The Ambient AI Medical Scribe Your Doctor Will Soon be Using is Music* to My Ears

The patient note you read in the future will most likely be generated primarily by a computer and this will be a good thing

The skeptical cardiologist has heretofore been somewhat skeptical of the benefits of AI in health care. However, I have embraced the use of an AI medical scribe during my office visits in the last few months and find it enhances my performance as a clinical cardiologist.

Patients may have already encountered the human medical scribe. I used human scribes** for a few years before the pandemic, and they were very helpful in keeping track of what was said by the patient and what I recommended. Sometimes orders were put in which is always a nice time saver.

Overall, they allowed me to spend more time interacting with the patient and less interacting with the electronic medical record which is a huge plus.

These human scribes weren’t always easy to find, required training and adding their salaries to physician expenses was costly.

In the last year, the AI medical scribe has been released upon the medical community.

A NEJM catalyst article earlier this year summarized the launch of one such scribe within the northern California Kaiser Permanente Medical Group.

They noted the same factors that drove the uptake of human scribes: “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”

The article uses the term “Ambient artificial intelligence (AI) scribes” which use a smartphone microphone to transcribe encounters as they occur but do not retain audio recordings.

The program was launched in late 2023 and was quite successful.

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.

Physicians at Kaiser mentioned many of the reasons I love the AI scribe:

“It makes the visit so much more enjoyable because now you can talk more with the patient and concentrate on their concerns.” Anecdotally, we also heard from clinicians that the AI scribe was particularly useful for very long appointments (>60 minutes), including one in which a 50-page transcript could easily be condensed and edited by the clinician to document their interaction. A new physician user noted, “I use it for every visit I can and it is making my notes more concise and my visits better. I know I’m gushing, but this has been the biggest game changer for me.” Those who used the AI scribe also commented on its capability to facilitate more personal, meaningful, and effective patient interactions. The same physician said, “I even had a patient praise the fact that I could listen instead of type during the visit.”

and patients like it:

Early assessments of patient feedback have also been positive, with a small proportion of patients opting out of ambient AI use and many reporting improved interaction with their physicians. Based on preliminary data in a sample of 21 patient surveys from a single clinic site, 71% reported they spent more time speaking with their physician, while one said they spent less time. Overall, 81% of patients reported that their physician spent less time looking at the computer screen than in their previous visits. All patients stated that the AI scribe either had no effect or enhanced their visit. All patients reported feeling neutral to very comfortable about an AI tool being used in their visit.

I will be writing in more detail about my experience which at this time includes using Doximity’s free AI medical scribe and Freed’s AI medical scribe which requires a monthly subscription.

Doctors, let me know if you are using an AI medical scribe, what your experience is, and what you have used.

Patients, let me know your experience, expectations, and concerns with doctors using AI scribes.

Scribblingly Yours,

-ACP

*I’m a big fan of ambient music. Check out Brian Eno’s Music for Airports the next time you fly

or this gem (perhaps a little too rhythmic for true ambient but created by one of my favorite obscure artists)

**My son served as my human scribe one summer before his senior year in high school and by the end of his tenure, he had the cardiology-specific medical knowledge of a 4th-year medical student.