AI scribes: guide and resources

The excitement among many doctors about AI scribes is high. In a recent article in the Medical Post magazine, Dr. Rosemarie Lall, a family physician in Toronto said “I will never go back.” She said the burden of paperwork had been so bad she was “dreading” her workday until she got an AI scribe. “It decreases the cognitive load you feel at the end of the day!” For Dr. Ali Damji of Mississauga, Ont., the time-saving is astonishing. He started using an AI scribe at the start of the year and found for a clinic day with 14 patients (mix of in-person and virtual), he now spends a total of 30 minutes after the clinic on all documentation including referrals. He estimates using an AI scribe is saving him at least four hours during the week and at least two or three hours over the weekend. “This is almost like getting a whole day of your life back!” he observed.Still there are many doctors who finish on time, don’t do charting on evenings and weekends, and are able to spend time talking with patients in person. They prepare their charts in advance of the encounter and see no value from changing their workflow with this technology. Their argument is that AI scribe is essentially a new technology that helps inefficient doctors without good administrative support see more patients and do less admin work. They argue it will help a good portion of younger doctors who were never trained to prepare their charts in advance, prewrite their notes or standardize their care.Still the good news is you can’t go wrong even if you choose a vendor that doesn’t last. Experts say lock-in or migration isn’t an issue like clinicians have reported with EMR systems.Of course, with an AI you have to review everything—to check for any “hallucinations”—before you put it in the chart but doctors who like AI scribes find that a lot faster than writing it themselves. It gets the basics done and one only needs to tweak it.Below are resources the Medical Post found during our reporting broken into sections:Key AI scribes in CanadaQuestions for providersDr. Ali Damji’s trial of 3 systemsKey AI scribes in CanadaThe Medical Post looked at seven key AI scribes in Canada: AutoScribe, Docsplain, Empathia, Mikata, Quip, Scribeberry and Tali.CostMost AI scribes offer tiered pricing. We’ve listed the price—as of June 2024—that applies to most doctors but prices range and change rapidly. AutoScribe: $155 (Tier 1)Docsplain: $49.99Empathia: $119 (Basic)Mikata: $129Quip: $89Scribeberry: $99 (Pro)Tali: $135EMR data push-pull availableThis refers to whether one uses cut-and-paste to get the clinical summary from the AI scribe into the EMR or if it can “push” and “pull” data. (That is, it can pull patient data such as patient name, etc., from the EMR and push some info from the encounter into the EMR.) Consider how good the vendor’s service is and how easy it is to set up the EMR integration. Here is status as of June 2024:AutoScribe: Telus PS Suite, OscarDocsplain: Telus PS SuiteEmpathia: OscarMikata: Telus PS Suite, Telus MedAccess, QHR AccuroQuip: Integration with PS Suite and Oscar are now in progressScribeberry: Chrome extension for any cloud-based EMRTali: Oscar Pro, Healthquest, TELUS EMRs coming soonLanguagesHere is of June 2024:AutoScribe: 22Docsplain: 55Empathia: 18Mikata: English, French and 11 other languagesQuip: English (French in development)Scribeberry: More than 30Tali: English, French and SpanishPrivacyAll of the AI scribes looked at by the Medical Post are Personal Information Protection and Electronic Documents Act (PIPEDA) compliant. For patients who have concerns about the AI scribe, Dr. Damji finds they are usually relieved when he “explains to them what PHIPA (Ontario’s healthcare info act) means and that it has the same level of security as our EMRs that I’m charting into.”All of the AI scribe companies provide patient consent forms.“The general sense is it is a low-risk tool but it delivers great results,” said Abhinav Kalra, executive vice-president for connected care at Canada Health Infoway. “In the next two or three years it is going to become a commodity.”Machine learning Do you want your scribe to learn from you and use machine learning at the local level (integrating previous learnings and practices, for example)? Do you want it at the global level (from across your AI scribe’s network)? Many vendors allow you to have a choice about this.Other factors to considerAverage encounter time: For mental health and psychiatry, you want to be sure your system can handle 60-minute encounters.Workflow adaptability: Can the AI scribe pause or consolidate recordings (for example, put a pre-visit dictation and patient visit together)?Questions for providersHere are other things doctors might want to think about or ask the provider about (from a number of sources):Data storageIs all personal health information stored within Canada?Do you store the audio recordings? Do any third parties ever have access to the transcripts or notes (ex. for content monitoring?)Privacy and securityHave any third parties done a review of your privacy and security?Do you transmit any personal information through URLs (ex. URLs with patient names and/or healthcare numbers)Are there any third-party trackers installed within your application (ex. Microsoft Clarity)FeaturesDo you have any additional features that can be bundled with the AI scribe to add more value?SupportWhat is your phone number for support? Do you also have email/ticket support?Dr. Ali Damji trial of 3 systemsThe weight of admin work had been wearing on Dr. Ali Damji. So he made a New Year’s resolution. “OK, I’m gonna try this out,” he said he remembers telling himself. “As of Jan. 2024, I’m going to try implementing AI scribe into my practice.”So he signed up for free trials from Autoscribe, Scribeberry and Tali and experimented with them sequentially at the Credit Valley Family Health Team in Mississauga, Ont. where he practices in January. He also partly did the trials because he’s his clinic’s quality improvement program director. Each AI scribe system had pluses and minuses. None of the three offered integration at the time with his EMR, Accuro so he cuts and pastes from an iPad into her EMR but he finds that easy. Here are the pluses and minuses of the three systems he looked at:AutoScribe• First Al Scribe used• Pros: Two factor authentication, led by U of T DFCM faculty so excellent support provided, lots of templates.• Cons: A bit clunky to use, high cost, loading patients is a large admin burden. (AutoScribe Express version must then be used to avoid this).• Used Tier 1 initially, was upgraded for free to Tier 2 after running into issues with it. Scribeberry• Second vendor used• Given a trial to use for free 20 times per month.• Pros: Very easy to use and launch, easy copy paste function with Accuro Go, very customizable, uses ChatGPT interface so familiar to most users, can generate referrals and other documents in addition to SOAP notes, cheaper than competitors and great level of service, excellent tech support.• Cons: No two factor authentication, some concerns with not always including everything. Tali• Third and final vendor trialed before making a decision• Pros: Very slick and nice looking app, can be used on a mobile device easily, quick to launch, future EHR assistant capabilities, future Accuro integration?• Cons: Expensive, not able to generate referrals or other documents. (Note: a rep from Tali said the system does in fact have a referral template and have had since last year). Bottom line (Dr. Damji’s experience)• Patients have been very supportive• Have even had patients asking “where's the iPad?” if I forget it as they feel it is providing enhanced care for them when I am not distracted with note writing• Most accept the Al scribe (very few do not).• Some have had questions about privacy and security which can be easily answered with the materials from the company/consent form.• Has literally been the best thing I have ever done in my practice to improve joy in work.• All charting/referrals are done when I leave clinic (no after hours charting).• Inbox and forms are under much better control.• I enjoy my encounters with my patients even more (not worrying about charting).• Multiple issue visits are no longer draining as I’m not the one writing about all of it afterwards.• Improved quality of care, referrals, documentation, and e consults. Reflections on adopting the technology• Still takes some time to review the notes.• Far less than writing or dictating them, and the notes are better than if I did them especially when tired.• Need to be OK with “letting go” of some of the nuances of note taking.• You can guide the Al but it's almost like having a real assistant.• Estimate of time saved: For a clinic with 14 patients (mix of in person and virtual), 30 minutes total after the clinic was spent on all documentation including referrals with Al scribe. This included multiple surprise visits and add ons.• Compared to without Al scribe, a similarly booked urgent care clinic created over 1.5 to 2 hours of additional documentation after the clinic. Ultimately he chose Scribeberry.

AI scribes: guide and resources

Register for free access or login.

Related Topics