Implications of Artificial Intelligence–Powered Ambient Scribes

Investment in artificial intelligence (AI)-powered ambient scribes has surged, as health systems across the country pilot this technology.1,2 Recent studies have found that ambient scribes reduced documentation burden, with associated enthusiasm among clinicians regarding their potential.[3][4][5][6] However, a new Viewpoint by Nong and Neprash 7 in JAMA Health Forum raises concern that AI scribes may increase health care spending by increasing diagnostic and procedure coding intensity and recommending low-value services.Nong and Neprash raise important points that have not been addressed empirically and are among several unanswered questions that may be important for policy.Understanding the full implications of ambient scribes requires rigorous evaluation, not only of documentation burden and patient-and clinician-reported satisfaction, but also of downstream impacts, both positive and negative, on health system outcomes.These include outcomes related to health care spending as well as quality of care and equity. Health Care SpendingAs argued by Nong and Neprash, 7 ambient scribe companies are incentivized to provide a financial return on investment to their customers: health systems and physician practices.Although not the only means to offer a financial return, there is a real risk that financial return will be generated through more intensive diagnostic coding.Prior work has convincingly shown that health systems strategically upcode services when financially advantageous, contributing to growing health care costs.8 However, health care organizations do not upcode at equivalent rates, due in part to the cost and sophistication required.9 Ambient scribes have the potential to automate upcoding by capturing Quality of CareDespite their rapid adoption, there are also important questions regarding the potential impact of ambient scribes on health care quality.Early evidence suggests that ambient scribes may improve +