AI is here to stay, integrated into almost all aspects of everyday human life, and we can no sooner wind this back than we can push the evils of the world back into Pandora’s Box.

The administrative support AI tool of AI scribes seems innocuous at first blush, and surely unable to cause patient harm, particularly as the benefits of these scribes are so easy to see. How many patients on average do you see daily? For the sake of simple maths, let’s say 10, and for each, you spend an average of 3 minutes writing their clinical records – the document critical for ensuring continuity of patient care, promoting patient safety, and, providing you with a critical defense should a patient complaint arise. So, 30 minutes per day, 150 minutes or 2.5 hours per week, equating to a whopping 7,800 minutes or 130 hours per year, writing dental records. Imagine what you could do if you got this time back, both for your patients and for yourself. 

Are your records always of sufficient quality to ensure continuity of patient care? If you were to audit yourself against your regulator’s standard, it is likely you will find that they are not, at least, not consistently. The stresses of practice steal time and absorb your intellectual bandwidth. It is natural that your administrative obligations will slip as your cognitive burden grows. The cost of this slippage can be high, to practitioners and patients alike. The conversation of consent, possibly the most critical conversation to document to support any written consent forms, is usually the first thing to fall away when we are pushed, critically impacting any future defense. 

Enter AI scribes stage left, trained to listen and record, then, collate a meaningful record of everything that counts. No more trying to hold the dosages of patient medications in our heads while the patient lists off a seemingly endless stream of complex drug names. No more risks and warnings comprehensively outlined but undocumented, leaving us wide open to a legal claim. No more gaps in patient records, leading to gaps in patient care. Surely, this is the solution? 

While there can be no doubt that AI scribes provide an elegant solution to an endemic problem in our practices, there are some considerations practitioners must make before diving in. 

Duty of care 

The AI does not have a duty of care to patients – you do, and this cannot be delegated. While AI will provide a beautiful and comprehensive record, and we are trying to claim back some valuable time, resist the temptation to shortcut and fail to thoroughly review the records and correct any errors or hallucinations. ‘The AI got it wrong’ is never going to be an accepted defense. 

Patient consent 

Whenever you review any article about AI, it will commonly surmise that we ‘cannot remove the human from the loop (meaning you). However, don’t forget the other human in the loop – the patient. Patients ought to be consulted before adopting AI of this nature as it is their private and personal medical information we are asking the AI to scribe. Australia has a requirement to obtain and document patient consent built into the guidance¹. This is a requisite step that cannot be missed. The first legal claims regarding a failure to obtain consent for the use of AI are maturing in the US, and the rest of the world is watching on with interest².

Data storage and sovereignty 

Consider where the patient’s data is stored. It is a common misnomer that all Australia patient information must be stored in Australia to meet the requirements of the Privacy legislation. However, there is an allowance to store this data offshore, providing the storage jurisdiction meets the minimum requirements of the Australia Privacy Principles (APPs)³. Regardless, at this stage, AI scribes that store their data onshore in Australia are a much ‘safer bet’ partly, as it is an enormous burden on a practitioner to continuously review the legislation of any jurisdiction holding your patient data to ensure the APP’s are constantly met, and partly, due to the specter of data sovereignty. Data sovereignty is essentially the concept that the laws of the jurisdiction where the data is stored apply to that data, and, therefore, if the relevant jurisdiction’s legislation states that they (the jurisdiction) ‘own’ the patient data, and/or that the AI itself can use the data for the purposes of training or learning, you have a big problem. At the time of writing, onshore storage of patient data is safest, for all parties involved. 

AI hallucinations 

Hallucinations can and do occur. These may relate to the quality of the hardware/microphone you are using, background noise, or simply the complexity of the language we use. Records must be thoroughly checked to ensure hallucinations don’t creep in and change the nature and intent of your records, potentially having a deleterious impact on patient safety. 

Note bloat^4,5 

Comprehensive records are essential, however, voluminous records can be as risky as skinny, undetailed notes, as practitioners are too time poor to read them – either to confirm their veracity or to review them prior to the commencement of the patient’s next appointment. Records need to be comprehensive, but they also need to be meaningful and usable. 

Do the risks of AI scribes dominate and overpower the rewards? We don’t believe so, as considered implementation of AI scribes with thorough monitoring should reduce practitioner administrative burdens, reduce stress and increase patient safety. Consider and thoughtful are the key words here, and Dental Protection has a safe use of AI Framework to support you in just that here.

AI scribes if used well, can help rather than harm, giving us back time and promoting patient safety – remember what the last thing in Pandora’s Box was…? Hope.

References 

1 Australian Health Practitioner Regulation Agency - Meeting your professional obligations when using Artificial Intelligence in healthcare 

2 Patients Sue Two More Health Systems Over AI Scribe Use 

3 Chapter 8: APP 8 Cross-border disclosure of personal information | OAIC 

4 Addressing Note Bloat: Solutions for Effective Clinical Documentation - PMC 

5 Note bloat | British Dental Journal