Equipping doctors with AI co-pilots

Most doctors go into medicine because they want to help patients. But today’s health care system requires that doctors spend hours each day on other work — searching through electronic health records (EHRs), writing documentation, coding and billing, prior authorization, and utilization management — often surpassing the time they spend caring for patients. The situation leads to physician burnout, administrative inefficiencies, and worse overall care for patients.

Ambience Healthcare is working to change that with an AI-powered platform that automates routine tasks for clinicians before, during, and after patient visits.

"We build co-pilots to give clinicians AI superpowers," says Ambience CEO Mike Ng MBA ’16, who co-founded the company with Nikhil Buduma ’17. "Our platform is embedded directly into EHRs to free up clinicians to focus on what matters most, which is providing the best possible patient care."

Ambience’s suite of products handles pre-charting and real-time AI scribing, and assists with navigating the thousands of rules to select the right insurance billing codes. The platform can also send after-visit summaries to patients and their families in different languages to keep everyone informed and on the same page.

Ambience is already being used across roughly 40 large institutions such as UCSF Health, the Memorial Hermann Health System, St. Luke’s Health System, John Muir Health, and more. Clinicians leverage Ambience in dozens of languages and more than 100 specialties and subspecialties, in settings like the emergency department, hospital inpatient settings, and the oncology ward.

The founders say clinicians using Ambience save two to three hours per day on documentation, report lower levels of burnout, and develop higher-quality relationships with their patients.

From problem to product to platform

Ng worked in finance until getting an up-close look at the health care system after he fractured his back in 2012. He was initially misdiagnosed and put on the wrong care plan, but he learned a lot about the U.S. health system in the process, including how the majority of clinicians’ days are spent documenting visits, selecting billing codes, and completing other administrative tasks. The average clinician only spends 27 percent of their time on direct patient care.

In 2014, Ng decided to enter the MIT Sloan School of Management. During his first week, he attended the “t=0” celebration of entrepreneurship hosted by the Martin Trust Center for MIT Entrepreneurship, where he met Buduma. The pair became fast friends, and they ended up taking classes together including 15.378 (Building an Entrepreneurial Venture) and 15.392 (Scaling Entrepreneurial Ventures).

“MIT was an incredible training ground to evaluate what makes a great company and learn the foundations of building a successful company,” Ng says.

Buduma had gone through his own journey to discover problems with the health care system. After immigrating to the U.S. from India as a child and battling persistent health issues, he had watched his parents struggle to navigate the U.S. medical system. While completing his bachelor’s degree at MIT, he was also steeped in the AI research community and wrote an early textbook on modern AI and deep learning.

In 2016, Ng and Buduma founded their first company in San Francisco — Remedy Health — which operated its own AI-powered health care platform. In the process of hiring clinicians, taking care of patients, and implementing technology themselves, they developed an even deeper appreciation for the challenges that health care organizations face.

During that time, they also got an inside look at advances in AI. Google’s Chief Scientist Jeff Dean, a major investor in Remedy and now in Ambience, led a research group inside of Google Brain to invent the transformer architecture. Ng and Buduma say they were among the first to put transformers into production to support their own clinicians at Remedy. Subsequently, several of their friends and housemates went on to start the large language model group within OpenAI. Their friends’ work formed the research foundations that ultimately led to ChatGPT.          

“It was very clear that we were at this inflection point where we were going to have this class of general-purpose models that were going to get exponentially better,” Buduma says. “But I think we also noticed a big gap between those general-purpose models versus what actually would be robust enough to work in a clinic. Mike and I decided in 2020 that there should be a team that specifically focused on fine-tuning these models for health care and medicine.”

The founders started Ambience by building an AI-powered scribe that works on phones and laptops to record the details of doctor-patient visits in a HIPAA-compliant system that preserves patient privacy. They quickly saw that the models needed to be fine-tuned for each area of medicine, and they slowly expanded specialty coverage one by one in a multiyear process.

The founders also realized their scribes needed to fit within back-office operations like insurance coding and billing.

“Documentation isn’t just for the clinician, it's also for the revenue cycle team,” Buduma says. “We had to go back and rewrite all of our algorithms to be coding-aware. There are literally tens of thousands of coding rules that change every year and differ by specialty and contract type.”

From there, the founders built out models for clinicians to make referrals and to send comprehensive summaries of visits to patients.

“In most care settings before Ambience, when a patient and their family left the clinic, whatever the patient and their family wrote down was what they remembered from the visit,” Buduma says. “That’s one of the features that physicians love most, because they are trying to create the best experience for patients and their families. By the time that patient is in the parking lot, they already have a really robust, high-quality summary of exactly what you talked about and all the shared decision-making around your visit in their portal.”

Democratizing health care

By improving physician productivity, the founders believe they’re helping the health care system manage a chronic shortage of clinicians that’s expected to grow in coming years.

“In health care, access is still a huge problem,” Ng says. “Rural Americans have a 40 percent higher risk of preventable hospitalization, and half of that is attributed to a lack of access to specialty care.”

With Ambience already helping health systems manage razor-thin margins by streamlining administrative tasks, the founders have a longer-term vision to help increase access to the best clinical information across the country.

“There’s a really exciting opportunity to make expertise at some of the major academic medical centers more democratized across the U.S.,” Ng says. “Right now, there’s just not enough specialists in the U.S. to support our rural populations. We hope to help scale the knowledge of the leading specialists in the country through an AI infrastructure layer, especially as these models become more clinically intelligent.”