Report: Ambient Scribes Help With Burnout, But Financial Impact Unclear
A Peterson Health Technology Institute (PHTI) report suggests that while ambient scribe technology is likely improving clinician burnout, the financial impact on health systems is unclear.
The report is based on extensive interviews and convenings with health system leaders, leading AI companies, and industry experts participating in PHTI’s AI Taskforce.
The Peterson report notes that physician adoption has been uneven. 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.
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, the report said.
“User experience and rigorous outcomes analysis are critical for getting any new technology right, especially one with such immense potential,” said Christopher Longhurst, M.D., M.S., chief clinical and innovation officer at UC San Diego Health and executive director of the Jacobs Center for Health Innovation, in a statement. “Our health system started piloting ambient scribes within the last year, and the insights gleaned from PHTI’s AI Taskforce will help inform our decisions around broader implementation and measurement.”
In a competitive marketplace, the report noted, ambient scribe companies are differentiating by expanding the user base into nursing and other clinical roles; extending into the revenue cycle and adjacent administrative workflows; integrating more deeply into clinical workflows, such as visit preparation, referrals, and orders; and offering highly customized or co-developed ambient scribes at the specialty level.
The evidence base for ambient scribes improving efficiency directly by reducing documentation time and, thereby, creating capacity is limited; however, the report notes that as the technology and implementation processes improve, time savings may become more apparent.
As ambient scribes extend into coding with the promise of optimizing evaluation and management (E&M) and hierarchical condition category (HCC) coding, the report notes that 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.
The Peterson report found that 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.
Provider organizations participating in the research are at various stages of piloting, scaling, and deploying ambient scribes within their organizations. Senior executives from CommonSpirit Health, Intermountain Health, Mass General Brigham, MultiCare, Ochsner Health, Providence, UC San Diego Health, and Yale New Haven Health participated in the Taskforce. The Taskforce was co-led by Prabhjot Singh, MD, PhD, and Margaret McKenna, both advisors to PHTI.
Other experts who provided assistance to the Taskforce represented Abridge, Andreessen Horowitz, Bessemer Venture Partners, Commure, DeepScribe, Elion, Flare Capital Partners, Fourier Health, HLM Investment Partners, Infinitus Systems, Kaiser Permanente, Microsoft, Nabla, Oliver Wyman, Oracle Health, R1, Stanford Health Care, Stanford Institute for Human-Centered Artificial Intelligence, Suki, and UPMC. Manatt Health provided facilitation and research support for the Taskforce.
