混合环境 临床文档和医生绩效:工作之外的工作,文档延迟和财务生产力
Lidia Mvr Moura1,2,3,4, Rebecca G Mishuris5,6, Joshua P Metlay5,7
1Department of Neurology, Massachusetts General Hospital, Boston, MA, USA. lidia.moura@mgh.harvard.edu.
Journal of general internal medicine
|November 17, 2025
概括
一个混合环境临床文档 (ACD) 计划减少了临床医生的下班时间和文档延迟,同时在50天内提高了财务生产力. 这种生成性人工智能工具对改善临床医生的福祉和医疗保健效率充满希望.
科学领域:
- 医疗信息学 医疗信息学
- 医疗保健中的人工智能
- 临床工作流的优化 临床工作流优化
背景情况:
- 医疗保健系统面临着提高临床医生的生产力和减轻倦怠的压力.
- 工作时间后的电子健康记录 (EHR) 文档,称为"工作以外的工作" (WOW),大大增加了临床医生的疲劳.
- 由人工智能驱动的生成环境临床文档 (ACD) 工具是一个潜在的解决方案,但它们在现实世界中的有效性需要评估.
研究的目的:
- 评估混合ACD程序,结合生成AI和虚拟书记,对临床医生的工作模式的影响.
- 评估超时工作 (WOW) 的变化,文件延迟和临床医生的财务生产力.
- 确定ACD采用与初级保健实践中关键绩效指标之间的关联.
主要方法:
- 一项从7月1日至2024年12月30日进行的回顾性研究,涉及14个成人初级保健实践中的181名临床医生.
- 66名临床医生自愿参加混合ACD计划,利用大型语言模型生成笔记草案,由人类书记员审查.
- 测量50天后激活期的结果包括WOW,文档延迟 (注释开放≥2个工作日) 和财务生产力 (wRVUs),使用概括估计方程进行分析.
主要成果:
- 环境临床文档 (ACD) 的采用最初增加了WOW的32.1%,但在第50天显著减少了41.7%.
- 文件延迟持续改善,延迟关闭笔记的几率在第10天下降了66.5%,在第50天下降了66.0%.
- 临床医生的财务生产率稳步增加,在第10天上升1.5%,在第50天上升12.1%.
结论:
- 混合ACD计划表明,随着时间的推移,与减少超时工作 (WOW) 有积极的关联.
- 实施ACD导致了临床笔记完成速度的显著改善.
- 该研究表明,ACD的采用可以在50天内提高临床医生的财务生产力.
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