Ninety-Six Ways to Measure a Scribe: Fragmented Evaluation of Ambient Scribes in Healthcare

원문 초록

Ambient artificial intelligence (AI) scribes have moved rapidly from experimental pilots to enterprise-wide deployment across health systems, promising reduced documentation burden and improved clinician experience. While research evaluating these tools has expanded quickly, there are no agreed-upon protocols or standardized metrics for assessing their performance, making it difficult to compare findings or cumulatively synthesize evidence across studies. Across 54 recent evaluation studies, we identify ten evaluation dimensions and 40 distinct metrics, operationalized in 96 different ways-35 of them (36%) used by only a single study. Assessment is dominated by documentation efficiency and time, measured in 44 of 54 studies. The other dimensions appear at broadly similar rates (16-24 studies each), and safety and clinical outcome least consistently of all. Ripple effects on the broader care system, such as impact on patients' care outcomes, redistribution of work, changes in billing and coding intensity, and downstream use of notes by other clinicians are rarely assessed. Moreover, the metrics used rely heavily on self-report and are fragmented and inconsistently operationalized, which limits comparability and hinders synthesis across studies. As an effort to support more rigorous and cumulative evaluation, in this paper we review the study designs, data sources, and metrics commonly used to evaluate ambient AI scribes in healthcare settings, discuss the limitations of current evaluation practice, and argue for a more holistic approach grounded in a standardized, multi-dimensional set of metrics.