The widespread adoption of artificial intelligence (AI) is rapidly reshaping health care in the United States, and one of the fastest-growing AI tools used by clinicians are ambient scribes—systems that listen to conversations between clinicians and patients and automatically generate medical notes.

While developers of these tools and some health care professionals highlight the potential benefits of ambient scribes —including more face-to-face time for patients and clinicians, less clinician effort spent on documentation, and lower labor costs due to clinician turnover—there is growing concern that they also drive up health care spending. For example, ambient scribes are designed to document patient encounters more comprehensively, a feature often promoted as a key advantage. However, more detailed documentation could also have the unintended consequence of increasing health care costs by enabling greater coding intensity, which can refer to the number of diagnoses per visit, potential to recommend additional procedures, or higher-intensity service billing.

A new nationwide study supported by the National Institute for Health Care Management (NIHCM) Foundation and led by researchers at the UMN School of Public Health (SPH) will address gaps in our understanding of ambient scribes and the impact they’re having on our health care system. The study will explore the impact of ambient scribes in three main areas:

• Clinician productivity. Researchers will examine how delegating documentation of patient visits to ambient scribes affects the number of patients clinicians see and the overall volume of patient visits.
• Coding intensity. Researchers will assess whether the use of ambient scribes changes how visits are documented and billed, including the number of diagnoses recorded, the specific services billed, and the share of higher-intensity evaluation and management visits,which come with higher copays for patients.
• Health care spending. This study will analyze how ambient-scribe adoption affects total and per-visit health care spending, and the extent to which any changes are driven by increased clinician productivity versus more intensive coding.

  

To conduct the study, researchers will analyze Medicare claims data from across the United States to compare clinicians at health systems before and after adoption of ambient scribe technology. Researchers will study outcomes including clinician productivity and coding intensity, and total spending.

“Health systems are adopting ambient scribes willy-nilly right now,” said Hannah Neprash, SPH associate professor and co-principal investigator. “This may be a great development for clinician well-being, but scribes may also drive up health care costs for patients and the federal government. With this study, we aim to develop the evidence base to guide responsible adoption of ambient scribes.”

“Developers and health systems are claiming that ambient scribes are a kind of magic bullet that benefit both clinicians and patients, but the fact is that there is just a lot about this new technology that we don’t know,” said Paige Nong, SPH assistant professor and co-principal investigator. “As the first nationwide study of its kind, this project will help policymakers understand ambient scribes’ impacts on spending and support healthcare delivery organizations in making informed decisions about these tools.”

The study is scheduled to be completed in December 2026.