OBJECTIVE: The use of ambient AI documentation tools is rapidly growing in US hospitals and clinics. Such tools generate the first draft of clinical notes from scribed patient-provider conversations, which clinicians can then review and edit before signing into electronic health records (EHR). Understanding how and why clinicians make modifications to AI-generated drafts is critical to improving AI design and clinical efficiency, yet it has been under-studied. This study aims to address this gap. MATERIALS AND METHODS: We conducted semistructured interviews with 30 clinicians from the University of California, Irvine Health who used a commercial ambient AI tool in routine outpatient care. We invited them to describe how and why they edited AI drafts based on both their personal experience and review of some real-world examples identified from our previous studies. RESULTS: Modifications to AI drafts were primarily made to improve clinical accuracy and specialty-specific precision, reduce medico-legal and liability risk, and meet billing, coding, and documentation standards. Such editing was necessary due to reasons such as transcription errors, speaker attribution mistakes, overconfident statements without evidence, missing key clinical details, and AI's lack of information about the patient context. CONCLUSION AND DISCUSSION: Improving ambient AI documentation will require coordinated effort from vendors, institutions, and clinicians. Key targets include core model reliability (eg, transcription accuracy), specialty- and encounter-level customization, clinician-level personalization, more effective EHR integration, and institutional support (eg, training, governance, and standardized review guidance), complemented by clinicians' adaptive communication strategies that strengthen human-AI collaboration.

OBJECTIVE: Ambient artificial intelligence (AI) documentation is increasingly used to draft clinical notes from patient-provider conversations, but how clinicians revise and finalize these drafts is not well understood. This qualitative content analysis study characterizes real-world edits to AI-generated drafts and identifies opportunities for improvement of AI design and the implementation process. MATERIALS AND METHODS: Eight coders analyzed clinical documentation generated by ambient AI from 200 clinical encounters. We developed an inductive coding framework with 11 codes across 3 categories: clinical content, terminology, and language style. Interrater reliability was assessed using Cohen's kappa. We then applied thematic analysis to synthesize patterns across the coded edits. RESULTS: The most frequently edited content pertained to clinical facts including orders (eg, procedures, lab tests) (40.0%), symptoms (30.3%), medication prescriptions (27.3%), and diagnosis descriptions (25.9%). In comparison, edits related to terminology use (11.6%) and language style (7.2%) were less frequent. The results of our thematic analysis show that most edits can be categorized into one of the following 5 types: to revise factual discrepancies, to add medical specialty-specific details, to express diagnostic certainties, to convert patient expressions into objective assessments recorded in medical terms, and to reorganize or condense content. CONCLUSION AND DISCUSSION: Clinicians routinely revise ambient AI drafts to modify factual details and clinical specificity. Future work on AI development and clinical implementation should emphasize specialty customization and support personalized documentation practices, alongside clinician education that promotes robust and consistent review routines to ensure documentation quality.

BACKGROUND AND SIGNIFICANCE: Ambient listening tools powered by generative artificial intelligence (GenAI) offer real-time, scribe-like support that reduce documentation burden and may help alleviate burnout. This study assesses physician-perceived benefits and challenges of ambient AI implementation through surveys and evaluates its effectiveness in clinical workflows using automatically recorded electronic health record (EHR) time-efficiency metrics. METHOD AND MATERIALS: A quality improvement pilot has been underway at UCI Health since December 2023. Epic EHR Signal metrics were analyzed to assess changes in note length, documentation time, and same-day encounter closure rates. Matched pre- and post-implementation surveys evaluated physician-perceived changes in documentation burden, clinical efficiency, and care quality. We also examined open-ended survey responses using thematic analysis to supplement quantitative findings. RESULTS: Analysis on EHR usage data from 167 physicians showed significant reductions in note-writing time, despite an increase in note length. Survey responses (n = 65) also indicated statistically significant improvements across multiple domains. Physicians reported reduced cognitive demand (P = .031) and documentation effort (P = .014), alongside perceptions of enhanced clinical efficiency, patient-centered care, and EHR system usability. Thematic analysis confirmed these quantitative findings and identified opportunities for improvement, including specialty-specific customization and expanded AI functionality. DISCUSSION: Ambient AI tools demonstrated improved documentation efficiency, perceived care quality, and reduced cognitive workload. These benefits suggest potential to alleviate key burdens in clinical documentation. CONCLUSION: Future development should prioritize customization for specialty-specific and individual physician needs, ensure the reliability and accuracy of AI-generated content, and integrate ethical and legal considerations to facilitate safe and scalable implementation in patient-centered care contexts.

OBJECTIVES: Patients with rare diseases often face long delays before receiving a diagnosis. Using electronic health records for automated phenotyping and diagnosis of rare diseases is a promising approach but can be challenging because critical information is often recorded in unstructured notes rather than structured fields. This systematic review synthesizes the current literature applying natural language processing (NLP) and large language models (LLMs) for rare disease phenotyping and diagnosis from clinical text. MATERIALS AND METHODS: A systematic search was conducted in PubMed, ACM Digital Library, and IEEE Xplore. Two reviewers independently screened papers and extracted data. Methodological rigor and quality of the studies were evaluated using the MI-CLAIM framework. RESULTS: The search resulted in 135 studies; 27 of them met the inclusion criteria. Methods used spanned rule-based systems, classical ML/DL models, transformer architectures, and LLMs. Transformer- and LLM-based approaches outperformed earlier methods in entity recognition, phenotype extraction, and diagnostic ranking. Several studies demonstrated clinical impact, such as increased genetic testing and identification of undiagnosed cases. However, most studies relied on retrospective and single-center datasets. Reporting of preprocessing, evaluation, and reproducibility was largely inconsistent, and interpretability, fairness, and privacy were rarely addressed. DISCUSSION: Natural language processing and LLMs show strong potential to accelerate rare disease diagnosis. However, heterogeneity in methods and metrics hinders cross-study comparability. Data scarcity, lack of generalization, and limited transparency remain significant challenges. CONCLUSIONS: Natural language processing/LLM methods can support timely diagnosis of rare diseases using unstructured clinical text. Future research should prioritize multicenter studies, standardized evaluation frameworks, transparency, and fairness safeguards to enable reliable, equitable deployment.

Abstract The emergence of digital media has changed the way people live and learn. In the context of the new era, digital media is gradually integrating into people’s life and learning. Digital media contains massive images, and fine-grained image recognition for digital media has become an important topic. The challenge of fine-grained image recognition is that the difference between different categories is small, and the difference between the same categories is sometimes large. This work designs a fine-grained image recognition based on feature enhancement (FIRFE). This extracts as much information as possible from fine-grained images under weak supervision to improve the recognition accuracy. When the existing methods extract image features, the feature extraction other than the most significant local feature is not enough. This deals with local features alone and ignores the relationship between features. First, this paper designs a feature enhancement and suppression module to process image features. Secondly, this paper designs pyramid residual convolution. This uses different scale convolution kernels to capture different levels of features in the scene. Thirdly, this paper uses the softpool method to rationally allocate the information weight in the pooling process. Fourth, this paper uses feature focus module to mine more features. This focuses on obtaining similar information in multiple local features as discriminant features to further improve the recognition. Fifthly, this paper carried out systematic experiments on the designed method. The proposed method achieves 94.3%/95.7% accuracy, 92.9%/94.1% recall, and 91.4%/92.2% F1 score on different datasets. This verified the superiority of this method for fine-grained image recognition of digital media.