An increasing number of companies offer AI-based clinical scribes—tools that record the interaction between clinician and patient and subsequently produce documents including summaries, reports and letters, using natural language processing and generative AI.

In Australia, several AI scribe platforms are now available for use in healthcare environments, including a couple developed by physiotherapists.

However, AI scribes are not ‘plug and play’ applications.

Users need to be trained to use them effectively and also need to train the scribe to meet their individual needs and match their working patterns.

It is important that users are aware of their professional obligations when using AI in their practice (see Resources below).

Darren Ross MACP, physiotherapist and CEO of AI scribe developer PatientNotes, and Associate Professor Kerrie Evans FACP (right), Group Chief Education and Research Officer at allied healthcare organisation Healthia and a senior research fellow at the University of Sydney, have both introduced AI scribes in their workplaces over the past 12 months.

An evidence-based approach

Last year, Kerrie used the introduction of AI-based clinical scribe platform Lyrebird Health at Healthia as an opportunity to conduct a study on its impact on clinical documentation in private practice.

The mixed-methods study, which was presented at last year’s FOCUS24 national conference and has been submitted for publication, looked at the perceptions and experiences of allied health professionals and their patients as the new system was introduced.

The study looked at two main outcomes: the impact of the scribe platform on time spent completing administrative tasks and patient experience.

‘We found that there was a significant reduction in time spent doing notes and how often clinicians were doing notes out of hours,’ says Kerrie.

‘AI promises to do all those things but there was previously a lack of quality research demonstrating its effects in allied health.

'Our study suggests that the platform helped to prioritise consult time and reduce administrative burden.’

At the end of the study, 95 per cent of the clinicians said they would recommend the AI scribe.

‘Even those who were not able to spend adequate time navigating and using the platform said they would still recommend it.

'There’s an understanding that this is the way of healthcare in the future,’ Kerrie says.

Patients were generally positive about the impact of using an AI scribe.

Kerrie notes that many of the patients were more familiar with AI than the clinicians and were curious about how it was being used.

And importantly, they trusted their clinician to use it safely.

‘What came through was that the trust a patient has in their clinician extends to their clinician’s use of the AI scribe,’ she says.

Kerrie says it was also clear from the study that the use of AI positively affected the therapeutic alliance between clinician
and patient, allowing the clinician to be engaged and present rather than distracted by having to take notes.

‘Both clinicians and patients felt that using AI allowed them to better engage with each other.

'That feedback even came from clinicians who already felt that therapeutic alliance was one of their strengths,’ she says.

‘Patients said things like “A lot of the times when I’m talking to a clinician, they’re looking at their computer screen, typing, while I’m talking and I don’t feel heard.

'Whereas from the very first time using AI, I had eye contact and direct conversation; it was great.”’

Making AI work for you

Not everyone will use an AI scribe the same way.

Darren says he’s worked with all types at PatientNotes, from keen early adopters to technologically challenged clinicians who prefer talking to typing and reluctant practice managers who know they need it to improve their practice.

‘Twelve months ago, probably 0.1 per cent of the population would have been using it.

'Now it’s around seven to 10 per cent.

'There are still people writing paper notes and keeping a paper diary—they are never going to be ready for it and that’s fine,’ he says.

AI scribe programs should be flexible, say Kerrie and Darren.

The platforms they use are customisable through the use of macros, templates and prompts.

Some users prefer to record the whole session, add a few notes and then generate summaries, letters and any other documentation that’s needed.

Others would rather take their own notes, dictating or transferring them to the app at the end of a session, and just use the platform for generating documentation.

Darren and Kerrie both use a hybrid of the two approaches.

Darren says it’s up to the practice owner to be across potential ethical, data security and safety issues from the beginning.

Many government agencies and national bodies have released guidelines for implementing AI (see Resources below).

A key point is to make sure that the platform doesn’t send its data offsite or overseas—for privacy and security reasons, it should be stored on the practice servers.

Patients should be informed that AI is being used and provide consent to the session being recorded.

Ultimately, Kerrie and Darren say, using an AI scribe for clinical documentation will make physiotherapists and clinics more effective.

‘At the end of the consult, our clients will get a summary of everything they covered, which has never happened before.

'This volume of data sharing with the patient is something that’s traditionally been missing,’ Darren says.

Both are also looking forward to the next stage of AI integration in the clinic—using it to suggest exercise prescriptions, provide links to exercise and education videos online and even guide clinical reasoning.

‘I would recommend getting on board now because this is just the first wave and there will be more to come in the future,’ Kerrie says.

Tips for implementing AI scribes

• Look for the platform that best meets your clinic’s needs.
• Have people within your organisation who can champion the use of the scribe and help less technologically adept staff adapt.
• Take responsibility as the practice owner for ensuring staff are trained. However, don’t force staff to use it; it should be their choice.
• Ensure clinicians understand their professional obligations (see Resources box).
• Create resources to help staff explain it to patients.

Tips for using AI scribes effectively

• Understand that it takes time to get used to working with an AI scribe and to customise it with templates or macros— typically two to three weeks.
• Make sure the microphone is suitable for the space.
• Ask your patient specific questions and if necessary speak results from assessments aloud. You can dictate or type in extra information during or after the session.

Resources

Ahpra
Meeting your professional obligations when using artificial intelligence in healthcare - click here

Australian Government, Department of Industry, Science and Resources

Voluntary AI safety standard: guiding safe and responsible use of artificial intelligence in Australia - click here

Therapeutic Goods Administration 

Artificial intelligence (AI) and medical device software - click here