What is digitally-assisted provider documentation?
Digitally-assisted provider documentation solutions leverage artificial intelligence (AI) and other advanced technologies to deliver real-time support during the documentation process in order to reduce care team burden, improve clinical documentation quality at the point of care, avoid common deficiencies, and ensure accurate coding.
The vendor landscape encompasses a broad array of solutions with varying levels of human involvement, from traditional in-person scribes to manually document encounters to fully automated AI-driven documentation solutions. Vendors and solutions exist within four overlapping sub-categories:
- Traditional in-person scribe services. These companies provide medical scribes to document clinical encounters, transcribe dictation, and assist with patient throughput. Providers can easily customize documentation to their preferences.
- Virtual/remote scribe solutions. Virtual solutions securely connect providers with remote scribes during clinical encounters to complete EHR documentation in real time.
- Tech-Enabled Human (HITL). Human in the loop (HITL) solutions assist users with tools such as real-time clinical support, natural language processing, and ambient clinical documentation. Providers initiate encounters and some customization options may be available.
- Intelligent Documentation (HOTL). Human out of the loop (HOTL) solutions capture clinical conversations to generate real-time notes within the EHR. HOTL solutions are entirely tech-driven, with no human involvement and minimal or no customization options.
"Recent breakthroughs in artificial intelligence have already fueled a wave of new healthcare-grade products, and speed to adoption will continue to increase. But AI will never replace humans in healthcare–it lacks our capacity for critical thinking, empathy, and creative problem-solving. Its real value comes from its ability to reduce burdens, find and analyze information, and augment the provider experience."
The case for digitally-assisted provider documentation
While human scribes can improve efficiency and make provider workloads more manageable, the traditional on-site scribe is increasingly viewed as a human band-aid for a larger informatics problem. And for some organizations, the disadvantages of human scribes (which include frequent turnover, higher labor costs compared to digital, and widely variable skills) outweigh the benefits.
Digital health companies have placed their bets squarely on AI as the most viable path forward. Even the most sophisticated tech-enabled human (HITL) solutions have required some level of human-led quality assurance, which incurred additional turnaround time and forced providers to complete documentation outside of clinic time. But with recent AI breakthroughs, the most advanced intelligent documentation solutions bypass human involvement in the documentation process and decrease average turnaround time–usually four to 24 hours–down to about 10 seconds.
Value for investment
| Traditional in-person scribes | Virtual/remote scribes | Tech-enabled humans | Intelligent documentation | |
| Annual scribe/solution cost | $40,000 | $35,000 | $20,000 | $10,000 |
| Provider time (estimated value)* | $15,000 | $15,000 | $22,000 | $29,000 |
| Total investment | $55,000 | $50,000 | $42,000 | $39,000 |
| Reduction in documentation burden (est.) | 90% | 80% | 60% | 50% |
*Approximate value of provider time for each solution
| Financial gains | • Improved physician productivity: Approximately $30,000 per year for a single additional patient appointment each day (assuming $125 reimbursement) • Reduced medical coding expenses • Quicker and more accurate reimbursements |
| Non-financial gains | • Decreased documentation burden • Less after-hours “pajama time” • Improved patient experience • Improved access with incremental visits |
Key attributes of digitally-assisted documentation solutions
New and future digitally-assisted documentation solutions will continue to leverage AI and reduce provider burden to the greatest possible extent. The best solutions digital solutions will include:
Workflow enhancement: Solutions should streamline and simplify clinical and coding workflows while improving documentation quality.
Coding recommendations: Automated coding tools should generate codes directly from clinical documentation, provide real-time guidance, and flag inconsistencies.
Diagnosis recommendations: Solutions should reduce physician cognitive load with real-time clinical decision support.
Ordering and referrals: Intelligent ordering and referral input tools within the streamlined workflow.
Patient education: Real-time patient education recommendations during clinical conversations and simplified ordering/assignment.
Organizing for success with digitally-assisted provider documentation
What health systems should consider as they assess their needs and investigate digital documentation solutions:
- Determine an appropriate strategy for the enterprise: a single one size fits all solution for all providers, or a hybrid/platform approach with multiple digital documentation support modalities to support individual providers and specialties.
- Carefully design pilots to understand impact and workflow, and test the validity of the business case. Pilots should be targeted to provider groups that will demonstrate solution impact compared to baseline.
- Identify provider expectations for documentation support, such as work relative value units, encounter close rate, patient satisfaction, or other considerations.
- Build a framework for long-term success that includes scribe governance, key performance indicators, and periodic provider utilization and performance review.
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1 https://pubmed.ncbi.nlm.nih.gov/31438114/
2 https://www.acpjournals.org/doi/10.7326/M16-0961
3 https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2790396
4 https://amia.org/about-amia/amia-25×5/25×5-documentation-burden-reduction-toolkit
5 Assumptions: $1.50 physician labor cost per minute, 20 patients per day for 48 working weeks, 30 scribe hours per week
6 https://www.ama-assn.org/practice-management/physician-health/how-much-physician-burnout-costing-your-organization#:~:text=For%20an%20organization%2C%20the%20cost,onboarding%20costs%20for%20replacement%20physicians.
7 nejmcareercenter.org/minisites/rpt/the-high-costs-of-hiring-the-wrong-physician/
