JMIR Publications

ABSTRACT

Background:

There is significant potential for ambient scribe technology to enhance healthcare productivity, with a growing range of applications being developed and implemented internationally. Strong organisational drivers to improve efficiency, coupled with the technology’s potential to help address clinician burnout, are accelerating interest and adoption. However, limited attention has been paid to the integration of such systems within electronic health records and unintended consequences as stakeholders navigate their implementation and integration into clinical practice.

Objective:

This study therefore aimed to explore the processes involved in implementing and adopting ambient scribe technology across diverse healthcare settings.

Methods:

We conducted a real-time, longitudinal qualitative evaluation of a pilot implementation of an integrated ambient scribe system across NHS primary care and secondary hospital settings within a care system in the Midlands region of England. Data collection involved in-depth one-to-one interviews conducted in several phases: an initial scoping study to identify key interests and stakeholders for inclusion, followed by an implementation study with participants involved in the pilot. We also conducted 16 hours of non-participant observations of consultations. The implementation study gathered data at two time points, before implementation and three to four weeks after, to capture experiences, changes, and emerging impacts over time.

Results:

We collected data from 45 individuals. Use cases varied across settings and shaped how ambient scribe systems were deployed. Differences between general practice and secondary care in documentation purpose, format, and workflow created challenges for developing and validating templates, though the technology showed flexibility across contexts. Automated note-taking often improved patient interaction but required clinicians to adjust how they spoke to ensure the technology captured their reasoning. Outputs were sometimes generic, reinforcing defensive documentation and reducing personal tone or contextual recall. Integration pathways carried distinct trade-offs: stand-alone systems (which were used by many stakeholders in our study) were easier to adopt but offered limited long-term benefits, while integrated systems required greater effort and standardisation yet promised improved efficiency and safety.

Conclusions:

The ambient scribe market remains immature and volatile, creating strategic uncertainty for health systems. Careful procurement approaches are needed to balance the risks and benefits of integrated versus stand-alone systems, while aligning user demand with organisational needs for integration.