AI scribe..

[Psych25]

Hey guys! I found out about an AI scribe service through a Facebook group and wanted to write a review about it.

It is mdhub. The website is mdhub.ai

It has been a very good experience so far. I am able to create templates as well as give feedback to the AI to mimic my writing style. A big plus is the mobile app that they have which allows for easy uploading of patient encounters. So far it has been the best one I've tried out and seems like the more I use it, the better it gets. It has saved a ton of time with documentation. They are currently offering it for free as well. If you don't currently use an AI scribe, I would definitely check it out.

If you are using a different one, which one and what is your most/least favorite things about it?

I understand that some may be completely against the idea of using AI and, if you are, I'm not trying to sell you on it. I find it helpful and every patient that I've come in contact with and discussed that I was using it to assist with my documentation has not pushed back at all. It allows a much more therapeutic interview from my experience.

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[clausewitz2]

Hey guys! I found out about an AI scribe service through a Facebook group and wanted to write a review about it.

It is mdhub. The website is mdhub.ai

It has been a very good experience so far. I am able to create templates as well as give feedback to the AI to mimic my writing style. A big plus is the mobile app that they have which allows for easy uploading of patient encounters. So far it has been the best one I've tried out and seems like the more I use it, the better it gets. It has saved a ton of time with documentation. They are currently offering it for free as well. If you don't currently use an AI scribe, I would definitely check it out.

If you are using a different one, which one and what is your most/least favorite things about it?

I understand that some may be completely against the idea of using AI and, if you are, I'm not trying to sell you on it. I find it helpful and every patient that I've come in contact with and discussed that I was using it to assist with my documentation has not pushed back at all. It allows a much more therapeutic interview from my experience.

Genuinely considering trying this out in the very near future. I assume the first stabs at aping your style were pretty far off the mark; how many notes did you have to edit and provide feedback on until it started capturing the things you cared about? Any chance you could provide short (de-identified, obviously) snippets of early notes versus trained notes?

EDIT: as a chronic overdocumenter an AI I could train to even be 90% effective in writing something close to what I would have written would be a gamechanger. It would be so much easier to get through the workday without getting crispy if notes just sort of happened.

 

[WisNeuro]

My spouse recently tested out Dax and said that it was somewhat impressive in early testings at her place of employment.

 

[Psych25]

Genuinely considering trying this out in the very near future. I assume the first stabs at aping your style were pretty far off the mark; how many notes did you have to edit and provide feedback on until it started capturing the things you cared about? Any chance you could provide short (de-identified, obviously) snippets of early notes versus trained notes?

EDIT: as a chronic overdocumenter an AI I could train to even be 90% effective in writing something close to what I would have written would be a gamechanger. It would be so much easier to get through the workday without getting crispy if notes just sort of happened.

I do not have snippits of my earlier notes. I would say that it took about 2 weeks for the AI learned my writing style. I continued to add detail in the comment section of the AI to explain what I would like explained better/more thorough in certain areas/etc. I can include a trained note assessment/plan.

I would definitely give it a shot and continue to sharpen your note. The AI isn't perfect, but I would say each day it is getting better.

Also, they have the option to provide feedback on the site (questions/comments), and they will get back to you fairly soon. I give feedback frequently and have received some positive feedback regarding how to maximize the software.

Trained note example (I would go in and change details as needed after this transcript was created):

Assessment:
The patient's depression and anxiety are likely influenced by recent family events and the ongoing stress of his divorce. His recent hospitalization and upcoming PHP will provide intensive therapy and support during this challenging time. The patient's Prozac dosage may need to be adjusted in the future, depending on his response to the medication.



The patient's sleep disturbances are concerning, as poor sleep can exacerbate mental health symptoms. It may be beneficial to explore both behavioral strategies for improving sleep hygiene and potential medication options for short-term sleep aid.



The patient's relationship with his two children appears to be a significant source of stress and anxiety. It may be beneficial to explore options for improving this relationship, such as family therapy or mediation, and to ensure the patient has strategies for managing stress related to this.



In conclusion, the patient's mental health needs are complex and require a comprehensive, multi-faceted treatment approach. This should include monitoring and adjusting his Prozac dosage as needed, addressing his sleep disturbances, and providing support and strategies for managing the stress related to his family situation.



Plan:

Depression: The patient is experiencing symptoms of depression, which were triggered by the suicide of his sister a year ago. The recent filing for divorce, which occurred this past month, has exacerbated this and led to him being hospitalized for approximately 1 week (discharged 3 days ago). The current medication regimen of Prozac 40mg appears to be beneficial and well-tolerated. The patient agrees to continue with the same medication at this time.

Generalized Anxiety disorder: The patient is experiencing symptoms of anxiety, which have been exacerbated by the recent stressors as mentioned above. The patient's current medication regimen of Prozac 40mg appears to be beneficial. The patient agrees to continue with the same medication. Also discussed CBT techniques with him. He is to continue seeing his therapist.

Sleep disturbance: The patient reported having trouble both falling and staying asleep. They mentioned that pain contributes to their sleep issues. They have been taking Flexeril, a muscle relaxant, but it has not been assisted with sleep. They expressed interest in trying Seroquel, but after discussing the potential side effects, we agreed to try Trazodone at 100mg first. If this does not improve their sleep, we will consider other options. We also discussed good sleep hygiene and he plans to incorporate some of these techniques.

-He is to follow-up in 2-3 weeks.

 

[Psych25]

My spouse recently tested out Dax and said that it was somewhat impressive in early testings at her place of employment.

Are you aware of anything specific that they like about it? It seems like the other AI scribes I've used have not been as thorough as I'd like regarding my notes (typically very basic). TIA

 

[Merovinge]

I do not have snippits of my earlier notes. I would say that it took about 2 weeks for the AI learned my writing style. I continued to add detail in the comment section of the AI to explain what I would like explained better/more thorough in certain areas/etc. I can include a trained note assessment/plan.

I would definitely give it a shot and continue to sharpen your note. The AI isn't perfect, but I would say each day it is getting better.

Also, they have the option to provide feedback on the site (questions/comments), and they will get back to you fairly soon. I give feedback frequently and have received some positive feedback regarding how to maximize the software.

Trained note example (I would go in and change details as needed after this transcript was created):

Assessment:
The patient's depression and anxiety are likely influenced by recent family events and the ongoing stress of his divorce. His recent hospitalization and upcoming PHP will provide intensive therapy and support during this challenging time. The patient's Prozac dosage may need to be adjusted in the future, depending on his response to the medication.



The patient's sleep disturbances are concerning, as poor sleep can exacerbate mental health symptoms. It may be beneficial to explore both behavioral strategies for improving sleep hygiene and potential medication options for short-term sleep aid.



The patient's relationship with his two children appears to be a significant source of stress and anxiety. It may be beneficial to explore options for improving this relationship, such as family therapy or mediation, and to ensure the patient has strategies for managing stress related to this.



In conclusion, the patient's mental health needs are complex and require a comprehensive, multi-faceted treatment approach. This should include monitoring and adjusting his Prozac dosage as needed, addressing his sleep disturbances, and providing support and strategies for managing the stress related to his family situation.



Plan:

Depression: The patient is experiencing symptoms of depression, which were triggered by the suicide of his sister a year ago. The recent filing for divorce, which occurred this past month, has exacerbated this and led to him being hospitalized for approximately 1 week (discharged 3 days ago). The current medication regimen of Prozac 40mg appears to be beneficial and well-tolerated. The patient agrees to continue with the same medication at this time.

Generalized Anxiety disorder: The patient is experiencing symptoms of anxiety, which have been exacerbated by the recent stressors as mentioned above. The patient's current medication regimen of Prozac 40mg appears to be beneficial. The patient agrees to continue with the same medication. Also discussed CBT techniques with him. He is to continue seeing his therapist.

Sleep disturbance: The patient reported having trouble both falling and staying asleep. They mentioned that pain contributes to their sleep issues. They have been taking Flexeril, a muscle relaxant, but it has not been assisted with sleep. They expressed interest in trying Seroquel, but after discussing the potential side effects, we agreed to try Trazodone at 100mg first. If this does not improve their sleep, we will consider other options. We also discussed good sleep hygiene and he plans to incorporate some of these techniques.

-He is to follow-up in 2-3 weeks.

This strikes me as severe note bloat, I would gently push a resident into reducing 50-90% of the verbage depending on the point. Can you imagine trying to read through a patient's chart if every progress note they had was that long?

 

[Psych25]

This strikes me as severe note bloat, I would gently push a resident into reducing 50-90% of the verbage depending on the point. Can you imagine trying to read through a patient's chart if every progress note they had was that long?

This was on an initial H&P in an outpatient setting. The expectation is to write very thorough with this.

If you would like, you can very easily change it.

Here is an example of an inpatient note that I have.

Treatment Plan:
Pharmacologic interventions:
- Continue lamotrigine for anxiety and bipolar depression, gradually increasing the dose as indicated.
- Continue Seroquel for mood stabilization, depression, and anxiety symptoms (off-label). Consider increasing the dosage to 500mg, with 400mg at bedtime and 100mg during the day.

- Continue to monitor symptoms and adjust medications accordingly.
- Encourage patient to continue attending group psychotherapy.
- Engage patient in milieu therapy.
- Encourage medication compliance.
- The patient will be seen by the medical team for a full physical evaluation and will address any medical issues identified.
- Social work to do a full psychosocial assessment and provide the patient with resources for needs identified.

*Risks and benefits were discussed. Possible side effects explained. The patient was given a chance to ask questions and voice any concerns. The patient was able to verbalize understanding and wishes to proceed with the outlined treatment.

 

[WisNeuro]

Are you aware of anything specific that they like about it? It seems like the other AI scribes I've used have not been as thorough as I'd like regarding my notes (typically very basic). TIA

I'll ask and get back. They're a PCP, so a little different in content. But, she also writes/charts more extensively than most PCPs from what I have seen.

 

[reca]

Lol, I tried one of these. Apparently there's a PG-13 filter set. It refused to note anything I asked about sexual history. Really annoying because it was extremely relevant to the patient case.

 

[Candidate2017]

Seems like a great tool for residents who are too lazy to think things through but are required by their attendings to write 15 page notes. Otherwise, having one's own dot phrases and personalizing them for each patient would be more useful.

Heck, even something like this:

S: Doing ok, same. Med compliant. No side effects. No SI.
O: MSE bullets, vitals...
A/P: MDD, GAD. Continue meds. RTC 12 weeks.

I used to think notes like that were stupid. Now I realize those old school docs are geniuses.

 

[clausewitz2]

Seems like a great tool for residents who are too lazy to think things through but are required by their attendings to write 15 page notes. Otherwise, having one's own dot phrases and personalizing them for each patient would be more useful.

Heck, even something like this:

S: Doing ok, same. Med compliant. No side effects. No SI.
O: MSE bullets, vitals...
A/P: MDD, GAD. Continue meds. RTC 12 weeks.

I used to think notes like that were stupid. Now I realize those old school docs are geniuses.

I couldn't function with notes like that, in that I would spend the first half of each appointment wondering who the **** the person in front of me was unless I saw them quite regularly.

 

[futureapppsy2]

I'll ask and get back. They're a PCP, so a little different in content. But, she also writes/charts more extensively than most PCPs from what I have seen.

I could have sworn your wife is an OB/GYN—did I just make that up?

 

[TexasPhysician]

I do not have snippits of my earlier notes. I would say that it took about 2 weeks for the AI learned my writing style. I continued to add detail in the comment section of the AI to explain what I would like explained better/more thorough in certain areas/etc. I can include a trained note assessment/plan.

I would definitely give it a shot and continue to sharpen your note. The AI isn't perfect, but I would say each day it is getting better.

Also, they have the option to provide feedback on the site (questions/comments), and they will get back to you fairly soon. I give feedback frequently and have received some positive feedback regarding how to maximize the software.

Trained note example (I would go in and change details as needed after this transcript was created):

Assessment:
The patient's depression and anxiety are likely influenced by recent family events and the ongoing stress of his divorce. His recent hospitalization and upcoming PHP will provide intensive therapy and support during this challenging time. The patient's Prozac dosage may need to be adjusted in the future, depending on his response to the medication.



The patient's sleep disturbances are concerning, as poor sleep can exacerbate mental health symptoms. It may be beneficial to explore both behavioral strategies for improving sleep hygiene and potential medication options for short-term sleep aid.



The patient's relationship with his two children appears to be a significant source of stress and anxiety. It may be beneficial to explore options for improving this relationship, such as family therapy or mediation, and to ensure the patient has strategies for managing stress related to this.



In conclusion, the patient's mental health needs are complex and require a comprehensive, multi-faceted treatment approach. This should include monitoring and adjusting his Prozac dosage as needed, addressing his sleep disturbances, and providing support and strategies for managing the stress related to his family situation.



Plan:

Depression: The patient is experiencing symptoms of depression, which were triggered by the suicide of his sister a year ago. The recent filing for divorce, which occurred this past month, has exacerbated this and led to him being hospitalized for approximately 1 week (discharged 3 days ago). The current medication regimen of Prozac 40mg appears to be beneficial and well-tolerated. The patient agrees to continue with the same medication at this time.

Generalized Anxiety disorder: The patient is experiencing symptoms of anxiety, which have been exacerbated by the recent stressors as mentioned above. The patient's current medication regimen of Prozac 40mg appears to be beneficial. The patient agrees to continue with the same medication. Also discussed CBT techniques with him. He is to continue seeing his therapist.

Sleep disturbance: The patient reported having trouble both falling and staying asleep. They mentioned that pain contributes to their sleep issues. They have been taking Flexeril, a muscle relaxant, but it has not been assisted with sleep. They expressed interest in trying Seroquel, but after discussing the potential side effects, we agreed to try Trazodone at 100mg first. If this does not improve their sleep, we will consider other options. We also discussed good sleep hygiene and he plans to incorporate some of these techniques.

-He is to follow-up in 2-3 weeks.

It is your note, so you can obviously create them however you want. The below is not meant to be critical, but instead to help most understand if AI is worth their time. Your example is much more detailed than the average psych outpatient new eval. Most private practice psychiatrists are not doing this. E&M doesn’t require this detail, other clinicians wouldn’t want to read it, and if anything, a bunch of click box templates for legal purposes would be more specific/detailed in the A/P portion.

Can AI take an entire session and create a much more simplified note with specific memorized cya phrases in programmed areas like a template? Every time you start a TCA, does it produce a handout for patients and give a pre-programmed risk/benefit portion?

Otherwise EMR’s like Charm allow you to create templates in every way possible. Click boxes can be pre-clicked or allow a click box to formulate entire sentences. Beyond the history, I don’t type a single sentence in my notes. It is already there in templates or I type brief phrases like:

Start Prozac 20mg daily - MDD/GAD

Maybe AI is more efficient for just the history portion to summarize patient provided info without typing?

If this is taking weeks of tweaking and customizing and still requires edits, is it saving you time? Did you previously use detailed templates?

AI is getting so much media attention, but outside of starting blog articles or travel suggestions, I haven’t seen it really help much in the real world.

 

[WisNeuro]

I could have sworn your wife is an OB/GYN—did I just make that up?

Family med w/OB/GYN. Kind of a dying breed.

 

[Psych25]

It is your note, so you can obviously create them however you want. The below is not meant to be critical, but instead to help most understand if AI is worth their time. Your example is much more detailed than the average psych outpatient new eval. Most private practice psychiatrists are not doing this. E&M doesn’t require this detail, other clinicians wouldn’t want to read it, and if anything, a bunch of click box templates for legal purposes would be more specific/detailed in the A/P portion.

Can AI take an entire session and create a much more simplified note with specific memorized cya phrases in programmed areas like a template? Every time you start a TCA, does it produce a handout for patients and give a pre-programmed risk/benefit portion?

Otherwise EMR’s like Charm allow you to create templates in every way possible. Click boxes can be pre-clicked or allow a click box to formulate entire sentences. Beyond the history, I don’t type a single sentence in my notes. It is already there in templates or I type brief phrases like:

Start Prozac 20mg daily - MDD/GAD

Maybe AI is more efficient for just the history portion to summarize patient provided info without typing?

If this is taking weeks of tweaking and customizing and still requires edits, is it saving you time? Did you previously use detailed templates?

AI is getting so much media attention, but outside of starting blog articles or travel suggestions, I haven’t seen it really help much in the real world.

Thank you for the feedback.

The AI is able to incorporate specific CYA phrases on every note if you want those included. As for specific for TCAs/APs/etc, that I am not sure of. I would love to know if so.

I would say that initial history that AI generates is probably the portion I use the most. Occasionally use the plan portion/helpful reminders what was discussed without jotting down everything.

I agree that AI still has a long way to go, but I would say it has helped save me significant amounts of time when seeing several new patients on an inpatient unit and only needing to carry around my phone using the mobile app.

 

[whopper]

I'm not against AI and if we can positively use it great. I'm against it's use in a negative manner.

The problem, however, here is from what I understand these programs grab data the patient's data and writing from notes to go to it's database so in effect it's arguable it's violating HIPAA.

Is it for real? Maybe not, but this is for the law to decide and there's arguments for and against. For this reason I'm a bit hesitant, but if it later turns out to be kosher fine with me.

 

[clausewitz2]

I have been experimenting with these scribes a bit more, trying out berries.icu and Lindy. Berries was clearly built by a psychiatrist and is definitely the plug-and-play solution; I also have gotten specific responses to my feedback within 10 minutes of sending it from their team, so they are definitely listening to users. They're not customizable yet and seems better for follow-ups than for intakes but they do promise customizable templates soon. needs a touch of editing but notes are produced within a few minutes of completion of session.

Lindy is super customizable and will let you directly edit the system prompt and even choose which underlying LLM to use (GPT 3.5 Turbo v Claude 3 Opus among others). It's not going to be usable for me at the moment (can't record from a browser or tab and I use a headset, so conversation would be entirely one-sided) but if that functionality comes in I might go over to it. It can also use transcripts produced from other sources but the workflow becomes complicated. It's a shame, a couple hours monkeying with the prompt got me to a good approximation of my style with Opus and less misinformation from hallucination than you might expect from just mishearing someone normally.

I am getting quite close to the point of copy-and-paste notes being generated that are actually fairly informative and detailed and rich with relevant quotations. If Google gets into this with the ginormous context window that Gemini Pro has, and the ai could review every single note you have ever written about a particular patient every time it generates a note from the transcript...it could be a very powerful tool for productivity.

The particular Lindy instantiation I was using also unbidden made specific treatment suggestions regarding both meds and therapy approaches/targets that were not at all unreasonable. The folks out there doing 15 minute med checks with minimal cognitive work...the computer is coming for you.

EDIT: So far it has changed my approach in appointments a bit in the sense that I end up vocalizing a lot more of the treatment plan more explicitly (where appropriate) so it can get captured. This is probably a salutary thing I think, nothing like saying things out loud to make you realize you're way off course.

 

[PsyDr]

Sounds like a great way to get sued for some BS an AI wrote.

https://www.politico.com/news/2024/03/24/who-pays-when-your-doctors-ai-goes-rogue-00148447#:~:text=The%20explosion%20of%20AI%20tools,attorneys%20pushed%20back%2C%20will%20hold

 

[clausewitz2]

Sounds like a great way to get sued for some BS an AI wrote.

https://www.politico.com/news/2024/03/24/who-pays-when-your-doctors-ai-goes-rogue-00148447#:~:text=The%20explosion%20of%20AI%20tools,attorneys%20pushed%20back%2C%20will%20hold

I think allowing AI to make decisions about interventions absolutely has a big can of tort worms. I don't advocate for that, but I can imagine things moving that way in the future.

As far as potentially inaccurate documentation, well, you should always check over anything you write for the medical record. But I think we have all seen truly egregious documentation, often produced by the same people for decades to a similar level of quality, with nary a whiff of a lawsuit.

Hooray for the standard of care being so, so low in our field.

EDIT: Also, settings with sovereign immunity that are not the VA tend to have the most trouble attracting qualified staff and also have the least to lose liability wise, so I am guessing 'prescribers' are going to get hit there first.

 

[PsyDr]

I think allowing AI to make decisions about interventions absolutely has a big can of tort worms. I don't advocate for that, but I can imagine things moving that way in the future.

As far as potentially inaccurate documentation, well, you should always check over anything you write for the medical record. But I think we have all seen truly egregious documentation, often produced by the same people for decades to a similar level of quality, with nary a whiff of a lawsuit.

Hooray for the standard of care being so, so low in our field.

EDIT: Also, settings with sovereign immunity that are not the VA tend to have the most trouble attracting qualified staff and also have the least to lose liability wise, so I am guessing 'prescribers' are going to get hit there first.

I might take a different tact. I personally think that the chart note reflects the provider’s opinion, not objective facts (e.g., ability to palpate an abnormality; patient’s perception of cognitive impairment compared to objective reality; etc). Maybe the examiner’s haptic sensation is lower than the palpable abnormality, maybe the abnormality is less than haptically discern -able… there is no AI determination of that difference.

End of day, there is only one entity with a license, and only one entity with legally recognized liability. I’m not ceding anything.

 

[calvnandhobbs68]

I might take a different tact. I personally think that the chart note reflects the provider’s opinion, not objective facts (e.g., ability to palpate an abnormality; patient’s perception of cognitive impairment compared to objective reality; etc). Maybe the examiner’s haptic sensation is lower than the palpable abnormality, maybe the abnormality is less than haptically discern -able… there is no AI determination of that difference.

End of day, there is only one entity with a license, and only one entity with legally recognized liability. I’m not ceding anything.

I don’t get what you’re saying here. It’s extremely unlikely that some error in documentation by an AI scribe is gonna be the make or break difference in a malpractice lawsuit. As noted above, there are much higher risk specialities who have incredibly crappier documentation and this is barely a concern. Human scribes are the norm for a lot of other specialties (EM, derm, ophtho, etc) and you have the same issues where you’re the one responsible for documentation in the end. It just hasn’t been feasible or cost effective for specialities with lower reimbursement or lower patient volume until now.

If you’re talking about the “treatment suggestions” part, that’s a different story and yes you obviously should not be putting treatment recommendations in a note you haven’t reviewed.

 

[clozareal]

I've been really liking Freed and Nabla, both of which use OpenAI as the underlying architecture. Nabla now has a function where you can dictate a note as well as note templates specific for psychiatry which is going to make it higher for me.

My malpractice insurance carrier had a webinar about AI in clinical practice recently. Perhaps it'll be of interest to others.

Artificial Intelligence: The Good, The Bad, and Everything In-Between | Cooperative of American Physicians, Inc

The adoption of artificial intelligence across the healthcare spectrum is increasing rapidly... and so are the associated risks. In this...

www.pathlms.com

 

[Stagg737]

I do not have snippits of my earlier notes. I would say that it took about 2 weeks for the AI learned my writing style. I continued to add detail in the comment section of the AI to explain what I would like explained better/more thorough in certain areas/etc. I can include a trained note assessment/plan.

I would definitely give it a shot and continue to sharpen your note. The AI isn't perfect, but I would say each day it is getting better.

Also, they have the option to provide feedback on the site (questions/comments), and they will get back to you fairly soon. I give feedback frequently and have received some positive feedback regarding how to maximize the software.

Trained note example (I would go in and change details as needed after this transcript was created):

Assessment:
The patient's depression and anxiety are likely influenced by recent family events and the ongoing stress of his divorce. His recent hospitalization and upcoming PHP will provide intensive therapy and support during this challenging time. The patient's Prozac dosage may need to be adjusted in the future, depending on his response to the medication.



The patient's sleep disturbances are concerning, as poor sleep can exacerbate mental health symptoms. It may be beneficial to explore both behavioral strategies for improving sleep hygiene and potential medication options for short-term sleep aid.



The patient's relationship with his two children appears to be a significant source of stress and anxiety. It may be beneficial to explore options for improving this relationship, such as family therapy or mediation, and to ensure the patient has strategies for managing stress related to this.



In conclusion, the patient's mental health needs are complex and require a comprehensive, multi-faceted treatment approach. This should include monitoring and adjusting his Prozac dosage as needed, addressing his sleep disturbances, and providing support and strategies for managing the stress related to his family situation.



Plan:

Depression: The patient is experiencing symptoms of depression, which were triggered by the suicide of his sister a year ago. The recent filing for divorce, which occurred this past month, has exacerbated this and led to him being hospitalized for approximately 1 week (discharged 3 days ago). The current medication regimen of Prozac 40mg appears to be beneficial and well-tolerated. The patient agrees to continue with the same medication at this time.

Generalized Anxiety disorder: The patient is experiencing symptoms of anxiety, which have been exacerbated by the recent stressors as mentioned above. The patient's current medication regimen of Prozac 40mg appears to be beneficial. The patient agrees to continue with the same medication. Also discussed CBT techniques with him. He is to continue seeing his therapist.

Sleep disturbance: The patient reported having trouble both falling and staying asleep. They mentioned that pain contributes to their sleep issues. They have been taking Flexeril, a muscle relaxant, but it has not been assisted with sleep. They expressed interest in trying Seroquel, but after discussing the potential side effects, we agreed to try Trazodone at 100mg first. If this does not improve their sleep, we will consider other options. We also discussed good sleep hygiene and he plans to incorporate some of these techniques.

-He is to follow-up in 2-3 weeks.

Interesting. I’m a bit split here as I hate those points under the assessment. Agree with others that it’s bloat and honestly sounds like it’s mostly boilerplate BS as opposed to an actual decent formulation.

Imo the plan section looks better. I like when a doc puts a brief reason for their changes or why they think the patient is depressed (though that should be in assessment). I don’t do a problem by problem plan like this, but don’t mind it in others’ notes.

My biggest question is still how is this any better than just using T2T software like Dragon with dot phrases/templates? I can see the utility if you write more detailed subjective portions/HPIs and not having to go back to write these. Doesn’t seem to add much outside of that imo.

Seems like a great tool for residents who are too lazy to think things through but are required by their attendings to write 15 page notes. Otherwise, having one's own dot phrases and personalizing them for each patient would be more useful.

Heck, even something like this:

S: Doing ok, same. Med compliant. No side effects. No SI.
O: MSE bullets, vitals...
A/P: MDD, GAD. Continue meds. RTC 12 weeks.

I used to think notes like that were stupid. Now I realize those old school docs are geniuses.

I still think they suck. If a patient is truly stable with no changes it’s fine. But if not and changes are being made, it tells me nothing. As a consulting doc I’ll sometimes get notes like this and they’re useless. And when a patient comes to me on 10 psych meds with several doing the same thing it and there’s no reasoning I have no idea how they ended up there. Usually the patient doesn’t either.

 

[clausewitz2]

My biggest question is still how is this any better than just using T2T software like Dragon with dot phrases/templates? I can see the utility if you write more detailed subjective portions/HPIs and not having to go back to write these. Doesn’t seem to add much outside of that imo.

For me it really is the more detailed subjective portions that are hugely helpful. As is I either have to spend considerable time after appointments and usually don't remember many of the things I would want to remember or act like a stenographer during the appointment. This way I can just talk to the patient.

 

[Penguin10]

For me it really is the more detailed subjective portions that are hugely helpful. As is I either have to spend considerable time after appointments and usually don't remember many of the things I would want to remember or act like a stenographer during the appointment. This way I can just talk to the patient.

What kind of response are you getting from patients when you introduce it?

 

[clausewitz2]

What kind of response are you getting from patients when you introduce it?

'Sure, that's fine' is the modal response.

 

[Stagg737]

For me it really is the more detailed subjective portions that are hugely helpful. As is I either have to spend considerable time after appointments and usually don't remember many of the things I would want to remember or act like a stenographer during the appointment. This way I can just talk to the patient.

I guess for me it doesn’t matter because I’m all telehealth for outpatient so I’m just typing away. I could see this being more helpful if you sitting face to face without a screen.

 

[clausewitz2]

I guess for me it doesn’t matter because I’m all telehealth for outpatient so I’m just typing away. I could see this being more helpful if you sitting face to face without a screen.

Oh I am mostly telehealth for outpatient and so this is what I end up doing, but having to split my attention to typing means I just am not present in the same way. You pick up on different things and notice different nuances and have a different cadence to your speech when you're just engaged solely with a patient than when you are focused on trying to write things down.

 

[clausewitz2]

As an example, here's a note that Lindy generated s/p system prompt engineering but without any other input from me. All I did was upload the transcript and give the patient's name and age. Only edits here are to protect confidentiality:

Subjective:

E is a 37 year old female who presented for psychiatric follow up. She recently started a new job working in patient access at a medical office, checking patients in and verifying insurance. She finds the work easy so far but worries it may become boring. She took this position to have an income as she prepares for her upcoming wedding in one month, which she is very excited about. Wedding planning has been a source of stress, with many vendors to communicate with and payments to make. After the wedding, she plans to move in with her new husband and rent out her current home.

Mood:

E describes her mood as "pretty good overall", "positive", and "occasionally stressed". She is surprised at how well she is handling multiple major life stressors and changes simultaneously, noting "10 years ago I would be like a mess." While not everything about the wedding planning has gone perfectly, she feels the positives far outweigh the negatives. She still experiences some negative feelings but is "just kind of dealing with it."

Sleep:

Over the past 6 months, E has intermittently been waking around 2am and having difficulty falling back asleep for about 3 hours. This occurs about once every 10 days. She has noticed a correlation between this sleep disturbance and having more than one alcoholic drink in the evening. In an effort to reduce alcohol intake, she has gone from 6-7 drinks per week to 3-4. The sleep issue has only occurred once in the past 2 weeks since starting her new job, which requires an earlier wake time. When it does occur, she feels "kind of tired" the next day but is still able to function.

Substance Use:
As noted above, E has reduced her alcohol intake from 6-7 drinks per week to 3-4 drinks per week, in part because she noticed a correlation between drinking more than 1 drink and waking in the night. She is also motivated to reduce alcohol in case she becomes pregnant.

Medications:
E continues to take bupropion XL 300mg daily and escitalopram 20mg daily. She denies any adverse effects from these medications.

Therapy:
E continues to see her therapist weekly, although has missed the last 2 sessions due to scheduling difficulties with her new job. She hopes to figure out a new therapy schedule soon.

Stressors:
E's elderly cat was recently diagnosed with another age-related illness. She has been anticipating his passing for a couple years now and finds it to be "kind of just the constant anticipatory grief." She gives him medication daily and assesses that he still has an adequate quality of life. However, she feels very conflicted, stating "please just die because I've been mentally preparing for his death for so long...this is torture and at the same time I'm like, please don't die because he was my first pet and he means a lot." The timing of his decline has been challenging with everything else she has going on.

Relevant Psychosocial Factors: E is getting married in one month and feeling excited but also stressed by the planning process. Many family members are having big emotional reactions to the wedding that E is having difficulty relating to. After the wedding, she will be moving in with her husband and attempting to rent out her current home. She is also grieving the anticipated loss of her elderly cat.

Mental Status Examination (MSE):
Appearance: well-groomed, appears stated age
Behavior: cooperative and engaged
Motor: no abnormal movements noted
Speech: normal rate, rhythm, volume and prosody
Mood: "pretty good overall"
Affect: bright, reactive, full range
Thought Process: linear, goal-directed, coherent
Thought Content: future-oriented, no SI/HI or psychotic symptoms
Cognition: grossly intact per interview
Insight/Judgment: good insight, judgment intact

Objective:
Vitals: Not obtained at this visit.

Collateral Information: None obtained.

Assessment:
E is a 37 year old female who presented for ongoing medication management and supportive therapy in the context of multiple life stressors, including starting a new job, getting married in one month, moving, and caring for her terminally ill elderly cat. Despite these challenges, she presents with a bright affect and reports her mood is generally positive, which she notes is a marked change from how she would have coped with this level of stress in the past. She has made efforts to reduce her alcohol intake, which seems to have had a positive impact on the intermittent middle insomnia she was experiencing. She continues to find her medication regimen of bupropion XL 300mg and escitalopram 20mg daily to be effective without adverse effects. Therapy sessions have been helpful for her but she has missed a few appointments recently due to scheduling issues. Overall, E demonstrates good insight and judgment, as well as adaptive coping skills during this time of transition and anticipatory grief. Ongoing pharmacotherapy and psychotherapy is indicated for maintenance of her current stability.
Plan:

1. Continue current medication regimen of bupropion XL 300mg daily and escitalopram 20mg daily
2. Encourage continued therapy with current provider, assisting in problem-solving scheduling issues
3. Supportive discussion around stress management techniques and self-care practices during this busy time
4. Process anticipatory grief related to elderly cat's condition as needed
5. Refill medications for 90 days to allow time to find new provider if needed due to insurance changes
6. Return to clinic in 8 weeks, tentatively scheduled for 5/31 at 1:30pm

*****

There are still aspects of this I'm unhappy with (consolidating the Stressors and Psychosocial Factors section for a start) and the plan is wordier and has more boilerplate supportive therapy suggestions than I would ever actually write. So there's a ways to go. Still, this was literally the result of clicking record, uploading a file, and pressing a button. I couldn't find any significant errors or hallucinations, not ideal but if I had to sign off on it unedited I wouldn't be ashamed to have my name attached to it or anything. Sophisticated formulation it is not but good enough to go on.

 

[ObsequiousAplomb]

As an example, here's a note that Lindy generated s/p system prompt engineering but without any other input from me. All I did was upload the transcript and give the patient's name and age. Only edits here are to protect confidentiality:

Subjective:

E is a 37 year old female who presented for psychiatric follow up. She recently started a new job working in patient access at a medical office, checking patients in and verifying insurance. She finds the work easy so far but worries it may become boring. She took this position to have an income as she prepares for her upcoming wedding in one month, which she is very excited about. Wedding planning has been a source of stress, with many vendors to communicate with and payments to make. After the wedding, she plans to move in with her new husband and rent out her current home.

Mood:

E describes her mood as "pretty good overall", "positive", and "occasionally stressed". She is surprised at how well she is handling multiple major life stressors and changes simultaneously, noting "10 years ago I would be like a mess." While not everything about the wedding planning has gone perfectly, she feels the positives far outweigh the negatives. She still experiences some negative feelings but is "just kind of dealing with it."

Sleep:

Over the past 6 months, E has intermittently been waking around 2am and having difficulty falling back asleep for about 3 hours. This occurs about once every 10 days. She has noticed a correlation between this sleep disturbance and having more than one alcoholic drink in the evening. In an effort to reduce alcohol intake, she has gone from 6-7 drinks per week to 3-4. The sleep issue has only occurred once in the past 2 weeks since starting her new job, which requires an earlier wake time. When it does occur, she feels "kind of tired" the next day but is still able to function.

Substance Use:
As noted above, E has reduced her alcohol intake from 6-7 drinks per week to 3-4 drinks per week, in part because she noticed a correlation between drinking more than 1 drink and waking in the night. She is also motivated to reduce alcohol in case she becomes pregnant.

Medications:
E continues to take bupropion XL 300mg daily and escitalopram 20mg daily. She denies any adverse effects from these medications.

Therapy:
E continues to see her therapist weekly, although has missed the last 2 sessions due to scheduling difficulties with her new job. She hopes to figure out a new therapy schedule soon.

Stressors:
E's elderly cat was recently diagnosed with another age-related illness. She has been anticipating his passing for a couple years now and finds it to be "kind of just the constant anticipatory grief." She gives him medication daily and assesses that he still has an adequate quality of life. However, she feels very conflicted, stating "please just die because I've been mentally preparing for his death for so long...this is torture and at the same time I'm like, please don't die because he was my first pet and he means a lot." The timing of his decline has been challenging with everything else she has going on.

Relevant Psychosocial Factors: E is getting married in one month and feeling excited but also stressed by the planning process. Many family members are having big emotional reactions to the wedding that E is having difficulty relating to. After the wedding, she will be moving in with her husband and attempting to rent out her current home. She is also grieving the anticipated loss of her elderly cat.

Mental Status Examination (MSE):
Appearance: well-groomed, appears stated age
Behavior: cooperative and engaged
Motor: no abnormal movements noted
Speech: normal rate, rhythm, volume and prosody
Mood: "pretty good overall"
Affect: bright, reactive, full range
Thought Process: linear, goal-directed, coherent
Thought Content: future-oriented, no SI/HI or psychotic symptoms
Cognition: grossly intact per interview
Insight/Judgment: good insight, judgment intact

Objective:
Vitals: Not obtained at this visit.

Collateral Information: None obtained.

Assessment:
E is a 37 year old female who presented for ongoing medication management and supportive therapy in the context of multiple life stressors, including starting a new job, getting married in one month, moving, and caring for her terminally ill elderly cat. Despite these challenges, she presents with a bright affect and reports her mood is generally positive, which she notes is a marked change from how she would have coped with this level of stress in the past. She has made efforts to reduce her alcohol intake, which seems to have had a positive impact on the intermittent middle insomnia she was experiencing. She continues to find her medication regimen of bupropion XL 300mg and escitalopram 20mg daily to be effective without adverse effects. Therapy sessions have been helpful for her but she has missed a few appointments recently due to scheduling issues. Overall, E demonstrates good insight and judgment, as well as adaptive coping skills during this time of transition and anticipatory grief. Ongoing pharmacotherapy and psychotherapy is indicated for maintenance of her current stability.
Plan:

1. Continue current medication regimen of bupropion XL 300mg daily and escitalopram 20mg daily
2. Encourage continued therapy with current provider, assisting in problem-solving scheduling issues
3. Supportive discussion around stress management techniques and self-care practices during this busy time
4. Process anticipatory grief related to elderly cat's condition as needed
5. Refill medications for 90 days to allow time to find new provider if needed due to insurance changes
6. Return to clinic in 8 weeks, tentatively scheduled for 5/31 at 1:30pm

*****

There are still aspects of this I'm unhappy with (consolidating the Stressors and Psychosocial Factors section for a start) and the plan is wordier and has more boilerplate supportive therapy suggestions than I would ever actually write. So there's a ways to go. Still, this was literally the result of clicking record, uploading a file, and pressing a button. I couldn't find any significant errors or hallucinations, not ideal but if I had to sign off on it unedited I wouldn't be ashamed to have my name attached to it or anything. Sophisticated formulation it is not but good enough to go on.

 

[clausewitz2]

And as contrast, the same person from berries.icu below. This requires a fair amount of editing to be useful and I do not like a lot of the structure. This one is just ridiculously bloated at the moment, more so than most exemplars even from berries. They are extremely responsive to feedback, however, and just in the past few days I've been toying with it they introduced a distinction between psychiatry f/u notes and therapy f/u notes, so we'll see if it gets better. They say customizable templates are coming soon - if it actually happens and it does allow real ability to specify structure it is closer to being usable.

I'm still struck a bit by the things the AI managed to interpolate from the conversation in terms of propositional attitudes and emotional state of the patient which I think were largely accurate but not discussed explicitly.

Subjective:
Chief Complaint: The patient reports stressors related to changes in employment and preparations for an impending wedding, but notes an overall good handling of these issues.

History of Present Illness (HPI): The patient begins the session acknowledging a lack of awareness about the scheduled appointment, indicative of a preoccupied state of mind linked to a new job started “last week” and an upcoming wedding "a month from yesterday". The patient expresses excitement about the marital event juxtaposed with the stress of commencing new employment at [REDACTED] to ensure income continuity. Describing the role as administrative, entailing tasks like checking in patients and verifying insurance, the patient is still in the process of being trained and evaluating the new work environment.

When probed about the choice of the current job, the patient conveyed an absence of deliberation, accepting the first offer received from a batch of applications to unspecified positions. A notable lack of confidence pervades the patient's discourse about future career aspirations. Contrastingly, the patient is handling a multitude of stressors including a demanding commute , moving residences, and wedding preparations unexpectedly well, remarking on a sense of personal growth and a feeling of being "unstuck."

The patient’s mood is described as "really good," and surprisingly uncomplicated considering the multitude of substantial life transitions. The patient acknowledges occasional negative feelings, mostly surrounding family and emotional complexities tied to wedding preparations but remains highly functional and positive. Sleep issues reported include difficulty falling asleep and waking up around "2 in the morning," characterized by staying awake for "like, 3 hours" before managing to sleep again. These disturbances occur approximately "once every 10 days" and have been more frequent in the past 6 months.

The patient notes a history of alcohol consumption negatively affecting sleep and is reducing intake with potential pregnancy in mind. The patient's adherence to current medication, 300 milligrams of extended-release Wellbutrin and 20 milligrams of Lexapro, is solid, with no reported side effects. Despite recent disruptions to therapy schedules due to the new job, the patient values the continuity in mental health treatment.

Symptoms Recap - Interval Changes:
1. Stress: The patient is experiencing notable life stressors related to job changes, wedding planning, and relocation but reports handling the stress "eerily well," which is a positive change.
2. Sleep disturbances: The patient describes new challenges with sleep, waking up in the middle of the night and staying awake for extended periods, with a frequency increase over the last six months.

Current Psychiatric Medications: The patient is currently taking 300 milligrams of extended-release Wellbutrin and 20 milligrams of Lexapro, with no reported issues concerning these medications.

Medication Adherence: The patient confirms ongoing adherence to prescribed psychiatric medications, with no reported missed doses.

Side Effects: The patient does not report any side effects from medication.

Sleep: The patient reports intermittent difficulty with sleep initiation and maintenance, which seems aggravated by alcohol consumption but is a recent and notable change.

Mood: The patient's mood is characterized as positive, with occasional stress responses, but generally resilient and buoyant.

Nutrition: No specific details on nutrition habits or consumption patterns are provided in the transcription.

Substance Use History:
- Alcohol: The patient consumes a reduced amount of "3 or 4 drinks a week" from an earlier level, mindful of potential pregnancy.
No other substance use or "process addictions" are mentioned.

Past Psychiatric History: The patient is currently engaged in weekly therapy sessions, although recent employment changes have disrupted this schedule.

Social History: The patient is soon to be married, is currently engaged in fixing up a property for living post-wedding, and is actively managing properties with an intent to rent for income and retain equity.

Objective:
- General Appearance and Behavior: The patient's attire and grooming were appropriate, with no significant peculiar behaviors observed during the visit.
- Motor Activity: The patient displayed normal motor activity, with no indications of abnormal movements or restlessness noted.
- Speech: The patient exhibited coherent speech with appropriate volume and speed, showing no signs of language impairments.
- Eye Contact: The patient maintained regular eye contact during the visit, with no indications of unusual patterns.
- Affect: The patient's affect was predominantly positive, displaying a wide range of appropriate emotional expressions in response to various topics discussed.
- Thought Process: The patient's thought process reflected organized and coherent thinking, with logical discussion and no indications of disorganized thinking.
- Cognition: The patient demonstrated intact cognitive function, displaying orientation and clear memory throughout the conversation.
- Insight & Judgment: The patient expressed insight into personal challenges and demonstrated sound judgment while discussing life decisions.
- SI (Suicidal Ideation): The patient did not report any suicidal ideation during the visit.
- HI (Homicidal Ideation): The patient did not express any homicidal thoughts or ideations.
- AH (Auditory Hallucinations): No reports or signs of auditory hallucinations were observed during the visit.
- VH (Visual Hallucinations): The patient did not mention any visual hallucinations during the visit.


Assessment & Plan:


Assessment:
The patient reports life changes including a new job, an upcoming wedding, the patient's move, and the future husband's house renovations. While these events are stressors, the patient expresses handling these changes surprisingly well, reflecting a potential adjustment disorder with mixed anxiety and depressed mood symptoms. Despite some sleep disturbances, like waking up in the middle of the night, the patient's mood remains generally positive, with moments of stress related to wedding planning and concern for a sick pet. The sleep issues hint at insomnia due to another mental disorder, potentially exacerbated by alcohol consumption. Medication adherence to Wellbutrin and Lexapro is consistent, and no side effects are reported; however, therapy sessions have not been maintained regularly due to the patient's current workload. There is no indication of thoughts of self-harm or risk to others.

Plan:
- Continue current medications (Wellbutrin 300mg ER and Lexapro 20mg) barring any new side effects or concerns.
- Encourage the patient to continue engagement with psychological therapy as it can be beneficial during times of significant life changes, once a more suitable schedule is identified.
- Advise the patient to monitor alcohol intake, particularly as it pertains to sleep quality, and consider abstaining to evaluate its impact on sleep.
- Educate about proper sleep hygiene practices to address insomnia and establish a regular sleep schedule, especially in light of variable work hours.

Follow-Up:
- Schedule the next appointment for 8 weeks, with flexibility based on the patient's insurance changes and financial considerations. Encourage the patient to reach out if they need to reschedule or opt for an alternative plan.

 

[Bartelby]

Thanks for posting these! This is impressive, but both remind me of a brand new medical student who transcribes almost every detail of the interaction. These notes create so much bloat. I dread the day when I need to review significant volumes of this kind of documentation.

 

[clausewitz2]

Thanks for posting these! This is impressive, but both remind me of a brand new medical student who transcribes almost every detail of the interaction. These notes create so much bloat. I dread the day when I need to review significant volumes of this kind of documentation.

Lindy at least will also let you set up an LLM to summarize medical documents, so don't worry, the snake can eat its own tail.

 

[psychmd03]

Yeah I gotta say these are some wildly long and unnecessary notes. I prefer much more succinct documentation. Notes just don’t really take that long where it’s needed to have something transcribing a whole visit into a note and imo leaves you more open to issues if you end up in court.

 

[sloh]

Seems like a great tool for residents who are too lazy to think things through but are required by their attendings to write 15 page notes. Otherwise, having one's own dot phrases and personalizing them for each patient would be more useful.

Heck, even something like this:

S: Doing ok, same. Med compliant. No side effects. No SI.
O: MSE bullets, vitals...
A/P: MDD, GAD. Continue meds. RTC 12 weeks.

I used to think notes like that were stupid. Now I realize those old school docs are geniuses.

The way.

 

[psycho-matic]

Oh I am mostly telehealth for outpatient and so this is what I end up doing, but having to split my attention to typing means I just am not present in the same way. You pick up on different things and notice different nuances and have a different cadence to your speech when you're just engaged solely with a patient than when you are focused on trying to write things down.

So if you aren't having to write everything down, does that mean the AI is getting an audio recoding of the meeting to generate the note?

 

[clausewitz2]

So if you aren't having to write everything down, does that mean the AI is getting an audio recoding of the meeting to generate the note?

Records the audio, generates a transcript, destroys the audio, passes the transcript to the LLM. LLM generates notes from that transcript. Most of the ones I have looked at then also delete the transcript after a certain amount of time has passed, often around 14 days.

EDIT: I suppose you could also record the audio locally, generate a transcript using Audacity or something, and feed the transcript to the model yourself.

EDIT EDIT: Something that often gets overlooked with these things is that the kind of performance you are seeing right now is the worst LLMs will ever be at the task. They will only get better at it as time progresses. Maybe we hit some kind of wall of performance hovering slightly above this generation of LLMs but there is no sign of this happening at present. A bigger bottleneck is probably going to be having adequate infrastructure to support the kind of data centers needed to support them. Some of these companies are starting to look at building dedicated power plants just for this purpose.

 

[ObsequiousAplomb]

I could see reviewing this as part of training or for process notes or for initial consultstions. It seems excessive for routine clinical use.

 

[psycho-matic]

Records the audio, generates a transcript, destroys the audio, passes the transcript to the LLM. LLM generates notes from that transcript. Most of the ones I have looked at then also delete the transcript after a certain amount of time has passed, often around 14 days.

EDIT: I suppose you could also record the audio locally, generate a transcript using Audacity or something, and feed the transcript to the model yourself.

EDIT EDIT: Something that often gets overlooked with these things is that the kind of performance you are seeing right now is the worst LLMs will ever be at the task. They will only get better at it as time progresses. Maybe we hit some kind of wall of performance hovering slightly above this generation of LLMs but there is no sign of this happening at present. A bigger bottleneck is probably going to be having adequate infrastructure to support the kind of data centers needed to support them. Some of these companies are starting to look at building dedicated power plants just for this purpose.

Thanks. Will they sign a BAA?

 

[clausewitz2]

Thanks. Will they sign a BAA?

You sign a BAA to sign up to use them as it happens.

 

[clausewitz2]

I could see reviewing this as part of training or for process notes or for initial consultstions. It seems excessive for routine clinical use.

Lindy has a button you can actually click to have the LLM regenerate it longer or shorter, so you can titrate to desired level of detail in many ways.

 

[psychma]

What would a patient agreement to an ai scribe look like?

 

[clausewitz2]

1. Explain what you are doing.
2. Explain the precautions being taken for security.
3. Ask them if they have any questions.
4. Ask for their permission to proceed.
5. Document the conversation.

As long as you do this contemporaneously, I don't think you get much out of having some separate form. The use per se cannot violate HIPAA if they understand and agree to it.

 

[calvnandhobbs68]

1. Explain what you are doing.
2. Explain the precautions being taken for security.
3. Ask them if they have any questions.
4. Ask for their permission to proceed.
5. Document the conversation.

As long as you do this contemporaneously, I don't think you get much out of having some separate form. The use per se cannot violate HIPAA if they understand and agree to it.

Yeah right I think people make way too big of a deal out of this (I feel like as usual in psychiatry....). This happens literally all the time in other specialities, the doctor walks into the room with a scribe they don't even explain who they are half the time and they start typing everything you say.

The biggest thing would be explaining the security precautions around the transcript but for instance I don't give patients the minute details of what I'm doing with security around their medical records constantly. Your radiology images can get sent halfway around the world to some radiologist in Hawaii on their personal computer and you'd never know.

 

[clausewitz2]

Apres celui-ci, le deluge:

Risks from Language Models for Automated Mental Healthcare: Ethics and Structure for Implementation

Amidst the growing interest in developing task-autonomous AI for automated mental health care, this paper addresses the ethical and practical challenges associated with the issue and proposes a structured framework that delineates levels of autonomy, outlines ethical requirements, and defines...

www.medrxiv.org

 

[TexasPhysician]

I’d strongly advise against anything I’ve seen here. These aren’t good notes from an insurance billing standpoint, legal standpoint, or simplicity standpoint. This is more academia based at the expense of everything else.

 

[clozareal]

Apres celui-ci, le deluge:

Risks from Language Models for Automated Mental Healthcare: Ethics and Structure for Implementation

Amidst the growing interest in developing task-autonomous AI for automated mental health care, this paper addresses the ethical and practical challenges associated with the issue and proposes a structured framework that delineates levels of autonomy, outlines ethical requirements, and defines...

www.medrxiv.org

This is related to using LLMs for clinical care, not for documentation/scribing.

 

[clausewitz2]

This is related to using LLMs for clinical care, not for documentation/scribing.

Yes, I did actually read the paper in fact. This is more gesturing towards the idea that if we don't think there's going to be a tremendous expansion of the use of AI in our profession in our lifetimes we are kidding ourselves.

 

[clausewitz2]

Berries.icu is piloting a functionality that ostensibly allows personalization of note formats and style that it can apply automatically to future notes it generates. It seems to require you editing a note it generated up to your specifications once or twice, but if it actually got to the truly auto-magic stage... will report back once I've tried it.

 

[clozareal]

Berries.icu is piloting a functionality that ostensibly allows personalization of note formats and style that it can apply automatically to future notes it generates. It seems to require you editing a note it generated up to your specifications once or twice, but if it actually got to the truly auto-magic stage... will report back once I've tried it.

MDHub has a directory of templates that you can steal from other people and you can create your own note template too. You can also ask questions about the patient and it'll find it for you from the old notes that are in it (are they trying to be a standalone EMR?)
Freed also has this functionality to learn your style as well. This has been my favorite option so far.
Nabla came out with a function that you can input patient context prior to recording the audio.