Primary Supervisor: Dr Zoe Fritz, zbmf2@cam.ac.uk
Supervisory Team Members: Professor Niels Peek
Project Outline
‘Digital scribes’ or Ambient voice technology (AVT) is rapidly expanding across the NHS (NHS England). This technology records clinical conversation and generates documentation, aiming to save clinicians time and improve clinician-patient interaction. AVT is designed to make traditional history taking and documentation more efficient. There is emerging evidence of it being effective in a range of settings (Olsen et al, 2025).
However, concerns are growing about unintended consequences (Eccles et al., 2025). The outputs of AVT are guided by pre-defined templates which tend to focus on what technology developers and clinicians think is important (symptom history, medical history, drug history etc). What these templates often miss is what matters most to patients themselves. This gap is particularly significant for older patients, whose care priorities may differ considerably from standard clinical priorities (Conroy et al 2023, Regan et al 2022), and may not emerge through standard history taking (Van den Ende et al 2021).
This project explores how AVT might be harnessed to amplify the older patient’s voice rather than supress it. It considers not only the practical questions of how AVT might be designed to capture patient priorities, and how this might be evaluated, but also the ethical questions of how to ensure equity and autonomy for older patients in the context of this new technology (Leung et al, 2025).
The project will start with a systematic review of AVT in older patients in primary, emergency and secondary care settings. Building on this, an ethical analysis of the issues identified with AVT in older patients will be undertaken, in order to map the ethical and pragmatic challenges. The findings will be used to propose changes to commonly used AVT templates, through a co-design process with older patients, clinicians, and technology developers. A pilot implementation of modified AVT templates in hospital and primary care settings will be evaluated through ethnographic evaluation. A sample of clinicians and older patients will be observed during clinical consultations and interviewed about their experiences with AVT, in particular exploring issues identified in earlier studies. Findings will inform the final design of AVT templates. Outputs will be disseminate through the national Ambient Voice Innovation and Development (AVID) community.
Project Plan
Year 1: Systematic review and ethical analysis; protocol writing; ethics approvals
Year 2: Co-design of AVT templates; preparation of pilot implementation.
Year 3: Pilot implementation of AVT templates; ethnographic evaluation.
Year 4: Data analysis; write up; dissemination.
Main Methods to be Used
Overarching Empirical Ethics methodology (Huxtable et al , 2019)
Systematic Review
Ethical analysis
Non-participant observation
Qualitative Interviews
Qualitative analysis
Key References
Conroy SP, van Oppen JD ( 2023 ) . Are we measuring what matters to older people? . The Lancet Healthy Longevity vol. 4 , ( 7 ) e354 - e356 .
Eccles A, Pelly T, Pope C, Powell J. Unintended consequences of using ambient scribes in general practice. BMJ. 2025 Aug;390:e085754. doi: 10.1136/bmj-2025-085754.
Huxtable, R., Ives, J. Mapping, framing, shaping: a framework for empirical bioethics research projects. BMC Med Ethics 20, 86 (2019). https://doi.org/10.1186/s12910-019-0428-0
Leung TI, Coristine AJ, Benis A. AI Scribes in Health Care: Balancing Transformative Potential With Responsible Integration. JMIR Med Inform. 2025 Aug 1;13:e80898. doi: 10.2196/80898. PMID: 40749188; PMCID: PMC12316405.
NHS England “AI-enabled ambient scribing products in health and care settings”
Olson KD, Meeker D, Troup M, et al. Use of Ambient AI Scribes to Reduce Administrative Burden and Professional Burnout. JAMA Netw Open. 2025;8(10):e2534976. doi:10.1001/jamanetworkopen.2025.34976
Regen E, Phelps K, van Oppen JD, et al
Emergency care for older people living with frailty: patient and carer perspectives
Emergency Medicine Journal 2022;39:726-732.
van den Ende ES, Schouten B, Kremers MNT, et al. Understanding what matters most to patients in acute care in seven countries, using the flash mob study design. BMC Health Serv Res. May 19 2021;21(1):474. doi:10.1186/s12913-021-06459-4