it work for you better.

Melanie Cole, MS: Fascinating. Really such an exciting time, and certainly in your field, Dr. Schlueter. This was really such an interesting discussion. Thank you so much for joining us, sharing your incredible expertise and your opinions and perspectives on how quickly this amazing technology is moving and how it's helping to streamline offices. Thank you so much again for joining us.

Erin Schlueter, MD, FACOG: Thank you so much for having me. It was great talking to you.

Melanie Cole, MS: To explore all our Women's Health Perspectives episodes and clinician-focused content, visit the Delivery Room, the Unified OBGYN intranet from the tile on your Okta dashboard. I'm Melanie Cole. And to learn more, you can always visit unifiedhc.com. Thank you so much for listening to Women's Health Perspectives, presented by Unified Women's Healthcare.