June 8, 2025 • 26 mins
05/25/25
The Healthy Matters Podcast
S04_E17 - Bedside Bots! AI Scribing in Healthcare
With Special Guest: Brian Imdieke, MAN, ANP-BC
Ever feel like your doctor is paying more attention to their keyboard than to you? You're not alone—and that's one of the problems AI scribes are trying to fix. But how do they work? How good are they? Is my data still private? And are we nearing the age of Dr. Bot, M.D.?
In this episode, we'll take a look at how artificial intelligence is transforming the exam room with Clinical Informaticist and published expert, Brian Imdieke (MAN, ANP-BC) of Hennepin Healthcare. We’ll explore how AI scribes work, who's using them, what they’re doing well—and where they might still fall short. From reducing caregiver burnout to reclaiming precious face-to-face time in the exam room, we'll unpack the promise, the pitfalls, and the privacy questions around this transformative technology. Join us!
We're open to your comments or ideas for future shows!
Email - healthymatters@hcmed.org
Call - 612-873-TALK (8255)
Get a preview of upcoming shows on social media and find out more about our show at www.healthymatters.org.
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 01 (00:01):
Welcome to the Healthy Matters podcast with Dr.
David Hilden, primary carephysician and acute care
hospitalist at HennepinHealthcare in downtown
Minneapolis, where we cover thelatest in health, healthcare,
and what matters to you.
And now here's our host, Dr.
David Hilden.
Speaker 02 (00:19):
Hey, everybody, and welcome to episode 17 of the
podcast.
I am your host, David Hilden.
And, you know, we all talkabout AI in our lives, but did
you know that it's also presentin healthcare?
So today, we are going to talkabout artificial intelligence
and how it's showing up in examrooms, not as a robot doctor,
but as a silent partner, takingnotes, reducing paper, maybe
(00:41):
even saving a little sanity, butwe'll find out about that.
Joining to help me out today tomake sense of the technology
and how it is impactinghealthcare is Brian Imdek.
He is an adult nursepractitioner and a published
expert on the topic.
Brian, welcome to the podcast.
It's a pleasure to be here.
Thank you for having me.
So set the scene for us.
What is a clinicalinformaticist?
Because you deal with thosekinds of folks.
(01:02):
Yeah.
And tell me about your job hereat
Speaker 03 (01:04):
Hennepin Healthcare.
For sure, for sure.
I like to compare a clinicalinformaticist to that tech-savvy
family member.
Every family has a tech-savvyperson, somebody who's looking
up the best travel website,who's looking up the best
roadmaps and how to get frompoint A to point B, maybe the
budgeting app.
We as clinical informaticistsdo something similar, but in the
(01:24):
healthcare environment.
And the role is to helphealthcare teams and patients
use technology better to improvecare.
Clinical informaticists focuson ensuring digital tools like
the electronic health record anddifferent applications are
well-designed and they supportbetter, safer, and more
efficient care.
Speaker 02 (01:43):
So you talked about the electronic health record.
We use that here for 20-someyears.
And most big systems around thecountry use electronic health
records.
For our listeners, describe,first of all, what is the
electronic health record?
What are you talking aboutthere?
Speaker 03 (01:56):
Oh, boy.
The electronic health record isbasically the repository for
all of the clinical care that isgiven to patients.
The electronic health record isused to communicate between
providers and others in the careteam.
It's also used to track thecare progression and what kind
of interventions are done.
We use the electronic healthrecord to communicate
(02:17):
diagnostics.
And it is a huge repository ofso much information, and it
follows the patient's continuumover a course of time.
There's thousands uponthousands of data points for
each individual patient.
And so the electronic healthrecord is how we convey the care
that is given to patients.
Speaker 02 (02:37):
So I grew up in the age of the paper charts.
We used to have to go to thebasement of this hospital, this
very hospital we're sitting in,and get a grocery cart.
It was a grocery cart.
And we would have a stack ofmanila folders full of paper
records, and I would have topour through those.
So if you wonder why yourdoctor or your nurse
practitioner didn't know thatyou had a CT scan 18 years ago,
(02:58):
it's because it was buried inthis paper chart.
So the electronic health recordhelps a great deal of that.
That's why there's computers inthe exam room.
But talk about where artificialintelligence now, that's the
main topic of today, that'sdifferent from the electronic
health record, right?
Speaker 03 (03:13):
Right, right.
So artificial intelligence isbasically helping in the
circumstance and what we'regoing to be talking about today
is helping providers put theirthoughts into the electronic
health record to take theinformation between a patient
and a provider and put that intothe health record in a way that
is clinically meaningful to notonly the individual provider,
(03:35):
but the patient as well.
Speaker 02 (03:36):
So that might be a little bit scary to some people.
You're going into your visitand now we're talking about
artificial intelligence.
How does
Speaker 03 (03:43):
it work in health care?
So right now there are a lot ofdifferent use cases where it's
basically taking artificialintelligence, takes existing
information and constructs itand puts it into a way that is
digestible, that's meaningfulfor providers and patients.
It can help predict diseasetrajectory.
It can help predict whether ornot a patient is going to be
admitted to the hospital or ifthey are at risk of
(04:06):
deterioration.
There's different models in howAI is used in healthcare.
The one way that we are usingit predominantly is to basically
be present during a clinicianand patient visit.
And during that visit, arecording is basically taken.
And the AI takes thatrecording, leans on algorithms
(04:27):
and large language models tobasically help generate a note,
a clinical note for that visit.
And what that leads to issubstantial reduction in the
effort that it takes for aprovider to put together the
note for that
Speaker 02 (04:42):
visit.
So are the clinicians, doctors,nurse practitioners, physician
assistants, are they embracingthe technology in general?
Absolutely.
Speaker 03 (04:49):
Absolutely.
As you had talked about, weused to do diagnostics.
documentation and conductorcare through paper, right?
And now so much of that hastranslated into the electronic
record.
And what that did, it shiftedan immense amount of burden from
just writing in paper tohanding off that administrative
burden to clinicians, toproviders, to nurse
(05:10):
practitioners, to doctors.
And on average, for a visitprior to AI, it would take on
average about 10 to 12 minutesper visit for a doctor or nurse
practitioner to type up thatnote.
Because they literally And theytype it.
Patients probably see it whenthey're visiting with the
provider.
Oftentimes, the provider isthere typing away, looking into
(05:31):
the computer.
Not at you.
Not at you.
You know, missing that reallyimportant dialogue, that
face-to-face dialogue.
I hear it in my friendnetworks.
It seems like I went to thedoctor and they didn't pay
attention to me.
And with AI, the provider, theclinician, can refocus their
attention to the patient,knowing that in the background,
(05:51):
all of that really fine, crucialclinical detail is being
captured and put into theelectronic health record.
Ultimately, it's myresponsibility.
It's our responsibility asclinicians to authenticate and
make sure that information isaccurate.
But the reduced burden and thereduced cognition and effort to
remember that information isparamount.
(06:11):
And there has not been anyother technological solution in
my experience as a clinicalinformaticist that there has
been with this AI scribe.
Speaker 02 (06:20):
Yeah, you know, and with apologies to all those who
developed the electronic healthrecord, I spend an extraordinary
amount of my time typing.
You know, I went to medicalschool.
I passed a couple classes inscience, but the most important
class I took in high school wastyping.
Yeah.
You know, I'm a good typer, andit's helped me out a And what a
kind of a silly thing to haveto say, but I spent a good
(06:41):
portion of last Saturday morningtyping from my dining room
table, my clinic notes.
And it took a great long timejust to type them even as a good
typer.
And I don't think that that isprobably good for your
healthcare.
So your clinician has twooptions.
They can sit and type on thecomputer while you're in with
them and then they're notlooking at you, or they can do
(07:03):
what I actually do choose to do.
I tell myself, put your handsoff that keyboard, take your
hands off that keyboard, takeyour hands away from that mouse
and look and talk to yourpatient.
But the price I pay for that,It's Saturday mornings I'm
typing my notes because I didn'thave time during the day.
So it seems to have clearbenefits.
But what do you say to patientsabout your being recorded when
you're at one of your mostvulnerable moments?
Speaker 03 (07:23):
Yeah, it's a great question.
And transparency and beingforthright is really important.
And we do ask permission and weare forthright with informing
patients that we are doing arecording.
We're using AI to generate thenote so I can spend more time
focusing on you.
And so we keep that level oftransparency.
And I wouldn't even say sellingpoint, but putting this back
(07:45):
into kind of going back to theearlier point that I think
there's been a large contingentof patients who have felt like
their visits have become alittle bit less ingenuous
because of the distractionsbecause of the electronic health
record.
And so patients have been verywilling to accept this
technology.
by and large.
Sure, there are some examplesin some cases that there's a
(08:08):
level of trust or a reason thatthey'd rather not partake, and
that's okay.
We can always fall back totyping or doing traditional ways
of doing our documentation.
But we are forthright, again,with this technology and that it
is present.
And to be honest, AI solutionsare only going to be more and
more prevalent in healthcarebecause of the substantial
(08:28):
benefits that it does promise,especially within a complex and
highly regulated industry.
Back
Speaker 02 (08:35):
to that exam room.
Speaker 03 (09:03):
consent process that I just spoke to.
But basically at that point, Ipress a button on my phone and
during the entire visit, thatphone is recording.
You just set it there on thedesk.
Just set it right there inbetween us.
And we'll see if thattechnology changes in the
future.
It likely will.
But for right now, it's justusing your own personal device
and app on the phone.
Really slick, really easy touse.
And that's the thing that'sreally enticing about it is
(09:25):
because so many solutions andtechnology are hard to embrace
or hard to deploy or hard toincorporate into clinical
workflows.
This is really, really easy.
One, it's really easy to adoptand the impact is so
substantial.
Speaker 02 (09:40):
So this might come as a shock to you and others,
but I'm a very verbose guy.
In fact, I barely can, I nevershut up.
What does, how does this thingknow?
How does this software knowwhat I want put in Jane Doe's
medical record and how much I'mjust shooting the breeze with
it?
Yeah, yeah.
I shoot the breeze.
I'm talking to them about theirtrip to Norway for the first 10
(10:01):
minutes.
And does that have to all go inthe chart?
Speaker 03 (10:03):
It doesn't.
And And that's the reallyimpressive component of this is
that it relies on past medicalinformation and data to filter
out some of that conversation.
It's going to filter out someof where was that recent trip.
But it may include somethingalong the lines of patient is
having food insecurity or thereis a difficulty with something
(10:24):
at home.
It will incorporate that.
And at the same time, it'scrucial for the clinician to
review one of those notesbecause maybe it did miss that
for you.
You wanted to include thosedetails on that trip to Norway.
You might have to just typethat little bit in.
Or maybe it includes a littlebit of something that, you know,
that didn't need So you mighttake that out of the note.
So that's a balance.
But to answer your question, itdoes a really good job of
(10:48):
filtering out some of thatchit-chat that is really
important for that humanconnection between a patient and
a provider, and also includingthe really important clinical
information.
Yeah,
Speaker 02 (10:59):
and I'll be honest with you, Brian.
I struggled with that when Ifirst heard of this stuff
because to me that knowing thatmy patient took a trip to
Norway, I'm just continuing onthat example, matters.
It really does.
I know what they like to do.
I know that they like to gohiking or I don't know.
I know that they like to gocamping in the jungle where they
pick up tick-borne diseases.
So it is kind of relevant togetting to know people.
(11:21):
And so I don't want to lose allof it.
But then again, I don't need towrite a Herman Melville novel
every time in their note.
Speaker 03 (11:28):
Absolutely.
And that's the balance.
It learns based off of pastexperiences and a huge amount of
data.
But it can't quite get to thepoint where it's going to be
really specific and individualto that individual provider
because we all practicemedicine.
We all practice advancedpractice nursing a little bit
differently.
And so there are the needs tomake those final curations to
(11:52):
the note that meet your personalneeds.
So here's a big
Speaker 02 (11:54):
question.
Who benefits from AI inhealthcare?
The hospitals and clinics, thedoctors and nurse practitioners
and physician assistants, yourclinicians, patients, who
benefits?
All of these.
above in my opinion.
So first
Speaker 03 (12:07):
and foremost, this is driven towards providers.
You know, when I look at ourhealthcare system, our
clinicians, advanced practiceproviders, physicians, nursing
staff, therapists, they are thebedrock to a functioning
healthcare system.
And right now, that's at risk.
You know, in a recent studyfrom the American Medical
(12:27):
Association, I think this was acouple years ago, 20% of
physicians are consideringleaving practice in the next two
years.
Right?
That's a scary situation.
And in primary care, there's a
Speaker 02 (12:36):
shortage of tens of thousands predicted for the next
decade.
Speaker 03 (12:39):
Right.
And that also translates intosome providers are needing to
reduce their time spent inclinic because the complexities
have just grown so immense.
Right?
So there's the provider benefitto this from a wellness
perspective and being able toretain our clinical workforce.
Right?
And taking these administrativeburdens off clinicians have
already shown.
We have some statistics andsome of the work that we've done
(13:01):
here at Hennepin on that space.
From a patient perspective, wehave already alluded to already
that patients stand to benefitto have that more human,
authentic connection betweenthemselves and their clinician
because the clinicians aren'tfeeling like they're struggling
for survival, needing to typealong that entire visit.
And so patients have shown thatthey benefit from the
(13:25):
eye-to-eye contact, that humanlistening, that full
attentiveness through the visit.
Studies have shown that.
Many of my colleagues arereporting that as well.
All of this translates into theorganizations themselves
because, again, organizationsneed to retain their staff right
now.
They need to retain theirclinicians to be able to
continue providing care topatients and the communities.
(13:45):
There's a substantial benefitto the organization in investing
in a tool that has this muchimpact straight away because
there are so many things that wehave tried along the lines of
improving efficiencies andthings for clinician wellness.
Nothing really has compared towhat we've seen with the AI
Scribe solution.
Before the break.
Speaker 02 (14:04):
Last question is, are outcomes better?
What portions of healthcarehave improved in the few years
it's been
Speaker 03 (14:10):
being accepted?
Yeah.
And a lot of the data, a lot ofthe information really centers
around that provider wellnessexperience.
We have around 140 or 150providers here at Hennepin using
this solution right now.
And we did a study not too longago of the first 60 days, okay?
Symptoms of burnout and feelingoverwhelmed went down by 30%.
Job satisfaction went up by30%.
(14:33):
Stress at work went down by 13%as well.
Those are pretty substantial,staggering statistics.
Within that as well, we werealso able to pull information
out of the electronic record tosee the amount of time that
providers are spending doingtheir clinical documentation.
There was a 40% reduction inthe time spent that providers
(14:55):
are typing their notes.
So each note is taking aboutfive to six minutes less on
average.
The other component that we'relooking at is over the course of
the day, we've had someproviders that are spending an
hour less per day ondocumentation.
That's five hours in a week.
That's a lot of time that thatprovider is getting back to
focus on other areas of clinicalcare are also on themselves so
(15:17):
they can get home and not doingtheir documents.
Maybe go see their kids.
Go see their kids, notcompleting results on the
sideline of a soccer game orspending time being able to
attend to their parents becausetheir parents are aging.
All of those things.
Because what you're talkingabout here is pajama time,
right?
Pajama time.
What's pajama time?
Pajama time is that time spentin the electronic health record
(15:38):
in those overnight hours,typically starting at 7 p.m.
and ending at 7 a.m.
So we can measure
Speaker 02 (15:43):
pajama time by that clinician that you're sitting
with, that advanced practiceprovider, that doctor.
We can measure how much timethat person is spending off
hours in the electronic healthrecord.
So that was a great discussionof what AI and what AI scribes
can do.
But now we're going to take aquick break.
And when we return, Brian'sgoing to cover the safety and
privacy aspects of thetechnology.
(16:04):
And I hope you'll address themillion-dollar question, Brian,
am I going to be obsolete?
Is AI going to replace peoplein the future?
Don't answer it yet, but that'swhere we're going to talk about
after a short break.
Stay with us.
We'll be right back.
Speaker 00 (16:19):
When Hennepin Healthcare says, we're here for
life, they mean here for you,your life, and all that it
brings.
Hennepin Healthcare has ahospital, HCMC, a network of
clinics in the metro area, andan integrative health clinic in
downtown Minneapolis.
They provide all of the primaryand specialty care you'd expect
to find, as well as serviceslike acupuncture and
(16:41):
chiropractic care.
Learn more athennepinhealthcare.org.
Hennepin Healthcare is here foryou and here for life.
Thank you.
Speaker 02 (16:56):
And we're back talking with Brian Imdicka about
artificial intelligence and AIscribes in healthcare.
Okay, so Brian, you've talkedus through what it is, but it's
natural to think, oh mygoodness, somebody's listening
to my personal stuff.
What is your first response topeople when they bring up
questions like, oh, I don'ttrust this?
Speaker 03 (17:15):
I validate that question and that concern
because in this day and age ofinterconnectivity and how data
is shared, whether it's withinhealthcare or outside of
healthcare, we have to be verycognizant of that.
Patient health information,protected health information is
the cornerstone of somethingthat we hold very highly dearly
in healthcare and here atHennepin.
What we call PHI.
(17:36):
PHI, right?
The PHI, it's almost in theinitial, anytime that we are
working within the organizationor outside the organization, it
is fundamentally crucial that weprotect that.
And so when we were going downthis path of considering an
AI-scribed solution, that wasparamount.
We worked very closely with ourlegal team.
We worked very closely withwith our patient privacy team.
(17:58):
We worked very closely with ourcompliance team to make sure
that our relationship with ourvendor made it sure that we
respected PHI to the utmostdegree.
And those values were sharedvery much by our vendor as well.
How information is shared togenerate the clinical note is
protected and encrypted at avery high level.
It exceeds any regulatory orcertifying bodies.
(18:20):
And again, it comes down totransparency as well with
patients that we conveyed thatthis is something that we are
using.
And that PHI, again, issomething that we hold very,
very dearly and is of the utmostimportance.
Speaker 02 (18:33):
But Brian, I'm coming to you.
I'm telling you all about mypersonal problems and you've got
your phone recording me.
How do I know you're not goingout to happy hour with your
clinician friends and you'relistening or you're talking
about, let me play this back foryou.
Okay, I'm being cynical.
Speaker 03 (18:48):
No, no, that's okay.
That's the first time I'veheard that exact question.
And to be honest, I don't haveimmediate access to that
recording.
And So to answer that specificquestion, we as healthcare
providers are held to the samedegree of privacy security.
We can only use a patient'shealth information or components
(19:08):
of a visit for clinicalpurposes only.
There is not to be used forsharing stories or is not to be
used for personal gain.
All of that is strictlyprohibited and the same concept
applies with the AI Scribe
Speaker 02 (19:22):
solution.
It really does.
Your information is in there inthe electronic health record as
well, and that is protected 14ways from Tuesday as well.
Speaker 03 (19:30):
Yeah, this is ultimately not a new concept.
It's just highlighted becauseof the recording aspect and that
recording is ultimately shared.
That's what maybe sets it apartfrom other solutions that we
currently have.
Speaker 02 (19:43):
So the million dollar question is, is this
going to replace you and I?
Is this going to replace theclinician?
Is this going to replace all ofus?
Are people just going to getall their health care from a
machine?
Speaker 03 (19:54):
Short answer to that, in my personal opinion, is
no, right?
And I feel, and I think that isreally established not only by
myself, but others who are veryknowledgeable in this field, is
what this solution has promotedis that reconnection that
human-to-human connection thathas been lost by a lot of the
distractions and the burdens andthe obstacles in the healthcare
(20:15):
delivery system.
In this particularcircumstance, clinical
documentation takes a lot oftime.
Reducing that and that time isreinvested into that
human-to-human connection thatis backed by that clinical
expertise.
And so I don't ever see AIYeah,
Speaker 02 (20:32):
and that I think is reassuring and actually does
make some sense if we could haveAI replace some of these
documentation tasks.
I have also heard, though, thatwhen you run diagnosis through
AI, it's better than I am.
And so there must be moreapplications.
In other words, you put in your12 symptoms and ask a whole
(20:53):
bunch of guys like me and thenask AI, AI might be right.
I mean, a computer beat theworld's best chess player.
It's probably true that it'sgoing to beat the world's best
diagnostician too.
So there must be other roles inwhich it is helpful.
So to round out this episode,could you sort of talk to us
about the future?
I get it that you can't predictit any better than any one of
us, but what do you see?
(21:14):
What are some of the cooladvances You
Speaker 03 (21:17):
know, there's a short-term and a long-term
answer to that question.
I think short-term, there aregoing to be the things along the
lines of how AI will helpsuggest orders and diagnostics
for a particular visit.
I talked a little bit earlierabout how the EHR is full of
thousands of data points for anindividual patient.
(21:37):
AI can help summarize those, sowe're making sure that we're
capturing all the clinicalinformation that could be lost
otherwise, and so there is theability to to do chart
summarizations.
There's also a future in wherethis is not just for nurse
practitioners, physicians,assistants, doctors.
I see this being a solutionvery soon for nursing.
I think that's reallyimportant.
Our nursing colleagues arefacing similar burdens and
(22:01):
attrition that physicians andadvanced practice providers are.
So on a short-term basis, I seethis broadening.
This is going to become moreand more ubiquitous in care.
It's going to be part of thehealthcare delivery.
I think in the what is thatinformation and how can we
capture patients' experiencesthat are happening outside of
(22:23):
the conversation between theprovider and the patient?
How are we capturing impact ofmedications and taking
medications?
What are the socioeconomicfactors that are influencing a
patient's care?
How is a day-to-day livedexperience from a patient being
potentially captured with AI ina collaborative and with all the
(22:43):
safeguards that we've alreadytalked about?
So we have So I really
Speaker 02 (22:52):
like what you said there, especially when you
talked about nurses and others.
Because, folks, you reallydon't want your nurse sitting at
a computer documenting what he,she, or they do all day long.
You would rather them be doingthe high-level skills that
they're trained to do.
And so it's all overhealthcare.
Your therapist, your physicaltherapist, your OT, all of the
(23:12):
aspects of healthcare, it couldbe more than just you and I in
our lives.
So I really like what you saidabout that.
So Brian, to close us off.
What excites you the most, ormaybe what worries you the most,
about AI in healthcare in thefuture?
Speaker 03 (23:26):
Yeah.
I think what excites me mostwith AI and what we've
experienced in these earlystages is that substantial
reduction in the burdens thatclinicians face and the ability
to focus more on patients, tofocus more on themselves, to
find more fulfillment inpractice, and to have that
better human-to-human connectionwith patients.
That's why all of us went intomedicine.
(23:48):
That's why all of us went intois to help people.
And again, there's been so manyobstacles to that human
connection that AI really has anopportunity to help get us back
to that human connection thatis lost beyond just in
healthcare right now in my mind.
So that's what really excitesme.
(24:08):
I think there's so much morepotential down the road and this
will change very quickly.
I think the thing that scaresme most is that if we rest on
our laurels and say, yep, wehave AI scribes and we can There
is so much more that we need todo to fix our antiquated
healthcare system right now.
And just to reduce cliniciandocumentation burden and not
(24:29):
focus on the larger picture, wehave to keep going.
We have to look at new waysthat we interact with patients.
We can't continue to go downthe current ways that we're
delivering care.
And so how do we leveragetechnology?
How do we leverage the peoplewho are doing the work and the
processes to ultimately makethis a better experience for
everyone, patients andproviders?
(24:49):
That's brilliant.
and Brian, if there's anythingAI could do, what would you wish
for?
Getting more of a holistic viewof what is impacting our
patients' health and what ourpatients' lives are, right?
Again, so much is focused onthose 15 to 20 minutes that we
have with patients.
We can't crack the surface.
How can AI broaden ourunderstanding of patients' lived
(25:10):
experiences while alsoleveraging the improved
connection that patients havewith their providers?
And I think that that is what Ihope to see in Brian, brilliant
Speaker 02 (25:24):
advice.
And listeners, you're going tobe hearing, I guarantee you're
going to be hearing more aboutAI throughout your life, but in
healthcare as well.
And so I hope you got a glimpseof what that technology might
look like next time you go intoyour clinic visit.
Brian Imdik is probably thebiggest expert that I know in my
personal and professional lifeon the subject.
(25:45):
So Brian, thank you for beinghere.
It's my pleasure.
Thank you for having me.
It's been great hearing yourwise advice.
on a topic that affects us all.
Listeners, I hope you'veenjoyed this episode and I hope
you'll join us for the nextepisode when we will talk about
chronic obstructive pulmonarydisease with pulmonologist Dr.
Caroline Davis.
It's going to be a great show.
In the meantime, be healthy andbe well.
Speaker 01 (26:06):
Thanks for listening to the Healthy Matters Podcast
with Dr.
David Hilden.
To find out more about theHealthy Matters Podcast or
browse the archive, visithealthymatters.org.
Got a question or a comment forthe show?
Email us at healthymatters athcmed.org or call 612-873-TALK.
There's also a link in the shownotes.
(26:27):
The Healthy Matters podcast ismade possible by Hennepin
Healthcare in Minneapolis,Minnesota, and engineered and
produced by John Lucas atHighball.
Executive producers areJonathan Comito and Christine
Hill.
Please remember, we can onlygive general medical advice
during this program, and everycase is unique.
We urge you to consult withyour physician if you have a
more serious or pressing healthconcern.
(26:49):
Until next time, be healthy andbe well.
Welcome to the Healthy Matters podcast with Dr.
David Hilden, primary carephysician and acute care
hospitalist at HennepinHealthcare in downtown
Minneapolis, where we cover thelatest in health, healthcare,
and what matters to you.
And now here's our host, Dr.
David Hilden.
Speaker 02 (00:19):
Hey, everybody, and welcome to episode 17 of the
podcast.
I am your host, David Hilden.
And, you know, we all talkabout AI in our lives, but did
you know that it's also presentin healthcare?
So today, we are going to talkabout artificial intelligence
and how it's showing up in examrooms, not as a robot doctor,
but as a silent partner, takingnotes, reducing paper, maybe
(00:41):
even saving a little sanity, butwe'll find out about that.
Joining to help me out today tomake sense of the technology
and how it is impactinghealthcare is Brian Imdek.
He is an adult nursepractitioner and a published
expert on the topic.
Brian, welcome to the podcast.
It's a pleasure to be here.
Thank you for having me.
So set the scene for us.
What is a clinicalinformaticist?
Because you deal with thosekinds of folks.
(01:02):
Yeah.
And tell me about your job hereat
Speaker 03 (01:04):
Hennepin Healthcare.
For sure, for sure.
I like to compare a clinicalinformaticist to that tech-savvy
family member.
Every family has a tech-savvyperson, somebody who's looking
up the best travel website,who's looking up the best
roadmaps and how to get frompoint A to point B, maybe the
budgeting app.
We as clinical informaticistsdo something similar, but in the
(01:24):
healthcare environment.
And the role is to helphealthcare teams and patients
use technology better to improvecare.
Clinical informaticists focuson ensuring digital tools like
the electronic health record anddifferent applications are
well-designed and they supportbetter, safer, and more
efficient care.
Speaker 02 (01:43):
So you talked about the electronic health record.
We use that here for 20-someyears.
And most big systems around thecountry use electronic health
records.
For our listeners, describe,first of all, what is the
electronic health record?
What are you talking aboutthere?
Speaker 03 (01:56):
Oh, boy.
The electronic health record isbasically the repository for
all of the clinical care that isgiven to patients.
The electronic health record isused to communicate between
providers and others in the careteam.
It's also used to track thecare progression and what kind
of interventions are done.
We use the electronic healthrecord to communicate
(02:17):
diagnostics.
And it is a huge repository ofso much information, and it
follows the patient's continuumover a course of time.
There's thousands uponthousands of data points for
each individual patient.
And so the electronic healthrecord is how we convey the care
that is given to patients.
Speaker 02 (02:37):
So I grew up in the age of the paper charts.
We used to have to go to thebasement of this hospital, this
very hospital we're sitting in,and get a grocery cart.
It was a grocery cart.
And we would have a stack ofmanila folders full of paper
records, and I would have topour through those.
So if you wonder why yourdoctor or your nurse
practitioner didn't know thatyou had a CT scan 18 years ago,
(02:58):
it's because it was buried inthis paper chart.
So the electronic health recordhelps a great deal of that.
That's why there's computers inthe exam room.
But talk about where artificialintelligence now, that's the
main topic of today, that'sdifferent from the electronic
health record, right?
Speaker 03 (03:13):
Right, right.
So artificial intelligence isbasically helping in the
circumstance and what we'regoing to be talking about today
is helping providers put theirthoughts into the electronic
health record to take theinformation between a patient
and a provider and put that intothe health record in a way that
is clinically meaningful to notonly the individual provider,
(03:35):
but the patient as well.
Speaker 02 (03:36):
So that might be a little bit scary to some people.
You're going into your visitand now we're talking about
artificial intelligence.
How does
Speaker 03 (03:43):
it work in health care?
So right now there are a lot ofdifferent use cases where it's
basically taking artificialintelligence, takes existing
information and constructs itand puts it into a way that is
digestible, that's meaningfulfor providers and patients.
It can help predict diseasetrajectory.
It can help predict whether ornot a patient is going to be
admitted to the hospital or ifthey are at risk of
(04:06):
deterioration.
There's different models in howAI is used in healthcare.
The one way that we are usingit predominantly is to basically
be present during a clinicianand patient visit.
And during that visit, arecording is basically taken.
And the AI takes thatrecording, leans on algorithms
(04:27):
and large language models tobasically help generate a note,
a clinical note for that visit.
And what that leads to issubstantial reduction in the
effort that it takes for aprovider to put together the
note for that
Speaker 02 (04:42):
visit.
So are the clinicians, doctors,nurse practitioners, physician
assistants, are they embracingthe technology in general?
Absolutely.
Speaker 03 (04:49):
Absolutely.
As you had talked about, weused to do diagnostics.
documentation and conductorcare through paper, right?
And now so much of that hastranslated into the electronic
record.
And what that did, it shiftedan immense amount of burden from
just writing in paper tohanding off that administrative
burden to clinicians, toproviders, to nurse
(05:10):
practitioners, to doctors.
And on average, for a visitprior to AI, it would take on
average about 10 to 12 minutesper visit for a doctor or nurse
practitioner to type up thatnote.
Because they literally And theytype it.
Patients probably see it whenthey're visiting with the
provider.
Oftentimes, the provider isthere typing away, looking into
(05:31):
the computer.
Not at you.
Not at you.
You know, missing that reallyimportant dialogue, that
face-to-face dialogue.
I hear it in my friendnetworks.
It seems like I went to thedoctor and they didn't pay
attention to me.
And with AI, the provider, theclinician, can refocus their
attention to the patient,knowing that in the background,
(05:51):
all of that really fine, crucialclinical detail is being
captured and put into theelectronic health record.
Ultimately, it's myresponsibility.
It's our responsibility asclinicians to authenticate and
make sure that information isaccurate.
But the reduced burden and thereduced cognition and effort to
remember that information isparamount.
(06:11):
And there has not been anyother technological solution in
my experience as a clinicalinformaticist that there has
been with this AI scribe.
Speaker 02 (06:20):
Yeah, you know, and with apologies to all those who
developed the electronic healthrecord, I spend an extraordinary
amount of my time typing.
You know, I went to medicalschool.
I passed a couple classes inscience, but the most important
class I took in high school wastyping.
Yeah.
You know, I'm a good typer, andit's helped me out a And what a
kind of a silly thing to haveto say, but I spent a good
(06:41):
portion of last Saturday morningtyping from my dining room
table, my clinic notes.
And it took a great long timejust to type them even as a good
typer.
And I don't think that that isprobably good for your
healthcare.
So your clinician has twooptions.
They can sit and type on thecomputer while you're in with
them and then they're notlooking at you, or they can do
(07:03):
what I actually do choose to do.
I tell myself, put your handsoff that keyboard, take your
hands off that keyboard, takeyour hands away from that mouse
and look and talk to yourpatient.
But the price I pay for that,It's Saturday mornings I'm
typing my notes because I didn'thave time during the day.
So it seems to have clearbenefits.
But what do you say to patientsabout your being recorded when
you're at one of your mostvulnerable moments?
Speaker 03 (07:23):
Yeah, it's a great question.
And transparency and beingforthright is really important.
And we do ask permission and weare forthright with informing
patients that we are doing arecording.
We're using AI to generate thenote so I can spend more time
focusing on you.
And so we keep that level oftransparency.
And I wouldn't even say sellingpoint, but putting this back
(07:45):
into kind of going back to theearlier point that I think
there's been a large contingentof patients who have felt like
their visits have become alittle bit less ingenuous
because of the distractionsbecause of the electronic health
record.
And so patients have been verywilling to accept this
technology.
by and large.
Sure, there are some examplesin some cases that there's a
(08:08):
level of trust or a reason thatthey'd rather not partake, and
that's okay.
We can always fall back totyping or doing traditional ways
of doing our documentation.
But we are forthright, again,with this technology and that it
is present.
And to be honest, AI solutionsare only going to be more and
more prevalent in healthcarebecause of the substantial
(08:28):
benefits that it does promise,especially within a complex and
highly regulated industry.
Back
Speaker 02 (08:35):
to that exam room.
Speaker 03 (09:03):
consent process that I just spoke to.
But basically at that point, Ipress a button on my phone and
during the entire visit, thatphone is recording.
You just set it there on thedesk.
Just set it right there inbetween us.
And we'll see if thattechnology changes in the
future.
It likely will.
But for right now, it's justusing your own personal device
and app on the phone.
Really slick, really easy touse.
And that's the thing that'sreally enticing about it is
(09:25):
because so many solutions andtechnology are hard to embrace
or hard to deploy or hard toincorporate into clinical
workflows.
This is really, really easy.
One, it's really easy to adoptand the impact is so
substantial.
Speaker 02 (09:40):
So this might come as a shock to you and others,
but I'm a very verbose guy.
In fact, I barely can, I nevershut up.
What does, how does this thingknow?
How does this software knowwhat I want put in Jane Doe's
medical record and how much I'mjust shooting the breeze with
it?
Yeah, yeah.
I shoot the breeze.
I'm talking to them about theirtrip to Norway for the first 10
(10:01):
minutes.
And does that have to all go inthe chart?
Speaker 03 (10:03):
It doesn't.
And And that's the reallyimpressive component of this is
that it relies on past medicalinformation and data to filter
out some of that conversation.
It's going to filter out someof where was that recent trip.
But it may include somethingalong the lines of patient is
having food insecurity or thereis a difficulty with something
(10:24):
at home.
It will incorporate that.
And at the same time, it'scrucial for the clinician to
review one of those notesbecause maybe it did miss that
for you.
You wanted to include thosedetails on that trip to Norway.
You might have to just typethat little bit in.
Or maybe it includes a littlebit of something that, you know,
that didn't need So you mighttake that out of the note.
So that's a balance.
But to answer your question, itdoes a really good job of
(10:48):
filtering out some of thatchit-chat that is really
important for that humanconnection between a patient and
a provider, and also includingthe really important clinical
information.
Yeah,
Speaker 02 (10:59):
and I'll be honest with you, Brian.
I struggled with that when Ifirst heard of this stuff
because to me that knowing thatmy patient took a trip to
Norway, I'm just continuing onthat example, matters.
It really does.
I know what they like to do.
I know that they like to gohiking or I don't know.
I know that they like to gocamping in the jungle where they
pick up tick-borne diseases.
So it is kind of relevant togetting to know people.
(11:21):
And so I don't want to lose allof it.
But then again, I don't need towrite a Herman Melville novel
every time in their note.
Speaker 03 (11:28):
Absolutely.
And that's the balance.
It learns based off of pastexperiences and a huge amount of
data.
But it can't quite get to thepoint where it's going to be
really specific and individualto that individual provider
because we all practicemedicine.
We all practice advancedpractice nursing a little bit
differently.
And so there are the needs tomake those final curations to
(11:52):
the note that meet your personalneeds.
So here's a big
Speaker 02 (11:54):
question.
Who benefits from AI inhealthcare?
The hospitals and clinics, thedoctors and nurse practitioners
and physician assistants, yourclinicians, patients, who
benefits?
All of these.
above in my opinion.
So first
Speaker 03 (12:07):
and foremost, this is driven towards providers.
You know, when I look at ourhealthcare system, our
clinicians, advanced practiceproviders, physicians, nursing
staff, therapists, they are thebedrock to a functioning
healthcare system.
And right now, that's at risk.
You know, in a recent studyfrom the American Medical
(12:27):
Association, I think this was acouple years ago, 20% of
physicians are consideringleaving practice in the next two
years.
Right?
That's a scary situation.
And in primary care, there's a
Speaker 02 (12:36):
shortage of tens of thousands predicted for the next
decade.
Speaker 03 (12:39):
Right.
And that also translates intosome providers are needing to
reduce their time spent inclinic because the complexities
have just grown so immense.
Right?
So there's the provider benefitto this from a wellness
perspective and being able toretain our clinical workforce.
Right?
And taking these administrativeburdens off clinicians have
already shown.
We have some statistics andsome of the work that we've done
(13:01):
here at Hennepin on that space.
From a patient perspective, wehave already alluded to already
that patients stand to benefitto have that more human,
authentic connection betweenthemselves and their clinician
because the clinicians aren'tfeeling like they're struggling
for survival, needing to typealong that entire visit.
And so patients have shown thatthey benefit from the
(13:25):
eye-to-eye contact, that humanlistening, that full
attentiveness through the visit.
Studies have shown that.
Many of my colleagues arereporting that as well.
All of this translates into theorganizations themselves
because, again, organizationsneed to retain their staff right
now.
They need to retain theirclinicians to be able to
continue providing care topatients and the communities.
(13:45):
There's a substantial benefitto the organization in investing
in a tool that has this muchimpact straight away because
there are so many things that wehave tried along the lines of
improving efficiencies andthings for clinician wellness.
Nothing really has compared towhat we've seen with the AI
Scribe solution.
Before the break.
Speaker 02 (14:04):
Last question is, are outcomes better?
What portions of healthcarehave improved in the few years
it's been
Speaker 03 (14:10):
being accepted?
Yeah.
And a lot of the data, a lot ofthe information really centers
around that provider wellnessexperience.
We have around 140 or 150providers here at Hennepin using
this solution right now.
And we did a study not too longago of the first 60 days, okay?
Symptoms of burnout and feelingoverwhelmed went down by 30%.
Job satisfaction went up by30%.
(14:33):
Stress at work went down by 13%as well.
Those are pretty substantial,staggering statistics.
Within that as well, we werealso able to pull information
out of the electronic record tosee the amount of time that
providers are spending doingtheir clinical documentation.
There was a 40% reduction inthe time spent that providers
(14:55):
are typing their notes.
So each note is taking aboutfive to six minutes less on
average.
The other component that we'relooking at is over the course of
the day, we've had someproviders that are spending an
hour less per day ondocumentation.
That's five hours in a week.
That's a lot of time that thatprovider is getting back to
focus on other areas of clinicalcare are also on themselves so
(15:17):
they can get home and not doingtheir documents.
Maybe go see their kids.
Go see their kids, notcompleting results on the
sideline of a soccer game orspending time being able to
attend to their parents becausetheir parents are aging.
All of those things.
Because what you're talkingabout here is pajama time,
right?
Pajama time.
What's pajama time?
Pajama time is that time spentin the electronic health record
(15:38):
in those overnight hours,typically starting at 7 p.m.
and ending at 7 a.m.
So we can measure
Speaker 02 (15:43):
pajama time by that clinician that you're sitting
with, that advanced practiceprovider, that doctor.
We can measure how much timethat person is spending off
hours in the electronic healthrecord.
So that was a great discussionof what AI and what AI scribes
can do.
But now we're going to take aquick break.
And when we return, Brian'sgoing to cover the safety and
privacy aspects of thetechnology.
(16:04):
And I hope you'll address themillion-dollar question, Brian,
am I going to be obsolete?
Is AI going to replace peoplein the future?
Don't answer it yet, but that'swhere we're going to talk about
after a short break.
Stay with us.
We'll be right back.
Speaker 00 (16:19):
When Hennepin Healthcare says, we're here for
life, they mean here for you,your life, and all that it
brings.
Hennepin Healthcare has ahospital, HCMC, a network of
clinics in the metro area, andan integrative health clinic in
downtown Minneapolis.
They provide all of the primaryand specialty care you'd expect
to find, as well as serviceslike acupuncture and
(16:41):
chiropractic care.
Learn more athennepinhealthcare.org.
Hennepin Healthcare is here foryou and here for life.
Thank you.
Speaker 02 (16:56):
And we're back talking with Brian Imdicka about
artificial intelligence and AIscribes in healthcare.
Okay, so Brian, you've talkedus through what it is, but it's
natural to think, oh mygoodness, somebody's listening
to my personal stuff.
What is your first response topeople when they bring up
questions like, oh, I don'ttrust this?
Speaker 03 (17:15):
I validate that question and that concern
because in this day and age ofinterconnectivity and how data
is shared, whether it's withinhealthcare or outside of
healthcare, we have to be verycognizant of that.
Patient health information,protected health information is
the cornerstone of somethingthat we hold very highly dearly
in healthcare and here atHennepin.
What we call PHI.
(17:36):
PHI, right?
The PHI, it's almost in theinitial, anytime that we are
working within the organizationor outside the organization, it
is fundamentally crucial that weprotect that.
And so when we were going downthis path of considering an
AI-scribed solution, that wasparamount.
We worked very closely with ourlegal team.
We worked very closely withwith our patient privacy team.
(17:58):
We worked very closely with ourcompliance team to make sure
that our relationship with ourvendor made it sure that we
respected PHI to the utmostdegree.
And those values were sharedvery much by our vendor as well.
How information is shared togenerate the clinical note is
protected and encrypted at avery high level.
It exceeds any regulatory orcertifying bodies.
(18:20):
And again, it comes down totransparency as well with
patients that we conveyed thatthis is something that we are
using.
And that PHI, again, issomething that we hold very,
very dearly and is of the utmostimportance.
Speaker 02 (18:33):
But Brian, I'm coming to you.
I'm telling you all about mypersonal problems and you've got
your phone recording me.
How do I know you're not goingout to happy hour with your
clinician friends and you'relistening or you're talking
about, let me play this back foryou.
Okay, I'm being cynical.
Speaker 03 (18:48):
No, no, that's okay.
That's the first time I'veheard that exact question.
And to be honest, I don't haveimmediate access to that
recording.
And So to answer that specificquestion, we as healthcare
providers are held to the samedegree of privacy security.
We can only use a patient'shealth information or components
(19:08):
of a visit for clinicalpurposes only.
There is not to be used forsharing stories or is not to be
used for personal gain.
All of that is strictlyprohibited and the same concept
applies with the AI Scribe
Speaker 02 (19:22):
solution.
It really does.
Your information is in there inthe electronic health record as
well, and that is protected 14ways from Tuesday as well.
Speaker 03 (19:30):
Yeah, this is ultimately not a new concept.
It's just highlighted becauseof the recording aspect and that
recording is ultimately shared.
That's what maybe sets it apartfrom other solutions that we
currently have.
Speaker 02 (19:43):
So the million dollar question is, is this
going to replace you and I?
Is this going to replace theclinician?
Is this going to replace all ofus?
Are people just going to getall their health care from a
machine?
Speaker 03 (19:54):
Short answer to that, in my personal opinion, is
no, right?
And I feel, and I think that isreally established not only by
myself, but others who are veryknowledgeable in this field, is
what this solution has promotedis that reconnection that
human-to-human connection thathas been lost by a lot of the
distractions and the burdens andthe obstacles in the healthcare
(20:15):
delivery system.
In this particularcircumstance, clinical
documentation takes a lot oftime.
Reducing that and that time isreinvested into that
human-to-human connection thatis backed by that clinical
expertise.
And so I don't ever see AIYeah,
Speaker 02 (20:32):
and that I think is reassuring and actually does
make some sense if we could haveAI replace some of these
documentation tasks.
I have also heard, though, thatwhen you run diagnosis through
AI, it's better than I am.
And so there must be moreapplications.
In other words, you put in your12 symptoms and ask a whole
(20:53):
bunch of guys like me and thenask AI, AI might be right.
I mean, a computer beat theworld's best chess player.
It's probably true that it'sgoing to beat the world's best
diagnostician too.
So there must be other roles inwhich it is helpful.
So to round out this episode,could you sort of talk to us
about the future?
I get it that you can't predictit any better than any one of
us, but what do you see?
(21:14):
What are some of the cooladvances You
Speaker 03 (21:17):
know, there's a short-term and a long-term
answer to that question.
I think short-term, there aregoing to be the things along the
lines of how AI will helpsuggest orders and diagnostics
for a particular visit.
I talked a little bit earlierabout how the EHR is full of
thousands of data points for anindividual patient.
(21:37):
AI can help summarize those, sowe're making sure that we're
capturing all the clinicalinformation that could be lost
otherwise, and so there is theability to to do chart
summarizations.
There's also a future in wherethis is not just for nurse
practitioners, physicians,assistants, doctors.
I see this being a solutionvery soon for nursing.
I think that's reallyimportant.
Our nursing colleagues arefacing similar burdens and
(22:01):
attrition that physicians andadvanced practice providers are.
So on a short-term basis, I seethis broadening.
This is going to become moreand more ubiquitous in care.
It's going to be part of thehealthcare delivery.
I think in the what is thatinformation and how can we
capture patients' experiencesthat are happening outside of
(22:23):
the conversation between theprovider and the patient?
How are we capturing impact ofmedications and taking
medications?
What are the socioeconomicfactors that are influencing a
patient's care?
How is a day-to-day livedexperience from a patient being
potentially captured with AI ina collaborative and with all the
(22:43):
safeguards that we've alreadytalked about?
So we have So I really
Speaker 02 (22:52):
like what you said there, especially when you
talked about nurses and others.
Because, folks, you reallydon't want your nurse sitting at
a computer documenting what he,she, or they do all day long.
You would rather them be doingthe high-level skills that
they're trained to do.
And so it's all overhealthcare.
Your therapist, your physicaltherapist, your OT, all of the
(23:12):
aspects of healthcare, it couldbe more than just you and I in
our lives.
So I really like what you saidabout that.
So Brian, to close us off.
What excites you the most, ormaybe what worries you the most,
about AI in healthcare in thefuture?
Speaker 03 (23:26):
Yeah.
I think what excites me mostwith AI and what we've
experienced in these earlystages is that substantial
reduction in the burdens thatclinicians face and the ability
to focus more on patients, tofocus more on themselves, to
find more fulfillment inpractice, and to have that
better human-to-human connectionwith patients.
That's why all of us went intomedicine.
(23:48):
That's why all of us went intois to help people.
And again, there's been so manyobstacles to that human
connection that AI really has anopportunity to help get us back
to that human connection thatis lost beyond just in
healthcare right now in my mind.
So that's what really excitesme.
(24:08):
I think there's so much morepotential down the road and this
will change very quickly.
I think the thing that scaresme most is that if we rest on
our laurels and say, yep, wehave AI scribes and we can There
is so much more that we need todo to fix our antiquated
healthcare system right now.
And just to reduce cliniciandocumentation burden and not
(24:29):
focus on the larger picture, wehave to keep going.
We have to look at new waysthat we interact with patients.
We can't continue to go downthe current ways that we're
delivering care.
And so how do we leveragetechnology?
How do we leverage the peoplewho are doing the work and the
processes to ultimately makethis a better experience for
everyone, patients andproviders?
(24:49):
That's brilliant.
and Brian, if there's anythingAI could do, what would you wish
for?
Getting more of a holistic viewof what is impacting our
patients' health and what ourpatients' lives are, right?
Again, so much is focused onthose 15 to 20 minutes that we
have with patients.
We can't crack the surface.
How can AI broaden ourunderstanding of patients' lived
(25:10):
experiences while alsoleveraging the improved
connection that patients havewith their providers?
And I think that that is what Ihope to see in Brian, brilliant
Speaker 02 (25:24):
advice.
And listeners, you're going tobe hearing, I guarantee you're
going to be hearing more aboutAI throughout your life, but in
healthcare as well.
And so I hope you got a glimpseof what that technology might
look like next time you go intoyour clinic visit.
Brian Imdik is probably thebiggest expert that I know in my
personal and professional lifeon the subject.
(25:45):
So Brian, thank you for beinghere.
It's my pleasure.
Thank you for having me.
It's been great hearing yourwise advice.
on a topic that affects us all.
Listeners, I hope you'veenjoyed this episode and I hope
you'll join us for the nextepisode when we will talk about
chronic obstructive pulmonarydisease with pulmonologist Dr.
Caroline Davis.
It's going to be a great show.
In the meantime, be healthy andbe well.
Speaker 01 (26:06):
Thanks for listening to the Healthy Matters Podcast
with Dr.
David Hilden.
To find out more about theHealthy Matters Podcast or
browse the archive, visithealthymatters.org.
Got a question or a comment forthe show?
Email us at healthymatters athcmed.org or call 612-873-TALK.
There's also a link in the shownotes.
(26:27):
The Healthy Matters podcast ismade possible by Hennepin
Healthcare in Minneapolis,Minnesota, and engineered and
produced by John Lucas atHighball.
Executive producers areJonathan Comito and Christine
Hill.
Please remember, we can onlygive general medical advice
during this program, and everycase is unique.
We urge you to consult withyour physician if you have a
more serious or pressing healthconcern.
(26:49):
Until next time, be healthy andbe well.
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