Ambient scribing reduces cognitive burden of documentation

New research published in JAMA Network Open suggests that ambient scribing is associated with reduced cognitive burden of clinical documentation.    

Researchers conducted the pre-post quality improvement study between April and June 2024 in the outpatient setting of an academic health system. After receiving brief training on ambient scribe technology, a group of clinicians, including physicians, nurse practitioners and physician assistants, gained access to the scribing tool. 

The study combined objective metrics and survey feedback to assess healthcare providers’ experiences using ambient AI for clinical documentation. 

From baseline to post-intervention, the use of the ambient scribing tool was associated with 20.4% less time in notes per appointment. What’s more, the use of ambient AI increased same-day appointment closure by 9.3% and decreased after-hours work time by 30.0% per workday. 

Survey responses also underscored that ambient AI was associated with reduced cognitive burden of documentation on clinicians. Clinicians reported using ambient AI-generated notes to help recall their patient encounters with a level of detail they would not have documented themselves. Additionally, many clinicians said building off ambient scribe-generated notes was easier than writing clinical notes from scratch.  

Still, the study authors emphasized that while clinicians viewed these ambient scribing functions positively, there are potential downsides of ambient scribing for clinical documentation. 

For instance, though the findings suggest that the time and cognitive effort saved with ambient scribing was associated with a better clinician experience and increased focus on patients, the authors noted that the use of ambient scribe-generated notes could decrease clinicians’ opportunities to reflect while note-writing, thereby limiting instances to address missed diagnoses or treatments.  

Additionally, the post-use survey feedback further indicated that ambient scribing was not yet providing a “keyboardless” experience.  

“To some clinicians, the need to review and edit was insignificant, but for others, it was cited as a reason not to use the current version of ambient scribing,” the study authors wrote. 

The study also found an association between ambient scribing and longer note length, which may raise concerns about the inclusion of unnecessary or redundant details that bury medically pertinent information, also known as “note bloat.” 

However, researchers have also observed increased note length with the use of medical scribes, so this is not a challenge unique to ambient scribing.  

Notably, clinicians participating in the study expressed optimistic pre-pilot opinions about ambient scribing, which may have biased the findings. 

Despite their initial optimism, survey data revealed lower optimism among some clinicians after using ambient scribing. These providers may have come from specialties where the workflow was less conducive to the current ambient scribing approach, the study noted. Additionally, they may have had unrealistic expectations about the tool.  

The authors noted that current ambient scribing products may be a better fit for some clinicians or organizations than others. For instance, clinicians who are seeking a fully “keyboardless” solution or are particular about the style of their notes may find current ambient scribe tools unsatisfying, they wrote.  

Overall, while clinicians expressed differing opinions about the accuracy and completeness of ambient-generated notes, on average, these clinicians viewed ambient scribing positively after using it for seven weeks. 

“These findings are encouraging and provide support for longitudinal trials across a variety of subspecialties to fully assess the effectiveness of ambient scribing across a health system, which will be important to justify costs in the current business models for purchasing this technology,” the researchers wrote. “Ongoing feedback from clinicians and patients is needed to inform future development and strategic investments in ambient scribing.” 

Hannah Nelson has been covering news related to health information technology and health data interoperability since 2020.