Dr. Terry Ribbens, a practicing family medicine physician and associate chief medical officer at St. Luke's Health System
Photo: St. Luke's Health System
Boise, Idaho-based St. Luke's Health System has more than 18,000 employees across eight medical centers and 370 clinics. The wellness of its physicians and advanced practice providers has been a key priority for the health system since the pandemic.
THE CHALLENGE
During and after the COVID-19 crisis, documentation burden increased significantly with electronic health records – and even more so with higher in-basket message volume. Staff were looking for viable technologies to decrease all of this administrative burden placed on providers. St. Luke's clinicians, like clinicians across the country, were facing significant burnout.
"These repetitive, time-consuming responsibilities were pulling clinicians away from direct patient care, contributing to fatigue and an overall sense that technology was adding friction rather than reducing it," said Dr. Terry Ribbens, a practicing family medicine physician and associate chief medical officer at St. Luke's Health System.
"Navigating the EHR, finding information, coding encounters, writing notes and completing documentation all add up – leading to providers completing their administrative work after hours," he added. "We monitored EHR pajama time and noticed it was increasing and were concerned this contributed to burnout of our physicians and advanced practice providers."
PROPOSAL
Some areas within the health system used human scribes to assist with documentation, which was effective but not scalable due to cost and limited personnel. As artificial intelligence technology advanced, St. Luke's staff began assessing available options.
"Our goal was to implement a system that would enable clinicians to concentrate on patient care while automating the documentation process through AI," Ribbens explained. "It was important that any system integrated smoothly with existing clinical workflows.
"The team at Ambience Healthcare really took the time to get to know us," he continued. "We were impressed at the quality of their product during our evaluation. They came to Boise and wanted to deeply understand our health system and worked with us to co-develop technology to handle documentation, coding and note generation in real time across all specialties in our health system."
The goal was to have AI reduce the cognitive and clerical burden so providers could spend more time connecting with patients and less time and cognitive load on administrative work.
MEETING THE CHALLENGE
St. Luke's implemented the documentation automation AI technology across a wide range of specialties and care settings, including primary care, behavioral health, subspecialties and hospital-based environments.
"Each specialty operates differently," Ribbens said. "Workflows, patient interactions and documentation needs vary significantly, so it was critical AI could adapt to these nuances. Our providers needed to be satisfied with the documentation output from the technology.
"High utilization across specialties – above 70% – was a key measure of success for us, because true impact only comes when clinicians in every field, from cardiology to neurology, find the technology useful and reliable in their day-to-day practice," he added.
The Ambience AI integrates directly with St. Luke's Epic EHR, allowing the AI to automatically generate documentation and coding suggestions within existing workflows. Physicians and advanced practice providers use the platform to streamline note creation, improve coding accuracy and reduce administrative burden – without disrupting patient interactions.
"The technology's flexibility and seamless integration helped drive consistent adoption and meaningful utilization across the health system," he noted. "We found providers were immediately comfortable using the technology with minimal training due to its ease of use."
RESULTS
The results, Ribbens said, have been transformative.
"This was the first time we had physicians and advanced practice providers clamoring for new technology for the EHR, leading to lots of demand to scale," he reported.
"Today, 75% of our physicians have Ambience licenses, with 83% encounter-level utilization across ambulatory specialties," he continued. "According to Epic UAL data, we've seen a 35% decrease in time spent documenting after hours and a 15% increase in patient face time."
Seventy-five percent of pilot clinicians reported reduced cognitive burden, along with a modest provider-driven increase in patient volumes. The AI had an early financial return on investment, generating $13,049 in annual revenue per clinician through enhanced hierarchical condition category and greater evaluation and management coding accuracy.
ADVICE FOR OTHERS
For health systems assessing or reassessing AI technology, utilization is a critical metric, Ribbens advised.
"Low utilization indicates that barriers are hindering clinicians from adopting the AI technology," he noted. "Identifying and understanding these obstacles – whether actual or perceived – is essential," he said.
"My advice would be to demo different AI technologies head to head across specialties and settings of care," he concluded. "Our pilot consisted of around 100 providers across 10 ambulatory specialties. Seeing how these tools perform in real clinical workflows is essential to choosing the right vendor. Many ambient AI vendors can write a note, but the depth of clinical understanding, coding accuracy and ease of workflow integration vary widely."
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