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Ambient Artificial Intelligence Scribes to Alleviate the Burden of Clinical Documentation

Clinical documentation in the electronic health record (EHR) has become increasingly burdensome for physicians and is a major driver of clinician burnout and dissatisfaction. Time dedicated to clerical activities and data entry during patient encounters also negatively affects the patient–physician relationship by hampering effective and empathetic communication and care. Ambient artificial intelligence (AI) scribes, which use machine learning applied to conversations to facilitate scribe-like capabilities in real time, has great potential to reduce documentation burden, enhance physician–patient encounters, and augment clinicians’ capabilities. The technology leverages a smartphone microphone to transcribe encounters as they occur but does not retain audio recordings. To address the urgent and growing burden of data entry, in October 2023, The Permanente Medical Group (TPMG) enabled ambient AI technology for 10,000 physicians and staff to augment their clinical capabilities across diverse settings and specialties. The implementation process leveraged TPMG’s extensive experience in large-scale technology instantiation and integration incorporating multiple training formats, at-the-elbow peer support, patient-facing materials, rapid-cycle upgrades with the technology vendor, and ongoing monitoring. In 10 weeks since implementation, the ambient AI tool has been used by 3,442 TPMG physicians to assist in as many as 303,266 patient encounters across a wide array of medical specialties and locations. In total, 968 physicians have enabled ambient AI scribes in ≥100 patient encounters, with one physician having enabled it to assist in 1,210 encounters. The response from physicians who have used the ambient AI scribe service has been favorable; they cite the technology’s capability to facilitate more personal, meaningful, and effective patient interactions and to reduce the burden of after-hours clerical work. In addition, early assessments of patient feedback have been positive, with some describing improved interaction with their physicians. Early evaluation metrics, based on an existing tool that evaluates the quality of human-generated scribe notes, find that ambient AI use produces high-quality clinical documentation for physicians’ editing. Further statistical analyses after AI scribe implementation also find that usage is linked with reduced time spent in documentation and in the EHR. Ongoing enhancements of the technology are needed and are focused on direct EHR integration, improved capabilities for incorporating medical interpretation, and enhanced workflow personalization options for individual users. Despite this technology’s early promise, careful and ongoing attention must be paid to ensure that the technology supports clinicians while also optimizing ambient AI scribe output for accuracy, relevance, and alignment in the physician–patient relationship.

Authors: Tierney, Aaron A;Gayre, Gregg;Hoberman, Brian;Mattern, Brit;Ballesca, Manuel;Kipnis, Patricia;Liu, Vincent;Lee, Kristine

NEJM Catalyst. 2024;5(3). doi:10.1056/cat.23.0404

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