Cited by 162Electronic Health Records SystemsArtificial Intelligence in Healthcare and EducationNursing Diagnosis and Documentation

The DOI matches its Crossref record; 47 of the 47 references it cites were found in a registry or an index; none of the 39 sources its claims cite is checked for support yet.

Challenges of developing a digital scribe to reduce clinical documentation burden

Open access

Abstract

Clinicians spend a large amount of time on clinical documentation of patient encounters, often impacting quality of care and clinician satisfaction, and causing physician burnout. Advances in artificial intelligence (AI) and machine learning (ML) open the possibility of automating clinical documentation with digital scribes, using speech recognition to eliminate manual documentation by clinicians or medical scribes. However, developing a digital scribe is fraught with problems due to the complex nature of clinical environments and clinical conversations. This paper identifies and discusses major challenges associated with developing automated speech-based documentation in clinical settings: recording high-quality audio, converting audio to transcripts using speech recognition, inducing topic structure from conversation data, extracting medical concepts, generating clinically meaningful summaries of conversations, and obtaining clinical data for AI and ML algorithms.

Overview

AI snapshot

Written from the paper’s full text.

TL;DR

This perspective paper identifies and discusses the major technical and data-related challenges to developing a "digital scribe" that automatically documents clinician–patient conversations using speech recognition and NLP. It argues that progress is best achieved by solving each pipeline challenge individually rather than pursuing a holistic solution.

Key findings

The paper is a challenge-identification piece rather than an empirical study, so it reports no primary outcomes of its own; its claims are framed around cited evidence and the authors' analysis.

  • A cited study found word error rates of 35% or higher for simulated medical conversations using commercial ASR engines, and the authors note these were best-case results from controlled, near-ideal acoustic conditions.
  • The authors enumerate challenges across five pipeline stages: audio recording/ASR, topic structuring, medical concept extraction, summarization, and data collection (summarized in Table 1).
  • Existing tools such as MetaMap and cTAKES map text to UMLS concepts but were designed for written text; with default settings, "I am feeling fine" maps "I" to "blood group antibody I," "feeling" to "emotions," and "fine" to "qualitative concept" or "legal fine."
  • One cited effort developed its own corpus of 3000 conversations annotated by medical scribes because no public corpus was available, described as a costly investment.

Methods

This is a conceptual/perspective review, not an empirical study; it identifies and discusses challenges via narrative synthesis of prior literature and a summary table (Table 1) mapping tasks to challenges. No dataset, sample, or statistical analysis is reported. The paper draws on cited prior work (e.g., ASR engine comparisons, diarization research, UMLS mapping tools) to illustrate each challenge.

Limitations

The paper does not present a formal limitations section; as a perspective piece it offers no empirical validation of the challenges it describes. The text makes evident that the challenges are largely illustrated through cited studies and hypothetical examples rather than systematic evidence, and the authors note that evaluation of digital scribes in clinical environments (quality of care, patient satisfaction, clinician efficiency, documentation time, organizational dynamics) remains to be conducted. The authors also state that collecting sufficient data at the scale needed for AI/ML could alone take years, and that the closed data-sharing environment slows progress.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1038/s41746-019-0190-1

Cites

47 of 47 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Figures

Fig. 1 Digital scribe pipeline. A digital scribe acquires the audio of the clinician–patient conversation, performs automatic speech recognition to generate the conversation transcript, extracts information from the transcript, summarizes the information, and generates medical notes in the electronic health record (EHR) associated with the clinician–patient encounter. Speech recognition, information extraction, and summarization rely on AI and ML models that require large volumes of data for training and evaluation.
Fig. 1 Digital scribe pipeline. A digital scribe acquires the audio of the clinician–patient conversation, performs automatic speech recognition to generate the conversation transcript, extracts information from the transcript, summarizes the information, and generates medical notes in the electronic health record (EHR) associated with the clinician–patient encounter. Speech recognition, information extraction, and summarization rely on AI and ML models that require large volumes of data for training and evaluation.CC BY · PubMed Central
Fig. 2 Three examples of transitions of clinician–patient conversations lacking clear boundaries and structure. Medical conversation fragments are on the left and the respective topics are on the right. Medical conversations do not appear to follow a classic linear model of defined information seeking activities. The nonlinearity of activities requires digital scribes to link disparate information fragments, merge their content, and abstract coherent information summaries.
Fig. 2 Three examples of transitions of clinician–patient conversations lacking clear boundaries and structure. Medical conversation fragments are on the left and the respective topics are on the right. Medical conversations do not appear to follow a classic linear model of defined information seeking activities. The nonlinearity of activities requires digital scribes to link disparate information fragments, merge their content, and abstract coherent information summaries.CC BY · PubMed Central

Verification

Claims the paper makes

22 Not checked yet · 16 Own interpretation · 2 No basis given

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Show all 17 claims

  • Probably not a substantial claim. 17
  • It may state two separate claims as one. 11
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Citations

Cites

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Metadata

Authors
Quiroz, J. C., Laranjo, L., Kocaballi, A. B., Berkovsky, S., Rezazadegan, D., & Coiera, E.
Affiliations
Macquarie University (AU)
Corresponding author
Quiroz, Juan C.
Venue
npj Digital Medicine
Published
2019-11-22
Volume
2
Issue
1
Pages
114-114
ISSN
2398-6352 (ISSN-L)
OpenAlex
W2989925457
Cited by
162
References
47
Citations by year
2026: 26 · 2025: 37 · 2024: 26 · 2023: 24 · 2022: 18 · 2021: 16 · 2020: 12 · 2019: 1
FWCI
2.21
Type
journal article
Language
en
Open access
Locations
  • npj Digital Medicine (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
  • UTS ePRESS (University of Technology Sydney) (submittedVersion, other-oa)
  • Swinburne figshare (Swinburne University of Technology) (submittedVersion, cc-by)
Funders
Department of Health | National Health and Medical Research Council (APP1134919)
Topics
  • Health Sciences › Health Professions › Health Information Management › Electronic Health Records Systems
  • Health Sciences › Medicine › Health Informatics › Artificial Intelligence in Healthcare and Education
  • Health Sciences › Nursing › Research and Theory › Nursing Diagnosis and Documentation
Keywords
clinical documentation burden, speech recognition, medical scribes, speech-to-text, topic modeling, medical concept extraction, physician burnout

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

A language model drew the claims from the paper on 2026-10-06, under version 3 of the claim definition (model deepseek-v4.1-flash, prompt extract-v3).

A second model labelled each claim on 2026-10-06 (model jev-1.13-20260917, definition revision gold-guideline-v0.2).

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

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