Dragon Ambient eXperience (DAX) Copilot Evaluation (DAX)

Dragon Ambient eXperience (DAX) Express Pilot Evaluation

AI solutions like, Dragon Ambient eXperience (DAX) Copilot (Nuance/Microsoft), hold the potential to significantly enhance provider and patient interactions and alleviate pain points that contribute to burn out. Atrium Health was the first healthcare system in the world to pilot Nuance's DAX Copilot intelligence (AI) enabled scribe software, which synthesizes a draft clinic note by "listening" to the conversation between a provider and patient. After 180 days of use by primary care clinicians and advanced practice providers (APPs), along with a control group, the investigators assess provider satisfaction, patient experience, and provider efficiency through qualitative and quantitative methods.

Study Overview

• Status: Completed
• Conditions: Automated Clinical Documentation
• Intervention / Treatment: Other: Dragon Ambient eXperience (DAX) Copilot

Detailed Description

In this non-randomized stepped-wedge trial, clinicians (including physicians and advanced practice providers [APP]) specializing in family medicine, internal medicine, and general pediatrics were recruited from outpatient clinics located in North Carolina and Georgia. The intervention group was divided into 5 waves between June and August 2023 based on clinic locations. Prior to the activation of accounts, clinicians underwent a one-hour training session on DAX Copilot. Meanwhile, a comparison group comprising clinicians not utilizing DAX was recruited in five waves from locations and specialties similar to those of the intervention group. Two types of primary outcomes, electronic health record (EHR) metrics and financial metrics, were assessed after 180 days of intervention. EHR metrics include time in EHR (EHR8), work time outside of work (WOW8), time in documentation (Note8), completed appointment rate, same day closure rate, and note length. Financial metrics include gross revenue per visit and work relative value units (wRVU) per visit. Secondary outcome include provider satisfaction survey, provider interview, and patient satisfaction survey.

• Study Type: Interventional
• Enrollment (Actual): 238
• Phase: Not Applicable

Contacts and Locations

Study Locations

• United States
  • Georgia
    • Macon, Georgia, United States, 31201
      • Atrium Health Navicent
    • Rome, Georgia, United States, 30165
      • Atrium Health Floyd
  • North Carolina
    • Charlotte, North Carolina, United States, 28203
      • Atrium Health
    • Laurinburg, North Carolina, United States, 28352
      • Scotland Health Care System
    • Winston-Salem, North Carolina, United States, 27157
      • Atrium Health Wake Forest Baptist

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• clinicians specializing in family medicine, internal medicine, and general pediatrics (including physicians and advanced practice providers [APPs])
• (intervention group) showed interests in participating in Dragon Ambient eXperience (DAX) Copilot
• (control group) clinicians who opted out from Dragon Ambient eXperience (DAX) Copilot in vendor's baseline survey
• (control group) clinicians who worked in the same clinic/region as the intervention group

Exclusion Criteria:

• preceptors
• inactive DAX participants (i.e., had DAX license but never activate it)
• have the same first use and last use DAX date
• missing demographics

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Health Services Research
• Allocation: Non-Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Active Comparator: Intervention - Dragon Ambient eXperience (DAX); Clinicians interacted with DAX Copilot	Other: Dragon Ambient eXperience (DAX) Copilot; The tool (DAX) listens to the conversation between a clinician and patient/caregiver during their visit, provides transcriptions between different speakers for the clinician to review, edit, and included in the final EHR notes.; Other Names: Dragon Ambient eXperience (DAX)
No Intervention: No Intervention - Control group; Clinicians with standard care

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Total EHR time	Total time on EHR (during and outside of clinic sessions) per 8 hour of patient scheduled time.	Month 10
Work outside of work	Time on EHR outside of scheduled patient hours per 8 hour of patient scheduled time.	Month 10
Time on encounter note documentation	Hours on documentation (note writing) per 8 hour of scheduled patient time	Month 10
Completed appointment rate	Total completed visits over scheduled visits	Month 10
Same day closure rate	Number of visits closed on the same day over total scheduled visits	Month 10
Note length	Length of note in EPIC for each visit	Month 10
Gross revenue per visit	Total charged amount in each day over total completed visits on the same day	Month 10
wRVU per visit	Total work relative value units (wRVU) in each day over total completed visits on the same day	Month 10

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Provider satisfaction	REDCap survey to clinicians in both groups (intervention and control) and assess their satisfaction of the new tool.	Month 4
Provider interview	12 semi-structured interview on clinicians in the intervention group. Each interview was facilitated using an interview guide with a semi-structured list of questions to help guide the conversation and answer the learning objectives.	Month 1
Patient satisfaction	Patient satisfaction on the visit - patient satisfaction surveys are collected as part of routine care, which will be accessed through Medallia. Scores range between 0 (worst) to 10 (best) with one decimal point.	Month 6

Collaborators and Investigators

• Sponsor: Wake Forest University Health Sciences
• Collaborators: Hieu Nguyen, MS - Biostatician; McKenzie Isreal, MPH - project manager; Casey Stephens, MPH - Health services researcher
• Investigators: Principal Investigator: Tsai-Ling Liu, PhD, Wake Forest University Health Sciences; Principal Investigator: Timothy C Hetherington, MS, Wake Forest University Health Sciences; Study Chair: Jeffrey A. Cleveland, MD, FAAP, Wake Forest University Health Sciences

Study record dates

Study Major Dates

• Study Start (Actual): June 19, 2023
• Primary Completion (Actual): December 15, 2023
• Study Completion (Actual): December 15, 2023

Study Registration Dates

• First Submitted: March 18, 2024
• First Submitted That Met QC Criteria: March 22, 2024
• First Posted (Actual): March 26, 2024

Study Record Updates

• Last Update Posted (Actual): March 29, 2024
• Last Update Submitted That Met QC Criteria: March 27, 2024
• Last Verified: March 1, 2024

More Information

Terms related to this study

• Keywords: speech-to-text; Dragon Ambient eXperience (DAX); intervention evaluation
• Other Study ID Numbers: IRB00098063

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No