Copilot, Not Autopilot: Steno Health's Dr. Alex Milani on Curate: Scribe

About This Episode

Steno Health co-founder and CEO Alex Milani, a physician with an MBA, breaks down how Curate Scribe (powered by Steno) works inside a home health visit, the time it saves, and why it's a copilot, not autopilot.

Transcript

Tom: All right, we're back live at the Last Visit First podcast. My next guest is Alex. He's the CEO of Steno Health, building the AI tools inside of Homecare Homebase. Really excited to have you here.

Alex: Yeah, thrilled to be here. First off, thanks to Homecare Homebase for having us, and not only embedding us in their EHR but embedding us in their booth. So really excited to be here and show the product.

Tom: Wait, so if I'm a user and I want to see it, you actually go to the Homecare Homebase booth?

Alex: Yeah, so we are in the booth.

Tom: They're calling the product Curate.

Alex: Yes. Which is powered by Steno.

Tom: That's awesome. Okay, tell us more. How's it going? Where are you at? What's going on?

Alex: So we're officially live, which we're thrilled about. I would say the go-to-market's been nothing but excellent. Right now there's a waiting list of about eighteen... About eighteen agencies that are on track to be onboarded over the course of this next month. And then after that, it's just keep going from there.

Tom: Wow, that's awesome. So waiting lists, which means people like it a ton. You've been out doing nursing visits, teaching nurses how to use Curate: Scribe inside of a home health visit. How's that going? Tell me about it.

Alex: It's great. It's definitely a learning curve. It's definitely a change in the way you document, the way you interact with patients. But after a week or so of onboarding, it's transformative, specifically for the start of care. But you definitely get a lot of time savings and a lot more quality in your documentation on all visit types, I would say.

Tom: How's it work? So I'm a nurse, I'm going into the home, I knock on the door, start my point of care tablet. How?

Alex: Yeah, so it actually starts before you go to the home. We summarize all the documentation, the referral documents, before the visit, so you get up-to-date information as you're walking in. Once you enter the home, you consent and record the interaction. Feel free to answer questions throughout, or just use the tablet as a guide. Then when you're done, get back in the car, hit submit, and the whole thing's pretty much filled in. There's this unique debrief process that happens after that, but that's the thousand-foot view.

Tom: So it's really human in the loop though, right? It listens to the visit, it tries to predict what the answer should be, it creates those answers, and then it gives the nurse the opportunity to say, this was right, this was wrong.

Alex: Exactly. You're definitely not on autopilot. It's a copilot tool. What I mean by that is, when I say there's an onboarding period, you have to learn how to interact with your patients and speak certain things out, because the AI can't know the patient's blood pressure is 120 over 80 unless they say that. So there's this interesting phenomenon that happens during the first four-ish weeks of using the tool, where most of the interaction that is filled in happens in the debrief, when they're recording with the AI outside the patient's home. But after around four weeks or so, around seventy percent is filled in from that encounter inside the home. They learn how to speak more, it's more organic, and then that 30% happens in the debrief. But you're completely on copilot, not autopilot.

Tom: That's awesome. I know from all the other AI stuff that I've built and talked to, you can speak to AI about forty times faster than you can type it. So as long as the nurse is having a conversation with the patient and talking through the whole time, what your blood pressure is, your temperature, your pulse ox,

Alex: Your meds.

Tom: your medications, your physical assessment, your lung sounds are clear and bilateral, no gurgling, then the AI is gonna know that as it does your physical assessment documentation.

Alex: Exactly.

Tom: It picks that up. So you're really talking through the visit. Give me some estimates of time savings that you're seeing.

Alex: Yeah, so this is part of the beauty about it being embedded in HCHB. It's not this hacky RPA way in. So there's also some time savings with that, but just from the documentation alone, with the start of care we see usually around thirty to forty minutes, I would say. With subsequent visits there's less to fill in, but you still get five to fifteen, twenty minutes.

Tom: So if I have to enter the medications and type them in in Homecare Homebase, look up all that, it's two minutes of medication, you're saving me twenty, thirty minutes there. The clinical documentation's gotta be a lot faster. Allergies are faster.

Alex: 'Cause it knows all that, and by the way it's great at spelling, it's great at doing those kind of things as well. Yeah, of all the things that we do, meds is number one, just because you can line up seven pill bottles and take a picture, you can take a picture of the discharge summary at the patient's home, you can dictate it directly. And as you know, entering meds is very cumbersome.

Tom: That's awesome. That's really cool. How are you pricing it? Or is Homecare Homebase selling it?

Alex: Homecare Homebase is selling it. So no prices, but it's being sold on a per patient per month basis. We're the technology, I guess. We're not the business side. Just the integration, and then the AI behind the scenes.

Tom: Tell us a little bit about you.

Alex: Yeah, so I'm co-founder and CEO of Steno, physician by training. I went to medical school at Emory, also did an MBA there, which got me into the business side of healthcare. I worked at a few different startups, and then started this a few years ago to bring innovation to the post-acute side of healthcare.

Tom: This guy's a freaking unicorn, you guys. There's not many doctors that have an MBA as well and want to get into the business side, so that's good. It's really cool. I'm super excited about what you guys are doing. The whole industry's talking about it, and one of the things I get asked a lot as we travel around the country talking to people is, at some point if you don't have some kind of a Curate: Scribe product in your application, how are you gonna be able to recruit and retain nurses? If the guy down the street doesn't have it and you have it, you should be able to recruit and retain more nurses than the guy down the street.

Alex: Yeah, a hundred percent. There's a lot of reasons why folks want this, but that's definitely one of them: the quality of life of their clinicians. There's no one in the healthcare space that probably documents more than a home health clinician. And if we can allow them to cook dinner for their kids or something, I think that's just a win in itself.

Tom: And you guys work in hospice too?

Alex: Yeah, hospice as well.

Tom: You have some other products as well that you guys are working on? What's coming in the future?

Alex: Yeah, so we have some ICD-10 coding. Everything's copilot, I just always want to preface that. OASIS QA review, and then we're also getting into how we can get more insights to the agency about their patients: who to see, how to see them, when to see them. So we're touching a little bit there as well.

Tom: That's awesome. How fast are you guys developing now? Elliott Wood and I were talking earlier that the speed of development is so much faster now with all the AI tools that are available.

Alex: Yeah, so on the engineering side, agentic coding is definitely 10x-ing engineers. But I'd say a big thing we're also seeing is on the product side, where our PMs can actually build an MVP-style tool very fast, without taking so much engineering resources, and then deploy it to the engineers and they make it scalable. So it's pretty interesting.

Tom: That's awesome. Well, I'm glad you're here. So you're here meeting customers, talking with Homecare Homebase. You guys are demoing in the booth?

Alex: Yeah, we're demoing in the booth. Come by, we're front and center over there, next to the claw machine.

Tom: That's cool. Who's with you?

Alex: My co-founder, Barat, and our head of strategy, Jeremy.

Tom: Cool, so both those guys are here. That's awesome. All right, well, appreciate you stopping by. Thanks for being here. Super excited to come over and see what you guys are up to. I think everybody in the room is talking about AI and Scribe and some kind of automation. So I think you're on the right track, Alex.

Alex: We hope so.

Tom: All right, congratulations. Awesome. See ya.