Prompt-directed ambient artificial intelligence for automated multidisciplinary tumor board documentation.

BACKGROUND: Tumor board documentation is challenging due to complexity of multidisciplinary input. Ambient artificial intelligence (AI) for medical dictation uses generative methods to summarize voice data. Strategic prompting can improve model output. We evaluated prompt-directed ambient AI for automated tumor board documentation and compared ambient AI with manual documentation. PATIENTS AND METHODS: We performed a prospective quality improvement study evaluating ambient AI for documentation of multidisciplinary head and neck cancer tumor board discussions at a tertiary institution in 2025. The primary intervention was verbal prompting during case discussions to improve documentation quality. Primary cohorts were unprompted and prompt-directed ambient AI tumor boards. A paired comparator sub analysis included manual and ambient AI documentation from the same meetings. We validated our prompted ambient AI workflow with additional tumor boards. Documentation was evaluated using a modified MODe (Metric for Observation of Decision Making)-based rubric across 5 domains: demographics, tumor characteristics, radiology findings, pathology findings, and discussion, with criteria rated on a 1-3 scale (1=incorrect/omitted, 2=partial, 3=complete documentation). RESULTS: We analyzed results of 12 tumor board across 4 cohorts: unprompted ambient AI, prompt-directed ambient AI, manual documentation, and internal validation. In the primary cohorts, prompt-directed ambient AI improved Tumor Characteristics domain score (q = 0.042) and total score (p = 0.005) versus unprompted ambient AI, with no difference in per-patient discussion time (p = 0.158). In the paired comparator analysis, ambient AI improved total score (p < 0.001) and Discussion domain score (q < 0.001) versus manual documentation, while reducing administrative time per patient (p < 0.001). The internal validation cohort showed statistically comparable scores across all domains. CONCLUSIONS: Directed prompting during head and neck tumor board improved generated summaries, without increasing discussion times. Compared with manual documentation, ambient AI improved documentation quality, while diminishing administrative burden.