When the government began the push for electronic health records (EHR) as part of the American Recovery and Investment Act of 2009, public and private health care providers were required to demonstrate ‘meaningful use’ by 2014. Perhaps you remember visiting your doctor about this time only to discover he or she was frustrated, face buried in a computer screen desperately trying to find all the pulldown menus necessary to advance to the next page. Your doctor had to type physician notes while listening to you and examining you. Of course, that does not work well and is detrimental to the quality of your physician visit.
The earlier EHR systems were not designed with doctors in mind the way Microsoft Office was designed with office workers in mind. The dominate EHR systems were designed by committee, quite literally. Doctors are incentivized by the government to collect information on you for reasons that have nothing to do with your health. Some of the inputs were intended to satisfy public health researchers’ curiosities, rather than patients’ needs. A few years ago, I read about a clinic in California that had a disproportionate number of Albanian patients. Come to find out, the EHR system had a pulldown menu for nationality. The physicians grew weary of all the nonmedical data that they were supposed to collect and began to use the first choice as the default nationality, which happened to be Albanian.
EHRs are about to change for the better. Artificial intelligence is becoming integrated into EHR systems in ways that boost productivity and help doctors better understand their patients. Kaiser Family Foundation Health News reported on AI scribe systems that take notes of physician visits so doctors can focus on their patients. KFF Health News:
When Jeannine Urban went in for a checkup in November, she had her doctor’s full attention.
Instead of typing on her computer keyboard during the exam, Urban’s primary care physician… had an ambient artificial intelligence scribe take notes. At the end of the 30-minute visit, Urban’s doctor showed her the AI summary of the appointment, neatly organized into sections for her medical history, the physical exam findings, and an assessment and treatment plan for her rheumatoid arthritis and hot flashes, among other details.
It is hard to imagine a bigger improvement in primary care. Doctors focus on their patients and then let their patients proof the record for accuracy, which should improve communication tremendously.
The clinical note, which Urban could also review on the patient portal at home, was incredibly thorough, she said. It summarized all of her questions and concerns and the doctor’s responses. The scribe “made sure we didn’t miss anything,” Urban said.
AI also has the potential to assist physicians with the examination, diagnose medical conditions, suggest interventions, and draw inferences. Something else AI may be able to help with is summarizing the medical history, making it easier for your doctor to get up to speed on your condition prior to a patient encounter. Have you ever gone to your doctor only to realize you are reexplaining things you expected your doctor to already know? Have you had to explain medical history that is already in your medical records? My wife literally had her doctor ask if another doctor was treating a condition that the first doctor had previously ordered tests for but had never followed up on. (No, apparently nobody was treating that condition.) More from KFF Health News:
But many questions remain. Does the use of ambient AI scribes improve patient care and health outcomes? Will doctors use time they gain by employing an AI scribe to improve the quality of the time they spend with their patients or just boost the number of patients they see? To what extent will expanding the amount of detail available from a patient visit lead to bigger bills if the AI scribe is integrated with a coding app that optimizes provider charges?
During a 10-to-15-minute office visit your doctor must become familiar with what was discussed in past visits, listen to current conditions, interpret current diagnostic tests, and then decide on a course of action going forward. That is a lot of information for a 10-to-15-minute window. What gets missed (at least in my experience) is the review of medical history. This has happened numerous times to me, especially during veterinary visits and visits where medical records involve more than one doctor. AI may be able to help with some of this complexity.
Read more at KFF Health News: Doctors Increasingly See AI Scribes in a Positive Light. But Hiccups Persist