Prospective Evaluation of AI Generated History of Present Illness Drafts in the Emergency Department

Prospective Evaluation of Artificial Intelligence-generated History of Present Illness Drafts in the Emergency Department

This single-center prospective observational study evaluates whether an on-premise, large language model-based tool (EDnote) that generates a draft history of present illness (HPI) from real-time transcription of the patient-physician encounter produces documentation of higher quality than conventional physician-written HPI in the emergency department. The treating physician writes the conventional HPI blinded to the AI draft. Unedited AI-generated HPI drafts and conventional HPI are compared through blinded review by independent emergency physicians.

Inclusion Criteria:

• Age ≥19 years; presenting to the emergency department; initial encounter documented with EDnote; verbal consent to study participation.

Exclusion Criteria:

• Cardiac arrest; limited ability of both patient and guardian to communicate verbally; refusal of participation.