Ambient Artificial Intelligence Scribes to Alleviate the Burden of Clinical Documentation

Tierney, A. A.,  et al. (2024).

NEJM Catalyst, 5(3).

https://doi.org/10.1056/cat.23.0404

Abstract

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.

Key Takeaways

• Ambient artificial intelligence (AI) scribes show early promise in reducing clinicians’ burden, with a regional pilot noting a reduction in the amount of time spent constructing notes among users.

• Ambient AI scribes were found to be acceptable among clinicians and patients, largely improving the experience of both parties, with some physicians noting the transformational nature of the technology on their care.

• Although a review of 35 AI-generated transcripts resulted in an average score of 48 of 50 in 10 key domains, AI scribes are not a replacement for clinicians. They can produce inconsistencies that require physicians’ review and editing to ensure that they remain aligned with the physician–patient relationship.

• Given the incredible pace of change, building a dynamic evaluation framework is essential to assess the performance of AI scribes across domains including engagement, effectiveness, quality, and safety.

Clinical documentation of patient identities in the electronic health record: Ethical principles to consider

Decker, S. E., et al. (2023). 

Psychological Services.

Advance online publication.

https://doi.org/10.1037/ser0000816

Abstract

The American Psychological Association’s multicultural guidelines encourage psychologists to use language sensitive to the lived experiences of the individuals they serve. In organized care settings, psychologists have important decisions to make about the language they use in the electronic health record (EHR), which may be accessible to both the patient and other health care providers. Language about patient identities (including but not limited to race, ethnicity, gender, and sexual orientation) is especially important, but little guidance exists for psychologists on how and when to document these identities in the EHR. Moreover, organizational mandates, patient preferences, fluid identities, and shifting language may suggest different documentation approaches, posing ethical dilemmas for psychologists to navigate. In this article, we review the purposes of documentation in organized care settings, review how each of the five American Psychological Association Code of Ethics’ General Principles relates to identity language in EHR documentation, and propose a set of questions for psychologists to ask themselves and their patients when making choices about documenting identity variables in the EHR.

Impact Statement

Psychologists in organized care settings may face ethical dilemmas about what language to use when documenting patient identities (race, ethnicity, gender, sexual orientation, and so on) in the electronic health record. This article provides a framework for considering how to navigate these decisions based on the American Psychological Association Code of Ethics’ five General Principles. To guide psychologists in decision making, questions to ask self and patient are included, as well as suggestions for further study.

Here is my summary:

The authors emphasize the lack of clear guidelines for psychologists on how and when to document these identity variables in EHRs. They acknowledge the complexities arising from organizational mandates, patient preferences, fluid identities, and evolving language, which can lead to ethical dilemmas for psychologists.

To address these challenges, the article proposes a framework based on the five General Principles of the American Psychological Association (APA) Code of Ethics:

1. Fidelity and Responsibility: Psychologists must prioritize patient welfare and act in their best interests. This includes respecting their privacy and self-determination when documenting identity variables.
2. Competence: Psychologists should possess the necessary knowledge and skills to accurately and sensitively document patient identities. This may involve ongoing training and staying abreast of evolving language and cultural norms.
3. Integrity: Psychologists must maintain ethical standards and avoid misrepresenting or misusing patient identity information. This includes being transparent about the purposes of documentation and seeking patient consent when appropriate.
4. Respect for Human Rights and Dignity: Psychologists must respect the inherent dignity and worth of all individuals, regardless of their identity. This includes avoiding discriminatory or stigmatizing language in EHR documentation.
5. Social Justice and Public Interest: Psychologists should contribute to the promotion of social justice and the elimination of discrimination. This includes being mindful of how identity documentation can impact patients' access to care and their overall well-being.

To aid psychologists in making informed decisions about identity documentation, the authors propose a set of questions to consider:

1. What is the purpose of documenting this identity variable?
2. Is this information necessary for providing appropriate care or fulfilling legal/regulatory requirements?
3. How will this information be used?
4. What are the potential risks and benefits of documenting this information?
5. What are the patient's preferences regarding the documentation of their identity?

By carefully considering these questions, psychologists can make ethically sound decisions that protect patient privacy and promote their well-being.

Physician Burnout Is Widespread, Especially Among Those in Midcareer

Brianna Abbott
The Wall Street Journal
Originally posted 15 Jan 20

Burnout is particularly pervasive among health-care workers, such as physicians or nurses, researchers say. Risk for burnout among physicians is significantly greater than that of general U.S. working adults, and physicians also report being less satisfied with their work-life balance, according to a 2019 study published in Mayo Clinic Proceedings.

Overall, 42% of the physicians in the new survey, across 29 specialties, reported feeling some sense of burnout, down slightly from 46% in 2015.

The report, published on Wednesday by medical-information platform Medscape, breaks down the generational differences in burnout and how doctors cope with the symptoms that are widespread throughout the profession.

“There are a lot more similarities than differences, and what that highlights is that burnout in medicine right now is really an entire-profession problem,” said Colin West, a professor of medicine at the Mayo Clinic who researches physician well-being. “There’s really no age group, career stage, gender or specialty that’s immune from these issues.”

In recent years, hospitals, health systems and advocacy groups have tried to curb the problem by starting wellness programs, hiring chief wellness officers or attempting to reduce administrative tasks for nurses and physicians.

Still, high rates of burnout persist among the medical community, from medical-school students to seasoned professionals, and more than two-thirds of all physicians surveyed in the Medscape report said that burnout had an impact on their personal relationships.

Nearly one in five physicians also reported that they are depressed, with the highest rate, 18%, reported by Gen Xers.

The info is here.