Consumer-to-Clinical Language Shifts in Ambient AI Draft Notes and Clinician-Finalized Documentation: A Multi-level Analysis
Authors: Ha Na Cho, Yawen Guo, Sairam Sutari, Emilie Chow, Steven Tam, Danielle Perret, Deepti Pandita, Kai Zheng
Organizations: Department of Informatics, University of California, Irvine, Irvine, CA, USA · Institute for Clinical and Translational Science, University of California, Irvine, Irvine, CA, USA · Department of Medicine, University of California, Irvine, Irvine, CA, USA · Department of Physical Medicine & Rehabilitation, University of California, Irvine, Irvine, CA, USA
Ambient AI generates draft clinical notes from patient-clinician conversations, often using lay or consumer-oriented phrasing to support patient understanding instead of standardized clinical terminology. How clinicians revise these drafts for professional documentation conventions remains unclear. We quantified clinician editing for consumer-to- clinical normalization using a dictionary-confirmed transformation framework. We analyzed 71,173 AI-draft and finalized-note section pairs from 34,726 encounters. Confirmed transformations were defined as replacing a consumer expression with its dictionary-mapped clinical equivalent in the same section. Editing significantly reduced terminology density across all sections (p < 0.001). The Assessment and Plan accounted for the largest transformation volume (59.3%). Our analysis identified 7,576 transformation events across 4,114 note sections (5.8%), representing 1.2% consumer-term deletions. Transformation intensity varied across individual clinicians (p < 0.001). Overall, clinician post-editing demonstrates consistent shifts from conversational phrasing toward standardized, section- appropriate clinical terminology, supporting section-aware ambient AI design.
Ambient artificial intelligence (AI) documentation tools are increasingly deployed to reduce clinician documentation burden, but their implications for biased language in clinical notes remain unclear. We conducted a large-scale comparison analysis of AI drafts and corresponding clinician finalized notes to quantify stigmatizing language changes pre- and post-editing. Using a lexicon-based natural language processing (NLP) pipeline, we measured (1) the prevalence of stigmatizing language in AI drafts, (2) the prevalence and term composition in final notes, and (3) the frequency of removal or introduction of stigmatizing terms. Across 66,297 paired note sections, 21.4% of AI draft sections contained at least one stigmatizing language mention, rising to 24.0% in clinician finalized versions. Introductions occurred more often than removals, suggesting clinician editing can be a net source of stigmatizing language entering the EHR with using Ambient AI.
Yiliang Zhou, Yawen Guo, Sairam Sutari +9
Department of Informatics, University of California, Irvine, Irvine, CA, USA · Institute for Clinical and Translational Science, University of California, Irvine, Irvine, CA, USA · Department of Radiological Sciences, University of California, Irvine, Irvine, CA, USA +3
Ambient AI documentation systems generate clinical note drafts that clinicians frequently revise before signing off into electronic health records, yet how these edits alter hedging language remains unclear. We conducted paired analysis of clinician-edited portions of ambient AI drafts and final notes to examine (1) whether these edits change the prevalence of hedging language, (2) whether these edits exhibit a systematic shift toward greater certainty or uncertainty, and (3) whether these changes in hedging prevalence and directionality differ by ambient AI vendors and clinical specialties. Among 62,811 paired note sections, hedging terms were more often introduced into previously non-hedged text than removed from previously hedged text, and post-edit text contained more hedging mentions than pre-edit text. Directionality analyses showed a significant overall tendency toward greater uncertainty in hedging-related replacement edits. Vendor and specialty analyses revealed substantial heterogeneity in hedging prevalence, pre-to-post changes in hedging mentions, and directionality.
Yiliang Zhou, Yawen Guo, Di Hu +6
Department of Informatics, University of California, Irvine, Irvine, CA, USA · Institute for Clinical and Translational Science, University of California, Irvine, Irvine, CA, USA · Department of Medicine, University of California, Irvine, Irvine, CA, USA +1
Ambient AI is increasingly adopted in healthcare to automatically generate clinical notes from patient-clinician conversations, with the potential to substantially reduce clinician documentation burden. However, generated notes may omit clinically relevant information discussed during the encounter, creating information gaps that can affect downstream care. Knowledge graphs (KGs) constructed from encounter transcripts can provide a structured representation of what was discussed and enable systematic identification of missing information from generated notes that are critical for patient care. In this study, we introduce Coverage-Directed Revision (CDR), a model-agnostic framework that constructs a KG from the encounter transcript, identifies medical concepts absent from an initially generated note, and directs large language models (LLMs) to restore the missing information without modifying the underlying note-generation system. We evaluate CDR on two datasets: 1) Pitt-Bench, a local dataset comprising rehabilitation sessions, and 2) ACI-Bench, a public dataset for benchmarking clinical note generation. We tested four underlying LLMs widely used in ambient AI systems. The results show that CDR consistently improves content recall across all evaluated conditions. Our study provides a practical approach for improving the completeness of ambient AI-generated clinical documentation.
Jakir Hossain, Yi-Fei Zhao, Hongjian Wang +9
Department of Biomedical Informatics, University of Pittsburgh, Pittsburgh, PA · Stern School of Business, New York University, New York, NY · Department of Occupational Therapy, University of Pittsburgh, Pittsburgh, PA +3