Practical Considerations for Using AI Scribe

Artificial Intelligence (AI) is increasingly transforming the primary care landscape, integrating into a variety of platforms to enhance physician and clinic workflows. Some of the most common applications in health care include scribes, predictive analytics, virtual health assistants, diagnostic support, and personalized treatment plans.

This guidance developed by the Doctors Technology Office (DTO) focuses on practical considerations for choosing and implementing an AI scribe solution in practice, and provides an end-to-end implementation roadmap. It also includes privacy and ethical considerations and other limitations to be aware of. The aim is to empower physicians to effectively harness AI capabilities, while upholding professional and ethical standards.

As the field of AI evolves, our team will continue to update this information. The DTO is available to provide tailored guidance and practice support.

To get connected to our health technology team, or to request more information, reach us at 

What are AI Scribe technologies?

AI scribe technology is one of the most common use cases for AI in medical practice. AI scribes are tools that can generate medical notes from real-time verbal conversations between a physician and their patient. This removes the need for a physician to actively document during a patient encounter, with the intention of reducing the time-consuming task of manual charting and enhancing patient engagement.

These technologies use various AI models, such as natural language processing, automatic speech recognition, and machine learning models to interpret spoken words, understand context, and discern medical terminology by listening to conversation. The models should be custom-trained and tailored to the specific linguistic and terminological nuances of the healthcare industry, striving for accuracy and relevance in medical documentation.

End-to-End AI Scribe Implementation Considerations

*Note: the considerations outlined below are intended for physicians working in private practice. Physicians working in facilities should consult with their technology administrator and adhere to their organization's established protocols and approved platforms before integrating AI technologies into their work.

The best AI scribe tools do more than just lessen administrative tasks—they can also enhance the precision of patient records and the overall quality of physician-patient interactions. However, there is no one-size-fits-all solution. It is crucial to assess the specific needs of your clinic and to select a tool tailored to meet those distinct needs.

You can use the steps below to guide the implementation of an AI scribe solution in your practice, ensuring that the tool and process align with your clinic's specific requirements and operational workflows. Note that these steps do not need to be completed in order. Some steps can be undertaken simultaneously to streamline the implementation process.

Assess clinic needs

Before selecting an AI scribe tool, thoroughly consider the nature of your practice, as well as your clinic’s specific needs. Use the matrix below to identify key requirements and match them with the features different AI scribe solutions offer. You can use it both during the assessment of your clinic’s specific requirements, and when interacting with vendors during demonstrations.

This AI Scribe Selection Matrix is available for viewing and downloading: 

Additional considerations when assessing your needs:

  1. Compatibility with Your Practice Environment: Reflect on the nature of your practice and choose a tool that best meets your unique needs. If your work involves visiting multiple locations, you may want to opt for an AI scribe that offers mobile phone compatibility, which could enhance your flexibility and efficiency. Also consider which computer operating system your clinic is running, and any technical requirements to run the AI scribe (e.g. download versus web browser, Mac versus Windows, etc.) as this may impact which options are available to you. You may also want to consult your EMR vendor to determine which option is most compatible with your practice.

  2. Patient Demographics and Language Needs: Assess the common linguistic and cultural characteristics of your patient panel. If a substantial number of your patients are non-native English speakers, prioritizing an AI scribe known for its proficiency in handling diverse accents, or one that supports multiple languages, is critical. This is important not only for effective communication and accurate documentation, but also for providing appropriate care and running an ethically sound practice. 

  3. Customizable Documentation Needs: Consider any unique documentation needs of your practice. If you currently use different encounter note templates, you might consider choosing an AI scribe that allows for customizable templates rather than being confined to a set of pre-defined options. Look for a tool that not only supports customization, but also provides a user-friendly interface with minimal effort for adjusting at no or low cost.

 

Research Available Solutions

Investigate the various AI scribe tools currently available. Based on your clinic’s assessed needs, identify which options are most likely to be suitable and aligned with privacy and security considerations. Gather information about each tool’s features and capabilities to determine the best fit for your practice. Use the matrix to help document your findings.

Consult with Peers

Reach out to colleagues within the same specialty who have implemented the AI scribe tools you are considering. Learn from their experiences regarding the tool’s effectiveness, ease of integration, and impact on clinical workflows. Peer insights can provide valuable real-world perspectives that complement vendor information. This outreach can also help you explore whether the AI scribe tool has been implemented effectively in clinical settings like yours, taking into account-specific factors such as types of patients seen and practice workflows. You can also contact a Practice Support Program (PSP) Peer Mentor by contacting

Schedule Vendor Demos

Arrange demos with shortlisted vendors to see the AI scribe tools in action. Prepare a list of specific questions and scenarios based on your clinic’s needs to test the tool’s functionality and relevance. This step should provide a practical understanding of each tool’s capabilities.

Inquire Thoroughly & Review Terms of Service

During a demo, ask detailed questions about the tool’s performance and features that may be important to your practice. If initial answers are unclear or insufficient, contact the vendor afterwards to ensure your concerns are addressed. Review the terms of use and consult an expert if in doubt.

Request a free trial period

Ask vendors for a trial period to test the AI scribe tool within your clinic’s environment with clinic staff and other colleagues. This hands-on experience shows how well the tool meets your specific needs and integrates with your existing systems. Note: A free trial should not be used for patient encounters, as the terms of service may be different from the paid version and should only be used to test with clinic staff or colleagues, etc.

Start small and gradually

Deploy the AI scribe tool on a small scale. You can use the tool with a select group of patients before scaling up. Implementing a new technology takes time to become efficient, so be sure to adjust your schedule accordingly to allow for integration of new workflows. Consider starting with a short-term contract with the vendor in case something changes. These steps will help to minimize disruption and allows for adjustments as needed.

Continuous Evaluation and Feedback

After implementation, continuously monitor the tool’s performance and impact on your practice. Identify areas for improvement and contact the for help optimizing the use of AI scribe in practice. Seek the experience of peers who are using similar tools and communicate with the vendor as needed. This helps to ensure you and your team use the tool effectively, and resolve issues quickly.

Obtain Patient Consent

Inform your patients about the technology, including potential risks such as errors and privacy issues. Obtain informed consent (verbal) prior to recording a clinical encounter, and establish a process for managing consent. This process should include determining who collects consent, how it's documented (e.g., in the EMR), and what to do if a patient revokes consent.

Privacy and Security Considerations for Implementing AI Scribes

The AI scribing industry is still relatively unregulated, and guidance is continuing to develop. Physicians need to ensure that any AI scribe technology they implement meets current industry security standards, and that appropriate steps are taken to safeguard patient data. 

The College of Physicians and Surgeons of BC (CPSBC) has released interim guidance to help promote responsible use of AI. Physicians have a responsibility to ensure that patient privacy and confidentiality are being maintained and safeguards are in place. The CMPA has also published an FAQ that addresses questions on privacy and security of AI scribe.

Some important considerations include:

  • Ensuring you understand the Terms of Use and Privacy Policy. Consider seeking general advice from our privacy team at privacy@doctorsofbc.ca, or use a legal expert for your specific needs and questions. 

  • Conducting a Privacy Impact Assessment (PIA) for your clinic. 

  • Requesting the vendor to present any security certifications, and ensuring you understand how any personal patient data is being stored, accessed, and transmitted. 

  • Implementing a clinic AI Policy to standardize secure use across providers, and to help identify situations where AI may not be appropriate for use. 

Limitations of AI Scribe

AI tools come with limitations that require physicians to review and potentially correct AI-generated documentation. This ensures it is being used in a safe and responsible manner. Some of these limitations and mitigation strategies to consider are listed below.

We also recommend consulting the CPSBC’s Ethical Principles for Artificial Intelligence in Medicine for guidance on safe and ethical use.

Limitations include:

  • Hallucinations (inaccurate information): AI-generated content may contain fabricated or incorrect details.

    • Mitigation strategy: Manually review and edit AI-generated notes for accuracy. Highlight and report inaccuracies to developers for model refinement.

  • Contextual Misinterpretation: Complex medical dialogues may be misinterpreted by AI due to lack of context.

    • Mitigation strategy: Manually review and edit AI-generated text for contextual accuracy.

  • Accent and Dialect Recognition: AI may inaccurately transcribe speech from various accents or dialects.

    • Mitigation strategy: Speak clearly and possibly at a slower pace to aid recognition. Report specific accent issues to the developer to improve AI training. Thoroughly review notes for correctness.

  • Interoperability Issues: AI tools may face difficulties integrating with existing EMR systems.

    • Mitigation strategy: Select AI tools known for EMR compatibility. Use AI tools with simple workflows that transfer easily to your EMR.

  • Continuous Learning and Adaptation Needs: AI models require updates to adapt to new medical knowledge and practices.

    • Mitigation strategy: Engage with the AI vendor by providing feedback on clinical relevance and accuracy.

  • Environmental Challenges: Background noise and poor acoustics can hinder AI's speech recognition accuracy.

    • Mitigation strategy: Use noise-reducing microphones and enhance room acoustics. Repeat or clarify important points, if necessary, to ensure accuracy.

  • Biases in Training Data: AI may exhibit biases based on the data it was trained on, affecting its outputs.

    • Mitigation strategy: Be aware of potential biases and carefully review AI generated notes. Report any suspected biases to developers for correction.

 

The Doctors Technology Office is an initiative of the Family Practice Services Committee (FPSC), a joint partnership of Doctors of BC and the Government and BC.

Page last updated: September 27, 2024