Nuance Communications Chief Strategy Officer Peter Durlach

Digital Health

Nuance Unveils GPT-4 Enabled DAX Express

Generative AI is making its biggest healthcare splash yet after Microsoft-owned Nuance Communications unveiled DAX Express with GPT-4 integration.

Dragon Ambient eXperience (DAX) Express creates clinical note drafts from patient-provider conversations in a matter of seconds by eliminating the need for a human quality checker before clinicians can review and upload the notes to the EHR.

DAX Express is the first clinical documentation application to combine conversational and ambient AI with OpenAI’s GPT-4 model, but its main goal remains the same as its predecessor: reduce administrative burden so providers have more time to focus on patients.

• Following a nearly $20B acquisition in 2022, Nuance’s latest solution is also fully backed by Microsoft’s enterprise resources and the scale of the Azure cloud.

• That’s not to mention Microsoft’s recent $10B investment in OpenAI, which it’s clearly trying to monetize sooner rather than later. Starting this summer, DAX Express will be open for early access to all providers using DAX or Dragon Medical One.

When we spoke to Nuance Chief Strategy Officer Peter Durlach a few weeks ago about an older AI model that some readers might still remember – ChatGPT – he raised some good questions about AI’s future in healthcare.

• How do these models fit into regulatory guidelines?
• What’s the indication for use?
• Can you explain the black box?
• How will the FDA operate in the middle of this?

With how fast AI is moving, these questions are going to be front and center in discussions with everyone from patients to regulators. In the last month alone, we’ve seen Doximity leverage similar tech in its DocsGPT tool that lets providers quickly fax prior authorizations, and Google announced that its Med-PaLM 2 model is consistently passing medical exams at an expert level.

The Takeaway

It’s hard to believe that Nuance DAX Express is considered the “early stages” of generative AI given how transformative these models are right out of the gates. There’s already a tsunami of startups working on new AI-enabled healthcare products, but the fact that Nuance’s 550k physician user base is about to have access to DAX Express highlights how powerful platform and distribution advantages are going to be on a level playing field where everyone has access to similar magic on the backend.

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The Wire

• Patients Prefer Immediate Test Results: Nearly every patient (96%) would rather get their test results as soon as possible via the patient portal, even if their provider hasn’t reviewed the results yet, according to a new survey in JAMA Network Open. After surveying 8.1k patients across four geographically diverse medical centers, only 7.5% reported that reviewing results before their provider increased worry, and worry was most common among those with abnormal results. That said, over 95% of patients with abnormal results still preferred to access their results immediately.

• Northwell Opts for Epic: New York-based Northwell Health is moving from Allscripts to Epic Systems in an EHR switch that’s expected to see its first phase go live in 2025. Northwell said the EHR jump is intended to enable a single patient record across all of its care venues, ideally cutting down on workflow redundancies and improving the patient experience. They’re in for a heavy implementation, with Northwell’s operations spanning 21 hospitals and about 900 outpatient facilities.

• Cleveland Clinic IBM Quantum System One: Adding to this week’s Sci-Fi news cycle was the deployment of the IBM Quantum System One at Cleveland Clinic, the first quantum computer dedicated exclusively to healthcare research. The installation is the fruit of a 10-year partnership between Cleveland Clinic and IBM centered around developing quantum computing pipelines to screen drugs targeted at specific proteins, improving prediction models for cardiovascular risk, and searching genome sequencing findings for more effective Alzheimer’s drugs. It looks as futuristic as it sounds.

• Providers Taking Measured Approach to AI: An Intelligent Medical Objects survey of over 300 “provider leaders” gave a good snapshot of the current priorities at care delivery orgs. While perennial favorites like burnout and data quality topped the list of challenges, it was interesting to see 84% report working with over 20 individual software vendors, contributing to integration frustrations (32%) and long implementations (17%). Respondents are also taking a measured approach to AI, with 85% believing AI’s received too much hype, yet a vast majority viewing it favorably for improving clinical quality (81%) and admin functions (83%).

• MedArrive + Ouma Health: MedArrive is partnering with Ouma Health to bring comprehensive maternal-fetal care directly into the homes of vulnerable women on Medicaid. MedArrive providers can now connect Medicaid patients to Ouma’s maternal health support if deemed necessary during in-home visits, including services such as prenatal / postpartum care, behavioral health screenings, remote patient monitoring, and lactation support. 

• SpectrumAi Secures $20M: SpectrumAi secured $20M in Series A funding to improve applied behavioral analysis (ABA) therapies and effectiveness tracking with autistic patients. The startup’s Twyll EHR and Patterns analytics platform improve data capture and objective measurement of ABA therapy, which historically has been tracked using only “subjective parent and provider surveys.”

• Step Counts Falling: A recent JAMA study revealed that the pandemic brought a notable decline in daily step counts, even after social distancing restrictions were relaxed, suggesting that COVID-19 affected long-term behavioral choices. Fitbit data from 5,443 US-based participants recorded at least six months before and after COVID lockdowns revealed major declines in daily steps (from 7,808 to 7,089), with the greatest declines among people from lower socioeconomic status and individuals who reported worse mental health early in the pandemic.

• Babylon Chronic Condition Management: Babylon Health is launching a suite of personalized programs geared toward high-risk members living with chronic conditions such as hypertension, diabetes, lower back pain, prenatal care, anxiety, and depression. The new programs are offered as part of Babylon’s integrated primary care model that collects and monitors patient data to optimize the timing of virtual touch points and digital exercises before supporting them with multidisciplinary care teams when needed. 

• AppliedVR Receives HCPCS Code: Virtual reality startup AppliedVR secured an HCPCS Level II code (E1905) for its RelieVRx solution that combines a headset with VR-guided CBT exercises for chronic pain management. CMS’ coding decision categorizes RelieVRx as durable medical equipment, making it the first digital therapeutic to be placed in an existing benefit category. The distinction is a critical step on the path toward securing Medicare coverage eligibility, which in turn can help with gaining broader commercial coverage.

• Remote Monitoring Efficiency: Remote cardiac monitoring can have a major ecological and economic impact. Analysis of 32,811 patients with cardiac implantable electronic devices found that over two years, RM eliminated $10.5M in costs and 12,597 metric tons of greenhouse gas emissions (GHG). Although much of those reductions came from eliminating travel (31.7M miles, $3.45M in gas, 12,518mt of GHGs), RM also eliminated 14.2M printed pages ($3M, 78mt of GHGs) and $3.7M in workforce costs.

• DOJ Changes Tune on Change Deal: The U.S. Department of Justice dropped its opposition to Change Healthcare’s acquisition by UnitedHealthcare Group and its Optum subsidiary. The DOJ and the states of Minnesota and New York had opposed the deal, but on Monday they filed a court brief that effectively ends their opposition. Having already completed the acquisition, Change and Optum will now be full speed ahead as they continue their integration.

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