International Journal on Bioinformatics & Biosciences (IJBB) Vol 14, No.

1, March 2024

AI SCRIBES: BOOSTING PHYSICIAN EFFICIENCY IN

CLINICAL DOCUMENTATION
Omosalewa Itauma1,2 and Itauma Itauma3
1,2
Department of Obstetrics & Gynecology, Wayne State University School of Medicine,
Michigan, USA
3
DeVos Graduate School of Management, Northwood University, Michigan, USA

ABSTRACT
The increasing demand on healthcare systems has amplified the burden on physicians and other healthcare
professionals, with a huge portion of time dedicated to documenting patient encounters. Prolonged
charting periods not only contribute to decreased physician productivity but also emerge as a prominent
factor in physician burnout. This study investigates the potential of Artificial Intelligence (AI) to mitigate
this challenge, focusing on AI-powered medical scribing as a solution to alleviate the burden of traditional
charting methods in documentation of patient encounters and improve overall physician productivity. This
research contributes to the ongoing discourse on the role of AI in healthcare and seeks to inform
healthcare professionals, administrators, and policymakers about the potential benefits of integrating AI-
powered medical scribing to improve physician efficiency and mitigate the impact of extensive charting on
overall productivity and well-being.

KEYWORDS
Physician Productivity, Artificial Intelligence (AI) scribes, Electronic Health Records, Charting, Physician
Burnout

1. INTRODUCTION
In the ever-evolving landscape of healthcare, the role of physicians and other health care
professionals have become increasingly demanding, with a substantial portion of time dedicated
to the meticulous task of charting on the electronic health record (EHR) [1,2]. For every hour
physicians spend on direct clinical care, up to two additional hours are spent on EHR and
administrative related tasks during the clinic day [2]. These tasks are not limited to office hours,
with physicians investing an extra one to two hours each night for additional EHR-related and
clerical tasks [2]. The advent of electronic health records (EHRs) was intended to streamline
documentation processes, yet physicians find themselves grappling with prolonged charting
periods, adversely affecting both productivity and overall job satisfaction [1]. This study delves
into a transformative solution—Artificial Intelligence (AI)—to mitigate the challenges posed by
traditional charting methods. By harnessing the power of AI with AI-powered medical scribing,
we aim to not only alleviate the burden of documentation but also create a paradigm shift towards
a more efficient and fulfilling healthcare ecosystem.

2. THE CHARTING CONUNDRUM: A DRAIN ON PHYSICIAN PRODUCTIVITY

As physicians navigate the intricate web of patient encounters, the burden of charting emerges as
a formidable obstacle. The time spent on documentation not only hampers their ability to provide
DOI: 10.5121/ijbb.2024.14102 9
 International Journal on Bioinformatics & Biosciences (IJBB) Vol 14, No.1, March 2024
timely and comprehensive care but also erodes into time that could be spent on direct patient
care, contributing to diminished overall productivity [2,3]. The ensuing challenge is not merely a
matter of time management but also extends to the core of physician-patient relationships and the
quality of healthcare delivery. In a typical patient encounter, the patient narrates their
problems/concerns and answers questions asked by the physician to obtain comprehensive
information about the patient's condition. The physician may chart as the patient is speaking or
after the encounter. Charting on a computer while a patient is speaking can introduce several
challenges for both the physician and the patient. These challenges include a) divided physician
attention where juggling note-taking with listening and understanding makes it more difficult to
fully focus on the patient's concerns which can lead to missed information, misunderstandings,
increased risk of errors in documentation, and a less effective consultation; b) reduced rapport
when the physician is focused on the computer screen, whereby eye contact and nonverbal
communication are diminished, potentially impacting the patient's experience and outcomes; c)
documentation delays with frequent pauses for charting, disrupting the natural flow of the
patient-physician conversation, extending the length of consultation, and limiting the time
available for addressing the patient's concerns.

To mitigate the challenges with documentation while seeing the patient, physicians can choose to
complete charting after the patient encounter. Problems with this approach include a) missed
information due to recalling details from a completed encounter especially for complex cases or
lengthy appointments, leading to inaccurate or incomplete documentation, potentially affecting
treatment decisions and future care; b) time pressure and rushed documentation trying to meet
deadlines for completing medical records, increasing the risk of errors and omissions; and c)
incomplete medical records which can negatively impact patient care as well as patient
satisfaction and engagement in their own care.

3. CHARTING OVERLOAD AND PHYSICIAN BURNOUT

The ramifications of extensive charting are not confined to reduced productivity alone; it also
leads to the alarming rise of physician burnout [4,5,6,7,8]. Data entry in EHRs are often
burdensome, time consuming, requiring extensive documentation, with physicians spending
hours clicking through menus, entering data, and filling out form fields [5,6,7,8]. This takes away
from valuable time they could spend interacting with patients and providing care, leading to
decreased job satisfaction [6]. Accurate and detailed documentation is however important to
demonstrate the rationale behind treatment decisions, to help protect physicians in case of
malpractice claims [9]. Thorough documentation is also important for quality assurance and
research, allowing healthcare institutions to track outcomes, identify areas for improvement, and
advance medical knowledge. Additionally, maintaining accurate and complete medical records
aligns with a physician's ethical obligation to provide the best possible care to their patients. This
includes ensuring that all relevant information is readily available to ensure safe and effective
treatment. The cognitive load of multitasking, entering accurate, thorough, and complete clinical
documentation in an efficient manner in addition to tight schedules and burdensome EHRs
contribute to physician burnout [6,7,8]. This emotional and physical toll on physicians,
exacerbated by the incessant demand for detailed documentation, jeopardizes their well-being
and compromises the very essence of compassionate healthcare [6,7,8]. Addressing the root
causes of burnout becomes imperative for sustaining a resilient healthcare workforce. In March
2020, the Department of Health, and Human Services (HHS) issued a report delineating three
main objectives to alleviate clinician burdens associated with EHRs that impact patient care:
diminish the time and effort needed for clinicians to document health information, streamline
compliance with regulatory requirements, and enhance the overall ease of use of EHRs [1,10].

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4. AI AS A SOLUTION TO IMPROVE CLINICAL DOCUMENTATION

EFFICIENCY
Physician productivity can be assessed by patient visit volume in a specified period [11]. The
burden of manual charting is acutely felt by physicians who grapple with an increasing caseload
and stringent time constraints [12]. The paradox of spending more time on administrative tasks
than patient interactions underscore the urgency for innovative solutions.

In this dynamic healthcare landscape, where time is a finite and invaluable resource, AI
integration in patient charting offers potential benefits that may revolutionize physician efficiency
and redefine the healthcare narrative. By automating routine documentation tasks, AI has the
potential to redefine productivity metrics and liberate physicians to focus on the core tenets of
clinical decision-making and patient care.

4.1 AI-Powered Scribes

An AI-powered medical scribe, also known as AI scribe, is a technology-driven solution that
assists healthcare professionals, particularly physicians, in the documentation and management of
patient information. The role of a human medical scribe involves recording patient encounters,
transcribing medical information, and managing administrative tasks to allow healthcare
professionals to focus more on patient care [15]. AI-powered medical scribes aim to automate
and enhance this process using AI technologies.

4.1.1 Efficiency and Effectiveness of AI-Powered Scribes

Clinical documentation solutions introduced over the years to decrease the burden of traditional
manual data entry include voice dictation systems, transcription services, and human medical
scribes (physical or virtual). Voice dictation systems use advanced speech recognition software to
transcribe verbal input from the physician into written text, facilitating the documentation of
patient information. Medical transcription services involve the conversion of voice-recorded
medical reports dictated by physicians or other healthcare professionals into written text. Medical
scribes are specifically present during patient consultations for clinical documentation in real-
time while being directly supervised by a physician. They operate under the guidance of the
physician and do not have independent responsibilities, but they play a supportive role by
assisting with tasks such as charting and other data entry into the EHR to streamline the
physician's workflow [15].

AI-powered scribes have been shown to have significant advantages over these methods. In one
study, the AI-powered scribe demonstrated a speed approximately 2.7 times greater than both
typing and voice dictation for documentation of the patient's history, and for documentation of
the physical examination, the AI-powered scribe demonstrated a speed approximately 2.17 times
faster than typing and approximately 3.12 times faster than voice dictation [13]. Transcription
services are not performed in real time and may have up to a 24-hour turnaround time [18].
Medical scribes decrease the clinical documentation burden but need the presence of an extra
person and can be expensive with high turnover rates [14,16,17]. In one study, physicians using
medical scribes experienced a 10% increase in productivity with a cost of $98,588 in a year [14].
The AI-powered scribe can execute the tasks handled by medical scribes, simultaneously cutting
costs, and minimizing the personnel required in consultation rooms. These advantages have the
potential to enhance efficiency, lessening the time physicians dedicate to documentation and
opening avenues to broaden healthcare accessibility [16].

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 International Journal on Bioinformatics & Biosciences (IJBB) Vol 14, No.1, March 2024

5. TECHNICAL IMPLEMENTATION OF AI SCRIBES

The technical implementation of AI scribes involves a combination of advanced algorithms, data
processing methods, and integration with existing healthcare IT infrastructure. AI scribes
leverage advanced algorithms to understand and generate human-like text. Natural language
processing (NLP) algorithms and deep learning models, including recurrent neural networks
(RNNs), convolutional neural networks (CNNs), are commonly used for accurate speech-to-text
conversion [19,20]. These models are trained on large datasets of medical conversations to
improve accuracy and adapt to diverse accents and speech patterns.

5.1. Data Processing Methods

Efficient data processing is crucial for the accuracy and effectiveness of AI scribes. Data
processing involves handling healthcare data, ensuring privacy and compliance with regulations
such as the Health Insurance Portability and Accountability Act of 1996 (HIPAA). Enacted in
1996, the Health Insurance Portability and Accountability Act (HIPAA) is a federal law that
mandated the establishment of national standards to safeguard confidential patient health
information, preventing its disclosure without the patient's consent or knowledge [21]. The
HIPAA Privacy Rule, issued by the US Department of Health and Human Services (HHS), serves
as the implementation framework for the stipulations of HIPAA. A primary objective of the
Privacy Rule is to ensure the proper protection of individuals' health information while
facilitating the necessary flow of such information for the provision and advancement of high-
quality healthcare and the safeguarding of public health and well-being [21].

The effective implementation of AI scribes in healthcare necessitates meticulous attention to data

processing methods to safeguard patient privacy and adhere to regulatory frameworks such as
HIPAA. The following subsections elaborate on the crucial preprocessing steps involved in
handling healthcare data within the context of AI scribes:

5.1.1. Data Anonymization and De-identification

To comply with HIPAA regulations and protect patient confidentiality, healthcare data undergoes
rigorous anonymization and de-identification processes. Personal identifiers such as names,
addresses, and social security numbers are systematically removed or replaced with pseudonyms,
ensuring that the data used by AI scribes cannot be traced back to individual patients [22]. This
step is integral in minimizing the risk of unauthorized access and potential breaches while
facilitating the ethical use of patient information.

5.1.2. Tokenization for Textual Data

Textual clinical data, rich in medical jargon and sensitive patient information, requires
specialized preprocessing techniques like tokenization. Tokenization breaks down medical
narratives into smaller units, such as words or subword tokens, enhancing the efficiency of
Natural Language Processing (NLP) algorithms in understanding and generating text. This
process aids in maintaining the context of medical information while mitigating the risk of
exposing sensitive details during data processing [23].

5.1.3. Encryption of Patient Data

The encryption of patient data is a fundamental step in ensuring the security of healthcare
information during transmission and storage. Advanced encryption algorithms are applied to

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protect sensitive data, rendering it unreadable to unauthorized entities. Encryption measures
guarantee the confidentiality of patient records and prevent data breaches that could compromise
the integrity of the healthcare system [20].

5.1.4. Secure Data Transfer Protocols

In the integration of AI scribes with healthcare IT infrastructure, secure data transfer protocols
are implemented to facilitate the exchange of information between different components. The use
of secure protocols, such as HTTPS (Hypertext Transfer Protocol Secure), ensures that data
transmitted between the AI scribe module and EHR systems remains encrypted and protected
against interception by unauthorized entities [24].

5.1.5. Regular Audits and Monitoring

To maintain ongoing compliance with privacy regulations and security standards, healthcare
organizations implement regular audits and monitoring of AI scribe systems. Continuous
evaluation of access logs, data handling processes, and security protocols helps identify and
rectify potential vulnerabilities. This proactive approach is crucial in upholding the integrity of
patient data and sustaining trust in AI-assisted clinical documentation [25]. Incorporating these
data processing methods not only ensures HIPAA compliance but also establishes a robust
foundation for the ethical and secure utilization of AI scribes in clinical settings. By addressing
privacy concerns and regulatory requirements, healthcare organizations can confidently embrace
AI-driven technologies to enhance physician efficiency in documentation processes.

5.2. Integration with Healthcare IT Infrastructure

The seamless integration of AI scribes into existing healthcare IT infrastructure is essential for
widespread adoption. The integration ensures real-time collaboration and data exchange between
AI scribes and other healthcare applications [24]. The seamless integration of AI scribes into
existing healthcare IT infrastructure is a critical aspect of their successful implementation. This
section explores the challenges associated with interoperability and highlights solutions, focusing
on the pivotal role of Application Programming Interface (API) integration with EHR systems:

5.2.1. Interoperability Challenges

The diverse landscape of healthcare IT systems often poses challenges in achieving seamless
communication and data exchange between different platforms. EHR systems, which serve as the
central repositories of patient data, may have varying data formats, standards, and protocols.
Interoperability challenges arise when attempting to integrate AI scribe modules, necessitating a
comprehensive strategy to ensure effective collaboration and information flow [22].

5.2.2. Standardized Data Formats and Protocols

One key solution to interoperability challenges is the adoption of standardized data formats and
communication protocols. Establishing common standards, such as Health Level Seven
International (HL7) for data exchange and Fast Healthcare Interoperability Resources (FHIR) for
interoperability, facilitates the seamless integration of AI scribes with EHR systems.
Standardization promotes consistency in data representation, reducing the complexity of
integration efforts and enhancing the interoperability of healthcare IT infrastructure [26].

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5.2.3. API Integration

APIs play a significant role in enabling the integration of AI scribe functionalities with EHR
systems. APIs act as intermediaries that allow different software components to communicate and
share data in a standardized manner. By developing robust APIs, healthcare organizations can
establish a secure and efficient communication channel between the AI scribe module and the
EHR system. This facilitates real-time data exchange, ensuring that physicians have access to the
latest and most relevant patient information during the documentation process [27].

5.2.4. Modular Architecture for Scalability

Implementing a modular architecture enhances the scalability and flexibility of AI scribe

integration. Breaking down the integration process into manageable modules enables healthcare
organizations to update or replace components without disrupting the entire system. This
approach accommodates evolving technology, minimizes downtime, and supports the seamless
addition of new features or improvements to AI scribe functionalities [22].

5.2.5. User Interface Integration

Ensuring a cohesive user experience is paramount in the integration of AI scribes with existing
healthcare IT interfaces. The user interface should provide a unified platform where physicians
can seamlessly transition between AI-assisted documentation and traditional EHR functionalities.
A user-friendly interface promotes user acceptance and adoption, contributing to the overall
success of AI scribe implementation [28].

5.2.6. Continuous Monitoring and Maintenance

Post-integration, continuous monitoring and maintenance are essential to address any issues that
may arise and to adapt to changes in the healthcare IT landscape. Regular updates, patches, and
performance evaluations contribute to the sustained functionality and security of the integrated
AI scribe system, ensuring its alignment with evolving standards and regulations [27]. By
addressing interoperability challenges through standardized data formats, API integration,
modular architecture, and user interface considerations, healthcare organizations can seamlessly
incorporate AI scribes into their existing IT infrastructure. This approach enhances physician
efficiency and contributes to the overall improvement of clinical documentation practices.

5.3 Schematic Representation of AI Scribe Integration

Figure 1 illustrates the seamless integration of AI scribes within the healthcare system,
emphasizing the workflow from physician-patient conversation to the completion of a
consultation report. The diagram highlights key stages, including speech-to-text conversion,
integration with Electronic Health Record (EHR) systems, and the finalization of clinical
documentation. The process begins with a physician-patient conversation during a clinical
consultation. The physician engages with the patient, discussing symptoms, medical history, and
treatment options. As the conversation unfolds, the spoken words are captured and processed
through Speech-to-Text conversion using advanced Natural Language Processing (NLP)
algorithms. These algorithms enable the accurate conversion of spoken language into text,
preserving the context and nuances of medical conversations [31]. The transcribed text is
seamlessly integrated with the Electronic Health Record (EHR) system. API integration ensures
smooth communication between the AI scribe module and the EHR, allowing for the exchange of
relevant patient data. This integration enables real-time access to patient records and ensures that

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the AI-generated text aligns with the patient's medical history and existing data within the EHR
[27]. The transcribed text forms the basis for the clinical documentation of the patient encounter.

AI scribes assist physicians in generating detailed and accurate documentation, capturing relevant
information from the conversation. This step enhances the efficiency of the documentation
process and contributes to the completeness and accuracy of medical records. The generated
clinical documentation is received by the physician for review and verification. The physician
can add any additional details, corrections, or insights based on their professional judgment. After
reviewing the document, the physician electronically signs off on the documentation, validating
its accuracy and completeness. The finalized documentation forms the basis of the completed
consultation report. This comprehensive report serves as a detailed record of the patient
encounter, including diagnosis, treatment plans, and any additional recommendations. The
completed consultation report is stored securely within the EHR system, contributing to
longitudinal patient care, and providing valuable insights for future consultations.

Figure 1: AI Scribe Integration in Healthcare System

This schematic representation emphasizes the synergy between AI scribes and healthcare
professionals in the clinical documentation process. By automating the transcription and initial
documentation steps, AI scribes enable physicians to focus more on patient care and less on
administrative tasks. The integration with EHR systems ensures that the generated documentation
seamlessly aligns with existing patient records, contributing to a holistic and efficient healthcare
workflow.

6. OBSTACLES TO IMPLEMENTATION, ETHICAL IMPLICATIONS, AND

PRIVACY CONCERNS
The integration of AI-powered medical scribes into the fabric of healthcare practices is not
without its challenges. Obstacles include potential biases in AI algorithms, the need for robust
validation, data privacy and security concerns, interoperability issues, and the challenges of
training healthcare professionals without significant disruptions in workflow [16,25,29].

AI necessitates substantial datasets for training purposes. Ensuring the trust of patients and
physicians in the confidentiality of their data is paramount. Organizations are obligated to
establish transparent policies outlining the collection, storage, utilization, and sharing of data
from patients and end-users [30]. Prior consent is important for collecting any identifiable data,
and such consent should explicitly detail how the data will be employed or shared. Organizations
should prioritize the utmost levels of safety, reliability, and accuracy in their AI solutions [30].
Robust data security measures are crucial to ensure patient privacy and HIPAA compliance.
Training data should accurately represent the population under consideration and organizations
should be transparent regarding the diversity of their training data, ensuring efforts to enhance
diversity for accurate representation [30]. It is also important for organizations to establish
standardized procedures for recognizing implicit bias and preventing machine learning models
from assimilating these biases. Moreover, where relevant, organizations should implement
protocols for monitoring disparate outcomes, especially those impacting vulnerable patient
populations [30].

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It is important to ensure that AI scribes are accurate and reliable, and that they do not replace the
human element of the doctor-patient relationship. A nuanced understanding of these challenges is
imperative for devising strategies to ensure a seamless transition towards an AI-enhanced
charting environment.

7. CONCLUSION
The potential benefits of AI-powered medical scribes are significant, and it is likely that AI-
powered medical scribes will play an increasingly significant role in healthcare in the future. AI
scribes can relieve physicians of the burden of tedious documentation, seamlessly capturing the
details of patient encounters and improving efficiency in clinical documentation. This not only
fosters deeper patient-physician connections but also empowers physicians to make more
informed decisions, leading to improved quality of care and enhanced patient satisfaction. Other
benefits include improved accuracy in medical records, minimizing the risk of errors and
omissions that could compromise patient safety, and enhanced data collection, paving the way for
groundbreaking research and personalized medicine. However, ensuring the accuracy and
reliability of AI scribes is paramount. This requires rigorous testing and continuous refinement.
Additionally, the human element remains irreplaceable, and striking the right balance between AI
assistance and physician-patient interaction is key. With careful consideration and ethical
implementation, AI-powered medical scribes can usher in a new era of healthcare, where
technology and humanity work in harmony to deliver the best possible care to every individual.

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