When Jeannine Urban went in for a checkup in November, she had her doctor鈥檚 full attention.
Instead of typing on her computer keyboard during the exam, Urban鈥檚 primary care physician at the practice in Media, Pennsylvania, had an ambient artificial intelligence scribe take notes. At the end of the 30-minute visit, Urban鈥檚 doctor showed her the AI summary of the appointment, neatly organized into sections for her medical history, the physical exam findings, and an assessment and treatment plan for her rheumatoid arthritis and hot flashes, among other details.
The clinical note, which Urban could also review on the patient portal at home, was incredibly thorough, she said. It summarized all of her questions and concerns and the doctor鈥檚 responses. The scribe 鈥渕ade sure we didn鈥檛 miss anything,鈥 Urban said.
Ambient AI scribes are being hailed by physicians as a game changer that helps free them to focus on their patients rather than their computer keyboard. By releasing doctors from the onerous and time-consuming task of documenting what happens during every patient encounter, , AI scribes may help reduce physician burnout and after-hours 鈥減ajama time鈥 catching up on work in the evening.
The potential of AI to transform every aspect of the health care system 鈥 from patient care to clinical efficiency to medical innovation 鈥 is an area of intense focus, including by the Trump administration.
Last January, President Donald Trump issued an to remove barriers to American leadership in AI. Later in the year, a from the federal Department of Health and Human Services invited stakeholders to weigh in on how the department can accelerate the adoption of AI in health care.
Several startup vendors in recent years have introduced ambient AI scribe products that can be integrated into electronic health records. EHR market leader Epic is technology, which it expects to release widely early this year, according to , a family medicine physician who is chief medical officer and vice president of clinical informatics at Epic.
Health tech experts estimate that a third of providers have access to ambient AI scribe technology. As adoption looks likely to grow rapidly over the next few years, many expect it to become more of a recruiting tool, a minimum requirement for incoming clinicians, who are increasingly prioritizing work-life balance.
鈥淚t鈥檚 part of keeping doctors happy,鈥 said , a professor and the chair of the Department of Medicine at the University of California-San Francisco, whose forthcoming book, , explores how AI is transforming health care. 鈥淗ealth systems that initially might have done a hard-nosed return-on-investment calculation 鈥 many are softening on that and realizing that the cost of recruiting and retaining doctors is pretty high.鈥
But many questions remain. Does the use of ambient AI scribes improve patient care and health outcomes? Will doctors use time they gain by employing an AI scribe to improve the quality of the time they spend with their patients or just boost the number of patients they see? To what extent will expanding the amount of detail available from a patient visit lead to bigger bills if the AI scribe is integrated with a coding app that optimizes provider charges?
For now, these questions remain mostly unanswered.
Urban said that the AI scribe didn鈥檛 change her experience as a patient very much. Typically, after a patient gives verbal permission, the AI scribe records the visit on a phone and organizes the conversation into the structure of a clinical note, filtering out small talk that isn鈥檛 pertinent to the medical visit but incorporating relevant details about a family member鈥檚 recent cancer diagnosis, for example. The scribe鈥檚 note is often then integrated into the provider鈥檚 EHR. The doctor later reviews the note and signs off on it.
Even though the visit may not feel very different to patients, some clinicians report that ambient AI scribes are changing patient encounters in unanticipated ways.
鈥淣ow, when I鈥檓 doing a physical exam, I have to say what I鈥檓 doing and what I鈥檓 finding out loud in order for the AI scribe to document it,鈥 said , Urban鈥檚 primary care doctor. 鈥淧eople find that very interesting,鈥 she said.
When Capalongo places her stethoscope over the carotid artery under a patient鈥檚 jaw, for example, she might say that she doesn鈥檛 hear a 鈥渂ruit,鈥 or vascular murmur, whose presence could indicate atherosclerosis. Patients have told her, 鈥淚 never knew why a doctor would listen there,鈥 she said.
Saying things out loud for the AI scribe that would typically appear only in a clinical note can create its own set of challenges, particularly during sensitive physical exams. Doctors may feel it鈥檚 important to adjust their conversation accordingly.
鈥淪ometimes patients are anxious and scared and my saying things that they don鈥檛 understand or they may worry about during an uncomfortable examination does not help the situation and honestly is insensitive to what the patient is going through,鈥 said , a professor in the Division of Colon and Rectal Surgery at the University of Minnesota, who is also chief health informatics and AI officer at Fairview Health Services in Minneapolis. 鈥淚鈥檒l keep that top of mind and make sure I record it鈥 after the visit.
鈥淗ow we have conversations with patients about these tools is really important, in particular for maintaining trust and ensuring accurate information,鈥 Melton-Meaux said.
Studies have found that, across a range of measures such as completeness, timeliness, and coherence, the notes created by ambient AI scribes are generally at least as good as, and sometimes better than, traditional documentation, said , a pediatrician who is vice president for applied informatics at the University of Pennsylvania Health System.
An ongoing concern is around AI 鈥渉allucinations,鈥 in which false, sometimes fabricated information appears in an AI output.
Kaiser Permanente, an of ambient AI scribe technology, provides it to more than 25,000 doctors, advanced practice providers, and pharmacists systemwide. It has found hallucinations to be 鈥渜uite rare,鈥 said , an internist who is vice president of AI and emerging technologies at KP.
But they happen. An AI-scribe-generated note, for instance, might say that the doctor planned to refer someone to a neurologist or to follow up in two weeks. The problem? The doctor might not have said that.
鈥淭he technology is not perfect, and that鈥檚 why physicians are reviewing it,鈥 Yang said. It鈥檚 learning from regular physician visits as it goes, he said. That鈥檚 why having a person check the work product is critical.
Still, even such a 鈥渉uman-in-the loop鈥 system is fraught, Wachter said. 鈥淗umans stink at maintaining vigilance over time,鈥 he said.
As the use of ambient AI scribes becomes routine, some clinicians worry that the technology will widen the divide between health care haves and have-nots.
Large health systems are able to move forward with the technology, Melton-Meaux said. But what about critical access hospitals or small private practices? 鈥淭here need to be more resources,鈥 she said.
Physicians鈥 enthusiasm for ambient AI scribes stands in sharp contrast to their negative reaction to electronic health record systems that have become widely adopted in recent years to replace paper charts.
鈥淒uring the last 10 years, when EHRs became a thing, we all became very grumpy, overworked data scribes,鈥 Wachter said.
The introduction of AI scribes makes physicians feel like technology is working for them rather than the other way around, health care AI experts said.
And AI scribes are 鈥渢raining wheels鈥 for more consequential adoption of AI in health care, Wachter said.
To improve health care value and save costs, Wachter said, we need a system that makes it more likely that physicians will practice evidence-based medicine to order the right tests and prescribe the right medications.
鈥淚t鈥檚 a few years away, but it鈥檚 all AI-dependent,鈥 he said.
Epic has introduced roughly 60 AI use cases for patients, clinicians, and administration, with over 100 more in the works.
鈥淚t’s so much bigger than a scribe,鈥 said Epic鈥檚 Gerhart. 鈥淚t’s literally listening and acting in a way that tees things up for me so that I can take action.鈥