AI documentation tools

[Celexa]

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I respect the existential debates around the use of AI in medicine and education and certainly have my own thoughts, but making a polite request to keep this thread to discussion of experiences specifically with the integrated AI documentation tools that are popping up everywhere.

My institution has DAX and I tried it for the first time this week. Hilarious that the current recording time limit is 75 minutes per recording (my intakes are scheduled for 90). It caught some aspects very well but hilariously ignored completely large swaths of the HPI/psych symptom history, even parts that were less narrative and more focused (ie, discussing the symptoms, triggers, frequency, etc of panic attacks). Fortunately the transcript is there to refer back to.

I do think with relatively little tweaking it will be very helpful in summarizing medication history, etc. It did a great job summarizing the non pharm and behavioral strategies I reviewed with the patient, and that I can see being quite useful particularly in both providing the patient with a summary of what we talked about and also allowing me to track what I work on with pts from visit to visit.

But it is hilarious (and sad?) how utter trash it is at recognizing the diagnostically important parts of the interview. Don't ask me if im more annoyed by that bc it therefore wasn't as helpful for me as it has been for some of my non psych colleagues, or reassured that our jobs may be some of the last standing in medicine....

Anyone else using AI integration for notes? Whats your experience been?

 

[clozareal]

I've used Freed, Heidi, mdhub, Nabla, and my native AI app in Charm. Some are better than others. Nothing compares to the quality of writing your own notes. Only use it if you're okay with "probably good enough" notes most of the time rather than great, useful notes all the time when you're writing it yourself.

I anticipate it'll get better over time.

 

[TexasPhysician]

AI for notes is terrible. Even if it wrote decent notes, it would take more time to proof-read than just using a good template.

 

[Atreides]

I find them useful for follow ups but abysmal for intakes.

 

[comp1]

I know it's unusual, but I love writing notes, actually much more than the patient interview which can be a disorganized, rambling and even psychotic mess. I get drained by the interview and refreshed by the notes. Notes are art. They're a lot more lasting. I love getting an inpatient back 10 years later and being able to jump RIGHT back in from reviewing my old notes. And with discharge summaries, I like really going in depth as to what was done and why so that future providers can figure out what works and what doesn't (medication and behavioral interventions) really quickly and easily without repetition. It's kind of sad that AI will likely perfect this earlier than the interview.

 

[pewpewlaserz]

I am in cash-pay private practice and tried several commercial AI scribes. My general impression is they save some time once you've done enough fine-tuning to fit your documentation style.

Ultimately, I am not using them because my patients care a lot about their privacy: they do not want an audio transcription of their sessions going into the cloud somewhere. I respect this as privacy is a major appeal of going to cash-pay private practice.

To incorporate the time-saving from AI, I built my own AI scribe workflow without the privacy concerns (data stays completely local). It's actually quite simple with off-the-shelf hardware and software solutions that cost less than $1000 to set up. I was initially surprised by how easy it was but I guess I shouldn't have been since there are so many of these AI scribe companies.

 

[vanfanal]

I am in cash-pay private practice and tried several commercial AI scribes. My general impression is they save some time once you've done enough fine-tuning to fit your documentation style.

Ultimately, I am not using them because my patients care a lot about their privacy: they do not want an audio transcription of their sessions going into the cloud somewhere. I respect this as privacy is a major appeal of going to cash-pay private practice.

To incorporate the time-saving from AI, I built my own AI scribe workflow without the privacy concerns (data stays completely local). It's actually quite simple with off-the-shelf hardware and software solutions that cost less than $1000 to set up. I was initially surprised by how easy it was but I guess I shouldn't have been since there are so many of these AI scribe companies.

I like the idea of being in control of the data as well.
Would love to get a "how to build your own AI scribe" manual if you ever have the time. 😉

 

[Sushirolls]

@pewpewlaserz IS an AI, @vanfanal didn't you know? AI creating AI. It's already begun... [Joke]

 

[romanticscience]

I find them useful for follow ups but abysmal for intakes.

Same here. The one integrated into my EMR does a fairly good job with drafting an updated last note carried forward (i.e., adapts to the style of the last note you wrote).

 

[Gubernac]

I've used Freed, Heidi, mdhub, Nabla, and my native AI app in Charm. Some are better than others. Nothing compares to the quality of writing your own notes. Only use it if you're okay with "probably good enough" notes most of the time rather than great, useful notes all the time when you're writing it yourself.

I anticipate it'll get better over time.

I'd love to hear your preferred of these ones. I've tried Nabla, I find it to gives adequate to legitimately decent HPIs 90% of the time, and nearly completely useless assessments. I do find it saves me a ton of time on intakes. I'd love to find one that responds more dynamically to edit instructions I give it similar to what I see from chat GPT but hippa compliant and stuff.

 

[clozareal]

I'd love to hear your preferred of these ones. I've tried Nabla, I find it to gives adequate to legitimately decent HPIs 90% of the time, and nearly completely useless assessments. I do find it saves me a ton of time on intakes. I'd love to find one that responds more dynamically to edit instructions I give it similar to what I see from chat GPT but hippa compliant and stuff.

Freed has the "Magic Edit" to dynamically change your note to whatever you specify it to do. People also like Berries.

 

[FlowRate]

We use Abridge. I use it only for intakes and only for like a first draft of the HPI. It saves me about 50% of the time I would spend writing an HPI, but I often need to add details or restructure. It really struggles with the sort of nonlinear/affect-following interview style typical of many psychiatrists and often has a hard time incorporating detail on a topic gathered when returned to later in the interview.

I found that taking the transcript from Abridge and running it through copilot (BAA/HIPAA safe) did a slightly better job but it's a more cumbersome workflow and requires crafting a really solid prompt.

For follow-ups, I have a very succinct documentation style and have come to just accept leaving sentence fragments in the HPI that I type up during the appointment. (With some cleaning.)

 

[Stagg737]

I realize this is the AI thread, but nothing I've tried (which is admittedly not too many) has come close to just using a dragon dictation wand with a few smart features. In the ER I could do my whole notes in 10 minutes max that way, straightforward patients/notes were usually around 5 minutes.

 

[vanfanal]

I've tried as a few as well and I'm not impressed...obviously the software has no capability to read between the lines and narrate a formulation throughout the HPI; it cannot differentiate between which points are more and less salient. And to go back over and edit it takes even more time compared to my dictating. FWIW, I'll have to find other ways to be more efficient with documentation...I can certainly be more brief.

 

[Bartelby]

I've tried as a few as well and I'm not impressed...obviously the software has no capability to read between the lines and narrate a formulation throughout the HPI; it cannot differentiate between which points are more and less salient. And to go back over and edit it takes even more time compared to my dictating. FWIW, I'll have to find other ways to be more efficient with documentation...I can certainly be more brief.

I wondered about that. I haven't yet tried AI notetakers, but I can dictate a follow-up note in 5 or fewer minutes for most cases. If you have to wait for the AI to put the text into the note, edit the text, and add things I'm not sure it would be any easier even if it is pretty good.

 

[Merovinge]

I wondered about that. I haven't yet tried AI notetakers, but I can dictate a follow-up note in 5 or fewer minutes for most cases. If you have to wait for the AI to put the text into the note, edit the text, and add things I'm not sure it would be any easier even if it is pretty good.

I can see this being a thing for consults/ED/IP (where I also used dictation), but personally I spend 2 minutes finishing f/u notes in OP world when concurrently documenting. I do not write any assessment/plan (that's the 2 minutes) since it takes cortical functioning, but I complete the full S and O portion of all my notes while the patient is in the room. I have a hard time seeing the appeal of this type of AI software but clearly I must be missing something.

 

[calvnandhobbs68]

I can see this being a thing for consults/ED/IP (where I also used dictation), but personally I spend 2 minutes finishing f/u notes in OP world when concurrently documenting. I do not write any assessment/plan (that's the 2 minutes) since it takes cortical functioning, but I complete the full S and O portion of all my notes while the patient is in the room. I have a hard time seeing the appeal of this type of AI software but clearly I must be missing something.

Yeah I think if you really did the therapy approach of not writing or writing very minimally with nothing between you and the patient, the ambient listening could be pretty helpful in at least getting most of the points into the note you'd have to type out anyway.

I also just concurrently type for the most part and all my patients are used to it because I do it from day 1....so I get most of the info in the note during the appointment, check it over and then re-write my assessment/plan afterwards.

 

[R. Matey]

I wondered about that. I haven't yet tried AI notetakers, but I can dictate a follow-up note in 5 or fewer minutes for most cases. If you have to wait for the AI to put the text into the note, edit the text, and add things I'm not sure it would be any easier even if it is pretty good.

Used DAX a few times and switched back to dictation for basically this reason. Another is that I find that writing out the session note myself helps me to remember what the hell actually happened.

ETA: I also have patient privacy concerns that the provider facing material has not adequately explained (e.g., will pt data be used for training new models?)

 

[Stagg737]

Yeah I think if you really did the therapy approach of not writing or writing very minimally with nothing between you and the patient, the ambient listening could be pretty helpful in at least getting most of the points into the note you'd have to type out anyway.

I also just concurrently type for the most part and all my patients are used to it because I do it from day 1....so I get most of the info in the note during the appointment, check it over and then re-write my assessment/plan afterwards.

Was going to say I could see this being useful for in-person appointments, especially with therapy incorporated, where you want to be forward facing with the patient the entire time. Biggest problem I see with that is if you are wanting to exclude certain topics or statements from the record then you might have to go back and redact/edit heavily or just rewrite the note.

If you do exclusively telehealth for outpatient (like me), it seems kind of pointless as you've got the screen and keyboard in front of you anyway unless you're a very slow typist.

 

[Gubernac]

We use Abridge. I use it only for intakes and only for like a first draft of the HPI. It saves me about 50% of the time I would spend writing an HPI, but I often need to add details or restructure. It really struggles with the sort of nonlinear/affect-following interview style typical of many psychiatrists and often has a hard time incorporating detail on a topic gathered when returned to later in the interview.

I found that taking the transcript from Abridge and running it through copilot (BAA/HIPAA safe) did a slightly better job but it's a more cumbersome workflow and requires crafting a really solid prompt.

For follow-ups, I have a very succinct documentation style and have come to just accept leaving sentence fragments in the HPI that I type up during the appointment. (With some cleaning.)

Agreed, this is like identical to my experience and workflow... much less helpful on follow-ups since it's usually a handful of sorta bulletpoints rather than the much longer ones I give for my intakes. I'd add that it really seems to miss pretty important details at times. I'll do an entire DIVA-5 for ADHD diagnosis and it'll nearly miss the entirety of the responses given.

 

[Gubernac]

Used DAX a few times and switched back to dictation for basically this reason. Another is that I find that writing out the session note myself helps me to remember what the hell actually happened.

ETA: I also have patient privacy concerns that the provider facing material has not adequately explained (e.g., will pt data be used for training new models?)

if they use the material for training new models... there will be some interesting outcomes. The psychiatrists who use it for documentation are a specific group of psychiatrists (of which I am a part of). You might find that the AI makes notes for this specific type of psychiatrist that are quite different from psychiatrists as a whole due to whatever variables you want to ascribe to psychiatrists that use AI documentation and their interviewing and documenting styles.

 

[FlowRate]

Agreed, this is like identical to my experience and workflow... much less helpful on follow-ups since it's usually a handful of sorta bulletpoints rather than the much longer ones I give for my intakes. I'd add that it really seems to miss pretty important details at times. I'll do an entire DIVA-5 for ADHD diagnosis and it'll nearly miss the entirety of the responses given.

Yes, It's terrible with semi-structured interviews and especially terrible with pertinent negatives. It almost never includes STOPBANG or narcolepsy tetrad (esp if negative) and usually omits a lot of the detail from the ACEPLUS questions that I ask.

 

[clausewitz2]

Yes, It's terrible with semi-structured interviews and especially terrible with pertinent negatives. It almost never includes STOPBANG or narcolepsy tetrad (esp if negative) and usually omits a lot of the detail from the ACEPLUS questions that I ask.

This is the point at which it'd be great if you could just whip out an Opus/Gemini Pro API key and set up something simple to call an actual frontier LLM and feed whatever standardized instruments you like to use into context.

 

[FlowRate]

This is the point at which it'd be great if you could just whip out an Opus/Gemini Pro API key and set up something simple to call an actual frontier LLM and feed whatever standardized instruments you like to use into context.

Absolutely. If I wanted to put a little more effort into crafting a prompt that I drop into our HIPAA compliant copilot, and if abridge made it less annoying to grab the full transcript, I think it'd do a pretty good job. It's just a little fiddly to do all that for a 20% (but noticeable) increase in note quality vs. typing that part myself / using templates.

 

[Stagg737]

Absolutely. If I wanted to put a little more effort into crafting a prompt that I drop into our HIPAA compliant copilot, and if abridge made it less annoying to grab the full transcript, I think it'd do a pretty good job. It's just a little fiddly to do all that for a 20% (but noticeable) increase in note quality vs. typing that part myself / using templates.

This is basically me. The amount of time it would take me to create the templates and get everything set up exactly how I want is probably not worth the minimal amount of time and benefit I would get from using the AI. This is partly due to the nature of my settings and also partially due to my pretty significant OCPD traits, lol.

Maybe someday it will be worth it, but for now dictation is more than adequate for me.

 

[psycho-matic]

I am in cash-pay private practice and tried several commercial AI scribes. My general impression is they save some time once you've done enough fine-tuning to fit your documentation style.

Ultimately, I am not using them because my patients care a lot about their privacy: they do not want an audio transcription of their sessions going into the cloud somewhere. I respect this as privacy is a major appeal of going to cash-pay private practice.

To incorporate the time-saving from AI, I built my own AI scribe workflow without the privacy concerns (data stays completely local). It's actually quite simple with off-the-shelf hardware and software solutions that cost less than $1000 to set up. I was initially surprised by how easy it was but I guess I shouldn't have been since there are so many of these AI scribe companies.

Nabla is excellent and by default, does not send an audio recording into the cloud. It provides the option to send the audio transcript to the cloud so the developers can hear it and use it to improve the platform, but it's not mandatory.