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Becker’s Healthcare Podcast
AI That Delivers: Adoption, Scale, and Impact at Endeavor Health, UPMC, Reid Health, and Duke Health
00:28:09
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- [00:00]
A
Welcome everyone to the Becker's Healthcare Podcast. Today we're excited to bring you a special conversation that was recorded live at a Bridges Executive Summit which took place during Becker's 10th annual Health, IT, Digital Health and RCM conference in early October. This panel is moderated by David Claxton, Senior Consultant for AI and Technology Enablement at Duke, and he was joined by an outstanding group of healthcare leaders. Chris Carmody, the CTO and Senior Vice President upmc, Misty Faust Cofield, Vice President and Chief Nurse Officer at Reed, and Justin Bruick, the System VP of Innovation and Research at Endeavor. Together they explore the real world impact of AI in healthcare, diving into adoption, scalability and outcomes. You'll hear valuable insights and actionable takeaways that you can bring back to your own organization. We'd like to say a big thank you to Abridge for sponsoring this one of a kind summit and for helping foster these important conversations. Now let's jump into the discussion.
- [00:57]
B
Well, thank you all for joining. 40 minutes is not going to be enough for this, so I'm just going to dive right into it and let you all introduce yourselves a little bit more as we go through this. But today I really want to talk about a few different things and a lot of it is experience with Ambient as well as partnerships with Abridged and get into your experience in that. So at Duke, we decided in late 2024 that ambient was going to be something that we were going to go full in on and we wanted to do it more from the provider experience comb burnout than really trying to have providers see more patients. So for us it was really provider well being and we went through a head to head competition. We did a crossover study. We're an academic, so we tend to get very deep into these surveys and these studies can be good, can be bad, but for us it was a pretty clear winner of who we wanted to go with and who our providers felt was a good partner and a better solution. And it took us about two months to do that survey and then we decided in early January to go full bang. So we took a different approach than some other places. We went full bang out of the gate and to date we're at about 2,500 clinicians using a bridge technology across a wide variety of different specialties, different roles. We're in the inpatient setting as well. And what I want to learn from you all is what was your experience? How did you come to to utilize Ambient? How did you come to the determination of going with a bridge and Similar experiences. Different experiences. As you've decided to expand, we'll go ahead and start here.
- [02:34]
C
Sure. So I'm Chris Carmody. I'm the CTO at upmc. And our journey is a little unique because that gentleman over there in the corner trying to leave actually still practices medicine at upmc. So we were part of the origin story of a bridge at UPMC in terms of developing the technology and. And providing a living lab for a bridge to evolve and form. However, we still put them through the wringer. We actually went down the path. Couple things happening. We were coming from nine electronic health records, main systems, a little over 3,000 applications connected to those nine different applications across 42 hospitals, mostly in Pennsylvania. And we made the decision to move to EPIC and actually just went live for half of our health system on Saturday. So if anything proves partnership, me flying here this morning and showing up two minutes ago, I think that that should speak for itself. But in our journey to prep for the EPIC project, kind of, you know, to create that foundation, we knew that we wanted to evaluate and leverage the best technologies to advance our organization. And ambient obviously, being one. So the latest stats I have, we're about 1800 physicians that are using it. It's mostly primary care, but it's starting to trickle out beyond that. But with our go live on Saturday and then a future go live for the rest of our organization, we're going to jump up to probably 7,000 physicians using it. And then we have a whole plethora of items that we want to do in leveraging the technology that we're talking with Shiv and team at Abridge. So we see this as a great partnership, a way to advance, and not necessarily. I just read this the other day from a good friend working underneath the shadows of epic. I think EPIC is kind of the baseline and we're building off of that with innovation. And again, a company like abridged to help us transform patient care, which is why we're doing all this work.
- [04:45]
D
There wasn't the lightning bolt that came from the sky when you said that. That was really good.
- [04:50]
B
That's great. Misty, I know you have a different experience. You were launched with your nursing staff, which is something that we're really interested in. So I've already told you I'm going to be pinging you and we're going to be new best friends, but I'd love to hear the experiences that you've had with nursing and just give us a little background on how that's going for you.
- [05:09]
E
Absolutely. Misty Faust, Cofield, Vice President Chief Nursing Officer at Reed Health in Richmond, Indiana. So as you shared, we are working on our launch with nursing, which we are so incredibly excited about. So just to give you a little bit of background, we did fully launch on our ambulatory side. So with all of our outpatient clinics and just for full understanding of our medical staff, about 95% of those individuals are employed and about 90% of those physicians and apps have chosen to select a bridge. So we noticed quickly how wildly successful this was on the ambulatory side and I thought we need this for nursing. So we quickly engaged with a bridge and what we've been able to do with the focus truly being on human connection and bringing the joy back to the work at the bedside. Many of you know nursing is about the art of nursing and the science of nursing. But a bridge has allowed us to really focus on the joy in nursing. And we are rolling out with a medical surgical unit in two weeks. So we went through the entire ramp up, all the preparatory work and are so excited and I'll share more later on, but so excited about the rejuvenation that we've already seen in our staff, just knowing that how this is going to change their practice moving forward.
- [06:36]
B
Thanks, Missy. That's outstanding. Justin.
- [06:39]
D
So Chatham House rules here, right? So I'll say that, you know, Bridge all the different companies that exist out there, the reason that we were interested in this is our physicians were pissed, they were disengaged, they were angry. We are coming together as a brand new system. So anybody know who Endeavor Health is? We're formerly North Shore University Health System, Edward Elmhurst Northwest Community Swedish Hospital. So we're now Endeavor and we had to bring all these clinicians to the same platform. We had to get them excited about joining and basically giving up the autonomy of their own brands, their own communities, their own ways of working. And that did not make people happy. And in fact, our employee engagement for our physicians was in like the first percentile or something like that. I mean it was that bad. So in my role, I oversee innovation and research for the system. And so anything that I wanted to do was a hard no, clinicians did not want to engage if we showed up. Oversee our center for Personalized Medicine and Genomics. Try going and explaining the need for a physician who never learned about genomics to need to order genetic tests when they have a pile of, you know, this high and they're not engaged. And so for us, the reason that we actually looked at this was how do we solve for we'd call it brain width, time width, all these different things, so that they actually could find space to engage in these other things. And I will tell you, if we had not been able to solve for the burnout factor for just their overall experience, my job would right now be even harder because there would not be a willingness to see innovation come to the table.
- [08:18]
B
We touched upon this a little bit, but I want to dive a little deeper into. It is the partnership that we've experienced at Duke, and I'd love to hear your experiences as well. So for us, as you mentioned, this is one of the only technologies that I've ever been a part of where people are sending me thank you emails and very happy to be using it, which is something totally different than I'm used to. Usually. It's why the hell are we doing this? However, with this and some of the specialists who think the notes could be tailored more towards their specialty or there's things that they think it's missing even when they have those issues arise, the partnership that we've seen with Abridged has just been something that we. We haven't experienced before. It's always receptive. It's always looking to improve the product. It's always doing things in a timely manner, and it really feels like a true partnership with them versus just a commercial contract. And I'd love to see. I like to think that Duke's special and our physicians definitely think that. I like to think it's only us, but I'm sure it's not. So I'd love to hear a little bit more about how it's been for y'.
- [09:18]
D
All.
- [09:19]
B
Okay, so you're a little different because they were born out.
- [09:21]
C
Well, they were born, but, you know, it's. It's still a challenging environment, especially when, you know, we're coming from a position of being from behind. Again, as I mentioned before, just having the non ehrs and trying to do something innovative and doing at scale for our institution, but building upon your experience, I would say we're in the same boat. And I would take it a step further that the cool part of working with Shiv and team is actually bringing forth new ideas. Some of them crazy, but some of them very applicable to get at the problem. Solving what is a problem at UPMC and how we prioritize that is probably different than how Duke does it. And I think that's what makes this relationship very unique, is listening and understanding and what matters to us. Again, it's not some press release kind of thing. It's, hey, we have this problem, we have this challenge. Some of the areas that we're looking at right now just to share, like ptot, home health, those types of areas. And there's some other crazy stuff that I'm not going to mention until we vet them a little bit further. But that's the unique value that we've seen in our partnership.
- [10:28]
B
Great. Thanks, Misty. How about what you've seen so far, especially from the nursing standpoint? Because I know that's new in the grand scheme of things. And I think that for us, year of 2025 was clinicians. Let's get our providers on ambient. I think 2026 is going to be a lot around nursing and how do we improve nursing happiness? How do we improve their efficiencies? So I'd love to hear a little bit more about the partnership with you.
- [10:54]
E
Absolutely. The partnership with the Bridge has been simply amazing. They've been very open to feedback. Sometimes myself and my team have wild ideas which they welcome, and they're incredibly open to us pushing them and to them pushing us, which makes us better. So we're very, very thankful for that. And one thing that our team quickly noticed with a Bridge was this was a tool designed to fit their workflow, and they were not reworking their workflow to fit a tool. So they were eager to share and have been nothing short of great partners, have been on site with us for simulation so that we can continue to tweak the product, the rollout, have been in the trenches with our teams day in and day out. So it's been nothing short of exceptional. So I'm sorry, it doesn't just happen at Duke.
- [11:49]
B
That's all right.
- [11:50]
D
Our experience has been the complete. No, I'm kidding. The. The way that I think about this, really, it's back to the idea of coming at you with a sales team versus a team that's really a solutions team. And I feel like that's how our team really viewed a bridge, is they were coming with a team of people that were here to help. And I think about the amount of trainings that we did and the amount of webinars and we had webinars that physicians would stay on beyond the half hour, beyond the hour to the hour and a half, just because they got more and more excited about it and the team was there to listen to them and they didn't just hang up and say, next call. So I think that was the idea that it wasn't about selling. It was really about people who were excited about the solution and what it could do.
- [12:42]
B
We had very similar experiences with the amount of webinars. I'm sure that we would have cut some back if possible. But I think it just speaks to the overall there. I use the words customer service and I think it's just again, something that we haven't seen in healthcare before, at least I haven't seen in recent years. So again, I think it's something that based in their core, the technology obviously works. But I think the true call to customer service is something that we've really appreciated at Duke. We've talked again a little bit about it and I think in general everybody knows the reception from clinicians has been outstanding. I'd love to hear a little bit more. Maybe we start with you, Justin, on how has it been for you with your clinicians, how has it been with patients and the experiences that they've been having so far?
- [13:33]
D
So we went live with our first physician office in September of 2024 and it was like a 50 patient pilot that was supposed to run I think six months. Maybe somebody on the sales team had a target to hit. So by January 1, somehow we had signed an agreement to go to 1000. But it was because of what we had seen in the data. In our first pilot data, we were looking at this again from a burnout perspective. And we've now had the ability to do pre tests, post tests and all those things. And I think the latest that we've seen is it's about a 40% reduction in what our physicians perceiving to be having one symptom of burnout. And so that in itself we haven't seen anywhere. In fact, burnout has just continued to go up against all the other pressures that they have. So that was signal to noise ratio that really came through 200 providers in that study. Another thing that we've been looking at right now is overall level of adoption and how does that adoption actually translate into the physician's perception of their ability to spend dedicated time, face time with patients. And actually we've seen that go from 50% of physicians saying that they felt they could do that to over 80%. And so those are the things where it's like getting back to the joy of practice, being able to spend the time those are there. And there is going to be some literature published hopefully in the next couple months. Here they're just wrapping it up. That speaks to what happens if you have providers who are using the tool greater than 75% of the time versus those who are using it less than 25% of the time, with some pretty significant statistical improvement on patient satisfaction and experience.
- [15:10]
B
Thanks, Justin. Misty.
- [15:11]
E
Sure. On the ambulatory side, I can share that. Our pajama time, that's something. We're an epic house. So we measure pajama time, which is the time the physician spends or app spends in the chart after work time, and we decrease that by almost 90%. Our urgent care location is our highest utilizer of a bridge, and we had eight apps who were getting out three hours late, especially during viral season when it's very, very busy, who are now finishing on time. Our patient experience scores have increased dramatically across all of our locations that we have utilized a bridge. So that when recognizing that and then seeing how that translates to the nursing side, I can tell you that we have not made this mandatory for our nurses to join with a bridge and be part of that. But it has quickly as the champ have been selected and they're talking with their peers. We have nurses coming every day. One of my colleagues is here. She can attest, I want the training. I want to go live. I want this to be part of my practice because they see the cognitive workload and the burden that this will decrease and actually allow them to get back to the joy of what they're doing. So I am incredibly optimistic that this will decrease the burnout across the system for our nursing staff. And we also plan to use this as a recruitment and retention tool.
- [16:37]
C
I've been told numerous times, again, amid all the change that we're going through at upmc, that if we take a bridge away, they're going to quit. And that's not just Shiv. It's many more than just him. And honestly, that's. As I mentioned before, we've sort of held back our deployment because we had all this other change. The ground is shifting beneath them. And honestly, most of our physicians don't even care what we're doing with the ehr, but they care about using a tool that actually makes a difference, taking away, reducing that cognitive burnout. And then when you talk about the patient care aspect now, they're turning and actually talking and having more engagement. So we've seen as well, improvements in the patient satisfaction scores and that sentiment analysis that we're also doing with some other NLP modeling. But it's been, it's. Again, I'm excited not only to get past this, go live, but to actually fully deploy a bridge across all of our physicians and really focus in on where we can take it. And then we have A big project to go after nursing documentation. We just, we just deployed 9,000 iPhones to our nurses to use like Rover. But again, Abridge is going to be so instrumental in helping their, you know, their flow sheets and nursing documentation as we move forward.
- [17:57]
B
So I'm going to go a little off script here and Guru may kick me out of doing any of these in the future. But my question in general is where have you seen challenges? How have you combated them? How has a bridge helped you through those challenges so far? Misty, you want to go ahead and start?
- [18:11]
E
Sure. Happy to. I think one thing at our organization, technology can be a four letter word. So our approach to a bridge has been more of a cultural initiative and not a technology initiative. So a cultural initiative in the sense that this is something that we want to bring to our patients and to our caregivers. So not a technology that you have to fit your process to fit this piece of technology. So I think our approach has been a big something that is different with a bridge. So that's been something that's been vitally important as we've rolled this out.
- [18:50]
D
So just some anecdotes that we have from our system. So people said that our older clinicians were going to be a little bit hesitant to this, to use this. And actually over 30% of our users are 20 years plus in practice. And that's where you get those stories coming out of. I'm going to practice for another five years because of this. And we have several clinicians that will say that in front of anyone. This has changed that. So the other side of that is physicians who are just magically efficient. Right. And there's no need for them to have this tool. And what we've actually been able to go back to them and say, let's just dissect your workflow. You're right. You can actually knock out a note in two seconds. Great. But listen to what we're seeing throughout the rest of the system. We're seeing that for the same number of patients, the level of service that we're capturing through this is increasing. And so RVU productivity is going up around on average for our system, about 6.5% per provider. So would you be willing to give it a shot, given you're on an RVU productivity model, to see if this might be able to help you? And those are those kind of small one offs that you have to have because again, the very productive clinicians are often the ones that don't need a lot of technology. So you have to come at them with a different angle. And I think they're starting to see that there is truth in that. There are some specialties, however, where it just doesn't make sense. What we're looking at it now is deploying it at the right time. So new patients is a very different use case than having an existing patient. So for a lot of our specialists, they are using it for that new patient.
- [20:22]
B
I love that approach. And to piggyback off that a little bit, where we've seen some of the resistance in our surgical specialties when they use it. The nice thing about it is you don't have to use all of the note, especially for new patients, they find tremendous value in the HPI and saving them a lot of time. So I think it's. For us, it's get them to try it. That's the hardest part. As soon as they try it, they fall in love with it and then. And then they're continued users. We see generally 85 to 90% of somebody that's used to continue to use it, which I think is an outstanding statement there. Love to hear your experience.
- [20:57]
D
Yeah.
- [20:58]
C
I mean, again, because. Because of the situation we're in, I think it's more the word of mouth from other clinicians that are, that are other physicians that are using it. So the demand is there. So I think there's very little resistance at this, at this point juncture right now, but we'll see as we move along. And I think with any new technology, any change, you're always going to have these people that are so resistant and that's that small percentage that you honestly, you want to move out of your organization anyway. So that's my perspective.
- [21:28]
B
So let's be a little provocative with this next question and maybe put a little pressure on a bridge while we're at it. Also, is where in the next two to three years do you see AI having the biggest impact in efficiency and workflow and provider satisfaction? I know at Duke we have a lofty goal, which may be a little bit science fiction, but how do we eliminate the computer almost completely from the, from the clinician workflow? I know that seems a little bit lofty, but between computer vision, between ambient, the things that are happening now, I don't think it's as far away as we necessarily think. And I think that just speaks to. We are centered around bringing back the joy and bringing back that experience between a doctor and patient. And I'd love to hear where you all are thinking in the future. Where are we going? Where can we Push a bridge together to get to Justin. You want to go ahead and start.
- [22:24]
D
So as I think about kind of the way that we've been applying a lot of these technologies, solutions, it's been applying them to our current practice. And I think what we need to do next is say, okay, we now have these tools, go back to first principles, thinking, and say, why is it that that problem exists in the first place? Can we start thinking about the care redesign that needs to happen and how AI can actually change the entire model? As everybody knows, we don't have enough clinicians. The current shortage is like 40,000 primary care docs by 2035. And so the question is, how are we going to care for those patients differently? And so my feeling is AI is going to have to play that role. And how do we start to divvy up and start to think, think about AI in terms of patient segmentation, all of those things, and how do you bring these tools to really meet those different patient populations? Selfishly, And I've shared this with the bridge team on the research side, I think about the fact that most clinicians, when they came out of medical school, they had this little flame inside of them that said, I want to change the world. And the reality is they come into a health system and immediately it's like, snuffed out. And the question is, is by us doing these things and creating the brain with the mind, with all those things, can they actually start to lean into what is the future of health care again? And part of that, for me, is, selfishly, clinical trials and trying to think about that next level of, now that we're seeing the patient in front of us, most primary care doctors are not thinking about, can I enroll a patient into a clinical trial? But if it has that whisper or that little note that says, based off the conditions, all these things that are at play here, this actually might be something interesting. And in primary care, as we're seeing the launch of more wearable technologies and things like that, my feeling is there's going to be more and more opportunities for us to do clinical trials in primary care. And there's no way you could talk about clinical trials to physicians in primary care unless you freed up a lot of time. So that's my hope, is that there's going to be this kind of wave of new technologies that start to push us into prevention, and we'll have created the space and time for clinicians to actually be able to have those conversations.
- [24:29]
C
Okay, so practically in two or three years, I think nursing is Going to be a big win for us. Now that they have that device in their hand, they can actually do more, have a better. Get back to that joy of providing clinical care and being compassionate and not have to be running around and worrying about what's happening in this room, that room, and in our hospitals. The one thing I'm excited about is getting rid of all the PCs everywhere. So we bought a lot of hospitals and there's some hospitals that have a PC in every patient room. With we have the wows, right? There's so many devices floating around. It's like, can we, like, simplify this world To Justin's point, you know, let's get back to like, the basics here, leveraging that technology. But I think from an AI perspective, our goal as a healthcare industry should be really with the amount of talented clinical people that we work with. And again, I'm speaking on behalf of IT people. We should enable them to do twice as much as they're able to do right now. So we should be able to empower, enable physicians to do, to see and care for twice as many patients. We should enable nursing and all the other service lines that we support to do more with what they currently have because of the shortages, but also the power and the reliability of the different technologies that are coming. And I think that's where we're going to see a bridge make huge strides. And again, not just that efficiency piece, and it's actually going to impact how our, you know, our patient safety and our outcomes are going to be measured. I think there's going to be a huge measurable difference versus where we're at today versus three years from now. Leveraging technology because having that data, that information sooner can launch and leverage the different AI models. You know, forget about the, you know, the, you know, the sepsis monitoring. There's so many more things that we can be doing. There's so many secondary diagnosis that can be addressed much sooner. So we should be able to do more. That's what we should be striving for. Not just kind of removing costs and getting rid of people, but doing more with what we have.
- [26:34]
E
I would absolutely agree with everything that's been shared with. We have to get rid of the wows. We call them at my organization BMWs, because they're so expensive and they're never charged that they are essentially useless. So my goal is to completely deplete the supply of WOWs. And we are very blessed that we have smart room technology in our room. So we know that when Misty the RN walks into the room, that caregiver has entered the room. So my thought is all of that care should happen out loud, activated when the clinician walks in the room. And then that's documented across the system. So not only for nursing, but pt, rt, everyone in the care team, that room knows when you're there, activates, records that documentation, and then we have that entire experience documented, hands free and we're there in the moment with the patient. A few other areas where I see huge opportunities. I provide administrative oversight to surgical services. This will be a great tool for surgery. So in the moment we can see speak what we're doing, we can document what we're doing, we can code and get paid for what we're doing appropriately in those expensive spaces. Procedural areas, cath lab. I also serve our ambulance services and I would see a huge opportunity with first responders as they're doing emergency activities. They could be speaking their work. So to ensure not to miss any of that vital documentation, they're in the moment providing that life saving care and we are capturing every minute of that through AI.