During the summer of 2023, Dr. Rosemary Lall, a family physician working at a bustling medical clinic in Scarborough, hit her breaking point.
After nearly three decades on the job, Lall was ready to throw in the towel as she found herself buried under inescapable patient-related paperwork that often cut into precious family time.
“I lost all my joy of work,” Lall told Global News. “I was coming into work really dreading the day.”
That dread, Lall said, had less to do with the patient experience and instead came from the work associated with the “aftermath” — mandatory record-keeping that front-line health-care workers are expected to input into Ontario’s electronic medical records system.
Physicians, Lall said, are expected to update patient charts, fill out medical forms, provide sick notes and provide specialist referrals.
The administrative burden would often take her up to two hours per day. Ontario’s Medical Association has estimated family doctors spend 19 hours per week on administrative tasks, including four hours spent writing notes or completing forms for patients.
“I came to a crossroads where I’m going to quit, I’m going to give this up, or I’m going to find a solution,” Lall said.
The solution, Lall said, was new artificial intelligence note-taking apps that are designed to mimic doctor’s notes and reduce the amount of paperwork a physician would have to manually compile.
The AI Scribe program — which is run by OntarioMD, the digital technology arm of the Ontario Medical Association — allows doctors to choose from a handful of tools that act as a note-taking assistant during a patient visit.
Patients who give consent have a routine conversation about their ailment with the physician, while the doctor verbalizes their thoughts during the physical exam. The AI Scribe software is able to create and process a real-time transcript during the appointment.
Lall said the true benefit comes after the appointment when the AI Scribe compiles the information into a so-called SOAP note, a standard requirement for family physicians as prescribed by the College of Physicians and Surgeons of Ontario.
Artificial intelligence technology separates the information it hears into subjective information, as relayed by the patient, objective information, as relayed by the doctor, assessment information, as verbalized by the physician during a physical exam, and a plan of action for patient care. The four areas — subjective, objective, assessment and plan — make up the acronym SOAP.
Lall said it takes minutes for AI Scribe to collate the information, allowing her to move on to other patients while the SOAP note is being created in the background.
If the physician is unhappy with the note, Lall said, they can ask the AI model to regenerate the information or add more detail to any one of the categories. While the tool has some imperfections, she said, the improvements have been noticeable over the 10 months since she began using it.
“I really feel this should be the next gold standard for all of our doctors. It decreases the cognitive load you feel at the end of the day,” she said.
The Ford government has been so impressed with the technology that it announced a pilot program to allow 150 family physicians to use AI Scribe as part of their practices. The health minister said the early signs were promising but stressed the government would proceed carefully.
“We’re doing it in a very measured way so we can look at those results and see that the impact is there,” Deputy Premier Sylvia Jones told Global News. “Anecdotally, patients really appreciate it. Clinicians are seeing benefits.”
Still, some have questions about the data collected by AI Scribe, privacy and the potential for misuse.
“I would have significant concerns if it’s not properly executed,” said Liberal health critic and physician Dr. Adil Shamji.
“There are going to be important things to do in terms of ensuring patient confidentiality, ensuring accuracy,” Shaji said. “If it’s going to be truly autonomous with minimal oversight that would need to be very carefully implemented.”
France Gélinas, the Ontario NDP’s health critic, said artificial intelligence would be “part of the future of health care” in Ontario but needed to be carefully managed.
“You have to maintain the trusting relationship between the providers and the patient,” she said.
“That means respect their privacy. Are we there yet? I don’t think so. Will we be there? Absolutely. It will become part but let’s take the proper steps, finish the pilot, see what we learn from it.”
Lall said that after 29 years as a family physician, last Christmas was the first celebration that wasn’t interrupted by the need to update patient notes thanks to the AI notetaking software.
“For me, this has changed things,” Lall said. “It’s made me really happy.
“I will never go back.”
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