{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,11]],"date-time":"2026-08-11T12:39:03Z","timestamp":1786451943174,"version":"build-2736575974"},"reference-count":28,"publisher":"Oxford University Press (OUP)","issue":"4","license":[{"start":{"date-parts":[[2026,8,11]],"date-time":"2026-08-11T00:00:00Z","timestamp":1786406400000},"content-version":"vor","delay-in-days":35,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Center for Transformation of Internal Medicine","award":["# 238054"],"award-info":[{"award-number":["# 238054"]}]},{"DOI":"10.13039\/100000092","name":"National Library of Medicine","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000092","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["1R34NS140007-1"],"award-info":[{"award-number":["1R34NS140007-1"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,7,7]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To evaluate the comparative effectiveness of ambient documentation tools (ADTs) with distinct architectures (Tablet-Based Virtual Human\u2013Assisted Ambient [Tool A], EHR-Integrated Ambient [Tool B], and Standalone Ambient [Tool C]) on provider efficiency, documentation burden, and productivity in primary care.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and Methods<\/jats:title>\n                    <jats:p>We conducted a real-world comparative-effectiveness study of 163 primary care providers in a large integrated health system (January 2024-June 2025), analyzing 59\u00a0130 provider-days. Providers who did not adopt an ADT (n\u2009=\u200913) were excluded from comparative models. Exposure groups included Tool A (n\u2009=\u200965), Tool B (n\u2009=\u200968), and Tool C (n\u2009=\u200917). Primary outcomes were pajama time (hours of after-hours EHR activity per provider-day), visit closure within 2 days (proportion of encounters signed within 48 hours), proportion of manual note composition, and a composite opportunity score reflecting EHR efficiency (scaled 0-1). Outcomes were derived from daily provider-level EHR logs. Analyses used intention-to-treat and per-protocol frameworks with provider-clustered SEs and month fixed effects.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Compared with Tool B, Tool A was associated with increased pajama time (+0.022 hours of after-hours EHR activity per provider-day), higher manual note composition (+0.046 absolute proportion), lower timely visit closure (\u22120.120 [95% CI, \u22120.126,\u22120.115]), and reduced opportunity scores (\u22120.035[\u22120.044,\u22120.027]). Tool C reduced after-hours work versus Tool B (\u22120.007 hours per provider-day) and relative to both the reference tool and pre-exposure baseline levels (\u22120.055 hours per provider-day), but was associated with lower timely visit closure (\u22120.028[\u22120.036, \u22120.020]); opportunity scores were not significantly changed (\u22120.007[\u22120.018, 0.003]). Effects for Tool C correspond to approximately 30 fewer annual after-hours hours per provider.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Tool choice materially shapes real-world outcomes, and tool-specific comparative evaluation is essential to guide evidence-based procurement and deployment decisions.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/jamiaopen\/ooag155","type":"journal-article","created":{"date-parts":[[2026,7,27]],"date-time":"2026-07-27T13:42:49Z","timestamp":1785159769000},"source":"Crossref","is-referenced-by-count":0,"title":["Comparative effectiveness of ambient documentation tools in primary care tool-specific variations in efficiency, documentation burden, and productivity over time"],"prefix":"10.1093","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1191-1315","authenticated-orcid":false,"given":"Lidia","family":"Moura","sequence":"first","affiliation":[{"name":"Department of Neurology, Massachusetts General Hospital , Boston, MA 02114,","place":["United States"]},{"name":"Center for Value-Based Healthcare and Sciences, Massachusetts General Hospital , Boston, MA 02114,","place":["United States"]},{"name":"Department of Epidemiology, Harvard T. 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Chan School of Public Health , Boston, MA 02115,","place":["United States"]},{"name":"Harvard Medical School , Boston, MA 02115,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rebecca G","family":"Mishuris","sequence":"additional","affiliation":[{"name":"Harvard Medical School , Boston, MA 02115,","place":["United States"]},{"name":"Division of General Internal Medicine, Mass General Brigham , Boston, MA 02115,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joshua P","family":"Metlay","sequence":"additional","affiliation":[{"name":"Harvard Medical School , Boston, MA 02115,","place":["United States"]},{"name":"Division of General Internal Medicine, Mass General Brigham , Boston, MA 02115,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mamoon","family":"Habib","sequence":"additional","affiliation":[{"name":"Department of Neurology, Massachusetts General Hospital , Boston, MA 02114,","place":["United States"]},{"name":"Center for Value-Based Healthcare and Sciences, Massachusetts General Hospital , Boston, MA 02114,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jacqueline G","family":"You","sequence":"additional","affiliation":[{"name":"Harvard Medical School , Boston, MA 02115,","place":["United States"]},{"name":"Division of General Internal Medicine, Mass General Brigham , Boston, MA 02115,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katherine L","family":"Gallagher","sequence":"additional","affiliation":[{"name":"Division of General Internal Medicine, Mass General Brigham , Boston, MA 02115,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4405-0726","authenticated-orcid":false,"given":"Suzanne","family":"Brodney","sequence":"additional","affiliation":[{"name":"Division of General Internal Medicine, Mass General Brigham , Boston, MA 02115,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Meghan L","family":"Rieu-Werden","sequence":"additional","affiliation":[{"name":"Division of General Internal Medicine, Mass General Brigham , Boston, MA 02115,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer S","family":"Haas","sequence":"additional","affiliation":[{"name":"Harvard Medical School , Boston, MA 02115,","place":["United States"]},{"name":"Division of General Internal Medicine, Mass General Brigham , Boston, MA 02115,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,8,11]]},"reference":[{"key":"2026081106570861800_ooag155-B1","doi-asserted-by":"publisher","first-page":"1567","DOI":"10.1007\/s11606-024-08633-w","article-title":"Associations of primary care provider burnout 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