Tell us about you, your career, and how you came to found Saykara.
Harjinder Sandhu:I started my career in academia as a computer science professor. I transitioned to entrepreneurship in 2000 when a friend and I co-founded a company called MedRemote. We were fortunate to experience success in developing new speech recognition and machine learning solutions for the medical transcription industry. In 2005, we sold that company to Nuance Communications. I then served as VP and Chief Technologist of Nuance Healthcare’s R&D division until 2011, when I chose to co-found another health tech company, Twistle, with that same friend. Twistle is still around today and is doing very well. Although I continue to serve on its Board of Directors, I exited in 2015 to found Saykara.
My goal for Saykara was to apply the untapped potential of speech recognition, machine learning, and natural language processing to solve one of the most significant issues facing healthcare provider organizations today, which is the cumbersome and time-intensive nature of clinical documentation. Over the past five years, we’ve developed and launched a platform that uses artificial intelligence (AI) to interpret conversations between physicians and patients and automatically construct clinical notes, orders, and referrals, etc. for the medical record. And we do this through a voice-enabled assistant named Kara that physicians access via a mobile app.
Who are your customers, and what is the primary problem you are solving for them?
Harjinder Sandhu: Our customers are healthcare provider organizations, including independent physician practices as well as hospitals, health systems, and ambulatory surgery centers.
The main problem we are solving is that our nation’s physicians are spending more time on administrative work and data entry to electronic health record (EHR) systems than they are with patients, which leads to productivity loss, revenue erosion, and burnout. A study published in the Annals of Medicine observed that physicians spend nearly twice as much time doing administrative work as seeing patients. Many spend two to three hours a night working in the EHR; something commonly referred to as ‘pajama time.’ Numerous studies and surveys have observed that 50-71% of physicians experience burnout, which has worsened during the COVID-19 pandemic.
By automating clinical documentation, Saykara is helping relieve these pain points. We have many testimonials regarding the impact AI assistant has on productivity, work-life balance, and the physician-patient relationship. For example, a family practitioner said, “Now, with Saykara, I can see a patient in 15 minutes and I chart for 30 seconds. It’s just been a game changer.” A pediatrician said, “My spouse can tell you that I’m a much happier person when I come home knowing that I don’t have this weight of charts over my head.” An orthopedic surgeon said, “I can give my full attention to my patients, and I even have time during visits to talk with them about their vacations, grandkids or restaurants they recommend.” And the CEO of a multi-specialty physician group said, “Using the Saykara mobile AI assistant allows our providers to focus on their patients and create personalized, meaningful and collaborative interactions.” We have dozens of these kinds of testimonials.
Can you describe the inner workings of your technology, how the “magic” happens?
Harjinder Sandhu: Our system is designed to learn the intricacies of each medical specialty as well as individual physician styles and preferences. We currently have a semi-autonomous hybrid model that pairs our artificial intelligence (AI) with a human-in-the-loop reviewer, strengthening our knowledge base and ensuring that we return accurate results to our users on Day One.
Whereas the speech recognition component of our system captures what is being said, the natural language understanding component interprets what is being said. For instance, if a patient comes in for shoulder pain, the system first has to understand that shoulder pain is a symptom. It then has to build a story around shoulder pain based either on what the patient is saying or the physician is summarizing. When did it happen? What caused it? How severe is it? Next, the system has to take that story in its raw data format and compose a comprehensive, high-quality clinical note, which the physician sees.
Our system also has to filter out the noise, and by that, I mean it has to understand the kinds of information a physician needs to gather based on the reason for a patient visit, then accurately predict and anticipate what is relevant and what is not. For example, if a patient arrives at a dermatologist’s office to have skin tags removed and starts talking about the anxiety they’ve been experiencing over the purchase of a new house, the dermatologist will not likely want or need to document those details. Our system can learn this and focus solely on what’s relevant to the dermatologist’s clinical note. On the other hand, if a patient arrives at a family practitioner’s office and starts talking about the anxiety they’ve been experiencing over purchasing a new house, the family practitioner will likely want and need to document those details.
How has the coronavirus pandemic affected your business, and how are you coping?
Harjinder Sandhu: All of our employees have been working from home since early March. We are based in downtown Seattle, which as ground zero for coronavirus outbreaks, meant we were among the first in the country to make the transition to remote work. In this respect, I’d say we’ve been managing really well, and our productivity has remained high. Like many businesses, we’ve grown very reliant on Zoom meetings.
Given our customers are healthcare provider organizations, certainly, they’ve been affected quite significantly and are having to continually adapt to changing conditions and new challenges. Most physicians using our system had to quickly shift from in-person visits to virtual visits. In response, we launched an all-hands-on-deck campaign to educate and support them on how to optimize our AI assistant for use in conjunction with telehealth systems so they could avoid having to manually document their virtual visits. We also developed seamless integration with the Zoom platform, which allows physicians to use our AI assistant for remote care in a manner comparable to in-person care.
A welcome surprise was the fact sales inquiries for our AI assistant went way up, as did the number of new users. The downtime many physicians experienced early in the pandemic provided them with the opportunity to research our solution. And now that lockdown orders have been lifted, many physicians are experiencing pent-up demand based on months-long delays in elective procedures and postponements in follow-up visits. This has translated to an urgency around implementing our solution and getting relief from the associated documentation burden.
We’re also seeing greater interest from health systems seeking to fight worsening levels of physician burnout and make up for revenue shortfalls by giving physicians a means for seeing more patients. Being able to offload time-intensive and laborious clinical documentation is a win-win on both of those fronts.
Do you find that the younger generation of physicians is more intrigued by what Saykara is doing or is perhaps less skeptical of an AI solution?
Harjinder Sandhu: That’s an interesting question. Although we anticipated our solution would appeal to the younger generation of physicians — those who grew up with technology from a very early age and can’t remember life without the Internet – we see as much if not more interest from physicians who began their careers when patient charts were of the paper variety and cell phones didn’t exist. Physicians who spent many years practicing without electronic health record systems are quick to embrace our solution because it untethers them from the computer and removes the tedium and slog of data entry. Our AI assistant allows them to focus on their patients without that distraction. For them, it’s like returning home. It’s more like the era when clinical documentation was far simpler and less time-consuming.
Although it’s been around for decades, artificial intelligence is, in many ways, still in its infancy, especially in the context of digital health. What do you see for the future?
Harjinder Sandhu: I envision that artificial intelligence (AI) will become central to virtually every aspect of healthcare and will likely be able to identify the best course of treatment for many of the most common ailments. I think the documentation component we’re currently addressing is just the tip of the iceberg. Over the next three to five years, AI systems will undoubtedly start to understand the process of providing care to patients and will be able to assist physicians in ways not yet being contemplated. People will look back and wonder how healthcare was ever delivered without these kinds of AI systems, similar to the people look back and wonder how we ever lived without our smartphones.
Do you have any final thoughts, any advice for fellow entrepreneurs?
Harjinder Sandhu: As far as advice goes, what I generally think about and what I recommend to startups leaders is to have both a big vision and a small vision. The big vision is about what you can do if you’re wildly successful…what you can do that’s earth-shattering and changes the game completely. Use that as motivation and guiding light for where you see your company in the future. The small vision is about what you can do now to delight your customers and make your product indispensable. A lot of entrepreneurs get hung up on the big vision, and they don’t recognize or map out the steps required to get there. If you do what is necessary to realize the small vision and keep building on that, you’ll have the ability to see the big vision through to fruition.
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