From discovery to organization-wide deployment: how Mankato Clinic chose Nabla

Margaux Benoit

Business Developer

Andrew Lundquist, DPM

Chief Medical Officer at Mankato Clinic

Already a month into 2024 and still having trouble figuring out the do’s and don’ts around ambient AI solutions for clinical documentation? It’s no secret that for the past year and a half, ambient documentation solutions have been making a lot of noise in the market. To cut through the noise, our team brings you lessons from their real-life implementation.

In addition to the inherent demands of the profession, clinicians bear the extra responsibility of having to skillfully navigate the continual emergence and overwhelming influx of new technologies. It turns out, the hype around generative AI over the past 12 months has been both a blessing and a formidable challenge.

A blessing, because there have been few times in the history of medicine, where new technologies have been adopted so rapidly, and enthusiastically. A challenge for executives and decision-makers as they find themselves grappling with the technological, clinical, and legal intricacies of AI, all the while having to address the pressing demands of clinicians for more efficient workflows that promote care quality and support their well-being.

The excitement for the unique, and immediate benefits that ambient AI solutions can deliver significantly accelerates the implementation of these technologies in traditionally slow healthcare organizations. In a recent podcast interview, Dr. Kristine Lee, MD, Associate Executive Director of Virtual Medicine Technology and Innovation at The Permanente Medical Group qualified Nabla’s adoption as “spreading like wildfire”, also demonstrating how proactive executives swiftly embraced Nabla to enhance physician wellness.

Every health system and medical group moves at its own pace, and many today are still in the early stages of discovery and decision-making around ambient AI solutions. How does one identify, evaluate, select and implement this new product category across their care team? While there is no one size fits all approach, learning from other implementation cases is certainly useful.

In the past few months, we have been progressively rolling out Nabla to Mankato Clinic’s 200+ care professionals. Margaux Benoit, Business Development Manager at Nabla, interviewed Mankato Clinic’s CMO, Dr Andrew Lundquist, to learn more about what their journey has been like with ambient AI implementation.

Margaux: Andrew, you are a well-known proponent of ambient documentation. Could you provide us with a brief introduction on how you acquired such extensive knowledge in this field?

Drew: I have always been interested in how trust can be nurtured between a clinician and a patient. As a Chief Medical Officer, I have to make sure that our clinicians are given the best tools to do their jobs. Early on, we saw ambient documentation as a potential game changer for improving patient and physician interactions. I went on LinkedIn and reached out to as many people working in this space as I could, and had as many conversations as possible. Since it was early on, most companies talked to me and I learned to trust the technology. This led to trials and demos of most of the products.

Margaux: Let's discuss the adoption of Nabla at Mankato Clinic. After trying Nabla for yourself, how did your experience influence adoption among your peers?

Drew: I quickly found that Nabla was easy to trial and I started using it on my own. I started telling people about my experience and before I knew it, quite a few people joined me. This was very different from the other tools that we had tried where clinicians dropped out because of the burden on their workflows.

Margaux: How would you describe clinicians' reactions to Nabla? Were they curious, careful, afraid?

Drew: All of the above. Clinicians are not any different than anyone else, in that some are early adopters, and some lag behind the curve. A tool has to be beneficial and safe for the physician and the patient alike to be trustworthy.

Margaux: For those who have been using it the longest at Mankato Clinic, have you noticed any specific changes in their attitudes towards the technology?

Drew: I have seen less apprehension as time went on. Most clinicians become more and more comfortable with relying on the technology to help them. Most would be seriously inconvenienced if we took it away at this point.

Margaux: How would you say Nabla has impacted your clinical workflow today, whether that would be your relationship with patients, your day-to-day in the clinic, or other?

Drew: I used to take about 40% of my work home, and now I do not take any. Nabla helps me to focus on my patients' concerns and really have a meaningful conversation with them. I find myself less distracted trying to remember what I forgot about a patient an hour ago because that is all documented.

Margaux: On an executive level at Mankato Clinic, and you yourself being the Chief Medical Officer, how would you describe the decision-making process leading to the choice of Nabla?

Drew: We had a lot of internal discussions as we went through the process of finding the right tool. The organic spread of Nabla was one of the key points as we did not have to pull teeth to get people to use this tool. This was different from some of the other tools that we had piloted. I never want to force change on clinicians as their workflows are sacred to them. The best change comes when people are motivated and make the changes themselves.

Margaux: Based on your conversations with colleagues in other medical groups, what barriers do you believe currently slow down piloting and adopting ambient AI solutions?

Drew: I think that people are waiting for the perfect tool integrated into the EHR and doing everything that a scribe would do. Because every EHR is different, the reality is that there is no perfect implementation. Some tools are also very costly, rendering that aspect of the equation inaccessible to the majority of clinicians.

Margaux: In this space, various factors play a crucial role in the adoption of ambient AI technology. What would you say were the strongest motivations at Mankato Clinic?

Drew: The biggest motivator was to free up time for providers, and for that, we had to have a tool that was both effective and high quality.

Margaux: Your experience is quite unique, as you had piloted another vendor, which you described as disappointing. How do you think this influenced your decision-making process and the motivations you were discussing?

Drew: We were scarred by a previous pilot. We were charged a lot of money and we only had 1 clinician who wanted to use it in the end. I think this really set the bar for us in terms of the expectations we had for the partner we were looking for: flexibility, ability to execute, and a strong understanding of our workflows.

Margaux: What are you hearing today from your clinical team? What do they expect next?

Drew: We are excited to be using Nabla for the potential benefits that are coming down the road, including smooth EHR integration, coding recommendations, and review of previous medical records. We know that we are at the beginning of what is going to be a very exciting couple of years as this technology comes to be more mature

Margaux: As a now expert in the field, what do you think are the main drawbacks of clinical documentation solutions today, and where do you see the most promise?

Drew: I am not sure if I am an expert or if I am just a documentation snob (Laughs). The challenge is getting a good quality note in every specialty, as there are so many different workflows that we need to break into. The most promising thing is that we can really reduce clinician burnout, and improve clinician lives by giving them more time to focus on patient needs.

Margaux: If you were to offer advice to a fellow CMO or executive team at another clinic seeking an ambient AI solution, what would it be?

Drew: I would tell them to have as many conversations with the clinicians as they can to fully understand their needs and workflows. Then select a tool that is malleable enough to be used across those specialties. Be ok with something that isn’t perfect. Trust your clinicians to make it work. We are used to overseeing students and residents. AI tools are the same, they need to be monitored, but they also make our lives much better. The benefits of saving a few minutes in every visit is worth the trade off of changing away from the current model of dictation that relies on more clinician time and input.