Physician experiences with AI documentation

Rebekah Bernard, MD

I admit that I’m a bit of a skeptic when it comes to artificial intelligence (AI) in medicine. Sure, a computer algorithm may be able to spit out a reasonable differential diagnosis when straightforward symptoms are spoon-fed into it by a medical professional. But how will AI stack up against a fully trained human physician when faced with a ‘typical’ patient? You know, the one who presents for management of diabetes, hypertension, and anxiety; “Oh, and by the way, I have a cough, my toe hurts, and why am I so tired all the time?” COMPUTER. OVERLOAD.

While I don’t believe that AI is ready to replace physicians when it comes to the practice of medicine (now or possibly ever), I have been shocked at how far it has progressed in acting as a medical scribe. About a year ago, I was offered the chance to beta-test an AI documentation system that promised to transcribe an office visit into a succinct SOAP note. While I started the trial with high hopes, the system was unable to keep up with the myriad of patient complaints and chronic conditions discussed in a single visit, especially when acute and chronic problems were addressed, as is usual in primary care. After a few hours of copy/pasting data into the correct SOAP note format, I gave up.

But what a difference a few months make in the world of AI! After stumbling upon rave reviews for an AI documentation system in one of my social media medical groups, I logged in for a free 10-note trial. By the 9th patient visit, I was grabbing my credit card to sign up. I’m also hearing from many of my colleagues who are ecstatic about how AI has helped improve their quality of life.

How AI scribes work

Here’s how most AI scribe systems work. When you’re ready to start, open the program in a browser window and click ‘record’.Since I usually review patient charts before I bring them in, I simply talk out loud so the system can start recording.“I’m going to see Mary, a 51-year-old woman with hypertension and diabetes. Last time she was in, I increased her blood pressure medicine, so we’ll see how her readings are today. I need to check her electrolytes and she’s due for a mammogram.”

I then bring the patient in and proceed with my visit as normal, as the AI system listens to the history in the background. To allow the system to capture aspects of the physical exam, say the results aloud. For example, I might tell the patient, “Your blood pressure is perfect—120/70 with a pulse of 60,” or “Your heart has a regular rate and rhythm, and I don’t hear any murmurs.” This allows the system to pick up and record the pertinent data. I then explain to the patient my treatment recommendations and discuss the follow-up plan, which the AI system will synthesize into the assessment and plan.

Once you click ‘stop recording,’ the system generates a comprehensive SOAP note within minutes. Some programs also auto-generate a visit summary to print or email to the patient, as well as a transcription summary. Now comes the part where the physician is still necessary: Review the note and correct any AI errors or unnecessary elements. Once the note is edited, copy/ paste it into your EHR, and voila! You are done!

While notes are not perfect and almost always require some editing, I’ve been astounded by the overall quality of AI documentation – somehow, the program can sift through the small talk and document just the relevant clinical details. The system can also translate foreign languages—mine can generate near-perfect notes in English of visits conducted entirely in Spanish and in Portuguese.

Benefits of AI documentation

Using AI for documentation has significantly decreased the amount of time that it takes me to finish my office notes. This allows me to keep up with documentation in real-time, rather than waiting until the end of the day to close out my charts. Michael Elliott, MD, a physician who uses the system Freed, has noticed the same. “AI scribing has allowed me to claw back some time and having a summarized conversation (as well as an actual transcription) allows me to relax and be more in the moment with my patients, instead of staring at a screen and typing the whole time.”

In addition to time savings, physicians note that AI dictation improves the clinical experience for themselves and patients. Kissi Rosabel Blackwell, MD, a family physician in Texas who also uses Freed, says, “I feel less overwhelmed in my day-to-day patient encounters knowing that conversations are saved accurately and securely and organized in a coherent fashion, even when I’m extremely busy.” Blackwell notes that the system decreases her anxiety about forgetting important details, which can occur when patients have a long list of concerns. “I’m no longer worried that I’ve forgotten to document something or missed what medication I’ve promised a patient I’d send for them.” She also appreciates the summary that the system generates. “It creates perfect patient friendly instructions at the end of the visit to share with patients so they can also recall important details of our visit.” Blackwell says that the price point of her system, currently $99/ month, is key to the success of AI dictation programs. “It’s affordable for primary care physicians who have long since had trouble affording things like scribes.”

Connecticut Internist/Pediatrician Vasanth Kainkaryam, MD has had positive experiences with the AI system Abridge, which he selected for ease of use as well as price point. "As a physician with a degree in Health Informatics, I'm always looking for technology solutions to help make workflows better and to battle burnout,” he says. “[AI] has changed the entire way I work with patients. I'm able to focus on having conversations and thinking aloud with patients instead of remembering what I have to write down.” Kainkaryam says that AI is finally an example of electronic record keeping that can make life easier for doctors. “When used well, AI will actually enhance the doctor-patient experience, and reduce burnout. Unlike EMRs and other solutions, I think it's one of the few that will actually make a big difference."

Downsides

Not every physician is in love with the current AI dictation systems on the market.“I personally found it took more time to proofread and edit the AI notes than it does to craft my own,” says Elizabeth Galla, MD, a pediatrician in Cary, NC. Instead, she has simplified her workflow by using an online AI dictation program provided through her web browser. “Even better, it’s free!”

Aaron Rosenberg, MD, a Wisconsin physician, also finds AI notes cumbersome to edit, but has found another way to work with the software. Rather than allowing his system to listen in on the office visit, he dictates directly to his system after each visit, and allows AI to synthesize the note. “This is still faster than [standard] dictation or writing the whole thing myself, but it excludes the non-relevant parts,” he says.

Noting that no AI service is perfect, some physicians are working to improve the systems. Jack Jeng, MD, MBA accepted a position with AI system Freed. “As a practicing physician, I know documentation can be time-consuming and may even lead to job dissatisfaction and burnout,” he says. “My role is to help prioritize our work so that Freed is the most helpful AI scribe on the market. This includes setting the direction for additional problems we will free clinicians from, such as pre-charting and billing.” Sakina Shikari Bajowala, MD, an allergist in Illinois, created a Facebook page dedicated to helping AI users learn from each other. “I believe that a group of intelligent and motivated early adopters can be incredibly helpful to learn to maximize the benefits of this new technology,” she says. “While AI isn’t perfect, our input can help shape it to meet our needs.”

Rebekah Bernard, MD is a family physician in Fort Myers, FL and the author of Physician Wellness: The Rock Star Doctor’s Guide.