From a Patient Perspective, Governance Is Crucial for Ambient Listening Tools
HEALTHTECH: What are some of the risks associated with a lack of governance?
PRATT: Data security is a big part of this. When facilities are collecting data without governance in place, what is collected, how it’s collected and who has access become critical issues. There is now a recorded patient voice at a time when hacking and cybercrime are occurring frequently, and several hospitals have already had data stolen. How are we going to protect patients’ data, and who is responsible?
CHARLES: The corollary of security is privacy. Patients share things with clinicians that they don’t share with anybody else — information that is private and potentially stigmatizing. There’s already a security risk related to third-party vendors managing audio recordings and transcription, but even internal quality assurance teams may listen to recordings to make sure they’re accurate. That’s not something patients would necessarily expect, that people outside the care team would listen to the recording, so that feels like a violation of privacy.
Patient access also comes up. Do patients have a right to their recordings and transcriptions? Organizations are determining how long to save recordings. Could attorneys access them in a malpractice lawsuit? Could law enforcement access them under a court order? These are huge issues that arise from the nature of the recording itself.
Another risk is AI automation complacency. We know that clinicians are rushed and often tired, and there is a risk that they could accept a transcription without editing it enough and that incorrect information could become part of the patient’s medical record.
CRUMBLY: Particularly in the African-American community, researchers and advocates are looking at the European Union model to ask what rights people have to their data. Tuskegee University alums such as James Felton Keith have written about advocating for not only patients’ rights but also broader data rights for Americans and people around the globe. That’s why governance is so important, particularly in the U.S., as AI is growing so quickly.
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HEALTHTECH: What best practices for patient consent and notification do you recommend?
CHARLES: The basic premise is that patients should be treated as autonomous individuals who have a choice about how and what to communicate and the right to receive information needed to make an informed decision. Patients need clear notice, meaningful choice and the opportunity to receive written information before recording begins.
PRATT: Ambient AI is a layered process, and consent practices should recognize that. When a patient says, “I want care,” it may not mean, “I also want you to record information or use ambient AI for other purposes.” A best practice is to separate those aspects — patients should not feel that one requires the other. Plain language is critical. Saying, “All of your information is being transcribed by AI” doesn’t tell patients anything. Does recording start when they walk in the door? When the physician comes in? What about “smart” rooms with recording capabilities built in? Is it still recording when the physician leaves? Organizations that are doing this well are creating a layered, continual process with explicit information about what’s being recorded, how and what patients’ rights are regarding access, and corrections.
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