How AI is transforming clinical documentation

Dr. Vik Mali, M.D., is a physician and the owner of Mali & Mali Pediatrics, an independent pediatric practice in Michigan. After nearly three decades in medicine, Mali & Mali has seen documentation evolve from paper charts to electronic records and now to artificial intelligence-powered tools. We talked with him about how AI is reducing documentation burden, helping clinicians close charts faster, improving operational efficiency, and supporting independent practices as they grow.

Q: How has the documentation burden changed over time, and what feels different now?

A: I've been doing this for 27 years, with three years of training before that. So much of the documentation has felt like it's being done to us as physicians. I find that technology has made everyone's job easier, but maybe not the physicians'. For the first time with AI, I find that this is being done for us. My little bit of experience with it — really just three weeks — has been pretty transformative. It's exciting.

Years ago, when we were on paper, there were many times we didn't know what we didn't know. There were lost documents and loops that were never closed. We could order something and never see a result. Maybe ignorance was bliss. But as all of [these elements] have been surfaced and become visible, it's felt like taking a sip from a firehose.

Q: Why has reducing documentation time been such a priority for your practice?

A: Years ago, athenahealth introduced click count, which measured mouse clicks and keystrokes. We found there were certain providers who had more clicks and more keystrokes than anyone else. They were opening charts late at night to revise them, and we were getting a sense of burnout. This was back in 2012, and we thought, "How can we make this better for the provider?” To the point where I told my CSM (customer success manager): "What I need from you is anything that makes the lives of my providers better."

A lot of it is: What can we automate? The accelerators (clinical accelerators within athenaOne®) have been game-changing, personally. There are two or three things in my everyday workflow that athenaOne has incorporated that have made it better. Chart prep (athenaOne's Encounter Prep) revolutionized how we take care of patients because we spend a few minutes preparing the night before, and now we're ready when we walk into the exam room.

athenahealth medical dictation software also made a huge difference. Before athenaOne AI and Ambient Notes, we could dictate directly into athenaOne, which reduced typing and allowed us to focus on the patient. Those were already valuable tools. The newer generation of AI tools is going to take that to the next level.

Q: How does faster documentation affect both clinician well-being and the business side of the practice?

A: It's important on so many levels.

Not finishing charts weighs on a provider. Having many open charts and thinking, "I'll get back to that," hangs over your head. That's not healthy at all. You think that if you go back to it later, you'll make it better. In reality, you often just need to focus on closing the chart. For yourself, for your patient, and for the revenue cycle. Because if we don't get those charts closed [and submitted], none of us gets paid, and we all have bills to pay.

One of the ways I track how my providers are doing is through our daily huddle at 12:45. We talk about the schedule. We talk about things going on in their lives. When I notice their encounter count [changes] or they're not closing their charts, I can often tell that something is going on in their lives. That's the giveaway to me. It's no longer about counting clicks and keystrokes. It's about whether they're getting their charts closed.

Q: What makes AI feel transformational for physicians right now?

A: I think there's this evolution, this timeline where maybe not a lot happens or things happen incrementally. Every so often, you get these big blips in evolution. Whether you're talking about ecosystems, populations, or technology, this is a big deal.  

This is the real thing for physicians. This is the first time we have tools to ask those questions, focus on our patients, while still having the documentation and transcription. It's magical. It really is one of those things that until you try it, you don't understand how transformative it is.

We've alpha-tested Sage™, and even in that short period, it's been an iterative process. And it just continues to get better., and even in that short period, it's been an iterative process. And it just continues to get better.

I think this is the going to be the future of how we interface [with technology]. Right now, we interface using a mouse or a trackpad or our keyboards. More and more of this [in the future] is going to be voice. And the idea of simply approaching the interface and asking a question — much like you do with various AI platforms — is going to become more common.

Q: How is AI changing the way you access information and interact with the patient chart?

A: Knowledge is comforting, reassuring, and empowering. Now I can ask questions directly. I can ask it to pull up specific labs. Or [I can ask]: Has this patient had X-rays since their last visit? Has this patient seen a specialist? And it will work to try and surface that information immediately; I'm not digging through the chart the same way I was before.  

During a general session today, I heard someone call it "chart spelunking," as they were really taking a deep dive — looking for threads of information that we hope we don't have to do.

Right now, as it's being surfaced to us, we have various visual indicators that tell us that this is information that my staff has brought in, versus what has come through automation. The idea of not having to necessarily go through each line or each document and just being able to ask for what I need — that is empowering. We could find out anything we want.

Q: How do you see AI working alongside clinical judgment rather than replacing it?

A: I think it's an augmentation. I think it is going to empower us. There's that adage that AI is not going to replace physicians. Frankly, there's a shortage of us. But physicians who use AI will replace physicians who do not. I think it's inevitable. I don't think there's any escaping it. I don't think we should escape it. I think we should be empowered by it and use the tool to its fullest capability.

Just try it. I think a lot of it is inertia. There are those who are ingrained in their way of doing things, and they think it's better. When I have tried ambient documentation, I am noticing that I cover a lot in these visits — whether it's the education piece, the conversations, and even repeating myself to help information sink in — and it's capturing it. My notes aren't abridged. It's capturing all those little elements that make my notes more robust.

In pediatrics, we've always talked a certain way. When we're doing a physical examination, moms are worried about whether we've found something. We've always been trained to go step by step and say the lungs are clear, the heart sounds great, the ears look fine — just reassuring them all along. That's also helpful in the AI environment because it allows the AI to document what we've been doing all along.

[Before, I was] frantically taking notes and leaving a lot out. It was very distilled and just getting to these big leaps in the story. Now the narrative is so much better captured.

Q: What kind of value have you seen from athenaOne and athenahealth overall?

A: I realize the value I am getting because the quality has been phenomenal. The incremental improvements that happen monthly, quarterly, and yearly have absolutely been well worth it.

I think for new clients, they know until they truly live it. There's inertia and there's fear. And I think once we overcome that fear, once we overcome that inertia, I think there's a lot to be gained.

There are so many elements to it. I've always said that the document management — that's a magical feature. We didn't need AI for that. That's something that's been happening [for years] with athenaOne. Documents arrive in the document management center and within minutes find their way to exactly where they're supposed to go.

We've always said we need the right people doing the right tasks. When the right information is presented to them, they can truly act in the best interest of the patient, themselves, the practice, and our neighborhood.

Q: How has athenaOne helped your practice stay independent and efficient as you've grown?

A: We've grown from two physicians to 12 physicians, and we haven't had to hire as many staff members because we allow athenaOne to do the work for us.

The analogy that I use when I'm talking with other physicians is — if you're playing a sport, you let the club head do the work. You let the racket do the work. You let the hockey stick do the work. It's a tool, and you want to use it to its fullest capability.

I wish I would have told myself [when first setting up the system within the practice], take the time. Take a breath. Invest the time. Especially this precious time at the beginning. Spend this precious time taking care to set up the workflows, set up the order sets. Follow the lead of your implementation team. And lean into it.

I would say — hand out a little notebook or a pad of paper to everyone and have them write down in real time where their pain point is when the implementation team is there, when the coaching is there. And work through those. Take the time and do it early because the earlier you fix it, the more you enjoy the benefits of that.