{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,24]],"date-time":"2026-03-24T08:15:42Z","timestamp":1774340142451,"version":"3.50.1"},"reference-count":38,"publisher":"Oxford University Press (OUP)","issue":"2","license":[{"start":{"date-parts":[[2025,10,16]],"date-time":"2025-10-16T00:00:00Z","timestamp":1760572800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,2,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background and Significance<\/jats:title>\n                    <jats:p>Ambient listening tools powered by generative artificial intelligence (GenAI) offer real-time, scribe-like support that reduce documentation burden and may help alleviate burnout. This study assesses physician-perceived benefits and challenges of ambient AI implementation through surveys and evaluates its effectiveness in clinical workflows using automatically recorded electronic health record (EHR) time-efficiency metrics.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Method and Materials<\/jats:title>\n                    <jats:p>A quality improvement pilot has been underway at UCI Health since December 2023. Epic EHR Signal metrics were analyzed to assess changes in note length, documentation time, and same-day encounter closure rates. Matched pre- and post-implementation surveys evaluated physician-perceived changes in documentation burden, clinical efficiency, and care quality. We also examined open-ended survey responses using thematic analysis to supplement quantitative findings.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Analysis on EHR usage data from 167 physicians showed significant reductions in note-writing time, despite an increase in note length. Survey responses (n\u2009=\u200965) also indicated statistically significant improvements across multiple domains. Physicians reported reduced cognitive demand (P\u2009=\u2009.031) and documentation effort (P\u2009=\u2009.014), alongside perceptions of enhanced clinical efficiency, patient-centered care, and EHR system usability. Thematic analysis confirmed these quantitative findings and identified opportunities for improvement, including specialty-specific customization and expanded AI functionality.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>Ambient AI tools demonstrated improved documentation efficiency, perceived care quality, and reduced cognitive workload. These benefits suggest potential to alleviate key burdens in clinical documentation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Future development should prioritize customization for specialty-specific and individual physician needs, ensure the reliability and accuracy of AI-generated content, and integrate ethical and legal considerations to facilitate safe and scalable implementation in patient-centered care contexts.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/jamia\/ocaf180","type":"journal-article","created":{"date-parts":[[2025,10,1]],"date-time":"2025-10-01T12:06:19Z","timestamp":1759320379000},"page":"273-282","source":"Crossref","is-referenced-by-count":10,"title":["Evaluating ambient artificial intelligence documentation: effects on work efficiency, documentation burden, and patient-centered care"],"prefix":"10.1093","volume":"33","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-2048-1798","authenticated-orcid":false,"given":"Yawen","family":"Guo","sequence":"first","affiliation":[{"name":"University of California, Irvine Department of Informatics, , Irvine, CA 92617,","place":["United States"]}]},{"given":"Jiayuan","family":"Wang","sequence":"additional","affiliation":[{"name":"University of California, Irvine Department of Informatics, , Irvine, CA 92617,","place":["United States"]}]},{"given":"Di","family":"Hu","sequence":"additional","affiliation":[{"name":"University of California, Irvine Department of Informatics, , Irvine, CA 92617,","place":["United States"]}]},{"given":"Steven","family":"Tam","sequence":"additional","affiliation":[{"name":"University of California, Irvine Department of Medicine, , Irvine, CA 92617,","place":["United States"]}]},{"given":"Charles","family":"Gilman","sequence":"additional","affiliation":[{"name":"University of California, Irvine UCI Health, , Orange, CA 92868,","place":["United States"]}]},{"given":"Emilie","family":"Chow","sequence":"additional","affiliation":[{"name":"University of California, Irvine Department of Medicine, , Irvine, CA 92617,","place":["United States"]}]},{"given":"Danielle","family":"Perret","sequence":"additional","affiliation":[{"name":"University of California, Irvine Department of Physical Medicine & Rehabilitation, , Irvine, CA 92697,","place":["United States"]}]},{"given":"Deepti","family":"Pandita","sequence":"additional","affiliation":[{"name":"University of California, Irvine Department of Medicine, , Irvine, CA 92617,","place":["United States"]}]},{"given":"Kai","family":"Zheng","sequence":"additional","affiliation":[{"name":"University of California, Irvine Department of Informatics, , Irvine, CA 92617,","place":["United States"]}]}],"member":"286","published-online":{"date-parts":[[2025,10,16]]},"reference":[{"key":"2026012716172086500_ocaf180-B1","author":"Office for Civil Rights","year":"2009"},{"key":"2026012716172086500_ocaf180-B2","doi-asserted-by":"publisher","first-page":"501","DOI":"10.1056\/NEJMp1006114","article-title":"The \u201cmeaningful use\u201d regulation for electronic health records","volume":"363","author":"Blumenthal","year":"2010","journal-title":"N Engl J Med"},{"key":"2026012716172086500_ocaf180-B3","doi-asserted-by":"publisher","first-page":"e060865","DOI":"10.1136\/bmjopen-2022-060865","article-title":"Electronic medical record-related burnout in healthcare providers: a scoping review of outcomes and interventions","volume":"12","author":"Li","year":"2022","journal-title":"BMJ Open"},{"key":"2026012716172086500_ocaf180-B4","author":"American Medical Informatics Association","year":"2025"},{"key":"2026012716172086500_ocaf180-B5","doi-asserted-by":"publisher","first-page":"e51003","DOI":"10.2196\/51003","article-title":"Use of epic electronic health record system for health care research: scoping review","volume":"25","author":"Chishtie","year":"2023","journal-title":"J Med Internet Res."},{"key":"2026012716172086500_ocaf180-B6","doi-asserted-by":"publisher","first-page":"2248","DOI":"10.1016\/j.mayocp.2022.09.002","article-title":"Changes in burnout and satisfaction with work-life integration in physicians during the first 2 years of the COVID-19 pandemic","volume":"97","author":"Shanafelt","year":"2022","journal-title":"Mayo Clin Proc"},{"key":"2026012716172086500_ocaf180-B7","doi-asserted-by":"crossref","DOI":"10.23970\/AHRQEPCTB47","volume-title":"Measuring Documentation Burden in Healthcare","author":"Wang","year":"2024"},{"key":"2026012716172086500_ocaf180-B8","doi-asserted-by":"publisher","first-page":"57","DOI":"10.1038\/s41746-021-00432-5","article-title":"The digital scribe in clinical practice: a scoping review and research agenda","volume":"4","author":"van Buchem","year":"2021","journal-title":"NPJ Digit Med"},{"key":"2026012716172086500_ocaf180-B9","doi-asserted-by":"publisher","first-page":"1121","DOI":"10.1055\/a-2597-2017","article-title":"Clinical implementation of artificial intelligence scribes in healthcare: a systematic review","volume":"16","author":"Hassan","year":"2025","journal-title":"Appl Clin Inform"},{"key":"2026012716172086500_ocaf180-B10","doi-asserted-by":"publisher","DOI":"10.1056\/CAT.25.0040","article-title":"Ambient artificial intelligence scribes: learnings after 1 year and over 2.5 million uses","volume":"6","author":"Tierney","year":"2025","journal-title":"NEJM Catal"},{"key":"2026012716172086500_ocaf180-B11","doi-asserted-by":"publisher","DOI":"10.1056\/CAT.23.0404","article-title":"Ambient artificial intelligence scribes to alleviate the burden of clinical documentation","volume":"5","author":"Tierney","year":"2024","journal-title":"NEJM Catal"},{"key":"2026012716172086500_ocaf180-B12","doi-asserted-by":"publisher","first-page":"100157","DOI":"10.1016\/j.fhj.2024.100157","article-title":"Use of an ambient artificial intelligence tool to improve quality of clinical documentation","volume":"11","author":"Balloch","year":"2024","journal-title":"Future Healthc J"},{"key":"2026012716172086500_ocaf180-B13","doi-asserted-by":"publisher","first-page":"614","DOI":"10.1055\/a-2559-5791","article-title":"The STREAMLINE Pilot\u2014study on time reduction and efficiency in AI-mediated logging for improved note-taking experience","volume":"16","author":"Kakaday","year":"2025","journal-title":"Appl Clin Inform"},{"key":"2026012716172086500_ocaf180-B14","doi-asserted-by":"publisher","first-page":"381","DOI":"10.1093\/jamia\/ocae304","article-title":"Ambient artificial intelligence scribes: utilization and impact on documentation time","volume":"32","author":"Ma","year":"2025","journal-title":"J Am Med Inform Assoc"},{"key":"2026012716172086500_ocaf180-B15","doi-asserted-by":"publisher","first-page":"149","DOI":"10.1016\/j.jdin.2024.02.009","article-title":"Artificial intelligence-driven digital scribes in clinical documentation: pilot study assessing the impact on dermatologist workflow and patient encounters","volume":"15","author":"Cao","year":"2024","journal-title":"JAAD Int"},{"key":"2026012716172086500_ocaf180-B16","doi-asserted-by":"publisher","first-page":"975","DOI":"10.1093\/jamia\/ocae022","article-title":"The impact of nuance DAX ambient listening AI documentation: a cohort study","volume":"31","author":"Haberle","year":"2024","journal-title":"J Am Med Inform Assoc"},{"key":"2026012716172086500_ocaf180-B17","doi-asserted-by":"publisher","first-page":"2625","DOI":"10.1007\/s11606-024-08924-2","article-title":"Impact of an artificial intelligence-based solution on clinicians\u2019 clinical documentation experience: initial findings using ambient listening technology","volume":"39","author":"Galloway","year":"2024","journal-title":"J Gen Intern Med"},{"key":"2026012716172086500_ocaf180-B18","doi-asserted-by":"publisher","first-page":"375","DOI":"10.1093\/jamia\/ocae295","article-title":"Ambient artificial intelligence scribes: physician burnout and perspectives on usability and documentation burden","volume":"32","author":"Shah","year":"2025","journal-title":"J Am Med Inform Assoc"},{"key":"2026012716172086500_ocaf180-B19","doi-asserted-by":"publisher","first-page":"e258614","DOI":"10.1001\/jamanetworkopen.2025.8614","article-title":"Evaluation of an ambient artificial intelligence documentation platform for clinicians","volume":"8","author":"Stults","year":"2025","journal-title":"JAMA Netw Open"},{"key":"2026012716172086500_ocaf180-B20","doi-asserted-by":"publisher","first-page":"e251904","DOI":"10.1001\/jamanetworkopen.2025.1904","article-title":"Physician perspectives on ambient AI scribes","volume":"8","author":"Shah","year":"2025","journal-title":"JAMA Netw Open"},{"key":"2026012716172086500_ocaf180-B21","doi-asserted-by":"publisher","first-page":"660","DOI":"10.1055\/a-2337-4739","article-title":"Effect of ambient voice technology, natural language processing, and artificial intelligence on the patient\u2013physician relationship","volume":"15","author":"Owens","year":"2024","journal-title":"Appl Clin Inform"},{"key":"2026012716172086500_ocaf180-B22","author":"Abridge","year":"."},{"key":"2026012716172086500_ocaf180-B23","author":"Microsoft","year":"."},{"key":"2026012716172086500_ocaf180-B24","doi-asserted-by":"publisher","first-page":"591","DOI":"10.2307\/2333709","article-title":"An analysis of variance test for normality (complete samples)","volume":"52","author":"Shapiro","year":"1965","journal-title":"Biometrika"},{"key":"2026012716172086500_ocaf180-B25","author":"KLAS Arch Collaborative","year":"."},{"key":"2026012716172086500_ocaf180-B26","doi-asserted-by":"publisher","DOI":"10.1002\/0470011815.b2a15177","volume-title":"Encyclopedia of Biostatistics","author":"Woolson","year":"2005","edition":"1st ed."},{"key":"2026012716172086500_ocaf180-B27","doi-asserted-by":"publisher","first-page":"453","DOI":"10.1146\/annurev-publhealth-040617-013507","article-title":"Designing difference in difference studies: best practices for public health policy research","volume":"39","author":"Wing","year":"2018","journal-title":"Annu Rev Public Health"},{"key":"2026012716172086500_ocaf180-B28","doi-asserted-by":"publisher","first-page":"297","DOI":"10.1080\/17439760.2016.1262613","article-title":"Thematic analysis","volume":"12","author":"Clarke","year":"2017","journal-title":"J Posit Psychol"},{"key":"2026012716172086500_ocaf180-B29","doi-asserted-by":"publisher","first-page":"337","DOI":"10.3390\/bioengineering11040337","article-title":"The role of AI in hospitals and clinics: transforming healthcare in the 21st century","volume":"11","author":"Maleki Varnosfaderani","year":"2024","journal-title":"Bioeng Basel Switz"},{"key":"2026012716172086500_ocaf180-B30","doi-asserted-by":"publisher","first-page":"653","DOI":"10.3233\/SHTI250921","article-title":"Ambient listening in clinical practice: evaluating EPIC signal data before and after implementation and its impact on physician workload","volume":"329","author":"Guo","year":"2025","journal-title":"Stud Health Technol Inform"},{"key":"2026012716172086500_ocaf180-B31","doi-asserted-by":"publisher","first-page":"923","DOI":"10.1093\/jamia\/ocaa229","article-title":"Physicians\u2019 electronic inbox work patterns and factors associated with high inbox work duration","volume":"28","author":"Akbar","year":"2021","journal-title":"J Am Med Inform Assoc"},{"key":"2026012716172086500_ocaf180-B32","doi-asserted-by":"publisher","first-page":"e243201","DOI":"10.1001\/jamanetworkopen.2024.3201","article-title":"Artificial intelligence\u2013generated draft replies to patient inbox messages","volume":"7","author":"Garcia","year":"2024","journal-title":"JAMA Netw Open"},{"key":"2026012716172086500_ocaf180-B33","doi-asserted-by":"publisher","first-page":"e2460642","DOI":"10.1001\/jamanetworkopen.2024.60642","article-title":"Ambient listening\u2014legal and ethical issues","volume":"8","author":"Cohen","year":"2025","journal-title":"JAMA Netw Open"},{"key":"2026012716172086500_ocaf180-B34","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1007\/s43681-021-00075-y","article-title":"The ethical AI\u2014paradox: why better technology needs more and not less human responsibility","volume":"2","author":"De Cremer","year":"2022","journal-title":"AI Ethics"},{"key":"2026012716172086500_ocaf180-B35","doi-asserted-by":"publisher","first-page":"e62443","DOI":"10.7759\/cureus.62443","article-title":"Ethical considerations in the use of artificial intelligence and machine learning in health care: a comprehensive review","volume":"16","author":"Harishbhai Tilala","year":"2024","journal-title":"Cureus"},{"key":"2026012716172086500_ocaf180-B36","doi-asserted-by":"publisher","first-page":"401","DOI":"10.1017\/S0963180108080535","article-title":"Ethical challenges of telemedicine and telehealth","volume":"17","author":"Kaplan","year":"2008","journal-title":"Camb Q Healthc Ethics"},{"key":"2026012716172086500_ocaf180-B37","doi-asserted-by":"publisher","first-page":"e115","DOI":"10.1016\/S2589-7500(20)30275-2","article-title":"Ethical issues in using ambient intelligence in health-care settings","volume":"3","author":"Martinez-Martin","year":"2021","journal-title":"Lancet Digit Health"},{"key":"2026012716172086500_ocaf180-B38","doi-asserted-by":"publisher","first-page":"e26297","DOI":"10.1016\/j.heliyon.2024.e26297","article-title":"Ethical and regulatory challenges of AI technologies in healthcare: a narrative review","volume":"10","author":"Mennella","year":"2024","journal-title":"Heliyon"}],"container-title":["Journal of the American Medical Informatics Association"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/jamia\/article-pdf\/33\/2\/273\/64718312\/ocaf180.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/jamia\/article-pdf\/33\/2\/273\/64718312\/ocaf180.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,27]],"date-time":"2026-01-27T21:17:31Z","timestamp":1769548651000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/jamia\/article\/33\/2\/273\/8287711"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10,16]]},"references-count":38,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2025,10,16]]},"published-print":{"date-parts":[[2026,2,1]]}},"URL":"https:\/\/doi.org\/10.1093\/jamia\/ocaf180","relation":{},"ISSN":["1067-5027","1527-974X"],"issn-type":[{"value":"1067-5027","type":"print"},{"value":"1527-974X","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2026,2]]},"published":{"date-parts":[[2025,10,16]]}}}