Appl Clin Inform 2025; 16(04): 1121-1135
DOI: 10.1055/a-2597-2017
Special Topic on Reducing-Technology Related Stress and Burnout

Clinical Implementation of Artificial Intelligence Scribes in Health Care: A Systematic Review

Hadeel Hassan
1   Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, Canada
2   Program in Child Health Evaluative Sciences, Peter Gilgan Research Institute, The Hospital for Sick Children, Toronto, Canada
,
Amy R. Zipursky
2   Program in Child Health Evaluative Sciences, Peter Gilgan Research Institute, The Hospital for Sick Children, Toronto, Canada
3   Department of Emergency Medicine, The Hospital for Sick Children, Toronto, Canada
,
Naveed Rabbani
4   Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, United States
,
Jacqueline G. You
5   Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts, United States
6   Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, United States
,
Gabe Tse
7   Department of Pediatrics, Stanford University, Stanford, California, United States
,
Evan Orenstein
8   Information Services and Technology, Children's Healthcare of Atlanta, Atlanta Georgia, United States
9   Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, United States
,
Mondira Ray
10   Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts, United States
,
Chase Parsons
10   Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts, United States
,
Stella Shin
8   Information Services and Technology, Children's Healthcare of Atlanta, Atlanta Georgia, United States
9   Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, United States
,
Gregory Lawton
11   Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States
,
Karim Jessa
3   Department of Emergency Medicine, The Hospital for Sick Children, Toronto, Canada
,
Lillian Sung
1   Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, Canada
2   Program in Child Health Evaluative Sciences, Peter Gilgan Research Institute, The Hospital for Sick Children, Toronto, Canada
,
Adam P. Yan
1   Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, Canada
2   Program in Child Health Evaluative Sciences, Peter Gilgan Research Institute, The Hospital for Sick Children, Toronto, Canada
› Institutsangaben

Funding J.G.Y. and M.R. are supported by the National Library of Medicine/National Institutes of Health grant (grant no.: T15LM007092). L.S. is supported by the Canada Research Chair in Pediatric Oncology Supportive Care.
Preview

Abstract

Background

Artificial intelligence (AI) scribes use advanced speech recognition and natural language processing to automate clinical documentation and ease administrative burden. However, little is known about the effect of AI scribes on clinicians, patients, and organizations.

Objectives

This study aimed to (1) propose an evaluation framework to guide future AI scribe implementations, (2) describe the effect of AI scribes along the domains proposed in the developed evaluation framework, and (3) identify gaps in the AI scribe implementation literature to be evaluated in future studies.

Methods

Databases including Embase, Embase Classic, and Ovid Medline were searched, and a manual review was conducted of the New England Journal of Medicine AI. Studies published after 2021 that reported on the implementation of AI scribes in health care were included. Descriptive analysis was undertaken. Quality assessment was undertaken using the Newcastle–Ottawa Scale. The nominal group technique was used to develop an evaluation framework.

Results

Eleven studies met the inclusion criteria, with 10 published in 2024. The most frequently used AI scribe was Dragon Ambient eXperience (n = 7, 64%). While clinicians often reported improved documentation quality, AI scribe accuracy varied, frequently requiring manual edits and raising occasional concerns about errors. Nine of 10 studies reported improvements in at least one efficiency metric, and seven of ten studies highlighted positive effects on clinician wellness and burnout. Patient experience was assessed in three studies, all reporting favorable outcomes.

Conclusion

AI scribes represent a promising tool for improving clinical efficiency and alleviating documentation burden. This systematic review highlights the potential benefits of AI scribes, including reduced documentation time and enhanced clinician satisfaction, while also identifying critical challenges such as variable adoption, performance limitations, and gaps in evaluation.

Protection of Human and Animal Subjects

No human subjects were involved in the project.


Supplementary Material



Publikationsverlauf

Eingereicht: 18. Februar 2025

Angenommen: 29. April 2025

Accepted Manuscript online:
30. April 2025

Artikel online veröffentlicht:
19. September 2025

© 2025. Thieme. All rights reserved.

Georg Thieme Verlag KG
Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

 
  • References

  • 1 Coiera E, Kocaballi B, Halamaka J, Laranjo L. The digital scribe. NPJ Digit Med 2018 1. 01
  • 2 Ghatnekar S, Faletsky A, Nambudiri VE. Digital scribe utility and barriers to implementation in clinical practice: a scoping review. Health Technol (Berl) 2021; 11 (04) 803-809
  • 3 Yates SW. Physician stress and burnout. Am J Med 2020; 133 (02) 160-164
  • 4 Levy DR, Withall JB, Mishuris RG. et al. Defining documentation burden (DocBurden) and excessive DocBurden for all health professionals: a scoping review. Appl Clin Inform 2024; 15 (05) 898-913
  • 5 Mess SA, Mackey AJ, Yarowsky DE. Artificial intelligence scribe and large language model technology in healthcare documentation: advantages, limitations, and recommendations. Plast Reconstr Surg Glob Open 2025; 13 (01) e6450
  • 6 Nuance Communications Inc. Northwestern Medicine deploys DAX Copilot embedded in Epic within its enterprise to improve patient and physician experiences. Accessed at: https://news.nuance.com/2024-08-15-Northwestern-Medicine-deploys-DAX-Copilot-embedded-in-Epic-within-its-enterprise-to-improve-patient-and-physician-experiences 2024
  • 7 Dbouk R, Shanks D, Mishuris R, Pele Yu. PAC02 Pajama Time(Less) Stories - Early Experiences with Ambient AI Documentation. Accessed at: https://eventarchive.epic.com/Past%20Events/2024%20Events/UGM/Advisory%20Councils/Physicians%20Advisory%20Council%20(PAC)/PAC02%20Pajama%20Time(less)%20Stories%20-%20Early%20Experiences%20with%20Ambient%20AI%20Documentation.pdf 2024
  • 8 Basha I. The Human Factors in the Adoption of Ambient Artificial Intelligence Scribe Technology: Towards Informed and User-centered Implementation of AI in Healthcare. [Waterloo]: University of Waterloo; 2024
  • 9 Cao DY, Silkey JR, Decker MC, Wanat KA. Artificial intelligence-driven digital scribes in clinical documentation: pilot study assessing the impact on dermatologist workflow and patient encounters. JAAD Int 2024; 15: 149-151
  • 10 Page MJ, McKenzie JE, Bossuyt PM. et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ 2021; 372: n71
  • 11 van Buchem MM, Boosman H, Bauer MP, Kant IMJ, Cammel SA, Steyerberg EW. The digital scribe in clinical practice: a scoping review and research agenda. NPJ Digit Med 2021; 4 (01) 57
  • 12 Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics 1977; 33 (01) 159-174
  • 13 Cruz Rivera S, Liu X, Chan AW, Denniston AK, Calvert MJ. SPIRIT-AI and CONSORT-AI Working Group. Guidelines for clinical trial protocols for interventions involving artificial intelligence: the SPIRIT-AI extension. Lancet Digit Health 2020; 2 (10) e549-e560
  • 14 Vasey B, Clifton DA, Collins GS. et al; DECIDE-AI Steering Group. DECIDE-AI: new reporting guidelines to bridge the development-to-implementation gap in clinical artificial intelligence. Nat Med 2021; 27 (02) 186-187
  • 15 Vasey B, Nagendran M, Campbell B. et al. Reporting guideline for the early-stage clinical evaluation of decision support systems driven by artificial intelligence: DECIDE-AI. Nat Med 2022; 28: 924-933
  • 16 Liu X, Cruz Rivera S, Moher D, Calvert MJ, Denniston AK. SPIRIT-AI and CONSORT-AI Working Group. Reporting guidelines for clinical trial reports for interventions involving artificial intelligence: the CONSORT-AI extension. Nat Med 2020; 26 (09) 1364-1374
  • 17 Group Techniques for Program Planning. A guide to nominal group and Delphi processes. J Appl Behav Sci 1976 12. 04
  • 18 Liu TL, Hetherington TC, Dharod A. et al. Does AI-powered clinical documentation enhance clinician efficiency? A longitudinal study. NEJM AI 2024; 1 (12)
  • 19 Haberle T, Cleveland C, Snow GL. et al. The impact of nuance DAX ambient listening AI documentation: a cohort study. J Am Med Inform Assoc 2024; 31 (04) 975-979
  • 20 Owens LM, Wilda JJ, Hahn PY, Koehler T, Fletcher JJ. The association between use of ambient voice technology documentation during primary care patient encounters, documentation burden, and provider burnout. Fam Pract 2024; 41 (02) 86-91
  • 21 Liu TL, Hetherington TC, Stephens C. et al. AI-powered clinical documentation and clinicians' electronic health record experience: a nonrandomized clinical trial. JAMA Netw Open 2024; 7 (09) e2432460
  • 22 Albrecht M, Shanks D, Shah T. et al. Enhancing clinical documentation workflow with ambient artificial intelligence: clinician perspectives on work burden, burnout, and job satisfaction. JAMIA Open 2025 8. 01
  • 23 Galloway JL, Munroe D, Vohra-Khullar PD. et al. Impact of an artificial intelligence-based solution on clinicians' clinical documentation experience: initial findings using ambient listening technology. J Gen Intern Med 2024; 39 (13) 2625-2627
  • 24 Misurac J, Knake LA, Blum JM. Impact of Ambient Artificial Intelligence Notes on Provider Burnout. 2024
  • 25 Shah SJ, Devon-Sand A, Ma SP. et al. Ambient artificial intelligence scribes: physician burnout and perspectives on usability and documentation burden. J Am Med Inform Assoc 2025; 32 (02) 375-380
  • 26 Tierney AA, Gayre G, Hoberman B. et al. Ambient artificial intelligence scribes to alleviate the burden of clinical documentation. NEJM Catal 2024 5. 03
  • 27 Bundy H, Gerhart J, Baek S. et al. Can the administrative loads of physicians be alleviated by AI-facilitated clinical documentation?. J Gen Intern Med 2024; 39 (15) 2995-3000
  • 28 Nguyen OT, Turner K, Charles D. et al. Implementing digital scribes to reduce electronic health record documentation burden among cancer care clinicians: a mixed-methods pilot study. JCO Clin Cancer Inform 2023; 7: e2200166
  • 29 Rule A, Chiang MF, Hribar MR. Medical scribes have a variable impact on documentation workflows. Stud Health Technol Inform 2022; 290: 892-896
  • 30 Sloss EA, Abdul S, Aboagyewah MA. et al. Toward alleviating clinician documentation burden: a scoping review of burden reduction efforts. Appl Clin Inform 2024; 15 (03) 446-455
  • 31 Sinsky CA, Rule A, Cohen G. et al. Metrics for assessing physician activity using electronic health record log data. J Am Med Inform Assoc 2020; 27 (04) 639-643
  • 32 Han S, Shanafelt TD, Sinsky CA. et al. Estimating the attributable cost of physician burnout in the United States. Ann Intern Med 2019; 170 (11) 784-790
  • 33 Shin P, Desai V, Conte AH, Qiu C. Time out: the impact of physician burnout on patient care quality and safety in perioperative medicine. Perm J 2023; 27 (02) 160-168
  • 34 Wu Y, Wu M, Wang C, Lin J, Liu J, Liu S. Evaluating the prevalence of burnout among health care professionals related to electronic health record use: systematic review and meta-analysis. JMIR Med Inform 2024; 12: e54811
  • 35 Budd J. Burnout related to electronic health record use in primary care. J Prim Care Community Health 2023 14. :21501319231166921
  • 36 Corby S, Ash JS, Mohan V. et al. A qualitative study of provider burnout: do medical scribes hinder or help?. JAMIA Open 2021; 4 (03) ooab047
  • 37 Miksanek TJ, Skandari MR, Ham SA. et al. The productivity requirements of implementing a medical scribe program. Ann Intern Med 2021; 174 (01) 1-7
  • 38 Gottlieb M, Palter J, Westrick J, Peksa GD. Effect of medical scribes on throughput, revenue, and patient and provider satisfaction: a systematic review and meta-analysis. Ann Emerg Med 2021; 77 (02) 180-189
  • 39 Ma SP, Liang AS, Shah SJ. et al. Ambient artificial intelligence scribes: utilization and impact on documentation time. J Am Med Inform Assoc 2025; 32 (02) 381-385
  • 40 Guyatt GH, Oxman AD, Vist GE. et al; GRADE Working Group. GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ 2008; 336 (7650) 924-926
  • 41 Nuance; 2025 Clinical documentation solutions for nurses. Accessed at: https://www.nuance.com/en-gb/healthcare/care-settings-specialties/nursing.html?srsltid=AfmBOorHdZOBqyrBVZ4Y_6RgID0N3VlyOvvNaZSm0sJPvYg1vUA7UNS
  • 42 Bakdash L, Abid A, Gourisankar A, Henry TL. Chatting beyond ChatGPT: advancing equity through AI-driven language interpretation. J Gen Intern Med 2024; 39 (03) 492-495