The island’s largest healthcare system has started to integrate artificial intelligence, or AI, into its physician-patient conversations. It says it will reduce doctor workload and improve efficiency. But a healthcare union says it’s unsure.
Northwell Health is rolling out Abridge, an AI software that’s ambient, or on in the background, into physician’s toolboxes. Northwell’s Head of Technology, Kristin Myers, said the idea is that the AI program, which is specifically designed for use in healthcare settings, will record and transcribe conversations between doctors and their patients. This will remove the need for physicians to spend time notetaking, reducing burden on them, improving their bedside manner and allowing them to be more efficient.
Alexandra Dahlberg, a staffer for the SEIU 1199 union that represents a range of Northwell employees, said the union and its members were uncertain whether ambient AI would truly lessen the workload for doctors, nurses and other healthcare staff, but were hopeful it would end up being something positive.
“We understand both the benefits and the risks of AI,” she said. “Our main feeling about this is that it’s happening. There’s ways it can be beneficial. What we need to do is implement guardrails and protections around it.”
Dahlberg said the union’s primary concern was that the ambient AI would end up increasing physician workload instead of lessening it, creating additional tasks of managing the AI and reviewing the transcription, as well as fear that if physicians weren’t required to take notes, their caseload would increase, adding on additional work they don’t have time for.
“With many technologies as they’re implemented, instead of reducing burnout or making a workload more manageable for workers, it actually increases the workload, because an employer will turn around and say, ‘Well, you have this technology, so now you should take on more patients. You should work faster,’” Dahlberg said. “We think that can harm patient care. However, if the use of AI means that our members have more time at the bedside and an ability to increase their quality of care and their time with the patient, then we definitely see the benefit in that.”
She said members currently report not having enough time for notetaking, so removing the time currently “dedicated” to the task would not necessarily mean they’d be able to take on more patients.
Dahlberg said a member raised a concern that similar to an increase in work when electronic record-keeping was implemented, the new technology would create additional steps for them.
“Electronic record keeping actually added a lot more elements that had to be captured per station because they had these tools,” she said. “Obviously, if that can improve quality care, we’re for that, but if it just adds to their workload…that can be an issue…Presumably, they’re going to have to read over what the AI has done, fact-check it and make sure that the AI captured it correctly. We worry it could actually just increase expectations on them in a way that distracts from their ability to just be present with patients.”
Myers said Northwell believed software like Abridge would truly lighten physicians’ load and emphasized the healthcare system would not be looking to replace doctors or healthcare staff with AI — ever.
“AI is a tool that helps augment them. It’s an assist. It’s not a replacement, absolutely not,” Myers said. “Always having a human in the loop is of paramount importance, especially in healthcare.”
“It basically ensures that there is less typing for the physicians,” she added. “ I think that that’s really important, if you think about the amount of time that physicians are taking to document the visits, this is going to really be able to support them in reducing that administrative burden.”
Myers also said physicians would not be required to use Abridge. It would be an option for them, she said, if they believed it was helpful to them and their work. Additionally, all patients would be given the option to opt in or out of the software being used during their visit.
Northwell said patient information and conversation transcription is stored in Abridge’s system for 14 days before being automatically deleted from the servers and system. After it’s collected, it’s moved into a digital storage space owned by Northwell. The software is entirely HIPAA compliant, Northwell said.
Dahlberg also raised concerns over a lack of training on the AI software for Northwell staff, emphasizing a need for strong guidance from Northwell on how Abridge and other similar programs should be used.
“Something that will have to be dealt with is that there is not currently a lot of training or guidance on AI, as it’s being implemented,” she said. “Many members are seeing it already being integrated into software that they use…and they have not heard anything from their managers on whether they should be using it and if there will be training.”
Dahlberg added there was a concern that AI has biases that might be added into conversations and has a documented tendency to “make things up” or hallucinate, random information. She was concerned that there was a chance those things could slip into AI documentation and alter patient care.
“The way AI is being developed is by being fed all the information that exists in the world, and that can include a lot of biases,” Dahlberg said. “We have a long history of racial bias, in the world, especially in the healthcare world. If AI is being fed any information that has that, there’s a world where that bias could come out in a healthcare setting. We need to make sure that there is some sort of auditing happening that protects patients from that as well as from what they call hallucinations…completely false stuff that AI writes that’s not based in reality.”
“We need to make sure that there is auditing happening for that,” she added. “We also need to make sure that there is always a professional, an expert, one of our members involved.”
Myers said doctors and healthcare staff would always be involved and that physicians would be reviewing transcripts. Physicians and staff would always be the ones making diagnoses and prescribing treatment, she said.
Dahlberg said some union members were excited about the continued use of AI, some nervous, some both. But the union was clear-eyed about the reality of AI implementation and was not opposed to it.
“I really think the most important thing is just that the healthcare professionals and the patients have a voice in this,” she said. “We can’t say for sure if this is a beneficial thing or if it’s going to be more of a harmful thing. The important thing is that our members are really listened to as it’s being implemented.”
