When a health system rolls out new technology that it insists will make physicians’ lives easier, the announcement is typically met with skepticism. But the use of augmented intelligence (AI)—often called artificial intelligence—has changed that. The Permanente Medical Group’s rollout of ambient AI scribes to reduce documentation burdens has been deemed a success, saving most of the physicians using it an average of one hour a day at the keyboard.
Using the microphone on a secure smartphone, the ambient AI scribe transcribes—but doesn’t record—patient encounters and then uses machine learning and natural-language processing to summarize the conversation’s clinical content and produce a note documenting the visit.
“People were genuinely surprised with the ability of the technology to appropriately filter the conversation from a transcript into a clinical note—people were blown away by that,” Kristine Lee, MD, an internist and associate executive director of virtual medicine, technology and innovation at The Permanente Medical Group, said during an interview on the “Gist Healthcare Daily” podcast.
A primary care physician, Dr. Lee noted that she has had decadeslong relationships with some patients and the ambient AI scribe filtered out all the talk about children and pets and the exchange of Christmas greetings while producing a note that she would have had to type into the record herself.
The Permanente Medical Group is a member of the AMA Health System Program, which provides enterprise solutions to equip leadership, physicians and care teams with resources to help drive the future of medicine.
Quick and wide adoption
Dr. Lee is also the senior author of a NEJM Catalyst commentary that describes how The Permanente Medical Group rolled out the scribe technology tool, offering it to 10,000 physicians at 21 locations in Northern California. It was adopted by 3,442 physicians who used it in 303,266 patient encounters during the 10-week period before Christmas.
This includes 968 physicians who used the tool more than 100 times.
At the start of the study period, the ambient AI scribe was used almost 20,000 times a week and then exceeded 30,000 times in seven of the 10 weeks studied.
“This was the quickest spread of technology and quickest adoption of new technology in the medical group ever,” Dr. Lee said during the podcast.
She said criteria used to select a vendor were:
- Accuracy. The note the scribe produced had to be good enough so that extensive physician editing was not required.
- Ease of use and training. The tool is so intuitive, there was no need “to teach 10,000 physicians how to jump through 17 hoops to use it,” Dr. Lee said.
- Privacy and security. She explained that they wanted a model that was ready to use and did not require using The Permanente Medical Group patient data to train it.
Staff training included a one-hour webinar and trainers available at the 21 locations in Northern California.
A one-page handout explaining the technology was made available to patients and posters were developed to display in facilities where the tool was being used. Patient consent was obtained before using the ambient scribe during the visit.
The goals for using the ambient AI scribes listed in the NEJM Catalyst commentary include:
- Reducing the burden of documentation within and outside of direct patient encounters.
- Enhancing the patient-physician relationship and improving patient engagement by increasing the amount of time physicians could interact with patients instead of the computer during the visit.
Nearly two-thirds of the 1,081 physicians responding to an AMA survey (PDF) said they see advantages to using AI, and the AMA has developed new principles (PDF) to address the development, deployment and use of health care AI. Learn with the AMA about the emerging landscape of AI in health care.
Look out for hallucinations
The most enthusiastic physician adopters of the AI ambient scribe were primary care physicians, psychiatrists and emergency doctors, Dr. Lee said, noting that, on average, most scribe-using physicians spent one less hour a day on the computer.
This is time physicians can use in any manner they choose, Dr. Lee said, adding that the ambient AI scribe was not seen as a productivity tool to encourage squeezing in more appointments.
Instead, the focus is on staff retention by reducing burnout and returning joy to practice, patient-care experience enhancement—as well as using it as a recruitment tool to make The Permanente Medical Group a more attractive place to work for talented physicians.
Refinement of the tool, however, is ongoing.
While most notes were accurate, a tiny percentage did contain “hallucinations,” which is the term used when AI provides false information without a sound basis.
For example, one physician mentioned scheduling a patient’s prostate exam, but the AI scribe recorded that the exam had been performed.
Another time, the doctor discussed issues with the patient’s hands, feet and mouth, which the AI-generated summary recalled as “the patient being diagnosed with hand, foot and mouth disease,” Dr. Lee and her colleagues wrote.
Learn about how Kaiser Permanente’s AI approach puts patients and doctors first.
