The impact of using AI-powered voice-to-text technology for clinical documentation on quality of care in primary care and outpatient settings: a systematic review

Abstract

BACKGROUND: AI-powered Voice-to-text Technology (AIVT) offers a promising solution to reduce clinicians' documentation burden during consultations, allowing more focus on patient interaction. This systematic review assesses AIVT's impact on care quality in primary care and outpatient settings, focusing on seven components: effectiveness, efficiency, safety, patient-centredness, timeliness, equity, and integration. METHODS: A systematic search of five databases (Medline, Embase, Global Health, CINHAL, Scopus) was conducted for studies published up to September 20, 2024. Studies were included if they assessed the use of AIVT for medical documentation in primary care or outpatient settings, compared to manual or non-AI documentation methods, and reported outcomes relevant to the seven quality components. A narrative synthesis was conducted; meta-analysis was unfeasible due to study heterogeneity. FINDINGS: Of 1924 papers, nine studies were included (n = 524 healthcare professionals, n = 616 patients, 1069 consultations). Most (n = 7) were from the USA, with others in Bangladesh and the Philippines. All studies assessing effectiveness, patient-centredness, and efficiency (n = 9, 6, and 5, respectively) reported improvements, including faster documentation, reduced administrative burden, and enhanced patient-provider interaction. Safety findings were inconclusive; three of six studies raised concerns. Four studies highlighted seamless AIVT integration with Electronic Health Records, improving service timeliness. Three studies identified equity issues, referring to limited diversity and controlled simulation settings. INTERPRETATION: AIVT tools enhance documentation efficiency and patient-centred care, but concerns over transcription errors and generalisability warrant further testing in large-scale, diverse real-world settings. FUNDING: This study was supported by the National Institute for Health and Care Research (NIHR) North-West London Patient Safety Research Collaboration (NIHR NWL PSRC, Ref. NIHR204292), with infrastructure support from the NIHR Imperial Biomedical Research Centre.

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