"It’s been life-changing:" five questions with Ike Rasmussen, DAX superuser

Since back in his residency days when the technology was “in its infancy,” family medicine physician Isaac “Ike” Rasmussen, MD, has been an early and enthusiastic adopter of voice recognition software. So when Nuance debuted DAX, the artificial intelligence-powered medical note-taking scribe now available to every Intermountain Health care provider who wants it, he was ready. “DAX does not disappoint,” he said. “It’s life changing.”?

Read on to find out how.

You’re one of our top DAX users. What do you like so much about this tool??

I’ve always liked to jump in early. Way back in residency when Dragon was just getting off the ground as a voice-to-text tool, I’d be walking from the clinic to the hospital dictating notes. ?It was often humorous to read the output of the voice-to-text software, because it would transcribe so inaccurately at times.?

As time went on, the software became better and better, and now with the technology leveraging the power of artificial intelligence, I was ready to jump in and try out the latest and greatest.?

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How do you use it??

At the beginning of the day, my workflow starts with creating little placeholders for the patients I’m going to see on clinic day. I just create a new DAX note for each patient with some identifiers, so then I can quickly go back to that note right when I walk in the room and have it fired up and recording, and then just go about the visit as I would.?

At the end of the visit, if there’s anything else needed in the assessment and plan, I can quickly dictate it and then close the DAX encounter. Within two minutes, an organized note in the appropriate format, with all of the pertinent details, is ready to copy into the patient’s chart. Epic will make this even easier when the software can talk directly to the EMR.?

The big difference is that during the visit I’m focusing on the patient instead of trying to get stuff into the chart, which is always a pain. You’re sitting there typing at the computer screen and it just completely disrupts the flow of the visit.?

There’s a drawing that’s become kind of famous where a kid draws their doctor visit, and the doctor is on the computer with their back turned.??

I’m just thinking about my own personal doctor’s visits that I’ve had in the past, or physicians that I’ve shadowed either during residency or med school, and the ones I loved the most and really admired were the ones just completely engaged with the patient and ignored the computer. That’s the best scenario, to have the physician really engaged in the conversation, and that back and forth is so necessary for good patient care.??

I have one colleague who was so annoyed about having to document and work at the computer during the visit that he’d sometimes joke with the patient like, “oh, are you still here?”?

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But then if you don’t document during the visit, how do you remember everything??

You either have to get information into the chart as you go or write it down on a piece of paper, or what I would do most of the time is just try to keep it in my mind: Okay, we’ve talked about hypertension, hyperlipidemia, diabetes, talked about their foot pain and talked about this mole – but when that list grows to nine or 10 problems, that becomes a huge cognitive burden. So letting DAX do it all for you and having a nice summary of all the problems you discussed and the care plan at the end is just amazing.?

Not only does it document all the information, but it presents it in a way that’s really well thought out. It cuts out all the “chit chat” and focuses the note on the important medical details, which is just crazy to me that it’s able to take the pertinent information and summarize only what’s relevant to their medical situation. It’s kind of mind-blowing.??

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Is it pretty accurate??

Most of the time the notes are spot-on. In the past they’ve left something to be desired at times, but with the most recent updates in the last few months, the quality and detail have been amazing. I’m looking forward to the future of this technology. It’s only going to get better from here. It’s hard to believe how far we’ve come since I started my residency 14 years ago!