Some patients may notice a new trend at their medical appointments: a request to have a phone app or computer program record their conversation with their doctor. Ambient clinical voice, or ambient listening, is an artificial intelligence-driven tool that transforms a conversation between a provider and patient into a clinical note that can be added to electronic health records.
It’s intended to capture all relevant information accurately with a goal of reducing administrative burden by cutting down on the amount of documentation. Journalists could get several ideas for stories (see below) from this development.
How it works
Two physicians gave a demonstration of ambient listening technology during a January webinar hosted by Becker’s Hospital Review. In a simulated exercise, one physician pretended to be a patient presenting with a nagging cough and a snake bite. Meanwhile, the other physician performed a mock exam, in which he prescribed an antibiotic and gave instructions for skin care for the snake bite and recommended over-the-counter medications for the cold.
Within a couple of minutes, the AI program compiled an easy-to-read, bulleted note for the physician with specific sections for medical and social history, current medications, findings from the physical exam, the doctor’s diagnosis, and the recommended medical treatment plan, including the prescription, need for a follow-up visit and plan for lab work. The physician just needed to review it for accuracy, add a voice note with any other thoughts and push a button to add it to the health record.
As many as 75-85% of physicians may adopt the technology, with affordability being the only potential setback, according to predictions by John Lynn and Colin Hung of Healthcare IT Today during a recent podcast.
“When doctors see what ambient clinical voice can do, their eyes light up,” Hung said.
Unlike technologies that require a lot of training, clinicians simply voice what they’re thinking, Lynn said. Instead of a physician thinking the patient has a particular type of rash or they’re going to prescribe a certain medication, for example, they say everything out loud so it can be recorded.
Going forward, look for more medical centers to adopt ambient listening programs and integrate them with electronic health records, and for the programs to add additional features. Ideally, Lynn and Hung said, a clinician could ask the program to pull up the last three lab values for a patient, or display a medication history without having to search the health record.
Adoption is ongoing
The technology is already being implemented at multiple medical centers around the country, including Yale New Haven Health in Connecticut, Emory Healthcare in Georgia, the University of Michigan Health-West, the University of Pittsburgh Medical Center and the University of Kansas Health System.
UM Health-West in Wyoming, Mich., started using an AI scribe service in 2020. The tool has been most successful among the 100 or so primary care physicians, who see patients with a wide variety of conditions, according to an article from EpicShare.
They record using an app on their cell phone or tablet. Some physicians kick back and enjoy a conversation with the patient, then take a minute or two after leaving the exam room to voice some specific items they might not have said out loud.
Others make sure to say everything that needs to go into the note out loud during the visit so they don’t need to add anything else. Soon after, a note is drafted and ready for the physician’s review.
So far, they estimate that physicians save an average of 10 minutes on notes per day. So-called “pajama time,” or time spent after hours, increased slightly but that was largely from physicians reviewing notes, not having to create them from scratch, the article said.
As an added bonus, patients reported their visits were much more engaging and some said they enjoyed seeing their recorded words posted to patient portals because they felt the doctor understood what they were saying.
Emory University urologist Vikram Narayan, M.D., described how he uses an AI scribe at his practice in a November 2023 article in Urology Times. He pulls up his daily patient schedule in the AI scribe app on his phone, taps on a patient’s name as he enters the room, and once he has patient consent, records the visit.
Once the visit is complete, he receives a summary including a history of present illness (HPI – a chronological description of the development and progression of a patient illness from the start to current state), assessment and treatment plan.
The accuracy “is amazing,” he said, adding that he can pay more attention to the patient conversation and he feels less mentally fatigued at the end of the day.
Study finds limitations
As can be expected with any newer technology, ambient scribes aren’t quite perfect. The Permanente Medical Group in California implemented these tools in October 2023 for 10,000 of its physicians and staff. Several physicians with the medical group published an article in NEJM Catalyst last month detailing their experience within the first 10 weeks.
At that time, the program had been used by 3,442 physicians to assist in over 303,000 patient encounters across a wide array of medical specialties and locations. The response from physicians who used it was favorable, with doctors citing the technology’s “capability to facilitate more personal, meaningful and effective patient interactions and reduce the burden of after-hours clerical work.” Some patients also had positive feedback, noting improved interaction with physicians not spending time looking at computer screens.
But upon reviewing a sample of 35 AI-generated transcripts, the physicians found some inconsistencies and errors. One physician mentioned scheduling a prostate examination for a patient, and the AI scribe summarized that a prostate exam had been performed.
In another, the physician mentioned issues with a patient’s hands, feet and mouth. The AI summary said the patient was diagnosed with hand, foot and mouth disease — not quite the same. Some AI-generated summaries missed potentially important details such as chest pain and anxiety assessments.
“Despite this technology’s early promise, careful and ongoing attention must be paid to ensure that the technology supports clinicians while optimizing output for accuracy, relevance and alignment in the physician-patient relationship,” wrote the study authors, noting that “AI scribes are not a replacement for clinicians.”
Story angles to consider
Healthcare IT Today has covered ambient clinical voice in several podcasts and blog posts, all of which can serve as good background information for future stories. One interview focused on a program specifically for physical therapists, who are constantly on the move with their patients.
Journalists looking to cover this trend could tackle different angles such as asking physicians and/or patients what they think of the programs or talking to tech experts about how the technology is likely to be augmented in the near future.
How accurate is it? How is adoption varying by specialty? For example, a psychiatry visit might look very different than one for primary care physicians.
Also to consider: Are such programs leading to reduced burnout for clinicians? And what about patient privacy? Are recordings being stored by these programs, and if so, how is that data being protected?
Resources
- Ambient Clinical Voice – a podcast from Healthcare IT Today.
- Back to the future with ambient listening – a webinar from Becker’s Hospital Review.
- Is Ambient Dictation the Future of Clinical Documentation? – an article from Forbes.
- How Clinical Ambient Intelligence can Address Clinician Burnout – an article from TechTarget.com.
- Ambient clinical documentation shows promise for physicians – an article from Urology Times.
- Ambient Listening Helps Primary Care Doctors Finish Notes Faster – an article from EpicShare.
- Abridge becomes Epic’s First Pal, brining generative AI to more providers and patients, including those at Emory Healthcare – a news release from Emory University.
- Yale New Haven Health to provide AI-driven clinical documentation – an article from Becker’s Health IT.
- New AI tools can record your medical appointment or draft a message from your doctor — an article from AP.
