Beyond the SOAP note: AI scribes set to do much more in Canadian primary care

AI scribes are still primarily about generating SOAP notes but in the next 12 months, predicts Canada Health Infoway’s senior physician leader Dr. Rashaad Bhyat, we’ll see a lot more additional functionality to help further reduce administrative burden. “All of the vendors are actively improving their products and looking forward to doing more to support clinicians,” he said.“As standalone products, AI scribes serve a very useful function in terms of capturing a clinical conversation between a physician and a patient, transcribing it and formatting it in a nice way, saving the doctor or other clinician time, but the bigger picture is what scribes can do beyond producing a SOAP note. For that to happen, integration with clinicians’ existing workflows through their EMRs will be critical going forward.”The additional functionality Dr. Bhyat is referring to includes the processing of referral notes, lab requisitions and prescriptions discussed during an encounter with a patient. While some AI scribes are now able to generate a referral note, it’s much better if the AI scribe is integrated with the clinician’s EMR because “depending on how good the integration is or how deep it is, an integration can provide more context and richer information for the referral,” he said.In the absence of an integration, the clinician can add information from the EMR to the referral note. “I’ve done that and it works well,” said Dr. Bhyat, “but integration would definitely add value and that’s where the market is heading.”Of the nine AI scribe vendors family physicians, nurse practitioners, community-based pediatricians and registered nurses in remote communities were able to select for a one-year licence at no charge courtesy of the federal government as of June, eight are currently integrated with one or more EMRs. For example, five are integrated with Accuro, three are integrated with Telus PS Suite and one is integrated with Oscar Pro. (A complete list showing AI scribe integrations with EMRs is available here. Select “View all” then “EMR Integration matrix.”)Integration with EMRs wasn’t an Infoway requirement for pre-qualifying AI scribes, but the vetting process “was intended to encourage integration and nudge the market in that direction, because of the huge administrative burden in primary care—much of which is linked to digital tools that are challenging to use,” said Dr. Bhyat.Though not a requirement for pre-qualification, single sign-on capability, another feature enabling ease of use, was positively assessed during vetting and, as of December, is supported by six of the nine pre-qualified AI scribes.Prescriptions and lab requisitions“If you are very specific about what medications you are prescribing, scribes can already generate that very accurately in the plan,” said Dr. Bhyat, who practises medicine in Brampton, Ont. and is a faculty member at the Toronto Metropolitan University School of Medicine. “If the scribe is integrated with your EMR, it can then pull up the prescribe module with what you have outlined ready to go. Similarly for lab requisitions, if you order a complete blood count and urinalysis, the next step would be to bring up a standardized provincial or territorial lab requisition form with the boxes already ticked off. A number of scribe products are already looking at that.”Having the ability to process referrals, lab requisitions and prescriptions in the background “can really help to reduce clinical administrative burden, reduce cognitive load and improve the general experience with the clinical encounter by having the clinician be more present, do less typing and engage more directly with the patient,” said Dr. Bhyat, adding doctors didn’t sign up to be data entry clerks.Several AI scribes are now able to generate patient-friendly summaries of a clinical encounter, he added, “because it’s often hard for patients to remember everything a doctor or nurse practitioner recommends—especially if they’re not feeling well.” Another feature some vendors are working on is a pre-visit summary that clinicians can use to update them on what has been happening with a patient they haven’t seen for months.“A lot of patients are living longer with many co-morbidities and if you haven’t seen someone for six months, they may have seen a few specialists or may have had a hospital admission,” said Dr. Bhyat. “In order to prepare for a visit like that, clinicians often have to read through a lot of documentation before they go into a consultation. That’s a significant cognitive load, but an integrated AI-powered tool can potentially provide you with an overview of the issues and challenges that an individual has faced before you see them.”Infoway originally budgeted to provide 10,000 doctors and other approved clinicians with a free one-year licence for use of a pre-qualified AI scribe, but as of Dec. 9, 12,000 primary care clinicians have registered for the program, and over 9,100 are now using their selected tool an average of seven times daily.Preliminary findings from the program indicate that 95% of clinicians report reduced administrative burden, 91% report reduced cognitive load, 86% report significant time savings (from 5 to 20 minutes per patient per day), 45% say they can now complete all their documentation during the workday, 90% feel more present with their patients, 96% say AI scribes are easy to use and 98% would recommend AI scribes to their peers.Infoway will consider revisiting the pool of qualified vendors and additional licences over the next several months based on market interest, evolving program needs and availability of funding, “but it would be focused on moving the needle and nudging these products along the maturity model of greater integration and added features that can support the reduction of administrative burden,” said Dr. Bhyat.“We’re really trying to improve the state of primary care because doctors are drowning. They’re quitting left, right and centre and it’s not necessarily that we don’t have enough doctors. They’re just not attracted to comprehensive primary care in part due to challenges that can be improved by tools like these.”With the introduction of cutting-edge technology in primary care, “we can encourage a whole new generation of family doctors, nurse practitioners and others to come into family medicine. That’s really the ultimate goal,” said Dr. Bhyat.

Beyond the SOAP note: AI scribes set to do much more in Canadian primary care

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