How to request patient consent for using ambient listening
Organizations should consider multiple touchpoints for obtaining patient consent for using ambient listening in clinical documentation.
Although patients are generally comfortable with their providers using ambient listening for clinical documentation, there's room to improve in terms of getting patient consent for using the AI, according to a new study in JAMA Network Open.
Particularly, healthcare organizations should prioritize multiple touchpoints for getting patient consent and letting patients provide consent for certain types of care encounters and not for others, the researchers recommended.
Ambient listening is a form of generative AI that was designed to ease the EHR documentation burden that's long contributed to provider burnout. Ambient documentation listens to clinical encounters and uses the audio recording to generate an EHR note.
Most leading EHR vendors have created ambient documentation tools within their systems, and the provider organizations that have deployed them report serious improvements in their burnout rates.
But what about the patient on the other side of that encounter? The researchers noted that there's potential for medical errors and cybersecurity incidents associated with ambient documentation. These risks directly impact the patient, drawing attention to patient perceptions of the tool and granting of informed consent.
This latest report, based on initial ambient AI rollout in ambulatory practices within an academic medical center, found that patients can see the tool's utility but want clarity when giving their consent.
Ambient listening boosts documentation and experience
Attitudes around ambient listening among the study's patient participants were generally positive, with 74.8% saying they are comfortable or very comfortable with their provider using it during a medical encounter. Factors like high trust in their providers, the level of detail given when being asked for consent and knowing the intended use for the tool all swayed patient acceptance.
Positive patient attitudes likely stem from the perceived benefits of ambient documentation. Patients agreed that the technology could reduce provider burden, support better clinical decision-making and facilitate stronger patient-provider communication.
Still, healthcare organizations should still be aware that patients have their concerns with the technology, just as they view AI as a whole with some caution.
Patients weary of AI security, health equity implications
Although patients acknowledge the numerous benefits ambient listening can have on their healthcare encounters, they still have their hesitations.
For instance, patient respondents said they were worried about the privacy and security of these systems, as well as the legal liability if ambient documentation leads to a medical error. Patient respondents also expressed concerns about health equity, such as when a Spanish-speaking patient is in a room with ambient AI that cannot understand Spanish.
Indeed, when considering these factors more closely, patients are more likely to second-guess their decision to consent to ambient documentation.
According to the report, patients given a basic overview of the technology were more likely to give their consent for its use than those given more detailed information about AI features, data storage and corporate involvement (81.6% versus 55.3% granting permission).
Discussing patient consent for ambient documentation use
As more healthcare organizations leverage AI, including ambient listening and documentation, they will need to determine ethical approaches to obtaining patient consent.
Currently, the most common way organizations obtain patient consent for ambient documentation is verbally before the individual encounter. While patients and providers alike told the researchers that this discussion is fruitful, there is room to create more touchpoints for patient education about AI to ensure completely informed consent.
For starters, healthcare organizations should have an opt-in approach, meaning patients must explicitly give permission for their providers to use ambient documentation tools. Patients must be told about the technology's capabilities and limitations, how the tool protects data privacy and how it is used in medical decision-making.
Furthermore, patients need to know more about the consent process. For example, healthcare organizations should explain if and how patients can withdraw their consent for using ambient listening during medical encounters. Clinics might also consider allowing patients to opt into ambient listening for some visits while opting out during other, more sensitive visits.
Notably, healthcare organizations should consider offering multiple touchpoints for this conversation.
Patients could receive a notification with their pre-visit materials to learn more about and opt into or out of ambient listening. This might also occur during appointment check-in with a member of nonclinical staff so patients can dedicate more time discussing clinical matters with their providers.
When patients enter the exam room, providers should once again provide patients a quick reminder about the ambient documentation tool and reiterate their right to opt out of the technology.
Next, practices should consider outlining liability for when errors or security incidents occur. Per the study, 64.1% of patients said the physician is responsible when ambient listening leads to a medical error. Another 76.7% said the ambient documentation vendor is responsible for any cybersecurity incidents that could occur.
The patient consent process is a critical time during which healthcare organizations can address the risks for such incidents and the liability should they happen.
Finally, the researchers suggested practices obtain patient consent for ambient documentation tools separately from consent for use of other health IT. AI is rapidly evolving, so patients might consider AI differently than they do other forms of health technology.
"By adopting a comprehensive approach to informed consent and actively addressing the potential risks and benefits of these technologies, healthcare systems can ensure that ambient documentation enhances, rather than detracts from, the quality of patient care," the researchers concluded. "Ongoing research and ethical analysis will be crucial in guiding the development of technologies that serve the interests of patients and clinicians."
Sara Heath has covered news related to patient engagement and health equity since 2015.
