An AI scribe tool is being rolled out across the country's emergency departments. Photo: 123RF
An AI scribe tool is being rolled out across the country's emergency departments following trials in Hawke's Bay and Whanganui.
However, while some clinicians were heralding the Heidi AI Scribe technology as "the way of the future", others said more effective evaluation was needed to ensure benefits touted by its designers translated to the pressures of the emergency medicine.
Late last month, Health Minister Simeon Brown said trials in Hawke's Bay and Whanganui had shown the system slashed the time clinicians spent on administrative duties.
"Doctors using the AI tool were able to see, on average, one additional patient per shift because of the time saved. That means faster care for patients and less waiting time in emergency departments.
"Based on this success, Health NZ has purchased an initial 1000 licences for frontline staff in emergency departments, enabling its nationwide rollout," Brown said.
Health Minister Simeon Brown. Photo: RNZ / Mark Papalii
Tool slashes time spent on patient notes
The creator of the tool, Heidi Health, said the trials reduced the average time spent on documenting patient notes from 17 minutes to 4 minutes.
Created in Australia, the system was currently used in two million consultations each week across 116 countries, and had been adapted to work with the clinical language and systems used in New Zealand hospitals.
Co-founder of Heidi Health, Dr Thomas Kelly said reducing the administrative burden would allow staff more time to focus on the needs of their patients.
"Healthcare professionals should never have to choose between providing quality patient care and their own wellbeing. Yet the realities of an ED, with complex cases, heavy patient demand, and workforce shortages, can make that a difficult balance.
"Heidi's ability to allow emergency staff to focus more on patient care, whilst providing much-needed relief from administrative burden, we hope will go some way to making that balance easier," Kelly said.
Risk of catastrophic error higher in ED settings
However, Otago University Professor of bio-ethics Angela Ballantyne said ongoing work would be needed to evaluate the effectiveness of the tool in the high pressure environment of the country's emergency departments.
"In ED you've got a team-based environment, multiple people contributing to the notes and, obviously, you've got critically unwell patients. So the risk of an error in those notes having a really catastrophic impact on patient safety and care is much higher," Ballantyne said.
Otago University Professor of bio-ethics Angela Ballantyne. Photo: Supplied
She said she had spoken to one doctor using a similar tool where a slight change in how a patient's response had been recorded could have had serious implications for their treatment.
"The tool made a very subtle error. The patient had said they experienced this symptom for the first time 'in the morning' and the tool had changed it to 'every morning'. So a very subtle difference but [it] has really significant clinical implications if someone else comes along and reads and tries to interpret that note.
"This doctor said it was only on the second read through that they realised that the error had been made," she said.
Ballantyne said she was concerned that the Hawke's Bay trial - which reviewed the experience of eight clinicians using the tools - had not gone into enough depth ahead of being implemented through the country's hospitals.
"If this was a drug that was being rolled out there's very set stages and processes for evaluating the safety and efficacy of those kind of products. Part of what's tricky about the AI tools is that there's not a clear regulatory pathway.
"So I would really encourage the government - at this point - to put in place mechanisms to evaluate and monitor this roll out and to be really publicly transparent about those details.
"I'm not saying don't do it but, I think, do it carefully and evaluate," Ballantyne said.
AI tool supports doctors in high pressure environment
Chair of the New Zealand faculty of the Australasian College for Emergency Medicine Dr Kate Allan has worked with the tool.
She said the technology acted as a silent assistant, listening to doctor's and patient's conversations and writing the clinical notes as they occurred.
She found it allowed doctors to deal with interruptions and changing situations without losing track of information.
"If I've just been to see a patient and I get pulled very quickly to go and see another patient - and you're multi-tasking like that - I feel it's much safer because the memory is there. Whereas if you're going from A to B to C you could lose track when you're writing your notes," Allan said.
The technology was trialled at Hawke's Bay Hospital (pictured) and Whanganui Hospital. Photo: RNZ / Peter Fowler
She was impressed by the technology's ability to hear in noisy environments and cut out discussion during a consultation, which might be irrelevant.
"It's incredible how it's able to collate and summarise what [patients] say to us and putting it into the context of the consultation. It's pretty amazing what it can do," Allan said.
The time freed up by the tool allowed her to be more detailed in the information she used in notes - but it was still necessary to review the information.
"You have to check it. We all know that AI - at this stage - hallucinates and we need to ensure that's not happening," Allan said.
She had encountered some reluctance from patients to divulge personal information using the tool but said she was not concerned about any potential for privacy breaches.
"We know that all of the patient information that we are collecting gets deleted after it's been used and we know that none of it's been used as an AI learning tool, so the AI is not learning off what's going into it. Every patient has to be consented to use it and they can decline it, so that's fine.
"It's like recording a telephone call - you can't do it with getting pre-approval," Allan said.
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