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Becker’s Healthcare Podcast
Suki & McLeod Health’s Three-Phase Roadmap for Scalable AI and Scribe Adoption
00:14:38
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- [00:00]
A
Hi everyone, this is Lucas Voss with Becker's Healthcare. Thanks so much for tuning in to the Beckers Healthcare podcast series. Fantastic to have you. Today we're going to talk about the three phases to success, McLeod's health roadmap for scalable AI scribe adoption. And joining me for that discussion is Dr. Brian Frost, CMIO at McLeod Health. Dr. Frost, thanks so much for being here today. It's great to have you.
- [00:21]
B
Thanks for having me.
- [00:21]
A
Absolutely. I want to start off with introductions for our audience that might not know you if you could just introduce yourself and give us a little bit of an overview of your organization.
- [00:30]
B
So I am Brian Frost. I'm a emergency room physician and chief medical information officer for McLeod Health. We are a seven hospital system in rural South Carolina. We're a non for profit hospital and non academic. And I think that's really important to kind of frame the discussion here because we do not unlike some of the larger health systems out there, we don't have a huge foundation. And so innovation is very dependent on finances. And so when we pick a solution or a vendor, we're very careful in selecting that vendor. The ROI has to be there and we really cannot afford to purchase a solution that is a lemon, so to speak. We've got to make sure that it is going to live up to whatever the solution is that we're. The problem that we're trying to solve, it really has to solve it, which.
- [01:20]
A
Has become very important, especially in a crowded AI space. And we know especially ambient AI has really become a strategic priority for our a lot of organizations. It's very important, it's risen to the top. What factors from your perspective have made AI scribes so important for physicians, but also for organizations from a strategic perspective?
- [01:42]
B
We knew this was an area we wanted to get into. And the problem that we're solving, everybody's solving, is physician burnout. I really don't like that term so much, but it's the cognitive burden of practicing medicine. It's the thing that sucks the life out of a physician who wants to get back to return to the joy of practicing medicine. And so, so we knew we wanted to be in this space, but we also one of the things I was very aware of, so in medical school they teach you do not take drug reps. When they give you free stuff, don't take it. And there's a reason behind that. Because they want us to be bias resistant. They want us to prescribe medications not because the vendor bought you breakfast that morning, but because they actually treat patients and Patients will get healthier. I wanted to approach vendor selection in a very similar fashion in this space. I had seen a lot of the advertising, I'd seen a lot of the demos. And so we put together what I'm going to describe as a bias resistant, multiphase approach to vendor selection in this space.
- [02:47]
A
And I want to talk about that approach a little bit more in detail. Can you walk us through it's three phases?
- [02:51]
B
It is.
- [02:51]
A
Can you walk us through those three phases? And you mentioned the bias piece. How is it minimizing that bias and how is it improving those workflows?
- [02:58]
B
Well, the experiment was fascinating to me personally, because I didn't recognize the problem with the unconscious bias is you're not conscious of it. So I was pretty sure that I was not biased, but I was also pretty sure my organization was. And so I put this experiment together to kind of prove to the organization that the vendor that I thought was best for this area was the one we should select. And boy, was I wrong. It was very humbling when I got to the other end of this experiment. So the first part of the experiment was actually pre phase, phase zero, I'll call it. I spent about six months vetting all the vendors in this space. I went through Avia Marketplace, I went to class, I went to various demos, and I excluded a majority of the vendors based on scalability concerns or financial viability. I didn't feel like they'd still be there in a year or two. And I narrowed it down to the top four vendors in this space. And these are common vendors that everyone knows and everyone is using and then entered those into phase one of the experiment. So, and I can't believe I the vendors agreed to do this. So let me just tell you what I did. We, together with some revenue cycle people at our organization, I put together 15 patient scripts. And these were very detailed scripts. They were describing pretty bread and butter cases that you might see in medicine. And I had three physicians, I had a cardiologist, a surgeon and a family doctor. Each of them had five encounters to see. And we got, we had basically actors come in and play the part of patients. And these were operational leaders throughout the organization. Like my cio, the chief of staff was on this. Our corporate cmo, Chief Quality officer, sir, was there. We had a lot of it. Senior executives play the patients. And these scripts were fun because they were very complicated. Their goal was to try to throw off the AI. So they had interruptions. They had, you know, family member actors who would interrupt the patient and contradict the patient. We had, like nurses would bust in the middle of the encounter and give extraneous information on a different patient. One of the encounters. I actually created the script and then right at the last minute for flipped it a little bit. This script, I had the surgeon. It was all about the surgeon. I made the surgeon be kind of a jerk to the patient and dismissive of the referring physician. Which is funny because the surgeon is not like that at all in real life. So it's fun for all of us to watch this. And the goal of this experiment was to see how well the note output was generated. And so the rules of the game were that the vendors had to be there in real time. They had to record these interactions between the patient and the physician. They had to send me the note output immediately following the interaction, so they had no time to edit the note. We took those notes and we ran them through three groups of people. We had revenue cycle experts, we had physicians, and then we had non clinical patients who would review the notes and rate them. And this was the part in the experiment where I became humbled because the vendor that I chose to be, the one that I thought the organization should go with, finished last place.
- [06:20]
A
Which is an incredible experience because you're. Again, it's a fast evolving space. I do want to ask a follow up to this. Obviously this is a very involved process. How important was it to actually run this exercise? And if you're talking with other leaders, is this something that you would recommend others do as well, to really make an informed decision?
- [06:41]
B
It's hard to do, but if you can do it, yes, because. And the goal is to get rid of unconscious bias. Commonly when you look at the various vendors or any vendor, I don't care which space we're talking about. It's so hard to remain objective and to look at. They all say the same things. Unfortunately, a lot of the vendors will say the exact same thing. It's not until you get a little deeper under the tech stack and you look at what is under the hood do you start to realize there's some pretty significant differences between the vendors. And that's definitely true in this space while we did this evaluation. So let's move into phase two of the experiment. Phase two, we had the two vendors that survived phase one come back and present their workflow to a broad group of physicians across McLeod Health. And the focus was on physician workflow. How well could you incorporate this into your practice? And so that's what they were evaluating. In parallel, we had the clinical Informatics department and the IT security folks really look under the hood and look at the tech stack, both from a security perspective, but also the just pure. What can this company do? Looking beyond ambient, because I'm pretty firm in my belief that if we're going to fundamentally transform healthcare delivery, we've got to go way beyond just ambient documentation.
- [08:05]
A
And then phase three is then the.
- [08:08]
B
It was the time to pick, right? And my CEO was great about this because my initial plan was to do a bake off between the two surviving vendors. She said, and it was really the physicians, they were so adamant that one vendor, One vendor performed 90% compared to the other. She said, let's not do a bake off. Let's just go with the one that all the physicians liked. If it doesn't work out, we'll switch. And so we ended up going live with the vendor, which happened to be Suki, which I didn't, I almost didn't even evaluate because of the name. I just thought, I don't know what, that's kind of a funny name. And it was, it was significant. The KPIs that we were able to get out of this were very interesting. So we went into it with very firm understanding that we were not going into this space to solve a financial problem. We were very clear with the doctors, we don't want to make money. If we break even, great, we'll be fine. If we just break even, we want to mitigate burden. We also told the doctors, if you get that time back in your day, don't use that time to see more patients. Because the last thing I want to do, let's say you've got a family doctor who is seeing 35 patients per day and you give him some time back in his day. The last thing I want to do is have that doctor pick up five more patients. So we emphasized, and I'll tell you, I mean, there's some doctors who are just starting their practice and they do need to see more patients. But you know, if you're an established physician, we want you to spend more time with your patients. We want to have you spend more time with your families after hours. And so that's what we emphasized. So my doctors were extremely happy. Just like all the solutions, everybody says ambient makes a big difference, life changing difference for these doctors. So from a physician perspective, I was happy, my medical staff was pleased, but I didn't expect my CFO to be as happy as he was. So let me just tell you a mistake we made when we set out on this pilot, we initially made the decision to only include the physicians who were at the 70th percentile of efficiency. And that decision was born out of fear. So most of the vendors in this space, they issue a subscription model. So you Sign up for 500 licenses and you pay a fixed fee for those licenses. The problem with that model is if I didn't have 100% adoption, I've got some licenses that are unseated that I'm paying for and I didn't want that. And so when I get down to the total cost of ownership, I consider not only the licenses I'm not using, but also if I have a doctor, let's say, who enjoys using it but doesn't fully adopt it, you know, they may just use 10 times a month. Could I handle, you know, the cost of $400 per provider per month? No. So what we did, we went live. And by the way, that was a dumb decision because the doctor's practice, who's super efficient, doesn't really have much pajama time. I mean, there's not a lot of after hours that they're spending. And so a little further into the pilot, probably month two, we negotiated with Suki to come up with a new model. So we came up with a encounter based pricing model that unlocked something that I didn't expect. So what that allowed us to do is to simply pay a small fee per encounter with a cap that was actually a little lower than the other vendors we were looking at. And now I don't have to worry about who gets a license or not. So one of the things a lot of CMIOs are now learning, that they're now in the business of license swapping, where I have to pull a license from one doc because they're not really using it and try to give it to another, or maybe they like it, but they just don't use it much. And I got to make this decision, am I going to pull this from that doctor and give it to another? I don't have to worry about that. I've actually provisioned all of our doctors with licenses. The other thing I'll say is you really can't predict who will adopt and not. I had several doctors that I was absolutely certain were going to love the product and didn't adopt. And then I had some I thought weren't going to adopt and they loved it. So I didn't have to worry about that. The second thing is it aligns the interest between the vendor and the health system. So I wasn't, you know, it was, they went at risk essentially, if we didn't adopt and utilize it, they didn't get paid. And so they were very vested in making sure we scaled the product currently. And this is what I'm really excited about. Net. And I'm going to tell you our financial ROI on this. Just looking at CPT changes. So looking at level four charges went up, level three charges went down and we had probably about an 8 to 10% increase in volume. Just those changes alone, Net after subscription costs, we're currently right now making $2,636 per provider per month, net every month. And I don't think you can get there without a utilization based model. Without some creative math. You have to kind of look past the fact that you're paying for licenses that aren't being fully utilized.
- [13:22]
A
Yeah, absolutely. It certainly makes an impact on. It has an impact on physicians. It has an impact financially on the organization, as you've highlighted, which is really important. Dr. Frost, thanks so much for being here. What a great conversation. Anything else that you want to share that might be important for our listeners to understand about the project itself, itself, or in general your feelings towards ambient AI? Any final thoughts on the topic?
- [13:42]
B
Yeah, I'll just say so. I'm very optimistic about how these platforms will transform healthcare delivery. They are the thing that is now in the room with the patient and the doctor and I feel like they're a platform to deliver a lot more than just ambient documentation. So real excited about clinical decision support. You know, the time I spend in chart review is a big amount of my time. Having a specialty specific summary of the patient is going to make a huge difference revenue cycle. There's a lot of things that this platform can deliver to the provider to make us better providers and at the end of the day provide better care for patients.
- [14:20]
A
So, and that's the key. Better outcomes, better care for patients. Dr. Frost, thanks so much for taking the time. It's great to have you.
- [14:25]
B
Thanks for the time.
- [14:26]
A
Yeah, absolutely. And you can certainly turn into more podcasts from becker's healthcare@beckershospitalreview.com and we also want to thank our podcast sponsor, Suki.