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AI in Physiotherapy: unlocking its potential in your clinical practice with Darren Ross

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In this episode, Darren helps us with understanding how Artificial Intelligence can be utilised in our very own clinical practice. We discuss “Patient notes” which is a new AI software which can assist with clinician’s patient notes and Dr’s letters and how this works for clinicians. Darren also discusses the shortfall of AI and how it cannot replace Physiotherapists.

Darren Ross is a Musculoskeletal Physiotherapist and Director of Physica clinics in Melbourne, with over 27 years of clinical experience. Having chaired the APA Musculoskeletal Physiotherapy Victorian Chapter, Darren's expertise is further showcased through guest lectures at APA and LaTrobe University, notably focusing on spinal courses and now in "AI in Healthcare".

To find more information on the AI patient notes: www.patientnotes.app.

If you like the podcast, it would mean the world if you're happy to leave us a rating or a review. It really helps!

Our host is @sarah.yule from Physio Network

SPEAKER_00:

Haitian Notes uses generative AI in a secure platform to basically listen to the consultation that you're using and then by doing that it formulates and puts together all of the aspects of your discussion with your patient including your other things such as objective findings that you might've mentioned and bundles it into notes using what are called prompts. Prompts are the 2023, 2024 new language. So prompt engineering then means that everything in that content, that consult will then be put into the exact format, style and populated how you would like.

SPEAKER_02:

Today, we explore the world of AI, how it intersects with the physiotherapy and the healthcare world, and what the future may look like. Darren Ross is a man of many talents. He is a musculoskeletal physiotherapist and one of the directors at Physica Clinics in Melbourne. He's an entrepreneurial leader driven to deliver great healthcare experiences, which has seen him building other businesses like ClinicArmor, and now working in the field of AI with Patient Notes app, which aims to reduce the admin load for healthcare professionals. I think you're going to love today's episode. I'm Sarah Yule, your co-host, and this is Physio Explained. Well, Darren, welcome to the Physio Explained podcast.

SPEAKER_00:

Thanks for having me, Sarah. Really looking forward to chatting.

SPEAKER_02:

Now, I'm going to start the podcast today with a thank you, because I've had the pleasure of working alongside you for many years and your leadership and your entrepreneurial mindset and vision is incredibly inspiring and has certainly influenced my journey and mindset. So, I'm very excited for you to have a platform to share all your wisdom with more people.

SPEAKER_00:

Super kind of you to say that, Sarah. Wisdom is probably a word used maybe out of context, a bit of a crazy brain. And if you Somebody listening out there has a similar brain to mine and gets something out of this and learns and takes it forward. That's amazing. And I have the same appreciation for everything with you. And I'm excited at the next few minutes.

SPEAKER_02:

Fabulous. Well. Let's launch into it and talk about AI. Now, the world has seen the dawning of a new era with AI, and it's here whether we like it or not. Now, I'm curious, what was your first encounter with AI technology in reducing administrative loads?

SPEAKER_00:

Yeah, I was really, really fortunate. I mean, AI is new. It's a platform that we're hearing about in the last sort of 15, 18 months with ChatGPT, but The reality is that large language models have been around for 10 to 15 years. Our CEO at Patient Notes has been working with large language models for pretty much all that time at his role at Zendesk. But we heard about ChatGPT and we sort of started to explore what can that do. I was approached last June, so June 2023, with a beta version of Patient Notes and it was created by Jason Smale to solve his wife, who is a Musk physio's Burden with Clinical Admin. He came into our lunchroom at Physica where you and I had many, many chats. And he put up his laptop and just showed me. And it wasn't perfect. It wasn't what it was like now. And I've just looked at it and I've said, this solves so much of our admin burden with clinical notes and just letter writing that we all don't love doing. And I saw it. And it was one of those things that I'm always fascinated by technology. And at that exact moment, moment was just a, this will change the scope of healthcare moving forward. So that was really my first aspect. And then I put it out to test and I started to realize that, hey, I could do better clinical notes than I could do beforehand. I could write my new patient letters. I could write my letters to doctors and save me a good few minutes every consult. And yeah, again, I just wanted to help take that out to more physios and more healthcare professionals.

SPEAKER_02:

It's pretty incredible software. I've certainly used it for all of my patients as well. For someone listening that hasn't used the software, can you just give a brief run through of what it actually looks like?

SPEAKER_00:

So, Haitian Notes uses generative AI in a secure platform to basically listen to the consultation that you're using. And then by doing that, it formulates and puts together all of the aspects of your discussion with your patient, including your other things such as objective findings that you might have mentioned, and bundles it into notes using what are called prompts. Prompts are the 2023-2024 new language. So prompt engineering then means that everything in that consult will then be put into the exact format, style, and populated how you would like. And from there, you have the ability to edit your draft, create small little changes, put those back into your practice management system. The generative work takes about 30 seconds to bundle all of your audio of your notes. And then you can populate letters, either an action plan that takes about another 10 to 15 seconds or medical letters. All the different letters will use your language and style. It can even use the templates that you've got in your existing practice management system. So an example is my consulting room is probably about seven or eight meters away from the front desk. And by the time my patients actually left the room, I've got my clinical notes done. I've got an action plan done and I've got a referral or a thank you letter or an update to my surgeon all done. So no longer would I have to sort of add it to my to do lists and then get to it at lunchtime or whenever I could do. So that's where the real admin load is saved. The other real great thing is that it populates it in compliant format. So for your medico-legal, whether it be your professional body or APRA or whatever it may well be, so that you don't have spelling mistakes, grammar, things that aren't asked. So again, that reduces your liability as a practitioner and also as a practice owner.

SPEAKER_02:

Pretty phenomenal. And as they say, I think the power of AI lies not in its intelligence, but in its ability to unlock ours. And I think this is certainly the case here. And as you said, it's capturing all of the things we're already doing. It's not thinking up a diagnosis for us and those sorts of things. So we are still able to be strong in our diagnosis and our assessment and treatment. It's just helping with the administrative component.

SPEAKER_00:

Yeah, correct. A good medical specific AI software like patient notes will have a clean, secure platform every single consult. So it doesn't do what we talk about this AI hallucination. When I talk with a lot of practitioners and they sort of say, well, can we use chat GPT? If you start putting in a lumbar spine patient and an example into one that learns, see, wow, the first couple of consults, it's doing a really, really good job. And then it'll start to create this Hang on, it's picked something up from previous consults or a previous lumbar spine. And you can't afford to have that when we're in a really critical note environment. So every consult needs to be, what is being said? What is being done? And I again say, it's great at doing the admin load. It doesn't have the clinical reasoning or the emotional intelligence that a practitioner will build in. So it will never replace physios, doctors, vets, because we have those things that AI does not have at this stage. And probably the way that as soon as you look at the back end of AI, it's a numbers, it's a formula. It won't have that level that we can bring to us. So it's really important that you work your prompts and you'll understand what prompt engineering is in this era so that you can then get the best out of it.

SPEAKER_02:

What you put in, you get out.

SPEAKER_00:

Exactly. Yep.

SPEAKER_01:

This podcast is sponsored by Cliniko.

SPEAKER_02:

Fantastic. And how much have you seen change over the last six months in this world?

SPEAKER_00:

The technology is literally changing every week to two weeks. We're bringing out new features and functionality into patient notes every week at this stage, but also the backend in terms of the accuracy of the audio transcription and the detail that we can build into clinical notes and reports is changing drastically. To give you an idea, we're now able to create clinical notes and create in the style that you would like. And it's great for your in-rooms consults. We're working on features that will then build long-form reports, such as NDIS reports or medico-legal reports that might be 20, 30 pages. And that technology to have that report building that would normally take a practitioner four hours to build, we'll be able to do that in probably less than a minute. that is going to be on the horizon in the next couple of months to release to people. So thinking that you can build something that is admin heavy and in that time format because of the way it's moving. But it's really important to know, again, that's how you prompt engineer. It's not just a plug and play and assume that all these things will happen within 20 seconds of setting your system up.

SPEAKER_02:

And that will hopefully have quite a significant impact potentially on the burnout rates that we see in our professions and across healthcare professions. We know that burnout is also linked to the accumulation of all of those smaller tasks that can sometimes take away from the RAM power that we have for the bigger, more cerebral tasks like diagnosis.

SPEAKER_00:

Absolutely. I'm on the Australian Physio Business Group for Victoria and And we've got a student representative. And at our previous meeting, the student representative said, our upcoming graduates are worried about burnout in physio before they even graduate. And I was really sad to hear that. And thinking in a really good clinical environment, a supportive mentoring environment, and hopefully with these tools that can help, we can really reduce that. But the fear of coming out already preconditioned to that was actually a sad reflection of the message that's going through, I felt. And if you think that AI is going to replace your admin team or your receptionists, again, I'm not advocating that. I think reallocating admin people to their purpose and tapping into their skill set, rather than just didactically repeating what a therapist might have dictated, is actually best practice within an organization as well.

SPEAKER_02:

Absolutely. And as with many things, I think this idea of having a more abundant mindset means that we can actually take on board these new inventions and work them in and create the newest version of best practice.

SPEAKER_00:

Yeah. And one of my really exciting things I've done over the last sort of six to nine months is met with the different professional bodies, met with the bodies that oversee all of the allied health, both in Australia and also some internationally. And at the moment, our gold standard is soap notes. That's what's put up there. Now, you and I, having gone through masters, we know that there's so much deeper you can go with your clinical note taking. But I think the thing that AI opens up is the ability to go to a super sort of next gold standard. And I think that in the next six to 12 months, The acronym SOAP is going to be replaced with an AI equivalent that then says, this is what the AI can do in terms of building your subjective and your education and all of that aspect. But let's use a combination of a hybrid model of what we can do as practitioners to elevate that gold standard across society. all industries. And that's what really excites me. And working with some of those associations already to move that bar is sort of, I guess, a real sort of added benefit of the wider picture of where this can take us.

SPEAKER_02:

Absolutely. It's sounding like in terms of speculating sort of the future of AI and physiotherapy, hopefully we're going to be adopting this more and more.

SPEAKER_00:

Yeah, I think so. Definitely. I mean, you know, you already see practices using things like ChatGPT and Canva and all of these AI tools to help with the administration, the marketing, the SEO, website creation. So that's fantastic for the content side of things. For the clinical side of things, yeah, patient notes and other systems will be out there to help with that. And I think there's definitely an AI bubble at the moment that everyone's talking about AI. Golf clubs have got AI now written on them, however. But AI is not new, but the reliability and the validity of the AI I think is going to keep getting better. What's on the horizon? Again, we can only speculate, but I think what you mentioned early on is you can't have your head in the sand with it and sort of say, oh yeah, it's not around and I'm not going to use it or it's not secure or it's not possible to use in a healthcare environment. It's been used in chest x-rays and the reliability and validity of picking up pathology on scans is the accuracy is amazing. So if it's going to that stage and now we're looking at AI in robotic surgery, then as clinicians adopting it in a way as a tool set. And I often say, if you're a builder, will you go back to an old handsaw or would you teach your apprentice to sort of go the old school way? Whereas you might do work on a safer, more effective, more efficient tools, but you still need to have the skills to operate those.

SPEAKER_02:

Absolutely. And it seems like there's just a massive potential for enhancing the quality of care patients receive in the way of follow-up documentation and those sorts of things. Our human interaction hopefully remains as wonderful and as good as it is and can be in our profession as well.

SPEAKER_00:

The one thing I've really enjoyed is getting away from sitting over the keyboard or sitting over a clipboard and just talking to my patients. And just letting the consultation, letting things flow. And I could give you lots of stories where in the last sort of six to 12 months where I've had those sessions where I go, I probably wouldn't have got as deep or I wouldn't have got the outcomes I would have if I had been over my PC and my typing's not 150 word per minute typist. And so getting back and engaging in that. And after 26 years of being clinical, just going back to that has been worth it on its own. Now, it's not to say that AI is perfect. You know, you've still got to read your notes. You've still got to read the letters and the communication that goes out, even though it's tailored to your style, because you're responsible for what's medico-legally being done. And AI is an algorithm-based sort of large language model. And it's really important you don't get complacent or lazy rather than use it as a tool for efficiency and effectiveness and all of these other aspects.

SPEAKER_02:

Exactly right. Certainly when I use it, I often say to patients, I'll be using it for the administrative component, but I'll still do all the thinking and the human work. And people are usually pretty happy with that.

SPEAKER_00:

Yeah, exactly.

SPEAKER_02:

Now, I'm going to take a little shift. I think you're obviously an incredibly entrepreneurial individual and entrepreneurial leader. Can you share a bit of a defining moment that led you to embrace this entrepreneurial leadership within the physiotherapy space and within that, what that sort of leadership actually looks like?

SPEAKER_00:

One of the things that physios have is an amazing clinical reasoning brain. And I always say to people, the best thing I ever did was my master's program that trained and sort of made me almost like a Jedi clinical reasoner. And What that does, I think the carry over to general life and problem solving has been invaluable. So I do have a little bit of a crazy brain. I hate, again, that entrepreneurial leadership. It sits a bit weird, but I think I'd love to almost have a physio clinical reasoning leadership in the sense of fostering what your brain is solving. And if you see a problem coming up with solution, whether that be for your patient, whether it be for the clinic or whether it be for other aspects, it's just a matter of Not turning off that little crazy monkey in the brain sometimes, but just letting it ponder and letting it come to the head at the right time. An example of that is, I guess, even during sort of COVID, you know, we're all shut down and working out what to do and what we're going to do with hygiene and linen. And I've been sitting on this idea of washed down into cleaning covers. And very quickly, we had to all change our behaviors overnight. So out of that sort of came the clinic armor range, which was the wipe down bed covers. And that was really only to keep our clinic open and then other clinics open. And now that's sort of being sold all around the world. And I've had a few of these other ideas and inventions that have been commercialized and are still commercialized. And I think it's okay as a physio to have these other concepts. And if you see a problem, solving those. And this is where the patient note side of thing is also coming in is going, It's made for the right reasons. It was made by an amazing software engineer to solve the admin burden of his wife, who's a physio. And having that purpose really then sort of is something that sits really well with my values. And I've just got, I've got to get this out there. I've got to share

SPEAKER_02:

it. Fabulous. Well, that is excellent wisdom as suitably predicted, Darren. So, thank you so much for your time today. You tackle many, many things and somehow still have time for a surf. So very much. Thank you.

SPEAKER_00:

Thank you, Sarah. And anyone that wants to look at patient notes, patientnotes.app. If AI is not yet for you, do yourself a little bit of favor, look into some of the amazing AI prompt engineering or courses that are on some of the platforms. Just explore what's possible because it might just help you out in a facet of life and make things just a little bit easier.

SPEAKER_02:

Excellent advice. Thanks so much again Darren.

SPEAKER_00:

Thanks again Sarah for having me. I really appreciate everything you do.

SPEAKER_02:

Thank you.