Adoption of AIScrib by a doctor raises ethical issues

Many New Zealand GPs have featured the use of AI scribes to transcription patient notes during consultation despite continued challenges despite legal and ethical surveillance, data security, patient consent, and the impact on research led by the University of Otago at the University of Otago.

The researchers surveyed 197 primary care providers in February and March 2024, providing snapshots when they used AI spreading in clinical practice. Most of the respondents had GPS, while others included nurses, nurses, rural emergency care providers and practice managers. The early experiences of AI-Scribes were mixed together. Users express both enthusiasm and optimism, along with concern and frustration.

Forty percent of those surveyed reported using AI scribes to take notes from patients. Only 66% read the terms of software use, and 59% reported seeking patient consent.

Chief professor at Angela Ballantine, a bioethicist at the Department of Primary Health Care and General Practices, says AI transcription services are being rapidly picked up by primary care practices despite national regulations and guidelines still being developed.

Most of the surveyed participants who used AI-Scrib estimated that using them in all consultations would save 30 minutes to 2 hours a day, and found 47% to be useful or extremely useful. However, a considerable minority said the software didn't save time overall. This is because it took a long time to edit and edit the notes generated by AI.

Healthcare professionals who responded to the survey mentioned concerns about the accuracy, completeness and brevity of patient notes generated by AIScribes.

One doctor said: Another commented that they stopped using AI transcription because of the very high “hatography rates” and often very subtle.

Others expressed concern about their inability to understand New Zealand accents and vocabulary and te Leo Maori. He mentioned pausing recordings when patient-identifying information such as name and date of birth is needed.

More than half of those surveyed said they used AI-Scribe to change the dynamic consultations with patients. They said it was because they needed to explain the results of physical examinations and their thought processes in words so that transcription tools could capture the information.

One of the GPS surveyed said, “Today someone said, 'There's pain here' and pointed to the area, so I cried out, 'Oh, the pain in the upper right quadrant?' ”

Professor Ballantine says the impact of AI tools on clinical practice and patient interactions needs to be tracked and evaluated.
People using AI-Scribe felt that through more eye contact and active listening, they could focus more on their patients and develop better engagement and relationships.

There was concern among those investigated whether AI-Scribe uses comply with New Zealand's ethical and legal frameworks.

Professor Ballantine says he has a professional and legal responsibility to ensure that clinical notes are accurate, whether healthcare professionals have used AI transcription tools or not.

“They need to be aware of checking patient notes for accuracy. However, as many survey respondents pointed out, carefully checking each clinical note generated for each AI can override time savings.”

Professor Ballantyne says that the benefits AI-Scrib can offer are crucial that it is balanced with the need to ensure patient rights and data security.

“Most AIScribs rely on international cloud-based platforms (often privately owned and controlled) for data processing and storage, where they can be accessed, and how they can be protected from cyber threats.

“There are also the inherent data governance issues that are unique to Aotearoa, which need to be recognized and resolved, particularly with a focus on Māori data sovereignty.”

In July, New Zealand's National Artificial Intelligence and Algorithm Expert Advisory Group (NAIAEAG) – Te Whattu Ora supported two surrounding AI-Scribe Tools, Heidi Health and IMEDX, for use by Aotearoa clinicians. NAIAEAG takes into consideration privacy, security, ethical and legal issues.

Professor Ballantine said that as long as the AI tools are novel, it is not possible to assume that patients will agree to their use.

“Patients should be given the right to opt out of AI use and still have access to care, and health providers should have appropriate training and guidelines in place.”

The New Zealand Medical Council is expected to release guidance on the use of AI later this year. This is likely to require patients who agree to use AI transcription tools.

Professor Ballantine said AI tools have improved over time and could improve some of their ethical concerns.

“Coupled with proper training, excellent governance and patient consent, the future of AI Scribes has a lot of promise.”

The research paper, “Using AI scribes in primary care consultations in New Zealand: An Exploratory Survey,” Journal of Primary Health Care You can read it here: https://www.publish.csiro.au/hc/hc25079