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Dr. Will Stymiest, a family physician in Fredericton, noticed a big change in a fellow doctor a few months ago: He almost always left the office first.
“Since he started using the AI tool, he was leaving before me almost every day,” Stymiest said, referring to new software that’s used to transcribe and summarize conversations between clinicians and patients. “There’s a little bit of jealousy there. This clearly is making a difference for him. Maybe it could make a difference for me, too.”
A week into trying out the same AI scribe tool himself, Stymiest said he was won over.
“I’ve three small kids [to do] two daycare pickups on the way home, so I have to be out at a particular time. I’m so far spending less time in the evenings and on weekends kind of catching up.”
Ambient artificial intelligence scribe programs are software that uses a microphone to listen to conversations between clinicians and patients. They filter out small talk off the top and then summarize the visit into a structured medical note that the doctor can use to share with other team members — such as physicians, nurses and physiotherapists — and becomes part of the patient’s medical file.
The software also learns or develops its intelligence from extensive datasets of speech samples, such as patient visits.
Stymiest is testing an AI scribe for three months as part of a New Brunswick Medical Society trial of several products.
He said that in addition to his practice, he also sees how it might benefit the province’s health-care system. Stymiest figured if he consistently cuts 30 minutes of paperwork daily, he could see up to three additional patients per day, including new ones. In a province with 92,000 people on a waitlist for a primary care provider as of April, the scribes could play a small part in shortening that list.
Fewer hours spent on paperwork
Other provinces are also interested. The Ontario Medical Association (OMA) recently had physicians evaluate AI scribes to see if they could be used in doctors’ offices and hospitals to save physicians time and improve their quality of life.
Dr. Onil Bhattacharyya, director of the Women’s College Hospital Institute for Health System Solutions and Virtual Care (WIHV) in Toronto, helped evaluate six AI scribes on such measures as the accuracy and quality of the medical notes and their ability to handle multiple speakers and accents.
Competition among physicians was fierce. “We had 1,000 people sign up for 150 spots,” he said. “It’s not quite Taylor Swift tickets, but it’s close.”
To Bhattacharyya, physician interest in AI scribes reflects how they address a pressing problem: “punishing” administrative burdens, including documenting patient visits.
In April, the Ontario government published a list promoting ways for family doctors to “put patients before paperwork” that included AI scribes. The province noted AI scribes will only be used during a visit if the patient gives their consent, and the privacy of patient health information will continue to be protected under existing legislation.
Alberta’s College of Physicians and Surgeons and the Canadian Medical Protective Association offer similar guidance as about 30 vendors are now vying for a piece of the AI scribe pie in medicine.
Ontario funded a study by OntarioMD, WIHV and others to evaluate how AI scribes reduce the administrative burden in primary care. Family doctors reported spending three hours less per week on administrative tasks after-hours when using AI scribes.
Scribes allow ‘quality time’ with patients
Scribes in health care aren’t new. Doctors have long dictated patient notes into recorders to have them typed up later, and a few physicians in Canada still turn to medical scribe paraprofessionals to prepare the summaries.
Dr. Vandana Ahluwalia, a rheumatologist in Brampton, Ont., uses a medical scribe — a paraprofessional she trained herself — as well as an AI scribe.
The human scribe “changed my life completely,” Ahluwalia said. Like Stymiest, she said she was stuck writing her medical notes in the evenings and on weekends.
Ahluwalia said the demands began about 10 years ago when the province started to move to electronic health records. While the amount of information that goes into a patient’s chart electronically adds to the quality and legibility, she said, it also contributes to “overflowing” paperwork.
Now, Ahluwalia uses her medical scribe, Dilnoor Sidhu, for rheumatology patients she has seen for years. She prefers how Sidhu highlights key points from a patient’s previous visits, which current AI tools can’t do, and he performs other administrative work in the office.
“I can spend quality time” with patients and “be a lot more empathic,” she said. Plus, she said, she now has time to do more complex physical exams.
But medical scribes are rare in Canada, Ahluwalia acknowledged, and there are no training programs in this country. For family physicians struggling with documentation, she said AI scribes are a good option.
Dr. Tahmeena Ali, a family physician in South Surrey, B.C., has been using an AI scribe tool for about eight months.
Ali estimated the tool saves her at least 20 per cent of her time, and by being more efficient, she sees patients with appointments on time.
“I think most of them recognize that anything that can help me with my job and provide better patient care and decrease the chances that I’m going to leave family practice ultimately benefits them in the end.”
Doctors weigh cost and other drawbacks
But AI scribes aren’t perfect. Ali provided an example of how the tool misinterpreted information: Based on its training from what other family physicians often suggest for back pain, the AI scribe added specific back exercises that Ali never mentioned herself. Each time a patient had a similar back issue, Ali would have to delete the incorrect text.
Another disadvantage, said Fredericton family doctor Stymiest, is that, so far, the AI scribe tool can’t pick up everything that goes on during the appointment, such as how a patient appears or acts.
Patients seem to accept the introduction of the AI tool at their appointments. Stymiest said no one in his practice has declined consent to using it so far, and only one of Ali’s 900 patients said no.
The physicians said they explain to their patients how the tool works in the background, listening in on the visit and transcribing the conversation. Often the recordings themselves are not kept, just the notes generated.
Federal guidelines on AI in medicine generally recommend FASTER principles:
- Fair when it comes to including or amplifying bias.
- Accountable, such as accurate notes that comply with laws and ethics.
- Secure at classifying information and protecting privacy.
- Transparent, such as notifying users they’re interacting with an AI tool.
- Educated on the tool’s strengths and limits.
- Relevant at improving outcomes.
In Ontario, Bhattacharyya said hospital networks like Unity Health have added an AI medical scribe tool to patient care. Women’s College Hospital, where he’s a family physician, is still weighing the risks and benefits of the tool, including its cost. At $400 per month, multiplied by the 100 doctors on staff, the cost of adopting the AI scribe could be prohibitive.
Bhattacharyya said for family doctors working in the community, the costs range from $100 to $400 a month, which many balked at in the Ontario report. Prices could come down with bulk purchases, he said.
A new Canadian study found that an artificial intelligence early warning app helped prevent unexpected hospital deaths by 26 per cent. The technology isn’t meant to replace medical staff, but serve as an additional tool for patient care.
In Canada, the next step is to incorporate AI scribes into electronic health records so clinicians don’t have to copy and paste from different software programs, Bhattacharyya said.
Dr. Vincent Liu, chief data officer for the Permanente Medical Group and senior research scientist at the Kaiser Permanente’s research division in California, wrote about the benefits of incorporating AI into electronic health records in the New England Journal of Medicine. He’s looking ahead.
“I don’t think that patients or clinicians are ready to take humans out of the loop or let AI make critical decisions or be, you know, driving those decisions without human oversight,” Liu said in an interview.
“I see AI in health becoming part of the standard way that we take care of patients, and I think that it won’t be long in the future where patients themselves are wanting to receive care that’s AI informed.”