By Michelle Crouch
Co-published with The Charlotte Ledger
When pediatrician Jocelyn Wilson sees patients at Atrium Health Levine Children’s Charlotte Pediatrics, she begins each visit with a simple request: for permission to record the conversation.
The reason isn’t surveillance — it’s efficiency.
Like a growing number of doctors, Wilson uses an artificial intelligence tool that listens to her conversations with patients. It then transforms them into a clinical visit summary that she can review, edit and upload to a patient’s medical record in just a few minutes.
The goal? To allow doctors to spend less time doing paperwork and more time caring for patients.
“I’ve never really liked using the computer very much when I’m in the exam room … I just feel like I’m not very present,” Wilson said. “Now, I don’t have to be writing anything down. I can make direct eye contact.”
She said the AI tool, known as DAX Copilot, is saving her more than an hour a day entering appointment details into patient medical records.
While health care systems are using AI in a variety of ways to reshape care behind the scenes, these “virtual scribe” tools are some of the most visible to patients — they bring AI directly into the exam room.
More than 1,500 Atrium Health doctors are licensed to use DAX Copilot, according to an Atrium spokeswoman. At least three other North Carolina systems — Novant Health, UNC Health and Duke Health — are using similar technology.
The platforms are similar to the AI tools that many other industries — from finance to marketing — have adopted to streamline tasks like note taking and summarizing information.
AI tools aren’t perfect
The AI assistants are not perfect, however, and health care providers are grappling with some of the same challenges experienced in other industries.
Research has shown that voice recognition programs don’t always understand people in racial minorities, people who speak English as a second language and people with speech disabilities. The tools can also misinterpret information or even fabricate responses — a phenomenon called hallucination — underscoring the need for doctors to review the summaries.
“It’s imperative to have a human in the loop to make sure that we’re properly evaluating these tools and making sure they are working for all different types of patients and doctors,” said Allison Koenecke, an assistant professor of information science at Cornell University, whose research uncovered problems with AI-generated medical notes.
Health care systems also need to address patient concerns about privacy and ensure that patients are told how the software works so they can make informed decisions about whether to participate.
What patients can expect
Atrium was the first health system in the country to test DAX Copilot — short for Dragon Ambient eXperience Copilot — a platform developed by Microsoft subsidiary Nuance. The software installs a secure app on doctors’ smartphones that does the recording.
Wilson piloted an early version, which she described as “somewhat clunky.” But the latest iteration, she said, is incredibly accurate, and she has been using it consistently for the past few months.
Here’s how it works: Before Wilson walks into the room, she records a brief note about the patient and the reason for the visit.
Once inside, she introduces herself and explains the process, saying something like, “I have my phone with me today because it’s helping me write my notes at the end of the day. If you’re OK with that, it’ll just sit here and listen to our conversation.”
So far, she said, no patient has declined.
Wilson then sets her phone down on the counter and doesn’t touch it again until she leaves and stops the recording. Within minutes, the software sends a visit summary to her computer for her to review and edit.
A cure for physician burnout?
In a perfect world, Wilson said, doctors would have time between appointments to update their notes while the details are fresh in their memories.
“But the reality is, sometimes you’re in a patient room longer than expected, and there are two or three more patients waiting to be seen,” Wilson said. “And when you’re five or six patients in and haven’t started any of (your notes), that internal pressure starts to build. You’re anxious you’ll forget something, stressed about how long it’s going to take to catch up.”
Wilson said DAX Copilot has drastically reduced the stress of unfinished notes. Instead of staring at a blank screen, she now has a draft summary waiting for her.
“It’s a lot easier to edit a note than it is to start a note,” Wilson said.
Since she started using the technology, she said she has more time for lunch breaks and for exercising or cooking a meal in the evenings, rather than “writing notes right until it’s time to go to bed,” she said.
When the clinic is busy, DAX Copilot also allows her to squeeze more patients into her day, she said.
Burnout has become a crisis among physicians nationwide, with about half reporting symptoms in 2023, and a major culprit is the increasing burden of documentation. A 2020 Mayo Clinic study found that doctors spend one to two hours outside of the office writing up required notes from patient visits, cutting into personal and family time.
A study published in JAMA Network Open found that 47 percent of Atrium Health physicians using DAX Copilot reported a significant reduction in time spent doing documentation at home.
Eric Poon, chief health information officer at Duke Medicine, was also an early tester of the DAX Copilot technology in his primary care practice.
After years of running late for appointments, he said the tool has significantly improved his efficiency.
This three-part NC Health News/Charlotte Ledger series explores how artificial intelligence is shaping the state’s health care.
Today: Doctors are turning to “virtual scribes” to take notes, raising privacy concerns.
Tuesday: How North Carolina health care providers are harnessing AI.
Wednesday: How state regulators are approaching the use of AI in health care.
“Since I started using the technology about a year ago, I could actually step back from the keyboard and not take telegraphic notes as I talked to the patient, and I realized that I was able to have much closer conversations with patients in a natural way,” he said. “And then guess what? I find that I’m now finishing clinic on time for the first time in my clinical life.”
So far, Poon said, about 50 Duke physicians have been trained on DAX Copilot.
Privacy and accuracy concerns
About 70 percent of patients nationally are comfortable with physicians using AI in appointments, according to a 2024 survey. However, patients do have some reservations, the poll found, with just over half saying health care AI is “a little scary” and 70 percent expressing concerns about data privacy.
At a time when any phone or computer can be hacked, some patients worry about where a recording could end up. Atrium says the DAX Copilot app on physicians’ phones is accessible only through biometrics or password authentication, and recordings disappear after doctors approve the associated AI-generated clinical note.
When it comes to accuracy, it’s important for doctors like Wilson to carefully review the AI-generated content to ensure that it’s correct, Koenecke said.
Her research into one Microsoft speech-to-text tool revealed error rates twice as high for Black speakers as for white speakers. And when investigating a non-Microsoft model, she found instances where the technology omitted facts or fabricated content. In one case, for example, it invented a nonexistent medication called “hyperactivated antibiotics.”
As with many AI technologies, the success of these virtual scribes will likely depend largely on how they are implemented, Koenecke said. Will they be used to reduce the burden on physicians, with adequate time for screening and review? Or will hospitals deploy them to push physicians to see more patients and increase revenue?
Without adequate oversight, she said, the AI assistants could “lead to really massive downstream harms, especially for certain groups whose speech isn’t well captured by these tools,” Koenecke said. “How can we make sure these workers who are already overworked aren’t just skimming through and clicking ‘OK’?”
NC Health News reporter Emily Vespa contributed to this report.
This article is part of a partnership between The Charlotte Ledger and North Carolina Health News to produce original health care reporting focused on the Charlotte area. You can support this effort with a tax-free donation.
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