In the fall of 2024, artificial intelligence-powered ambient scribe technology was rolled out across the University of California, San Francisco (UCSF) health system, allowing otolaryngologists and other clinicians to transcribe conversations with patients into text with just a click of a button.
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July 2025Since then, Nicole Jiam, MD, an otologist and assistant professor of otolaryngology-head and neck surgery at UCSF, has found that the innovation has allowed her to engage more fully with her patients, with more eye-to-eye interaction, as opposed to being turned to a computer monitor, typing.
It has also reduced the time she has had to work on documentation at home. She would sometimes need to work on notes until past 11 p.m. Now this at-home time doesn’t typically extend past 7 or 8 p.m., she said.
“I would say, a lot less pajama time,” Dr. Jiam said.
Nonetheless, she needs to be sure to review all the notes herself, lest the AI insert a mistake into the note, which is ultimately the responsibility of the physician, and there is typically at least a little editing needed, she said. And she still writes her own assessment and plan, feeling it is the best way to capture the nuances of what can be a complex clinical picture, she said.
Benefits of Ambient Scribes
As ambient scribes are assessed and adopted at an astounding pace in ENT departments and healthcare systems in the U.S. and around the world, many doctors are finding them to be a liberating breakthrough that has substantially reduced the time they need to spend in the electronic health record—where no physician wants to be — and instead have more fulfilling, and maybe even more clinically effective, encounters with the patients for whom they care. But the systems come with limitations, and, reportedly, price tags between about $200 and $600 a month per physician. So, while the trend is moving swiftly toward ambient scribes, the choice is a consequential one for health systems.
“Anything that can make our work more efficient and let us focus on patient care, which is what brings us joy, is going to be really beneficial for physicians—and ultimately also patients, since the clinicians, when they’re less burned out, are more likely to provide better care,” said Anaïs Rameau, MD, associate professor and director of new technologies at the department of otolaryngology–head and neck surgery at Weill Cornell Medical College in New York. “But this also comes with a cost.” Her center has been trying out the ambient scribe system Dragon Ambient Experience (DAX).
Anything that can make our work more efficient and let us focus on patient care, which is what brings us joy, is going to be really beneficial for physicians—and ultimately also patients, since the clinicians, when they’re less burned out, are more likely to provide better care. —Anaïs Rameau, MD
In an American Medical Association (AMA) survey report published earlier this year, among the 1,183 respondents, including 464 primary care physicians and 719 specialists, the feedback reflected a rapid uptake of AI. In a survey performed in November 2024, 80% of the respondents said that using AI for documentation of billing codes, medical charts, or visit notes would be relevant to their practice. That was up from 74% in August of 2023 (AMA. https://tinyurl.com/2s36fpzd).
Users of AI for documentation jumped considerably just from August 2023 to November 2024—from 13% of respondents to 21%.
The survey found that 55% were either already using or planning to use AI for documentation in the near term, up from 39% in 2023.
This year’s American Academy of Otolaryngology–Head and Neck Surgery (AAO–HNS) Report on Artificial Intelligence said easing administrative burden is a key role for AI (Otolaryngol Head Neck Surg. doi:10.1002/ohn.1080).
“A key use case is clinical documentation, the biggest time sink for most physicians in clinic,” the authors wrote. “Increasingly, minimal clinician input is needed to produce highly relevant, accurate documentation while relieving clinicians of a clerical burden.”
Studies have typically shown that physicians tend to save time working in the EHR, although not all of the results are dramatic.
A study from the University of Pennsylvania that included 46 clinicians from 17 specialties found that from April 2024, the pre-technology baseline, to June 2024, the use of an ambient scribing tool was associated with a decrease in time in notes per appointment, from 10.3 minutes to 8.2 minutes, a 20.4% drop. There was a 30% decrease in after-hours work time per workday, a drop from 50.6 minutes to 35.4 minutes a day (JAMA Netw Open. doi:10.1001/jamanetworkopen.2024.60637).
A similar study out of Stanford found that, over three months, the median time per note was reduced by about half a minute with an ambient scribe (J Am Med Inform Assoc. doi:10.1093/jamia/ocae304). A companion study at Stanford found large reductions in task load and feelings of burnout (J Am Med Inform Assoc. doi:10.1093/jamia/ocae295).
But the data don’t always paint a picture of a dramatic boon in time savings for everyone. The Stanford study found that ambient scribes were only used in about half of patient encounters over the study period—9,629 out of 17,428 — and that there was “significant inter-user heterogeneity.”
In a recently published report on its one-year experience with an ambient scribe that involved 2.5 million uses, the Permanente Group found that not all physicians tended to save a large amount of time (NEJM Catal Innov Care Deliv. doi:10.1056/CAT.25.0040).
“High users”—those in the top third by volume—“comprised the vast majority—89% of the total—of ambient AI scribe activations,” the Permanente researchers said. “High users also tended to have more time spent in notes, orders, and clinical review per appointment, while having fewer visits per day, on average, prior to ambient AI scribe deployment.”
These high users saw a reduction of 0.7 minutes—42 seconds—per note, while low users—those comprising the bottom two-thirds of use volume—saw a reduction of just 0.15 minutes—9 seconds—per note.
Reductions were also seen for ambient scribe users in “pajama time” and time spent on documentation between 7 a.m. and 7 p.m. Eighty-four percent of users said it improved their patient interaction, and 82% said it improved their work satisfaction.
Among patients, 39% reported that their doctor was spending more time than usual talking directly to them, and 56% said it improved the quality of their visit.
A March 2025 report from the Peterson Health Technology Institute AI Taskforce—made up of representatives from eight health systems, 10 ambient scribe companies, and other experts in health innovation—said the evidence suggests the early impact to be positive on burnout and cognitive load but mixed on time saved and financial effects (Peterson Health Technology Institute. https://tinyurl.com/2rxxydpf).
“Given the costs and limited evidence to date on return on investment, however, there is a real risk that as ambient scribe adoption continues apace, health systems will implement solutions in ways that add to overall costs of care,” task force members wrote.
Cleveland Clinic went through a rigorous process in 2024, evaluating several platforms across 80 specialties and subspecialties. Earlier this year, Ambience Healthcare’s platform was rolled out across the entire system.
Paul Bryson, MD, MBA, director of the Cleveland Clinic Voice Center, who was involved in the trials of some of the systems, said he has had a good experience. When an encounter is done, he can go into Epic and easily get the note broken down into its component parts.
“When I click in Epic (EHR) my Ambience tab, my HPI (history of present illness) and assessment and plan are right in front of me, and then I can quickly skim it and put it into my note and finish it,” he said.
Dr. Bryson—who still works with human scribes sometimes as he goes through the transition—needs to review the ambient scribe’s notes, but said that it has not been time-consuming.
“The editing hasn’t been real burdensome,” he said. “I feel like the ambient scribe sometimes can capture more extended conversations a little bit better, depending on the human scribe …. Sometimes when you’re having a really long conversation about surgery and post-op and stuff like that, sometimes some things can get lost if somebody’s transcribing for you.”
Training and Implementation
As for the training?
“Five minutes,” Dr. Bryson said. “It’s super quick.”
During the pilot phase, providers reported reduced mental load, faster documentation time, decreased burnout, and less time spent working on documentation outside of work. In addition, providers felt the notes were detailed and improved care coordination across specialties.
Eric Boose, MD, Cleveland Clinic’s associate chief medical officer, said that “during the pilot phase, providers reported reduced mental load, faster documentation time, decreased burnout, and less time spent working on documentation outside of work. In addition, providers felt the notes were detailed and improved care coordination across specialties.”
Andres Bur, MD, associate professor of otolaryngology-head and neck surgery and vice chair for technology, AI, and innovation at the University of Kansas Medical Center, in Kansas City, Kan., said he recently tried several ambient scribe platforms as his center explores its options.
When we have tools that take care of documentation for us, initially you’re going to be very careful to make sure that the scribe is behaving appropriately, that it’s documenting what you say,” he said. But as you see good results, as you start to become more reliant on the tool, then you may be less likely to check. —Andres Bur, MD
“In ENT, we tend to have very quick visits with our patients, where ultimately documentation ends up being a substantial percentage of the time spent on each visit. So these tools really have the potential to make us more efficient and allow us to take care of more patients and focus more on caring for patients rather than on clinical documentation,” he said, adding that it takes a little time to get used to the systems and learn how to customize your preferences.
“I think the tools are getting there in terms of what they’re capable of,” he said.
Dr. Jiam, who uses the Ambience Healthcare platform, said that knowing the ambient scribe is recording the visit is reassuring.
“Because I know that note-taking—whether it’s right after that visit or long-term at the end of the day—is not going to be as burdensome, I can be more in the moment and present with the patient and have that sort of detail,” she said. “The HPIs, and even some of those longer histories, don’t feel as burdensome or daunting because I don’t feel like I have to capture all of that on the spot to do right by the patient.”
She said her training involved a one-hour group training session with a vendor representative.
The HPIs, and even some of those longer histories, don’t feel as burdensome or daunting because I don’t feel like I have to capture all of that on the spot to do right by the patient. —Nicole Jiam, MD
Tulio Valdez, MD, MS, professor of otolaryngology-head and neck surgery at Stanford Medicine, in Stanford, Calif., where he is a pediatric otolaryngologist, said his center tried platforms for about half a year and recently rolled out the DAX platform across the system.
“I’ve been using it for the last month, and to be honest, it’s great,” he said. “It does provide much better feedback to patients because you’re really spending more time paying attention to them rather than typing or documenting or doing all the other things.”
He said the platform is not so good with Spanish language interactions, so if he wants to use the ambient scribe, he has to repeat what was said in English to have the notes recorded correctly.
Still, the ways it has saved time and improved the dynamics of visits have been a big plus, he said.
Challenges of the Tech
A language gap is not the only limitation that doctors are discovering with this technology.
Dr. Jiam said that sometimes the scribe will not use the correct medical terminology, typically when terms might be similar in meaning but have important differences in a medical sense.
“They may lump colloquial terms like ‘vertigo’ and ‘dizziness’ and ‘disequilibrium’ together when there is more sort of a medical precision behind how I use those words and how I’m defining them,” she said.
Also, she said, the timing aspects that have been discussed during the visit might not be accurately described in a summary.
“It may say, ‘This patient has had vertigo for like four months,’” when the reality is very different, she said. The AI might have rendered the discussion that way because the patient had believed it was vertigo, but it was actually disequilibrium, “with brief bouts, like less than a minute, of vertigo.”
But if the AI version were to be simply cut and pasted into the official note, “expert to another expert, it’s not really correct,” she said. This has led her to write her own assessment and plan, rather than use the ambient scribe for that.
“The accuracy behind it is not 100%, for sure,” but a healthy realization that it’s just “an adjunctive tool” will go a long way, she said.
Dr. Bur had a similar perspective, pointing to the risk of the potential for “automation bias,” or relying too much on an automated system, Dr. Bur said.
“When we have tools that take care of documentation for us, initially you’re going to be very careful to make sure that the scribe is behaving appropriately, that it’s documenting what you say,” he said. “But as you see good results, as you start to become more reliant on the tool, then you may be less likely to check.”
At Cleveland Clinic, Dr. Boose said there is an awareness of the need for careful use of the technology.
“We are committed to the safe and responsible use of AI in the healthcare setting,” he said. “This AI feature is not intended to diagnose, treat, cure, prevent, or mitigate any disease or other medical condition. Providers are required to read the note in its entirety to confirm its accuracy and completeness and edit as needed prior to signing the note.”
Dr. Rameau pointed to challenges seen with speech recognition technology for those with communication disabilities affecting voice, speech, or language. In a study on which she worked, published early in 2025, automatic speech recognition systems had a word error rate that was 10 times worse for those who were deaf and hard of hearing, with the worst results seen for those in the low speech intelligibility classification—an 85.9% word error rate for those encounters, compared to 5% for the normal hearing group. This raises the possibility of high error rates for those with laryngological challenges, such as those who use an electrolarynx (Laryngoscope. doi:10.1002/lary.31713).
“If we tend to rely more and more on this technology and it’s not documenting well for some of our patients with communication disabilities, then we could potentially have downstream harm to those patients because we’re just not collecting the right information and just not providing the same level of clinical decision support,” she said.
What’s Next
Otolaryngologists who follow technology closely say the increasing use of artificial intelligence in documentation is a clear step toward a more ingrained use of AI for actual diagnosis.
Dr. Bur said it is “absolutely a step in that direction.”
“The advantage of using tools like virtual scribes is that they can create structured data,” he said. “So they can actually extract specific variables that then can be used for predictive models in order to make predictions that ultimately help diagnose patients more accurately.”
“Absolutely, I think it’s going to assist in diagnosis,” Dr. Valdez said. “It’s still not giving those prompts—‘You should do this, you should do that’—but it’s a step away from being able to.”
Dr. Rameau said that if these platforms capture patient encounters more thoroughly, especially as they improve, that will only make AI better at making diagnoses. And she said research already suggests that artificial intelligence might be better than clinicians at diagnostics and clinical reasoning.
“As ambient AI becomes more widespread, probably some of this clinical decision support is going to be integrated into these tools,” she said. “And as that happens, it is possible that at some point there could be more of an assessment of AI versus humans, AI versus humans plus AI. And if AI is superior, then we really need to have a thoughtful conversation with our patients and figure out, you know, who decides. If AI is better, what would be the role of humans, and where would clinicians find themselves?”
She said otolaryngology, a surgical specialty, is a bit more protected. And the human touch and empathy are likely going to continue to be important to the healing process, she said. But, whatever happens, the medical community has to remember what AI is—not human, but technology produced by companies.
“We as clinicians have an oath … that you shall not do harm,” she said. “AI is not trained in that way. And AI is also created by Silicon Valley big tech companies, and their goal is to create profit. Our goal as clinicians is to heal our patients, so we have to be thoughtful about these things.”
Thomas R. Collins is a freelance medical writer based in Florida.
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