Dr. Michael Curren, Cardiologist; Medical Director, Clinical Informatics, University of Pittsburgh Medical Center (UPMC) Moderator: Chrissy Farr, Second Opinion Media
Category
đ€
TechTranscript
00:00 Well, hello.
00:01 How are you?
00:02 Good, yeah.
00:03 Enjoying the post-lunch aspect of this conference?
00:06 Absolutely, always my favorite session, post-lunch session.
00:09 Well, who is ready to see a demonstration of some very exciting technology?
00:15 Chrissy, for the day today, it's the first time you don't have to moderate,
00:19 you get to play the role of a patient.
00:21 So, most importantly, she's going to be playing a role.
00:24 None of this is going to be real medical history, just for the record.
00:27 So don't worry about me.
00:28 Don't worry about her.
00:30 She may or may not have some interesting diagnoses that we discover,
00:32 and we're going to get right to it.
00:34 So why don't we jump in?
00:35 Let's do it.
00:36 All right.
00:37 So we're going to be demoing an application called Abridged today.
00:40 So, Chrissy, while we talk about your medical problems here in the office today,
00:43 I'm going to use this technology.
00:45 It's going to record our conversation so you and I can talk,
00:47 and then it's going to help me to do a better job of delivering care to you.
00:50 Does that sound okay?
00:51 Sounds good.
00:52 All right.
00:53 Let's give it a go.
00:54 I'm going to start the recording.
00:57 So, Chrissy, what brings you to see me today?
00:59 I hear you've been having some problems.
01:02 So, since I arrived at the Fortune Brainstorm Health Conference,
01:07 I've been feeling quite a bit of fatigue.
01:10 Just since you arrived?
01:12 Just since I arrived.
01:14 And have you had any other symptoms with that?
01:15 Have you felt short of breath at all?
01:18 I haven't been experiencing that, but I did wake up this morning with giant ankles.
01:25 Giant ankles?
01:26 Oh, my goodness.
01:27 Could you put your shoes on?
01:28 Badly.
01:29 I had to squeeze them on.
01:30 Oh, goodness.
01:31 So your ankles swelled up, huh?
01:32 And did you have any other symptoms?
01:33 Did you feel like your heart was racing or your heart was skipping beats at all?
01:37 Nothing like that.
01:38 Nothing like that.
01:39 Just swelling.
01:40 And you're sure?
01:41 No shortness of breath over the past week or two?
01:43 Maybe going up a flight of stairs, feeling more short of breath with that prior to getting here?
01:47 Maybe all the chasing all the panelists around today.
01:50 Yes, that could certainly do it.
01:51 That could certainly do it.
01:54 And have you ever had any symptoms like this previously?
01:59 Nothing, no crazy swelling in my feet previously.
02:03 I think this is the first time.
02:05 Well, anytime I hear that as a cardiologist, I always worry about it being a heart problem.
02:09 And I'm looking through your records here.
02:11 And do you remember a few years ago, you actually did have a heart problem or something similar happened.
02:16 It was during the height of the pandemic.
02:17 There was a lot of stressors going on.
02:19 Being a journalist, traveling all over the place, all of a sudden you couldn't do that.
02:22 And you developed something called a stress cardiomyopathy.
02:24 You don't remember that, do you?
02:26 I think I somehow blocked it out.
02:29 We all tried to forget as much as we could at the pandemic.
02:32 So this is concerning that maybe this symptom has come, this condition has come back.
02:37 And so I think we should take it seriously.
02:38 So I'd like to do a couple of tests if that's okay with you.
02:41 I'd like to order some blood work.
02:43 I'm going to use some medical terms just to help me document something called a complete blood count.
02:47 I'm going to get a BNP level.
02:49 I'm going to get a basic metabolic profile.
02:51 And then I want you to come in and get something called an echocardiogram as soon as you can, maybe this afternoon or tomorrow.
02:56 That's an ultrasound of your heart.
02:58 And while we do that, we're also going to order an EKG.
03:00 Does that sound okay?
03:01 >> Sounds good.
03:02 >> And then we'll review all of these test results and talk about what our next steps are going to be.
03:07 But in the meantime, I noticed something back in the green room when we were coming out on stage here.
03:11 You walked in with two big bags of McDonald's and you opted to skip lunch today.
03:16 And I'm asking you about that because your blood work, your cholesterol was a little bit high.
03:22 >> You know me.
03:23 Me and my licky deez.
03:25 >> I was surprised.
03:26 But I understand sometimes it gets all of us.
03:29 So we're going to have to talk about that.
03:31 And I'd actually like you to talk to a nutritionist and really start to focus a little bit on maybe cutting out the McDonald's and think about maybe doing something a little healthier, like a vegan diet.
03:40 How does that sound?
03:41 >> A vegan diet?
03:42 Wow.
03:43 >> It's a lovely diet.
03:45 >> Yeah.
03:46 So with that, we'll touch base again, as I said, with all these test results, and then we will move forward.
03:52 So I'm going to stop our recording now, okay, and let's take a look at what we had.
03:58 >> So how long does this usually take, this part?
04:00 >> Yeah, so you're going to watch here on the screen.
04:02 It will show you how long it takes.
04:04 And what's happening now, the beauty of this model is this is getting ready to prepare communication for a number of different people.
04:12 From my selfish standpoint, I'm going to use it to write my note.
04:15 It's going to write my note for me.
04:17 At the same time, it's generating a document for my patient.
04:21 For you, that's going to be in more layman terms that you can review and have at your disposal.
04:26 And you see it's already completed.
04:28 Additionally, what we'll look at is some pulling from this unstructured data, some structured data elements, and recommend some ICD-10 codes to me just based upon the conversation that we had.
04:41 The last thing that it will do is it does support actually multiple different languages.
04:46 So you actually heard that introduction a little bit before we came out, a little bit of French.
04:50 And we do -- a bridge does support multiple languages.
04:53 So if I have a conversation with a patient in Creole, for example, that will translate for me into an English document.
05:00 And it supports multiple languages within a single conversation.
05:03 So let's take a look at what we got here.
05:06 So I'm just going to focus on the desktop here.
05:11 And here's the output of my note.
05:13 So I'm going to make this a little bit bigger so it's a little bit easier for us to see.
05:17 I'm just going to slide this over, give us a nice view.
05:20 Okay, so the first thing that I want to show you -- so the model is smart, but sometimes even it can't determine what an individual's pronouns are.
05:30 And I know from your record that your pronouns are not they/them.
05:33 They/she/her, and I can very quickly change that, and the note corrects itself very quickly.
05:37 It's very easy for me to do that without having to think much about it.
05:40 But let's just look very quickly.
05:41 Let's read a couple of lines of the history of present illness.
05:44 Make that a little bit bigger as I look over at the screen there.
05:46 So patient presents with fatigue and ankle swelling.
05:49 It started at the arrival at the conference.
05:51 You had no other symptoms, although you did note some increased exertion while chasing the panelists around.
05:57 Here we talk about your preference for fast food, specifically McDonald's.
06:00 That picked that up as we talked about that.
06:03 >> And I'd love to see -- I mean, you know, you could forget about what we talked about.
06:07 So how do you even know if this is even accurate?
06:10 >> So this is really cool.
06:11 So this is -- you know, I forget what I talk to my patients about, believe it or not.
06:15 You know, if you see 20 patients in a day and you get four patients behind or five patients behind, many doctors stack their documentation at the end,
06:22 and they say, "What did I talk about when I first patient?
06:24 How do I know that this is correct?"
06:25 So I can actually go in here and talk about high cholesterol levels.
06:32 And it's going to take me to the recording.
06:34 And I'm going to -- and I'm asking you about that because your blood work, your cholesterol was a little bit high.
06:40 >> You know me.
06:41 >> Yeah, I get --
06:42 >> Me and my Mickey D's.
06:43 >> I was surprised.
06:45 But, you know, so I can go and validate the conversation that I had from the note that it was created.
06:50 And so it confirms to me, yes, that was discussed and the patient told you about that.
06:54 So I can prevent those hallucinations from happening just by confirming that within my note.
07:00 And as I scroll down here, just to go through and talk about the assessment and plan.
07:04 So I talked about stress cardiomyopathy recurrence and the diagnostic testing that I'm going to order in a nice bulleted fashion.
07:11 This is in a format that we call a SOAP note.
07:13 Anybody who's trained in medicine understands what that format means.
07:16 It's how we all create our documentation and make it very straightforward to follow.
07:20 >> So it looks -- I mean, it looks dead on.
07:22 >> Yeah.
07:23 >> So what do you do at the next point where you need to figure out how to build this?
07:28 >> So, you know, as a provider, you know, we have to create codes.
07:33 >> Got to make money.
07:34 >> Because part of what we do, got to make money.
07:36 So I'm going to show you from our conversation.
07:38 So these are codes that came out related to the conversation that it's asking me if I want to include with the chart.
07:45 It's not leading me at all.
07:46 It's just saying, hey, based upon the conversation that I heard, this is what you could possibly use.
07:51 And I can click through here and select those that I see.
07:54 And you can see for cardiomyopathy is a diagnosis that has a lot of codes with it.
07:58 And it gives me some very generic codes and it gives me more specific codes.
08:01 And I could use those as a way to document.
08:06 So it's interesting.
08:07 I didn't even say Takotsubo syndrome.
08:09 Actually, a stress-induced cardiomyopathy is another term for Takotsubo syndrome.
08:13 So it's fascinating that it can do that for me.
08:16 >> Yeah, I mean, you know, just seeing this, it does give me some degree of confidence that you can basically kind of just sit here and communicate with me,
08:25 which is what you want to be doing as the physician.
08:28 But what would you say is kind of the one downside, if you had to say one, to a system like this?
08:33 >> The downside, it's learning a new workflow.
08:37 That's the only -- that's the biggest downside.
08:39 >> This does sit in Epic.
08:40 So it's within --
08:41 >> This sits in Epic.
08:42 It can work independently.
08:44 It really -- there's different ways to utilize it.
08:46 For a provider who works in an electronic health record, to have that within the health record, it definitely is an easier thing to do because I have to use the health record for everything else that I do.
08:55 I'm just showing you very quickly the patient summary, right, and just the summary for you as a layperson as opposed to me and my clinical documentation.
09:04 >> Wow.
09:05 Spot on.
09:06 Well, thank you so much.
09:07 >> Yeah, this has been great.
09:08 >> Thank you.
09:09 And I'm glad I'm not dying.
09:10 >> Yeah, you're going to be okay.
09:11 Just cut off the McDonald's.
09:13 >> Thank you.
09:14 >> Absolutely.
09:15 [BLANK_AUDIO]