‘Full circle’: How an AI tool easing administrative burdens at the St. Joseph’s academic Urban Family Health Team got its start at the healthcare network

Nearly 600 patients visit the St. Joseph’s academic Urban Family Health Team each week, so it’s easy for paperwork to pile up. Administrative burden is a leading concern for family doctors. The Ontario College of Family Physicians reports that 94 per cent of family doctors are overwhelmed with the volume of administrative and clerical work they must do, which is often completed after hours.

“Note-taking and charting is one of the more important tasks that adds to administrative burden for physicians,” says Dr. Akshaan Kaul, a family physician at St. Joseph’s Health Centre, a site of Unity Health Toronto.

The academic family health team recently began using AutoScribe by Mutuo, an AI-powered scribe that can generate notes for physicians to review, approve and add to the electronic patient record after a patient visit. AI scribes have been shown to reduce the time spent on this task by an average of 3 to 4 hours a week. Further, more than 75 per cent of physicians using AI-powered scribes report experiencing lower cognitive load – or the amount of working memory resources they are using – and better interactions with patients.

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“It allows the physician to have the majority of their notes completed by the time the patient leaves their appointment,” says Kaul. “Then it gives the physician freedom to modify or adjust the note as needed, which only takes a fragment of time compared to constructing the note from scratch.”

If patients consent to the use of the AI scribe, their doctor – freed from typing up notes during their appointment – can interact more naturally with them, with more eye contact and nonverbal communication.

“In the encounters that I’ve had so far, patients have liked and appreciated that,” notes Kaul.

Patients may also notice their family doctor summarizing and verbalizing important information that comes up in their conversation and during their physical examination. This helps the AI scribe more effectively capture this information. It also has the added bonus of improving communication and understanding between providers and patients.

“I’ve found that patients have liked that aspect of it because they actually get to hear what their doctor is thinking. The possibilities that they are considering for diagnosis and treatment are explicitly stated,” says Kaul. “I think it helps keep the patient more informed in the decision-making process.”

‘A full circle moment’

Mutuo, the company that created Autoscribe, has its origins at Unity Health Toronto.

“It’s a full circle moment,” says Dr. Noah Crampton, a family doctor and Chief Executive Officer of Mutuo. “The foundational research underpinning Autoscribe actually happened at Unity Health Toronto several years ago.”

In 2016, Crampton applied for a Clinician Scholar Program as part of his medical education at the University of Toronto and was connected with Muhammad Mamdani through the program. At that time, Mamdani was heading up a newly formed AI lab at St. Michael’s Hospital.

“I remember looking at Noah’s environmental scan and saying, ‘There’s an opportunity here,’” says Mamdani. “So we funded a fellowship and gave him access to some of our team members. We got a bunch of people together and he started creating this product.”

Crampton’s background as a family physician made him very attune to the needs of busy physicians.

“There was already a lot of literature about burnout among healthcare providers, which added to my discussions with colleagues on the reasons for burnout,” explains Crampton. “I was expressing my pain point of all the charting and documentation that we have to do and how that seemed like a task that a powerful AI could execute on.”

In 2019, AutoScribe received a boost of catalyst funding from Angels Den – Canada’s biggest medical research competition, led by St. Michael’s Foundation.

Since then, the AI lab has grown into a full-scale Data Science and Advanced Analytics program at Unity Health that has launched more than 50 artificial intelligence (AI) and analytics tools into practice. Mamdani now leads that program as the vice-president of Data Science and Advanced Analytics.

Likewise, Mutuo has grown and matured. Unity Health Toronto is a part owner of Mutuo, which gives it access to the tool. Mutuo is working on improvements to the Autoscribe program based on the feedback they receive from Unity Health physicians.

Towards better work-life balance

Currently, 21 staff physicians and the nurse practitioner at the academic family health team at St. Joseph’s are using the new technology, with plans to expand to second year residents and other members of the interprofessional team in future phases of implementation.

“The individuals that are using the AI scribe more often have become more comfortable with it and it’s been quite positive in terms of satisfaction with the notes; the time saved with the technology, of course; and the patients’ responses as well,” says Kaul.

The team is having monthly meetings with Mutuo to share feedback and the Mutuo team have already put in place changes to further improve the quality of the notes.

“That kind of back and forth to try to fine-tune how the program works and creates our notes is something that’s going to be ongoing as we move forward,” says Kaul.

Over time, the team hopes that by freeing up physician hours they will be able to see more patients, improving patient access to care. The team is also hoping that this technology will improve work-life balance for those using it – ultimately attracting more medical learners to careers in family medicine.

“If we’re able to shift the pendulum to have a better balance, that will show up – even subconsciously – in the way that we’re conducting ourselves at work,” says Kaul. “If learners hear that feedback and see that first hand, it will have a positive impact.”

By: Robyn Cox