▲ 87 points
back
95 comments
I’ve been beta testing this for several months. It’s OK. The notes it generates are too verbose for most medical notes even with all the customization enabled. Most medical interviews jump around chronologically and Dragon Copilot does a poor job of organizing that, which means I had to go back and edit my note which kind of defeated the purpose of the app in the first place.
It does a really good job with recognizing medications though, which most-patients butcher the name on.
Hallucinations are present, but usually they’re pretty minor (screwing up gender, years).
It doesn’t really seem to understand what the most important part of the conversation is, it treats all the information equally as important when that’s not really the case. So you end up with long text of useless information that the patient thought was useful but not at all relevant to their current presentation. That’s where having an actual physician is useful to parse through what is important or not.
At baseline it doesn’t take me long to write a note so it really wasn’t saving me that much more time.
What I do use it for is recording the conversation and then referencing back to it when I’m writing the note. Useful to “jog my memory” in a structured format.
I have to put a disclaimer in my note saying that I was using it. I also have to let the patient know upfront that the conversation is getting recorded and I’m testing something for Microsoft, etc. etc. You can tell who the programmer patients are because they immediately ask if it’s “copilot“ lol
I've been helping test it as well - your experience sounds identical to mine. I was initially very excited for it, but nowadays I don't really bother turning it on unless I feel the conversation will be a long one. Although I am very much looking forward to them rolling out the automated pending of orders based on what was said during the conversation.
LLM's have so much potential in medicine, and I think one of the most important applications they will have is the ability to ingest a patient's medical chart within their context and present key information to clinicians that would've otherwise been overlooked in the bloated mess that most EMR's are nowadays (including Epic).
There's been so many times where I've found critically important details hidden away as a sidenote in some lab/path note overlooked for years that very likely could've been picked up by an LLM. Just a recent example - a patient with repeated admissions over the years due to severe anemia, would usually be scoped and/or given a transfusion without much further workup and discharged once Hgb >7. Blood bank path note from 10 years ago mentions presence of warm autoantibodies as a sidenote; for some reason the diagnosis of AIHA is never mentioned nor carried forward in their chart. A few missed words which would've saved millions of dollars in prolonged admissions and diagnostic costs over the years.
Given everything I hear about LLMs for similar summary purposes including your description and that given above, it seems unlikely that the LLM would be all that likely to “notice” a side note in a huge chart. I agree that’d be great but I’m curious why you think it would necessarily pick up on that sort of thing.
> A few missed words which would've saved millions of dollars in prolonged admissions and diagnostic costs over the years.
I don't mean to come off antagonistic here. But surely the more important benefit is the patient who would've avoided years of sickness and repeated hospital visits?
I just wanted to jump in and say - don't give them too much credit on transcribing medication, I'm guessing this is Deepgram behind the scenes and their medication transcription works pretty well out of the box in my experience.
Screwing up gender and years sounds pretty serious to me?
Maybe they mean that it either doesn’t matter in context or it’s easy to catch and correct. Either way it seems reasonable to trust the judgement of the professional reporting on their experience with a new tool.
It's more in scenarios where I enter the room and I ask the patient whether this is their wife/husband etc. It's not like I'm going into the room and saying "hello patient you appear to be a human female". The model is having difficulty figuring out who actors are if their are multiple different people talking. Not a big issue if all you're doing is rewriting information. But if multi-modal context is required, its not the best.
The notes it generates are too verbose for most medical notes even with all the customization enabled.
I've noticed that seems to be a common trend for any AI-generated text in general.
Yes, the biggest problem with Healthcare AI assistants right now is that there is no way to "prompt" the AI on what a physician needs in a given scenario - eg. "only include medically relevant information in HPI", "don't give me a layman explanation of radiographic reports", "include direct patient quotes when a neurological symptom is being described" etc.
And the prompt landscape in the field is vast. And fascinating. Every specialist has their own preference for what is important to include in a note vs what should be excluded; and this preference changes by disease - what a neurologist want in an epilepsy note is very different from what they need in a dementia note for eg.
Note preferences also change widely between physicians, even in the same practice and same specialty! I'm the founder of Marvix AI (www.marvixapp.ai), an AI assistant for specialty care, we work with several small specialty care practices where every physician has their own preferences on which details they want to retain in their note.
But if you can get the prompts to really align with a physician's preferences, this tech is magical - physicians regularly confess to us that this tech saves them ~2 hours every day. We have now had half a dozen physicians tell us in their feedback calls that their wives asked them to communicate their 'thanks' to us for getting their husbands back home for dinner on an important occasion!
[Edit: typo and phrasing]
We tried it at my job, I got us in the beta. Go try Nudge AI and tell me what you think. Our providers found Nudge to be a far better product at a fifth of the price.
> Hallucinations are present, but usually they’re pretty minor (screwing up gender, years).
And if all hospitals were doing was having doctors treat patients, this would be ok. But healthcare is fueled by these "minor" details and this will result in delays in payment and reimbursent, trouble with patient identification, corruption of clinical coding, etc.
Did you encounter any instances of hallucinations or omissions?
One would image those to be the biggest dangers.
it's not minor when they screw up dosage
As a medical student, I used the dragon dictation software (no AI) to write notes in the ED and more recently I used a pilot of this ai version to write clinic notes.
Overall, I was quite impressed. It definitely made writing notes much faster, which all doctors hate to do. While it had some problems with where to put key pieces of information (like putting details from the physical exam back in the history), it only took 5 mins of rearrangement after the visit to complete the note.
For simple diagnoses, it does a decent job coming up with the assessment and plan, probably because all the simple diagnoses were in the training set. For more complex ones though, it needs to be exactly dictated by the doctor. I can see this being used very well in primary care.
Edit: When I said “coming up with an assessment and plan” I mean documenting the assessment and plan based on the ai’s recorded conversation with the patient. The conversation with the patient is meant to be understandable. The “assessment and plan” documentation on the other hand is jargony and meant to be read by other physicians.
This still sounds bad. 5 mins to rework your notes after each patient visit? I didn't assume doctors had that kind of time.
And let me make this clear. I, as your patient, I never NEVER want the AI's treatment plan. If you aren't capable of thinking with your own brain, I have no desire to trust you with my health, just like I would never "trust" an AI to do any technical job I was personally responsible for due to the fact that it doesn't care at all if it causes a disaster. It's just stochastic word picker. YOU are a doctor.
This doesn’t necessarily apply to this particular offering, but having working in clinical AI previously from a CS POV and currently from as a resident physician, something I’m a little wary of is the “shunting” of reasoning away from physicians to these tools (implicitly). One can argue that it’s not always a bad thing, but I think the danger can lie in this happening surreptitiously by these tools deciding what’s important and what’s not.
I wrote a little bit more of my thoughts here, in case it’s of interest to anyone: [0]
On that same vein, I recently made a tool I wrote for myself public [1] - it’s a “copilot” for writing medical notes that’s heavily focused on letting the clinician do the clinical reasoning, with the tool exclusively augmenting the flow rather than attempting to replace even a little bit of it.
[0] https://samrawal.substack.com/p/the-human-ai-reasoning-shunt
It does feel like we are hurtling towards a world where every industry will have a high volume producer of generated content, which will force the creation of a high volume summarizer of generated content.
"Having trouble processing a medical claim with 50+ pages of notes? Not to worry, Dragon Copilot Claim Review(tm) trims the fluff and tells you what really happened!"
"Having trouble understanding a large convoluted PR? Not to worry, Copilot(tm) Automated Review has your back!"
"Having trouble decided which cordless vacuum to buy? Not to worry, Amazon's Customers Say(tm) shows you what people think!"
There is definitely _some_ world utility to this arms race, but is it enough?
It's dumb and I hate it. It's exactly the same with job applications: AI generated resumes and AI generated cover letters read by AIs, we might as well save the compute time and send bullet points, but no we all have to continue the dance even though the music stopped. So many bright minds working on such degenerate technology... the flip side is that I spend less and less time online as LLMs greatly accelerated the slow rot that had taken hold of the web
The way you described it, that's not a problem at all, but a clear improvement. Thing is, every industry already has "a high volume producer of generated content" that, except for the last case, arose organically, due to reasons other than trying to confuse the reader. The creation of "a high volume summarizer" doesn't automatically mean an arms race.
Medical claims won't be growing in pages just because a doctor can parse them a bit faster. They may grow initially, because it's likely that people's mental capacity is what keeps other factors from ballooning the claims further - but it'll level out when some other practical limit is reached. Same with coding and PRs, same with research and all kinds of activities - except advertising.
There, AI will (already is) causing an arms race, because the "high volume producer"'s goal is to overwhelm their victims, so if the victims start protecting themselves with AI tools, the producer will keep increasing production to compensate. But that's not the fault of AI - it's the fault of allowing the advertising industry to exist.
Personally all I can hope for is that people start seeing it for what it is and just shorten their communication, foregoing the use of LLMs.
Didn't this have issues recently where symptoms or stories were hallucinated and attributed to the patient?
This seems like a tool that insurance companies would love to get a copy of the data stream, and that could get very sticky quite quickly.
I got my company into the beta of DAX Copilot, and it's ok. It's not fabulous. After a year only a third of doctors were still using it. We switched to another product that works better for our providers, but also costs a fifth as much as Dragon. Dragon Copilot is MASSIVELY overpriced, and it is not the premier healthcare note summary product now.
Is that other product Nudge?
This sounds like a basic STT/Transcription app. What makes it a "Healthcare Virtual Assistant"? Presumably it's been trained on a medical dictionary to recognize vocabulary from this domain? Dragon has been making transcription apps since 1997, originally based on Hidden Markov Models, I assume since updated to use transformers.
It reformulates the visit transcription as medical notes. That's the "virtual assistant" part afaik.
Interesting, but there is a lot of "intent" in writing notes and I am not convinced it could capture the full picture without significant human supervision. Would it really save time writing paperwork if you have to go through it anyways and check if there's anything wrong? At least when I write, I know it's correct.
> Interesting, but there is a lot of "intent" in writing notes and I am not convinced it could capture the full picture without significant human supervision. [...] At least when I write, I know it's correct.
To my understanding, notes would otherwise largely be written from memory after the visit - which adds a fairly significant opportunity for omissions and errors to sneak in.
It seems plausible to me that by fixing that low-hanging fruit, this tool could potentially reach current human levels of accuracy overall even if it has shortcomings in other areas, like not being as good at non-shallow reasoning. Not to necessarily say it's currently at human-level.
> Would it really save time writing paperwork if you have to go through it anyways and check if there's anything wrong?
Five minutes saved per encounter, allegedly[0]. The decrease in clinician burnout and patient satisfaction also seem pretty significant. But, not sure how much Microsoft have massaged those figures.
Not surprisingly there is a lot of competition in AI medical scribe software.
Some other companies in this space are Epic, Freed, Nuance, DeepScribe, Nabla, Ambience, Tali, Augmedix
This is Nuance, Microsoft acquired them in 2021 :)
I'm not sure why some people are so hostile to this tool. It sounds like Dragon Speak plus AI. It's not going to replace your doctor.
I think people are understandably worried that their doctors are going to start relying more on the AI for diagnoses
The outcome of this is essentially that AI generated healthcare decisions will be superficially laundered through a human doctor, rather than a human doctor simply using the AI as a tool
This may be compounded by insurance companies using the AI as their guideline for their plans and payouts, and government healthcare agencies using the AI as their guideline for acceptable treatment practices
Healthcare is already not an ideal industry from a patient perspective in many places. It is difficult to imagine AI making this situation better for patients
I was selected as one of the testers for MS Copilot for a large hospital in Florida after tested Microsoft DAX for a while (dog shit). Copilot has nice features, like customization of the sections, but I doubt anybody would spend time playing with that too much.
I tested 5 other Ambient AI tools in the past 6 months. All of them can extract the Chief Complaint and do a decent job with the HPI, but as soon as you get a more complicated case, they all fell apart. Sections like Physical Exam became a mess and I have to rewrite the whole thing.
So far the best, in my opinion, is still LucasAI by Lucas Health. Super simple to use, very basic interface. It just works and produces the best notes. I barely touch them. With the ICD10 codes, sometimes it doesn't pick the very best. This thing has been improved over the past month, but it's always much better than Copilot.
The AVS are both good, but with LucasAI I can translate immediately in Spanish and send it over to the patient via email/sms.
I haven't explored the integration with Copilot. Bad news, I know for a fact LucasAI is not fully integrated with Meditech yet, but I just copy and paste the whole note in 10 seconds. Not a problem. My buddy is using ECW and he said it's integrated. Haven't seen with my eyes.
>Nambla’s OpenAI powered Whisper
I hear the sound of 100 defamation lawyers cold calling Nabla right now
"Administrative burden" is a perfect use case of LLM. They are both bs.
Generally I agree but surely there is value in having detailed notes on patient visits, even if isn't worth the amount of effort currently expended on it.
I don't want anyone who considers patient notes administrative burden anywhere near my health care.
This is how Microsoft will start killing people in 2026.
All of the top corporations coming together to combine all the computing power in the world to make a machine with complete immunity for the sole purpose of denying you healthcare. Pretty bad!
Those systems already exist and they are not llm scribes. Check out nant health eviti, and others.
...in the US.
In most of the rest of the world we have functioning healthcare systems, and I imagine this will be useful in reducing the time doctors spend on paperwork and increasing the time they're providing healthcare.
The truth is these tools are coming. There are teething pains, but they will be the norm in a year or two. The real question is what does healthcare look like in 5-10+ years as deep knowledge tools start entering it and disrupting every step of the patient journey? I have hopes that it will bring medicine more local and personal again but I have fears that the productivity gains and cheap intelligence will just be used to strip resources out of healthcare for profit.
And I have fears enthusiastic technology adopters will blindly accept these tools as god because “the computer says so”. Forcing patients to do the same without the opportunity to give informed consent.
Marginalized groups will receive worse care because they weren’t in the training set.
Lazy doctors will get lazier.
Errors will be deeply buried in a bureaucracy with no available remedy because nobody at the ground level understands the technology.
Scheduling will become less transparent. Escalations will be automatically denied.