Below is an edited excerpt from a recent paper on AI in health care delivery systems authored by the Peterson Health Technology Institute. Manatt Health's Jared Augenstein, Naomi Newman, Allie Chafetz and Annie Fox supported Taskforce facilitation and research. Click here to read the full report.
As applications of artificial intelligence (AI) spread rapidly, ambient scribes are poised to become one of the fastest technology adoptions in healthcare history.
Without interrupting the natural flow of a visit, these solutions convert verbal patient-provider interactions into structured notes for clinical documentation and, eventually, medical billing. These solutions have the potential to reduce the paperwork burden on clinicians — which is a widespread source of discontent — and, in turn, reduce burnout, increase productivity, and improve the patient experience.
Today, approximately 60 ambient scribes are being implemented in practice. In an industry with notoriously long sales cycles and implementation timelines, there is no technology in recent memory that has been adopted more enthusiastically by clinicians or has scaled so uncharacteristically fast, absent a regulatory mandate.
This leaves decision-makers across the industry trying to determine if these solutions work and how to measure their impact. To answer these questions, leaders need a clear understanding of what outcomes (e.g., reduced clinician burnout, improved productivity) they are attempting to address and how to measure the performance of ambient scribes and the financial value of their improvements against those outcomes. With greater clarity about the effectiveness of ambient scribes, all health systems will have better information to guide their purchasing decisions and roll-out approach.
Ambient Scribe Adoption
Ambient scribes have been embraced by health systems because they offer a solution to the seemingly intractable dual challenges of burnout and labor productivity. Historically, increasing productivity meant asking clinicians to do more — not less — and, therefore, increased cognitive load, administrative burden, and ultimately feelings of burnout. Ambient scribe technology offers the promise of reducing time spent on documentation (during and after work) and creating capacity for more patient visits, or increasing the revenue captured per visit. Ambient scribes essentially enable clinicians to expend less effort per visit. This could result in higher patient volume and better visit quality.
Approaches to ambient scribe implementation have varied across health system participants, but most have focused on primary care as the first use case. Physician adoption has been heterogeneous. Often, there is one cohort of heavy users; another that uses ambient for some but not all visits; and another of low- or no-use clinicians, including those who tried and stopped. Interestingly, several organizations observed that the clinicians who saw the greatest benefit were those who had not yet optimized their documentation workflows, were consistently behind in notes, spent more time in conversation with their patients, or typically had longer summary notes.
Measuring Impact
Based on the experiences of early adopters, ambient scribes appear to reduce cognitive load and burnout and improve the patient experience — all of which may have downstream positive impacts on efficiency. The current evidence base for ambient scribes improving efficiency directly by reducing documentation time and, thereby, creating capacity is limited; however, as the technology and implementation processes improve, time savings may become more apparent.
Many ambient scribes are extending into coding with the promise of optimizing evaluation and management (E&M) and hierarchical condition category (HCC) coding. It is not yet known what the downstream impact will be, though it is reasonable to expect that given existing incentive structures, ambient scribes will support higher level coding, which — even if accurate — may increase healthcare spending and the costs of care.
Health systems are actively seeking to understand when and how ambient scribes can drive impact at scale. To date, the few published peer-reviewed studies show mixed results based on heterogeneous measures and methods. Standardized metrics would improve the ability to understand how these solutions impact the system, including (1) clinician impact, (2) patient impact, and (3) financial impact.
Next Steps
As ambient scribes continue to proliferate across the healthcare market, the industry is grappling with the immense potential of these tools and the evolving understanding of their strengths and weaknesses. Critically, there is a need for more standardized methodologies and metrics to understand performance across a range of indicators and for more research to understand their long-term impact on efficiency. Beyond ambient scribes, there are many other areas ripe for transformation with the help of AI-enabled administrative technologies. Notably, AI in revenue cycle is likely to be the next significant area of at-scale solution deployment.
Click here to read the full paper and findings.
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