What patients should know about doctor visit summaries by AI

As artificial intelligence continues to develop in seemingly all facets of life — including health care — experts say it's important for patients to know AI may be used in their care.

"I think we're going to see significant advances in AI use and AI capacity in the next few years," said Dr. Sian Tsuei, a family physician at Metrotown Urgent and Primary Care Centre in Burnaby, B.C.

"I think we're only seeing the start of it. So I would really encourage patients to continuously stay informed and for doctors to also be staying informed."

Here are some AI risks and benefits Tsuei and other experts recommend you discuss with your health-care provider.

Ask first

Next time you have an appointment with your family doctor, ask them if they are using AI.

If they are, a likely bet is that it's an AI scribe. Physicians' colleges and associations, including in Ontario and B.C., have released guidelines for doctors interested in using the technology to transcribe their conversations with patients instead of manually taking notes themselves.

In a recent trial in Ontario, doctors using AI scribes spent 70 to 90 per cent less time on paperwork, saving on average three to four hours per week.

In addition to saving doctors time, AI scribes can also improve the quality of patient visits, said Muhammad Mamdani, vice president of data science and advanced analytics at Unity Health Toronto.

"With your family doctor, a lot of them will spend quite a bit of time not just looking at you, but staring at their computer screen. They're busily typing away the conversation so it's on record," said Mamdani, who is also the director of artificial intelligence education and research in medicine at the University of Toronto.

"But that's a lot of time being spent away, not really listening to you with maybe the attention they should have."

How safe is my data?

Tsuei said cybersecurity is one of the most important factors as he considers using an AI scribe in his practice.

"To what extent has the technology developed appropriate cybersecurity measures? Do we actually understand cybersecurity threats and are [there] appropriate ways to defend against those?"

Some physicians may store patient data on the premises, while others may upload it to a cloud server or another location, said Nadia Shaikh-Naeem, vice-president of programs at Digital, an "innovation cluster" dedicated to AI development that is funded by the federal government.

It's important to ask about "digital residency," Shaikh-Naeem said, noting that Digital requires its health partner organizations to store data within Canada.

That's because the data should be protected by national information privacy laws such as the Personal Information Protection and Electronic Documents Act.

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Terry Stepien, CEO of Expeflow — one of Digital's partner organizations that is providing AI services to a psychology practice in Toronto — said it's important to ask if your data is encrypted.

If the data is transferred to a cloud server or an off-site server, "how does it move between where you are and the end location? Is it encrypted at all times as it's moving?" he said.

Stepien said it's also important to know who has access to patient data within the health-care practice — and to have a log that documents any activity in the patient files to ensure people without permission have not tried to access them.

What exactly am I consenting to here?

Your doctor must get your consent before using an AI scribe to record your conversations, according to both Doctors of BC and the College of Physicians and Surgeons of Ontario.

But it's also a good idea to ask specifically how the recorded and transcribed information will be used, said Shaikh-Naeem.

"Am I consenting to research? Am I consenting to my data being used to train the AI? Am I consenting to it being used internally for diagnostic purposes, my own broader diagnostics?" she said.

If the recording is being used solely for documentation in your electronic medical record, the AI model is "closed," Shaikh-Naeem said.

But some AI models are "open," meaning they learn from your data to improve their accuracy in future transcribing.

Is the AI-transcribed info about me accurate?

Doctors should be checking the AI transcriptions of patient visits, Mamdani at Unity Health Toronto said, noting that scribe technology requires a "human in the loop."

"Basically what happens is the scribes will do their work, but the physician will obviously have to review whatever the scribe has taken down," he said.

In its professional guidance about AI posted online, Doctors of BC cautions that not all AI scribes can accurately transcribe speech from patients who have accents.

"If a substantial number of your patients are non-native English speakers, prioritizing an AI scribe known for its proficiency in handling diverse accents, or one that supports multiple languages, is critical," the guidance says.

Experts say the onus is on the health-care provider to make an informed choice of AI technology and to be aware of potential patient concerns.

"It's always important as a patient to feel empowered with our data and how our data will be used," Shaikh-Naeem said.

"The doctor must be able to answer those questions in order to give the patients the comfort around their data and the usage of AI."