Beyond documentation burden: clinician-reported workflow and cognitive changes associated with ambient documentation technology.

OBJECTIVE: To examine clinicians' experiences using ambient documentation technology (ADT) in ambulatory practice, with a focus on impacts on documentation workflows, perceived cognitive burden, and clinical reasoning. MATERIALS AND METHODS: This survey study included clinicians participating in an ADT pilot at NYU Langone Health between March and December 2024. Clinicians completed a baseline survey before receiving access to ADT and a posttrial survey after use. Outcomes included self-reported changes in documentation time, workflow, communication, cognitive load, and clinical and diagnostic reasoning. RESULTS: Eighty-four clinicians across multiple specialties participated. Most reported reduced documentation time (75 [89%]) and preferred editing ambient notes (65 [77%]). Many reported reduced cognitive load (49 [58%]), while fewer reported improvements in clinical (22 [26%]) or diagnostic reasoning (20 [24%]). Clinicians who viewed note writing as part of their reasoning process reported heterogeneous cognitive effects, whereas those who did not reported no perceived benefit. A subset reported workflow changes (26 [31%]) or changes in patient communication (22 [26%]) to integrate ADT. Concern about reliance on ADT was reported by 26 clinicians (31%). DISCUSSION: Clinicians using ADT commonly reported efficiency gains and reduced cognitive burden, although reported cognitive effects varied across clinicians and practice contexts. CONCLUSION: Clinicians reported reductions in documentation burden and changes in documentation workflows following ADT adoption, with heterogeneous perceived effects on clinical reasoning. Implementation should address both efficiency and changes to clinicians' cognitive and workflow practices.