CDI for ARIA

Author(s): Ashish Sharma

Problem statement:

The meticulous review of patient records has become paramount to ensuring high-quality care and
optimized patient outcomes. Chart review, involves the systematic examination of patient
documentation to extract relevant clinical data, understand historical medical events, and inform
current and future medical decisions. Such reviews are integral to serving as a foundational pillar for
evidence-based practice.

Clinical Documentation Improvement (CDI) stands out as vital for enhancing the accuracy and clarity of
patient records. Integral to chart review—a systematic analysis of patient documentation—CDI ensures
reliable data extraction, directly impacting patient care quality and healthcare efficiency.

A typical radiation oncologist spends between 30 – 60 mins for new consult chart review and between
15 – 30 mins for a follow-up chart review, depending on the complexity of the case. In many practices,
dedicated staff help with these activities.

Opportunity:

There are approximately 6000 practicing radiation oncologists in the US1 and 600 practicing radiation
oncologists in Canada2. There was an average of 204 new consults and 954 follow-up consults in the US 3
in 2019 and this is expected to grow at 5% every year till 2030.

Low-end estimate for time spent on documentation activities in 2019

Activity n (incidence) Hours spent

US New consult 1,224,000 612,000
US Follow-up consult 7,724,000 1,431,000

For U.S, Canada, and Australia, we estimate that approximately 2,300,000 hours are spent on
documentation activities annually. Assuming, Varian has 60% market share in these geos, we estimate
that 1,400,000 hours would be spent in ARIA if ARIAOIS/RO was used for these documentation activities.

With use of novel med-focused large language models and development of features like “Summarize
patient4” and “Chat with patient documents4” we propose that we will save 20% time spent on
documentation activities. This will save up to 280,000 hours annually in the above geos. If the average
billing rate/ opportunity cost for 1 clinical documentation improvement personnel is USD 100/hour on
average, this will lead to a potential savings of USD 28,000,000 annually.

1
Geographic Distribution of Radiation Oncologists in the United States
2
Supply and Demand for Radiation Oncologists in Canada: Workforce Planning Projections from 2020 to 2040
3
Results From the ASCO 2019 Survey of Oncology Practice Operations
4
Appendix A
An average new consult typically contains the following 5

Type of document Average number of

words
Referral letter 500
Medical history and physical examination 2000
report
Pathology report(s) 1000
Imaging reports 2000
Lab reports 2000
Previous treatment records/ discharge 2000
summary
Consent forms 1000
Total 10,500 words

A state-of-the-art med focused LLM like GPT4, Med PALM2 typically costs USD 0.1/1000 words. These
costs are expected to decrease over time. For example, the usage costs of GPT-3.5 have reduced by a
factor of 30 over the past 2 years (from USD 0.06/1000 in 2020 tokens to 0.002/1000 tokens in 2023).

We estimate that a new consult will use up to USD 2 in summarization and up to USD 2 in conversations
and reasoning. For follow-up consults, these costs will be similar. A new consult and follow-up will
consume up to USD 4 in LLM compute as of 2023. We expect this cost to decrease to USD 1 by 2024.

We propose pricing each consult using CDI for ARIA at USD 5. Given that there close to 8 million new and
follow up consults in the above geos annually, this presents an annual opportunity of USD 40 million as
of 2023, growing at least 5% annually. At Varian’s present market share of up to 60%, this opportunity is
approximately USD 24 million as of 2023.

5
https://www.acr.org/-/media/ACR/Files/Practice-Parameters/Communication-RO.pdf
Appendix A
Summarize Patient
Summarize Patient creates a table of contents (TOC) view for a patient’s medical record, which consists
of the patient’s demographics in ARIA, patient documents, lab results, Chief Complaint, HPI,
Impression/Plan, etc.

The TOC presents all data available for the patient in ARIA as navigable content. Each item in the TOC
expands to a summary which cites the source of the summary. It also contains sections of the
document/note used to arrive at the presented summary and allows navigation to the linked content in
a single click.

Clinicians can copy the summary, or linked content directly to create encounter items. They can also
copy these to a scratchpad and manually edit them to create encounter items.

Chat with patient documents

Chat with patient documents provides a chatbot experience over documents and other unstructured
data in the patient record. It allows clinicians to ask questions on a set of patient documents or a single
patient document. The response from chat with patient documents provides a link to the sections of the
documents used to provide the response.