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Comparative effectiveness of ambient documentation tools in primary care tool-specific variations in efficiency,
Lidia Moura1,2,3,4, Rebecca G Mishuris4,5, Joshua P Metlay4,5
1Department of Neurology, Massachusetts General Hospital, Boston, MA 02114, United States.
JAMIA Open
|August 12, 2026
Summary
Different ambient documentation tools (ADTs) impact primary care efficiency. EHR-integrated ambient tools (Tool B) showed better outcomes than tablet-based (Tool A) or standalone (Tool C) ambient documentation systems.
Area of Science:
- Health Informatics
- Clinical Efficiency
- Primary Care Technology
Background:
- Ambient Documentation Tools (ADTs) aim to reduce provider documentation burden.
- Distinct ADT architectures may yield varying impacts on clinical workflows and efficiency.
- Comparative effectiveness studies are crucial for optimizing ADT selection and implementation.
Purpose of the Study:
- To compare the effectiveness of three ADT architectures: Tablet-Based Virtual Human-Assisted Ambient (Tool A), EHR-Integrated Ambient (Tool B), and Standalone Ambient (Tool C).
- To evaluate the impact of these ADTs on provider efficiency, documentation burden, and productivity in primary care settings.
Main Methods:
- A real-world comparative-effectiveness study involving 163 primary care providers over 18 months.
- Analysis of 59,130 provider-days, comparing outcomes between ADT groups (Tool A, Tool B, Tool C).
- Primary outcomes included after-hours EHR activity ('pajama time'), timely visit closure, manual note composition, and EHR efficiency scores.
Main Results:
- Tool A was associated with increased pajama time, manual note composition, and reduced timely visit closure compared to Tool B.
- Tool C reduced after-hours work compared to Tool B and baseline, but showed lower timely visit closure.
- Tool B demonstrated a more favorable profile regarding provider efficiency and documentation burden compared to Tool A and Tool C.
Conclusions:
- The choice of ADT architecture significantly influences real-world clinical outcomes.
- Tool-specific comparative evaluations are essential for informed procurement and deployment of ADTs.
- EHR-integrated ambient documentation tools may offer superior efficiency benefits in primary care.
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