- Hello everyone.
This is Brian Zimmerman
with the Becker's Healthcare Podcast.
Thanks for listening to this episode on AI
and healthcare, how to align and optimize.
I'm pleased to be joined today by Dr.
Tony Oliva, VP and Chief Medical Officer with Nuance
and Microsoft Company to discuss how
to integrate AI into your organization's yearly strategy.
Dr. Oliva, thank you so much for being here today.
- Oh, thank you. Happy to be here.
- So, so let's dive in and,
and the first question here is I'm just gonna, uh,
prompt you to introduce yourself a bit further for folks
that, that might not be familiar with you and, and,
and just share some, some background about the work you're,
you're doing at Nuance now.
- Sure, sure. Sounds good.
So, Tony Oliva, um, I am a family doc by training
prior to coming to Nuance.
Came back, came to Nuance in about 2013.
Prior to that, I spent, uh, 15 years on the hospital side
as a Chief Medical Officer, both at the,
starting a very small community hospital all the way up
to large system.
CMO came over to Nuance, really focused on,
um, their physician facing and
or CDI, clinical documentation, improvement products,
revenue cycle, um, improvement products,
and obviously some
of the physician documentation opportunities
that were going on at that time with Dragon
and now with, um, uh, Dax
and, uh, other products that we've had, uh, over time,
uh, as we've made the transition
and now recently acquired by, um, Microsoft.
And that whole process has been completed.
So we're also, um, uh, part of a,
a much larger organization now, um, with, uh,
a lot more access, obviously, to technology, research
and development than we had prior.
- Yeah, yeah. CER certainly.
Um, and, and it's an exciting time in healthcare in terms
of the, the rise of technology,
different technologies thinking here, course
of artificial intelligence,
and our healthcare leaders have always sought
to really cut costs and drive efficiency.
But, um, the, the hopes
for an interest in artificial intelligence being used for,
for these purposes has really grown substantially.
I, I, I think everybody would acknowledge that.
But curious to hear your, your exact take on
what you think the real opportunities for,
for artificial intelligence,
thinking about machine learning here too, different,
different types of technologies in healthcare.
What's, what's your assessment?
- Yeah, it's, it's really exciting.
I mean, and, and really in just the last five years,
it's just been, um, just been amazing at some of the things
that have been coming out
and even what we've been able to do.
You know, I, when I think of opportunity inside healthcare,
you know, cost savings always comes up.
I think we also forget sometimes about the revenue side, um,
and where some of these technologies can, um, support,
you know, revenue production too.
And we've cut a lot of cost out of healthcare.
And, uh, you know, the, the old adage, you,
you can't cost cut your way to success,
it just isn't going to work, right?
So there has to also be some focus on the revenue side.
And yes, there's obviously some great efficiencies
and the ability to, um, again, reduce costs with ai,
but there is also
because of those efficiencies, um,
some real opportunities at at achieving revenue,
especially on the physician side
as we talk about opportunities to potentially
increase patient loads, capture better documentation for
improved revenue on the billing side.
So there's many pieces here
that the two kind of come together.
Um, and I never wanna lose sight of
what AI could potentially do on the revenue side as well
as on the cost side.
- Yeah, I, I, it's a great point, uh, in terms
of not having this overemphasis on, on, on cost reduction,
that's not gonna be enough to, to achieve success.
And, and also it doesn't really, um, get that mindset,
that focus on innovation where, where a lot
of healthcare leaders are, are trying to go and,
and thinking here too about sort of, of course, you know,
hospital margins are still very, very thin
and some, some real challenges there,
but there has been some stabilization, um,
and I, I think perhaps a re-engagement among,
among some organizations in terms of thinking about their,
their long-term strategic planning, capital planning.
Um, and, and really thinking here, my my question
for you then, Tony, is thinking about all of this,
how can leaders really effectively incorporate AI into
their business strategies?
Are there any best practices you can share?
Tools, resources, any, any, any tips for folks out there?
- Yeah, so great question.
Um, boy, I, and,
and the opportunities are sort of mind-boggling,
when you think about it.
Um, which is a challenge, right?
Because, you know, the,
the concept is sort of where do you start?
And I think there's a risk that there's a, a feeling
that AI can sort of solve everything,
but AI doesn't have to solve anything there.
There're everything there, there are things
that are already working, right, that,
that don't really need to be impacted.
So how do you start to think about, um, this
margins are returning a little bit, um,
but volumes aren't is what, you know, we're sort of hearing.
So that's a real challenge.
You know, there's some uncertainty is sort of
where did the volumes go?
And they've not returned to sort of pre covid, um, numbers.
So that's a concern I think going forward.
And we're really facing some headwinds.
Um, I think on the policy side as far as where, um,
dollars may come, especially in the Medicare
and other, um, government programs.
So there's still a significant,
significant challenge out there.
So the question is, you know, whether there's dollars that,
you know, you, you want to sort of target towards innovation
and AI that are becoming available,
or can you even afford not
to invest in some of this technology?
And as I think about it, you know, the, the best places
where we can make the biggest impact
is on those things that require human beings
to do something, right?
So, uh, you know, the, the,
the electronic record's been a great asset,
but you still have to get stuff in there, right?
It does, it doesn't do you any good
until something gets put into that record.
So when you think about the manual processes,
whether you're a physician, whether you're a nurse,
whether you're on the administrative side
or the revenue cycle side, coding, whatever it may be,
there are manual, um, uh, things that have to happen.
I have to put documentation into the record.
Well, can I do that in a way that makes that easier
and less time consuming for me?
I'm a nurse, I have to document lots of things all day long.
Is there a way I can use technology or voice
or, um, automation to get some of that stuff into the record
so I don't have to look at it, go back to a, um,
a computer and actually put it in
or do something physically to get that information in?
Can I evaluate a record using AI to
identify opportunities to improve, uh, diagnosis capture,
or on the inpatient side, improve revenue capture
that should be appropriate
and is appropriate for what we've done?
We just haven't caught it.
So I think as you start to look at ai, those are the places
where you really need to start to focus on.
And I think if you start to sort of prioritize those things,
and then you add in the concept of
where can I save cost doing those things,
and where can I actually add revenue
put to those two things?
And if those two things sort of merge,
I could save some money
and increase revenue, I think that starts
to really become your target as we think about that.
And unfortunately, you just,
you can't boil the ocean, right?
It's, there's just so many things that you can do,
and there's so many people working on so many little niches.
You have to decide, uh, as an organization, you know,
where your big opportunities are, where,
where are you gonna get the biggest bang,
where are your biggest challenges from the standpoint of
both, um, efficiency
and, um, potential of improving revenue and,
and cutting costs.
- Yeah. So you hit on, hit on a few things there,
really thinking about revenue costs
and sort of also the, the,
the human beings involved improving
their experience as well.
Well, um, it, it,
and I appreciate the, the specificity
around do the documentation example too.
I think that, that, that illustrates sort of where this,
this planning can really be impactful.
Um, I'm, I'm curious if we can get some more
specifics maybe on the table here.
Um, if you could tell me, sort of describe what it kind
of looks like when, when an organization achieves alignment
in their technology Yeah.
And annual or multi-year business strategies.
I think it's, it's one thing to talk about that as an idea,
but what does it look like in practical measures and, and,
and are there any success stories
results that come to mind here?
- Yeah, no, so absolutely.
So as you think about,
we could talk about the dragon ambient
experience, for example.
So the ability to capture ambient conversation
and convert that into a note, right?
So in the, in the current world, you know, um,
or the majority of time we go in
and see a patient, we capture a lot of information.
We either enter it into the record
and type it in there, we do it afterwards,
entering information into the record.
It's sort of been the traditional process.
The ability to potentially short circuit that process
of me actually having
to enter the information becomes a huge value prop.
And if you think about what, what we've seen is
huge time savings for a provider.
If you think of, I'm spending 20, 25% of my time documenting
during the day, and I can shave that,
that is significant amounts of time both for me personally
as well as my potential of, of capturing revenue.
And that's what we're seeing in the range of five
to seven minutes per patient.
So if you can put that into a context of a bigger picture
for, you know, an organization looking at, you know, what
that opportunity might mean to, to somebody, if you say,
and, and the way I sort of think about this is, yes,
it's impactful for me as a single doc,
but as a leader, the potential exponential
impact on an entire group
or organization is, is gigantic, um, with that type of,
of potential, um, savings or impact.
So, um, if you just think about if, if,
if you're a 30 physician primary care practice,
and because of using ambient technology,
you are able to increase just three per patients per day.
We're seeing some in the range of, of, of four
to six patients a day.
But if you were just able to add three patients a day
across your group, that's 90 patients a day,
that's 18,000 patients a year
potentially in a 30 person group.
That is phenomenal when you think about that.
So if I am a leader
and I'm thinking, Hey, I need
to increase volume in my primary care practices,
we wanna bring more patients in,
I have two choices to do that.
Uh, my docs either that are currently seeing patients have
to see more, I have to go out and hire new docs, right?
18,000 visits is somewhere in the range of,
you know, four, maybe five physicians
to do that work, right?
That's huge. Um, so if, if you think about the concept
of, you know, going out
and hiring five more physicians, um, the cost of, uh,
even at, at the low end of being, you know,
$500,000 per doc in, in bringing them up
to speed, you know, you, you're talking about $2 million of,
of potential, you know, um, cost to do that.
Uh, if you could increase that productivity without,
without significantly affecting their life
and actually making their day better,
even seeing three more patients a day,
not only do you avoid having to go out
and add those, um, additional docs,
you're talking about adding somewhere in the range
of $1.4 million a year in just direct revenue,
not even counting the downstream revenue
that you get from a family practice doc seeing, you know,
another patient every day, right?
So the, the ROI, um, both from a personal level
of me being able to, to get through my day easier,
not having to redocument things, missing things
because I didn't remember them when I went back
and documented them, being able to sit in front
of my patient and actually have a conversation,
and then the potential revenue impacts that that can come
that we just don't think about in those volumes.
Um, the potential impact on a large multi-specialty provider
practice is just huge.
And I think as we start to think about ai, we really need
to think it about, think about it in those terms,
because there it is, the, the, the cost difference
of hiring a new physician versus giving them AI technology
to do their work isn't even close, right?
It's not even close. So I mean, that, those are real
experiences, right?
We're seeing that impact, you start to broaden
that across all of healthcare while we're facing a,
a provider shortage, while we're facing challenges with
access, um, population wanting to go
after markets, different things, uh, recruitment,
the potential drip down through healthcare
and the impact potentially that could have overall on,
on the challenges we're facing overall with healthcare are,
are just mind boggling.
So that's how I sort of look at this te that's why I'm,
you know, you start to get excited about this technology
because it is at times even doing a better job
of documenting that I would do on my own.
And not only am I saving time,
I potentially have an impact on revenue.
I can see more patients that aren't being seen.
So my community gets better care, uh, access to quality
and um, uh, information in real time.
Being able to go out
and find specific information while I'm right there looking
at it, potentially using AI to support diagnosis
captive, uh, or identifying different diagnoses, um,
ruling out different diseases.
I mean, it just goes on and on.
So I just don't think there's any shortage of,
of opportunity and the excitement.
I think we're just starting to feel the, just the initial
surge of what this could potentially bring us in the future.
- Yeah. And yeah, I appreciate you sort of flagging that.
Uh, we haven't spent a ton of time on it in,
in this conversation today,
but flagging that potential, um, benefit yield
for, for patients as well.
'cause it stands for reason, as you sort of pointed out,
you're able to see more patients, you're gonna be able to,
um, provide more access to care to, to the community.
I think anybody who's um, tried
to schedule a doctor's appointment recently can appreciate
how, how, how challenging it is to get in there.
So it just seems like a real deep need for, for patients too
to, to have these kind of improvements
- It across the board.
It's a win-win win. I mean, it just, I, I struggle
to find the negatives.
I really do. It's, it's, it's really hard that,
that even if there is some negatives, they're offset
so dramatically by the community impact the individual
provider impact the financial impact on the organization
and the employers of physicians.
I mean, the reality is, is most hospitals
that have employed physicians, you know,
they subsidize those practices, right?
They, it just, it's the natural end product of acquiring
practices and, and running practices
as a large organization versus, you know, a mom and pop and,
and the, the opportunity of recapturing some of
that re revenue, putting it back into other things instead
of just into supporting physician salaries
or provider salaries
and just so many, you know, opportunities that
you really need to think about it differently than just a
capital investment.
As we think about, um, where AI can bring in, I mean,
we don't think about adding physicians
as a capital investment, right?
So adding technology that can increase productivity
and all of these good down to,
we gotta think differently about this from a, you know,
a senior leadership perspective.
Where is the best to, to do that?
And, and then, I mean,
we don't even wanna haven't even brought up the concept of
what's the impact on burnout?
Will it keep more providers practicing
because, you know,
they're happier getting out a little earlier during the day.
Um, you know, it's, um, they're able
to spend time with their family.
They're not doing documentation at 10 o'clock at night when
the rest of the family's asleep.
There's so many things that I get excited about here that I,
I just become no-brainers, uh, if you think about the need
to, to take, uh, advantage of some of these things.
- Yeah, the, the, the, the documentation side
and burnout too is, is another huge piece of this.
There's so many implications
and possible ways this technology can, can touch the,
the healthcare system.
Um, and, and, and,
and Tony, your, your excitement is coming through loud
and clear , and it's, and it's great.
- Yeah. It's, its funny
'cause you know, I think back, you know,
when I was seeing patients all the time
and I'm looking at this technology
and I'm going, oh God, how would I, you know,
I would've just, I would've given anything to have some
of this stuff back I was writing on paper
back when I first started.
Right? Right. So, I mean, it's just, uh, I see this
and go, oh my gosh, um, a new physician coming into
this world has such a different, is gonna have just a,
such a different view of what they can do in healthcare than
what we were capable of doing 25 years ago.
It's just, it's, it's amazing to me
and very exciting, obviously.
- Yeah. Yeah. And, and, and I guess as we come to, we move
to a close here, uh, shortly,
but, um, I want, wanna get your take then, you know, you,
you, you've talked about how this technology excites you,
but what do you anticipate this all looks like
in the next five to 10 years?
Like, um, you, you just talked about sort of how uh,
a physician coming up is gonna have a very different
experience than, than than you did.
What does that experience look like?
- Yeah, I think, um, so two things. One is huge excitement.
'cause there's so much we could potentially do,
and we need to temper that with what we should do, right?
And I think that's the biggest challenge for the industry,
for us, right?
It's, we could throw all kinds of stuff in front of docs.
Is that the right thing to do? What should we be putting?
Is it really affecting patient care, patient safety?
My, um, experience going through
as a CMO on the hospital side was very heavy
into high reliability.
Are we making a, a, a, the experience
for a patient walking into a hospital safer,
walking into a physician's office, safer.
Um, so anything that we do to add to
distractions and other things that may take away from
what we can give that are positive, we have
to be very careful of.
So I think on our side, we have to be cautious.
What sounds good sometimes doesn't actually play out good
and could be, uh, um, problematic.
So I think that's one thing.
But I do think that as this technology gets better
and better and better, some of that'll take care of itself.
But I foresee, uh, uh, I mean, I foresee the ability
of really being able to get back to
walking into a room with a patient
and just really, truly just having a conversation, talking
through what I wanna do with that patient,
how I wanna present the, you know, how I want their care
to be, uh, to go forward, what's my plan?
And then all of that stuff is being taken
and used to develop a plan of interaction
with, um, post visit information going to the patient,
whether it's direct interaction with patients,
getting my orders taken care of
and done so that all I have to do is validate, um, them
so I don't have to actually input them.
You know, the, it is just what did I potentially miss
in high, you know, based on risk, um,
based on the conversation and the history of the patient.
And there's just so many things
that are just gonna be at the fingertips
of somebody going in the future that we, you know, I used
to walk out of the room and go open books.
I mean, really, I mean, seriously
and look up stuff that's gonna be gone.
I'm just gonna have to say something,
or it's gonna automatically identify something at risk
and just put it there for me.
I mean, just a huge difference.
Um, but I do think we have to
let the technology develop and not get out ahead of it,
because I think sometimes if we get out ahead of it,
we potentially could create risk, right?
And that's, I think I get on our side, we have
to be cautious and thoughtful.
We have to put safety first as we, we roll these things out
and, um, and present new opportunities to people.
- Important point there around sort of the,
the excitement's great,
but you don't want the, the, the excitement sort
of cloud judgment in terms of what you're,
what you're applying the technology to. Right? Exactly.
- Exactly. - Exactly. Yeah.
Well, well, Tony, as, as you sort of laid out, like the,
the, the implications of this technology touched
so many different parts of, of the healthcare ecosystem and,
and have a lot of potential to transform the, you know,
the care experience for, for, for patients and,
and for physicians of course, too.
Um, but there, there's so much here we probably just scratch
the surface on or barely touched.
Um, so is there anything else
before we sign off here, you want the listeners to,
to hear from you on, on, on this topic?
- Yeah, I, I, um, you know, know, not, not really.
I do think that it's important for organizations
to really take a step back
and think about where are those things that
have that biggest impact on my, my workforce,
my human workforce,
that I can make easier for them, right?
That, that AI
or new technologies that are coming out will ease
that burden so that,
that everyone can practice at the top of their license.
There's, there's, there's no value
for just putting stuff in.
The value is doing the assessment, right?
My value as a physician is seeing the patient,
evaluating the patient, uh, examining the patient,
making a diagnosis and a judgment on a plan to go forward.
It's not then going back
and putting the stuff in the record, which is important
because I need to know what I did
and other people need to know what I did.
But if I can spend the majority of my time
doing that first part, then that's a huge win,
because then I can do it with more people.
Uh, same goes for nursing, respiratory, pharmacy,
you name it, right?
So the ability to work at the top of your license,
not doing those, those tasks
that frankly we could potentially automate.
Um, that's where you start to, that's
where people should go back, start to focus.
Talk to experts in the AI community.
Where can they help? Where can we help?
And then, um, you know, start a, a good strategic plan
going forward about how to do this.
I, I think you don't want to get stuck in this thing
where you respond to every single person
that comes in the door with a new idea, right?
Or a new piece of a puzzle, um, that could get crazy, right?
So I think you really need to think about
a strategy around this.
How do I really want to think about ai?
How do I mesh all of this stuff together between cost
and revenue and efficiency and productivity
and my need for human resources
and the elevating cost of those human resources
so I can get them working at the top of their license.
- Dr. Oliva, thank you so much for,
for coming on the podcast today and,
and really discussing, uh, you know,
some exciting opportunities with, with AI and technology
and what the future of healthcare can look like.
I really appreciate you coming on the podcast.
- Absolutely. Thank you. Thank you very much.
- We also wanna thank our podcast sponsor Nuance,
a Microsoft company.
You could tune into more podcasts from Becker's Healthcare
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