Full Transcript Introduction to Ambient Scribes 0:00 Ambient Scribes are one of the most exciting developments we've seen in clinical workflows in years. 0:06 They promise less typing, less burnout, and more meaningful connection with patients. 0:11 And for many physicians, that alone feels like a long overdue shift in the right direction. 0:18 But here's the question. 0:19 Are they actually capturing the full clinical and financial story of The Visit? 0:26 Because what I'm seeing across practices of all sizes is that while ambient scribes are incredibly helpful, they're not the entire answer. 0:36 Welcome to Medical Money Matters, the podcast where you can find experts, answers, and resources so that you achieve mastery over the financial and business 0:49 aspects of your practice. 0:51 Hello, everyone. 0:52 I am your host, Jill Irina. 0:54 I began my career in accounting and finance and I have more than 30 years of experience running medical groups. 1:01 I own and operate a national healthcare consulting and revenue cycle company and am the author of Physician Heal Thy Financial Self. 1:09 In 2020, I co-founded the Physician Leadership Project, and in 2025 I released Physicians Edge, the first of its kind CME-accredited online business education 1:21 for physicians. 1:22 My passion is to increase financial and business literacy for Physicians. 1:28 Episode 178. If you didn't say it, it did happen. 1:34 The hidden risk of ambient scribes. 1:38 Ambient Scribes are one of the most exciting developments we've seen in clinical workflows in years. 1:43 They promise less typing, less burnout, and more meaningful connection with patients. 1:49 And for many physicians, that alone feels like a long overdue shift in the right direction. 1:56 But here's the question. 1:57 Are they actually capturing the full clinical and financial story of The Visit?
Podcast and Host Introduction 2:03 Because what I'm seeing across practices of all sizes is that while ambient scribes are incredibly helpful, they're not the entire answer. 2:14 And this isn't a knock on the technology. 2:16 In fact, I think it's one of the most important tools we've added to the clinical environment in a long time. 2:22 But like any tool, its value depends entirely on how it is used and what we assume it doing for us. 2:30 So let's start with what ambient scribes do really well, because there's a lot to appreciate here. 2:36 They reduce the physical and cognitive burden of documentation. 2:40 Instead of turning your back to the patient and then typing onto a screen, you can stay engaged, make eye contact, and actually listen. 2:48 That alone changes the dynamic of the visit in a meaningful way. 2:53 They also improve efficiency. 2:56 Notes are often generated quickly, sometimes even in real time, which reduces the amount of after hours pajama time charting that so many physicians have 3:05 come to accept as normal. 3:06 For some practices, that's been transformative. 3:11 And they can help with recall.
The Hidden Risk of Ambient Scribes 3:13 The system is capturing the conversation, Which means fewer missed details, fewer forgotten elements, and a more complete record of what was said in the room. 3:23 So yes, this is a powerful tool. 3:26 But it's still just a tool, and where things start to break down is in the gap between what is said and what it thought. 3:34 Because if you think about how you practice medicine, so much of your value is not in what you say out loud. 3:41 It's in, what's happening internally. 3:44 During a typical patient visit, you're constantly processing information. 3:48 You're building a differential diagnosis. 3:50 Your weighing risk. 3:52 your deciding what matters and what doesn't. 3:54 you are considering what could go wrong, even if it's unlikely. 3:59 Making judgment calls based on years, sometimes decades, of training and experience. 4:05 This is probably benign, but I can't ignore the possibility that it is something more serious. 4:11 Or, I'm going to treat this conservatively, but I need to keep a close eye on it. 4:16 Or given this patient's history, this is actually higher risk than it appears. 4:22 Those are sophisticated clinical decisions. 4:25 But here's the problem. 4:26 Ambient scribes are only capturing what is spoken. 4:30 And what has spoken is often a simplified, patient-friendly version of what you're actually thinking. 4:36 So what ends up in the note looks much less complex than the actual visit. 4:41 And that has real consequences. 4:44 Because from a coding perspective, from compliance perspective and from financial perspective complexity matters. 4:53 Medical decision-making is one of the core drivers of E&M coding, and medical decision making is based on things like the number and complexity of problems addressed, 5:04 the amount and the complexity data reviewed, AND the level of risk. 5:09 If those elements aren't documented, they don't count. 5:12 So if you're thinking through a complex differential diagnosis, but only verbalizing a simplified conclusion, the note may reflect a lower level of complexity 5:22 than what actually occurred. 5:24 And over time, that leads to under-coding. 5:27 Not once in a while, consistently. 5:30 And consistent undercoding is not a small issue. 5:34 As we've discussed in previous episodes, it's a slow, steady erosion of your revenue. 5:40 It's an underrepresentation of the work you're actually doing. 5:44 And in some cases it can even create compliance concerns in the opposite direction, because your documentation doesn't match the true acuity of you patient population. 5:56 Let me give you a simple example. 5:58 A patient comes in with chest pain. 6:00 In your mind, you're thinking through a range of possibilities. 6:03 Musculoskeletal pain, sure, but also cardiac causes, pulmonary embolism, maybe even something gastrointestinal. 6:11 You're weighing risk factors, history, presentation. 6:15 But what you say out loud might be something like, this is likely musculoskelital. 6:20 Let's treat it conservatively and monitor. 6:23 That's appropriate communication for the patient. 6:26 But if that's all that gets captured in the note, it tells a very different story than what actually happened cognitively. 6:33 And that difference matters. 6:35 So now we're in a new reality where documentation is no longer just about what you type. 6:40 It's about you say. 6:42 And that creates a challenge. 6:45 Because you may now need to say things out loud that you used to simply think. 6:50 You may need verbalize your differential diagnosis. 6:53 you need articulate your risk assessment. 6:56 Explicitly state what your ruling in or ruling out, what data you reviewed, and why you made the decisions you make.
Documenting Clinical Reasoning Out Loud 7:04 That's a shift. 7:06 And it's not always comfortable. 7:09 Because not everything you think is something you want to say in front of a patient. 7:14 There are moments in clinical care where your internal thought process includes possibilities that are serious, sensitive, 7:22 or even alarming. 7:23 You might be considering a diagnosis that would worry the patient unnecessarily if presented without context. 7:30 you might thinking about concerns related to compliance, behavior, psychosocial factors that require nuance and care. 7:38 And now, with an ambient scribe listening, the question becomes, how do you document those thoughts appropriately without creating unintended consequences 7:47 in the room? 7:48 This is where things get more complex. 7:52 Because on one hand, you need accurate documentation. 7:55 You need to capture the full scope of your clinical reasoning. 7:58 you Need to support appropriate coding and protect yourself from a legal standpoint. 8:04 On the other hand you, need, to maintain trust with your patient.You need To communicate in a way that is clear, compassionate, 8:11 and appropriate for the situation. 8:13 So there's a tension here. 8:16 And the solution is not to abandon the tool. 8:19 It's to evolve how we use it. 8:22 One of the most important skills that physicians will need to develop in this environment is intentional phrasing. 8:28 Learning how to say what needs to be documented in a way that is both accurate and appropriate. 8:34 For example, instead of saying nothing about your differential diagnosis, you might say, there are a few possibilities we're considering here, 8:42 including X, Y, and Z. 8:45 Based on what I'm seeing today, I think this is most likely X but we are going to keep an eye on it. 8:50 That communicates your thinking. 8:52 It documents your complexity. 8:54 And it does so in a way that is transparent, but not alarming. 8:59 There will also be times when what you need to document is not something you want to say out loud in that moment. 9:05 And that's where it's important to remember that the ambient scribe should not be the final version of your note. 9:11 It should always be first draft. 9:14 You still have the ability and the responsibility to review, edit, and add to that note before it becomes part of the permanent record. 9:23 That might mean adding an addendum. 9:25 It might meaning refining language. 9:27 it might means documenting elements of your thinking that weren't verbalized during the visit. 9:32 Because again, the goal is not just faster notes, it's better notes. 9:38 More accurate notes – notes that reflect the true complexity of the care you're providing. 9:46 You're listening to Medical Money Matters, a weekly podcast brought to you by Healthy Practices, A healthcare consulting and revenue cycle company dedicated 9:55 to keeping our clients independent. 9:57 If you're looking for more ways to strengthen your business skills, check out Physicians Edge, the first of its kind CME accredited online business education 10:07 for physicians. 10:08 It's a mini MBA online course designed to help you master the financial side of your practice. 10:15 You can find that and more about how we support practices like yours at healtheps.com. 10:22 That's www.healtheps .com And don't forget to follow or subscribe so you never miss an episode. 10:32 Now, let's zoom out a bit and talk about the operational and workflow implications of ambient scribes, because there's a lot happening here as well. 10:42 On the positive side, we're seeing improved efficiency in many practices. 10:46 Physicians are spending less time charting after hours.
Workflow Benefits and Implementation Challenges 10:50 Notes are being completed more quickly. 10:52 There's a sense of relief that comes from not having to carry that documentation burden into the evening. 10:58 We're also seeing improvements in patient engagement. 11:01 When the physician is not focused on a screen, the interaction changes. 11:06 Patients feel more heard. 11:08 The visit feels more human. 11:10 patients even feel like you spent more time with them, even if you didn't. 11:15 They just feel better about the visit and the attention they got from you. 11:20 And from a staffing perspective, there may be opportunities to reduce reliance on traditional scribes or reallocate resources in a more efficient way. 11:30 Those are real benefits, but there are also challenges that need to be acknowledged. 11:35 One of the biggest is over-reliance. 11:39 There's a tendency to assume that the technology is handling the documentation completely. 11:44 That what's being generated is accurate, complete, and sufficient. 11:48 And that's not always the case. 11:51 Without a structured review process, errors can slip through. 11:55 Omissions can go unnoticed. 11:57 Over time, note quality can become inconsistent. 12:01 There is also a learning curve. 12:04 Physicians are being asked to shift from thinking internally to speaking externally. 12:09 That's not a small change. 12:11 It requires awareness, practice, and in some cases, coaching. 12:16 Workflows may need to be adjusted. 12:18 Time may be built in for review and refinement. 12:22 Expectations need be set clearly within the organization about what done looks like when it comes to documentation. 12:31 Another challenge is variability. 12:33 Different physicians will adapt to this technology differently. 12:37 Some will naturally verbalize their thinking. 12:40 Others will continue to process internally, leading to differences in documentation quality and coding outcomes across the group. 12:48 And that variability can create both financial and operational issues. 12:53 So what does a best practice model look like? 12:56 It's not about choosing between ambient scribes or traditional documentation methods. 13:01 It is about integrating the technology into a thoughtful system. 13:05 That system includes physician and clinician awareness, understanding that what you think needs to be reflected in what is documented, 13:14 and that may require more intentional verbalization. 13:18 It includes a structured review process. 13:20 Notes should not be signed without being reviewed. 13:23 There should be an expectation that the ambient output is a draft and not a final product. 13:30 It include alignment with coding education. 13:32 Physicians need to understand how their documentation supports, or fails to support, appropriate coding levels in this new environment. 13:41 And it includes periodic audits. 13:44 Looking at note quality, looking at coding patterns, identifying trends, making adjustments. 13:51 Because what you don't want is a slow drift toward under-documentation and undercoding that goes unnoticed for months or even years. 14:00 And this is where the broader message comes in. 14:03 Technology is moving quickly, faster than most of us expected, and it's solving real problems. 14:11 But it's not replacing clinical judgment. 14:13 It's now replacing the need to communicate that judgment clearly. 14:16 And it is not eliminating the needs for systems, processes, and oversight. 14:22 Ambient scribes are solving the problem of documentation burden. 14:26 They are not fully solving problems of document accuracy, coding optimization, or clinical storytelling. 14:34 Those are still your responsibility. 14:37 So if you're using an ambient scribe or considering one, the question isn't just, is this making my life easier? 14:44 It's also, Is this accurately reflecting the care I'm providing? 14:49 Is the supporting appropriate coding? 14:52 is improving or potentially compromising my documentation quality?
Best Practices for Accurate Documentation 14:58 Because at the end of the day, the goal is not just to get the note done. 15:02 The goal, is to tell the story of The Visit in a way that is clear, complete, and accurate. 15:08 To reflect the complexity of your thinking. 15:11 to support the financial health of you practice. 15:14 And to protect both you and your patient. 15:17 This is a powerful tool. 15:20 But like any powerful tool, it needs to be used with intention. 15:24 It needs be supported by good systems, and it need to understood, not just adopted. 15:31 And if you're already using ambient scribes, It may be worth taking a closer look at your notes, at you coding patterns, 15:39 how your workflows have changed. 15:41 If you are thinking about implementing this technology, this is the moment to design it well from the beginning. 15:48 Because when you get this right, you don't just reduce documentation burden, You create better notes, stronger systems, and ultimately healthier, 15:57 more sustainable practices. 16:00 Until next time. 16:03 Before we wrap up, if today's conversation sparked any questions about whether you're truly capturing all of the revenue you've earned, 16:11 I want to point you to something we've built specifically for that. 16:15 At Healthy Practices, our Code Mastery program is designed to help physicians and medical groups close the gap between the carry they deliver and the Revenue 16:25 they actually collect. 16:27 Because in many cases, it's not about working harder. 16:30 It's about documenting, coding, and communicating your clinical work in a way that fully reflects its value. 16:37 This physician-to-physician training program is delivered via Zoom in four one-hour trainings throughout the year to simplify coding improve accuracy and 16:48 uncover missed revenue opportunities that are often hiding in plain sight. 16:52 So if you're ready to better understand your numbers and take control of your revenue, I'd encourage you to learn more about code mastery. 17:00 You can visit us at Healthy Practices or check the link in the show notes to get started.
Comments