Are AI Scribes Right for You?

Christie DeMason, MD, FAAOA
Chair AAOA Socioeconomic Committee

AI is currently one of the hottest topics — not just in medicine, but in everyday life. Physicians are now using AI to assist in writing medical presentations. There is now an AI app that can help answer unique medical questions by using only peer-reviewed medical journals to synthesize relevant information. AI can also be used to aid with documentation. AI scribe, also known as ambient scribe, records the conversation in the patient’s room and processes the conversation into a clinical note. Just like when other new technology comes out, it is important to weigh the pros and cons on if it will make sense for your practice.

Cost

There is likely a cost for using AI scribe (many academic centers have it for all providers). For anyone currently using scribes, this cost is significantly cheaper than human scribes (on average about 10 times cheaper). AI scribes range in price, especially depending on your practice size, but is typically a few hundred dollars a month per provider. 

Time

Saving time is one of the biggest pros to using the AI scribe. It saves physicians time as well as  improving the patient/physician relationship as the physician can focus more on the patient. However, there are some adjustments to using AI scribes. New templates need to be made. I personally have found that it works well for the history and for the assessment and plan, but have not found it helpful for the physical exam or procedures. This has been a common compliant for specialties as many AI scribe systems were first trialed with primary care so it is often not as good with specialty specific documentation.

Training

For those who have had human scribes, there is a lot of training that typically can take many months and there is typically yearly turnover. There is some “training” with using AI scribe in the form of proofreading the note after the visit. While AI scribe is very good at synthesizing the data as well as taking out certain parts of the visit like small talk, it is not perfect. For example, I have found that the AI scribe doesn’t put all the specific surgical risks that I go through with the patient in the note. Our AI scribe is supposed to be able to analyze what has been changed for the future, but so far I have not seen this improve. In quick visits or visits that I have very good templates, AI is not as helpful. However, for the complex visits with multiple problems it has been a game-changer. The time I spend proofreading is less than the time I was using to write notes. I personally have found it better than the human scribes in the amount I change – however, data suggest that AI scribe can have up to 25% error vs. human error is 7% (but this number assumes a trained individual). 

Other documentation

One of the biggest cons of the AI scribe compared to the human scribe is that it currently cannot do any pre-charting. However, there is lots of discussion that AI scribe will be able to do this in the future but it unclear how long it will take for this to happen. Some AI scribes currently have the ability to create discharge instructions for patients. The one I have does not have this feature so I can’t comment on the quality. There is discussion that AI scribe will also help with coding as well as patient messaging in the future.

Medicolegal concerns

The AI scribe listens and records the visit. With this, it is recommended to let the patient know that it is being used. I haven’t had patients request not to use it, but have heard that this can sometimes happen. (I have had a couple patients refuse the human scribe in the room.) It is also important to know how long the recording is kept. (The one I have is a week, so there is no long-term concern about having recordings.) The AI scribe is used through the EMR, so data breech is similar to that of having the EMR itself.

Overall, it is important to weigh out these pros and cons to see if AI scribe is right for you. These will differ depending on your current set up – human scribe vs. templates. I have personally found the AI scribe to be a wonderful addition and for me it works just as well as a human scribe. However, some of my colleagues still prefer the human scribe, but with the advent of AI, it is likely that AI will be the only option in a few years. It is essential to use AI in the early stages to make sure Otolaryngology can personalize it to meet our needs.

Once you decide to utilize AI scribe, there are many options. Here are some of the current options based off of some of the common EMRs (https://emrfinder.com/blog/5-emr-software-systems-with-ai/). Changing your current routine may seem daunting but the advantages of AI will make spending the time to make the change worth it especially knowing how much more it will offer in the future.