Nuance DAX

So today we’re chatting about Nuance DAX and how it’s used at your company. Before we jump into that, could you give a brief overview of the company and your role there?

I’m the founder and CEO of a tech-driven primary care provider under the value-based care model.

What business problem were you trying to solve with this tool?

We were trying to offer the best provider and patient experience at primary care visits. Producing a note for a visit can be pretty taxing on the provider: you want their focus to be on the patient, and oftentimes, phenomenal providers are not necessarily phenomenal archivists and documenters. We had heard from some physicians in our network who were using DeepScribe and why they liked it, and we tried it out. I really liked the vision of it. DeepScribe scratched the surface, but DAX was better at the actual execution: it can produce a note for you by ambient listening in the room and importing it into your EMR. It gives a really robust note, and we had a dramatic before and after comparison with it. Without it, we would see very bare-bones notes: “patient had X complaint, sent order for Y.” But with it, it’s like you were in the room: you’d get rich detail about the patient’s background and the context of their specific issues that we never had before.

What requirements were you looking for in a scribing tool?

The main requirement is just the quality of the note. We didn’t want anything that would be a step backwards, like if the note was poorly organized or required a lot of work to edit it.

What other vendors did you look at?

We started reviewing the options about two years ago. We looked at Suki, but it wasn’t in the same class, it wasn’t an ambient scribe. Suki was more like an Alexa at that point: you would ask it to open your medication ordering portal, and it could transcribe into specific spots you directed it to. But we wanted the ambient feature, the ability to record an entire encounter and summarize it into a note, and it was really only DeepScribe and DAX in that category. We used DeepScribe for three to six months with a handful of practitioners before going with DAX.

How did DeepScribe and DAX compare among your team and providers?

DAX is definitely more impressive. It’s much more production-grade in terms of the organization of the information. I mean, it’s a Microsoft product. It’s a hard space to be a small startup and compete on quality. I heard of a new product, Abridge, maybe they’re having some success.

Not every provider likes to use anything; some providers would opt out of scribing altogether. But the purpose is to help enable the provider. But for those who did use it, they typically were extremely impressed. At this point there was only the DAX Full Service offering, where the note is sent to a Microsoft employee who finalizes it and imports it into our EMR. We had certain formatting rules for them to follow so the import made the most sense to us. The main drawback of Full Service is the time it takes to close a note. The typical turnaround is within 24 hours, but that isn’t ideal for a physician who likes to close their notes at the end of the day.

How did DeepScribe and DAX compare on price?

DAX is about twice as expensive as DeepScribe. DAX Express has lowered the price, but it’s still more expensive. It’s clearly the best quality — if you can afford it.

What was the sales and onboarding experience like?

It was really good. It’s Microsoft, so they have a pretty large customer success team, and there were a lot of people involved with onboarding. I think the one place they could have improved was in the note templates you could pick from. There are a lot of decisions you can make in a note: five different doctors could write the same note five different ways. It helps to have a standardized version across our providers, but in DAX, you can’t choose from different templates for inspiration, you have to provide them exactly the items you want. It surprised me, because at this point they should have seen so many notes that they could offer some options. We got to a point where we had a template version that we loved, but it took us a while to get there, because we had to build it ourselves without any help from DAX.

What is the workflow like for DAX Full Service vs DAX Express? Are there any tradeoffs for the two options?

I can’t speak to the quality of the output for DAX Express, since I haven’t seen it. Either way the workflow starts out in the same way, where you start a visit with a patient and ask them if you can record, and then stop recording at the end of the visit. For DAX Full Service, the recording gets sent to a middleman in Microsoft who edits it and pastes it into Athena within a day. DAX Express uploads the recording directly into the EMR, within seconds. So it has two main benefits over the Full Service offering: it’s half the price, and there’s no turnaround time.

The lack of a middleman with DAX Express is a weakness, though: you lose some ability to customize, areas where we could train a human to use specific formatting, that the automated process just can’t handle. For example, sometimes during a visit, the physician might want to add something to a note; we didn’t want those additions to get overwritten during an automated import, and we had a signaling system with the DAX middleman to handle those cases. That’s something we lose with DAX Express.

What are the strengths and weaknesses for DAX Full Service?

The quality of the note is a super strength, and then its weaknesses are the turnaround time and the price.

Are you implementing DAX Express in your clinics?

We’ll be using it in the next clinic we open, but we aren’t using it yet.

How is the system’s reliability and stability?

I’m sure there have been some occasional glitches, but it’s never to the point where it feels unreliable.

Are there options for API integration between DAX and Athena?

DAX covers that, not us. Maybe DAX has some APIs that they would expose if we wanted access to the data, but it’s not really a requirement for us. We’re more concerned with whether DAX uses Athena’s API smartly when it imports, to minimize the amount of manual work involved. It’s also things like having the physician’s schedule accessible from the EMR so that DAX recognizes the physician and they can just click into the current appointment and start recording. If that information isn’t available, they have to start the recording by saying the patient’s details out loud.

How has the support and account management experience been?

It’s been at the higher end. I’ve seen some problems with the way they do their contracting: they have minimum term commitments, and they don’t let you remove licenses, only add them, so you can end up in situations where you’re overpaying if providers exit the practice. And they had a bit of a big corporate mindset of “Nope, there’s nothing we can do here.” Whereas somebody like DeepScribe would be much more flexible.

Do you feel you made the right decision going with DAX?

Yes.

Are there any other key growth areas you want to highlight?

I think just improving the integration with the EMR.

Do you have any advice for other buyers looking at AI scribes?

My sense is that if you’re going to use a scribe tool, use DAX, and go with DAX Express. But don’t force it on providers, you’ll always have some old-school people who don’t want to use it. But you can get a lot of value out of it. Any practice will have medical records requests from specialists or other providers, and we hear back that they’re so impressed with the notes we send them! They’d say we have the best providers in the country, this is genius.