Ambient scribe technology all the rage despite uneven interest and ‘still imperfect’ performance

As applications of AI spread rapidly across healthcare, ambient scribes are poised to become one of the fastest technology adoptions in the history of the sector, according to discussions conducted and analyzed by the Peterson Health Technology Institute in New York City. 

Today, approximately 60 ambient scribes are being implemented in practice, according to the PHTI market research report describing the project’s findings. “In an industry with notoriously long sales cycles and implementation timelines,” the authors state, “there is no technology in recent memory that has been adopted more enthusiastically by clinicians or has scaled so uncharacteristically fast, absent a regulatory mandate.”

In a section on early uptake and adoption, the analysts list five observations they made by reviewing the material generated by the discussions. 

1. Interest in ambient scribe technology is uneven across specialties. 

Some organizations report strong uptake beyond primary care, including in emergency medicine and surgical and procedural specialties, the authors report. “Interestingly, several organizations observed that those who benefited the most were not their tech-savvy early adopters, as those individuals had typically already optimized their documentation processes with dot phrases and templates,” they add. More: 

‘The clinicians experiencing the greatest benefits were those who had not yet optimized their current EHR-based clinical documentation workflows, were consistently behind in notes, spent more time in conversation with their patients or typically had longer summary notes.’ 

2. Adoption has been slower in certain subspecialties. 

When ambient scribe is widely available, adoption rates are typically 20–50%, PHTI reports. “However, one organization achieved 75–80% adoption in the clinical areas where it has been offered, which they attributed to a deliberate emphasis on note customization followed by hands-on training.”

‘Mass General Brigham shared that approximately 90% of its ambulatory primary care physicians have requested access to ambient scribe.’

3. Among those using ambient scribes, consistency of use is variable. 

“Typically, there is a cohort of ambient scribe superusers; a cohort using it for some but not all visits; and a cohort of low- or no-use clinicians, including those who tried it but stopped,” the analysts write. Meanwhile, PHTI found, those who have stopped using ambient scribe cited several reasons: the generated notes did not reflect their personal style or voice, they had minimal time or bandwidth to fully engage with the adoption process, they had already optimized their note-taking process and saw minimal efficiency gain, or the tool did not adequately support the languages spoken by their patients. 

‘One organization shared that, in the ambulatory setting, if a provider is an active user of ambient scribe, they use it for 30–40% of visits.’

4. While effective at documenting patient-clinician interactions, the technology is still imperfect.

Feedback suggests that some ambient scribes have difficulty summarizing complex interactions—like case conferences or discussions with patients and multiple caregivers—as the technology is not always able to accurately discern different voices. “From a clinical perspective, errors in documentation, such as attributing notes to the wrong person or ignoring critical details, pose risks,” the authors write. 

‘There is also the potential for technology hallucinations, whereby incorrect information is included as part of the visit summary.’ 

5. Some organizations are eager to experiment with applications of ambient scribe beyond ambulatory clinicians.

Yale New Haven Health, for example, is piloting ambient scribe with other types of providers who spend a lot of time with patients, such as residents, physical and occupational therapists, pharmacists, and social workers, PHTI reports. “Another organization suggested an efficiency opportunity for clinicians who need to reference each other’s notes in the inpatient setting,” the authors add. “For example, a nutritionist can review a note that was written by the attending clinician in a format that is relevant and applicable to their work.” 

‘Several are leveraging ambient scribe in the emergency department and looking forward to expanding to other hospital-based clinicians.’

There’s a good deal more in the 38-page report, which is posted here.