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| Although doctors are adopting artificial intelligence for basic tasks such as scheduling patient appointments, problems remain. |
When Janine Urban went for a checkup in November, she received the full attention of her doctor.
Instead of typing on a computer keyboard during the exam, Urban’s doctor at Penn Internal Medicine Clinic in Media, Pennsylvania, had an artificial intelligence scribe nearby take notes during the exam. At the end of the 30-minute consultation, Urban’s doctor showed her an AI summary of the appointment neatly organized into sections for her medical history, physical exam findings, rheumatoid arthritis and hot flash evaluation and treatment plan, and other details.
The clinical notes, which Urban could also review on her patient portal at home, were incredibly thorough, she said. It included all of her questions and concerns, as well as her doctor’s answers. The scribe “made sure we didn’t miss anything,” Urban said.
Ambient AI scribes are being hailed by doctors as an innovative tool that allows them to focus on their patients rather than their computer keyboards. Early research shows that AI scribes could help reduce physician burnout and after-hours “pajama time” catching up on evening work by freeing doctors from the tedious and time-consuming task of documenting what happens after every patient encounter.
AI’s potential to transform every aspect of the healthcare system, from patient care to clinical efficiency to medical innovation, is an area of focus, including by the Trump administration.
Last January, President Donald Trump issued an executive order removing barriers to U.S. leadership in AI. Later this year, a press release from the federal Department of Health and Human Services invited stakeholders to comment on how the department could accelerate the adoption of AI in healthcare.
In recent years, several emerging vendors have introduced ambient AI scribe products that can be integrated into electronic medical records. Epic, a leader in the EHR market, is piloting its proprietary AI scribe technology and plans to widely release it early this year, said Jackie Gerhart, Epic’s chief medical officer and vice president of clinical informatics and family medicine physician.
Medical technology experts estimate that one-third of healthcare providers have access to ambient AI scribe technology. With adoption expected to accelerate over the next few years, many expect this to become a recruitment tool and therefore a minimum requirement for new clinicians, with reports showing a growing trend towards prioritizing work-life balance.
“This is part of keeping doctors happy,” said Robert Wachter, a professor and medical director at the University of California, San Francisco. His upcoming book, A Giant Leap, explores how AI will transform healthcare. “While health systems may have initially made rigorous return-on-investment calculations, many companies are starting to soften their thinking and realize that the costs of recruiting and retaining physicians are significantly higher.”
However, many questions remain. Will the use of ambient AI scribes improve patient care and health outcomes? Will physicians use the time gained by employing AI scribes to improve the quality of time they spend with patients, or will they simply use it to increase the number of patients they see? When integrating AI scribes with coding apps that optimize providers’ rates, how much more detailed information from patient visits will result in increased billing?
For now, these questions remain largely unanswered.
Urban said the AI scribe didn’t change his experience as a patient much. Typically, after a patient gives verbal permission, an AI scribe records the visit over the phone and organizes the conversation into the structure of a clinical note, filtering out small talk unrelated to the visit and incorporating relevant details about a family member’s recent cancer diagnosis, for example. The scribe’s notes are often integrated into the provider’s EHR. The doctor will later review and sign the note.
While visits may not feel much different to patients, some clinicians report that ambient AI scribes are changing their patient encounters in unexpected ways.
“Right now, when you do a physical exam, you have to say out loud what you’re doing and what you’re finding for the AI scribe to document it,” said Dina Capalongo, Urban’s primary care physician. “People find it very interesting,” she said.
For example, when Ms. Capalongo places a stethoscope over a patient’s carotid artery under the jaw, she might say she doesn’t hear any “bruising,” or vascular murmurs, that could indicate atherosclerosis. Patients told her they “couldn’t understand why the doctor would listen there.”
Saying things out loud to an AI scribe that would normally only appear in clinical notes can present its own set of challenges, especially for sensitive physical exams. Physicians may feel it is important to adjust the conversation accordingly.
“Patients sometimes feel anxious and fearful, and telling them things they don’t understand or worry about during an uncomfortable exam doesn’t make things better, and frankly, they don’t care about what they’re going through,” said Genevieve Melton Moe, a professor of colorectal surgery at the University of Minnesota and chief medical informatics and AI officer at Fairview Health Services in Minneapolis. After the visit, he said, “I will always keep this in mind and make sure to record it.”
“How we have conversations with patients about these tools is critical, especially to maintain trust and ensure accurate information,” Melton-Moe said.
“Studies have found that across a variety of measures, including completeness, timeliness, and consistency, notes created by ambient AI scribes are generally at least as good as, and in some cases better than, traditional documentation,” said Kevin Johnson, a pediatrician and vice chancellor for applied informatics at the University of Pennsylvania Health System.
An ongoing concern concerns AI “hallucinations,” where the AI’s output displays false and even fabricated information.
Kaiser Permanente is an early adopter of ambient AI scribe technology, delivering the technology to more than 25,000 physicians, advanced practice providers, and pharmacists across the system. Daniel Yang, a physician and vice president of AI and emerging technologies at KP, said hallucinations were found to be “very rare.”
But they happen. For example, a note generated by an AI scribe might state that a doctor referred someone to a neurologist or scheduled a follow-up appointment in two weeks. problem? The doctor may not have said that.
“This technology is not perfect, which is why doctors are considering it,” Yang said. He says he learns from regular doctor visits. That’s why it’s important to have someone check your work products.
Still, Wachter says there are problems with such “human-involved” systems. “Humans are not good at staying alert for long periods of time,” he says.
As the use of ambient AI scribes becomes routine, some clinicians worry that the technology will widen the divide between the healthcare haves and have-nots.
Meltonmeaux said large health systems can take advantage of this technology moving forward. But what about critical access hospitals and small practices? “We need more resources,” she says.
Physician enthusiasm for ambient AI scribes stands in contrast to negative reactions to electronic medical record systems that have become widely adopted in recent years to replace paper charts.
“When EHRs took center stage over the last decade, we all became very grumpy, overworked data scribes,” says Wachter.
Healthcare AI experts say the introduction of AI scribes will help doctors feel like the technology is working for them, rather than the other way around.
And AI scribes are “training wheels” for more significant adoption of AI in the medical field, Wachter said.
Wachter said that to increase the value of health care and save money, we need a system that increases the likelihood that doctors will practice evidence-based medicine, order the right tests, and prescribe the right drugs.
“It’s a few years away, but it all depends on AI,” he said.
Epic has deployed approximately 60 AI use cases for patients, clinicians, and governments, with over 100 more in development.
“It’s much bigger than a scribe,” says Epic’s Gerhardt. “Literally, by listening and acting, things are arranged so that I can take action.”
