BACKGROUND AND SIGNIFICANCE: Ambient digital scribe (ADS) platforms, which combine ambient speech recognition and large language models to generate clinical documentation, are currently undergoing rapid clinical adoption. Early data suggest that ADS utilization may reduce documentation burden and improve provider efficiency; however, the ethical implications of this largely unregulated technology remain relatively unexamined. FINDINGS: In this article, we identify and explore 4 key ethical issues surrounding ADS technology-safety, bias, data ownership, and justice-from a range of stakeholder perspectives. We provide an overview of current international regulatory policies, highlighting the need for standardized evaluation and reporting guidelines. RECOMMENDATIONS: Drawing on established ethical frameworks, we propose actionable recommendations for safe and equitable ADS implementation, including standardized evaluation metrics, regulatory oversight, and safeguards at institutional and end-user levels. CONCLUSION: Ensuring the ethical implementation of ADS technology is essential for actualizing its potential benefits while upholding foundational principles of safety, equity, and transparency in clinical practice.

Artificial intelligence (A.I.) technologies are increasingly deployed across clinical care, yet reimbursement remains a major barrier to sustainable adoption. The Centers for Medicare & Medicaid Services (CMS) currently reimburses A.I.-enabled technologies through a fragmented set of procedural codes, add-on payments, and legacy payment models, none of which were designed to support the complexity or workflow integration of clinical A.I. This article examines how existing CMS reimbursement pathways for A.I. function in practice, identifies structural misalignments that limit adoption, and highlights the risks of continuing to rely on these approaches. We then propose policy-level solutions to modernize A.I. reimbursement, including clearer coverage pathways, value-aligned payment models, and mechanisms to promote equitable adoption across diverse healthcare settings. Aligning reimbursement with clinical value is essential to ensure that A.I. improves care delivery and can be sustainably integrated into routine clinical practice.

Motion processing is a key function for the survival of many organisms and is initially implemented in the primary visual cortex (V1) and the middle temporal area (V5/MT) of the primate visual cortex. Advances in machine learning approaches have led to the development of motion processing neural networks that have elucidated several aspects of this process. However, it remains unclear how adaptation, a canonical function of sensory processing, influences motion processing. In this study, we developed two recurrent neural networks to study motion processing: MotionNet-R, a baseline model, and AdaptNet, a model that employs adaptive mechanisms inspired by biological systems. Both networks were trained on natural image sequences to estimate motion vectors. We found that both networks developed response properties that resembled those of neurons found in areas V1 and MT, e.g., speed tuning, and AdaptNet recapitulated the motion aftereffect phenomenon (i.e., the waterfall illusion). We show that the emergent computational properties that implement the phenomenon in AdaptNet confirm previous theoretical hypotheses. Further, we compared the performance of the two networks and found that AdaptNet processed motion more efficiently, operationalized as reduced activation. While AdaptNet incurred reduced accuracy in response to prolonged constant input, it was both more accurate and sensitive in response to changes in motion input. These results are consistent with theoretical explanations of adaptation as a neural property that supports metabolic efficiency and increased sensitivity to change in the environment. Our findings provide novel insights into the neural mechanisms underlying motion adaptation and highlight the potential advantages of adaptive neural networks in modelling biological processes.

OBJECTIVE: While the use of medical scribes is rapidly increasing, there are not widely accepted standards for their training and duties. Because they use electronic health record systems to support providers, inadequately trained scribes can increase patient safety related risks. This paper describes the development of desired core knowledge, skills, and attitudes (KSAs) for scribes that provide the curricular framework for standardized scribe training. MATERIALS AND METHODS: A research team used a sequential mixed qualitative methods approach. First, a rapid ethnographic study of scribe activities was performed at 5 varied health care organizations in the United States to gather qualitative data about knowledge, skills, and attitudes. The team's analysis generated preliminary KSA related themes, which were further refined during a consensus conference of subject-matter experts. This was followed by a modified Delphi study to finalize the KSA lists. RESULTS: The team identified 90 descriptions of scribe-related KSAs and subsequently refined, categorized, and prioritized them for training development purposes. Three lists were ultimately defined as: (1) Hands-On Learning KSA list with 47 items amenable to simulation training, (2) Didactic KSA list consisting of 32 items appropriate for didactic lecture teaching, and (3) Prerequisite KSA list consisting of 11 items centered around items scribes should learn prior to being hired or soon after being hired. CONCLUSION: We utilized a sequential mixed qualitative methodology to successfully develop lists of core medical scribe KSAs, which can be incorporated into scribe training programs.

OBJECTIVE: Hiring medical scribes to document in the electronic health record (EHR) on behalf of providers could pose patient safety risks because scribes often have no clinical training. The aim of this study was to investigate the effect of scribes on patient safety. This included identification of best practices to assure that scribe use of the EHR is not a patient safety risk. MATERIALS AND METHODS: Using a sociotechnical framework and the Rapid Assessment Process, we conducted ethnographic data gathering at 5 purposively selected sites. Data were analyzed using a grounded inductive/hermeneutic approach. RESULTS: We conducted site visits at 12 clinics and emergency departments within 5 organizations in the US between 2017 and 2019. We did 76 interviews with 81 people and spent 80 person-hours observing scribes working with providers. Interviewees believe and observations indicate that scribes decrease patient safety risks. Analysis of the data yielded 12 themes within a 4-dimension sociotechnical framework. Results about the "technical" dimension indicated that the EHR is not considered overly problematic by either scribes or providers. The "environmental" dimension included the changing scribe industry and need for standards. Within the "personal" dimension, themes included the need for provider diligence and training when using scribes. Finally, the "organizational" dimension highlighted the positive effect scribes have on documentation efficiency, quality, and safety. CONCLUSION: Participants perceived risks related to the EHR can be less with scribes. If healthcare organizations and scribe companies follow best practices and if providers as well as scribes receive training, safety can actually improve.

Since the launch of the clinical informatics subspecialty for physicians in 2013, over 1100 physicians have used the practice and education pathways to become board-certified in clinical informatics. Starting in 2018, only physicians who have completed a 2-year clinical informatics fellowship program accredited by the Accreditation Council on Graduate Medical Education will be eligible to take the board exam. The purpose of this viewpoint piece is to describe the collective experience of the first four programs accredited by the Accreditation Council on Graduate Medical Education and to share lessons learned in developing new fellowship programs in this novel medical subspecialty.

OBJECTIVE: As part of the Heath Information Technology for Economic and Clinical Health (HITECH) Act, the Office of the National Coordinator for Health Information Technology (ONC) implemented its Workforce Development Program, which included initiatives to train health information technology (HIT) professionals in 12 workforce roles, half of them in community colleges. To achieve this, the ONC tasked five universities with established informatics programs with creating curricular materials that could be used by community colleges. The five universities created 20 components that were made available for downloading from the National Training and Dissemination Center (NTDC) website. This paper describes an evaluation of the curricular materials by its intended audience of educators. METHODS: We measured the quantity of downloads from the NTDC site and administered a survey about the curricular materials to its registered users to determine use patterns and user characteristics. The survey was evaluated using mixed methods. Registered users downloaded nearly half a million units or components from the NTDC website. We surveyed these 9835 registered users. RESULTS: 1269 individuals completed all or part of the survey, of whom 339 identified themselves as educators (26.7% of all respondents). This paper addresses the survey responses of educators. DISCUSSION: Successful aspects of the curriculum included its breadth, convenience, hands-on and course planning capabilities. Several areas were identified for potential improvement. CONCLUSIONS: The ONC HIT curriculum met its goals for community college programs and will likely continue to be a valuable resource for the larger informatics community in the future.