Hybrid Ambient Clinical Documentation and Physician Performance: Work Outside of Work, Documentation Delay, and...

Healthcare systems are under growing pressure to increase clinician productivity while reducing burnout. After-hours electronic health record (EHR) documentation- "work outside of work" (WOW)-is a major contributor to clinician fatigue. While generative AI-powered ambient clinical documentation (ACD) tools offer promise, their real-world impact remains uncertain.

To evaluate whether a hybrid ACD program (combining generative AI and a virtual scribe) is associated with changes in (1) WOW, (2) documentation delay, and (3) clinician financial productivity.

Retrospective study (July 1-December 30, 2024).

In total, 181 attending physicians and advanced practice clinicians across 14 adult primary care practices within a Massachusetts healthcare system. Sixty-six clinicians (36%) voluntarily enrolled in the hybrid ACD program, which was rolled out using an activation schedule.

The ACD tool used large language models to generate draft clinical notes that were then reviewed and finalized by a human scribe and integrated into the EHR. Participants received standardized training and technical support.

Outcomes over the 50-day post-activation period included (1) WOW (5:30 pm-7:00 am weekdays; all weekends/holidays); (2) documentation delay (proportion of notes open ≥ 2 business days); and (3) financial productivity (work relative value units, wRVUs). Generalized estimating equations were used, adjusting for clinician and panel characteristics.

ACD adoption had a dynamic impact. WOW initially increased by 32.1% (95% CI 25.5%, 39.1%) on day 10 but decreased by 41.7% (95% CI -51.8%, -29.4%) by day 50 compared to baseline. Documentation delay consistently improved, with the odds of delayed note closure reduced by 66.5% (95% CI -68.3%, -64.7%) at day 10 and 66.0% (95% CI -72.5%, -57.8%) at day 50. Financial productivity increased steadily by 1.5% (95% CI -0.2%, 3.2%) on day 10 and 12.1% (95% CI 5.7%, 18.9%) by day 50.

ACD adoption was associated with reduced after-hours work, faster note completion, and improved financial productivity within 50 days of implementation.