As healthcare continues to evolve and implement AI, the real clinical value of the technology may be difficult to discern. Ambient scribes are where AI has already changed spine practice. Most of the rest is still being sorted out, according to Rohaid Ali, MD.
Dr. Ali is a neurosurgeon and assistant professor at UChicago Medicine, where he directs minimally invasive endoscopic spine surgery and serves as clinical director of AI and computational neurosurgery. He trained at Stanford (Calif.) University School of Medicine and completed residency at Brown University in Providence, R.I., before serving as the inaugural complex spine fellow at Massachusetts General Hospital and Brigham and Women’s Hospital, both in Boston.
“Where my research has focused the most is really on that key question: where does the rubber actually meet the road?” Dr. Ali told Becker’s.
In 2023, he led a project using GPT-4 to rewrite surgical consent forms, which are typically written at a college reading level, for the average American reader. The study, published in npj Digital Medicine, found AI-generated, procedure-specific forms averaged a sixth-grade reading level and held up under expert surgeon review. Lifespan, Rhode Island’s largest health system, adopted a simplified universal consent form in 2023. The Providence-based system has since rebranded as Brown University Health.
He also helped a young patient who had lost much of her ability to speak after brain tumor surgery regain her voice through an AI voice clone, built from a 15-second clip she recorded for a school project. She typed into a phone app, and it spoke in her pre-surgery voice. “She eventually graduated off the device, but it was a nice bridge for her,” Dr. Ali said.
Where AI is working now
At the Congress of Neurological Surgeons annual meeting, Dr. Ali gave three AI-related talks and moderated a session called “AI for spine surgeons.” He sees three areas where AI is making a concrete difference today.
Ambient scribes. “From a workflow standpoint, this has been incredible,” Dr. Ali said. Patients report that physicians engage with them more and look at screens less, he said, and physicians in large studies report less burnout, less documentation time and the ability to see more patients. A multicenter study in JAMA Network Open found burnout among ambient scribe users fell from 51.9% to 38.8% after 30 days.
UChicago Medicine was an early adopter. Its pilot of Abridge’s ambient documentation platform with about 200 physicians found the share of clinicians giving patients undivided attention rose from 49% to 90%.
Still, adoption among spine surgeons has room to grow. In an informal poll during Dr. Ali’s CNS session, about 40% of attendees said they use an ambient scribe.
“It’s probably not a representative audience given that they’re spine surgeons at a national meeting, at a session on AI and spine,” he said. “But I think that’s one key area of growth.”
Visit preparation. Dr. Ali estimates only about 10% of spine clinic encounters lead to a surgical recommendation. AI that summarizes the chart before a visit — why the patient was referred, the chief complaint, key imaging findings — could improve throughput and cut waste, he said, meaning “needless visits, needless trips to the imaging, MRI, CT scan.” Some systems are also deploying patient-facing chatbots before appointments, which he likened to a flipped classroom.
Administrative work. Coding, billing and insurance appeal letters round out the list. Both payers and providers now use AI in adjudicating those tasks, Dr. Ali said.
What isn’t happening: “No one is going to claim that there’s an AI robot in the OR right now,” he said. “We’re not relying on ChatGPT in the OR yet, or Claude, or OpenEvidence, or any of these other tools.”
Asked whether any single vendor is pulling ahead, Dr. Ali pointed to a category instead. “Rather than a clear vendor, I would say the clear category that probably has some of the most utilization right now is ambient scribing,” he said.
He also urged caution about economics.
“It’s a fantastic product at a seemingly too-good-to-be-true price,” he said. “The question is, to what extent is the material that we’re using training future AI tools to do what we do, and to what extent is that good or bad in terms of overall patient care?”
Dr. Ali pushed back on an op-ed by Ezekiel Emanuel, MD, PhD, published by JAMA Perspective and co-authors arguing that AI alone will soon outperform physician-AI hybrid care at cognitive medical tasks.
“Given where we are now with technology, that is certainly not the case,” Dr. Ali said.
Mining years of outcomes data
The application Dr. Ali finds most exciting sits closer to clinical science. He is part of the Spine Core Study Group, a multicenter group drawn from the Quality Outcomes Database that has tracked validated patient-reported outcomes for thousands of patients over five years or more. Its analyses span conditions across the spine.
“We’re using AI now to look back at those registries and say, what did we miss?” he said. “What could we better understand about these disease conditions, the indication for surgery, risk factors? How can we predict who’s going to fail? Who’s going to have a worse outcome?”
Humans still run every stage of that cycle: operating, collecting data, following patients, applying clinical judgment to results and setting new guidelines. AI is one step in the loop.
“AI does not do the majority of the analysis,” Dr. Ali said. “But it’s increasingly becoming an indispensable role in that analysis, accelerating and reducing the barrier to asking these questions.”
The data depends on people, too. The group maintains more than 80% follow-up on patient-reported outcomes, he said, which is “what’s going to ultimately be key in ensuring that the quality of the input matches the quality of the output.”
Replacement fears and outdated impressions
Dr. Ali sees no sign AI is close to replacing physicians, but he cautions colleagues against dismissing it based on old experiences.
“Multiple things can be true at once,” he said. “There’s a human element in medicine, whether it’s medicine or surgery, that is nowhere near being displaced. On the other hand, I think we need to be careful about not over-indexing on an impression of AI that may be at this point outdated.”
A chatbot interaction from six months ago may look very different from one today, he said, and he sees a divide between surgeons who have used current ambient tools and those who tried early versions or none at all.
In his own practice, the scribe has freed up time with patients. After leaving an exam room, he no longer has to recall how many weeks of pain or physical therapy a patient reported. “All that mental load that’s now auto-populated in front of me in a note that I can edit,” he said. “That is a mental load off the interaction that then gets funneled back into the patient care.”
He is careful not to oversell it. “There’s still significant administrative documentation, EMR-related burden in the process of medicine today,” Dr. Ali said. “It’s not a cure-all, but where we can find these little pockets of assistance to improve the process, I think, are invaluable.”
New risks to watch
The risks that worry Dr. Ali most are the ones physicians can’t see. If denials climb for patients whose indications and complexity haven’t changed, he asked, “is there a concern that AI is being weaponized and utilized to accelerate those denials and to deny patients access to care?” He called it an evolving concern for spine surgeons and their advocacy for patients.
Some tools add work instead of removing it. Dr. Ali said Epic’s auto-generated replies to patient portal messages are often too long or miss key points in his experience, so reviewing them can take more effort than writing his own. He noted other users may have a different experience.
He also sees growing fatigue with AI-generated content, from manuscripts submitted to journals to conference slides to headlines, and an appetite for real human input.
“We just need to be discerning about where in the process it’s going to be helping us,” he said, “and where in the process it is hurting us as a society to communicate with one another. I think that’s a question of our time.”
Where to start
Several spine surgeons have asked Dr. Ali how to begin implementing AI into their practice. His advice: try a general AI tool yourself, without entering protected health information. Look into HIPAA-compliant ambient scribing services, and ask your health system whether it has evaluated one.
“You may not like it, or you may already have an existing workflow you like, and that’s fine,” he said.
He pointed to mammography, where AI tools that spot lesions radiologists may miss are becoming a standard of care. Spine has no equivalent yet.
“I’m not saying that we won’t get there,” Dr. Ali said. “But in the meantime, it’s worth trialing, at least seeing what the benefits are with these technologies.”
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