A Randomized Controlled Trial of Ambient Artificial Intelligence Scribe Technologies

The primary outcome measure is the change in provider mean time in notes per note in the second month of the trial from the providers baseline mean time in notes per note for the six months prior to enrollment. This change will be computed on the natural log scale. No patient level information will be collected for this outcome measure.

The Mini Z 2.0 Survey is a validated 10-item instrument designed to measure key factors influencing workplace satisfaction and burnout among healthcare professionals. Each item is scored on a Likert scale (1-5), with higher scores generally indicating more positive outcomes - greater job satisfaction, sufficiency of time for electronic medical record documentation, and lower levels of stress. For negatively framed items (e.g., stress due to the job or frustration with the electronic medical record), higher scores indicate lower levels of dissatisfaction. The total score ranges from 10 to 50, with scores ≥40 representing a joyful workplace. No patient level information will be collected for this outcome measure.

Provider task load adapted from the NASA Task Load Index (TLX), a validated tool for assessing perceived workload across six sub-scales: mental demand, physical demand, temporal demand, performance, effort, and frustration. For this study, we adapted the TLX to focus on note-writing workload, including four sub-scales (mental demand, temporal demand, physical demand, and effort) as done previously. Each sub-scale is rated from 0 (low task load) to 100 (high task load) and summed together for a total score scale of 0 (low task load) to 400 (high task load), lower is better. No patient level information will be collected for this outcome measure.

The Professional Fulfillment Index (PFI) is a validated 16-item instrument that uses a 5-point Likert scale (0-4) to measure professional fulfillment, work exhaustion, and interpersonal disengagement. For this study, we utilize the 4-item work exhaustion subscale which is a mean of the 4-items within that subscale, where a low score (0) indicates a lower level of exhaustion and a high (4) score indicates greater level of exhaustion. No patient level information will be collected for this outcome measure.

Self-reported satisfaction survey that asks physicians to consider note accuracy, patient safety, equity, and other potential unintended consequences and rate their overall likelihood to recommend use of the tool on a 1-10 scale. Higher scores (10) indicate greater satisfaction and likelihood to recommend, whereas lower scores (1) indicate dissatisfaction and unlikelihood to recommend. Providers are grouped as "Promoters" if they respond 9-10, "Passive" if they respond 7-8, and "Detractors" if they respond with a value less than or equal to 6. This grouping matches commonly accepted "Net Promoter Score" groupings. No patient level information will be collected for this outcome measure.

The study team will use physician-level billing information via RVU to determine their change in productivity from a retrospective baseline 6 months prior to enrollment. No patient level information will be collected for this outcome measure.

We will examine change from a retrospective baseline 6 months prior to enrollment in Signal metrics including pajama time per scheduled day. Using this data will determine how a providers time is utilized in the EHR. No patient level information will be collected for this outcome measure.

We will examine change from a retrospective baseline 6 months prior to enrollment in Signal metrics including time outside scheduled hours per scheduled day. Using this data will determine how a providers time is utilized in the EHR. No patient level information will be collected for this outcome measure.

We will examine change from a retrospective baseline 6 months prior to enrollment in Signal metrics including time spent in the system on unscheduled days where . Using this data will determine how a providers time is utilized in the EHR. No patient level information will be collected for this outcome measure.