Most doctors go into medicine because they want to help patients. But today's healthcare system requires doctors to spend hours each day doing other work—searching electronic health records (EHRs), writing documentation, coding and billing, preauthorization, and utilization management—often exceeding the time they spend to care for patients. The situation causes physician burnout, administrative inefficiencies, and poorer overall patient care.
Ambience Healthcare is working to change that with an ai-powered platform that automates doctors' routine tasks before, during and after patient visits.
“We created co-pilots to give doctors ai superpowers,” says Ambience CEO Mike Ng MBA ’16, who co-founded the company with Nikhil Buduma ’17. “Our platform is integrated directly into EHRs to allow physicians to focus on what matters most, which is providing the best possible patient care.”
Ambience's suite of products handles pre-charting and ai writing in real time, and helps navigate the thousands of rules to select the correct insurance billing codes. The platform can also send post-visit summaries to patients and their families in different languages to keep everyone informed and on the same page.
Ambience is already used at approximately 40 large institutions, including UCSF Health, 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 such as the emergency department, hospitals, and oncology suite.
The founders say doctors who use Ambience save two to three hours a 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 he was able to take a closer look at the healthcare system after breaking his back in 2012. He was initially misdiagnosed and assigned to the wrong care plan, but in the process he learned a lot about the US healthcare system. .U.S. including how most physicians' days are spent documenting visits, selecting billing codes, and completing other administrative tasks. The average doctor 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” entrepreneurship celebration hosted by the Martin Trust Center for MIT Entrepreneurship, where he met Buduma. The pair became fast friends and ended up taking classes together, including 15.378 (Building an Entrepreneurial Company) and 15.392 (Scaling Entrepreneurial Companies).
“MIT was an incredible training ground for evaluating what makes a great company and learning the fundamentals of building a successful company,” Ng says.
Buduma had gone his own way to uncover the problems in the healthcare 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 American medical system. While completing his undergraduate degree at MIT, he was also involved in the ai research community and wrote one of the first textbooks on modern ai and deep learning.
In 2016, Ng and Buduma founded their first company in San Francisco, Remedy Health, which operated their own ai-based healthcare platform. In the process of hiring doctors, caring for patients, and implementing technology themselves, they developed an even deeper appreciation for the challenges facing healthcare organizations.
During that time, they also learned about advances in ai. Google chief scientist Jeff Dean, a major investor in Remedy and now Ambience, led a research group within 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 doctors at Remedy. Subsequently, several of his friends and housemates started the large language modeling group within OpenAI. His friends' work formed the basis of the research that ultimately led to ChatGPT.
“It was very clear that we were at this inflection point where we were going to have these kinds of general-purpose models that were going to improve exponentially,” Buduma says. “But I think we also noticed a big gap between those general-purpose models and those that would actually be robust enough to work in a clinic. “Mike and I decided in 2020 that there should be a team specifically focused on perfecting these models for healthcare and medicine.”
The founders started Ambience by building an ai-powered scribe that works on phones and laptops to record details of doctor-patient visits in a HIPAA-compliant system that preserves patient privacy. They quickly saw that it was necessary to refine the models for each area of medicine and little by little they expanded the coverage of the specialties, one by one, in a process of several years.
The founders also realized that their scribes needed to adapt to back-office operations, such as coding and insurance billing.
“Documentation is not just for the physician, but also for the revenue cycle team,” says Buduma. “We had to go back and rewrite all of our algorithms to take encryption into account. “There are literally tens of thousands of coding rules that change every year and differ by specialty and contract type.”
From there, the founders created models for doctors to make referrals and send complete visit summaries to patients.
“In most care settings before Ambience, when a patient and family left the clinic, what the patient and family wrote down was what they remembered from the visit,” Buduma says. “That's one of the features that doctors like the most, because they try to create the best experience for patients and their families. “When the patient is in the parking lot, they already have a really solid, high-quality summary in their portal of exactly what you talked about and all the shared decision making around their visit.”
democratize healthcare
By improving physician productivity, the founders believe they are helping the healthcare system manage a chronic physician shortage that is expected to grow in the coming years.
“In healthcare, access is still a big issue,” Ng says. “Rural Americans have a 40 percent higher risk of preventable hospitalization, and half of that is attributed to lack of access to specialized care.”
Since Ambience already helps 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 is a really exciting opportunity to democratize the experience at some of the leading academic medical centers across the United States,” Ng says. “Right now, there are simply not enough specialists in the United States to support our rural populations. “We look forward to helping expand the knowledge of the country’s leading specialists through an ai infrastructure layer, especially as these models become more clinically intelligent.”
