Healthy Data Podcast_ Tom Moran (Northwestern Medicine) & Jordan Cooper (InterSystems)-20250312_090401-Meeting Recording
March 12, 2025, 1:04PM
21m 5s
Jordan Cooper started transcription
Jordan Cooper 0:03
Ran of northwestern medicine.
He is the VP and CMO of Northwestern Medicine Central du Page Hospital. For those who don’t know, Northwestern medicine is a health system headquartered in Chicago, IL, with 2700 inpatient beds and 11,000 providers across 12 hospitals and other ancillary facilities.
Tom, thanks for joining us today.
Moran, Thomas 0:23
Good morning.
How are you?
Jordan Cooper 0:24
So I was just at Ham’s the other week and a big topic on everybody’s mind is ambient listening.
That seems to be.
One of the profoundest impacts right now in early 2025 of Gen. AI on clinical medicine.
So Tom, let’s just kick this conversation off.
What is northwestern medicine doing with regards to ambient listening?
Moran, Thomas 0:49
Yeah, it’s a. It’s a tool that we’ve really been experimenting with over many years and has finally come up with a true implementation that benefits both the patient and the clinician in office visits.
And we’ve, we’ve tried so many times to come up with, how do we make that the work, the documentation of the clinician better? We’ve gone from, you know templates and macros and.
Scribes and voice dictation and.
Dragon and everything down to let me just have a conversation with the patient and let the computer and technology help me craft my note.
And we looked at it as a way, as does this help, and does it help both the patient and the physician and the organization as a whole?
To support it and we found very positive results that come up with it.
Talking to the docs, a lot of them are.
This tool allows me to interact with the patient in a more conversational way.
I’m not sitting facing a computer or trying to type.
I’m actually talking to the patient and in talking to the patient, it’s it frees up to get information.
Jordan Cooper 2:00
Mm hmm.
Moran, Thomas 2:05
In a different, different way than we typically do.
I’m not a court reporter, right? I am.
I am now a doctor taking care of the patient and in the background. The ambient tool is capturing the data and crafting a note for me to look at and review later.
But it does one other thing. It allows me to speak clearly of follow up.
And treatment plans and changes in medication that get documented.
But I don’t have to write them down and remember them when I go back to chart or try and do it during the encounter.
And what we found is physicians are like it’s kind of made me a a better documenter because it’s like my personal digital assistant.
I don’t have to sit there and go for Mrs. Smith. Did I change her low pressure dose?
Did I add a medication for Mr. you know, O’Hara?
Like which?
Jordan Cooper 2:58
Right.
Moran, Thomas 2:59
Which one did I do?
And it’s already there.
So finishing and completing the note when it comes through is quick and easy and the data is available for you to kind of zip through your documentation and move on.
Jordan Cooper 3:14
So I have so many questions.
Tom, I appreciate we’re getting into this topic.
I’m wondering if you have any data on how the implementation of ambient listening has affected after hours provider EHR access.
For example, I’ve seen patients all day.
I go home, have dinner with my family eight 9:00 PM.
I’m back on my computer looking at in basket or trying to finish up my notes.
Do you have any data on after hours impact?
Moran, Thomas 3:42
Yes.
Yeah. During our pilot, we looked at this.
And tracked it over. You know, the beginning of the pilot during the pilot and afterwards to see if it’s sustained and what we really found was we had a control group, didn’t use ambient listening.
There was really no change overall in pajama time. They discontinued to do what they were doing.
In the pilot group, what we found was anywhere like if you throw all users in it was a 26% reduction.
In pajama time.
So they’re saving 12 to 15 minutes a day, the Super users.
Were increased about 32% decrease because they put a little bit more effort into understanding the tool on how to use it and it saved them additional time to complete stuff.
Think of the tool ambient listening. We have lots of tools in our tool belt to document.
Jordan Cooper 4:40
Hmm.
Moran, Thomas 4:41
You know, we could pull up different things. Like I said, up a template, we could use a keyboard.
We could use our voice.
We could use macros.
There’s a lot of things that we could do.
This is a layer that allows the majority of the note to get done.
It organizes in a way of how you write your note and it gives you that insight into really what you explain to the patient and your assessment.
Plan your follow up or your treatment plan changes. That allows you very quickly if you wanted to complete the note before your next visit ’cause it’s it’s there or at the end of the day you could run through and just make sure all your notes are done.
Jordan Cooper 5:09
Mm hmm.
OK.
Moran, Thomas 5:21
Pajama time is one of those.
One of those funny metrics, right?
Like we all think it’s we got to eliminate it, but we have to understand that each day physicians have different pressures on them from not only work but family. And sometimes it’s like I’m checking out a clinic ’cause I have to go to one of my kids perform.
Or an event, or I’m going out to dinner and then I have the opportunity to go home and finish my records.
Jordan Cooper 5:45
Mm.
Moran, Thomas 5:49
It’s not bad, it’s.
Stability, right?
Jordan Cooper 5:52
Right.
Moran, Thomas 5:52
But overall, we want it would be great if we got to a point where notes are created.
They’re reviewed and done before you leave the office, so you don’t have any of that.
You have stuff to check on because you’re a physician and you wanna check on your patients. If you had labs and stuff, but that’s just being a doctor. That’s not doing additional documentation.
Jordan Cooper 6:14
So I’d like to ask about.
Patient consent. Are there any times when patients opt out of having ambient listening, record their visit and also are there times when providers opt out?
Moran, Thomas 6:32
So everyone then has gone and we we kind of took this as if you want to do this, we’re going to give it to you.
It wasn’t a wasn’t a way of thinking of God. If we pay for this, we’re going to have to give it to everybody and make sure everybody uses it. Get value out of it.
We took a different approach.
This is something that if you look across any organization.
Everyone doesn’t dictate. Everyone doesn’t use macros.
Everybody’s kind of got their own way of.
Working with an electronic record that fits their needs and their efficiency.
Jordan Cooper 7:06
Mm hmm.
Moran, Thomas 7:07
And for ambient listening, it came down to, you know what?
You could try it if it works really good for you, great. If it allows you to kind of get through the process of documentation better go ahead and use it.
Almost everybody has tried it, both those who were pros I wanted and those are. Hey, you know what? I don’t think it’s gonna work for me.
The ones that all got, it said. I wanna keep it.
Because it does help me.
Jordan Cooper 7:31
Mm hmm.
Moran, Thomas 7:32
That makes it better interaction for the patients. On consenting we consent, each patient let him know that we’re going to be listening.
Jordan Cooper 7:40
Mm hmm.
Moran, Thomas 7:41
There isn’t really any patient that looks at this and says I don’t want this to happen.
They think it’s pretty cool and overall the patient experience has really changed. We’ve seen a 1% increase in likelihood to recommend for all those users who are using DAX.
The patients have comments coming back as the DOC maintains better eye contact with me.
My notes for my appointments are already in my my chart. The next day I have a different conversation with my provider. I actually get my questions answered.
I’m able to think of them because I’m not staring at the side of the person of them typing into the computer.
Jordan Cooper 8:12
Mm hmm.
Moran, Thomas 8:19
And it’s almost like.
You’re more that patients feel that the doc is more present during the encounter, so it’s very positive coming back from the patient experience side.
Jordan Cooper 8:31
So are there any other uses other than populating the EHR of the data captured during the encounter? For example analytics or training large language models?
Moran, Thomas 8:42
It is.
A.
We’re constantly looking at how we could make this better.
There are.
There’s some parts of talking and getting documentation where you’re having conversation.
It’s great when you’re talking getting HPI and review systems and going through stuff.
Jordan Cooper 8:59
Mm hmm.
Moran, Thomas 9:03
It’s a little odd when you start doing physical exams, right?
Jordan Cooper 9:06
Hmm.
Moran, Thomas 9:06
So there’s a lot of docs that do not do ambient listening for the physical exam.
Now there are some very focused specialists.
Jordan Cooper 9:13
Mm hmm.
Moran, Thomas 9:16
You’re doing a knee exam or shoulder exam.
It kind of makes sense to you’re basically talking to the patient of what you’re doing with it, but if you’re a primary care doc and you’re doing kind of a head to toe exam and going through your patient, it’s a little odd to call out everything just so.
It gets documented and there’s a lot of times you could do that. Documentation.
Much quicker and the encounter is more focused if you do that with the standard tools that we already have.
Instead of ambient listening.
The data that we get, we collected it goes.
In it goes into the electronic record, just like if you would enter it regularly.
Jordan Cooper 9:54
Mm hmm.
Moran, Thomas 9:55
And we tee up some stuff. So like you get the reminder of the medication change, it fills out your assessment and plan and your follow up.
Up it’s it’s allowing that flow to happen in a easy way that I think for the first time overall it’s a technology that is adaptable to doctors workflow. Instead of doctors adapting to technology.
Jordan Cooper 10:22
So on that particular sentiment about extracting data into the EHR, I’m wondering.
I know that it Tees up the message and then you need a provider.
To review the data elements that were extracted from the conversation by the ambient listening technology, is there a button just to approve it?
And then you know, if I say, hey, you have an allergy to penicillin, it just populates in the allergy section of the EHR. If you you know, to what extent is it creating discrete data elements that can automatically be populated as opposed to?
Its kind of free text putting into the patient encounter note.
Moran, Thomas 11:03
Yeah, that’s a great question.
There’s we’re not at the point of filling out every discrete data point in the electronic record to kind of go through that.
Remember, there’s still the process of a regular visit, right?
You have a intake and people are filling out those discrete data parts. You’re part of your.
Healthcare team either an MA or a nurse that is going through and doing that initial intake and then you’re having the patient encounter reviewing that data that’s already there.
Jordan Cooper 11:24
Yeah.
Moran, Thomas 11:33
It’s more focused to creation of the note, but that note allows for better coding and capture for that visit, because listening to what you are doing and and discussing with the patient.
Is captured and documented.
You don’t have to remember.
Did I do that and am I specific about it?
So in one respect, the note creates more specificity for that encounter type.
Not necessarily. Placing in a discrete.
Data section.
Jordan Cooper 12:04
Got it.
I wanna kind of ask about something you just mentioned, so it allows for better coding.
So in a fee for service world, you know, everyone knows that electronic health records really originated in medical coding essentially and billing purposes.
But as we move towards a risk based a shared risk value based payment model where it’s not necessarily fee for service, I’m wondering the extent to which.
Coding and this is kind of departing a little bit.
So just allow this one tangent.
The extent to which ambient listening creating this patient capture maybe allowing for better coding, is that still applicable as kind of you take the risk and yes, you still need to capture the diagnosis and allergies and the different data elements that are captured during that visit, but maybe.
Coding isn’t as important.
How would shifting to the different payment model affect?
Moran, Thomas 13:01
So if you think of everybody you know when you get into shared risk models, right?
And you’re going to other than fee for service. Anything you do for that type of encounter benefits fee for service.
Jordan Cooper 13:15
Mm hmm.
Right.
Moran, Thomas 13:18
So there are complimentary of each other and the information that’s there. You create a. The best way to think about it. You create a better clinical record that could be conveyed to the next caregiver.
And you could find those gaps in carers that you need to fill easier because you’re not haunted and pecking through the record you’re discussing with the patient.
And that information is documented where you can actually act upon it.
So you know, you get the flag of, hey, this person’s gonna need a colonoscopy or they need the flu vaccination, whatever that discussion happens. And then you could actually act on it and order it going forward to close that gap.
Jordan Cooper 14:01
So.
How so?
Obviously there’s a cost associated with this ambient listening technology.
And clearly you’re communicating how it leads to improved provider satisfaction and improve patient satisfaction.
You’ve spoken about that in detail, but you know and perhaps and and I’d like you to speak on this.
Perhaps better coding allows the more revenue capture from payers in the FIFA service environment.
How do you justify the exppenditure that northwestern medicine is spending?
On ambient listening technology to, for example, the health System CFO.
Moran, Thomas 14:41
So.
If you’re the CFO, you want something that says. If I put this in and pay for it, are you gonna see more patients?
If you say that the docs are like I already seen my maximum number of pay, I can’t see anymore, so don’t give me something that you’re gonna make you know. Whip the Thoroughbred and get me to see more.
So I think you look at it in a way of.
Jordan Cooper 15:02
Yeah.
Moran, Thomas 15:06
You have a clinic.
You have a A, you know basic number of days.
You’re gonna be here.
This is the estimate number of patients that you see.
How do we allow you to see them more efficiently and effectively?
That one.
Your work is more enjoyable that you could do it in a more efficient way and you don’t have to spend time after clinic hours doing this.
And what we found is we see really an increase in the number of patients these docs are seeing almost every single DAC user on average.
Had a 4.7 appointment increase per physician.
Per month that has come through and those that were super users are high utilizers of Dax at over 5 extra appointments a month.
Not by. Hey, you need to do this. It just because of the efficiency space was open.
It was easier to see them and they saw more patients.
We didn’t tell them to see more patients. It just happened organically.
Wait.
Jordan Cooper 16:04
Hmm, that’s that’s actually something that I hadn’t heard of before. And that’s really interesting and accidental increase in revenue.
Moran, Thomas 16:13
So we you look at it as you always want better documentation.
It helps clinically and it helps with coding and reimbursement. You want that documentation to be consistent and easy.
Jordan Cooper 16:27
Mm hmm.
Moran, Thomas 16:28
And you want the encounters to be enjoyable for the patient ambient listening kind of covers all of those at the same time and eliminates that burden of doing.
It’s like the court.
Reporter side. But I keep going back to it. ’cause. It’s like it just does it for you.
Jordan Cooper 16:44
Right.
Moran, Thomas 16:47
So you could do what you do well as a clinician.
Interact with the patient, provide excellent care, review data and make assessment and plans as you go forward.
You don’t have to document everything in every box.
Let the computer do some stuff for you so you could do it more effectively.
Jordan Cooper 17:06
A few more questions and we’ll wrap up the episode. You said that providers are opting in.
The only ones who use ambient listening are those who are choosing to use ambient listening.
Do you have any data on the uptake?
What proportion of your clinical staff have chosen?
Moran, Thomas 17:23
Yeah. So we we started with a small group of docs.
We had about 50 docs to go through.
We focused in a couple different practice areas from specialty care to primary care. Right now we have people.
I could go through.
It’s almost all the specialties. Allergy, cardiology, dermatology, infectious disease, Pediatrics, pain ortho.
I mean, almost everyone has users that are in it.
Because what’s happening is.
Instead of something being.
Forced on you to hey, we. You need to learn this and take it and do it.
It becomes more of is their ability.
Can I get Dax?
Because I heard about it from my peers and it does help in the same offices, people are like, yeah, I want to get that too.
Jordan Cooper 18:07
Mm hmm.
Moran, Thomas 18:11
And I think that’s the the expansion of it becomes.
The really the docs are selling it themselves.
It’s not an IT project, right?
It’s not.
You must do this so we can get value out of it.
It’s turned into we provided something that actually provides value to clinicians and they’re taking it on and spreading it themselves, which makes a big difference overall in the usability and consistency and patience and patience do really.
Like it a lot.
I mean, they don’t have any problem with it.
Jordan Cooper 18:45
And Tom, on a previous question I asked a few minutes ago about.
Other uses for the data captured by the ambient listening technology.
I believe that there are some healthcare systems.
Northwestern may be included that uses data brokers for DE identified data to be used for other applications. For example, Omni may be an example of one in use at your health system.
Do you know if this data?
Contributes or helps drive that new revenue model.
The alternative?
Kind of software driven revenue model for Northwestern or is that just an entirely different topic?
Moran, Thomas 19:26
It’s a different topic.
Jordan Cooper 19:27
Got it.
Alright. And then the last question as I well as I wrap up, I’d like to ask you if there’s one thing you could tell yourself a year ago or two years ago before you started this journey towards ambient listening.
Some of our listeners may be saying, hey, it sounds pretty good. What is what?
What is one recommendation you would make to yourself or one bit of insight?
Something you’d like to tell yourself a few years ago before you began this journey.
Moran, Thomas 19:54
I think the biggest thing that you can kind of I would reflect back on is bring the CFO in early.
Let him understand where the benefit comes from and that you won’t see the result until you put it in and you can’t prove the result until you actually build it and let em use it.
And this is a perfect example of that in a project.
This is a a long road to bring forward and yes, technology has changed and it’s gotten better over time.
But you know, if you do something that provides value to clinicians, they’ll use it and it’ll be beneficial overall.
And you don’t have to sit there and and sweat the the cost and everything because.
It’s it helps overall all your your metrics of what you’re trying to accomplish.
With this, but you will never know it if you’re constantly waiting for perfection for it.
Jordan Cooper 20:50
Alright, well I appreciate your time for our listeners. Has been doctor Tom Moran, the VP and Chief Medical officer of Northwestern Medicine Central DuPage Hospital.
Tom, thank you for joining us today.
Jordan Cooper stopped transcription
