• The AI Clinic
  • Posts
  • Trust in Healthcare, Patient Scribes, and Virtual Nurses

Trust in Healthcare, Patient Scribes, and Virtual Nurses

Unpacking How AI is Changing Healthcare

Author

Patrick Figures
November 08, 2024

The AI Clinic Weekly Pulse #5 | Subscribe

What a week.

With the election behind us, we’re left to wrestle with lingering questions about what second Trump presidency means for the nation, our families, and the many implications it has for the healthcare industry at large.

While this newsletter is not a venue for my personal thoughts, I’m deeply curious to see what the new Trump Administration has in store for healthcare policy, AI regulation, and the government’s overall role in healthcare.

No doubt we’ll have lots to talk and write about in the coming years.

Today We’re Covering:

  • Alaska nurses voice safety concerns and labor complaints against a virtual nursing program that shifts more patient management to remote staff amidst the state’s staffing crisis.

  • Silicon Valley’s enthusiasm for AI in medicine and a warning that efforts to replace doctors with tech risk undermining patient trust and the physician-patient relationship.

  • OpenNotes and Abridge are conducting a study at Beth Israel Deaconess Medical Center to see if AI-generated summaries can help patients better understand their clinical notes and follow care instructions.

Let’s jump in.

Alaska Nurses Rally Against Virtual Nursing

Providence Alaska Medical Center’s new virtual nursing program—introduced to manage staffing shortages—has spurred significant concern among on-site nurses. This “co-caring” model combines bedside nurses with virtual nurses handling documentation, medication management, and discharge planning. While the hospital highlights its potential to increase care efficiency, many nurses argue that it could jeopardize patient safety and worsen bedside conditions.

Key Takeaways

  • Increased Patient Ratios: Bedside nurses in some units are now handling five patients, up from four, while supported by virtual nurses connected remotely via video. Nurses argue this dilutes the quality of in-person care.

  • Union Pushback: The Alaska Nurses Association has filed a labor complaint, voicing concerns that the new model overburdens bedside nurses and increases risks of missed patient needs.

  • Hospital Response: Hospital leaders say the model is a necessary innovation, pointing to successful implementations in other hospitals and emphasizing the need to address Alaska’s critical nursing shortage.

Why This Matters

Expect to see hundreds more stories like this as healthcare enters what could be seen as its own “Luddite moment.” This traditionally labor-intensive industry is now wrestling with the dual promise and threat of AI technology. Hospitals are understandably eager to innovate and address urgent nursing shortages through virtual solutions, remote staffing, and AI-enabled efficiencies. Yet, as Providence Alaska’s virtual nursing initiative shows, these changes don’t come without significant pushback, especially from a workforce with a long-standing skepticism toward healthcare leadership’s intentions.

It’s a nuances issue: technology offers a much-needed solution to labor shortages and workflow overloads, but it’s also challenging the role of bedside clinicians and stoking fears of job loss and compromised patient care. I fear that many healthcare workers are fighting the same losing battle as the luddites, but this will be an important trend to watch as the technology advances. Full Article

A Quick Aside: Patient Trust, Physicians, and AI

I stumbled upon an excellent blog post written by orthopedic surgeon Dr. Ben Schwartz centering on the tense relationship between AI and physicians and the knock on affects around patient trust in the existing healthcare system.

Schwartz's post critiques venture capitalist Marc Andreessen's misrepresentation of data from a JAMA study on trust in healthcare providers and uses it as a jumping off point to a broader discussion about the erosion of trust between the legacy healthcare industry and patients.

Andreessen's interpretation of the JAMA study—which showed a 31.4% drop in trust during the pandemic—ignored important context. Schwartz’s frustration with Andreessen’s take isn’t about a simple data misread; it’s about what that misread represents: an erosion of trust that opportunistic voices, in their enthusiasm to "disrupt," may be all too eager to capitalize on.

"Lack of trust in traditional health care providers is problematic for multiple reasons. It opens the door even wider for misinformation and any number of opportunistic grifters (happy to tell people what they want to hear, for the right price). Sowing distrust for self-serving reasons is not unique to health care. But when it comes to a person’s health and well-being, the results can be disastrous. The complete erosion of the doctor-patient relationship would certainly lead to greater health care costs and worse outcomes. Distrust in the medical system leads to underutilization of services, poor adherence to treatment, worse self-reported health status, and less preventive care."

As Schwartz points out, this crisis of trust opens the door for Silicon Valley’s next big push—replacing the traditional physician-patient relationship with AI-driven solutions. There’s money to be made, after all, in “reimagining” a system as massive as the U.S. healthcare industry, with venture capitalists eyeing tech-like returns from a $3.5 trillion market. Andreessen isn’t alone; other prominent VCs have long held that doctors "don’t scale" and that AI algorithms should take over much of their role. In their eyes, physicians are just another bottleneck that AI can streamline or, in time, eliminate.

But Schwartz believes this line of thinking is fundamentally flawed—and dangerous. The art of medicine extends far beyond diagnosis and prescription. The complex relationship between a doctor and a patient has profound implications for care, and no algorithm can replicate the trust and empathy built in that setting. AI’s promise in healthcare is real, but the notion that it can or should replace doctors reveals a deep misunderstanding of the field. This fixation on “replacing” doctors not only risks oversimplifying patient care but also threatens the critical doctor-patient relationship, a cornerstone of quality medicine. For Schwartz, reducing care to a matter of scalable data misses the point: healthcare is human care, and while tech can support it, it cannot replace it.

Schwartz highlights a fight that’s only beginning, and it’s one that healthcare executives ignore at their peril. As AI tools gain traction, their impact on healthcare’s delicate balance of power could become destabilizing, creating a crisis for the institutions—and people—at its core.

For over a hundred years, physicians have been the backbone of our healthcare system. They’ve crafted treatment plans, guided patient decisions, and quarterbacked care for patients under their supervision. AI now threatens to disrupt that balance.

With tools that aggregate, process, and analyze massive data sets, AI tools will spark uncomfortable questions about the physician’s role in decision-making, especially when algorithms can make certain assessments faster and potentially more accurately.

The financial incentives for new players eager to “shake up” healthcare cannot be overstated. The system’s inefficiencies and high costs are well known, making the “move fast and break things” mentality—typical in tech—tempting for those who see healthcare as ripe for innovation. But healthcare’s complexity defies quick fixes, and applying the tech industry’s aggressive model could further erode patient trust.

Healthcare has left itself vulnerable to disruption. Costs are high, quality is inconsistent, and access lags behind that of many other nations. This gives disruptors ammunition to push a message that rings painfully true for many: “The system isn’t working; let’s try something new.” And as Schwartz warns, once AI begins reshaping decision-making processes, we may face not only a shift in power but also a fracture in the doctor-patient bond that defines our current system.

Healthcare may need reform, but it needs reform that does its best to harmonize with the existing system, not one that diminishes it. As AI advances, the challenge for healthcare—and those who lead it—will be to find ways to integrate new technology without undermining the foundational relationships that make care effective. Schwartz’s call to action is clear: there’s opportunity for innovation, but there’s also risk. And the future of healthcare depends on finding the right balance.

OpenNotes and Abridge Partner on Patient-Centric AI Study

OpenNotes, a transparency-focused research initiative, is partnering with Abridge to explore how generative AI can improve patient engagement by making clinical notes more understandable. This six-month study, based out of Beth Israel Deaconess Medical Center’s OpenNotes Lab, will assess how AI-generated visit summaries benefit patients, particularly in clarity and accessibility.

Key Takeaways

  • Patient-Focused "Scribe": Unlike traditional scribe tools that assist clinicians, Abridge’s AI generates summaries designed for patients, simplifying complex medical information to enhance understanding and support follow-through on care instructions.

  • Focus-group Driven: Initial phases involve patient focus groups evaluating AI-generated visit summaries for effectiveness and readability.

  • Making Notes Accessible: Summaries aim to improve transparency and are written at an eighth-grade reading level, providing clear information on diagnoses, medications, and next steps.

Why This Matters

It’s refreshing to see innovation that's genuinely patient-centric from the ground up. One of healthcare’s ongoing challenges is how often the patient experience is sidelined in favor of solutions focused on clinical efficiency or revenue impact. With hospitals and providers as the primary revenue sources, there's often little incentive to invest directly in patient-facing advancements. That's why it’s a welcome surprise to see substantial resources and thought going into a project like this, which is so well-suited to the strengths of generative AI. If successful, this approach could set a new precedent for making patient engagement a priority, transforming how patients access, understand, and act on their health information. Full Article

Other Things Worth Checking Out

Here’s some more news that’s worth checking out:

That’s it for now. We’ll catch up again next week.

-Patrick

Enjoy this? Please take the time to forward to a friend or subscribe.