How VUMC's EHR virtual assistant will restore humanity in medicine: Q&A with Dr. Yaa Kumah-Crystal

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Yaa Kumah-Crystal, MD, is spearheading the pilot of Vanderbilt University Medical Center's new EHR voice assistant VEVA, which she hopes will bring back some of the humanity between patient and physician interactions that has been lost by the introduction of EHRs.

Dr. Kumah-Crystal, a pediatric endocrinologist and clinical informatics specialist at the Nashville, Tenn.-based health system, has special expertise in the development, implementation and evaluation of communication and documentation tools for clinical care support. She also serves as an assistant professor at VUMC's biomedical informatics and pediatric endocrinology departments.

As the project leader of VEVA, which launches Aug. 23 among a select group of VUMC physicians, Dr. Kumah-Crystal has been developing the digital assistant since January 2018. Here, she discusses her inspiration behind the project as well as what she's most excited to learn from the pilot.

Editor's Note: Responses have been lightly edited for clarity and length.

Question: What sparked the inspiration behind VEVA?

Dr. Yaa Kumah-Crystal: I first started thinking about the concept of being able to communicate with your computer and get medical information about a patient very early on. When I first got Siri on my iPhone, I saw how easy it was to ask about temperature or direction and it just made sense to be able to use that modality of talking to find information for healthcare purposes.

When seeing patients, I would be having a conversation with someone and then need to turn away and lose eye contact to look at the computer to find information. I found this so frustrating because it really takes away from the personal experience and the bond you try to develop with the patient. It just seemed like there had to be a better way to do it.

Q: How will VEVA help improve the patient-physician relationship?

YKC: What's really neat about having these voice interactions when you're with a patient is that he or she gets to participate in the conversation. When you're staring at a computer and typing in information, it's just you and the computer screen in front of you. Once information, like what a lab value is or what the risk had been, is spoken aloud the patient gets to hear it and experience it in the same time so that he or she has an understanding about what's going on and feels more engaged in a way that there hadn't been an opportunity before.

Q: How did you determine which group of physicians will pilot VEVA?

YKC: I work with an amazing group of other pediatric endocrinologists who are very tolerant of my enthusiasm for technology. Often when I get these ideas about new work flows I want to try out or new EHR designs, etc., I ask them if they'll try it because I think it will help potentially improve the way they're delivering care. They're usually really flexible and accommodating because they understand this could help save them time.

I thought this would be the best population to try VEVA with because they're my colleagues; we do the same kind of work, we see the same kind of patients. VEVA is designed for a work flow that I understand intimately, so if it's going to work in any population it's going to be among the same types of patients that providers are doing the same kind of work with. I think the digital promise of saving time, making the EHR less onerous is also appealing.

Q: How do you anticipate VEVA will affect physician workflow?

YKC: The biggest thing is that it will save time for them when they're trying to find information to put together the patient care summary they need in both their mind and on paper. One of VEVA's skills is generating a note, which is pulling through all the information about the patient's demographics, when he or she last saw you and any emergency department visits he or she has had, etc., and then VEVA pulls that data together in a format you can just use instead of having to search all over the computer to write your notes.

Q: What advice do you have for other hospitals that are looking to implement virtual assistants?

YKC: You really need to understand what the best way to deliver information is. One of the reasons why people get mad at voice recognition technology isn't so much that it doesn't work. Sometimes it just doesn't, whether the Wi-Fi is down or for whatever reason. But it's mostly that we don't know how to answer questions, so there's this gap between expectations versus reality.

When you ask for information, you expect to hear something back. But there are so many different contextual reasons why you'd expect to hear something back when you're an endocrinologist versus when you're an obstetrician. When I ask for a summary, depending on who I am, what I already know about the patient, how old the patient is, etc., I expect to hear different information back and I expect the person telling me that to know about all these contextual cues to give me exactly what I need. That has been the most challenging part, just understanding what is considered valuable information to share with someone else when you're delivering it via voice because unlike when you have a website and the information is always just there on the screen – you can skim it and pick apart the pieces you want – but with sound and voice, it's very linear. When someone is talking at you or when a machine is talking at you, you just have to listen to everything it says. People get very annoyed when you waste their time with something they don't consider important.

Q:  What are you most excited to learn from the VEVA implementation?

YKC: It's going to be really interesting to figure out what the reasons are that people would not adopt voice technology because it's very early days for this. There are certain people who just don't for different reasons like privacy concerns, etc. When you survey providers and ask them why they are or aren't using voice technology, there are answers like 'oh I'm embarrassed talking to my phone' and having conversations aloud or they have said 'I feel impolite talking to this technology when someone else is there,' which is just fascinating. People just have other apprehensions, so learning and understanding those and figuring out where it's a matter of is the technology right versus is this the right time for the technology is going to be really fascinating as well.

To participate in future Q&As, contact Jackie Drees at

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