Longitudinal effects ambient AI scribe use on documentation burden and financial productivity: A quasi-experimental study

Objective: To investigate the longitudinal effects of an ambient AI scribe use in primary care on outcomes related to documentation time, note writing patterns, and clinician financial productivity. Method: We conducted a quasi-experimental study with an interrupted time-series design to ascertain the effect of AI scribe use on note writing time, time outside of scheduled hours (TOSH), pajama time (530PM-7AM), note length, note closure <24hours, and work Relative Value Units (wRVU). For each primary care clinician (physician, advanced practice provider), date of initial access was day zero; each measure was calculated for 150 days prior (pre-period) and after (post-period) day zero. Results: 220 clinicians (Mean age=43.7, 70.9% females; 56.4% physicians) from 36 clinics, conducting 314,845 patient encounters were included. Compared to the pre-period, there was 7% decrease in note writing time at day zero (Incidence Rate Ratio (IRR) 0.93,95% Credible Interval (CI) [0.89,0.98]), increasing to 16% decrease by day 150 (IRR 0.84,95%CI [0.82,0.87]). There was no change in pajama time, TOSH, or wRVU at day zero; however, at day 150, there was a 19% decrease in pajama time (0.81,95%CI [0.73,0.90]), 13% decrease in TOSH (0.87,95%CI [0.77,0.98]), and a 2% increase in wRVU (1.02,95%CI [1.01,1.04]). At day zero, there was a 5% increase in note closures (1.05,95%CI [1.02,1.08]), with no difference to pre-period levels by day 150. There were no changes in note length at day zero or day 150. Discussion: There were persistent changes in AI scribe use measures over time as clinicians situated these tools within their workflows.