Duggan Matthew J, Gervase Julietta, Schoenbaum Anna, Hanson William, Howell John T, Sheinberg Michael, Johnson Kevin B
Department of Information Services, University of Pennsylvania Health System, Philadelphia.
Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania.
JAMA Netw Open. 2025 Feb 3;8(2):e2460637. doi: 10.1001/jamanetworkopen.2024.60637.
Timely evaluation of ambient scribing technology is warranted to assess whether this technology can lessen the burden of clinical documentation on clinicians.
To investigate the association of ambient scribing technology with efficiency, quality, and perceived burden of clinical documentation in the outpatient setting.
DESIGN, SETTING, AND PARTICIPANTS: This prospective, single-group pre-post quality improvement study was conducted between April and June 2024 in the outpatient setting of an academic health system in Philadelphia, Pennsylvania. Participants included physicians, nurse practitioners, and physician assistants. Data were analyzed from July to August 2024.
Access to an artificial intelligence-driven ambient scribing tool for outpatient notes.
The primary outcomes were time in notes per appointment, same-day appointment closure, after-hours work time, perceived burden of clinical documentation, and comments on clinicians' experiences using ambient scribing. A mixed-effects model was used. Both objective metrics and survey feedback were obtained. Targeted perspective questions, designed to assess clinician-perceived patient engagement and perceived documentation burden, were assessed on a 7-point Likert scale. Standard System Usability Scale (SUS) and net promoter score (NPS) formulas were used to analyze usability and recommendability data.
This study included 46 clinicians from 17 different medical specialties, with a mean (SD) of 11.1 (8.7) years in practice. From baseline to post intervention, use of the ambient scribing tool was associated with 20.4% less time in notes per appointment (from 10.3 to 8.2 minutes; P < .001), 9.3% greater same-day appointment closure (from 66.2% to 72.4%; P <.001), and 30.0% less after-hours work time per workday (from 50.6 to 35.4 minutes per workday; P = .02). Targeted perspective questions showed more favorable scores. Open-ended qualitative feedback from clinicians showed a range of positive, negative, and mixed feedback regarding their use of ambient scribing technology. SUS scores showed that the ambient scribing tool was easy to use. NPSs reflected the mixed qualitative feedback.
In this quality improvement study, the use of ambient scribe technology was associated with greater efficiency of outpatient clinical documentation, lower mental burden of documentation for clinicians, and greater sense of engagement with patients during outpatient appointments. Additional studies exploring urgent care settings, examining patient experience, and comparing multiple tools will be important to better understand the effect of ambient scribing on ambulatory care.
及时评估环境抄写技术很有必要，以确定该技术是否能减轻临床医生的临床记录负担。
调查环境抄写技术与门诊环境中临床记录的效率、质量及感知负担之间的关联。
设计、地点和参与者：这项前瞻性单组前后对照质量改进研究于2024年4月至6月在宾夕法尼亚州费城一个学术医疗系统的门诊进行。参与者包括医生、执业护士和医师助理。数据于2024年7月至8月进行分析。
可使用人工智能驱动的门诊病历环境抄写工具。
主要结局包括每次预约记录时间、当日预约完成率、下班后工作时间、临床记录的感知负担以及关于临床医生使用环境抄写体验的评论。使用了混合效应模型。同时获取了客观指标和调查反馈。旨在评估临床医生感知的患者参与度和感知记录负担的针对性视角问题采用7分李克特量表进行评估。使用标准系统可用性量表（SUS）和净推荐值（NPS）公式分析可用性和推荐性数据。
本研究纳入了来自17个不同医学专科的46名临床医生，平均从业时间为11.1（8.7）年。从基线到干预后，使用环境抄写工具使每次预约记录时间减少了20.4%（从10.3分钟降至8.2分钟；P <.001），当日预约完成率提高了9.3%（从66.2%提高到72.4%；P <.001），每个工作日的下班后工作时间减少了30.0%（从每个工作日50.6分钟降至35.4分钟；P = 0.02）。针对性视角问题显示得分更有利。临床医生的开放式定性反馈显示，他们对环境抄写技术的使用有一系列积极、消极和混合的反馈。SUS评分表明环境抄写工具易于使用。NPS反映了混合的定性反馈。
在这项质量改进研究中，环境抄写技术的使用与门诊临床记录效率提高、临床医生记录的心理负担降低以及门诊预约期间与患者的参与感增强相关。进一步开展探索紧急护理环境、检查患者体验以及比较多种工具的研究，对于更好地理解环境抄写对门诊护理的影响至关重要。
