3 days ago
AI-scribes boost GP efficiency but raise ethics concerns in NZ care
A survey of health professionals in New Zealand has revealed that the use of AI-powered transcription tools, or AI-scribes, is becoming prevalent among general practitioners while raising several ethical, legal, and confidentiality concerns.
The study led by the University of Otago, Wellington, involved 197 providers working in primary care and documented their experiences with AI-scribes during consultations. The majority of respondents were general practitioners, but the group also included nurses, nurse practitioners, rural emergency care providers, and practice managers.
Findings showed that 40 per cent of those surveyed were using AI-scribes for patient note-taking. However, only 66 per cent had read the software's terms and conditions, and 59 per cent sought patient consent before using the tool during consultations.
Mixed experiences
The responses collected painted a nuanced picture, with users expressing both optimism and frustration. Most who used AI-scribes reported they were helpful or very helpful, while 47 per cent estimated that using the tool in every consultation could save them between 30 minutes and two hours per day. However, a significant minority indicated that these gains could be offset by the time it took to review and correct AI-generated notes.
Some users described notable concerns around the accuracy, completeness, and conciseness of the notes produced. One doctor observed, "(It) missed some critical negative findings. This meant I didn't trust it." Another remarked on the frequency of errors, referred to as 'hallucinations', noting that, "the hallucination rate was quite high, and often quite subtle."
Practical challenges
Difficulties with understanding local accents, vocabulary, and te reo Māori were also mentioned. Some professionals described pausing the AI tool when discussing information that could identify the patient, such as names or dates of birth.
The presence of AI-scribes altered the manner in which clinicians interacted with patients. More than half the respondents said the use of the tool changed the dynamic of consultations, requiring doctors to verbalise physical examination findings and thought processes so the AI could capture relevant information. One surveyed GP recalled, "Today someone said, 'I've got pain here', and pointed to the area, and so I said out loud 'oh, pain in the right upper quadrant?'"
Broader implications
Professor Angela Ballantyne, Lead Researcher and Bioethicist in the Department of Primary Health Care and General Practise at the University of Otago, Wellington, said the adoption of AI transcription services is taking place rapidly in primary care, even as regulations and guidelines are still being established. "They need to be vigilant about checking patient notes for accuracy. However, as many survey respondents noted, carefully checking each AI-generated clinical note eats into, and sometimes negates any time savings."
Professor Ballantyne highlighted the importance of balancing the benefits of AI-scribes with patient rights and data security needs. She stated, "Most AI-scribes rely on international cloud-based platforms (often privately owned and controlled), for processing and storing data, which raises questions about where data is stored, who has access to it, and how it can be protected from cyber threats. There are also Aotearoa-specific data governance issues that need to be recognised and resolved, particularly around Māori data sovereignty."
Some respondents noted that the technology allowed them to engage more directly with patients during consultations, reporting increased eye contact and more active listening time. This, they felt, improved rapport and communication.
Consent and regulation
National guidance on the use of AI-scribes in healthcare is still developing. The National Artificial Intelligence and Algorithm Expert Advisory Group (NAIAEAG) at Health New Zealand – Te Whatu Ora has endorsed two AI-scribe tools, Heidi Health and iMedX, after considering privacy, security, and ethical issues. Medical Council of New Zealand guidance, expected to be released later this year, is anticipated to require explicit patient consent for the use of AI transcription tools.
Professor Ballantyne commented on the consent process: "Patients should be given the right to opt out of the use of AI and still access care, and adequate training and guidelines must be put in place for health providers."
She said AI technology is evolving, which may help address some current ethical and practical concerns. "Coupled with appropriate training, good governance and patient consent, the future of AI scribes holds much promise."
