Large-Scale Implementation of Ambient Artificial Intelligence Documentation and Its Effects on Electronic Health Record Efficiency and Clinician Well-Being

Abstract

Abstract Background Ambient clinical documentation tools are increasingly used to reduce administrative burden and improve provider experience. However, evidence describing their effects at scale across large, multisite health systems remains limited. Objectives The objective of this study is to evaluate the effect of Dragon Ambient eXperience (DAX) Copilot on documentation efficiency, note composition practices, and provider well-being across a multistate health system. Methods Due to rolling registration and training, we conducted a retrospective index-date-aligned pre–post analysis of objective electronic health record activity metrics, supplemented by a postimplementation survey. Physicians and advanced practice providers in ambulatory settings between June 2024 and November 2025 were included. Epic Signal data were analyzed for each provider over the 8 months before and after DAX activation. Metrics included active time in notes per appointment, proportion of note content originating from manual typing, copy/paste, or conventional voice recognition, and average note length. Surveys were administered 45 days postactivation to assess satisfaction, burnout, intent to remain with the organization, and work–life balance. Results A total of 210 providers met the inclusion criteria, defined as generating ≥25% of total note content using ambient voice technology and having at least 16 months of Signal Data (8 months pre- and 8 months postintervention). Compared with the preimplementation period, active note time decreased significantly (5.54–4.09 min per appointment; 26.2% reduction; p < 0.001). Despite a +28.8% increase in note length, manual documentation behaviors declined substantially, including typing (−51.7%), copy/paste (−42.7%), and conventional voice recognition (−67.8%). Survey responses ( n = 233; 26.4% response rate) indicated improvements across domains, with most respondents reporting reduced burnout, increased job satisfaction, improved work–life balance, and a strong preference to continue using DAX. Conclusion Deployment of ambient artificial intelligence documentation technology at scale was associated with improvements in documentation efficiency, substantial reductions in manual input, and improved provider well-being, supporting its potential to meaningfully alleviate documentation burden.