The Digital Scribe: A New Wave of Efficiency and Quality of Life for Plastic Surgeons

Clinical documentation places a tremendous daily burden on plastic surgeons. Clinical schedules often do not permit complete documentation in the electronic medical record (EMR), leaving providers to finish—or start—their notes well outside of normal work hours. Some physicians spend 2 hours charting for every 1 hour of patient interaction, highlighting inefficiencies of the current EMR workflow.1 Even with digital dictation technology, charting remains a key contributor to burnout.2 Current EMR documentation is ripe for enhancement. Digital scribes (DSs) offer a novel solution to this burden. Host companies, including DAX (Nuance and Microsoft), Abridge, and Freed, are gaining popularity.2 These artificial intelligence (AI)–based programs pull audio recordings of patient encounters and populate notes directly into the EMR (Fig. 1). They utilize automatic speech recognition to convert multispeaker conversations into transcripts and input them into natural language processing models. Models then extract details such as symptoms and examination findings, classify them by speaker and context, and summarize visits into templated note sections.3,4Fig. 1.: A schematic depicting the typical use of a DS in the clinic setting.DSs are becoming recognized for their clinical implications. One study investigating the impact of DSs in primary care found that DSs decreased the average time physicians spent in the EMR both during encounters and outside of traditional workday hours.2 These authors also reported that patients enjoyed how providers were more focused on them and how the quality of their conversations improved. Our institution is currently conducting a DS pilot trial, and already our division is pushing for widespread integration. We have found anecdotally that DSs refine 3 key clinical parameters: clinic efficiency, patient satisfaction, and surgeon quality of life. Alleviating the distraction of charting from surgeons enhances focus on clinical workflow. Numerous patients have commented positively about their surgeon documenting findings and thought patterns aloud for the DS; they appreciate the added degree of transparency and ability to engage more with their surgeon. Most strikingly, our piloting plastic surgeon has been able to complete all elements of documentation for 25–30 patients in as little as 45 minutes following the clinic. Based on this trial experience, the DS is a workflow transformation. Use of nights and weekends for medical documentation is ameliorated, leaving time for personal and professional pursuits. Limitations of this technology exist, including errors in word recognition, disparities in accuracy, and the need to train physicians to use new programs.4 We anticipate that research and experience will evolve DSs to a “computer-led” state wherein limitations are assuaged and the need for physician supervision is minimal.3 Clinical trials investigating the impact and cost-effectiveness of DSs are necessary until then.1 The plastic surgery community should play an active role in piloting DSs, as representation is crucial when training AI models. We are all watching AI become a ubiquitous tool; we must recognize the opportunity to optimize our value as plastic surgeons by harnessing the DS early on to improve efficiency, lessen burnout, and augment care. Technology wants what life wants—increasing efficiency, opportunity, and ubiquity.5 DSs are one more critical step on this evolutionary ladder toward a more optimal future. DISCLOSURES Dr. Sacks is a cofounder of LifeSprout, with equity and patents. The other authors have no financial interest to declare in relation to the content of this article.