Q&A: How ambient documentation is altering the provider workload

San Francisco-based Augmedix has progressed from a Google Glass-based clinical documentation startup to a publicly-traded, AI-enabled ambient automation platform that documents patient encounters and generates medical notes that can be transferred to an EHR.

The company, founded in 2012, also provides pre- and post-visit documentation offerings to give providers a more complete digital picture of a patient’s health journey. 

Ian Shakil, founder, director and chief strategy officer at Augmedix, spoke with MobiHealthNews to discuss the company’s evolution and its anticipated release of a new product in 2023. 

MobiHealthNews: Can you tell me about Augmedix and how it works in the ambient documentation space?

Ian Shakil: I started the company about 10 years ago with the mission to rehumanize the provider/patient interaction. Originally, we were only operating on Google Glass. What we did is we put technology at the point of care when providers and patients are having conversations.

What we do is we ambiently listen to those organic, chaotic, nonlinear conversations in the exam room. And in the background, we produce EHR notes better and faster than what the provider would do on their own. 

Over the years, the product has evolved quite a bit. Now, most of our providers actually use phones on stands or on lanyards, and yeah, we’ve come quite a way. These days, we serve 20 enterprise health systems. Last year, we publicly listed. We’re on the NASDAQ, and we’ve grown leaps and bounds.

MHN: When you think about how EHRs were done previously, there were medical transcriptionists who would help put the documentation together and providers would often dictate. Is the ability to have EHR done in a more automated fashion easing provider burnout?

Shakil: Actually, I think it’s getting worse. Yeah, there’s a bit of a story arc to how sort of documentation solutions have evolved. Originally, doctors would do their dictation in their Dictaphone, or these unusual devices, and it would go literally to a human transcriptionist. There’d be a multiday turnaround, and they would return that note verbatim. 

What’s different about our solution and others as well, we are voice solutions. We operate on an ambient basis. In other words, we perform the EHR documentation with structured data right into whatever EHR the provider is using from the already occurring conversation. So, when the visit is over, you’re done. 

But to kind of double click on one of the things you said, we still do have humans in the loop. We call them MDSs, or medical documentation specialists. It’s still imperative that we have these humans that perform last mile structuring so that what’s waiting in the EMR is just ready to sign.  

MHN: It seems like humans would be quite necessary because AI doesn’t understand all medical terminology at this point. Medical records must be accurate.

Shakil: One hundred percent. If it’s not [accurate], then the provider’s spending more time backspacing and restructuring, and that ends up being more trouble than it’s worth. And to heck with that, I’ll just write my own note. So you can think of it sort of as having Uber and then gravitating towards a driverless-car solution. We’re on the journey there, but we realize it’s going to take a lot of mastery of workflows and data, and just exponential machine learning modeling, to get to that Nirvana place that we’re all going towards. 

But we have another solution that we’re alpha testing and we call it Augmedix Go, and that is a pure AI solution. And a material number of providers, we hope next year will actually be able to adopt it with really good workflows that match our models. So, I do think, over time, we’re going to see some adoption, but it’s going to take years for widespread use of our pure AI solution. This is my forecast.

Additionally, [Augmedix is] really advancing our partnership with Google, and we’re listed on their marketplace. They’re actually doing a nice job of not only helping us with engineering technology and ASR (automatic speech recognition), but actually forging a channel partnership with us and helping us sell into health systems. It’s very interesting to see the big tech companies get involved in this space.