Impact of Unrestricted Artificial Intelligence Scribe Deployment in a Single Health System on Clinician Workload and...

Ambient artificial intelligence (AI) medical scribes may reduce documentation burden and clinician burnout. Whether use intensity drives benefits remains uncertain.

To evaluate the association between AI scribe (Heidi) enrollment and documentation burden and whether changes differ by use intensity.

Retrospective quality improvement study using an interrupted time series (ITS) indexed on each clinician's enrollment month adjusted for patient demographics and visit complexity. A secondary 3-group ITS compared enrolled nonusers, low users, and high users.

14-hospital health system in Boston, Massachusetts.

902 outpatient clinicians enrolled in Heidi; 605 users and 297 enrolled nonusers.

Heidi enrollment after system-wide implementation beginning January 2025.

The primary outcome was note-active time. Secondary outcomes included same-day and after-hours note closures, note length, and work relative value units (wRVUs).

1 637 227 encounters had notes authored by enrolled clinicians between 1 July 2024 and 31 January 2026. Enrollment was associated with an immediate reduction in note-active time (-1.21 minutes [95% CI, -1.74 to -0.68 minutes]), with larger reductions among high users (-2.50 minutes [CI, -3.55 to -1.45 minutes]) than nonusers (difference, -2.20 minutes [CI, -3.46 to -0.95 minutes]) and low users (difference, -1.72 minutes [CI, -3.03 to -0.40 minutes]). High users had greater increases in note length than nonusers (difference, +170.90 characters [CI, 21.07 to 320.70 characters]) and low users (difference, +270.70 characters [CI, 131.04 to 410.36 characters]). No differences were observed in same-day closure, after-hours closure, or wRVUs.

Observational design with potential unmeasured confounding; inability to distinguish AI-scribed from clinician-authored notes postenrollment.

Heidi enrollment was associated with reductions in documentation time and increases in note length, concentrated among high users. Enrollment was not associated with improvements in same-day, after-hours note closures, or wRVUs.

None.