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Fogleman BM, Goldman M, Holland AB, Dyess G, Patel A. Charting Tomorrow's Healthcare: A Traditional Literature Review for an Artificial Intelligence-Driven Future. Cureus 2024; 16:e58032. [PMID: 38738104 PMCID: PMC11088287 DOI: 10.7759/cureus.58032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/11/2024] [Indexed: 05/14/2024] Open
Abstract
Electronic health record (EHR) systems have developed over time in parallel with general advancements in mainstream technology. As artificially intelligent (AI) systems rapidly impact multiple societal sectors, it has become apparent that medicine is not immune from the influences of this powerful technology. Particularly appealing is how AI may aid in improving healthcare efficiency with note-writing automation. This literature review explores the current state of EHR technologies in healthcare, specifically focusing on possibilities for addressing EHR challenges through the automation of dictation and note-writing processes with AI integration. This review offers a broad understanding of existing capabilities and potential advancements, emphasizing innovations such as voice-to-text dictation, wearable devices, and AI-assisted procedure note dictation. The primary objective is to provide researchers with valuable insights, enabling them to generate new technologies and advancements within the healthcare landscape. By exploring the benefits, challenges, and future of AI integration, this review encourages the development of innovative solutions, with the goal of enhancing patient care and healthcare delivery efficiency.
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Affiliation(s)
- Brody M Fogleman
- Internal Medicine, Edward Via College of Osteopathic Medicine - Carolinas, Spartanburg, USA
| | - Matthew Goldman
- Neurological Surgery, Houston Methodist Hospital, Houston, USA
| | - Alexander B Holland
- General Surgery, Edward Via College of Osteopathic Medicine - Carolinas, Spartanburg, USA
| | - Garrett Dyess
- Medicine, University of South Alabama College of Medicine, Mobile, USA
| | - Aashay Patel
- Neurological Surgery, University of Florida College of Medicine, Gainesville, USA
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Li T, Yu L, Zhou L, Wang P. Using less keystrokes to achieve high top-1 accuracy in Chinese clinical text entry. Digit Health 2023; 9:20552076231179027. [PMID: 37256013 PMCID: PMC10226174 DOI: 10.1177/20552076231179027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 05/12/2023] [Indexed: 06/01/2023] Open
Abstract
Background As a routine task, physicians spend substantial time and keystrokes on text entry. Documentation burden is increasingly associated with physician burnout. Predicting at top-1 with less keystrokes (TLKs) is a hot topic for smart text entry. In Western countries, contextual autocomplete is deployed to alleviate the burden. Chinese text entry is intercepted by input method engines (IMEs), which cut off suggestions from electronic health records (EHRs). Objective To explore a user-friendly approach to make text entry easier and faster for Chinese physicians. Methods Physicians were shadowed to uncover the real-word input behaviors. System logs were collected for behavior validation and then used for context-based learning. An in-line web-based popup layer was proposed to hold the best suggestion from EHRs. Keystrokes per character and TLK rate were evaluated quantitatively. Questionnaires were used for qualitative assessment. Nine hundred fifty-two physicians were enrolled in a field testing. Results 14 facilitators and 17 barriers related to IMEs were identified after shadowing. With system logs, physicians tended to split long words into short units, which were 1-4 in length. 81.7% of these units were disyllables. Compared to the control group, the intervention group improved TLK rate by 40.3% (p < .0001), and reduced keystrokes per character by 48.3% (p < .0001). Survey results also promised positive feedback from physicians. Conclusions Keystroke burden and frequent choice reaction time challenge Chinese physicians for text entry. The proposed system demonstrates an approach to alleviate the burden. Contextual information is easily retrieved and it further helps improve the top-1 accuracy, with a smaller number of keystrokes. While positive feedback is received, it promises a benefit to protect patient privacy.
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Affiliation(s)
- Tao Li
- Information Technology Department,
Shanghai Sixth People's Hospital, Shanghai, China
| | - Lei Yu
- Information Technology Department,
Shanghai Sixth People's Hospital, Shanghai, China
| | - Liang Zhou
- Information Technology Department,
Shanghai Sixth People's Hospital, Shanghai, China
| | - Panzhang Wang
- Information Technology Department,
Shanghai Sixth People's Hospital, Shanghai, China
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Stephens J, Kieber-Emmons AM, Johnson M, Greenberg GM. Implementation of a Virtual Asynchronous Scribe Program to Reduce Physician Burnout. J Healthc Manag 2022; 67:425-435. [PMID: 36350580 PMCID: PMC9640286 DOI: 10.1097/jhm-d-21-00329] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
GOAL Administrative burden is one of many potential root causes of physician burnout. Scribe documentation assistance can reduce this burden. However, traditional in-person scribe services are challenged by consistent staffing because the model requires the physical presence of a scribe and limits the team to a single individual. In addition, in-person scribes cannot provide the flexible support required for virtual care encounters, which can now pivot geographically and temporally. To respond to these challenges, our health network implemented an asynchronous virtual scribe model and evaluated the program's impact on clinician perceptions of burnout across multiple outpatient specialties. METHODS Using a mixed-methods, pre-/postdesign, this evaluation measured the impact of an asynchronous virtual scribe program on physician burnout. Physicians were given the Professional Fulfillment Index tool (to self-assess their mental state) and free-text comment surveys before virtual scribe initiation and again at 3-, 6-, and 12-month intervals after program implementation. Descriptive statistics of survey results and qualitative review of free-text entries were analyzed for themes of facilitation and barriers to virtual scribe use. PRINCIPAL FINDINGS Of 50 physician participants in this study, 42 (84%) completed the preintervention survey and 15 (36%) completed all 4 surveys; 25 participants (50%) discontinued scribe use after 12 months. Burnout levels-as defined by dread, exhaustion, lack of enthusiasm, decrease in empathy, and decrease in colleague connection-all trended toward improvement during this study. Importantly, quality, time savings, burnout, and productivity moved in positive directions as well. PRACTICAL APPLICATION The cost burden to physicians and the COVID-19 pandemic inhibited the continued use of asynchronous virtual medical scribes. Nevertheless, those who continued in the program have reported positive outcomes, which indicates that the service can be a viable and effective tool to reduce physician burnout.
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Corby S, Ash JS, Mohan V, Becton J, Solberg N, Bergstrom R, Orwoll B, Hoekstra C, Gold JA. A qualitative study of provider burnout: do medical scribes hinder or help? JAMIA Open 2021; 4:ooab047. [PMID: 34396055 PMCID: PMC8358329 DOI: 10.1093/jamiaopen/ooab047] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 05/07/2021] [Accepted: 06/07/2021] [Indexed: 12/01/2022] Open
Abstract
Objective Provider burnout is a crisis in healthcare and leads to medical errors, a decrease in patient satisfaction, and provider turnover. Many feel that the increased use of electronic health records contributes to the rate of burnout. To avoid provider burnout, many organizations are hiring medical scribes. The goal of this study was to identify relevant elements of the provider–scribe relationship (like decreasing documentation burden, extending providers’ careers, and preventing retirement) and describe how and to what extent they may influence provider burnout. Materials and Methods Qualitative methods were used to gain a broad view of the complex landscape surrounding scribes. Data were collected in 3 phases between late 2017 and early 2019. Data from 5 site visits, interviews with medical students who had experience as scribes, and discussions at an expert conference were analyzed utilizing an inductive approach. Results A total of 184 transcripts were analyzed to identify patterns and themes related to provider burnout. Provider burnout leads to increased provider frustration and exhaustion. Providers reported that medical scribes improve provider job satisfaction and reduce burnout because they reduce the documentation burden. Medical scribes extend providers’ careers and may prevent early retirement. Unfortunately, medical scribes themselves may experience similar forms of burnout. Conclusion Our data from providers and managers suggest that medical scribes help to reduce provider burnout. However, scribes are not the only solution for reducing documentation burden and there may be potentially better options for preventing burnout. Interestingly, medical scribes sometimes suffer from burnout themselves, despite their temporary roles.
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Affiliation(s)
- Sky Corby
- Department of Pulmonary and Critical Care Medicine, School of Medicine, Oregon Health & Science University, Portland, Oregon, USA
| | - Joan S Ash
- Department of Medical Informatics and Clinical Epidemiology, School of Medicine, Oregon Health & Science University, Portland, Oregon, USA
| | - Vishnu Mohan
- Department of Medical Informatics and Clinical Epidemiology, School of Medicine, Oregon Health & Science University, Portland, Oregon, USA
| | - James Becton
- Department of Medical Informatics and Clinical Epidemiology, School of Medicine, Oregon Health & Science University, Portland, Oregon, USA
| | - Nicholas Solberg
- Department of Pulmonary and Critical Care Medicine, School of Medicine, Oregon Health & Science University, Portland, Oregon, USA
| | - Robby Bergstrom
- Department of Medical Informatics and Clinical Epidemiology, School of Medicine, Oregon Health & Science University, Portland, Oregon, USA
| | - Benjamin Orwoll
- Department of Medical Informatics and Clinical Epidemiology, School of Medicine, Oregon Health & Science University, Portland, Oregon, USA
| | - Christopher Hoekstra
- Department of Medical Informatics and Clinical Epidemiology, School of Medicine, Oregon Health & Science University, Portland, Oregon, USA
| | - Jeffrey A Gold
- Department of Pulmonary and Critical Care Medicine, School of Medicine, Oregon Health & Science University, Portland, Oregon, USA
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Rahhal R, Goad L, Bishop W. Impact of a Medical Scribe Program on Outpatient Pediatric Gastroenterology Clinic. J Pediatr Gastroenterol Nutr 2021; 72:220-225. [PMID: 32969957 DOI: 10.1097/mpg.0000000000002954] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
OBJECTIVES Medical scribes may offer a route to improve physician productivity and workflow efficiency with reduced physician time for documentation. To our knowledge, there is no prior literature on medical scribe impact on outpatient pediatric gastroenterology clinic operations. The primary aim of our study was to address this knowledge gap. METHODS Data were collected on encounters conducted by pediatric gastroenterology physicians at a tertiary center, during a summer scribe program. Scribes were trained and attended clinics in a nonrandomized fashion. Clinic efficiency was assessed by patient flow, tracked via the electronic medical record system. Medical note complexity codes, associated work relative value units (wRVUs), and note delinquency were compared between encounters with and without scribes. Patient satisfaction survey scores were compared between groups. RESULTS One thousand nine hundred seventy encounters were included. Documented medical note complexity (and wRVUs), note delinquency, patient satisfaction, and perceived overall quality of service were similar between groups. Clinic time for established encounters was statistically shorter with scribes (median 18 vs 21 minutes, P = 0.01), a 14% reduction. No significant difference was noted in new encounter clinic time. The time to note completion was shorter for new encounters with scribes (2 vs 3 days, P = 0.048). More notes were finalized by the third day postencounter when a scribe was present (63% vs 57%, P = 0.02). CONCLUSIONS The presence of medical scribes was associated with significantly more efficient clinic flow for established encounters and modest improvements in note completion rate. There were no measurable negative effects on documented medical note complexity or patient satisfaction scores.
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Affiliation(s)
- Riad Rahhal
- Division of Pediatric Gastroenterology, Department of Pediatrics, University of Iowa Children's Hospital, Iowa City, IA
| | | | - Warren Bishop
- Division of Pediatric Gastroenterology, Department of Pediatrics, University of Iowa Children's Hospital, Iowa City, IA
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Sharma HP. Enhancing practice efficiency: A key organizational strategy to improve professional fulfillment in allergy and immunology. Ann Allergy Asthma Immunol 2020; 126:235-239. [PMID: 33309885 DOI: 10.1016/j.anai.2020.12.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Revised: 11/11/2020] [Accepted: 12/02/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To review evidence-based strategies that have been noted to improve professional fulfillment and reduce burnout by enhancing practice efficiency. DATA SOURCES A comprehensive literature review was conducted to evaluate the strategies to improve efficiency of practice-a key driver of burnout among physicians. STUDY SELECTIONS Studies of efficiency-enhancing practices relevant to allergy-immunology were included. RESULTS Professional burnout is prevalent among physicians and is associated with negative outcomes affecting physicians, patients, and health care organizations. Recent surveys suggest at least 35% of US allergists-immunologists experience burnout. There are multiple drivers of professional burnout, some at the individual level and others at the organizational or practice level. Strategies to improve professional fulfillment may be conceptualized using the Stanford physician wellness framework, in which efforts target the following 3 reciprocal domains: culture, personal resilience, and practice efficiency. Organizational strategies that support physician well-being by creating a more efficient practice environment hold great promise, particularly for allergists-immunologists. The reduction of administrative burden and fostering of team-based care have been found in multiple studies to be cost-effective strategies to improve physician and patient satisfaction. CONCLUSION To ensure the well-being of the US allergy-immunology workforce and optimize patient outcomes, both private and academic allergy-immunology institutions should prioritize the adoption and iterative evaluation and refinement of these strategies to cocreate an efficient and ideal practice environment.
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Affiliation(s)
- Hemant P Sharma
- Division of Allergy and Immunology, Children's National Hospital, Washington, District of Columbia; George Washington University School of Medicine and Health Sciences, Washington, District of Columbia.
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