Artificial intelligence (AI) scribing tools are increasingly being used in NHS settings to enhance patient care and free up staff time.
In April, the Department of Health and Social Care announced support for NHS doctors to adopt AI tools that "bulldoze bureaucracy," allowing clinicians to focus more on their patients and less on documentation.
This follows a multi-site evaluation led by Great Ormond Street Hospital for Children, London, England, and funded by NHS England. The trial tested ambient voice technologies (AVTs) that listen to and transcribe consultations in real time. More than 7000 patients took part across settings including accident and emergency, primary care, community services, and mental health.
Interim data from the trial showed increased productivity and more time spent on direct care, particularly in emergency settings.
Several AI scribing tools are already being used within the NHS. Health technology company Accurx recently teamed up with Tandem Health to launch Accurx Scribe, a tool that can transcribe, summarise, and code patient consultations into a trust's clinical records, with functionality to write back to EMIS and SystmOne. It is currently being rolled out across GP practices using Accurx.
At the Royal Wolverhampton NHS Trust, a pilot of CLEARNotes is underway. The tool listens to patient consultations and generates a structured summary of the discussion.
Meanwhile, Heidi Health is being used by about 40% of GPs and is being piloted in 15 NHS trusts. The AVT tool provides real-time transcription, without storing audio files, in order to address patients' privacy concerns.
At Modality, a group of general practices in West Yorkshire, Heidi has been installed for all GPs and advanced clinical practitioners.
Tom Ratcliffe, a GP partner and digital transformation clinical lead for the group, said: "Clinicians find that it saves time and reduces their administrative burden, particularly around generating clinical correspondence after consultations."
Ratcliffe described using an AI scribing tool as "quite transformative" and particularly beneficial for clinicians who are slower typists or who take longer to write detailed notes.
"One of the really significant benefits we've experienced is that by having an ambient scribe writing the notes while you're speaking with a patient, it enables you to focus more on them," he told Medscape News UK. "That's really important, as you're then picking up on non-verbal cues that you can easily miss when you're distracted by the computer."
With GPs having between 30 and 50 clinical contacts per day, "having to think about exactly what to write for each of those encounters is quite a drain on your mental capacity," Ratcliffe said. "My colleagues and I have all found using an ambient scribe helps to reduce your cognitive load. Having a consistent format for the notes for every encounter is also helpful," he added.
Educating patients about the software is an important consideration. Thomas Kelly, co-founder and chief executive of Heidi Health, said clinicians are advised to obtain consent before using the tool and to explain to patients how an AI scribe works and what they can expect during a consultation.
"Patients can also learn more through a range of resources that GPs can put up in their practices that explain how Heidi works," Kelly said.
A transcription of the consultation will be generated, "but the audio is not permanently recorded or stored in a way that could ever be breached," he explained. "It's just being turned into that documentation in real time, and this process is happening on Heidi's servers in the UK." However, when a session is deleted from Heidi's servers, "it's deleted for everyone, and there is no way it can be retrieved."
Ratcliffe said that patients have reacted positively to their Modality GP using an AI scribing tool.
"With all the digital innovations we've introduced, we've always had patients who raised very reasonable questions about the privacy of their data," he said. "But the level of patient acceptance of using Heidi has been incredibly high."
Each patient is asked to give their consent for the scribing tool to be used. "I haven't heard of a single example of a patient declining use in an encounter, and we've done probably hundreds or thousands of these now," said Ratcliffe.
Andrew Noble works within the frailty service at Jean Bishop Integrated Care Centre in East Hull, England. He uses Heidi for consultations lasting up to an hour, which require lengthy administration time.
Staff training on the system emphasises vigilance about possible AI hallucinations in output.
According to Noble, one or two minor errors might occur during an hour-long consultation transcription. However, for shorter appointments, lasting 15 minutes, clinicians might expect error-free note-taking from the AI scribe.
Use of the tool has significantly improved the quality of note-taking. "The Heidi AI scribe halved the number of spelling mistakes, and it reduced the number of abbreviations quite significantly as well," said Noble.
Mistakes might include US spellings of antibiotics or the scribe mishearing the name of a medication. "But we do have human error when inputting our own notes, so those things were already happening from time to time," Noble observed.
Ratcliffe tested multiple AI scribe options before selecting Heidi Health. All platforms occasionally made minor errors.
"Anyone who uses any form of generative AI does find it will occasionally confabulate or hallucinate," he said. "One of the key parts of our training was around educating clinicians on the importance of understanding that their role has gone from spending lots of time typing up notes to carefully reading a transcript and checking for any potential issues."
Overall, "we haven't found that the error rate is high enough that means it's unsafe or not practical to use," said Ratcliffe.
Health Secretary Wes Streeting has described AI as a catalyst that will revolutionise healthcare. GPs appear to share this optimism.
"This was something that we worked really hard to roll out quickly because we did feel that it was game-changing," Ratcliffe explained. "I think it has been game-changing for a lot of our clinicians. When used properly, it can make a big difference."
With GPs working "above and beyond," Ratcliffe believes that AI scribing tools "could help us to move back to a safer place in terms of making our workload more manageable."
