AI scribes slash physician documentation time and reduce burnout

Artificial intelligence (AI) scribes can reduce the time physicians spend documenting patient visits by 69.1% during simulated primary care appointments, according to research led by University of Toronto PhD student LaShawn Murray.

The study - published in the journal JAMIA Open, and co-authored with University of Toronto professor Enid Montague and Dr. Onil Bhattacharyya of Women's College Hospital - involved nine physicians completing simulated patient encounters both with and without the use of AI scribes. These digital tools are capable of recording audio and using it to generate structured, regulatory-compliant clinical notes for a patient's medical chart - the record physicians use to document their care. 

The researchers used video recordings of each appointment to analyze how physicians spent their time. They found that when the scribes were in use, the doctors spent significantly less time documenting. 

"We know healthcare workers are experiencing burnout, which is associated with compromised patient safety and increased potential for errors, and can contribute to physician turnover," says Murray. 

"We also know that administrative tasks contribute to said burnout, so we want to find ways to reduce that strain." 

The study is part of a multi-phase project between University of Toronto's Wellness and Health Enhancement Engineering Lab and the Centre for Digital Health Evaluation, Women's College Hospital Institute for Health System Solutions and Virtual Care. The team's previous research compared the usability and performance of six AI scribe products; only the three performing tools were then used in this subsequent study. 

Without the AI scribes, physicians spent more than one-third of each simulated patient encounter on note taking. In addition to saving time during the patient interaction, Murray hopes incorporating AI will lead to more timely documentation. 

Documentation often gets delayed because there's just so much to do and the days are so busy; this can make it less accurate. 

I hope with this technology we see a reduction in things like charting being done after hours or days later. That would also create a reduction in cognitive labor with physicians having to remember what happened during appointments that occurred days prior." 

LaShawn Murray, PhD student, University of Toronto  

Researchers also observed an unexpected change in how some physicians kept track of their thoughts during appointments where AI scribes were used. The shift in workflow highlighted the role note taking can play in diagnosis. 

"The most interesting finding for me was seeing how physically creating the charts throughout the appointment prompted thinking and more clinical decision-making questions from the doctors," says Murray. 

"When the scribes were in use, we saw the adoption of scratch pads for note taking to help physicians remember to ask follow-up questions." 

With the scribes, instead of spending appointments switching between the patient and typing on the computer, physicians documented differently. Rather than charting throughout, physicians shifted toward reviewing and editing the AI-generated documentation after it had been produced. This resulted in fewer interruptions during the simulated encounters. 

One of the overarching goals of the project is to generate Ontario-specific research around AI technology in healthcare as Ontario physicians operate within different privacy regulations than their U.S. counterparts, which could affect how AI scribes are integrated into clinical practice. 

"When the studies were first coming out, we were seeing them come from these large U.S.-based hospital systems," says Murray. 

"So for us, it was really about focusing on the Canadian context and, even more specifically, within Ontario. It's not to say that we were the only ones in the space, but there was a gap in the literature looking at how AI impacts primary care delivery and what that means for Canadian healthcare." 

Murray, who has been studying AI scribes since 2023, has seen changes to the technology itself, with more customizable features and better integration into existing platforms but also in the conversations around the technology's potential. As the technology has become more widely adopted, expectations have also begun to change. 

"When the technology was new, the conversation was very much that this would solve all our problems," says Murray. 

"Now that's shifted to, 'hey maybe this is just one piece of the overall documentation burden that we're seeing,' because charts are not the only administrative burden facing physicians. We're also thinking about things like referrals, prescription orders, billing and regulatory expectations that are contributing to administrative work." 

While the study relied on simulated patient encounters, more research will be needed to understand how AI scribes perform in everyday clinical practice. 

For example, as the technology is more widely adopted, Murray wants to know how receptive patients will be to the use of AI scribes in the course of their care. 

"Are they appreciative of the differences in communication? Are there hesitancies in terms of being recorded and who has access to these recordings," says Murray. 

"I wonder about the impact for different patient populations as well. What happens when physicians who are almost always using AI scribes suddenly have one patient that doesn't consent to it being used in their care? This research has opened a lot more discussions and possibilities to consider."