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Doctors Are Using New AI Tools to Record Medical Exams, Draft Messages

— Thousands of doctors are using products based on large language models

MedpageToday
A photo of Dr. Lance Owens demonstrating the use of an AI tool on a smartphone
University of Michigan Health-West via AP

New artificial intelligence (AI) tools are helping doctors communicate with their patients, some by answering messages and others by taking notes during exams. It's been 15 months since OpenAI released ChatGPT. Already, thousands of doctors are using similar products based on large language models. One company said its tool works in 14 languages.

AI saves doctors time and prevents burnout, according to enthusiasts. It also shakes up the doctor-patient relationship, raising questions of trust, transparency, privacy, and the future of human connection.

Patients May Be Concerned About Doctors' Use of AI

In recent years, medical devices with machine learning have been doing things like reading mammograms, diagnosing eye disease, and detecting heart problems. What's new is generative AI's ability to respond to complex instructions by .

Medical appointments could be recorded by an AI-powered smartphone app that listens, documents, and instantly organizes everything into a note that patients can read later. The tool also can mean more money for employers because it won't forget details that legitimately could be billed to insurance.

Doctors should ask for consent before using the tool. Patients might also see some new wording in the forms at their doctors' offices.

Other AI tools could be helping doctors draft a message.

Physicians might tell patients they're using it, or they might not, said Cait DesRoches, director of OpenNotes, a Boston-based group working for transparent communication between doctors and patients. Some health systems encourage disclosure, and some don't.

Doctors or nurses must approve the AI-generated messages before sending them. In one Colorado health system, such messages contain a sentence disclosing they were automatically generated. But doctors can delete that line.

"It sounded exactly like him. It was remarkable," said patient Tom Detner, 70, of Denver, who recently received an AI-generated message that began: "Hello, Tom, I'm glad to hear that your neck pain is improving. It's important to listen to your body." The message ended with "Take care" and a disclosure that it had been automatically generated and edited by his doctor.

Detner said he was glad for the transparency. "Full disclosure is very important," he added.

Will AI Make Mistakes?

Large language models can misinterpret input or even fabricate inaccurate responses, an effect called . The new tools have internal guardrails to try to prevent inaccuracies from reaching patients -- or landing in electronic health records.

"You don't want those fake things entering the clinical notes," said Alistair Erskine, MD, MBA, who leads digital innovations for Emory Healthcare in Atlanta, where hundreds of doctors are using a product from Abridge to document patient visits.

The tool runs the doctor-patient conversation across several large language models and eliminates weird ideas, Erskine said. "It's a way of engineering out hallucinations."

Ultimately, "the doctor is the most important guardrail," said Abridge CEO Shiv Rao, MD. As doctors review AI-generated notes, they can click on any word and listen to the specific segment of the patient's visit to check accuracy.

In Buffalo, New York, a different AI tool misheard Lauren Bruckner, MD, PhD, when she told a teenage cancer patient it was a good thing she didn't have an allergy to sulfa drugs. The AI-generated note said, "Allergies: Sulfa."

The tool "totally misunderstood the conversation," Bruckner said. "That doesn't happen often, but clearly that's a problem."

What About the Human Touch?

AI tools can be prompted to be friendly, empathetic, and informative.

But they can get carried away. In Colorado, a patient with a runny nose was alarmed to learn from an AI-generated message that the problem could be a brain fluid leak. (It wasn't.) A nurse hadn't proofread carefully and mistakenly sent the message.

"At times, it's an astounding help and at times it's of no help at all," said C.T. Lin, MD, who leads technology innovations at the University of Colorado Health, where about 250 doctors and staff use a Microsoft AI tool to write the first draft of messages to patients. The messages are delivered through Epic's patient portal.

The tool had to be taught about a new RSV vaccine because it was drafting messages saying there was no such thing. But with routine advice -- like rest, ice, compression, and elevation for an ankle sprain -- "it's beautiful for that," Lin said.

Also on the plus side, doctors using AI are no longer tied to their computers during medical appointments. They can make eye contact with their patients because the AI tool records the exam.

The tool needs audible words, so doctors are learning to explain things aloud, said Robert Bart, MD, chief medical information officer at the University of Pittsburgh Medical Center. A doctor might say: "I am currently examining the right elbow. It is quite swollen. It feels like there's fluid in the right elbow."

Talking through the exam for the benefit of the AI tool can also help patients understand what's going on, Bart said. "I've been in an examination where you hear the hemming and hawing while the physician is doing it. And I'm always wondering, 'Well, what does that mean?'"

What About Privacy?

U.S. law requires healthcare systems to get assurances from business associates that they will safeguard protected health information, and the companies could face investigation and fines from HHS if they mess up.

Doctors interviewed for this article said they feel confident in the data security of the new products and that the information will not be sold.

Information shared with the new tools is used to improve them, so that could add to the risk of a healthcare data breach.

Lance Owens, DO, is chief medical information officer at the University of Michigan Health-West, where 265 doctors, physician assistants, and nurse practitioners are using a Microsoft tool to document patient exams. He believes patient data are being protected.

"When they tell us that our data are safe and secure and segregated, we believe that," Owens said.