Ambience Healthcare

So today we’re chatting about Ambience 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?

Our company is a long term care company, so we provide medical services for long term care assisted living, skilled nursing and independent living facilities. I’m the Chief Medical Information Officer there. I’m also a physician and see patients daily.

What was the need that led you to look for a product like Ambience?

The need was multifold. We were dealing with a lot of burnout in our space, which is a problem in the healthcare field in general. And one cause of that burnout is documentation. There’s a very heavy documentation load, and we were trying to find a product that could help with that. We specifically wanted a solution that could genuinely offload the documentation work, without requiring more staffing at the same time. We wanted to work smarter, not harder. We do have medical assistants who function as scribes to a degree, but they have a lot of turnover too. So we started investigating AI-enabled options and came across Ambience.

We also needed a product that could work with us as a partner, not just a number. We use a smaller EMR, so we needed someone who could work with us on that.

What requirements did you have when evaluating different products?

We didn’t start with a defined list of requirements at first; we wanted to be open to what was out there. Our end goal, though, was to make our providers happy. Price was a concern, but at the same time, if our providers are happy, there’s a financial benefit to that.

How did Ambience compare to its competitors?

Ambience seemed to be more hands-on and customizable from the start. They were very open to working with us to add or change features to fit our needs, whereas some of the other products we looked at felt much more like “this is what you get.” For example, during our pilot process, they added the ability to use the product on mobile phones and tablets, instead of just laptops. They also have been very open to product feedback and suggestions: I gave them some feedback that their interface was a bit confusing, and they changed it a day or two later. I don’t know if you’d get that with many other vendors.

Ambience also seemed to be more advanced in their technology. Some other companies are still using physical scribes in their process, whereas Ambience is AI only. I was impressed with that. The technology itself is very good: recordings are clear and filter out side conversations that aren’t relevant to the patient visit.

How has the onboarding and setup phase been so far?

The setup process took less than half an hour on a call with them. It was very quick to get up and running. We’ve been piloting the product for a few months and have a well-oiled process by now, so Ambience has actually designated one of our team members to take over the process to onboard our own clinicians. It’s been very smooth and easy, and doesn’t take long to learn the product.

How does Ambience fit into your existing workflow?

When you start a visit with a patient, you open up Ambience on your laptop or mobile device. Then you enter some demographic information and start recording. After that, you just have a regular conversation with the patient, and when you’re done with the visit, you stop the recording. Ambience knows where to put everything you talk about during the visit: so for example, if you do a cardiac exam and say “your heart sounds good,” it will add that information to the note with the appropriate medical terminology.

The heavy lifting is still in the assessment, of course. It won’t suggest anything for you, it just documents what you say. But it will add some details based on what you’re saying: so if you are seeing someone for high cholesterol and you tell it what medication and dosage they’re on, it will add a recommendation to follow a healthy diet and exercise. Stuff you were thinking about anyway but just didn’t say. It won’t suggest a diagnosis though. They do have a feature called auto codes, where if you say you’re seeing a patient for these specific conditions, but you also mentioned, say, hypertension, it will ask if you want to add that diagnosis or code to your note. That’s a new feature and it’s been very helpful with coding and billing.

Is Ambience integrated with your EMR?

No, it’s separate for now. We want to integrate moving forward, but wanted to pilot the product first. For now it generates the note in their product, and we copy and paste it into our EMR. It does have a function to copy and paste the whole note at once, so it’s not piecemeal.

There’s a verification step first: you review the note it generates, and you can add or change items in it, and then you sign off that everything is correct before copying it into the EMR. And you can change the text in the EMR, too, if needed.

How would you characterize the overall quality of the notes it generates?

So far, it’s been fantastic. Some of our auditors have given us great reviews, and you know, when the auditors love it, that’s very good news. They’re clear and well formatted. It helps us close our notes a lot faster. We were having issues with that, and we track the data on how quickly notes are closed, and patient and clinician satisfaction. We’ve seen that trend improve, which tells me that it’s working and that the data supports us moving forward with it.

Do you see any weaknesses or areas for improvement?

I’ll have a better answer once it’s more integrated with our EMR. But for now, the quality of the recordings is pretty good. Now and then it won’t understand a medication name that we say, but most of the time it’s correct. I will say, being able to record on your phone is useful, but actually viewing the chart on mobile is very difficult. It’s better for acute visits or something quick, so it’s still a nice feature to have, but it’s definitely a better experience on a laptop or tablet.

I would like to see the ability to do prep work prior to a visit; they don’t have that capability yet. For example, we have medical assistants doing work like medication reconciliation before a visit, and right now they do that in the EMR itself, not Ambience. But I think in the immediate future our priority would be improvements to help on the billing side with coding and things like that.

Have you had any stability or reliability issues?

No, it’s worked as long as you have an internet connection. You can also pause the recording and resume it later, so you don’t lose it.

How has the support experience been?

It’s been awesome. We are in almost-daily contact with their team to talk about how the pilot is going and if there are any areas for improvement. You can send questions or give feedback within the app itself, too, and highlight issues on a specific recording if something went wrong. They always get back to us very quickly and make changes in response to our feedback.

Do you feel like you made the right decision going with Ambience?

We’re still in the pilot phase, but so far, yes.

Are there any growth areas you’d like to see?

I think they should get into the predictive analytics side. You can use the HCC coding and the patient’s other diagnoses to start to identify high-risk patients, not necessarily to tell the provider what to do, but just to provide more information. I’m not sure that’s even on their roadmap, but it seems like that’s where medicine is heading.

Do you have any advice for other people who are evaluating similar products?

Do trials or pilots with as many companies as you can, as many as are financially feasible for you. Make sure your providers like the product, and see if the company is willing to help customize it to your needs. Talk to other people who are using it to see what their experience has been like. There are so many products out there that it’s hard to figure out what will work best without trialing them or talking to other users. And when you’re doing a pilot, make sure that both your most and least tech-savvy users try it out, to make sure they can both use it and get good results.

Pricing is certainly always an issue too. See if the product is tiered and what features and additions will increase the price. So far with Ambience, I get the sense that even though they’re helping develop the product for us, the price isn’t going up too: they’re tailoring it for our needs.