Using a Digital Scribe for Documentation

With the advent of digital scribe (automated clinical documentation) technology, you may be considering using this form of artificial intelligence (AI) to improve both efficiency and client care. Before you do, you will need to consider what the literature says about both the advantages and the risks of using a digital scribe, as well as your regulatory obligations, which you should review whenever you use new or emerging technologies in practice.

There are many potential benefits to digital scribing, including increased ability to focus on the client (as you do not have to take notes during the client encounter), increased efficiency, and increased accuracy in capturing the client’s voice. In addition, some practitioners have found that they are more likely to have a fuller discussion of their findings with their client, articulating thoughts and observations aloud so that they can be captured.

However, AI and digital scribe technologies are not infallible. It is important to remember that digital scribes are intended to assist with documentation (and in some cases clinical decision making), not to replace clinical judgement or clinical reasoning.  It is important to remember that data produced by digital scribes may be inaccurate or demonstrate inherent bias.

Currently there is no regulation specific to the use of AI or digital scribing in physical therapy practice in BC; however, if you use these tools, you must still meet all the existing College requirements.  For example, you must follow the College Standard of Practice related to documentation regardless of the documentation method which is used (paper-based, electronic, a digital scribe or other). Likewise, there are regulations and a Standard of Practice related to privacy and consent which must be adhered to when collecting and documenting personal information.

What Does a Digital Scribe Do?

Digital scribing is more than transcribing audio to text for use in a clinical record. Essentially, a digital scribe takes an audio recording of the encounter you have with your client, converts audio to text, and extracts the information it decides is important from the text. It may offer differential diagnoses or hypotheses based on the information it captures, refining it as the conversation continues, and it summarizes that information into what it determines is the correct section of your documentation template.

There are multiple digital scribe options/companies – before selecting a scribe for your practice, be sure to compare features, ask for a demonstration, and explore whether it meets your needs based on the advice below.

Ensure Privacy, Confidentiality and Data Security

As with any software or technology used in practice, it is your professional obligation to be aware of the privacy safeguards within the system, to ensure that they comply with provincial privacy legislation.  When utilising digital scribe technology, you must ensure that appropriate security protocols and the necessary privacy measures are in place.

These might include factors such as understanding how client information is anonymized or de-identified, being able to apply end-to-end encryption, confirming where and for how long the data is stored, and understanding whether the client’s data will be accessible to the digital scribe model for use as part of the data cache of the system (which can be used for training the model for enhanced accuracy and capacity over time). It is important that this this feature can be disabled.

It is also important to know what other security measures are built into the system (for example – what safeguards or options do you have if the digital scribe accidentally records a conversation that wasn’t supposed to be captured?). You should also know how to protect your client’s personally identifiable data (such as date of birth or ICBC case number) from being captured by the scribe. Completing a privacy impact assessment may be helpful to review the implications of using the tool and the safeguards required (more information on privacy impact assessments can be found at  https://www.oipc.bc.ca/documents/guidance-documents/2246#:~:text=A%20PIA%20should%20indicate%20the,and%20stores%20the%20personal%20information).

Obtain Informed Consent

You are required to obtain informed consent from your client to use a digital scribe during your session with them. You will need to explain what the digital scribe does, why you would like to use it, and any potential risks (for example, inaccuracy or data breaches) and how these will be mitigated. Include an explanation of how privacy is assured. Be clear that they may decline the use of the digital scribe without compromising treatment, and that the digital scribe will be turned off if they do not consent to its use.

Review the Output for Accuracy

You must review and edit the documentation produced by the digital scribe to ensure accuracy and to ensure that it meets the requirements of the Standard of Practice: Documentation. As a registrant, you are responsible for the accuracy of your documentation – not the digital scribe. It is the physical therapist who is accountable for the quality, accuracy, and comprehensiveness of the client record.  Ensure your clinical judgement and assessment findings, as well as your physical therapy diagnosis, treatment, goals and plan are accurately reflected in the final record.

In the clinical record, note what technology (including version number) was used to capture the chart note.

Risk of Bias in the Output

Be aware that current AI tools (including digital scribes) evolve and learn by reviewing large data sets; these data sets can include or reflect bias, and therefore the output of the tools will apply these biases. This could result in an incorrect interpretation or documentation of the conversation you have with your client.

The digital scribe needs to understand both your and your client’s speech (consider factors such as accents, medical terminology, ambient noise, other nearby conversations) and it will miss the nuances of non-verbal communication. It may not convert to text correctly and then its documentation and diagnostic suggestions may be inaccurate. It can summarize the salient pieces of the conversation to suggest hypotheses based on the learning it has done as a result of multiple previous client encounters with multiple other clinicians – if the dataset it has been trained on does not include data on rare conditions or red flag indicators, the scribe may not suggest these conditions or identify a concern when you, a physical therapist, would. The digital scribe is developed to recognize patterns and will default to the most frequent pattern it finds in its training dataset. The scribe may not suggest this as a differential diagnosis, or it may suggest a diagnosis that is entirely incorrect or implausible.

It is important to be mindful when reviewing scribed notes as the outcome may include bias leading to inaccuracies or gaps, and may not reflect how you would have captured the clinical interaction independently.

In Summary

Digital scribes, along with other AI technology, have the potential to be beneficial tools for client care. While there is currently no regulation related specifically to physical therapists use of digital scribing, as with any new tool, it is incumbent on registrants to ensure that the use of digital scribes adheres to all College Standards of Practice, as well as other legislation such as the Personal Information Protection Act (PIPA).

 

References

College of Physicians and Surgeons of Alberta (2024). Advice to the profession: Artificial intelligence in generated client record content. (https://cpsa.ca/wp-content/uploads/2023/08/AP_Artificial-Intelligence.pdf). Accessed Feb 29, 2024.

Baker HP, Dwyer E, Kalidoss S, Hynes K, Wolf J, Strelzow JA. (2024). ChatGPT’s Ability to Assist with Clinical Documentation: A Randomized Controlled Trial. J Am Acad Orthop Surg. 2024 Feb 1;32(3):123-129. https://doi.org/10.5435/JAAOS-D-23-00474 . PMID: 37976385.

Canadian Medical Protective Association (2023). AI Scribes: Answers to frequently asked questions. https://www.cmpa-acpm.ca/en/advice-publications/browse-articles/2023/ai-scribes-answers-to-frequently-asked-questions . Accessed May 22, 2024.

Clough RAJ, Sparkes WA, Clough OT, Sykes, JT, Steventon AT, King K. (2024). Transforming healthcare documentation: harnessing the potential of AI to generate discharge summaries. BJGP Open 7 February 2024; BJGPO.2023.0116  https://pubmed.ncbi.nlm.nih.gov/37699649/ . Accessed May 22, 2024.

Coiera E, Kocaballi B, Halamka J, Laranjo L. (2018). The digital scribe. NPJ Digit Med. 2018; 1:61., https://doi.org/10.1038/s41746-018-0066-9. Accessed May 22, 2024.

College of Physiotherapists of Ontario (2024). The AI will see you now: Thinking about the AI implications on practice. https://www.collegept.org/blog/post/college-blog/2024/04/22/the-ai-will-see-you-now-thinking-about-the-ai-implications-on-practice . Accessed May 22, 2024.

Falcetta FS, Kude de Almeida F, Lemos JCS, Goldim JR, Andre de Coasta C. (2023) Automatic documentation of professional health interactions: A systematic review. Artificial Intelligence in Medicine, Volume 137, 2023 ISSN 0933-3657, https://doi.org/10.1016/j.artmed.2023.102487 . Accessed May 22, 2024.

Shah WF. Addressing Clinical Documentation Challenges: The Role of AI Powered Digital Scribes. Journal of Artificial Intelligence & Cloud Computing. SRC/JAICC-165, https://doi.org/10.47363/JAICC/2022(1)153 . Accessed May 22, 2024

van Buchem MM, Boosman H, Bauer MP, Kant IMJ, Cammel SA, Steyerberg EW. (2021). The digital scribe in clinical practice: a scoping review and research agenda. NPJ Digit Med. 4(1):57.  https://doi.org/10.1038/s41746-021-00432-5 . Accessed May 22, 2024.

 

Published May 27, 2024