A growing body of work uses Natural Language Processing (NLP) methods to automatically generate medical notes from audio recordings of doctor-patient consultations. However, there are very few studies on how such systems could be used in clinical practice, how clinicians would adjust to using them, or how system design should be influenced by such considerations. In this paper, we present three rounds of user studies, carried out in the context of developing a medical note generation system. We present, analyse and discuss the participating clinicians’ impressions and views of how the system ought to be adapted to be of value to them. Next, we describe a three-week test run of the system in a live telehealth clinical practice. Major findings include (i) the emergence of five different note-taking behaviours; (ii) the importance of the system generating notes in real time during the consultation; and (iii) the identification of a number of clinical use cases that could prove challenging for automatic note generation systems.

In recent years, machine learning models have rapidly become better at generating clinical consultation notes; yet, there is little work on how to properly evaluate the generated consultation notes to understand the impact they may have on both the clinician using them and the patient’s clinical safety. To address this we present an extensive human evaluation study of consultation notes where 5 clinicians (i) listen to 57 mock consultations, (ii) write their own notes, (iii) post-edit a number of automatically generated notes, and (iv) extract all the errors, both quantitative and qualitative. We then carry out a correlation study with 18 automatic quality metrics and the human judgements. We find that a simple, character-based Levenshtein distance metric performs on par if not better than common model-based metrics like BertScore. All our findings and annotations are open-sourced.

Recent advances in Automatic Speech Recognition (ASR) have made it possible to reliably produce automatic transcripts of clinician-patient conversations. However, access to clinical datasets is heavily restricted due to patient privacy, thus slowing down normal research practices. We detail the development of a public access, high quality dataset comprising of 57 mocked primary care consultations, including audio recordings, their manual utterance-level transcriptions, and the associated consultation notes. Our work illustrates how the dataset can be used as a benchmark for conversational medical ASR as well as consultation note generation from transcripts.

Evaluating automatically generated text is generally hard due to the inherently subjective nature of many aspects of the output quality. This difficulty is compounded in automatic consultation note generation by differing opinions between medical experts both about which patient statements should be included in generated notes and about their respective importance in arriving at a diagnosis. Previous real-world evaluations of note-generation systems saw substantial disagreement between expert evaluators. In this paper we propose a protocol that aims to increase objectivity by grounding evaluations in Consultation Checklists, which are created in a preliminary step and then used as a common point of reference during quality assessment. We observed good levels of inter-annotator agreement in a first evaluation study using the protocol; further, using Consultation Checklists produced in the study as reference for automatic metrics such as ROUGE or BERTScore improves their correlation with human judgements compared to using the original human note.

We propose a method for evaluating the quality of generated text by asking evaluators to count facts, and computing precision, recall, f-score, and accuracy from the raw counts. We believe this approach leads to a more objective and easier to reproduce evaluation. We apply this to the task of medical report summarisation, where measuring objective quality and accuracy is of paramount importance.

Automatic summarisation has the potential to aid physicians in streamlining clerical tasks such as note taking. But it is notoriously difficult to evaluate these systems and demonstrate that they are safe to be used in a clinical setting. To circumvent this issue, we propose a semi-automatic approach whereby physicians post-edit generated notes before submitting them. We conduct a preliminary study on the time saving of automatically generated consultation notes with post-editing. Our evaluators are asked to listen to mock consultations and to post-edit three generated notes. We time this and find that it is faster than writing the note from scratch. We present insights and lessons learnt from this experiment.