Electronic medical records (EMRs) have been a tremendous benefit in exam rooms across the country, creating secure patient history databases that clinicians can easily access and update. Yet, they can also detract from the doctor-patient experience, as physicians must type notes into the system rather than devote their complete attention to patients.
To help put physicians back in front of their patients — and away from their keyboards — UC Davis Health has adopted an artificial intelligence (AI) scribe, which automatically records and transcribes conversations during medical visits. These systems preserve detailed medical notes so physicians can focus on their patients.
In preparation for the digital tool's rollout, UC Davis Health conducted a comprehensive survey to evaluate patient perceptions of the technology. The results, which informed how the scribe was implemented, were recently published in the Journal of Medical Internet Research (JMIR) Medical Informatics.
"We weren't sure how patients would respond to these AI transcriptions," said Gary Leiserowitz , Obstetrics and Gynecology chair and lead author on the paper. "There was little information from other institutions, so we worked with our patient experience colleagues to understand how patients might feel about it."
Survey results
The survey was emailed to more than 9,000 patients and around 1,900 responded. While 73% felt they were being heard during clinical visits, 23% stated their doctors were more focused on notetaking than on them.
"A lot of people feel medical documentation is a necessary evil, but hate it when their doctors are sitting in front of the computer, trying to record everything they're talking about," Leiserowitz said. "They feel like that connection is lost."
In the survey, 48% of respondents reported that an AI scribe would be a good solution, while 33% were neutral and 19% had concerns. Younger patients (18-30 years old) were more skeptical about the technology than older patients.
Patients were mostly worried about note accuracy (39%), privacy and security (13%) and the prospect of being recorded (13%). Many of the associated comments expressed concerns that the recordings could be hacked. Around 10% felt it would be bad for physicians and staff.
A seamless transition
When patients were asked when was the best time during their care experience to be informed that a digital tool would be taking notes, they strongly favored early notifications: They wanted to know while making an appointment, arriving at their doctor's office or checking in at a clinic. Most (57%) preferred to be notified face-to-face, while many (45%) were OK with email.
Results of the survey provided UC Davis Health with valuable guidance on how to communicate the transition to AI scribe. The team incorporated multiple educational touchpoints to get buy-in, prioritizing face-to-face discussions with patients.
"One of our important takeaways from the survey was that we had to educate patients about what the AI scribe could and could not do," Leiserowitz said. "Security was a big deal so, when we were vetting vendors, we made sure they only use domestic servers. And while the AI notes go into the EMR, the recording itself disappears within 10 days."
In addition, to ensure complete accuracy, the clinician checks and edits the notes before they are placed into the EMR. Patients can also review and advise their clinicians on possible corrections. Ultimately, if a patient is not comfortable with the system, they can opt out.
At UC Davis Health, a dedicated analytics oversight committee reviews all advanced analytics models, including those powered by AI, that are used in clinical decision-making. The committee's goal is to develop a streamlined and innovative approach that ensures health AI is implemented responsibly, ethically and effectively — always with the best interests of patients and the community in mind
"This often comes down to the quality of the relationship between the doctor and the patient," Leiserowitz said. "If the patient trusts us and understands why we're using it, they tend to accept it. That's why education is such a critical factor. It helps patients get comfortable with the technology."
