JMIR Publications

ABSTRACT

Background:

AI-powered ambient scribes are rapidly being adopted in healthcare settings, with growing interest in their potential to generate patient-facing visit summaries. While research has demonstrated that patients benefit from reading clinical notes, prior visit summaries were designed primarily to satisfy regulatory requirements rather than patient needs. Most existing ambient scribe research focuses on clinician perspectives, particularly regarding documentation burden and burnout, leaving patient preferences largely unexamined.

Objective:

This study aimed to engage patients as co-designers to understand what they want and need from an ambient scribe.

Methods:

Between October 2024 and April 2025, the research team conducted five structured virtual engagement activities with 16 members of the OpenNotes Lab Insight Panel, including 14 patients and 2 clinicians. Panelists were diverse across race, age, gender, disability status, health literacy, language, geography, and educational background. Activities involved observation of role-played clinical visits (a chronic conditions follow-up and a potential cancer diagnosis visit), review of ambient scribe–generated clinical notes and visit summaries, and structured discussion using a modified 1-2-4-all method. A Rapid Assessment Procedure (RAP) was used to analyze transcripts, meeting chats, and participant notes across all five sessions, with iterative coding by four team members and findings shared back to panelists.

Results:

Nine themes emerged and were grouped into three categories. Development themes included: Practicality (patients wanted clear tasks, timelines, defined responsibilities, and contingency plans); Language & Tone (preferred reading level ranged from 4th to 8th grade; patients wanted empathetic, personalized, non-judgmental language, particularly for sensitive visits); Accessibility (patients wanted multi-modal access including audio, print, and digital formats, with screen reader compatibility and portal shareability); and Clarity & Accuracy (panelists identified factual errors and omissions, including misattribution of anxiety as a diagnosis rather than a situational response, and wanted patient-reported information reflected). Implementation themes included Transparency (unanimous expectation of disclosure that content was AI-generated) and Patient Choice (universal desire for opt-out options and preference portability). Additional themes addressed workflow improvements, logistical challenges around note finalization timing, and desired outcome measures.

Conclusions:

Patients primarily want ambient scribe–generated visit summaries to function as practical care navigation tools with clear action items, transparent AI disclosure, and flexible formats responsive to both patient context and visit type. Realizing this potential will require collaboration among ambient scribe developers, EHR vendors, health systems, and patients, rather than layering new tools onto existing inefficient workflows.