Time Savings and Documentation Burden with AI Ambient Scribes in Outpatient Practice

Executive Summary

Detailed Research

Methodology

Most available evidence on AI ambient scribes comes from quasi‑experimental cohort and pre–post studies in large US health systems rather than randomized controlled trials. Typical designs compare EHR metadata (minutes of documentation per encounter, after‑hours time, documentation completion within 24 hours) in clinicians who adopt an ambient tool versus matched non‑adopters over a 4–9 month period, often supplemented by engagement or burnout surveys. One large 99‑provider study of Nuance DAX used mixed‑effects regression to compare pre‑implementation and post‑implementation metrics against peer‑matched controls, with baseline documentation time around 5–6 minutes per encounter.

Ambient listening systems (for example, DAX and Abridge) usually capture the entire visit conversation, generate a draft note via speech recognition and NLP, and then either route it for human quality review or deliver it directly back into the EHR for clinician sign‑off. Outcomes relevant to time savings include documentation minutes per encounter, after‑hours EHR use, clinic‑day time in the EHR, and self‑reported weekly hours spent charting, but these are not always measured consistently and often rely on vendor‑specific analytics, limiting cross‑study comparability.

Key Studies

Haberle et al., 2024 (Nuance DAX Cohort Study, JAMIA)

• Design: Outpatient, multi‑specialty cohort of 99 providers with 99 matched controls over approximately 5 months
• Sample: 99 providers with 99 matched controls
• Findings: Baseline documentation time in the EHR was 5.3 minutes per patient for DAX users versus 5.5 minutes for controls; at study end, DAX users decreased to 4.54 minutes while controls were essentially unchanged at 5.35 minutes (time saved ≈0.76 minutes per encounter, P<0.001). After‑hours EHR time increased by about 4.7 percentage points among DAX users while decreasing slightly among controls.
• Clinical Relevance: Large-scale validation showing some documentation work may shift outside normal clinic hours

Ambient Listening Implementation Study with Abridge, 2024–2025 (Large Primary Care System)

• Design: Primary care deployment tracking adoption from 0% to nearly 60% of eligible physicians over ~1 year
• Sample: Large primary care system using Epic Signal to track documentation time
• Findings: Early reports describe reductions in documentation burden, mental overload, and improved perceived ability to complete notes on time
• Clinical Relevance: Qualitative and workflow data support a pattern of modest EHR time reduction without degradation in note completeness

Nuance DAX Ambient Clinical Intelligence Rollouts (Multi‑site Evaluations)

• Design: Multi‑institution program evaluations
• Sample: Various health systems
• Findings: Physicians saving approximately 2.5 hours of documentation per week, largely by decreasing note writing after clinic. Self‑reported time savings equate to 30–40 minutes per physician workday
• Clinical Relevance: Clinicians cite the ability to leave on time and reduced cognitive load as key benefits

Ambient Documentation and Burnout in a Large Academic Health System, 2025

• Design: Survey‑based study across an academic system implementing ambient documentation tools
• Sample: Academic health system physicians
• Findings: 21.2% absolute reduction in burnout prevalence among users and improved perceived documentation efficiency at 84 days
• Clinical Relevance: Even modest EHR time reductions may translate into meaningful improvements in well‑being and intention to stay in practice

Clinical Implications

For osteopathic family physicians and internists seeing 18–24 patients per day, a reduction of 0.7–1.0 minutes of documentation per encounter translates into approximately 15–25 minutes per clinic session, or roughly 1–2 hours per week when accounting for template‑friendly visits where ambient scribes are less useful. When combined with improved note turnaround and decreased cognitive load, this can create space for OMT, longer face‑to‑face discussion, and more thorough structural examinations without increasing session length.

However, the Intermountain DAX cohort demonstrates that if the workflow is built around post‑visit review of delayed draft notes, ambient scribes may paradoxically increase after‑hours EHR use even as in‑clinic documentation time falls. Effective deployment therefore requires intentionally shifting review and editing into the visit or immediate post‑visit block, reconsidering template strategies, and aligning scheduling templates and staffing to avoid simply relocating documentation work to "pajama time."

Limitations & Research Gaps

Current evidence is predominantly observational, with self‑selection into ambient scribe use and relatively short follow‑up windows, which introduces confounding related to early‑adopter behavior and learning curves. Many reports rely on vendor‑specific analytics or self‑reported time savings rather than independent time‑motion studies, and very few include rigorous cost‑effectiveness analyses or stratified results by specialty and visit type.

Completed RCTs specifically quantifying time savings, burnout reduction, and patient‑reported outcomes are not yet available, and almost no data focus on osteopathic physicians or OMT‑heavy practices. Key unanswered questions include which physician characteristics predict the greatest time benefit, how ambient scribes interact with existing documentation training and team‑based care models, and whether long‑term use produces durable gains or plateauing effects over multiple years.

Osteopathic Perspective

From an osteopathic standpoint, reducing the clerical load of history documentation can reinforce the body–mind–spirit unity principle by allowing physicians to stay physically present with the patient instead of focusing on the keyboard, thereby supporting a more holistic, relational encounter. A modest per‑encounter time savings plus decreased cognitive load may enable more consistent incorporation of structural examination and OMT into routine visits, particularly when schedule templates explicitly convert freed time into hands‑on care rather than additional patients.

The principle that structure and function are reciprocally interrelated extends beyond anatomy to practice design; poorly configured ambient scribe workflows that shift documentation to after hours can undermine physician health and resilience despite marginal note‑time savings. Finally, the osteopathic tenet that the body has self‑regulatory mechanisms suggests that clinicians and systems should view AI scribes as augmenting, not replacing, clinician judgment—using the technology to capture the narrative while maintaining physician ownership of assessment, plan, and nuanced osteopathic reasoning in the record.