diff --git a/Iambilly_transcripts/07_07.txt b/Iambilly_transcripts/07_07.txt new file mode 100644 index 0000000..e69de29 diff --git a/Iambilly_transcripts/09_06.txt b/Iambilly_transcripts/09_06.txt new file mode 100644 index 0000000..e69de29 diff --git a/Iambilly_transcripts/10_07.txt b/Iambilly_transcripts/10_07.txt new file mode 100644 index 0000000..69cbdcf --- /dev/null +++ b/Iambilly_transcripts/10_07.txt @@ -0,0 +1,2202 @@ +Vijay Agarwal: 00:00 + We have associated for Brian's login is apps +surgeon at the rate makes you Neurosurgery. + +Vijay Agarwal: 00:08 + Yes, I'll do right away. + +Vijay Agarwal: 00:10 + Yeah. + +Vijay Agarwal: 00:10 + So the way we have set this. + +Vijay Agarwal: 00:12 + Up Brian and Emily is we have created alias emails on our MCQ neurosurgery domain which are apps searcher, apps practice administration, apps biller and apps supervisor. What happens is our single mail which is apps at the rate mechu Neurosurgery can now receive four types of emails means it receives for practice admin, biller, supervisor and surgeon. And for the testing, we have mapped surgeon to Brian's Gmail ID and everything else to your Gmail id. Okay. Technically the icloud issue should not impact us. + +Vijay Agarwal: 01:01 + We just have to re verify that. + +Vijay Agarwal: 01:04 + We have mapped the NPI code given to Brian with Apps plus Surgeon, which I believe we have. That's how Pratik is able to give all those OTPs to you because they show up in this mailbox right here. Okay. And when I do Apps plus Surgeon. + +Emily Clifford: 01:25 + So Vijay, you're saying it goes to both, right? It goes to the AppSent McQ Neurosurgery and then it also goes to our personal. It's forwarded then to our personal. + +Vijay Agarwal: 01:32 + Exactly. And even if mine's not getting it. + +Emily Clifford: 01:35 + To the right personnel, I can log into absent MCQ and tell him the code. + +Vijay Agarwal: 01:40 + Yes. + +Vijay Agarwal: 01:41 + Or we could simplify. We could even change the filter settings. + +Vijay Agarwal: 01:46 + Okay. + +Vijay Agarwal: 01:46 + And we can just route everything to you. + +Vijay Agarwal: 01:48 + We have right now done two separations. One goes to Emily and other goes to Brian. Okay. + +Emily Clifford: 01:54 + I mean I think we want to keep it separate so Brian can do has flexibility to do this. But can we add his other email address? Can we forward it to all of his email addresses so we just have a better rate of success for him getting it? + +Vijay Agarwal: 02:08 + Yeah, so we can set that up right now what we will do is we will add another forwarding address. + +Emily Clifford: 02:15 + Great. + +Vijay Agarwal: 02:16 + Okay. + +Vijay Agarwal: 02:16 + And Brian, if you can spell that for me, I'll add it right here. + +Emily Clifford: 02:20 + Your iCloud1 Brian,. + +Brian McHugh: 02:25 + Similar handle bmcq78justcloud.com. + +Vijay Agarwal: 02:45 + Yeah, I think this requires us to have a specific mobile app active. + +Vijay Agarwal: 02:50 + Lynn, can you re attach your mobile. + +Vijay Agarwal: 02:52 + To this email ID so I can forwarding. + +Vijay Agarwal: 02:57 + So Emily, there is one more setting. + +Vijay Agarwal: 02:59 + In MCQ neurosurgery domain for the email. + +Vijay Agarwal: 03:03 + That that you don't have a two. + +Vijay Agarwal: 03:05 + Factor authentication enabled and for the email ID forwarding, Google requires two factor to be mandatory. So for what we have been doing is adding our office Device as the second factor. So it allows us to enable forwarding. We will send you the steps on how you can enable on the entire domain. + +Emily Clifford: 03:30 + Okay. + +Vijay Agarwal: 03:30 + And as such, this is a temporary test phase. + +Vijay Agarwal: 03:33 + After a month, once we are live, you don't need any of this forwarding. + +Emily Clifford: 03:39 + Great. + +Vijay Agarwal: 03:40 + Okay. So. + +Vijay Agarwal: 03:47 + What we are going to try now. + +Vijay Agarwal: 03:48 + Is let me save the changes. Strange. Okay. + +Vijay Agarwal: 04:09 + So now Brian, if you try to. + +Vijay Agarwal: 04:10 + Log in with that NPI ID and password, let's see if your Gmail account receives it. And I already assumed that you have tested your spam box. + +Brian McHugh: 04:26 + That's a good question. No, I don't think I did. I'll double check that. Oh. + +Brian McHugh: 04:33 + Yeah, I did not test my spam box. + +Brian McHugh: 04:35 + It would be coming from that email with the. + +Emily Clifford: 04:40 + It'll look like this, right? I am Billy verification code. + +Vijay Agarwal: 04:44 + Yeah. + +Brian McHugh: 04:44 + Okay. All right. I'll double check. So. + +Brian McHugh: 04:47 + So Vijay, you want me to drop. + +Brian McHugh: 04:48 + Off this call and. + +Vijay Agarwal: 04:50 + No, not right now. If you can just check. I can check my email? Yeah. + +Brian McHugh: 05:23 + Yes. + +Vijay Agarwal: 05:25 + Is it in your spam? + +Brian McHugh: 05:29 + Yeah, looks like it goes to spam. + +Vijay Agarwal: 05:32 + Okay. Sorry Vijay, that's one step sorted. Okay, great. So if you can you. If you can just report not spam the next time it will show up in your inbox. Cool. + +Vijay Agarwal: 05:49 + So then this part is sorted. We don't have to worry about the. + +Vijay Agarwal: 05:51 + Icloud and all the other setup. + +Emily Clifford: 05:53 + Okay, great. + +Vijay Agarwal: 05:55 + Great. So yes. Now if you are able to type in your NPI ID password, get the otp, get into the app. + +Brian McHugh: 06:04 + Okay. + +Vijay Agarwal: 06:05 + Then you will have to drop off Google Meet. + +Brian McHugh: 06:08 + You want me to do that now? + +Vijay Agarwal: 06:10 + Yeah, you should drop off and do the whole login and see if dictation now pops up. + +Emily Clifford: 06:17 + And then you'll stay online and text if you have any issues. + +Brian McHugh: 06:21 + Okay. + +Brian McHugh: 06:21 + And you want me to try and. + +Brian McHugh: 06:22 + Do a brief trial dictation? + +Vijay Agarwal: 06:26 + That's okay. + +Vijay Agarwal: 06:27 + If it, if it shows up, then we know the entire flow works. But we just want to make sure. + +Vijay Agarwal: 06:31 + It's working on your device and then we'll show you what things we have tried. Okay. + +Brian McHugh: 06:35 + All right. I'll drop off and then I'll do. + +Brian McHugh: 06:37 + That and come back up. + +Emily Clifford: 06:38 + Okay. + +Vijay Agarwal: 06:38 + Okay. Well, finally that got sorted, so. + +Emily Clifford: 06:44 + Sorry. We should have thought of that. + +Vijay Agarwal: 06:46 + I know it's not very natural. + +Emily Clifford: 06:49 + Yeah, I don't know why it's not natural. You'd think it would be by now, but it's not. + +Vijay Agarwal: 06:54 + I mean, you assumed it's coming from. + +Vijay Agarwal: 06:55 + A trusted email id, right? + +Emily Clifford: 06:57 + Yes. Yeah. I never check spam for anything. Are you like read like you. You're Automated, wired to check. + +Vijay Agarwal: 07:08 + Yeah. So I'll tell you an incident what happened three years ago. We were getting emails from hackers that they have got access to some instances that we run, and they send that. + +Vijay Agarwal: 07:24 + Email to 10 people in the organization. + +Vijay Agarwal: 07:26 + And everything landed in spam. And after five days, they actually got into the system. So they kept on sending us notifications to before hacking and they could potentially negotiate a deal. + +Vijay Agarwal: 07:42 + So after that, I made it mandatory. + +Vijay Agarwal: 07:44 + That everyone checks spam. We don't want to miss out anything. + +Emily Clifford: 07:48 + Yeah. Oh, man, that's very scary. + +Vijay Agarwal: 07:50 + Yeah. Wow. + +Emily Clifford: 07:56 + Lesson of the day, check spam. + +Vijay Agarwal: 07:58 + Yeah. I mean, keep everything empty, you know, zero inbox, so zero spam box. Yep. + +Emily Clifford: 08:04 + You know, it's. You know what I think why it's people forget to do it is because now that everybody uses mobile so much for email, it's not in your face. You're not seeing it. You know, like if you don't have that, if you're not looking at it, you're just not even. + +Vijay Agarwal: 08:19 + Yeah, I see that happening with my personal mailbox. I'm not able to clean that spam. + +Emily Clifford: 08:24 + Yeah. + +Vijay Agarwal: 08:25 + But the official one is always clean. + +Emily Clifford: 08:28 + Got it. All right, let's hope it works this time. + +Vijay Agarwal: 08:36 + It should. I mean, so. Yeah, because we know what was the root cause. The root cause was the iOS 26.1 version and above. Okay. Done the testing till 26, but the library for dictation was not compatible. So we know that. We fixed it. We have tested it on multiple devices. + +Emily Clifford: 08:58 + Yeah. + +Vijay Agarwal: 08:58 + So we know that it should work. It's just that we now want to see if the user experience matches with what. Hi, Brian. + +Brian McHugh: 09:10 + Hey, guys. It worked. + +Emily Clifford: 09:12 + Great. Great. + +Vijay Agarwal: 09:12 + Okay, great. So now that it works. + +Vijay Agarwal: 09:16 + Brian, what we are trying to figure. + +Vijay Agarwal: 09:19 + Out right, in the next few weeks. + +Vijay Agarwal: 09:21 + Is we started with the hypothesis of. + +Vijay Agarwal: 09:23 + How someone is going to dictate. Okay. And we created a flowchart for that we all brainstormed in the month of March and April. Okay. But few things changed after that. That is, we do not have direct connection with epic, so we don't have pre patient records in the system. Okay. And we cater for patients to be added on the. On the live, you know, and we. + +Vijay Agarwal: 09:47 + Don't know if patient will be added before the dictation or after the dictation. + +Vijay Agarwal: 09:52 + So we had to cater that situation. Okay. And plus, when went through the case files, we also saw that our. + +Vijay Agarwal: 10:02 + Interpretation of templates is not the same. + +Vijay Agarwal: 10:05 + As the case files, because case files. + +Vijay Agarwal: 10:07 + Are showing us we could have five. + +Vijay Agarwal: 10:09 + Templates at the go. + +Vijay Agarwal: 10:10 + At. + +Emily Clifford: 10:11 + In. + +Vijay Agarwal: 10:11 + In one case. So it's not as simple as ACDF one. + +Vijay Agarwal: 10:14 + Right. + +Vijay Agarwal: 10:15 + It's a combination of five templates. It can have 10, 12 CPT codes. + +Brian McHugh: 10:21 + Say that again, Vijay. I'm not sure I followed the last piece like the. + +Brian McHugh: 10:25 + The template piece. + +Vijay Agarwal: 10:27 + Yeah. So when we designed the template, we took the templates from the cheat sheet that we had. And cheat sheet typically had one procedure name and five or six codes. But went through the case files when were training the AI model, we saw some of the case files have 15 to 20 codes in one procedure in one patient record. Okay. So which means each claim can have. + +Vijay Agarwal: 10:55 + Combination or more than one template. + +Vijay Agarwal: 10:57 + Which means you can have three templates. + +Vijay Agarwal: 10:59 + Applied to a single claim. + +Vijay Agarwal: 11:02 + Because you did X, Y and Z. + +Vijay Agarwal: 11:04 + Right? + +Emily Clifford: 11:04 + Right. + +Vijay Agarwal: 11:05 + So this we did not anticipate. + +Vijay Agarwal: 11:08 + This is a flow for templates. Right. So. So, but we made some changes in that. Okay. + +Brian McHugh: 11:14 + I just want to make sure. + +Brian McHugh: 11:15 + I just want to make sure. I understand that. Because. Because if it is a, you know, acdf, a one level acdf, like those should be the same CPT codes each time. If it's a two level acdf, same. + +Brian McHugh: 11:27 + CPT codes each time. + +Brian McHugh: 11:28 + There are, you know, if you want. + +Brian McHugh: 11:31 + To call it off, label cases where there's a nuanced piece to the case, you'll add in codes to that. + +Emily Clifford: 11:39 + Okay. + +Brian McHugh: 11:40 + We're on the same page. + +Vijay Agarwal: 11:40 + Okay. + +Emily Clifford: 11:40 + Yeah. + +Vijay Agarwal: 11:42 + So essentially what we did. I'll show you on the screen. + +Vijay Agarwal: 11:48 + We picked up the cheat sheet. + +Vijay Agarwal: 11:51 + Okay. + +Vijay Agarwal: 11:53 + And we said,. + +Vijay Agarwal: 11:58 + Say this, okay, this is one type of surgery and template which has six codes. Okay. And then so on each one of the cheat sheet had different naming conventions, right? XLIF1 level, and it has five. + +Vijay Agarwal: 12:14 + But then when we got into the. + +Vijay Agarwal: 12:16 + Actual case files, okay, that we got. And in these case files went through, you know, all the records of the actual claim document. Okay. I don't know which one has the entire document, but then we saw that claim had 15 to 20 CPT codes. Okay. + +Vijay Agarwal: 12:40 + Which does not correlate to a single template. + +Vijay Agarwal: 12:45 + This one. Right. It has like these many codes here which is not part of a single template. + +Brian McHugh: 12:50 + Got it. I see the same. + +Vijay Agarwal: 12:53 + That could change. Right? So which means when in the original journey, when we thought template, we thought, okay, it's easy. + +Vijay Agarwal: 13:01 + You can just select the template you. + +Vijay Agarwal: 13:02 + Want and you can do additional dictation and you can move on. + +Vijay Agarwal: 13:07 + Now, if you already know that you did three or four types of procedures. + +Vijay Agarwal: 13:11 + Which are part of the template, you will want to select the four templates okay. So we had to change that in the user journey so that you could select four templates. Okay. + +Vijay Agarwal: 13:26 + So what we are still trying to figure out, right, is the user experience. + +Vijay Agarwal: 13:30 + That the surgeon should have from opening imbele to completing the entire dictation. Okay. + +Vijay Agarwal: 13:38 + And when we say entire dictation, it is not just the audio part, but it is also the selection of patient,. + +Vijay Agarwal: 13:44 + Selection of template, looking at the transcript,. + +Vijay Agarwal: 13:48 + Because that has changed since we do. + +Vijay Agarwal: 13:50 + Not have live integrations available at the moment. + +Vijay Agarwal: 13:53 + So there are lots of scenarios that we are getting coming across. So some, as we are learning, we are incorporating some of those that we. + +Vijay Agarwal: 14:02 + Feel are low hanging fruits. + +Vijay Agarwal: 14:04 + So what we want you to do. + +Vijay Agarwal: 14:06 + Mainly right now in the next, you know, couple of days is look at your user experience. + +Vijay Agarwal: 14:12 + Do you think as a surgeon you. + +Vijay Agarwal: 14:14 + Are able to do this patient MRN entry, the audio note, the template selection seamlessly, or you do you think it's messy, cucumbersome, complex. We have to simplify something. Right. And that's the first feedback we want from you, the user experience. Okay. + +Brian McHugh: 14:35 + Yep. + +Vijay Agarwal: 14:37 + The next phase of the feedback is the actual audio note that you generate. + +Vijay Agarwal: 14:45 + That audio note will create a transcription. + +Vijay Agarwal: 14:49 + Okay. + +Vijay Agarwal: 14:50 + And we want you to check if. + +Vijay Agarwal: 14:51 + You are satisfied with the quality of transcription. + +Brian McHugh: 14:55 + Okay. + +Vijay Agarwal: 14:56 + Yep. + +Vijay Agarwal: 14:56 + Any dictation that you are not satisfied, we have it on the back end. You can just tell us with the. + +Vijay Agarwal: 15:02 + Screenshot that, hey, this is a dictation that you did in the mobile app. You will have a list. You just flag it off and send it to us. We will check why the transcription was not good. + +Emily Clifford: 15:14 + And you're saying that DJ because based on what you've done, you had mentioned this in a few calls ago, he'll say a word and the AI won't pull the correct word. That's what you mean, right? To scrub through and ensure that all the terminology actually corresponds to what he's saying. + +Vijay Agarwal: 15:30 + Yes. + +Vijay Agarwal: 15:31 + When we, when we showed the STT. + +Vijay Agarwal: 15:33 + Demo a few, you know, four to five weeks ago. Right? + +Emily Clifford: 15:36 + Yeah. + +Vijay Agarwal: 15:36 + That time were showing you various cases that happen. Yeah. + +Vijay Agarwal: 15:39 + So we want to make sure that. + +Vijay Agarwal: 15:41 + First the user experience of the app,. + +Vijay Agarwal: 15:44 + Second, the dictation quality, and then finally we land into the actual billing codes. + +Vijay Agarwal: 15:50 + Mapping. Yeah. + +Vijay Agarwal: 15:52 + So for the billing codes, we are. + +Vijay Agarwal: 15:54 + Running our own tests on the claim documents that you gave us. Okay. And we have, in some cases we. + +Vijay Agarwal: 16:03 + Are able to get 100 mapping. + +Vijay Agarwal: 16:05 + In some cases we are getting 85, 88% mapping. + +Vijay Agarwal: 16:09 + And in the others we are also flagging off what is not making sense at all. + +Vijay Agarwal: 16:13 + I Mean, the description is completely different from the codes. + +Vijay Agarwal: 16:19 + We probably got the wrong files. + +Vijay Agarwal: 16:22 + Possible. Right. + +Vijay Agarwal: 16:24 + The problem was that we don't know what happened with these claims. + +Vijay Agarwal: 16:27 + Were they accepted as is was their iteration. Okay. So what we need now for validation is potentially the claim journey from the billing team. + +Vijay Agarwal: 16:39 + Just a few where they can say, okay, these were the rejected claims. + +Vijay Agarwal: 16:43 + Okay. When they were submitted as is. + +Vijay Agarwal: 16:46 + And then they got converted as approved when the claim was modified. + +Vijay Agarwal: 16:49 + We don't have that journey and history right now. Lindsay, you want to add anything? + +Vijay Agarwal: 16:57 + No, just One thing that Dr. Brian has just created a cla. Not created a claim, he has just dictated, but he has to associate the patient from the association queue. + +Vijay Agarwal: 17:10 + Yeah. + +Vijay Agarwal: 17:10 + We will show it to him on the screen. + +Vijay Agarwal: 17:11 + I think we will have to show it to him exactly how to do it. + +Emily Clifford: 17:15 + Okay. + +Vijay Agarwal: 17:16 + Okay. + +Brian McHugh: 17:19 + You're bringing up interesting points, Vijay, because. + +Brian McHugh: 17:21 + One of the things we wanted to. + +Brian McHugh: 17:23 + Build toward, and maybe it's something that comes up earlier, is, you know, call them Surgeon X. Surgeon X dictates their procedure using their own language. + +Brian McHugh: 17:38 + That language is not appropriate to support. + +Brian McHugh: 17:42 + The CPT code they're trying to get a reimbursed for. + +Brian McHugh: 17:47 + And it. + +Brian McHugh: 17:48 + Ideally, the app would kind of lead the surgeon. Right. If you say, I did an app. I removed an appendix. + +Brian McHugh: 17:55 + Right. That. + +Brian McHugh: 17:56 + It starts with that. + +Brian McHugh: 17:58 + The app says, okay, so then you. You likely want to bill these CPT. + +Brian McHugh: 18:02 + Codes and your patient has a diagnosis supported by these ICD10 codes. The surgeon's like, yeah, that's what I'm trying to do. And then it kind of populates everything with the appropriate language. And then the surgeons, if they insist on dictating or want an active role, can simply adjust the file to reflect that specific patient. Everybody's on that page. Yeah. + +Vijay Agarwal: 18:27 + Okay. + +Emily Clifford: 18:28 + Wouldn't that be where the template comes in? Vijay, Isn't that when they would select the. So they dictate and then they select the appropriate templates. + +Vijay Agarwal: 18:37 + Yes. Yeah. + +Vijay Agarwal: 18:41 + So that's what we realized, that it's going to be a combination of templates, not one template. + +Vijay Agarwal: 18:46 + Yeah. So what we did was at this point, the surgeon dictates, they map it to a patient, they select a template,. + +Vijay Agarwal: 18:58 + Or they can select more than one template. + +Vijay Agarwal: 19:00 + Okay. + +Vijay Agarwal: 19:01 + Now, the intelligence is not yet applied. + +Vijay Agarwal: 19:03 + On the mobile app where we can. + +Vijay Agarwal: 19:05 + Tell them, hey, based on your dictation,. + +Vijay Agarwal: 19:07 + You may want to choose these templates. Okay. So this is part A of the. + +Vijay Agarwal: 19:12 + Intelligence, but the part B also is that their dictation does not support the. + +Vijay Agarwal: 19:19 + ICD and CPD codes for which they. + +Vijay Agarwal: 19:21 + Are trying to Get a claim. So we don't know yet if we. + +Vijay Agarwal: 19:25 + Should re ask them to redictate if they insist. Right. This is, this is where what Brian. + +Vijay Agarwal: 19:33 + Has been telling us from the last. + +Vijay Agarwal: 19:35 + Review as well, that for the doctors. + +Vijay Agarwal: 19:37 + Who don't dictate as per the payers accepted terminology, how do we guide them to either dictate for that terminology or how do we show them that hey, these are the codes. + +Vijay Agarwal: 19:49 + Did you mean these codes? + +Vijay Agarwal: 19:50 + Just select the codes and we will manage the terminology at our end. And if you still insist that you want to dictate, then go ahead and dictate this language. + +Vijay Agarwal: 20:00 + Okay. + +Vijay Agarwal: 20:00 + So that's what that is the user experience part. + +Vijay Agarwal: 20:03 + Okay. And this is a flow. + +Vijay Agarwal: 20:05 + For a surgeon who is not dictating. + +Vijay Agarwal: 20:07 + As we expect them to dictate. So we have to create a flow and a sequence. Right. + +Vijay Agarwal: 20:12 + But first we wanted to check what a pro surgeon like Brian does. + +Emily Clifford: 20:17 + Yeah. + +Vijay Agarwal: 20:17 + Who everything, you know, in his brain and he's able to do a perfect dictation. Right. And then we go to the step. + +Vijay Agarwal: 20:23 + Two because we are trying to fix. + +Vijay Agarwal: 20:25 + Brian's flow first and then the other surgeons flow. But Brian, you are right there. I mean that's the intelligence. We want to bring two levels to the surgeon. And, and the language for the builder and the. + +Brian McHugh: 20:39 + I mentioned something. + +Brian McHugh: 20:40 + I just want to raise two issues. + +Brian McHugh: 20:42 + One on the. And I think you guys have figured this out already. Vijay. But you had pulled up that cheat. + +Brian McHugh: 20:48 + Sheet where you said, look, here's a surgery that some of these codes showed up in a more, you know, templated surgery. + +Brian McHugh: 20:57 + So maybe I didn't communicate appropriately about this list. + +Brian McHugh: 21:02 + Some of those categories are fully packaged surgeries. So for example, what do we have here? Like one of them that's labeled ACDF1 level or XLIF1 level or ACDF2? Yeah, XLIF1 level. So that procedure, if you just. + +Brian McHugh: 21:26 + Did an xlif, those are all the codes you'd expect to bill. + +Brian McHugh: 21:29 + Then there are other columns on the cheat sheet that one of them I know is labeled osteotomies, for example. They don't reflect whole surgeries. They're kind of add on codes. + +Brian McHugh: 21:49 + And the whole cheat sheet collectively was. + +Brian McHugh: 21:53 + Given out to surgeons to say, you know, what surgery are you doing? + +Brian McHugh: 21:57 + You're doing an xlif. Okay. + +Brian McHugh: 21:59 + This is what you should bill here. + +Brian McHugh: 22:01 + We also included in the cheat sheet. + +Brian McHugh: 22:04 + Some common codes that get added into those procedures. + +Brian McHugh: 22:08 + So you've done an xlif and you also did an osteotomy. + +Brian McHugh: 22:12 + That's a frequent association. + +Brian McHugh: 22:14 + Okay. In the cheat sheet here, you know,. + +Brian McHugh: 22:17 + A list of the common osteotomy codes. So if you're holding the cheat sheet,. + +Brian McHugh: 22:20 + You say, did my xliff? Well, what about the osteotomy code? + +Brian McHugh: 22:23 + Yeah, that's on there too. + +Brian McHugh: 22:24 + But I just wanted to mention that to you because, and like I said, I think you guys figured this out already. If you're looking at that cheat sheet. + +Brian McHugh: 22:32 + And saying this surgery called osteotomy, you. + +Brian McHugh: 22:36 + Know, that's a little confusing. It's like, oh, right, that's not. + +Brian McHugh: 22:40 + Actually a complete procedure. That's a bucket of codes for a. + +Brian McHugh: 22:45 + Specific type of technical maneuver called an. + +Brian McHugh: 22:49 + Osteotomy that you might sprinkle into other procedures. + +Brian McHugh: 22:54 + The other thing that I don't think. + +Brian McHugh: 22:57 + Adds complexity, but just so you know, on your end, I'll stick with this. + +Brian McHugh: 23:02 + Example of an XLIF physically. + +Brian McHugh: 23:06 + In reality, what we'll usually do is a full X lift surgery. We stitch up that incision during the same operative period. The patient is rotated around and will then do a posterior fusion or arthrodesis, a lumbar arthrodesis that for many surgeons that will generate two independent operative reports. + +Brian McHugh: 23:35 + So it would be two, you know,. + +Brian McHugh: 23:38 + Complete surgical packets, if you will. On this cheat sheet. For certain surgeons, depending on your network status with the insurer, you may combine those two surgeries into one operative report. + +Brian McHugh: 23:58 + So sometimes you guys will see that. + +Brian McHugh: 24:01 + It would actually be a complete XLIF procedure followed by a complete lumbar arthrodesis procedure all in one operative report. + +Brian McHugh: 24:13 + And that would do what you would, I think you guys would expect it to do. It would take all the CPT codes. + +Brian McHugh: 24:21 + For XLIF and all the CPT codes for lumbar arthrodesis and just those would be listed out in order to. So it's a little bit modular in that way where sometimes these can be combined for bigger procedures. And that's kind of option A. + +Brian McHugh: 24:42 + Option B is you may do a. + +Brian McHugh: 24:46 + Whole procedure like a lumbar orthodesis, but there are some frequent add in codes like osteotomy that you may tack on because that was part of that particular surgery. + +Brian McHugh: 25:03 + And, and so we wanted it to be able to say, you know, it's,. + +Brian McHugh: 25:08 + I'm the surgeon, this is the patient. I did a lumbar arthrodesis at these levels. I also did, you know, two levels of osteotomy. + +Brian McHugh: 25:19 + And the intelligence of the app says,. + +Brian McHugh: 25:21 + Okay, so you did a lumbar arthrodesis. So you're trying to build these codes. + +Brian McHugh: 25:26 + And you're telling me you did two osteotomies. + +Brian McHugh: 25:29 + So you're trying to build these codes. So your operative report, the narrative needs to contain this language. And like we already went over, based on that procedure, we're assuming your patient has the appropriate ICD10 diagnostic codes that would substantiate that procedure. And, and all of that could kind. + +Brian McHugh: 25:54 + Of build the record. + +Brian McHugh: 25:58 + For the surgeon. + +Brian McHugh: 26:00 + So I just wanted to say that. + +Brian McHugh: 26:01 + Was the first thing I wanted to kind of tell you guys. + +Brian McHugh: 26:03 + The second thing I had communicated to. + +Brian McHugh: 26:05 + Emily, but I wanted to make sure I communicated here. And it was the format of the OPERA report, at least mine, which I think is something that should be modeled. I didn't invent it. I took it from mentors and whatnot. + +Brian McHugh: 26:19 + But if you look at our operative. + +Brian McHugh: 26:21 + Reports, it's the surge, it's demographic information, it's the surgeon's name, the CO surgeon's name, the date of the surgery. + +Brian McHugh: 26:27 + But then it's the pre. And this is a standard template across. + +Brian McHugh: 26:31 + All of Western medicine. + +Brian McHugh: 26:33 + It's a preoperative diagnosis. And then they typically list out the diagnoses. + +Brian McHugh: 26:40 + 1, 2, 3, 4, 5. Those are meant. Not all surgeons recognize this, but each of those is meant to correlate to. + +Brian McHugh: 26:49 + A specific ICD10 code. + +Brian McHugh: 26:54 + So you kind of start the operative report with. To the insurer who's going to be reimbursed the claim. The operative report starts with preoperative diagnosis. + +Brian McHugh: 27:05 + These are the ICD10 codes. + +Brian McHugh: 27:07 + And then further down is a description of the procedure. That's how we label it, description of procedure. And we list out the parts of the procedure. A lot of surgeons don't realize this either. + +Brian McHugh: 27:22 + That's meant to be. + +Brian McHugh: 27:25 + Each one of those items is meant. + +Brian McHugh: 27:27 + To correlate to a specific CPT code. Then when you move down to the. + +Brian McHugh: 27:34 + Narrative elements in the text, it'll say it usually says something like operative description or something like that. The first paragraph of that is what we call a history of present illness or an hpi, which is a narrative paragraph that introduces the patient. So it says Emily Clifford is a 35 year old female who came in with. + +Brian McHugh: 27:58 + And you list their diagnoses. + +Brian McHugh: 28:00 + So it's a re. It's a narrative version of the ICD10 codes. As such, we discussed surgery with her and proceeded with the below procedure. The next paragraph is the start of the actual narration of the procedure, which should go paragraph by paragraph, the narrative elements supporting the CPT code. Ideally there would be parallel construction from those. The list of ICD10 codes would map to the narrative history of present illness. So that the narrative component, Emily, is a 35 year old female with lumbar radiculopathy, lumbago, et cetera. + +Brian McHugh: 28:48 + That is in the sequence that is. + +Brian McHugh: 28:50 + Listed higher up on the report, line by line under preoperative diagnosis. And then the paragraph by paragraph description of each CPT code narrative description of each CPT code would parallel the header higher up in the report where the. + +Brian McHugh: 29:17 + Individual CPT codes were listed out. If does that make sense to people? I'll give you an example. + +Vijay Agarwal: 29:24 + And we have that on the screen. + +Brian McHugh: 29:26 + You have that. Okay. Okay. + +Vijay Agarwal: 29:30 + Emily had sent this to us. + +Brian McHugh: 29:33 + Okay. + +Vijay Agarwal: 29:35 + And I would have a follow up question on this. Okay. Does the sequence really matter from the claims perspective? Because the objective for the AI engine would be to identify all the ICD and CPD codes from the entire dictation that you gave us and then try. + +Vijay Agarwal: 30:03 + To correlate with the pre operative report or the post operative report that you. + +Vijay Agarwal: 30:08 + Have uploaded on the shared drive. Initially this was going to come from epic, but now on the shared drive. + +Vijay Agarwal: 30:14 + So for the engine, you send all of this block of data, irrespective of. + +Vijay Agarwal: 30:21 + Their sequence, and then the engine is. + +Vijay Agarwal: 30:25 + Supposed to come out with this final. + +Vijay Agarwal: 30:27 + List of codes and the flags that. + +Vijay Agarwal: 30:32 + It's not able to make sense from. + +Vijay Agarwal: 30:33 + The data that you send it. + +Vijay Agarwal: 30:35 + So the question is the sequence really important for the engine? + +Brian McHugh: 30:42 + The code sequence pj? + +Vijay Agarwal: 30:44 + Yeah, yeah. In the way you dictate. So you can dictate in your own sequence, but the engine will process the entire thing as one block of content. + +Brian McHugh: 30:56 + Yeah, I think that's if the question is, do the sequences of codes matter. + +Brian McHugh: 31:04 + Either how they're listed out one by one or how they're narrated. No, I don't think so. It's all for simplicity. + +Brian McHugh: 31:13 + And. + +Vijay Agarwal: 31:17 + Yeah, so I mean a very professional,. + +Vijay Agarwal: 31:20 + You know, surgeon who knows everything in their head in a sequence like you would do, you would say, hey, this is the patient and I just came out of, I mean with this ailment and then diagnosed with X. And then I am recommending this surgery or I did this surgery which had these pre operative conditions. And then you performed XYZ parts of the surgery. Right. You would go in precision sequence. + +Brian McHugh: 31:48 + Yeah. + +Vijay Agarwal: 31:48 + Right. Someone can be a bit haphazard and they can say I came out of surgery and I performed this surgery for patient X. Okay. + +Vijay Agarwal: 31:59 + And because I had recommended or found. + +Vijay Agarwal: 32:03 + ABC situations in the preoperative diagnosis. Okay. So even if they did all this haphazard. + +Brian McHugh: 32:10 + Yes. + +Vijay Agarwal: 32:11 + The engine would still have to figure out what is the patient, what was. + +Vijay Agarwal: 32:16 + The pre diagnosis and then what was. + +Vijay Agarwal: 32:18 + The actual surgery done? + +Vijay Agarwal: 32:20 + And then try to map it to ICD and cpts. Right? + +Brian McHugh: 32:23 + Yes. Yes. + +Vijay Agarwal: 32:25 + Okay. Yeah. + +Vijay Agarwal: 32:26 + Because the way that engine is working. + +Vijay Agarwal: 32:29 + Is all this block of data that you record and the patient documents, they. + +Vijay Agarwal: 32:35 + Get fed into it. Then it tries to make sense of what has been dictated versus what is the operative report telling us. + +Vijay Agarwal: 32:44 + And if there are red flags. + +Brian McHugh: 32:47 + Yep. + +Vijay Agarwal: 32:49 + So for the engine right now, sequence doesn't matter. + +Vijay Agarwal: 32:51 + Hence I wanted to check if the sequence really matters. + +Vijay Agarwal: 32:55 + But I think this description that you have given us, this is a very good guide for all the surgeons who. + +Vijay Agarwal: 33:02 + Don't have everything in their head. + +Vijay Agarwal: 33:04 + And then we can tell them now. + +Vijay Agarwal: 33:05 + Is the time to, you know, record the patient name, record the procedure date, record the pre diagnosis, record the operative, the entire surgery, code by code, something like that. So we can create a guided template. + +Brian McHugh: 33:22 + And to your point too, Vijay, like if we had a magic wand and could just make this product what we want it to be and the user. + +Brian McHugh: 33:32 + Experience what we wanted it to be, you know, people would use it as we wanted. + +Brian McHugh: 33:37 + We would push them to say, look,. + +Brian McHugh: 33:39 + Just put the patient information in, tell us you did an appendectomy, we'll construct the perfect operative report with all the. + +Brian McHugh: 33:48 + Right language, billing codes, etc. + +Brian McHugh: 33:52 + And then you can just, if there's. + +Brian McHugh: 33:53 + Some particular nuance to this case, feel free to add it in. + +Brian McHugh: 33:56 + But otherwise we'd really rather not have you dictating with your own language which doesn't map to the payer language. That's where the problems align. That'd be great. As we all know, in a user experience world, if you're trying to get clients to use it, they may just not want to do that. And then we have to correct for their current workflows. + +Vijay Agarwal: 34:17 + Yeah, yeah. So I think eventually, you know, we,. + +Vijay Agarwal: 34:21 + We could get to that state where. + +Vijay Agarwal: 34:22 + It's an end to end autopilot system. + +Vijay Agarwal: 34:27 + At least at the beginning. We have to make sure that if. + +Vijay Agarwal: 34:31 + Dictations are being made and if operated reports are being fed from a emr,. + +Vijay Agarwal: 34:38 + Then we are able to flag off. + +Vijay Agarwal: 34:42 + The content that is not making sense as per the payer's policy. That is step number one. + +Vijay Agarwal: 34:48 + Because we would need human in the loop to make the system more. + +Vijay Agarwal: 34:53 + Robust before we start telling them, hey, you just, you know, give the surgery name or just tell us the patient and then we figure out the entire report for you. Yes, we are right now at step one, but yes, I understand what you are trying to say. + +Vijay Agarwal: 35:08 + So I just want to clarify this again. Even in today's practice, surgeons do have to dictate after every surgery, right? + +Brian McHugh: 35:18 + There needs to be a operative report. + +Brian McHugh: 35:22 + Created after every surgery. + +Brian McHugh: 35:25 + Some people, many people dictate them. Many people like myself will use a template. + +Brian McHugh: 35:33 + And you're on the computer type. + +Brian McHugh: 35:35 + I just. + +Brian McHugh: 35:35 + The template comes up and I fill in the variables on the template. So it's. + +Brian McHugh: 35:41 + There's no dick, there's no dictation. + +Brian McHugh: 35:43 + In my workflow, I have templates that are saved in the emr. Some surgeons do that. Many surgeons still dictate. And dictation takes a couple forms. Dictation can be. And this is true of different hospitals as well. Some of the EMRs have Dictaphones that go straight to the EMR and there's a speech to text. Some surgeons, private offices, they'll carry around a dictation recorder and it will be transcribed later by a secretary or someone less common, obviously, as technology advances. And then many hospitals will still have a dictation service attached to the hospital. So you call the hospital dictation number. + +Brian McHugh: 36:35 + And you dictate into the hospital system. + +Brian McHugh: 36:39 + And then that hospital transcribes that dictation and faxes it to your practice once it's dictated. That's less and less common as well, as you might expect. One question came to mind, Vijay, when you were talking about connectivity and getting this documentation in time. + +Brian McHugh: 37:04 + Billy, Is it simple to add the. + +Brian McHugh: 37:11 + Camera function to just take a picture of those documents and it can be translated into text? And what I'm thinking is most doctors, as they're sitting at the workstation after the surgery's completed and have either a phone in their hand or. And they're dictating the operative report or are sitting at the computer putting together the operative report. The additional documents we would have if we had connectivity to the emr, are in front of them on the emr. And in my old app, which was totally different and much simpler, I would. + +Brian McHugh: 37:51 + Just pull up those documents and take. + +Brian McHugh: 37:53 + A picture of it and include that in the bundle back to my billing department so that they didn't have to go pull it from the emr. They had a PDF copy that was a picture. + +Brian McHugh: 38:07 + And I know, you know, you can also. + +Brian McHugh: 38:10 + I know now there's technology where it'll take that snapshot and extract the text and make that a document. Is that very difficult? Is that too error prone? + +Brian McHugh: 38:22 + I don't know. + +Brian McHugh: 38:22 + It may be a way to short circuit use cases where perhaps we'll never. + +Brian McHugh: 38:30 + Get connectivity in mainstream hospitals who use. + +Brian McHugh: 38:34 + Mainstream products like EPIC or Athena will get connectivity to those systems. Right. They're built to have connectivity. Some that are so old or hostile from a user standpoint that will never allow us to have connectivity. Is that a workaround there? + +Vijay Agarwal: 38:57 + So I think as we progress, you. + +Emily Clifford: 38:59 + Know,. + +Vijay Agarwal: 39:01 + Scanning or taking pictures from the. + +Vijay Agarwal: 39:05 + Mobile, putting it through a transcription engine that reads all the content, then tries to make sense of it. + +Vijay Agarwal: 39:13 + Of course the technology is available. + +Vijay Agarwal: 39:15 + It is still, I would say between 80 and 85% accurate. In very few cases it reaches 97 or 95%. So I think gradually what we can. + +Vijay Agarwal: 39:31 + Do is for those situations we can build this feature where they can potentially. + +Vijay Agarwal: 39:36 + Take pictures, upload it as the docket for the patient and then immediately tries to make sense of it. + +Brian McHugh: 39:44 + Yeah. + +Vijay Agarwal: 39:44 + But begin with we will have to at least get the correlation done between what we are getting from a EMR. + +Vijay Agarwal: 39:53 + Like epic, which is not definitely scanned, but it is more typed information. So it is you know, actually digital. + +Vijay Agarwal: 40:01 + Information that we are getting. + +Vijay Agarwal: 40:03 + And then we are comparing that against the digital note which you have dictated and trying to make sense for a successful claim. + +Vijay Agarwal: 40:12 + Because our focus right now is to make sure that we create a claim. + +Vijay Agarwal: 40:16 + Which is almost 100 accurate. + +Brian McHugh: 40:19 + Yeah. + +Vijay Agarwal: 40:19 + Although we will not be there, you know, in this phase. But eventually that's our first goal to address. And then we can start addressing on the data acquisition like what you're saying. + +Vijay Agarwal: 40:30 + Is the data acquisition layer where how many different ways can we acquire that data into imbele to process a claim? Yeah, I think but the technology is there. You are right, it can be done. + +Brian McHugh: 40:45 + Understood. + +Vijay Agarwal: 40:46 + Yeah. + +Vijay Agarwal: 40:47 + So, yes. + +Vijay Agarwal: 40:48 + So this to your question on the sequence. Okay. + +Vijay Agarwal: 40:53 + And what you had mentioned to Emily. + +Vijay Agarwal: 40:55 + I, I understand that the sequence is. + +Vijay Agarwal: 40:57 + Not important for the engine, but doctors,. + +Vijay Agarwal: 41:01 + They will have a sequence in their mind, the imbly engine right now that you will see and the transcriptions that. + +Vijay Agarwal: 41:09 + You will see will appear like a one big blob. + +Vijay Agarwal: 41:12 + Okay. It is not segregated by sentences or by paragraphs. It doesn't understand that. So it is all one dictation. So don't be confused. You know, why is it showing that? + +Vijay Agarwal: 41:25 + But we are just trying to consume. + +Vijay Agarwal: 41:27 + That as one single piece of content. + +Brian McHugh: 41:30 + Do you want me if I do mock dictations, Vijay? + +Brian McHugh: 41:33 + Because I actually, if I'm forced to dictate, there's a few hospitals I work at where I'm forced to dictate and I actually dictate the format into the report. Just because as you might Imagine there are fewer errors on the billing side if you can produce a document even if it's through dictation, where it's formatted appropriately. Because the biller who ultimately ends up with it's in an organized fashion, so they're far less likely to make mistakes. Do you want me to. If I'm doing mock dictations, should I do that or should I just dictate a block of text like many doctors would? + +Vijay Agarwal: 42:12 + I think you can give us that. + +Vijay Agarwal: 42:15 + Dictation piece where or better is if. + +Vijay Agarwal: 42:19 + You can just send a small note. + +Vijay Agarwal: 42:21 + Saying, Para 1 should be patient info, Para 2 should be pre diagnosis, Para 3 should be whatever you have recommended, Para 4, and so on. Right. + +Vijay Agarwal: 42:33 + What we will try to do in later versions is we will try to convert this block of data into something. + +Vijay Agarwal: 42:40 + Which fits into your template and automatically structure. + +Vijay Agarwal: 42:45 + Because right now, whatever you dictate as an audio, it will get converted into. + +Vijay Agarwal: 42:51 + One stream of text. No matter what. + +Brian McHugh: 42:54 + No matter what. + +Vijay Agarwal: 42:55 + Yeah. + +Vijay Agarwal: 42:56 + So what we can do is for presentation to billers, we can figure out if there is a better way to. + +Vijay Agarwal: 43:04 + Templatize, like you're saying, in different paras. + +Vijay Agarwal: 43:07 + And we templatize that for them to. + +Vijay Agarwal: 43:09 + Understand, oh, this is the patient data. And then second, hey, this is the preoperative diagnosis, and then so on. + +Brian McHugh: 43:17 + And that's all. That's all kind of available, by the way. Like if you. + +Brian McHugh: 43:20 + If your team just Googles, okay, operative report format, you know, it's a. + +Brian McHugh: 43:26 + There. + +Brian McHugh: 43:26 + There's subtle variations across the country, whatever, but they're all roughly similar in terms. + +Brian McHugh: 43:32 + Of, like medical schools used to hand. + +Brian McHugh: 43:34 + Out, because these were all paper forms. They'd say, okay, here's an operative report. This is how you're supposed to structure it. Here's a progress note. Here's a consult note. Here's a history and physical note. They're supposed to have almost a nationalized format to them. Each institution tweaks it slightly so it's not regulated like that. But if you guys wanted to look at typical formats, I think if you. + +Brian McHugh: 44:00 + Just googled it and you'd see. + +Vijay Agarwal: 44:02 + Yep. + +Vijay Agarwal: 44:03 + Yeah, if it's public knowledge, then we. + +Vijay Agarwal: 44:06 + Will find that out. We'll take that as a note and see, you know, what is the complexity to convert this block of dictation into that format? Right. Because like we discussed, there are multiple entry points into the claim engine. The real brain is the claim engine. + +Vijay Agarwal: 44:23 + And those entry points are that people can get to it just by selecting. + +Vijay Agarwal: 44:27 + The template and no dictation at all. Right. And the second entry point is you. + +Vijay Agarwal: 44:32 + Have a beautiful dictation and you also. + +Vijay Agarwal: 44:36 + Have a few more templates that you want to combine. + +Vijay Agarwal: 44:39 + Right. So dictations content is just one part. + +Vijay Agarwal: 44:44 + That we are trying to structure here. + +Vijay Agarwal: 44:47 + For the operative report. + +Vijay Agarwal: 44:48 + We don't know, you know, when we. + +Vijay Agarwal: 44:50 + Get to the actual stage of generating operative reports, what would happen if people. + +Vijay Agarwal: 44:56 + Only selected the templates? We don't have any other information. So we would pull in from EMR to create the patient para and then the pre diagnosis because there was no dictation. Right. Just a template. + +Vijay Agarwal: 45:10 + So then the EMR has most of. + +Vijay Agarwal: 45:11 + The knowledge for us to create that structured paragraph as an operative report. + +Vijay Agarwal: 45:17 + So we are still away in that. + +Vijay Agarwal: 45:20 + Sense to reach a stage where something. + +Vijay Agarwal: 45:22 + Like that can be fully automated. + +Brian McHugh: 45:24 + Say that last part again, Vijay. + +Brian McHugh: 45:26 + I just want to make sure we're clear on that. + +Vijay Agarwal: 45:29 + So the full operative report that we. + +Vijay Agarwal: 45:32 + Are trying to generate in terms of. + +Vijay Agarwal: 45:35 + Structured paragraphs, we are still away in. + +Vijay Agarwal: 45:38 + Terms of creating that. + +Vijay Agarwal: 45:39 + Because we are right now creating the. + +Vijay Agarwal: 45:42 + Claim form with the CPTs and ICDs. + +Vijay Agarwal: 45:46 + Mapped and not the whole operator report for the doctor. + +Vijay Agarwal: 45:50 + Because that is already available in EPIC that we are pulling out. Right. + +Brian McHugh: 45:56 + Well, what is already available in epic? + +Vijay Agarwal: 45:59 + So we get the EMR patient records. + +Vijay Agarwal: 46:02 + That people will submit within. + +Vijay Agarwal: 46:05 + So whatever they created in epic. + +Vijay Agarwal: 46:07 + Right, which is the diagnostic report, the patient record and the after surgical record or the report that they create. + +Brian McHugh: 46:17 + Yeah. + +Vijay Agarwal: 46:18 + So those documents they will upload in epic. And since it does not integrate with IMBD at the moment, we will have a copy of that uploaded manually into the shared drive of im. + +Vijay Agarwal: 46:30 + Billy. + +Vijay Agarwal: 46:32 + Now, the surgeon who is operating on. + +Vijay Agarwal: 46:36 + That patient does an additional dictation to. + +Vijay Agarwal: 46:39 + Tell us what surgery was performed in detail. And then we help them correlate that. + +Vijay Agarwal: 46:45 + To the ICD and CPD codes and. + +Vijay Agarwal: 46:47 + We compare that with the document we got from epic. + +Vijay Agarwal: 46:52 + Okay. + +Vijay Agarwal: 46:53 + So our final output is the claim form for this patient, for this encounter. + +Vijay Agarwal: 47:00 + That you are at, for the surgery that you are at. Right. + +Vijay Agarwal: 47:04 + So when you say the creation of a structured operative report, at the moment we are not generating a structured operative. + +Vijay Agarwal: 47:14 + Report as an output. Right. We are generating the claim form as an output. + +Vijay Agarwal: 47:21 + So. + +Vijay Agarwal: 47:22 + And I guess, yeah, sorry, please, no, keep. + +Brian McHugh: 47:27 + Keep going. Vision. Maybe you're. Keep talking. + +Vijay Agarwal: 47:30 + Yeah. + +Vijay Agarwal: 47:30 + So when you said that there is. + +Vijay Agarwal: 47:32 + A, you know, public knowledge for structuring. + +Vijay Agarwal: 47:37 + This paragraph, do you intend for IMBELE to create the entire reports in that structured format as well, apart from the claim form? + +Brian McHugh: 47:46 + Yeah, I think that would be ideally, yes. That's what I mean. When I say, you know, I pick up the app and just say, the patient's Emily Clifford. I did an acdf. I Am Billy generates the operative report. + +Brian McHugh: 48:01 + In the standard format and basically asks me if I approve of that. And then probably from a workflow standpoint. + +Brian McHugh: 48:10 + Says, okay, well that would mean that. + +Brian McHugh: 48:12 + You're going to claim this patient has these diagnostic codes and you're trying to. + +Brian McHugh: 48:18 + Bill for these CPT codes. + +Brian McHugh: 48:19 + I say, yeah, that's what I'm doing. + +Brian McHugh: 48:21 + And then it's. + +Brian McHugh: 48:22 + The operative report is generated and the claim form is generated. I have the ability to approve both or my billing director does and it's sent out. + +Brian McHugh: 48:33 + And I just want to make one. + +Brian McHugh: 48:34 + Comment, I think, in response to what. + +Brian McHugh: 48:38 + I think you were saying, Vijay, about. + +Brian McHugh: 48:42 + How we're not creating operative reports as an output from I Am Billy yet, because we need information from. + +Brian McHugh: 48:53 + The emr. + +Brian McHugh: 48:56 + And I just want to make sure I'm being clear. For example, the ideal operative report for any surgery. And they all should be roughly identical, Right. + +Vijay Agarwal: 49:12 + If you. + +Brian McHugh: 49:13 + An appendectomy is an appendectomy with subtle nuances for that patient. Right. That aren't really important for billing. Right. Surgeons will go off and say, well, you know, they're. We got into some bleeding for a period of time. We stopped that with gauze and whatnot. From a billing standpoint, nobody cares. + +Brian McHugh: 49:31 + Right? + +Brian McHugh: 49:32 + Like the claim is, you did appendect. That's what you're trying to get paid for, right? + +Brian McHugh: 49:38 + Just an appendectomy. + +Brian McHugh: 49:40 + If you're saying the bleeding and all the stuff you're describing equates to some additional code, okay. Then it's important from a claim standpoint. But none of it is important from a billing standpoint. The surgeons will involve it or include. + +Brian McHugh: 49:57 + It sometimes because they're just used to that, other times because it is important to be part of the record. + +Brian McHugh: 50:04 + If another surgeon has to go in, they know that there was this problem with bleeding and it's in the record, but from a billing standpoint, it doesn't matter. + +Brian McHugh: 50:15 + So my point is the ideal appendectomy. + +Brian McHugh: 50:19 + Or ACDF operative report is Googleable, right? + +Brian McHugh: 50:23 + You can say, Google me. What's, you know, give me the format. + +Brian McHugh: 50:28 + On ideal ACDF or operative report. + +Brian McHugh: 50:32 + Available, and then that's all we want an. + +Brian McHugh: 50:38 + Ability to kind of generate pre correlated with the appropriate codes and have that as an option for an output to suggest to the surgeon. + +Brian McHugh: 50:50 + Does that, does that make sense? + +Vijay Agarwal: 50:52 + Yeah. So. + +Brian McHugh: 50:53 + So I, I just want to be clear because you, it sounded like you. + +Brian McHugh: 50:56 + Had said, we can't Have a clean ACDF operative report be an output from imbilly because we don't have the information connectivity to the emr. And my point is an ACDF operative report is a generic document that we can put together and we can do that for every surgery. And the payer language almost defines the document. + +Vijay Agarwal: 51:24 + Understood. + +Vijay Agarwal: 51:24 + So maybe I took part of operative report to contain patient information and the. + +Vijay Agarwal: 51:33 + Pre surgical encounters information that comes as part of the whole operative report. So those two paragraphs where you describe. + +Vijay Agarwal: 51:41 + The patient and the diagnosis, this will. + +Vijay Agarwal: 51:46 + Not appear if we just select templates from imbl. If you select a template,. + +Brian McHugh: 51:54 + Good point. Like if you select, let's say you say, you know, acdf, you could have IM Billy as an output, generate the. + +Brian McHugh: 52:07 + Narrative component of the operative description. So the description of the actual operation that is largely dictated by what CPT codes you're trying to get reimbursed for. And the payer language,. + +Brian McHugh: 52:25 + It should be. + +Brian McHugh: 52:26 + Able to automatically generate that because that's available on the Internet. And then the optional comp or the nuanced component at the beginning, which is patient specific, the surgeon could fill in. + +Brian McHugh: 52:38 + Right. So you could say, look, I did. + +Brian McHugh: 52:40 + A routine acdf, so go ahead and generate my routine ACDF narrative, but give. + +Brian McHugh: 52:48 + Me the optionality to say the, you know, the patient was vj, we had. + +Brian McHugh: 52:51 + To delay surgery because he had a fever for a couple days. + +Brian McHugh: 52:54 + Like the stuff that's nuanced, you can. + +Brian McHugh: 52:56 + Dictate just that piece perhaps. + +Vijay Agarwal: 52:59 + Understood. + +Vijay Agarwal: 53:00 + So basically what we are currently solving. + +Vijay Agarwal: 53:05 + Is from the dictation we figure out the relevant ict, ICD and CPD codes. + +Vijay Agarwal: 53:12 + And we match it with the payer. + +Vijay Agarwal: 53:16 + Lingo and we bring that into the clip. + +Vijay Agarwal: 53:19 + So what I understand is for the operative report, this is just one component. + +Vijay Agarwal: 53:26 + Where you describe the procedure and which is standard Google. + +Vijay Agarwal: 53:31 + Google can give you the standard lingo. Okay, but before the operative procedures, there is a part where you describe the. + +Vijay Agarwal: 53:39 + Patient and the diagnosis and the other things which the surgeon can additionally dictate in their entire dictation flow. + +Brian McHugh: 53:50 + Yes, and even that to some degree could be automated. Vijay, like if I said,. + +Brian McHugh: 53:57 + If you. + +Brian McHugh: 53:58 + Googled, what's a typical hpi? + +Brian McHugh: 54:02 + So that's the history of present illness. It's a standard paragraph format for a lot of these documents. What's the typical HPI for someone with appendicitis? There's standard language that describes the diagnostic ICD10 codes for appendicitis. The surgeon would probably want to add color to that. + +Brian McHugh: 54:29 + Right. + +Brian McHugh: 54:29 + But 99.9% of patients who are there. + +Brian McHugh: 54:34 + In the hospital with an appendicitis who. + +Brian McHugh: 54:37 + Will then have an appendectomy performed on them should have largely identical documentation from a claim standpoint. + +Vijay Agarwal: 54:48 + Yeah. Yeah. + +Brian McHugh: 54:49 + The doctor will need to add some elements of color to it just for the documentation purposes. + +Vijay Agarwal: 54:58 + Yeah. + +Brian McHugh: 54:59 + But for the claim purpose, the ICD10 supporting language, the CPT supporting narrative, are boilerplate. + +Vijay Agarwal: 55:09 + Almost always the same for that pair, Correct? Exactly. + +Brian McHugh: 55:14 + And the one caveat that we've already gone over is in spine specific. + +Brian McHugh: 55:21 + Spine's probably the most complicated surgical coding, just so you guys know, for our procedures, we already discussed it. Routine back problem patient, routine language for. + +Brian McHugh: 55:34 + Their diagnostics, routine CPT language for their cpt. + +Brian McHugh: 55:39 + The only little tweak is the surgeries are all buckets of CPT codes with subtle modifications, like the lumbar arthrodesis surgery. + +Brian McHugh: 55:52 + But in this one, we did osteotomies. Okay. So that adds some CPT codes, maybe one, maybe two. And that each one of those CPT. + +Brian McHugh: 56:01 + Codes needs a little paragraph to describe what you did. And really, if you boil it down,. + +Brian McHugh: 56:10 + That's the only thing that makes spine so complex. + +Brian McHugh: 56:15 + In an appendicitis case where you're doing. + +Brian McHugh: 56:17 + An appendectomy, you can only do one procedure. + +Brian McHugh: 56:20 + There's nothing else to do. + +Brian McHugh: 56:22 + Right. + +Brian McHugh: 56:22 + So the language is identical. + +Brian McHugh: 56:24 + Spine is exactly the same, except you. + +Brian McHugh: 56:29 + Can sometimes tailor the procedure slightly more. + +Brian McHugh: 56:33 + In a case by case basis with. + +Brian McHugh: 56:36 + One or two extra codes. + +Brian McHugh: 56:38 + Because you tweaked what you did technically, just a little bit. + +Brian McHugh: 56:43 + But the concept, the principle, is the. + +Brian McHugh: 56:45 + Same, that even the ICD10 and CPT. + +Brian McHugh: 56:52 + Codes for an appendicitis diagnosis and an appendectomy surgery are identical across the board. + +Brian McHugh: 57:01 + The language that describes the ICD10 codes. + +Brian McHugh: 57:04 + And the CPT codes for that episode are largely identical across the board. The elements of the operative report that are not identical from one patient to the next that are not strictly demographic. Right. Obviously, John Smith is not Emily Clifford is not Brian McHugh. So the elements of the narrative report that aren't just demographic are very small percentages of the report. They're just color versions, you know, little. Little pieces of the story that. That make it VJ's appendicitis as opposed to Brian's. + +Brian McHugh: 57:45 + And they're. + +Brian McHugh: 57:46 + They're pieces of the clinical story that need to be in the report to communicate to other doctors, but they're irrelevant to the claim. + +Vijay Agarwal: 57:56 + So it means very specific minor details which may differ patient to patient. + +Vijay Agarwal: 58:03 + But otherwise, from the claims perspective, each. + +Vijay Agarwal: 58:06 + Code has its own language, which is primarily consistent for both ICD and cpd. Correct. + +Brian McHugh: 58:13 + And this is where exactly. + +Brian McHugh: 58:15 + And this is where most denials happen because the providers or the physicians get wrapped up in the story of the patient's journey, but don't include the critical language needed for the code. + +Brian McHugh: 58:34 + So it'll be, you know, I'll make it up. But VJ came in vomiting, he was. + +Brian McHugh: 58:38 + At the park with his kid. + +Brian McHugh: 58:39 + He had abdominal pain. + +Brian McHugh: 58:42 + They tell this whole story about how you got to the operating room or. + +Brian McHugh: 58:45 + What your diagnosis, but they don't use the language specific to support the ICD10 Code of Appendicitis we want to put in. It's like you're T.R. This patient had appendicitis. Right. Here's what needs to be in that description. + +Brian McHugh: 59:03 + You can add in that they were at the park and they had to get their dog, you know, taken care of before they got picked up by an ambulance. + +Brian McHugh: 59:11 + Like all that may be valuable to. + +Brian McHugh: 59:14 + The next provider who takes over for them or something, but in the eyes of the payer and from the standpoint of the claim, it's meaningless. + +Vijay Agarwal: 59:24 + Yep, understood. So I think that is the language. + +Vijay Agarwal: 59:28 + Part is what we are working on. + +Vijay Agarwal: 59:30 + For the ICD and CPT codes. Okay. But the pre, you know, the pre paragraphs, which is the patient description and the historical description, etc. Is something we are not currently building in the claim report. + +Vijay Agarwal: 59:46 + Right, But a actual operative report would contain all that historical data and the. + +Vijay Agarwal: 59:51 + Patient data plus the paragraphs which dictate the procedure that we are talking about and the relevant terms for the ICD10 codes and the CPD codes. + +Vijay Agarwal: 01:00:04 + So what I mean is for the entire report to be built, we need that dictation history. + +Vijay Agarwal: 01:00:10 + Okay. + +Vijay Agarwal: 01:00:11 + Or history from EPIC plus we need this, you know, generated content of the codes which. Which can be either dictated by the surgeon or generated by IM Delhi. + +Vijay Agarwal: 01:00:22 + But I am. + +Vijay Agarwal: 01:00:22 + Billy definitely fixes it in the final leg when it creates the claim form. + +Vijay Agarwal: 01:00:27 + So it creates the claim form with these codes plus the language which will be absorbed by the payers. Right? That's the final end objective. + +Vijay Agarwal: 01:00:39 + So it doesn't output a full operative. + +Vijay Agarwal: 01:00:41 + Report in the way you described. Okay. But it outputs a claim form which has the codes mapped and the language required for that. But I get what you are saying. + +Vijay Agarwal: 01:00:54 + Eventually, if someone can just dictate, then you have a full operative report in the template that you mentioned. + +Vijay Agarwal: 01:01:04 + We could borrow from Google, which is. + +Vijay Agarwal: 01:01:05 + Standard, and we could in fact create the whole template with the patient history, with whatever was observed, and then the. + +Vijay Agarwal: 01:01:13 + Relevant ICD language and the CPT language. Right. So it is like one form which is used for internal discussions as well as for payer. Sending it to the payer. + +Brian McHugh: 01:01:25 + Yeah, exactly. Correct. + +Vijay Agarwal: 01:01:26 + I got what you were saying. Yes. + +Brian McHugh: 01:01:28 + Okay, I know we're out of time. I just wanted to say one other thing and I'll say it quickly. That concept I just discussed with you,. + +Brian McHugh: 01:01:37 + That is also true for the operative description. + +Brian McHugh: 01:01:41 + Right. + +Brian McHugh: 01:01:41 + Surgeon to surgeon, they may go on and on about how they control bleeding. + +Brian McHugh: 01:01:46 + And what product they use if they're. + +Brian McHugh: 01:01:49 + Trying to get reimbursed for a laminectomy. There is standard laminectomy language. All the other color commentary irrelevant to a claim. + +Vijay Agarwal: 01:02:00 + You mentioned that in the past as well, so. + +Vijay Agarwal: 01:02:02 + But before we complete today's call, Brian,. + +Vijay Agarwal: 01:02:05 + There is one thing we have to make sure you have got on the app. + +Vijay Agarwal: 01:02:09 + So the dictation that you just made,. + +Vijay Agarwal: 01:02:13 + If you open the app, you will. + +Vijay Agarwal: 01:02:16 + See that on the top right corner. + +Vijay Agarwal: 01:02:19 + There is a folder icon. + +Brian McHugh: 01:02:27 + Oh, it logged me out. Yeah. + +Vijay Agarwal: 01:02:29 + Yeah. It's a good test that it should. + +Vijay Agarwal: 01:02:33 + Log you in and you should get. + +Vijay Agarwal: 01:02:34 + The OTP as well. + +Brian McHugh: 01:02:36 + Yeah, good point. You want me to do that, right? Right? + +Vijay Agarwal: 01:02:41 + Yes, I want. Yes. So. + +Vijay Agarwal: 01:02:43 + And you wouldn't have to log out of Google Meet because you're not doing the dictation. + +Vijay Agarwal: 01:02:47 + So app should still work. + +Brian McHugh: 01:02:49 + Yep. + +Brian McHugh: 01:02:50 + Give me a second. + +Brian McHugh: 01:03:27 + Okay. + +Brian McHugh: 01:03:27 + I'm in the app on the right top corner. + +Vijay Agarwal: 01:03:30 + You will see there is a folder icon. + +Brian McHugh: 01:03:33 + Yep. + +Vijay Agarwal: 01:03:35 + If you click on the folder, it. + +Vijay Agarwal: 01:03:38 + Shows the dictations which are not mapped. + +Vijay Agarwal: 01:03:40 + To a patient yet. + +Brian McHugh: 01:03:43 + I don't think I have any there. Mine. + +Brian McHugh: 01:03:45 + If I click on the folder, it says action required. These recordings were captured during high speed workflows and require EMR patient link before review. But I have no. And then it says no recordings pending because I didn't do a dictation. I'm sorry. + +Vijay Agarwal: 01:03:56 + Oh, you did not do a dictation. + +Vijay Agarwal: 01:03:58 + Okay. Last time I did. + +Brian McHugh: 01:03:59 + Yep. + +Vijay Agarwal: 01:04:00 + So what would happen is when you actually do the dictation test dictations, you. + +Vijay Agarwal: 01:04:07 + Start with entering an MRN and then. + +Vijay Agarwal: 01:04:10 + You do a dictation. When you finish the dictation, it will. + +Vijay Agarwal: 01:04:14 + Appear on the folder over there on the top. Then when you click over there, you will see the list of patients. + +Vijay Agarwal: 01:04:23 + Okay. + +Vijay Agarwal: 01:04:24 + That you need to associate this dictation with because we don't have live integration. + +Vijay Agarwal: 01:04:30 + With EPIC yet or any. Any emr. + +Brian McHugh: 01:04:33 + Right. + +Vijay Agarwal: 01:04:33 + So you need to actually tell us. + +Vijay Agarwal: 01:04:34 + Which patient is this. Okay. + +Brian McHugh: 01:04:36 + Okay. + +Vijay Agarwal: 01:04:37 + So can you. + +Vijay Agarwal: 01:04:38 + You. + +Vijay Agarwal: 01:04:39 + You need to select the practice, which is make your neurosurgery the Patient. + +Vijay Agarwal: 01:04:42 + Okay. + +Vijay Agarwal: 01:04:43 + And then it will tell you to. + +Vijay Agarwal: 01:04:45 + Select the template for which you had done the dictation. + +Brian McHugh: 01:04:48 + Yeah. + +Vijay Agarwal: 01:04:49 + Okay. + +Vijay Agarwal: 01:04:49 + Then it shows you all the ICD and CPT codes. + +Vijay Agarwal: 01:04:52 + Okay. + +Vijay Agarwal: 01:04:53 + You can choose to add and remove anything. + +Vijay Agarwal: 01:04:56 + Right now it is just a list. + +Vijay Agarwal: 01:04:57 + Derived from the template. + +Vijay Agarwal: 01:05:00 + Then you submit. + +Vijay Agarwal: 01:05:02 + After that, the audio and the patient data and the templates go to the. + +Vijay Agarwal: 01:05:09 + Backend brain of imb. + +Vijay Agarwal: 01:05:11 + Then they start prescribing, they start the. + +Vijay Agarwal: 01:05:14 + Matching process, and then they get into the biller queue. Okay. + +Vijay Agarwal: 01:05:18 + So which means for you to generate a full dictation that can get into biller's queue, you will dictate, you will do the patient mapping, you will select the templates. + +Vijay Agarwal: 01:05:32 + Okay. And then you will push it. + +Vijay Agarwal: 01:05:35 + So I really want to see is. + +Vijay Agarwal: 01:05:38 + As a actual surgeon, do you find. + +Vijay Agarwal: 01:05:41 + This whole process intuitive? This is the first feedback we would want on what we can simplify. + +Vijay Agarwal: 01:05:46 + Okay. + +Vijay Agarwal: 01:05:48 + Then the second feedback would be to see if your audio dictation got converted to appropriate English. + +Brian McHugh: 01:05:56 + Okay. + +Vijay Agarwal: 01:05:57 + These are the only two things we'll. + +Vijay Agarwal: 01:05:59 + Focus now for the next few days with you. Okay. While with. With the billing and, you know, Emily,. + +Vijay Agarwal: 01:06:04 + We are doing a lot of rounds of discussions. So there we'll focus on the, you. + +Vijay Agarwal: 01:06:09 + Know, actual quality part and the accuracy part. Yeah. This is how we want to structure the next few days on the test. + +Vijay Agarwal: 01:06:19 + So apart from this, what we have also done, I want to also show you that. So the team has also gone through. + +Vijay Agarwal: 01:06:28 + The 21 test cases that we had received. The. The sample case files. + +Vijay Agarwal: 01:06:34 + So we ran the imbly brain on those. + +Vijay Agarwal: 01:06:38 + Okay. + +Vijay Agarwal: 01:06:39 + And we have created a results document of this, of which certain cases were able to map 100 accurate. Certain cases were not. And some of them we flagged as a false positive. So we would want the billing team. + +Vijay Agarwal: 01:06:58 + Who gave us these sample cases, if. + +Vijay Agarwal: 01:07:01 + They can just check the particular report. + +Vijay Agarwal: 01:07:05 + Okay. Which we are flagging as a false positive. + +Vijay Agarwal: 01:07:08 + If they can check and tell us if Imbele is doing correctly or is. + +Vijay Agarwal: 01:07:12 + Something wrong with imbd. + +Brian McHugh: 01:07:14 + Okay. + +Vijay Agarwal: 01:07:16 + As a step number one. + +Brian McHugh: 01:07:18 + And we see that where Vijay. Like we could show what. What can we show the billing team? + +Vijay Agarwal: 01:07:25 + So we would basically tell them this. + +Vijay Agarwal: 01:07:28 + Results on all the 21 cases. We will tell them the case numbers. Okay. + +Vijay Agarwal: 01:07:33 + And the case numbers that we could not score. + +Brian McHugh: 01:07:36 + Got it. Okay. + +Vijay Agarwal: 01:07:38 + Okay. And in the report we have described what. What we think is not matching. Okay. + +Brian McHugh: 01:07:44 + Okay. + +Vijay Agarwal: 01:07:45 + So if the billing team can see. + +Vijay Agarwal: 01:07:47 + And tell us, no, your interpretation is wrong. And you know, this is how I. + +Vijay Agarwal: 01:07:50 + Am really should have operated. + +Vijay Agarwal: 01:07:51 + So we will feed that information back into Imbali. Okay. Yeah. Cool. + +Brian McHugh: 01:08:00 + This document, you'll email us this document,. + +Brian McHugh: 01:08:03 + Vijay, so we can. + +Vijay Agarwal: 01:08:05 + We are emailing a bunch of documents to Emily regularly. So we have the user manuals. We are going to email the coding accuracy report on the 21 cases. + +Brian McHugh: 01:08:17 + Okay. + +Vijay Agarwal: 01:08:18 + And we have also emailed her a. + +Vijay Agarwal: 01:08:20 + Few other documents on test cases. So, yes, we will. + +Vijay Agarwal: 01:08:23 + But we will try to also put some language around it on what document. + +Vijay Agarwal: 01:08:27 + Is meant for what purpose. Okay. Yeah, perfect. Cool. Cool. + +Brian McHugh: 01:08:34 + Sounds good. + +Vijay Agarwal: 01:08:34 + We took a lot of your time on the road. Sorry. + +Brian McHugh: 01:08:36 + No, it's okay. Yeah, I appreciate it. It was good to talk to you guys. This was fun. I'll play around the next couple days and. + +Brian McHugh: 01:08:43 + And provide some feedback. + +Vijay Agarwal: 01:08:45 + Yeah. Okay. Thank you. Bye. + +Brian McHugh: 01:08:47 + Thanks, everybody. + +Vijay Agarwal: 01:08:48 + Thanks. Bye. By. + diff --git a/Iambilly_transcripts/18_06.txt b/Iambilly_transcripts/18_06.txt new file mode 100644 index 0000000..93d6471 --- /dev/null +++ b/Iambilly_transcripts/18_06.txt @@ -0,0 +1,1821 @@ +Lince Varghese: 00:00 + Association Q that shows while the direct detection is being done and it has been associated automatically. Associated or not, that Q remains if it is not associated. Like if the MRN does not match it with the IMB system or Athena. + +Vijay Agarwal: 00:16 + So what happens if you click on that now? + +Lince Varghese: 00:18 + It is actually empty. We will have a direct dictation now and it. You will see that there is a Q here. + +Vijay Agarwal: 00:26 + Okay, so that is. + +Vijay Agarwal: 00:30 + So you are saying that is basically a draft. + +Lince Varghese: 00:33 + Yes. + +Vijay Agarwal: 00:34 + When something has not gotten associated with a patient, that means it is still in draft state. + +Lince Varghese: 00:39 + Yes. + +Vijay Agarwal: 00:40 + And when you see the cloud, what does that mean? + +Lince Varghese: 00:43 + That is an offline queue that represents. + +Vijay Agarwal: 00:47 + Like what is pending to be seen to the cloud. + +Lince Varghese: 00:50 + Yes, yes. + +Vijay Agarwal: 00:51 + And what does the green network mean? + +Lince Varghese: 00:53 + That that is just showing the availability. + +Vijay Agarwal: 00:56 + Of network availability of data on the mobile or connection and the cloud. + +Lince Varghese: 01:02 + It's connection between the mobile and the cloud. + +Vijay Agarwal: 01:04 + Okay, great. + +Lince Varghese: 01:11 + You are telling something, sir. + +Vijay Agarwal: 01:13 + No, no. + +Vijay Agarwal: 01:13 + So these icons that we have added, are they clickable enough? They seem very small to me. Have you tried with actual finger? + +Lince Varghese: 01:25 + Yes sir, I'm doing in the. The finger itself. + +Vijay Agarwal: 01:28 + Okay. Okay, cool. + +Lince Varghese: 01:31 + So the earlier. What we have seen is the new dictation. That. That is here what is reflecting today what we are going to see is direct dictation. So bypass leakage associated later. That's the. That's the option we are going. I'm going to select now. + +Vijay Agarwal: 01:51 + Okay. + +Lince Varghese: 01:52 + Okay, so this, in this form we have a surgery title. Doctor can give a surgery doctor title. That is also an optional thing. Even the name is an optional thing. MRN is required for the linking. Okay, just a second. + +Vijay Agarwal: 02:27 + Lindsay, did you check if this was. + +Vijay Agarwal: 02:30 + The original flow that we had shared with Emily? Because I don't think this is the. + +Vijay Agarwal: 02:36 + Input fields we had shown to them. + +Vijay Agarwal: 02:38 + When we designed the first version of the mobile app. In the first version of the mobile. + +Vijay Agarwal: 02:44 + App, what we had shown is on. + +Vijay Agarwal: 02:47 + The home screen you have a record button, a big record button. You click on it and the recording starts. + +Vijay Agarwal: 02:57 + Because she compare this with the original PDF that we had shared with her. + +Lince Varghese: 03:06 + I don't like. We have. We have in the mock up also we don't have, as you can see that we don't have. Actually I have already shared the mockup in that our portal. + +Vijay Agarwal: 03:21 + No, in the new mockup or in the old mockup. So the new. + +Vijay Agarwal: 03:25 + The old mockup which was March 10th or 18th. + +Vijay Agarwal: 03:29 + Right. + +Lince Varghese: 03:32 + Even there itself it is same as it is. + +Vijay Agarwal: 03:35 + So the new dictation step was that. + +Vijay Agarwal: 03:38 + He will search the patient and I. + +Vijay Agarwal: 03:44 + Mean he will first add the mrn and then he will. Or he will type the MRN and. + +Vijay Agarwal: 03:48 + Then he will proceed. Was that the flow? + +Lince Varghese: 03:51 + Yes. + +Vijay Agarwal: 03:52 + Okay. Okay. + +Vijay Agarwal: 03:56 + Yeah, because I just don't want Emily to come back with this point that this is. + +Vijay Agarwal: 04:00 + This was not what the original flow. + +Vijay Agarwal: 04:02 + Agreed. + +Vijay Agarwal: 04:03 + Was. + +Vijay Agarwal: 04:03 + Okay. + +Lince Varghese: 04:04 + No, no, sir, this is. This is what. What was there. And the MRN where we type is actually it was missing in the mockup because it is in the downside of that screen. So I have made it on the top so that patient information should be all together. + +Vijay Agarwal: 04:23 + Okay. + +Lince Varghese: 04:25 + And now we will select the hospital here. Start a secured patient. + +Vijay Agarwal: 04:39 + Can I, can I show you my screen once? + +Lince Varghese: 04:42 + Yes. + +Vijay Agarwal: 04:50 + So this was the original mock up. + +Vijay Agarwal: 04:52 + That we had shared. + +Vijay Agarwal: 04:53 + It is also part of, you know, the version history. + +Lince Varghese: 04:58 + Yes, yes. + +Vijay Agarwal: 04:59 + So here what we had said. + +Vijay Agarwal: 05:00 + There was one big button that said new dictation. + +Vijay Agarwal: 05:03 + Today's claims. Okay. + +Vijay Agarwal: 05:06 + There was no multiple buttons. + +Vijay Agarwal: 05:08 + Okay. + +Vijay Agarwal: 05:09 + And on the top we just had this. + +Vijay Agarwal: 05:11 + These things. + +Vijay Agarwal: 05:12 + No, whether network is there, data is there. + +Vijay Agarwal: 05:14 + It was not part of the icons here. + +Vijay Agarwal: 05:17 + Okay. Then when they did dictation, search by. + +Vijay Agarwal: 05:22 + MRN or select the customers,. + +Vijay Agarwal: 05:26 + Select the template or. + +Vijay Agarwal: 05:30 + Or you have this full dictation, no template. Okay. And then the recording screen. Okay. And then this was done. Dictation uploaded. You want to do another dictation or. + +Vijay Agarwal: 05:46 + Go back to home. + +Vijay Agarwal: 05:50 + And then you would see what are the claims which are in different status. And then for each claim, the details were shown. + +Lince Varghese: 06:03 + Sir, in these steps, what you were showing is the dictation doesn't happen less than three tabs. It has been allowed to see that only. + +Vijay Agarwal: 06:13 + No, this is the first tab. + +Vijay Agarwal: 06:14 + New dictation. This is the second tab. And then the template is the third. + +Vijay Agarwal: 06:20 + Tab and the dictation starts. + +Lince Varghese: 06:22 + Yes, but we have hospitals to be mapped there. So different hospitals are there. That comes before the patient selection. + +Vijay Agarwal: 06:33 + We have a different hospital selection. + +Lince Varghese: 06:37 + Yes. + +Vijay Agarwal: 06:37 + So, okay, there are two parts. + +Lince Varghese: 06:39 + Yes. + +Vijay Agarwal: 06:40 + If you look at the ui. Okay. + +Vijay Agarwal: 06:43 + The UI was not taking name of. + +Vijay Agarwal: 06:46 + The patient or was not asking for. + +Vijay Agarwal: 06:52 + What was the other thing? It was not asking for the other field that you were asking. + +Vijay Agarwal: 06:57 + Okay. + +Vijay Agarwal: 07:00 + Search by name or mrn. But either there was a list. + +Vijay Agarwal: 07:04 + Okay. And there was no. + +Vijay Agarwal: 07:08 + Data entry. So I know one piece that we. + +Vijay Agarwal: 07:13 + Have discussed that since there is no direct integration with the emr, okay. + +Vijay Agarwal: 07:18 + We will not get the patient list automatically. Okay. So he will have to type. Okay, This I know that we have discussed. + +Vijay Agarwal: 07:27 + So in our current flow. Now if you show your screen,. + +Vijay Agarwal: 07:33 + Let. + +Vijay Agarwal: 07:33 + Me just compare what was our original. + +Vijay Agarwal: 07:36 + Flow to her and what do we have now? + +Vijay Agarwal: 07:40 + So you have seen this mock up. + +Vijay Agarwal: 07:42 + That I just showed you, right? + +Lince Varghese: 07:45 + Yes, that I too have uploaded but later I have revised that version. + +Vijay Agarwal: 07:51 + I know, I know, but I don't. + +Vijay Agarwal: 07:54 + Think Emily has seen what version you have revised because it was only one time tagged to Emily for initial feedback. + +Vijay Agarwal: 08:03 + I don't think we have ever re tagged whenever we have changed the mock up. + +Vijay Agarwal: 08:07 + But anyways, let me see if we. + +Vijay Agarwal: 08:08 + Are close by to the flow and. + +Vijay Agarwal: 08:10 + Close by to the ui. Okay, then obviously we can manage her. + +Vijay Agarwal: 08:17 + Show me the screen again. + +Vijay Agarwal: 08:19 + Okay, so now. + +Lince Varghese: 08:24 + Okay, I can proceed with the dictation that because the network is available that would go directly to the AI means Sorry, not AI to the gcp. + +Vijay Agarwal: 08:36 + But why would it not get auto submitted? Why does he have to press the button again? + +Lince Varghese: 08:45 + I'm sorry sir, I'm missing like so. + +Vijay Agarwal: 08:48 + In showing a dictation. Yes, and that dictation did not auto sync. + +Vijay Agarwal: 09:00 + You had to press one button at the bottom. + +Vijay Agarwal: 09:01 + No. What was that submit dictation link? + +Lince Varghese: 09:06 + I'll create another claim just now. + +Vijay Agarwal: 09:09 + Okay? + +Vijay Agarwal: 09:10 + No, no problem. + +Vijay Agarwal: 09:10 + So now as soon as that is done, then this application queue is basically. + +Vijay Agarwal: 09:14 + That folder icon, right? + +Lince Varghese: 09:16 + Yes, exactly. So the names and the facility that we have chosen will not be selected if the MRN matches with the IMB system and it will be automatically synced with like whatever we have in the IMD system. Okay, that's why the name has been like Leo and not what I have typed. + +Vijay Agarwal: 09:39 + Can you repeat this? + +Lince Varghese: 09:40 + Okay, so what happens is in the direct dictation I, I, I type a surgery title, I type the reference name as if doctor knows or doesn't know what the database entry is for the patient so he can type anything for his reference. And if I type the MRN wrong? In that case if I select and if I do a dictation like patient is subhan resting on operating table, he will be having his labnectomy. And if I submit this particular. + +Vijay Agarwal: 10:19 + Claim which means he has given some dummy details there. + +Lince Varghese: 10:24 + Yes, exactly. So, so in that case the name of the patient is what I have selected now. + +Vijay Agarwal: 10:31 + but if it is found in the database then it is as per. + +Vijay Agarwal: 10:34 + The database here you are showing a green tick. + +Vijay Agarwal: 10:37 + Meaning it is verified name. + +Lince Varghese: 10:40 + Yes, exactly. + +Vijay Agarwal: 10:41 + Okay, but if it is verified it is already linked. Then why do I have to link patient again? + +Lince Varghese: 10:46 + Exactly. So under that condition I am clicking a link patient which has been synced with Leo Cruise here what happens is we need to have a manual encounter entry on what date it should be fetched if it is coming from Athena. This manual encounter page will not appear because it will take the latest encounter from the Athena. Because it is fetching from the IMB system. Manual encounter is needed here. Okay, next step is to select the templates that we have. And these are templates are the cheat codes that they have provided us. So I can select one of them and it is linked and it is submitted in the queue here. + +Vijay Agarwal: 11:32 + But hold on. + +Vijay Agarwal: 11:33 + If you remember what Brian had said. + +Vijay Agarwal: 11:36 + Last time, that there are two types of doctors, senior and junior. So when they do the dictation, we show them the dictation? Yes, and we show them the feedback. Are you saying the feedback of what is matching, what is not matching will. + +Vijay Agarwal: 11:51 + Come once we have the AI suggestions implemented? + +Lince Varghese: 11:54 + No, not at all. This, this AI suggestion we have not yet implemented. If you want I can show a demo of it how it will be working. Not here. Do you need me to show that right now? + +Vijay Agarwal: 12:10 + So first I was just trying to understand Brian's feedback. + +Vijay Agarwal: 12:12 + So Brian's feedback was that when I'm doing the dictation, okay. + +Vijay Agarwal: 12:17 + I would have not used the right. + +Vijay Agarwal: 12:19 + Words so I would show them that. Boss, your dictation was this. But I am going to change the dictation to this. + +Vijay Agarwal: 12:26 + Okay. + +Vijay Agarwal: 12:27 + Because this is what is required by the payer. + +Lince Varghese: 12:30 + Yes sir, I'll show that would better. + +Vijay Agarwal: 12:33 + Fine, no problem. + +Lince Varghese: 12:34 + So already shown to the pratic ones like I'll show you to you again,. + +Vijay Agarwal: 12:39 + We will see it later. + +Vijay Agarwal: 12:40 + So okay, if you go back in. + +Vijay Agarwal: 12:42 + Your flow now there is a dictation and you had to select the template. + +Vijay Agarwal: 12:47 + So template I think you should have. + +Vijay Agarwal: 12:49 + Selected before in the flow, in the. + +Vijay Agarwal: 12:53 + New dictation flow, direct dictation. + +Vijay Agarwal: 12:55 + Okay. + +Vijay Agarwal: 12:56 + When you added the name, okay. + +Vijay Agarwal: 13:01 + On the same screen you should have given the list of the template because otherwise we will not be able to show the suggestions. + +Vijay Agarwal: 13:14 + Okay. + +Vijay Agarwal: 13:15 + On the next screen after the dictation. + +Vijay Agarwal: 13:17 + Is done, our flow is that we. + +Vijay Agarwal: 13:21 + Need to show the suggestions to the. + +Vijay Agarwal: 13:23 + Doctor that based on the type of surgery, based on the template, based on the dictation. + +Vijay Agarwal: 13:30 + Okay. + +Vijay Agarwal: 13:31 + What you have given versus what the. + +Vijay Agarwal: 13:33 + Payer policy demands is not in sync. + +Vijay Agarwal: 13:36 + Because we don't even have the template. + +Lince Varghese: 13:43 + The scrutinizing will be two way. One with the templates that the doctor selects and second is what AI suggests. + +Vijay Agarwal: 13:53 + But how will we know what type. + +Vijay Agarwal: 13:55 + Of surgery is this? + +Vijay Agarwal: 13:56 + Because the surgery title we are giving. + +Vijay Agarwal: 13:58 + As a text box. + +Vijay Agarwal: 14:00 + I think that we need to give. + +Vijay Agarwal: 14:02 + As a drop down box because the. + +Vijay Agarwal: 14:05 + Title to a large Extent is similar to the template. + +Lince Varghese: 14:10 + Okay, sir, let me show that flow. Actually then I will have a better understanding what I should do. Just a second. + +Abhinav Srivastava: 14:19 + The other dictation flow. I remember we selected templates quite early in the step, not after this. Why this change in the flow? + +Lince Varghese: 14:33 + I am like that flow is basically you're saying like it was before the dictation itself. The template was being selected and here after this dictation it will be selected. So. + +Abhinav Srivastava: 14:45 + Yeah. + +Lince Varghese: 14:46 + Yes. So no, I. I'll make that right. Yeah. + +Abhinav Srivastava: 14:52 + Both flows should be the same and I think selecting the template beforehand makes much more sense. But let's see how it works out here. + +Prateek Kashyap: 15:02 + So. + +Lince Varghese: 15:11 + So this is what we have intend to do next time what happens is procedure is being recorded and that transcript is available with the. The junior doctor, whoever it is and sir, are you able to hear me? + +Vijay Agarwal: 15:28 + I can, yeah. + +Lince Varghese: 15:29 + Yes. So this transcript is being created for the. Right away. It is created after the junior doctor has done his recording. And later on based on that transcription itself we would have been suggested like we would have suggested these modules that could be missing. And this process is actually held by AI itself. So these are sub modules that AI is suggesting that in this particular procedure you might have missed. According to pair policy that could be included these CPT codes. So he can tap and dictate for the laminatomy module now. And this particular option will be transferred to the very top six session that we are going to upload. + +Vijay Agarwal: 16:19 + Okay, one second. Now. + +Vijay Agarwal: 16:24 + The doctor when he is doing a direct dictation. + +Lince Varghese: 16:29 + Yes. + +Vijay Agarwal: 16:30 + Because I'm a little confused with this. + +Vijay Agarwal: 16:31 + Direct and new to. To be honest, we will have to remove one. + +Vijay Agarwal: 16:34 + Okay. + +Vijay Agarwal: 16:36 + So we have to keep only one. + +Vijay Agarwal: 16:37 + Flow and. + +Vijay Agarwal: 16:42 + We will check with Emily. + +Vijay Agarwal: 16:43 + And you know which flow makes more sense. Okay. + +Vijay Agarwal: 16:49 + So now when the doctor comes in,. + +Vijay Agarwal: 16:52 + They select the patient or enter the mri. Okay. Till this I am fine. Now when they select the template, okay. Template is basically the codes or a group of codes. + +Lince Varghese: 17:08 + Okay. + +Vijay Agarwal: 17:09 + Correct. That is. That is what we have put in the template, right? + +Vijay Agarwal: 17:12 + Group of. + +Abhinav Srivastava: 17:13 + Yes. + +Vijay Agarwal: 17:15 + What Brian mentioned was that's junior doctors may not dictate all the things that are supposed to be there in the code. Okay. As per the payer policy. + +Lince Varghese: 17:28 + Yes. + +Vijay Agarwal: 17:29 + So why the doctor is dictating? Okay. We should actually tell them that you. + +Vijay Agarwal: 17:36 + Have selected this template. + +Vijay Agarwal: 17:39 + These are the things you need to dictate. + +Lince Varghese: 17:44 + Then under that condition template is. Will be of the procedure itself, right? + +Vijay Agarwal: 17:51 + Correct. + +Lince Varghese: 17:52 + If. If I see. Yeah. So these are all common procedures that is being done, sir. And these are The CPT codes accordingly. Okay, so ER visit will also like attach with MRI interpretation and. + +Vijay Agarwal: 18:16 + Yeah, yeah, yeah. + +Vijay Agarwal: 18:17 + Multiple procedures could be there. Combination of procedures could be there. That is going to be part of the template, no? + +Lince Varghese: 18:24 + Yeah, but we are actually templates as per him is a template would be the procedure that is being held like something like ACDF or a laminate. Tommy. So. + +Vijay Agarwal: 18:38 + Okay, so to answer your question, then. + +Vijay Agarwal: 18:40 + We should have multi select on the template. + +Lince Varghese: 18:43 + Exactly. + +Vijay Agarwal: 18:44 + Because last time I remember he mentioned. + +Vijay Agarwal: 18:46 + That the doctor who knows the CPD. + +Vijay Agarwal: 18:50 + Codes, they may just check the CPD codes. Okay? + +Vijay Agarwal: 18:54 + I mean check all the CPD codes. + +Vijay Agarwal: 18:56 + That are relevant to this. + +Vijay Agarwal: 18:57 + But there are doctors who may not. + +Vijay Agarwal: 18:59 + Know the CPT codes. Okay. + +Vijay Agarwal: 19:01 + So then they can just select those multiple surgical items that they have done. + +Vijay Agarwal: 19:06 + Okay. + +Vijay Agarwal: 19:07 + Basis that we will identify. + +Abhinav Srivastava: 19:09 + Okay. + +Vijay Agarwal: 19:09 + This is applied to these CPT codes and basis that we will figure out what the payer policy tells to be dictated. So the doctor can dictate using those terminologies without missing any aspect. + +Lince Varghese: 19:25 + I'll. I'll make arrangements for the multiple select on templates. + +Abhinav Srivastava: 19:30 + But we have the in the module for practice admin as well, right? They can create their own template. So if they have some exactly CPT codes that they want to be matched together in a particular practice in a particular procedure, then they can create that template and you know, they can. And the doctors can select that specific template. So I guess that can be solved based on the templates that the practice admin creates. + +Vijay Agarwal: 19:59 + So ab in what I understood last time, right. That during the surgery the doctor may. + +Vijay Agarwal: 20:05 + Have done certain procedures which has led. + +Vijay Agarwal: 20:09 + To another sort of a,. + +Vijay Agarwal: 20:16 + You know, CPD code. + +Vijay Agarwal: 20:17 + Okay. + +Vijay Agarwal: 20:17 + Because during the surgery you can have a situation. + +Vijay Agarwal: 20:20 + Okay? + +Abhinav Srivastava: 20:21 + Okay. + +Vijay Agarwal: 20:23 + Now only the doctor knows after the. + +Vijay Agarwal: 20:26 + Surgery is complete that I did procedure. + +Vijay Agarwal: 20:29 + One, procedure two, procedure three. + +Vijay Agarwal: 20:31 + Okay? + +Vijay Agarwal: 20:32 + So we will not have the template ready with all these combinations for each procedure. So doctor will have to at least select the type of procedure that he has done. + +Abhinav Srivastava: 20:47 + Okay. But with the selection of every template, they can also annotate it further with their additional dictation. Right? So that detail can come with the dictation that you know, this ACDF level three was done and apart from this, I also did so and so procedure additionally. So those CPD codes ultimately will all of the CPD codes, the template plus the dictation, everything will get mapped towards the final. So I don't think we necessarily need to add multiple template selection. But if you think that. + +Lince Varghese: 21:21 + No, no. + +Vijay Agarwal: 21:22 + So then what we should do, we. + +Vijay Agarwal: 21:23 + Should first only create the Flow as. + +Vijay Agarwal: 21:25 + A prototype, not code, anything. + +Vijay Agarwal: 21:27 + Okay. We show it to them that this. + +Vijay Agarwal: 21:30 + Is what they asked us to do. + +Vijay Agarwal: 21:32 + Last time to handle that complicated situation. + +Vijay Agarwal: 21:35 + Okay. + +Vijay Agarwal: 21:35 + We show the user experience, we run it through them multiple times and then. + +Vijay Agarwal: 21:39 + Only we go back to the code. + +Vijay Agarwal: 21:41 + So I think what you're saying makes. + +Vijay Agarwal: 21:43 + Sense if we are able to detect the procedure types. Okay. + +Vijay Agarwal: 21:49 + And attach it to the right CPT. + +Vijay Agarwal: 21:52 + Codes from the dictation. + +Vijay Agarwal: 21:54 + Okay. + +Vijay Agarwal: 21:54 + Then we tell the doctor that, boss,. + +Vijay Agarwal: 21:57 + As per your dictation, you have given. + +Vijay Agarwal: 22:00 + You have given indications that you had. + +Vijay Agarwal: 22:01 + Done these procedures which require these CPT codes. Okay. + +Vijay Agarwal: 22:06 + And then we have to tell them. + +Vijay Agarwal: 22:07 + That because of these CPD codes, your. + +Vijay Agarwal: 22:10 + Dictation should have also covered these additional. + +Vijay Agarwal: 22:14 + Sections or additional words. Okay. For this to be approved. So please redictate the additional part. Okay. + +Vijay Agarwal: 22:24 + For clarification. + +Vijay Agarwal: 22:25 + So that way the flow is guided. + +Vijay Agarwal: 22:27 + For the junior doctors. + +Abhinav Srivastava: 22:31 + Yeah, yeah. + +Vijay Agarwal: 22:34 + Before we do any technical implementation. + +Abhinav Srivastava: 22:38 + Okay. Okay. + +Vijay Agarwal: 22:39 + Yeah, you're right. + +Vijay Agarwal: 22:40 + So, Lynn, then let's not change one template, multiple template. + +Vijay Agarwal: 22:45 + Okay. + +Vijay Agarwal: 22:45 + Let's design the user flow first we. + +Vijay Agarwal: 22:48 + Get a proper clarification. + +Vijay Agarwal: 22:49 + Then only we will change anything. + +Vijay Agarwal: 22:51 + But what I can certainly see here, that surgery title should have been actually the selection of the template. Because, I mean, why would a doctor every time give a new surgery title? + +Vijay Agarwal: 23:04 + No, very difficult for him. + +Vijay Agarwal: 23:05 + He would rather select from the typical types of surgeries that happen. + +Abhinav Srivastava: 23:10 + Yeah. + +Lince Varghese: 23:11 + We are also provisioning to edit the templates and the CPT codes and their justifications, so. + +Vijay Agarwal: 23:18 + Oh, I don't think doctors are required to do that. + +Vijay Agarwal: 23:20 + That's only for the billing guy. + +Abhinav Srivastava: 23:22 + Yeah, yeah, that's for admin and the billing guy. + +Vijay Agarwal: 23:26 + So we had. I had also removed it or commented on the previous. The first design, right. Where we had like a mobile interface for Biller. + +Vijay Agarwal: 23:34 + Okay. + +Vijay Agarwal: 23:35 + So in that also I had commented that let's keep Biller only on the desktop. + +Lince Varghese: 23:42 + Yes, sir. + +Vijay Agarwal: 23:44 + So here on this screen that you have done Olins, the surgery title is actually our selection of template. Actually call the surgery type instead of the title. + +Vijay Agarwal: 23:57 + Okay. + +Vijay Agarwal: 23:58 + And then when they click on that row item, you get the list of templates where they can search by name. And it is all sorted by abcd. They are able to select a template. + +Vijay Agarwal: 24:09 + Okay. + +Vijay Agarwal: 24:10 + Over there. Then the patient reference name. + +Vijay Agarwal: 24:13 + I think you can keep it. + +Vijay Agarwal: 24:18 + But I would say move a patient mrm, which is required to the top. + +Abhinav Srivastava: 24:22 + Yeah, that should be the first input. + +Vijay Agarwal: 24:26 + And then last May, you can take the surgical name reference. + +Vijay Agarwal: 24:30 + So the patient reference name. Yeah. Yes, that should be the last. + +Vijay Agarwal: 24:36 + Whatever is mandatory for you. You Take at the top. + +Vijay Agarwal: 24:39 + Okay, so one thing, Lynch. + +Vijay Agarwal: 24:44 + The reason why we keep asking you to do this frequent updates to us. + +Vijay Agarwal: 24:48 + Now that before you implement anything in. + +Vijay Agarwal: 24:51 + Engineering, you show us the flow. Okay. + +Vijay Agarwal: 24:53 + We will prevent doing rework in engineering. + +Lince Varghese: 24:58 + Yes, sir. + +Vijay Agarwal: 24:59 + Okay. + +Vijay Agarwal: 25:00 + So hence there is so much of push that. Please show us. Please show us what is going on. Please show us. Because we don't want you to do. + +Vijay Agarwal: 25:05 + Double effort on anything. + +Vijay Agarwal: 25:09 + Okay. + +Vijay Agarwal: 25:10 + So I have understood that sequence. We will have to resequence it. + +Vijay Agarwal: 25:14 + So let's resequence first in the flowchart. + +Vijay Agarwal: 25:18 + Okay? + +Vijay Agarwal: 25:18 + You don't even have to do the whole mock ups. + +Vijay Agarwal: 25:21 + Okay? Just simple flow. + +Vijay Agarwal: 25:23 + You can write down what we discussed and what every screen will have in what sequence. And we agree on the current sequence. + +Vijay Agarwal: 25:31 + Okay. + +Vijay Agarwal: 25:32 + The only future thing that we want to agree with the doctor is that. + +Vijay Agarwal: 25:37 + The junior doctor situation that he had told us. + +Lince Varghese: 25:39 + Okay. + +Vijay Agarwal: 25:41 + What should be the ideal flow for that? When does the correction get highlighted and how does the correction get made by. + +Vijay Agarwal: 25:49 + The doctor in the dictation? + +Vijay Agarwal: 25:51 + That's a flow we will do properly. + +Vijay Agarwal: 25:52 + With UI and we will show to them in the next demo. Okay. + +Vijay Agarwal: 25:56 + And we will take their feedback before we implement. + +Lince Varghese: 26:01 + Yes, sir. + +Vijay Agarwal: 26:03 + Okay, so this flow I have understood. We will have to move the. You know, create a new design and then move. + +Vijay Agarwal: 26:10 + This is clear what else is happening on the mobile. + +Lince Varghese: 26:14 + So like direct dictation and new dictation itself. Rest all is the claims where we view last time. Also we have seen this where the templates codes are already visible at the bottom. + +Vijay Agarwal: 26:28 + Yeah. + +Vijay Agarwal: 26:29 + Okay. + +Lince Varghese: 26:31 + And like. And one more thing, sir. If. If patient is found or not found, it is being notified accordingly. + +Vijay Agarwal: 26:42 + I see. Okay. Very good, Very good. + +Lince Varghese: 26:48 + Okay, next thing is. + +Vijay Agarwal: 26:51 + So one more question. L. So there is alerts on the top and alerts at the bottom. What is the difference? + +Lince Varghese: 26:59 + Alerts. This concept. This is same as not. + +Vijay Agarwal: 27:02 + I see. + +Vijay Agarwal: 27:03 + I think the notification bar has become a little complicated. + +Vijay Agarwal: 27:07 + Okay. + +Vijay Agarwal: 27:08 + Because to be honest, I did not think these were part of our navigation. + +Vijay Agarwal: 27:13 + I thought that network was surely not. + +Vijay Agarwal: 27:16 + Part of our navigation. + +Vijay Agarwal: 27:19 + What you should do is, okay, either. + +Vijay Agarwal: 27:22 + Move the profile to the bottom and. + +Vijay Agarwal: 27:25 + Replace the alerts or you remove the. + +Vijay Agarwal: 27:28 + Alerts from the top. + +Vijay Agarwal: 27:30 + Whatever is easier for you. Yeah, sorry. + +Abhinav Srivastava: 27:37 + Yes. I was saying that alerts and the network icon, we can do away with those from the top. + +Vijay Agarwal: 27:43 + From the top? + +Abhinav Srivastava: 27:44 + Yeah. The alerts should come down and the network icon is not needed as such because it is already there in the phone. + +Vijay Agarwal: 27:51 + Yeah. And we have a cloud icon which is already showing that it is not synced. Yeah, because of no network. + +Vijay Agarwal: 27:58 + Right. + +Vijay Agarwal: 27:59 + So let's remove those two. But Lynn's. The bottom alerts is not showing that pending notifications. Which is the red mark. + +Lince Varghese: 28:07 + Yes, sir. + +Vijay Agarwal: 28:09 + Yeah. + +Vijay Agarwal: 28:09 + So you can remove the notification bell. + +Vijay Agarwal: 28:12 + And the network from the top. + +Abhinav Srivastava: 28:16 + And what does the record I can do in the footer if we click on it. So already have two buttons here in. + +Lince Varghese: 28:22 + The actually linked with the new dictation flow itself. The blue, dark blue one which you are seeing here. So if press record it goes to the direct detection itself. + +Vijay Agarwal: 28:32 + One direct detection shows. + +Vijay Agarwal: 28:38 + So I think abina what has happened. + +Vijay Agarwal: 28:40 + No, the new dictation is the ideal. + +Vijay Agarwal: 28:42 + Flow that EMR is integrated. Direct dictation is. + +Vijay Agarwal: 28:47 + EMR is not integrated. + +Vijay Agarwal: 28:49 + Okay. + +Vijay Agarwal: 28:50 + So we will need both depending on. + +Vijay Agarwal: 28:52 + What state we are for a particular clinic or for a particular launch. + +Vijay Agarwal: 28:57 + Okay. + +Vijay Agarwal: 28:58 + Right now we know that we are in a situation of direct dictation. + +Vijay Agarwal: 29:01 + We don't have EMR integration. + +Vijay Agarwal: 29:03 + Yeah. + +Vijay Agarwal: 29:04 + But in the future we will need. + +Vijay Agarwal: 29:06 + The new dictation flow. Probably. + +Vijay Agarwal: 29:08 + So for this launch. + +Vijay Agarwal: 29:10 + Okay. + +Vijay Agarwal: 29:10 + What we will do is we will. + +Vijay Agarwal: 29:11 + Hide the new dictation tab and we. + +Vijay Agarwal: 29:14 + Will link the record as a direct dictation. + +Vijay Agarwal: 29:16 + Because there is no emr, we don't. + +Vijay Agarwal: 29:18 + Expect the patients to be available. + +Abhinav Srivastava: 29:21 + Yeah. Everything is going to be direct dictation only. So. So the record icon. The footer icon should actually trigger. + +Lince Varghese: 29:30 + Yes. + +Prateek Kashyap: 29:32 + So. + +Vijay Agarwal: 29:32 + But only hide it lens. + +Vijay Agarwal: 29:34 + We are going to need this in the second iteration. Once we have figured out the EPIC Marketplace. The developer account that we require now. + +Lince Varghese: 29:42 + Yes. + +Vijay Agarwal: 29:43 + Don't remove all the backend work that we have already done. + +Vijay Agarwal: 29:48 + Okay. + +Vijay Agarwal: 29:49 + And you mark a note in. + +Vijay Agarwal: 29:51 + The code that this is going to. + +Vijay Agarwal: 29:52 + Be enabled when EMR integration is live. And we don't call it direct dictation or new dictation. + +Lince Varghese: 30:04 + Yeah, we will change it. + +Vijay Agarwal: 30:06 + Yeah. + +Vijay Agarwal: 30:08 + Probably call it surgery dictation or whatever is the right word. + +Vijay Agarwal: 30:13 + Okay, Pratik, let's check. + +Vijay Agarwal: 30:16 + What are these dictations called? + +Vijay Agarwal: 30:18 + Are these procedure dictations or surgical dictations? + +Abhinav Srivastava: 30:23 + Okay, sir. + +Vijay Agarwal: 30:25 + And before you go to Emily, just search online and see what is the right terminology. + +Vijay Agarwal: 30:29 + Yes. Yeah. + +Vijay Agarwal: 30:32 + TK So I think this. + +Vijay Agarwal: 30:33 + I am very clear, Lynn. + +Lince Varghese: 30:34 + Okay, sir. So as soon as our chain is being ready here. So if it has been forwarded to generally to all the dealers. Okay, I'll store the biller. Now. + +Vijay Agarwal: 31:03 + One thing, Lindsay. If we can do. + +Vijay Agarwal: 31:04 + No, that create all of these Im. + +Vijay Agarwal: 31:08 + Billy Biller 1, Biller 2, Biller 3, whatever. Instead of having separate Gmail accounts. + +Abhinav Srivastava: 31:14 + No. + +Vijay Agarwal: 31:14 + Just create those as aliases within the. + +Vijay Agarwal: 31:17 + Current apps at the rate make you. + +Vijay Agarwal: 31:19 + Account. + +Lince Varghese: 31:22 + So clear that actually. + +Vijay Agarwal: 31:25 + Okay, okay. No problem. + +Vijay Agarwal: 31:27 + Then Abhinav, I think you will have. + +Vijay Agarwal: 31:28 + To create and give it to him. + +Lince Varghese: 31:29 + No, no sir, I did. I didn't understood the procedure that we have to do. + +Vijay Agarwal: 31:34 + Okay. + +Vijay Agarwal: 31:34 + So basically Gmail account. The same Gmail id. + +Vijay Agarwal: 31:37 + No. + +Vijay Agarwal: 31:37 + Which is appset that it make you. + +Lince Varghese: 31:39 + Yes. + +Vijay Agarwal: 31:40 + It will allow us to create 30 alias IDs. + +Vijay Agarwal: 31:44 + All all linked to apps at the rate MCU. + +Vijay Agarwal: 31:47 + Okay. + +Lince Varghese: 31:48 + Okay fine. + +Vijay Agarwal: 31:50 + So all users, all the dummy users. + +Vijay Agarwal: 31:54 + For testing their OTPs will come into one account. So we don't need to manage five different Gmail accounts. + +Abhinav Srivastava: 32:01 + Yeah. Or I guess if. If this dashboard allows adding plus to the email addresses then you can just simply add plus and biller 1 plus biller 2. So everything will land in the same inbox anyways. + +Vijay Agarwal: 32:15 + Yeah. + +Vijay Agarwal: 32:16 + So Lindsay, did you understand what Abhinav mentioned? + +Lince Varghese: 32:20 + To create multiple billers in a practice admin. That. That's a provision that practice admin gives and. + +Vijay Agarwal: 32:27 + No, no, no. In the email id. Yes, in Gmail. What happens if you have apps at the rate make you neurosurgery? Okay. + +Vijay Agarwal: 32:39 + It comes into the main inbox. + +Lince Varghese: 32:41 + Okay. + +Vijay Agarwal: 32:42 + If you say apps plus biller one at the rate make you neurosurgery, it will create a label called Biller1 automatically and it will put the email automatically in that label. + +Lince Varghese: 32:55 + Okay. Like here tags. + +Vijay Agarwal: 32:58 + Yeah. So if you. This is which. This is biller one. + +Vijay Agarwal: 33:01 + No, it's not like this. If you compose here. Right. + +Vijay Agarwal: 33:04 + Compose on the click compose type here apps +biller1 pillar1. + +Vijay Agarwal: 33:18 + At the rate make you neurosurgery. Yeah. + +Vijay Agarwal: 33:28 + Just send a test mail. + +Abhinav Srivastava: 33:31 + Yeah, it will anyways land in this inbox only. + +Vijay Agarwal: 33:38 + So now in the apps inbox go to apps. + +Vijay Agarwal: 33:41 + This is biller. + +Vijay Agarwal: 33:41 + No, this is not apps. + +Lince Varghese: 33:43 + Okay. + +Vijay Agarwal: 33:44 + Do you have apps logged in anywhere? + +Lince Varghese: 33:47 + Yeah, I have. + +Vijay Agarwal: 33:49 + Oh my God. + +Vijay Agarwal: 33:55 + So what Abhinav is asking is if. + +Vijay Agarwal: 33:57 + Our admin panel allows us to add. + +Vijay Agarwal: 34:03 + A email id with icon and the. + +Vijay Agarwal: 34:09 + Validation does not fail. + +Vijay Agarwal: 34:11 + Okay. + +Vijay Agarwal: 34:12 + Then we don't even have to create the alias. + +Vijay Agarwal: 34:14 + We can just use that. + +Abhinav Srivastava: 34:16 + Yeah. + +Lince Varghese: 34:17 + Fine. Fine. + +Vijay Agarwal: 34:24 + Did we send it to the right id? + +Vijay Agarwal: 34:28 + Going to check Spam,. + +Abhinav Srivastava: 34:33 + I think. + +Vijay Agarwal: 34:33 + Spam? + +Abhinav Srivastava: 34:34 + Yes. Spam. Yeah. Report not spam. + +Vijay Agarwal: 34:37 + Report not spam. Just mark Report not spam. + +Vijay Agarwal: 34:40 + Yeah. + +Vijay Agarwal: 34:41 + So you see here how it has automatically come. So you don't need all these various Gmail IDs. + +Abhinav Srivastava: 34:47 + You can just keep on adding Biller 1, Biller 2, Billet 3 after plus whatever one you want to write, it. + +Vijay Agarwal: 34:52 + Will. + +Vijay Agarwal: 34:55 + We have Miller, one supervisor, one doctor, one. + +Vijay Agarwal: 34:58 + Right? + +Vijay Agarwal: 34:59 + Yes. + +Vijay Agarwal: 35:02 + Okay, so now let's go back to the admin. I have only 12 minutes left for the next meeting. So. + +Vijay Agarwal: 35:10 + You can go through. + +Abhinav Srivastava: 35:11 + Yeah, I guess the biller and supervisor. These two things you need to see, you can quickly go through them. + +Lince Varghese: 35:20 + So this is the one which we have recently done. + +Vijay Agarwal: 35:23 + Yeah, yeah. + +Lince Varghese: 35:26 + For Leo Cruz. We haven't. We can actually review that claim. + +Vijay Agarwal: 35:32 + Yeah,. + +Lince Varghese: 35:34 + This is the transcription. We have an option to edit the transcription as well. This is what CPT code has been generated. This thing. What we have seen the last time is the same for the Biller itself. One thing that has been changed is while creating this Leo, we have actually uploaded our document xlsx. + +Vijay Agarwal: 36:01 + Okay. + +Lince Varghese: 36:01 + So that particular document is available now. + +Vijay Agarwal: 36:05 + Okay. + +Lince Varghese: 36:06 + We have actually a visibility to. + +Vijay Agarwal: 36:11 + Okay,. + +Lince Varghese: 36:16 + Yeah. So this is. This is coming. And we can upload other files as well. Sure. For the scrutiny of that claim. + +Vijay Agarwal: 36:25 + Okay. + +Lince Varghese: 36:34 + So we have available PDF as well. So in this way we can have multiple files and Miller can actually view those files to scrutinize this particular claim. So after he has been scrutinized, if he feels like he can actually submit it to the supervisor, he can do that. + +Vijay Agarwal: 36:57 + And when you do reject claim, then what? + +Vijay Agarwal: 36:59 + It goes to the doctor again, we have. + +Lince Varghese: 37:02 + No, no. We have a whole case that would ask a reason why it is being. The same thing applies to the reject also. But it doesn't go back to the. The surgeon to have another date. If sergeant wants to have another claim to be entirely new claim to be processed, he can actually do that. + +Vijay Agarwal: 37:22 + No, generally what would happen last time when Brian explained. + +Vijay Agarwal: 37:25 + No, he. + +Vijay Agarwal: 37:26 + And also in the first flowchart discussion,. + +Vijay Agarwal: 37:29 + Emily had asked this that if doctor has not dictated properly. + +Vijay Agarwal: 37:33 + Okay. + +Vijay Agarwal: 37:34 + And Wheeler sees that it is not. + +Vijay Agarwal: 37:36 + Proper, he will ask the doctor to redictate and send the note. + +Lince Varghese: 37:41 + I think I've heard otherwise. Like he. He said like Biller should not go and ask to be doctor. Like what you have dictated on the listening for his audio. After listening to what his or her audio? + +Vijay Agarwal: 37:57 + No, no. + +Vijay Agarwal: 37:58 + I think go through that once again. Because Pillar should not change automatically the dictation. + +Vijay Agarwal: 38:05 + Hence Biller goes back to the doctor. + +Vijay Agarwal: 38:07 + And says, you know, we are not. + +Vijay Agarwal: 38:09 + Able to find this part in the dictation. Can you redictate and send. + +Lince Varghese: 38:13 + So the latest one. What you are talking about the latest meeting that we asked? + +Vijay Agarwal: 38:19 + No, no, before that in the. + +Abhinav Srivastava: 38:23 + Yeah, in the flowchart it is mentioned like this. Only that. + +Lince Varghese: 38:30 + Okay, so you want me to. If. If a claim gets Rejected. You want me to again travel the same to the doctor itself to read it? + +Vijay Agarwal: 38:39 + So that's what I was trying to figure out. What is the difference between hold and reject? + +Lince Varghese: 38:44 + No, it's just states. If we have a reject, it just states it's a. It's been rejected. That's it. + +Vijay Agarwal: 38:52 + That's what I'm thinking. What. What action actually happens within the system? Actually we don't need those two states. + +Vijay Agarwal: 38:59 + Unless there is a workflow getting triggered around that state. + +Vijay Agarwal: 39:04 + So I'm trying to figure out. + +Vijay Agarwal: 39:08 + The. + +Vijay Agarwal: 39:08 + User will get confused. Right. + +Vijay Agarwal: 39:11 + Okay. Either always say that there is a reject claim. Okay. + +Vijay Agarwal: 39:20 + And in that reject this is the reason and we want the doctor to read it. + +Vijay Agarwal: 39:27 + Okay. I think the flowchart has discovered from. + +Vijay Agarwal: 39:31 + What I remember links. + +Vijay Agarwal: 39:36 + If you check the flowchart one we. + +Vijay Agarwal: 39:39 + Will have to refine this. + +Vijay Agarwal: 39:40 + We don't need two separate states. Okay. + +Vijay Agarwal: 39:44 + Yeah. So either the claim is in execution. + +Vijay Agarwal: 39:48 + Which is say, you know, pending to be submitted, or it is rejected. There is no intermediate hold because by default whenever it is pending it is obviously on hold only. + +Lince Varghese: 40:03 + Okay, so we have two buttons that don't need to be shown here as submit to supervisor. + +Vijay Agarwal: 40:10 + So when you say reject claim payer. + +Vijay Agarwal: 40:12 + Rule then reject and route. What, what happens on reject and route? + +Vijay Agarwal: 40:16 + Where does it get routed to router. + +Lince Varghese: 40:19 + To back to the review queue itself. + +Vijay Agarwal: 40:21 + Review queue. + +Vijay Agarwal: 40:22 + But that review queue is not visible. + +Vijay Agarwal: 40:24 + As a status to Dr. No. + +Vijay Agarwal: 40:27 + It will not be but for the. + +Vijay Agarwal: 40:29 + Doctor when we are showing the claim. + +Vijay Agarwal: 40:31 + Statuses, the claim status on his mobile when it says ready which would mean. + +Vijay Agarwal: 40:39 + That review to Q would require him to resubmit a dictation. + +Vijay Agarwal: 40:45 + So if you go interview and if. + +Vijay Agarwal: 40:47 + It becomes say rejected. + +Vijay Agarwal: 40:48 + So if you go there so it. + +Vijay Agarwal: 40:50 + Should actually be required re dictation. + +Vijay Agarwal: 40:56 + Tap on Leo Cruz right now let. + +Vijay Agarwal: 40:58 + Me see what Leo Cruz screen shows here. Click. Scroll down. I see. Okay, so here we need to show those remarks and the redictation possibility to him. + +Vijay Agarwal: 41:15 + Now go into record again. + +Vijay Agarwal: 41:20 + In the record button on the mobile. + +Lince Varghese: 41:23 + So that's a new dictation flow like. + +Vijay Agarwal: 41:26 + Oh, so they can't select the existing. + +Vijay Agarwal: 41:28 + Running claim and dictate on that? + +Lince Varghese: 41:30 + No, not at all. + +Vijay Agarwal: 41:34 + I think we can simplify by giving them that either that button inside the. + +Vijay Agarwal: 41:39 + Claim so they can record it for that claim itself if there is another recording required. + +Vijay Agarwal: 41:46 + Okay. + +Vijay Agarwal: 41:46 + Anyways, you'll figure you figure out that. + +Vijay Agarwal: 41:48 + Flow once you look at the flowchart. + +Lince Varghese: 41:50 + Okay. + +Abhinav Srivastava: 41:56 + Okay, so here after biller what happens? Let's then quickly let's go to that. + +Lince Varghese: 42:02 + If it submits to the supervisor, we can have the same conditions that are being shown here. And the supervisor again like scrutinizes the entire claim with all the uploaded documents and whatever the edits has been made by the pillar. + +Prateek Kashyap: 42:21 + So. + +Lince Varghese: 43:00 + So now we have here for GEOP as well. So it is being like pending supervisor. The same thing appears to be like supervisor also and he would have a final approved claim. + +Vijay Agarwal: 43:21 + He. + +Lince Varghese: 43:21 + He also can do the same edits, add a diagnosis code and just save it like and if he needs to add a service line that can be do. Can we do that? + +Vijay Agarwal: 43:41 + So just here when he's adding an icd where is the corresponding cpt? + +Lince Varghese: 43:49 + Sir, it is like they're not packed I think. Sir, all the ICD codes are like their diagnosis of a person. Like what all things has been done. + +Vijay Agarwal: 44:00 + Yeah. + +Lince Varghese: 44:00 + And this CPT's particular procedures that has been held in the proceed like okay. + +Vijay Agarwal: 44:06 + So it is bottom. + +Vijay Agarwal: 44:07 + Okay, so essentially one of the key things here in our original sow know is that we have to prevent rejection of claims. Which means we need to detect flags that the CPT codes are not aligned with the ICD codes. + +Lince Varghese: 44:30 + On that condition. Like we have a. This particular page will tell what all things are there. That's what I am saying. Like we have a rack snippet and all that would help the killer itself to scrutinize what things happen has been selected. And what is that like? + +Vijay Agarwal: 44:51 + Okay, so there are two parts. + +Vijay Agarwal: 44:53 + If you see on the right hand side this box. + +Vijay Agarwal: 44:55 + No AI extracted entities. + +Lince Varghese: 44:57 + Yes. + +Vijay Agarwal: 44:57 + It has extracted CPD codes. It has extracted ICD codes. + +Lince Varghese: 45:01 + Yes. + +Vijay Agarwal: 45:01 + But what is most important is whether the pair conditions for each ICD code mapped to each CPD code. + +Prateek Kashyap: 45:12 + Yes. + +Vijay Agarwal: 45:13 + Is it done or not? + +Vijay Agarwal: 45:14 + That is very important. + +Vijay Agarwal: 45:15 + I assume this is going to happen. + +Vijay Agarwal: 45:17 + Once the AI suggestions thing is completed. + +Lince Varghese: 45:21 + Exactly. So the rack snippet is for that flow where you can see that which pair policy snippet would actually triggering this procedure of cbd. + +Vijay Agarwal: 45:33 + Okay. Okay. + +Abhinav Srivastava: 45:36 + And that high risk of rejection and things like that will get reflected accordingly. + +Vijay Agarwal: 45:40 + Right. + +Abhinav Srivastava: 45:41 + Risk category. Okay. So at the bottom there are two buttons. Hold and hold. We've already discussed reject and cancel. What's the difference here? + +Lince Varghese: 45:55 + So cancel actually removed the claim from the review queue itself. And after this just a. Yeah. So we have a reason to every entered and confirm what it will be removed from the system itself. + +Abhinav Srivastava: 46:19 + Now is it permanently removed or is it somewhere to be that it can be accessed later? If someone wants to audit what claims. + +Lince Varghese: 46:28 + Have been removed, it actually gets removed from this Very superviden. But practice admin would able to see this. Yes. + +Abhinav Srivastava: 46:40 + Okay. And reject frame will send it back to the biller or to the. + +Lince Varghese: 46:49 + No, it will just back to the review queue itself. + +Abhinav Srivastava: 46:53 + Okay. The same procedure. So we have to edit that in this case also I think it should get sent back to the Dr. Abhinav I'll drop. Yeah, yeah. + +Vijay Agarwal: 47:03 + Okay, bye. + +Lince Varghese: 47:15 + Here when we open a claim this is entirely what it is a CMS 1500 form. This form is not entirely editable because of fitback compliance and only particular fields that we have actually produced is in shown here. So if I. If I go again back to the claim management and by select the this first one what we have just been dictated. So it will be showing diagnosis what I even shows the diagnosis I have attended and paste and the CPT codes that are. Yeah, if you want. If the practice admin wants he can print out. Take a printout of it. Because this. This I am bill system is not at all linked with the Athena. So he would require a printout to just map it to the Athena. + +Abhinav Srivastava: 48:22 + They can upload it on the Athena system. Yeah, understood. Okay, so we have to work on the reject claim flow here like as video sir mentioned. + +Lince Varghese: 48:34 + Okay, let me go through this once again. + +Abhinav Srivastava: 48:38 + Yeah. I also remember in the flowchart when it has it is mentioned that it will go back to the doctor. So look at it once it should go back to the doctor and the cashier should be able to redictate. + +Lince Varghese: 48:57 + Okay. Anyway, Dr. Can predicted for the same patient again. But we need to append those dictation itself. + +Abhinav Srivastava: 49:07 + But not. It did not happen right now. No. On the flow that you showed, if he selected Leo Cruz again he can. + +Lince Varghese: 49:14 + Select the Leo cruise and he can dictate on it. + +Abhinav Srivastava: 49:16 + Okay, so we have to start the whole process again. So. + +Vijay Agarwal: 49:18 + But that will. + +Abhinav Srivastava: 49:19 + That will create confusion. No, that for Leo Cruz only there is earlier claim which was wrong. So the supervisor had to remove it from the system completely and then ask the doctor to redictate and I mean a couple of days might have passed between the do these two things and doctor might not recollect exactly what happened in that case. + +Lince Varghese: 49:42 + Okay. + +Abhinav Srivastava: 49:43 + Right. So it should. I guess you can create a separate status somewhere that these need your attention or redictate or add a new dictation. So things like that I guess we can add. So you. You go through that flow and let me know if you have any problems there confusion there. + +Lince Varghese: 50:02 + Okay, fine, I'll do. + +Abhinav Srivastava: 50:07 + Okay. + +Lince Varghese: 50:08 + After final approval of supervisor Also we have an option to export the data what we have created, but not as CMS 1500. It will be as what we have edited here at the supervisor level. And this export thing is also available at this below profile also. + +Prateek Kashyap: 50:29 + Okay,. + +Abhinav Srivastava: 50:31 + Okay. Okay. Yeah. Pratik, did we hear back from the Fair Health guys? Oh, no information because last. I'm not sure. That if she has forwarded or not. And if she has forwarded and we have not heard back, alternative path we'll have to find Given the access we take a dump. But I think it will better maintain in their GCP instance only so that data has not gone out of the geographical boundaries of the country. Healthcare is very sensitive, so we need to be sure about it. Follow up from Emily if we get some confirmation, then well and good. Otherwise we'll wait for a couple of days and then. Athena. Athena, thank you. Sorted. But now we are facing problem with VM login. But VM login, that is the question. So some IT team who helped with the VM set. The password is wrong. It is saying. Step by step document step by step. Emily will not understand right Step by step what she needs to do. She responds like that. + +Lince Varghese: 53:39 + I'm confused. + +Abhinav Srivastava: 53:40 + I don't know what to do. Give me step by step. Try to find out. + +Vijay Agarwal: 54:37 + System. + +Abhinav Srivastava: 54:56 + So email basically follow Pratik on the response from Fair Health and this login issue. Next week. Next week. We need to give them test flight access. At least share the credentials with us. In the meantime, we'll see what we can do. Okay,. + +Vijay Agarwal: 56:25 + Start your okay. + +Abhinav Srivastava: 56:27 + Bye bye. + +Prateek Kashyap: 56:29 + Thank you. + diff --git a/Iambilly_transcripts/29_06.txt b/Iambilly_transcripts/29_06.txt new file mode 100644 index 0000000..ff8cc00 --- /dev/null +++ b/Iambilly_transcripts/29_06.txt @@ -0,0 +1,645 @@ +Vijay Agarwal: 00:00 + Deck and the status of where we have reached. + +Emily Clifford: 00:02 + Okay. + +Vijay Agarwal: 00:03 + We will give you a full completed walkthrough of mobile plus biller plus supervisor. + +Abhinav Srivastava: 00:09 + Okay. + +Vijay Agarwal: 00:10 + And how the final CMS form gets downloaded. + +Emily Clifford: 00:14 + Okay. + +Vijay Agarwal: 00:15 + We will then also assist you to get the app downloaded on your mobile devices. + +Emily Clifford: 00:21 + Okay. + +Vijay Agarwal: 00:22 + So that you receive the OTP and you are able to log in. And we will also share with you scripts, sample scripts of what you can write at your end as a doctor because I'm sure you don't have all the lingo that Brian has. + +Emily Clifford: 00:38 + No. + +Vijay Agarwal: 00:39 + So still try the whole thing out. And then we will share an Excel sheet where you can log your observations in case something needs to be modified. + +Emily Clifford: 00:52 + Great. + +Vijay Agarwal: 00:53 + All of this is what we plan to cover today. So we will spend about five minutes on the deck and then we'll spend 10 to 15 minutes on the demo. Then we'll spend 10 minutes to get app downloaded on your devices and then share the remaining documents with you. That's how we plan to. Yeah. In case you want anything to be covered, please let us know. + +Emily Clifford: 01:14 + The only question I have is around the API, so I know that we had some setbacks across both Fair Health, epic, where are we with that? And then like how is that setting us back in terms of being able to actually like actively use the app? + +Vijay Agarwal: 01:32 + So I think as a failover method that we had discussed, we have now given a provision where the biller. I mean the person at the hospital is able to upload the documents. If you remember about that stage where Brian spoke about having a shared. Yeah. Shared drive and where they can upload. So we have built that in IM Billy now. + +Emily Clifford: 02:02 + Okay. + +Vijay Agarwal: 02:02 + So they can manually upload that doc, those documents in IAMBILLY that the builder supervisor is able to access. + +Emily Clifford: 02:09 + Okay. So you'll show me where that is and then we'll have to do. Do a training on whoever that is on the hospital. + +Lince Varghese: 02:15 + Of course. + +Vijay Agarwal: 02:16 + Yeah. So we still have, you know, few more weeks before we are. We are going to be ready for production. Right now the launch is beta, so we will also talk about what more things we are going to do in the next four weeks. And that includes training material and documentation and the knowledge aspects. + +Emily Clifford: 02:35 + Okay. + +Vijay Agarwal: 02:35 + Okay. So while Brian comes, one more thing that we are going to need now is more frequent meetings with you every week, at least once to catch up on all the observations that you are getting from Brian or other people who are using it. See if the kind of material that we are sharing with you, which is the documents, etc, are they good enough or not? + +Lince Varghese: 02:59 + Okay. + +Vijay Agarwal: 02:59 + And if there are an on demand, if you know anything that needs to be sorted out before the go live. So yeah, a lot of interaction. So Pratik is going to set up those calendars. So pre blog 30 minutes each week. At least 30 minutes each week and we extend it. + +Emily Clifford: 03:15 + Okay. And that is mainly for me and you guys. We wouldn't expect Brian to be on that. Right. So he's going to share with me and then I'll share with you. Okay, great. + +Vijay Agarwal: 03:23 + If you want to join, we can try it on Fridays when generally he's available. + +Emily Clifford: 03:27 + Okay. + +Vijay Agarwal: 03:27 + If he wants to hop on, he can. + +Emily Clifford: 03:29 + Sure, that sounds great. I was going to ask you one more thing. + +Brian McHugh: 03:33 + Shoot. + +Emily Clifford: 03:37 + I can't remember. Okay, no problem. + +Vijay Agarwal: 03:39 + You can drop a text whenever. + +Emily Clifford: 03:43 + Sounds good. But yeah, was telling I was talking to him on WhatsApp and were going through the emails to send the personal emails. Can you just explain why it's personal? Because it's attached to our Apple id. Right. We don't have an Apple ID for our professional, but that's okay. + +Vijay Agarwal: 04:05 + So essentially right now we are in beta test. The app is not available to the public for everyone. + +Emily Clifford: 04:12 + Right. + +Vijay Agarwal: 04:12 + So we can only add selected email IDs that will have access to IMD. We don't want to make it public. + +Emily Clifford: 04:19 + Okay. + +Vijay Agarwal: 04:19 + So for that we need to configure email IDs so you don't have to share the password, just the email IDs. Emails which have Apple account on your mobile app. So you have your iPhone device already in which you would have your Apple account. + +Abhinav Srivastava: 04:33 + Right. + +Vijay Agarwal: 04:34 + Share that email id. So we will enable that. You will receive an email from Apple on how to download the app. + +Emily Clifford: 04:41 + Okay. And then if I wanted anyone else on the team to use the beta app, same thing, I just give you their email address. Okay, great. + +Vijay Agarwal: 04:50 + So what we're also doing for ease of receiving two factor authentications and OTPs. Right. I've set up everything as a dummy user within our apps at the rate MACU ID which you generated for us. + +Emily Clifford: 05:06 + Okay. + +Vijay Agarwal: 05:07 + All type of emails for billers, supervisors, doctors will come into that and we will automatically forward it to your personal email IDs. + +Emily Clifford: 05:16 + Okay. + +Vijay Agarwal: 05:17 + You'll have to tell us which person in the team and what role you want us to enable and we will enable that. + +Emily Clifford: 05:23 + Okay, great, that's great. + +Vijay Agarwal: 05:25 + Because mobile app is for doctor by the way. So we don't need billers and supervisors on mobile, they will have direct login. + +Emily Clifford: 05:33 + Right, right. But in order for Brian to use this fully, we would need the biller to download this and use it as well because it's a key player. + +Vijay Agarwal: 05:43 + So Biller will be able to see everything on the dashboard. + +Lince Varghese: 05:47 + So. + +Vijay Agarwal: 05:47 + And for that we don't need much. We will give him his login access. We don't need his Apple id. + +Emily Clifford: 05:53 + Okay, so it's really only mobile, which doesn't really have to be anyone outside of me and Brian. The rest of everyone can be desktop. + +Vijay Agarwal: 06:00 + Okay, Exactly. Yes. + +Emily Clifford: 06:02 + Okay, great. Is there anything we can do. + +Brian McHugh: 06:09 + While. + +Emily Clifford: 06:09 + We wait for him? + +Vijay Agarwal: 06:11 + You can download the app. + +Emily Clifford: 06:14 + Yeah, hold on. So I don't know if you have trouble with this, but I can never remember my Apple id, so this might be harder than it should be. I didn't get the email yet, though. I gave. I gave Pratik my email. Okay, email my personal. Or am I going in the App Store? Like, where do I go? + +Vijay Agarwal: 06:36 + Should receive an email from Test Flight which says you are invited to use Imbelee. + +Emily Clifford: 06:41 + I. I got that, my work email, but I'm waiting for it to my personal email. + +Vijay Agarwal: 06:46 + Right, see, so your personal email. Then he would initiate. Pratik, can you please confirm? Have you initiated that? + +Abhinav Srivastava: 06:54 + Yeah, I just need to add it to the Test Light account. Just give me a second. + +Emily Clifford: 07:08 + Is the person's Apple ID stored somewhere within my mobile device? Like if I can't remember it? + +Vijay Agarwal: 07:16 + Oh, yeah, it is. Yeah. If you go to Settings and at the top you have your profile picture. + +Emily Clifford: 07:24 + Yeah. + +Vijay Agarwal: 07:25 + If you click there, you will see your name and your email id. That's your Apple id. That email is linked to your. + +Emily Clifford: 07:36 + Under personal information. + +Vijay Agarwal: 07:39 + Are you not able to see your picture, your name and then an email ID right below? + +Emily Clifford: 07:43 + I see my picture, I see my name and I see my email address, but I don't see an Apple id. + +Vijay Agarwal: 07:49 + No, that's the Apple id, the email id. + +Brian McHugh: 07:51 + So. + +Vijay Agarwal: 07:51 + Oh, sorry. So when we said Apple id, it means your Apple email id, whatever you're using on your mobile device, it's just. + +Emily Clifford: 07:57 + Your email,. + +Vijay Agarwal: 08:00 + Nothing else? + +Lince Varghese: 08:01 + Yeah. + +Emily Clifford: 08:01 + Oh, great. Okay. Because you know how when you have to like purchase something, you have to like put in an id? That's what I don't ever have. + +Abhinav Srivastava: 08:07 + No, no. + +Vijay Agarwal: 08:08 + So it's just the email ID which is set up on your mobile device. + +Brian McHugh: 08:11 + Got it. Okay. + +Vijay Agarwal: 08:13 + So technically this is the email ID which you would be using on App Store as well, right? + +Emily Clifford: 08:19 + It is, yes. + +Vijay Agarwal: 08:21 + So then that is what you need to share. + +Emily Clifford: 08:23 + Okay, I'll let you know when it downloads. I don't have it yet. + +Abhinav Srivastava: 08:28 + Yeah, we'll just. You'll be receiving that email In a couple of minutes. + +Emily Clifford: 08:31 + Sure. Take your time. If he is not able. If he's still in surgery and in another 10 minutes he's not here. Can you give me some other times? He has a very crowded surgical. + +Lince Varghese: 08:49 + No. + +Vijay Agarwal: 08:49 + What we will do is we will get you to download the app today. + +Emily Clifford: 08:53 + Okay. + +Vijay Agarwal: 08:54 + We will record this call with the whole demonstration and the flow. + +Emily Clifford: 08:58 + Okay? + +Abhinav Srivastava: 08:59 + Okay. + +Vijay Agarwal: 08:59 + Whenever he adds time during the week, please make him look at it. + +Abhinav Srivastava: 09:03 + Okay. + +Vijay Agarwal: 09:04 + And we will set up a call for this Friday as such, because we want to get feedback. + +Emily Clifford: 09:08 + Perfect. + +Vijay Agarwal: 09:09 + In case no one has been able to use. Then we will demonstrate that to him again on Friday. + +Emily Clifford: 09:13 + Okay, great. So I think let's get started. Unless you need me to download this first in order to go through the rest. + +Vijay Agarwal: 09:22 + Oh, no, we can. We can get started. + +Emily Clifford: 09:24 + Okay. Okay. + +Abhinav Srivastava: 09:38 + Okay. So so far we've already. We're already passed through phase one, two and three. So for the last time, when we connected, were at phase three. And some of these, Most of these pointers were work in progress. And as you can see that they are completed now. We have the ICD and CPD codes mapping logic in place, the end to end workflow right from when the patient is added to the dictation happening, the CPT and ICD codes getting mapped and the clean getting generated going to the biller and supervisor. Everything is done. Fine tuning of the AI model, the local hosted AI model that we're using is also done. We have achieved certain accuracy level which we are comfortable with right now to proceed forward. The remaining point being the EPIC and Athena connections. So as we discussed last time as well that we are facing some hurdles with the EPIC marketplace, we've also initiated the process with the EPIC guys and we have submitted a request and we are waiting for response from them. So we had set up a deadline of today. So by today we have not received anything. So tomorrow we'll be contacting their customer support team to see that where our application is currently right now and how it's going then also for Athena. Yeah, so for Athena, as you must be aware, Pratik would have been coordinating with you regarding some password issues that we are facing. So the password issues with the vm, the virtual machine is now sorted. And so, yeah, we'll take probably a couple of more days to get it done where we'll be able to seamlessly integrate with Athena and read all the data from it coming to phase four and five, where we are currently at right now. Yeah. So the functional, the core requirements, the functionalities of the app are done as of now, which we'll be demonstrating to you in a while, but going forward. So right now what we're working on is more towards, you know, making sure that we are compliant with the HIPAA requirements like having an audit trailer and all the compliance logging that is very important. And then also on the mobile app and within the system whenever a claim is generated and submitted, all of these things here, that seamless notifications are generated and delivered to the relevant users. And then yeah, right now we are at this stage where we are about to test all the features end to end. So after this demo we will be walking you through how to download the app in the Test flight and then you can start testing it actually and then these next two points will be forthcoming once we are done with the testing phase. As Vijay mentioned that post this call, from next week onwards we'll have some regular sync ups with you where we'll be going through all the bugs that you come across and we'll be addressing those. So probably, I'm estimating probably three to four weeks timeline there as well where we have all the bugs ready and you are fully sure about the app going to life. And yeah, parallel we'll also be working on creating the user manuals so that you know, any new user to the app knows exactly what features are there and how to start using it and where to find what. So yeah, like I mentioned here, all of these points we've already gone through. So now Linds, you can probably start with the demo, you can start sharing the screen and take us through the full functionalities end to end. And yeah, your email IDs have been added to the Test flight account. So you might have received an invitation email on your personal email IDs which you shared with Pratik. So yeah, I mean first we'll go through the walkthrough and then we'll walk you through how to download and start testing the app. + +Emily Clifford: 14:09 + Great. Hi Brian. + +Brian McHugh: 14:12 + Hi, how are you? + +Emily Clifford: 14:13 + Sorry. That's okay. + +Brian McHugh: 14:16 + Hey guys. All right. How's everybody doing? + +Vijay Agarwal: 14:19 + Good morning. + +Emily Clifford: 14:20 + Vijay, would you mind just going back to the one slide previously so Brian can see what is left? Yeah, yeah, right here. Great. Where, where you guys currently are and what we're working on the next few weeks. + +Abhinav Srivastava: 14:32 + Yeah, so as I mentioned that I mean we are mostly done with the functional requirements, the core functionalities of the app and the whole end to end workflow like right from starting from adding a patient and then you know, the dictation happening. The CPD and ICD Codes getting mapped, that claim get going to the pillar and supervisor for review. And so the whole workflow is done. So core functionalities are done. And now we are focusing more on, you know, working on making the whole infrastructure HIPAA compliant. So we'll need to, you know, implement some compliance logging and audit trails which are required under HIPAA guidelines. We are working on that. And then also, you know, working on integration, integrating a notification system. So. So that whenever any relevant activity happens, a claim is grade generated, a claim is rejected, things like that,. + +Vijay Agarwal: 15:28 + Relevant notifications. + +Abhinav Srivastava: 15:29 + Are generated and delivered across the app and on the desktop app. Also, right now we are at this third point where we are initiating the testing of these features with you guys. After a short demo, we'll be walking you through how to download the app from Test Flight accounts and actually start using the app at your end. And yeah, we also discussed that going forward, every week we'll have regular meeting cadences with Emily and if possible, you also where we just where we discuss all the bugs that you guys find during the testing and we are able to understand them and, you know, address them going forward. So probably next three to four weeks we'll be having those cadences so that by the end of the fourth week, everyone is confident that all the features are built and ready to be moved to the production environment or the live environment. + +Brian McHugh: 16:30 + Cool. + +Emily Clifford: 16:30 + Yeah. + +Vijay Agarwal: 16:31 + Just one more thing to be added, Brian. You gave us feedback to have a different dictation flow for junior doctors who may not be dictating in the way it is supposed to be. So we will be designing User Journey to accommodate those kind of changes. We will share mock ups before we actually implement that. So right now everything in the app is as per the original plan. The new recommendations that you gave, we will plan that in this week, show it to you first. Once you think that is more usable, then we will take it into development of technology. So right now our focus will be the original flow and how you know everything, all the data flows between a doctor, a PUJI supervisor and any back and forth between them. + +Brian McHugh: 17:20 + Okay, cool. And then I got my. I downloaded the app from Test Flight, but it needed the login credentials. I guess you guys will give us those at the end, right? + +Abhinav Srivastava: 17:29 + Yeah, yeah, definitely. We'll walk you through that. + +Vijay Agarwal: 17:32 + You're always one step ahead, Brian. You always get everything. + +Brian McHugh: 17:37 + I wish. + +Vijay Agarwal: 17:40 + Okay, so Lynn, so what are you. If you can go to the demo? + +Lince Varghese: 17:47 + Sure, I'll share my screen. + +Abhinav Srivastava: 17:49 + Yeah,. + +Lince Varghese: 18:12 + I guess you guys can see my screen, right? + +Vijay Agarwal: 18:15 + Yes, we can. + +Lince Varghese: 18:17 + Yeah. So this is what the login page of IAMB looks like on surgeon's end. That is a mobile app that I was not able to show you guys on previous demos because of security. So I take a screenshot, I have used it here so. So now. + +Vijay Agarwal: 18:38 + Let me add there. Brian, actually Google doesn't allow you to share any screen which has sensitive information so were never able to see what the login would look like which you are already seeing now since you have downloaded. But we had to take a screenshot just to make sure that you know what you are going to see inside is the actual screen replica. + +Lince Varghese: 19:06 + Okay, fine. So further this is a Dr. Daniel, already logged in with his credentials is going to do a surgical dictation means. + +Vijay Agarwal: 19:16 + Can you be a little louder? + +Lince Varghese: 19:18 + Yes. So this is Dr. Daniel going to have a surgical dictation. This is what we had was two kind of dictations earlier so we have decided to like reduce it to one as per the flow earlier that we have discussed in the beginning of the app. So now on the screen you can see that the surgeon could enter an MRN which has a required field and is not mandatory that it should be right. But of course if it is right then the patient is automatically get linked to our system which is been already there with certain MRN. So this is the MRN. I am typing here as MRN007 and I'll. I might not know the patient's name yet, but I'm giving it as Smith and the surgery as laminectomy. So this is the reference hospital that has been there and if I need I can have a manual entry too. I'm starting with my dictation. + +Vijay Agarwal: 20:38 + And Brian, only the MRN is mandatory. You don't need to enter anything else to start your dictation. Okay. Yeah. + +Lince Varghese: 20:52 + So starting with the dictation now. + +Emily Clifford: 21:04 + Is a 35 year old male with a long standing history of progressively worsening low back pain, relative lower extremity radiculopathy and severe neurogenic claudication. Refractory to conservative management including physical therapy, activity modification, anti inflammatory medications and epidural steroid injections. MRI demonstrated severe multi level lumbar spinal canal stenosis with significant facet nephropathy, ligamental flavum hypertrophy and neural for anon narrow due to progressive neurological symptoms and failure of non operative treatment, surgical decompression was recommended. Risks, benefits and alternatives were discussed in detail with the patient and informed consent was obtained. After proper identification of the patient in the preoperative folding area, the patient was brought to the operating room and placed under general endotracheal anesthesia without difficulty. Neuromonitoring electrodes were applied and baseline signals were obtained. The patient was carefully positioned prone on a Jackson spinal table with all pressure points adequately tied. The lumbar region was prepped and draped in standard sterile fashion. A surgical prima was performed confirming patient identity, operative site and planned procedure. Sub Procedure 1 Interoperative Localization Using fluoroscopic guidance, the L3 through S1 levels were identified and marked on the skin. Proper localization was confirmed in both intra posterior and lateral projections. Sub Procedure 2 Midline Exposure A midline posterior lumbar incision was made extending from the superior aspect of L3 to the inferior aspect of S1. Dissection was carried through the subcutaneous tissue utilizing electrocautery for hemostasis. The thoracolumbar fascia was incised in the midline and superiosteal dissection was performed bilaterally to expose the spinous processes. Laminate and facet complexes of L3 through S1 self containing retractors were placed to maintain exposure. + +Lince Varghese: 22:57 + So we have done with our dictation, right? Submitting secure dictation. This recording will be safely uploaded to the cloud and be saved. There now comes the association Q link. Since we have the MRN existing in our imv system no matter if Dr. Has sometimes misspelled the spellings of the name or anything else it is automatically matched with the patient named Nadesh Krishnan and the corresponding hospital that was Mercury neurosurgery. And next thing that we have to forward it to is have additional things that are required the claim to be processed on. So I'll click on this button called link Patient now have a manual entry on it. So I have bunch of list of templates that we have here. So the doctor can select any one of the templates that is required appropriately. So the patient has been now linked to our iambali system and now the dictation is being transcribed. + +Vijay Agarwal: 24:32 + And Brian, while this happens right you can still go back this process happens in the back. You don't have to be on the screen. So if you have multiple dictations you can do that in one go as well. + +Lince Varghese: 24:47 + So as you can see that we have our dictation done here. Now the next procedure is of extracting codes that is being done on backend. + +Vijay Agarwal: 25:03 + So this is where you need Internet connectivity to get AI coding. + +Lince Varghese: 25:11 + No, actually sir, it is happening in the backend itself. So even if the. If the network goes off after the submitting of the recording, it might not be affected on the doctor's end. So it has been now AI coded and we can see that like two ICD codes and one MCPD code has been deducted from that. And now it is ready for review from the biller's end. So now biller got this claim from his to his end. Now he can actually get on a review on that thing. + +Vijay Agarwal: 25:50 + So basically it shows on the screen that it is sent to billing and billing is on the web. So they will log into web now? + +Lince Varghese: 25:57 + Yes, so now I'll log in the web. So this is medical Villa and. One second. Yeah, so this is what today, 2 minutes ago we have generated killing for it has been transcribed here. So we can see on the right hand side there is a transcript on the. On. On the middle we have confidence of AI. We can see the pair policies documents that has been mapped here by the AI has selected particular CPTs and ICDs here. So these are the proofs of from the documents that we have that is being reflected upon. So on the next tab we have source audit. So we have one CPT code and two ICD code that has been matched. So the biller first need to confirm on source match. Otherwise he will not be able to submit it to the supervisors. But we'll get back to that. This is a standard like CMS 1500 form on the below side. Only the fields that are required to be seen are here. So in this case, if a biller wants to add a particular diagnosis code, he can. And a service line as two. Like this and he can save the changes. Okay. + +Vijay Agarwal: 28:32 + Yeah, but we assume he would never have to do this and it would all be done by the dictation itself. + +Lince Varghese: 28:40 + On the patient info. We get the patient info, whatever details we have entered from the possibility of creating a patient and uploading the docs. The document section is. Is on this section, I'll show that too. This is clinical metadata that this doctor has been there and operating facility which was there and what kind of particular template was selected. And this is the document section where the biller can upload documents of different types upon which he will be. He or she will be scrutinizing the claim as a whole. So to approve the this claim, first he has to confirm the source matches from the review itself. So once the source match has been confirmed. Once the source match has been confirmed, he can submit it to the supervisor. Now the status has been changed to pending supervisor review. So we can see that reflection on the mobile also that Ready for review has been changed for supervisor review. Now. I'm going to open now the supervisor flow on the review queue. The same process is need to be done from the supervisors and. + +Emily Clifford: 30:44 + Hey Brian, in our case the biller and the billing supervisor are the same person, is that right? Or will Matt have one of his people do it and he is still the supervisor Because I'm wondering if he is doing everything. Do we eliminate the Step 2 review by the supervisor if he's the one doing this initial review or is it his team and then him? + +Brian McHugh: 31:09 + It's usually his team and then him. + +Emily Clifford: 31:11 + Okay, so we keep this up. Okay. + +Brian McHugh: 31:15 + And just to ask while he's working, Vijay, if we, I think we discussed this last time. Let's say we know the patient Smith and we just did a laminectomy and we don't want to dictate the note. There's an option to just select standard laminectomy and we can addend, you know, paragraph of patient specific history and the same process will take out take place. And then I think he did mention this, but I just want to Double check the ICD10 codes and the CPT codes are extracted specifically based on the title of the procedure, the dictation body itself and then the payer specific rules, correct? + +Vijay Agarwal: 32:07 + That's correct. + +Brian McHugh: 32:08 + And then is there an additional function where you know, let's say to get CPT code X reimbursed appropriately for payer. Yes, that payer has a rule where you know, three sentences of specific language needs to be included. Is the report kind of quality assessed for the presence of that language? + +Vijay Agarwal: 32:36 + Yes. So that is where we see what is the rejection percentage from AI and we take these snippets out of what is the issue looking like? So if you see the scrub violations, right? These are some of the scrub violations that we are highlighting here for that pair. Now what we are going to work on is the new user flow that you mentioned to us where you can just select and the dictation is recommended and you don't even have to dictate that part. We are going to work on as experience and see how we can make that happen seamlessly. While right now whatever you mentioned from the dictation we derive everything and we try to determine if there is a high probability of success at the payer end. + +Brian McHugh: 33:27 + Yeah, yeah. + +Emily Clifford: 33:28 + Vijay, if Brian uses one of these templates, where does he go to edit? Is it in that same. Right here in that box he would. + +Vijay Agarwal: 33:35 + Just type over so he wouldn't have to edit anything. Right now on the mobile, he would just dictate and then select a template if he wants to. Okay, so that is it. And then Brian is done with the whole flow. The Biller sees what template Brian selected, what has he dictated and what ICD CPD codes we found out of the dictation. And then it creates the claim form. And if Biller finds anything is incorrect, he can add those ICD CPD codes. Okay. Based on the recommendations. Or he can send it back to Brian. And Brian would have to redictate another version. Okay, scroll down. So this is the supervisor form again. He sees everything the same way that the builder would have seen. + +Lince Varghese: 34:28 + So for the final approvals,. + +Brian McHugh: 34:32 + So he. + +Lince Varghese: 34:33 + Can expose the actually the content of the form itself with the demographics and the CPT codes that has been there and the ICD codes so that it can be later on put it to the Athena itself. + +Brian McHugh: 35:00 + And is there a way to automate that? Do we ever figure that out? Emily or Vijay? + +Vijay Agarwal: 35:05 + We are trying to figure that out. I think there is a connection breakage that were currently facing. So there is no direct way, by the way, Brian, there is no official prescribed way from Athena on the version that we have. Okay, so there is a different way in terms of automating user action and mouse and keyboard on the screen, which is called robotic automation. So we'll have to build a robotic automator to replicate everything that a human does. And for that we are going to experiment. But in the meantime, we have the CMS 1500 form which is ready to go. + +Brian McHugh: 35:44 + And that's just so I'm clear on the nomenclature, Vijay, that's that would be an agentic model that would actually kind of go through the robotic motions of entering it manually, but it's no longer a human doing it. + +Vijay Agarwal: 36:00 + Yeah, yeah. So because we don't have the API access or any other way to do it, and nor does our current Athena, you know, give us a way to enter something back. It only gives us a way to fetch patient records. + +Brian McHugh: 36:18 + So. + +Vijay Agarwal: 36:20 + So basically, since they don't have a way, then we will build this override like we built the override for the shared drive last time when we figured out that EPIC was not. Our hospitals were not, you know, comfortable to give us access to their environment. + +Abhinav Srivastava: 36:36 + So. + +Vijay Agarwal: 36:40 + Okay, so Lynn's basically now here. Once we have created, completed the claim. This is where you download the CMS. + +Lince Varghese: 36:52 + Yes, yes. There is another version of CMS 1500 that enables us to see entire form itself that belongs to practice admin. Okay. If I May show you. Just a second. + +Vijay Agarwal: 37:11 + You are like the practice admin for us about the supervisor who controls. + +Emily Clifford: 37:20 + Sorry, I can't hear. + +Vijay Agarwal: 37:20 + That's what we are trying to show now. By the way, Emily, what you see on the screen, that's a unique way of how you can run multiple aliases on the same email id. + +Brian McHugh: 37:56 + So. + +Lince Varghese: 38:04 + Under claim management,. + +Vijay Agarwal: 38:16 + We have the top one. Lindsay, we have it on the top already. It's all filtered by newest first. The first one is Natesh in the list? + +Lince Varghese: 38:25 + Yes. So when I click on Nadesh. So I have this entire CMS 1500 form here, but the details only with what we have figured it out and using AI that has been already filled, but many of the fields will not be able to fill because of this HIPAA compliance. So that is where this particular form is reflected as an entire form group practice admin. + +Vijay Agarwal: 38:57 + So whatever patient data we could fetch. Emily, those patient data we would fill. The surgical records we would fill. Okay. That we are getting the dictation, CPT codes, ICD codes we will fill. + +Emily Clifford: 39:11 + Okay. + +Vijay Agarwal: 39:12 + But we can't fill other data that comes in the PII for a patient. Okay. We don't have access to those. + +Brian McHugh: 39:23 + Vijay, say that again. Maybe I don't. Maybe I don't fully understand that. + +Vijay Agarwal: 39:27 + Yeah. So in the CMS form we are able to fill all the ICD and CPD codes. We are able to fill the patient's basic data that we collect. Right. Now, what we are not able to fill are the PII data of the patient, which we are not getting from EPIC yet automatically. Right. So we are not able to fill those parts of the data. So this form primarily contains everything around the codes on the service lines that are required in the claim. But the biller, when they are submitting it to the actual payer, they would have to fill the patient data from their surgical notes or records that they have. If we. If we are not able to bring all the data automatically into IMB. + +Brian McHugh: 40:19 + And we're not able to do that, why aren't we able to do that? Like we should be able to extract that from the notes and data we're getting from epic. Am I correct on that? + +Vijay Agarwal: 40:32 + So EPIC is not yet integrated directly with our system. Right. The way we are doing that is the pillar has to upload clinical notes and surgical notes in the shared drive within imbd. So if they upload it, then we will be able to get all the patient data that we could capture. Otherwise they have to enter that manually. + +Brian McHugh: 40:58 + And if they upload that into IAMBILLY those are documents I am. Billy would be able to extract the necessary data and fill it into the form. Correct. + +Vijay Agarwal: 41:09 + So we are focusing mainly on the claim section of the data extraction. We have not focused on what other data that the builders would need. We can figure that out once we see a few sample surgical documents that they are giving. And then I can determine what. What is the differential between what we are getting and what we are supposed to fill in the CMS form but we should be able to extract. That shouldn't be a challenge. Okay. So yeah, I mean this is where it ends in the flow where the final codes are available to everyone in the hierarchy right up to the practice admin. And once that has been processed, the same reflection also appears on the mobile for doctor. + +Brian McHugh: 42:00 + Okay, well, and Vijay, we can start playing around with this at this point and see how it goes for a couple cases and then bring questions back to you. Is that correct? + +Vijay Agarwal: 42:11 + I think right now what we are expecting you to do is play with the dictation on mobile and see the quality of transcription and the association with ICD CPD codes for a few cases and let us know if the transcription and the ICD CPD codes are well. From there we would move on. Next week we should test on the flow between Biller supervisor and the doctor that you should test. So we will be giving you a series of test cases that you should execute and you can tell us if you want to add more. + +Brian McHugh: 42:46 + Okay, sounds good. + +Emily Clifford: 42:47 + Great. + +Vijay Agarwal: 42:50 + So Lynce, are we able to share the login IDs for Brian and Emily on their mobile apps or should we do that offline? Brian has already downloaded, so he just needs to. + +Emily Clifford: 43:00 + I also downloaded it. + +Brian McHugh: 43:02 + Great. + +Vijay Agarwal: 43:03 + So why don't we try that login right now for Brian? + +Lince Varghese: 43:08 + Actually, sir, we would require some time. + +Vijay Agarwal: 43:11 + On that to create a login ID for Brian. + +Lince Varghese: 43:14 + Yes, yes. For that purpose. + +Vijay Agarwal: 43:18 + Yeah. So let's email Brian and Emily separate. At least they are able to download. So we know now they have the app. We just have to share the user ID and password with them. + +Lince Varghese: 43:27 + Yes, I'll do that. + +Vijay Agarwal: 43:28 + I'll do that. + +Abhinav Srivastava: 43:29 + Great. + +Emily Clifford: 43:29 + Lynn, Synth. One thing I noticed when I go into the login, I'm under the surgeon login page. Should I be under a practice admin login or is it. + +Vijay Agarwal: 43:38 + Oh, mobile is only for surgeon. Okay. You will also have the URL which you can see on the screen now. I am Billy McHugh, neurosurgery. + +Emily Clifford: 43:47 + Okay. + +Vijay Agarwal: 43:47 + So you will get this as well, Emily, and you will actually have multiple logins. Right. From biller supervisor to the practice admin for yourself. + +Emily Clifford: 43:56 + But for myself, I can still log in under the surgeon login with my own credentials, but I'm under the surgeon dashboard. Like I'm acting as a surgeon, but I can view with Brian's viewing. Great. + +Vijay Agarwal: 44:05 + So we will give you a separate ID as a surgeon and we'll give Brian a separate ID as a surgeon. + +Emily Clifford: 44:11 + Okay. + +Vijay Agarwal: 44:12 + And we'll give you multiple IDs for Biller supervisor and practice admin. + +Emily Clifford: 44:16 + Okay, great. + +Vijay Agarwal: 44:21 + Yeah. This week the focus is to get dictation, icd, cpd all sorted with a few dictations at your end and to understand if you are missing anything from a user experience from a final surgeon usage perspective. + +Abhinav Srivastava: 44:34 + Abhinav yeah, so I was just mentioning that shortly we'll be also sharing a Google sheet with you where you can log in all the bugs that you find during the testing. And the next week, whatever weekday we finalize on, whenever we have that call, we can go over all of those issues. So you might see a lot of fields, but don't worry about the formatting, just write whatever bugs you see there and how you feel them to write it and then we can format it later. So yeah, we share that sheet with you. And also since now we're giving this to you for testing, we also have started, you know, separating the live environment with the development environment. So for the development which we'll use internally, we have a separate URL and for that we need some additional settings in your DNS provider. So for that we will be sharing you the details and to what exactly needs to be done. So yeah, we need that support from you. + +Emily Clifford: 45:36 + Okay, just let me know. + +Vijay Agarwal: 45:38 + And Emily, just for your knowledge, this month, next month onwards, we may start seeing a jump in our Google cloud bills bit because now we have two separate environments. Right. + +Emily Clifford: 45:49 + What does that look like? So I'm aware. + +Vijay Agarwal: 45:52 + So right now were getting about 500amonth, we should see another 200 or so. But it will also depend on the AI consumption that now we are going to do. + +Emily Clifford: 46:03 + Right. + +Abhinav Srivastava: 46:04 + So. + +Vijay Agarwal: 46:05 + So I'm expecting between 500 and 800 for July and then in August, once we are go live in production, will take down the development environment completely. Okay, that should help us with more AI consumption in production in real. + +Emily Clifford: 46:21 + Okay, great. Very exciting. Thank you guys. Yeah, sounds great. + +Vijay Agarwal: 46:27 + Thanks Brian. Have a good day. Thanks Emily. + +Brian McHugh: 46:30 + Bye. + +Emily Clifford: 46:30 + Thank you. + +Vijay Agarwal: 46:31 + Bye bye bye. +