Impact of Digital Ambient EXperience on Pediatric Subspecialist Documentation Burden

NCT06812234 | Completed

• 1 other identifier: STUDY00001962
• Study Type: interventional
• Target: 21
• Locations: 1 country
• Sites: 1

Brief Summary

This randomized quality improvement pilot project aims to assess whether the implementation of generative AI software for documentation, Microsoft Nuance's Digital Ambient eXperience (DAX) Copilot, enhances physician documentation efficiency and reduces burnout.

Conditions

Burnout

Keywords

Documentation burden; Clinician Efficiency; Generative AI; Digital Ambient eXperience (DAX); Pediatric subspecialty care

Outcome Measures

Primary Outcomes (2)

• Pajama Time

  Per Epic Signal: Average number of minutes per scheduled day spent in charting activities outside 7 AM to 5:30 PM on weekdays, time outside scheduled hours on weekends, and time on unscheduled holidays. Numerator: Minutes spent in charting activities outside 7 AM to 5:30 PM on weekdays and outside scheduled hours on weekends. Denominator: Scheduled days where time was spent in the system within the reporting period.

  12 months prior to study through end of study period.

• Time in Notes per Appointment

  Per Epic Signal: Time spent writing notes per appointment. Numerator: Minutes providers spent in a notes activity or navigator section within the reporting period. Denominator: Appointments within the reporting period. Excludes data from days where the User Action Log data was not submitted.

  12 months prior to study through end of study period.

Secondary Outcomes (7)

• Progress Note Length (characters)

  12 months prior to study through end of study period.

• Note Contribution

  12 months prior to study through end of study period.

• Time to Appointment Closure

  12 months prior to study through end of study period.

• Proportion of notes completed using DAX copilot generative AI software

  12 months prior to study through end of study period.

• Patient Volume

  12 months prior to study through end of study period.

Study Arms (2)

Control

NO INTERVENTION

* No change in documentation practice * Complete modified KLAS net EHR experience surveys

Intervention

EXPERIMENTAL

\- Enrolled in DAX Copilot with appropriate training and asked to use for every eligible visit where the family does not decline use for 3 months.

Other: DAX Copilot

Interventions

DAX Copilot OTHER

* Enrolled in DAX Copilot program. * Epic Haiku verified and adapted to record visits for DAX. * Virtual training to add Patient List column to schedule for DAX Note Status, add appropriate smartlinks to note templates (AI-generated history of present illness, physical exam, and assessment and plan). * In person at-the-elbow support from Children's Epic Support on Site team at initiation and up to 2 additional sessions.

Intervention

Eligibility Criteria

• Age: 18 Years+
• Sex: all
• Healthy Volunteers: Yes
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Providers:
• Practices at Children's in a specialty supported by DAX Copilot product and with available documentation efficiency metrics from Epic's Signal product.
• \>0.5 clinical full time equivalent (cFTE)
• or more half days per week on average seeing outpatients as the primary provider (not overseeing trainees or APPs).
• Agrees to use the Children's EHR mobile application (Haiku) on their personal device.
• Agrees to offer use of the DAX Copilot generative AI software for all eligible patient visit encounters for the duration of the project period
• Sufficient and stable EHR data on documentation efficiency from Epic's Signal product, defined as:
• Having populated data available for at least 40 of the last 52 weeks.
• Having stable metrics for pajama time and time in notes in the last 6 months as determined by two physician informaticists based on visual inspection.
• \>75% of ambulatory documentation completed by the provider themselves (as opposed to taking over a note of a trainee or advanced practice provider).
• Visits: In person office visits in which interactions occur in English. For example, a visit with an interpreter present who translates verbally into English during the visit would be eligible. A visit in which all interactions occur in another language (i.e. the provider speaks the language the family uses as well) would not be eligible as the AI has not been developed yet for other languages.

You may not qualify if:

• Poor WiFi and cellular coverage in the clinic.

Sponsors & Collaborators

• Children's Healthcare of Atlanta: lead

Study Sites (1)

Children's Healthcare of Atlanta

Atlanta, Georgia, 30329, United States

Location

MeSH Terms

Conditions

Burnout, Psychological

Condition Hierarchy (Ancestors)

Stress, Psychological; Behavioral Symptoms; Behavior

Study Officials

• Stella Shin, MD

  Children's Healthcare of Atlanta

  PRINCIPAL INVESTIGATOR

• Evan Orenstein, MD

  Children's Healthcare of Atlanta

  STUDY DIRECTOR

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: NONE
• Purpose: HEALTH SERVICES RESEARCH
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Study Record Dates

• First Submitted: May 28, 2024
• First Posted: February 6, 2025
• Study Start: May 1, 2024
• Primary Completion: August 1, 2024
• Study Completion: August 1, 2024
• Last Updated: February 6, 2025

Record last verified: 2025-01

Locations

US (1)