Take Notes: AI Scribes to the Rescue?

Harry Moroz, Publications Lead

Canadian doctors are on the brink. The Canadian Medical Association (CMA) reports physician burnout nearly doubling since the pandemic, fueled in part by the ever-growing burden of administrative tasks like charting and documentation¹. These demands cut into precious time for patient interaction. However, a glimmer of hope emerges: AI scribes.

AI scribes are not your typical office assistants. Imagine a speech-to-text superpower combined with artificial intelligence. This technology captures conversations between doctors and patients, transcribing them into draft medical notes for review. The AI software, acting silently in the background (without recording the conversation in most cases), even parses the dialogue to identify key medical details and tailors the summary to the doctor’s preferred format. This frees physicians to focus on what matters most – their patients. While AI scribes are still finding their footing in Quebec, they have the potential to revolutionize healthcare documentation, giving doctors back valuable time. However, AI isn’t yet here to replace human touch. The continued value of human medical scribes is evident in their rising numbers and high effectiveness². Studies show they significantly benefit emergency physicians by handling billing and coding, boosting physician satisfaction, improving documentation quality, and even allowing for higher patient volume. Additionally, human scribes often describe their roles as stepping stones, offering mentorship, valuable clinical experience, and a path towards medical school ^3,4,5.

This article will explore the reasons behind the consideration of AI scribes, diving deep into the pros and cons, addressing potential concerns, and offering crucial reminders for future users of this technology in the medical field.

Benefits

There is strong agreement among doctors that AI has the potential to significantly improve medical practice⁶. A survey from Manitoba found that over 90% of surveyed physicians see value in AI-assisted tasks, with 70% specifically identifying charting and documentation as an area for improvement⁷. This finding was consistent with my discussions with clinicians in Montreal. These findings align with the increasing number of inquiries received by the Quebec government from physicians seeking solutions to reduce administrative burdens. There have been many studies conducted on this topic, and the benefits seem to fall into three main categories:

• Reduced Documentation Time: AI scribes have the potential to significantly reduce the time spent on charting, freeing up valuable time for patient care and reducing physician burnout. Specifically, a study found that AI-assisted documentation led to a 50% reduction in charting time for physicians⁸.
• Improved Patient Interactions: By minimizing distractions from note-taking, AI scribes can allow physicians to focus more on attentiveness and rapport building during patient visits. This can lead to a more positive patient experience and potentially contribute to better health outcomes⁹.
• Enhanced Record Quality and Accuracy: Studies suggest that AI tools can provide detailed and accurate medical records comparable to human input. AI can even surpass human performance in some cases, potentially improving the overall quality of patient care and documentation¹⁰.

While there appear to be benefits, there have been increasing concerns about the lack of detail and precision of AI scribes compared to human scribes. This raises the question: are AI scribes ready to be widely used?

Cons/Concerns of AI Scribes

While AI scribes offer a wave of potential benefits for both doctors and patients, there are some concerns that need to be addressed:

• Accuracy and Trust: There is some skepticism about the ability of AI to accurately interpret complex medical information and generate reliable documentation. This highlights the importance of physician oversight and review of AI-generated notes to ensure accuracy¹¹.
• Data Privacy and Security: The data security concerns raised by the doctors we surveyed align with broader anxieties regarding AI in healthcare. Ensuring patient data privacy is paramount, and AI tools must adhere to existing regulations and best practices⁷.
• Limited Functionality: Current AI scribes primarily focus on speech-to-text conversion. While this can significantly improve documentation efficiency, it may not capture the nuances of nonverbal communication or a doctor’s thought process during a patient encounter¹².
• Bias and Fairness: As with any AI system, there’s a risk that AI scribes could perpetuate biases present in the data used to train them. This could lead to inaccurate documentation or unequal care, particularly for marginalized patient groups¹².
• Cost-Effectiveness: While AI scribes can potentially save time and improve workflow, the initial investment and ongoing maintenance costs need to be weighed against the potential benefits for a particular practice.
• The Doctor-Patient Relationship: Some doctors worry that AI scribes might impede the human connection crucial for good patient care. It will be important to ensure that AI technology complements rather than replaces the important interactions between doctors and patients⁹.

These are just some of the cons and concerns surrounding AI scribes. As the technology continues to develop, it will be important to address these issues to ensure that AI is used ethically and effectively in healthcare.

Additional Reminders for Users of AI Scribes

AI scribes offer an exciting new technology to streamline medical documentation, but it’s crucial to use them responsibly. Here are some key reminders for physicians:

• Obtain Informed Patient Consent: Always get a patient’s consent before using an AI scribe. Explain how the recording will be used, stored, and potentially de-identified for algorithm improvement.
• Ensure Accuracy: AI-generated notes require careful review. Physicians are ultimately responsible for the accuracy and completeness of medical records.
• Review Privacy and Security: Understand how the AI scribe service you use handles patient data. Ensure it meets privacy regulations in your jurisdiction. This may involve encryption and privacy impact assessments.
• Maintain Secure Recordings: Decide whether to store AI scribe recordings. If you do, they must be stored securely in the patient’s chart for the required retention period. If not, you’ll need a policy for secure destruction after ensuring the chart entry is accurate.

By following these reminders, physicians can leverage the benefits of AI scribes while ensuring patient privacy and accurate medical documentation.

Conclusion

AI scribes offer compelling advantages in efficiency and accuracy, but ethical and professional standards must be upheld during integration. Protecting patient privacy, ensuring data accuracy, and obtaining informed consent are critical aspects of leveraging AI tools effectively and ethically in medical practice. As the landscape evolves, staying informed about regulatory changes and technological advancements.

Bibliography:

1. Loeppky, Keyli, et al. “Patients before Paperwork.” Canadian Federation of Independent Business, 1 Feb. 2024, www.cfib-fcei.ca/en/research-economic-analysis/patients-before-paperwork.

2. Geller GA, Ramirez R, Webster L. The rise of the medical scribe industry: implications for the advancement of electronic health records. JAMA. 2015;313(13):1315-6.
3. Allen B, Banapoor B, Weeks EC, et al. An assessment of emergency department throughput and provider satisfaction after the implementation of a scribe program. Adv Emerg Med. 2014:517319.
4. Dawkins B, Bhagudas KN, Hurwitz J, et al. An analysis of physician productivity and self-sustaining revenue generation in a free-standing emergency department medical scribe model. Adv Emerg Med. 2015:518179.
5. Eley RM, Allen BR. Medical scribes in the emergency department: the scribes’ point of view. Ochsner J. 2019;19(4):319-28.
6. Andis Robeznieks. Big Majority of Doctors See Upsides to Using Health Care AI. American Medical Association, 12 Jan. 2024, www.ama-assn.org/practice-management/digital/big-majority-doctors-see-upsides-using-health-care-ai#:~:text=Also%2C%2056%25%20of%20respondents%20thought,and%2041%25%20with%20patient%20privacy.

7. Doctors Manitoba. AI Scribes in Your Practice: Your Responsibilities. doctorsmanitoba.ca. Published March 1, 2024. Accessed May 21, 2024.
8. Boyle, Patrick. Can artificial intelligence improve doctor-patient visits and reduce burnout? American Association of Medical Colleges [Internet]. aamc.org. Accessed May 21, 2024
9. Topol EJ. The Topol Review: Preparing the healthcare workforce to deliver the digital future. Health Educ England; 2019.
10. Ayers JW, Poliak A, Dredze M, et al. Comparing Physician and Artificial Intelligence Chatbot Responses to Patient Questions Posted to a Public Social Media Forum. JAMA Intern Med. 2023;183(6):589–596. doi:10.1001/jamainternmed.2023.1838
11. Hutchison, Julia. American College of Emergency Physicians. How Do We Feel About AI Taking Over for Scribes? [Internet]. acepnow.com. Accessed May 21, 2024.
12. American Medical Association. ChatGPT and Generative AI: What physicians should consider [PDF]. [Internet]. 2023 [cited 2024 May 21]. Available from: ama-assn.org/system/files/chatgpt-what-physicians-should-consider.pdf