Suki Exec Team, Image from Suki.ai
Image from Suki.ai
Physician burnout is a huge issue in the U.S. The National Academy of Medicine found that 50% of the country’s doctors and over 60% of the country’s medical students and residents experience substantial symptoms of burnout. Often, according to FierceHealthcare, physicians spend 11% of their time after hours and on weekends on administrative work. Physician burnout costs the U.S. healthcare industry $4.6 billion per year or $7600 per physician per year.
It’s no wonder that Dr. Zubin Damania receives poignant responses from his youtube channel for the medical community when he talks about the subject of physician burnout.
In 2020, our healthcare system is on the cusp of change. More physicians, nurses, and healthcare workers recognize the need for humane medicine. Humane medicine is when the healthcare system puts the patient in the center to be cared for by a healthcare team. It’s the future of healthcare. It will involve changes in the current healthcare workflow. But, the change does not need to be painful or disruptive.
In the age of artificial intelligence, there’s a huge opportunity to cut through the grunt work, the clutter of massive healthcare workflows that we’ve created in the last two decades. We can deliver humane medicine enabled by technology that is efficient and centered around the relationship between the patient and the healthcare team.
One company that’s trying to do just that is Suki.ai. The Suki team has created an ai-powered, voice-enabled digital assistant for doctors.
I had the pleasure this month to sit down with Dr. Nathan Gunn, the COO of Suki.ai to talk about what it means to solve the problem of physician burnout and how the Suki team approached the problem differently.
What is the problem that Suki is trying to solve? How did Suki go about it?
The problem that Suki addresses is physician burnout, which is largely related to the administrative burnout that is placed on physicians by the Electronic Healthcare Record (EHR). For every minute doctors spend with a patient, they spend two minutes entering data into the EHR. If you looked at a doctor’s note 20 years ago, that note was there to help the doctor remember what is going on with the patient from one visit to the next. That note was also there for professional communication if your doctor referred you to another physician. Today, there’s much less clinical utility in the data for the physician.
Over the last few decades, particularly with the Affordable Care Act, clinical notes are being asked to do a lot more. The clinical note is now being used for billing, coding, reporting, legal uses, etc.. A lot of this work requires menial data entry to capture the relevant information in the EHR. We’ve taken one of the most esteemed professions and turned these professionals to data entry clerks. The issue of physician burnout is very real for most doctors.
Doctors are leaving medicine. They have higher suicide rates than other professionals. They rank higher on standard assessments of burnout. In fact, the burnout rate is north of 50%. Most of the burnout is related to the usage of EHRs.
For the last 10-20 years, there have been two solutions doctors used to alleviate the administrative burden. One solution is to hire an in-person scribe, who is usually an aspiring medical student and will likely leave in a year or so. This solution is expensive and the quality of notes from human scribes can be highly variable. There is also high turnover in this field. The second common solution is speech-to-text software. But the physician experience is not very good—doctors must fix a lot of misspelled words. They are tethered to their computer with a microphone and a cord. This solution involves a lot of pointing and clicking.
We developed Suki to be a true physician’s assistant that can take care of the grunt work and help physicians focus on what they went to medical school to do – take care of patients. Suki’s goal is to alleviate physician burnout by performing menial tasks seamlessly and unobtrusively; this is what technology can do at its best and when it is developed with a high degree of empathy for the end user. We use machine learning, so Suki is constantly learning and getting better, and we require no hardware so we are highly convenient. We are SaaS, so we are also scalable. Importantly, we provide a “consumer-grade” experience. We envision Suki to be the go-to solution for physicians in the near future.
What is the problem of moral injury? How does moral injury lead to burnout?
More generally, moral injury is a term often used to describe soldiers who encounter conflicting moral situations at war. The stress these situations cause can lead to a variety of mental health conditions such as PTSD.
For physicians, when we talk about physician burnout, we are also talking about moral injury. Physicians are trained to help people. They are humanists. They have extra empathy for the patient. If they work under too many constraints such as systems, time, resources, etc, as a physician, it can feel like you can’t help the patient the way that you want to help them.
For instance, you can’t spend enough one-on-one time with your patient because you have to key things into your EHR. Due to your ever-increasing administrative duties, you limit your patient appointments to 15 minutes. The combination of stress from not being able to truly serve your patient while performing clerical duties that do not utilize your skill sets can result in moral injury.
How does Suki balance the relationship between the clinician and the patient?
The vision here is that if the technology is really good, then you don’t even notice it. It’s like good wedding planning. We wanted to build Suki as an “invisible” assistant for the doctors so that the doctor has the time to be fully present with the patient, and the cognitive focus to be immersed in the clinical processes of information synthesis, diagnosis, and intervention.
The vision for Suki is ambient AI. Imagine your best day at work as a doctor, you’ve got an outstanding resident following you on rounds. They understand what you need, they do all the grunt work for you: data entry, orders, notes, etc. All you have to do is to focus on the patient. At 5 pm, you can go home. You don’t have 3 hours of charting to do when you get home. This is where we want Suki to end up. There’s no technology that can be completely ambient right now. But, Suki is closer than others.
The key here is for Suki to be the assistant to doctors. It’s worth mentioning that we find the concept of replacing doctors with AI naive and somewhat disrespectful to the profession.
The vision here is that if the technology is really good, then you don’t even notice it. The vision for Suki is ambient AI. Imagine your best day at work as a doctor, you’ve got an outstanding resident following you on rounds. They understand what you need, they do all the grunt work for you. The key here is for Suki to be the assistant to doctors.
What are some difficulties when trying to create an empathetic technology solution that does not inflict moral injury?
First, and credit to Zubin here, the problem with the term “burnout” is that it has an element of victim-blaming. It subtly implies that if the doctor just meditated more, exercised more, and learned to love their EHR, they would be less burned out. That perspective, of course, is outrageous. Physicians are humanists. They are people who went into medicine to help patients.
When technology is not respectful of the client it serves, in this case, it’s the physician, then it’s easy to add to moral injury.
Physicians are humanists. They are people who went into medicine to help patients. When technology is not respectful of the client it serves, in this case, it’s the physician, then it’s easy to add to moral injury.
For example, in the area of clinical decision support, it’s often very difficult to implement systems that do not inflict moral injury—most suggestions that come from the EHR are already very obvious, or irrelevant. How does that help? These are not systems designed, beginning to end, with the doctor foremost in mind.
We are not opposed to this example of clinical decision support, but there isn’t a usable solution until doctors are the ones telling you that it has value.
This is why working with the clinicians closely to design the right solution is very important.
How do you know that you have an empathetic solution?
There are two ways that you can measure your solution: appropriateness and viability.
Appropriateness means: will your solution add value to the humanistic settings of the client and patient interaction? For instance, having an overly engineered solution in the emergency waiting room will not help patients who are in pain while waiting for care. In this type of setting, you want solutions that patients can identify with and can make them feel better on a human level.
Viability means: whether the solution can work seamlessly inside the workflow. Does the solution lives up to the expectations? If it takes too much change in the existing workflow or is very disruptive to implement, then it will not be seen as an empathetic solution. On the other hand, if the solution does not live up to the expectation or it doesn’t help physicians where it’s intended to, then it’s not an empathetic solution.
How has Suki’s design helped to solve the physician burnout issue?
Computers are great helping with the cognitive burden and mining for details. Humans are good because they are creative.
Garry Kasparov, the chess champion that defeated IBM’s deep blue said, paraphrasing, “Computers are good that they don’t make mistakes. But, humans are good that they are creative. Give me a computer, and I’ll beat every computer and every person out there.”
Give me a computer, and I’ll beat every computer and every person out there.
This is how we think of Suki. We are here to make sure that things don’t slip through the cracks. We are here to do the menial work. We are here to mine the less interesting details. We are here to be an assistant. Every pixel in Suki is designed in service of the doctor. Suki’s very user-friendly. It takes 20 minutes to train a doctor. It runs on your phone. There’s no hardware, dictaphone, etc.. You get a consumer-grade experience. Doctors are used to using Alexa and Google Home at home. We want them to use a technology that’s as intuitive when at work. Usually the first-day doctors use Suki, they get back 2 hours on their day. No one has to train you how to use your iPhone, we want Suki users to have the same experience.
So far, physicians love Suki. We are very proud of how well the product has performed for our customers. Do you know about the Net Promoter Score? It tells you whether people like your products. For instance, Apple, Starbucks, and Netflix probably have an NPS score north of 50. Most EHRs have NPS in the negative range. Suki has a NPS trend between 50 and 60.
The healthcare workflow is vast. There’s plenty of grunt work to go around. Where is Suki’s focus?
Suki is clinician focused. Suki will help doctors, physician assistants, or family nurse practitioners, really anyone who sees patients. Suki is also “specialty agnostic.” We serve every clinician regardless of their area of medicine. Currently, we are focused on the ambulatory space. This is where Suki can help to improve the healthcare workflow immediately.
What do you think is the most important early decision that helped Suki become popular with physicians today?
We’ve been cognizant of creating a consumer experience that will truly deliver. We founded the company in April 2017. We had the first iteration of Suki in a doctor’s office in about 6 months. We wanted the feedback and the tough love. Since then, we’ve worked with physicians to go through many iterations of our product. Working closely with physicians, we’ve seen how Suki can integrate seamlessly into different types of workflows. The early decision of partnering with physicians has helped us to create a product that truly adds value.
Working closely with physicians, we’ve seen how Suki can integrate seamlessly into different types of workflows. The early decision of partnering with physicians has helped us to create a product that truly adds value.
In the age of artificial intelligence, it’s good to know that technology can help to bring more humanity into our day to day work. In some ways, automation, intelligence using AI is challenging all of us to think about our workflows. When a physician can see the vision of their perfect workday, and realize what is the most important: human relationships and sanity. This is when a company like Suki.ai, through working closely with physicians can provide the most value. The march toward humane healthcare just started.
