Generative AI

Policy

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We use AI at Test Medical Centre Cornerstone to support safe, high-quality, relationship-based health care, and operational efficiency. AI must be used responsibly and is not a replacement for clinical judgement or for the clinician-patient relationship.

Approved uses of AI include clinical note-taking using approved healthcare AI scribe tools and administrative use such as drafting letters, referrals, and reports, and analysing information.

AI must not be used to make clinical decisions, diagnose, prescribe, or give clinical advice to patients.

Before introducing generative artificial intelligence (AI) tools, we assess and mitigate the risks to ensure privacy and safety are protected. We comply with New Zealand legislation governing the use of AI, in particular the Privacy Act 2020 and its Information Privacy Principles (IPPs).

We recognise this is rapidly-evolving technology, and reassess our processes as needed.

See Privacy Commissioner | Te Mana Mātāpono Matatapu: Artificial Intelligence and the IPPs.

We consider the terms and conditions, privacy settings, data collection, and content ownership agreements of all AI tools, platforms, or apps in use. These are reassessed if updates are made to the tool. We don't allow confidential information owned by our organisation and copyrighted material to be entered into any generative AI tool.

Test Medical Centre Cornerstone has processes in place for AI use, to ensure that safety and privacy are not compromised:

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• All AI tools must be approved by senior leadership before being used.
• A Privacy Impact Assessment (PIA) is completed for each AI tool in use.
• Explicit verbal consent is obtained from the patient at the start of each consultation where AI is used, and this is documented in the clinical notes.
• Signage in the waiting area advises patients that AI tools are used.
• A statement on our enrolment form advises new patients that AI tools are used.

Information generated by AI must be reviewed and validated before it is saved. Where clinical notes are created using AI, the relevant clinician is responsible for their accuracy.

Safeguarding privacy and security

A Privacy Impact Assessment (PIA) must be completed for all AI tools in use, to evaluate potential risks and ensure compliance with New Zealand legislation.

See Privacy Commissioner | Mana Tohu Mātauranga o Aotearoa: Privacy Impact Assessments.

Before using an AI tool, we confirm:

• private or clinical information generated or processed by AI is encrypted and/or de-identified
• if/where data is stored (even temporary storage) and any privacy implications

  Storing data overseas (even temporarily) may breach New Zealand privacy legislation.

  Consent should be obtained for patient data being stored overseas.

• the AI tools used in our organisation meet New Zealand legislative requirements under the Privacy Act 2020.

Follow the privacy breach procedure for any breaches that result from AI use.

Obtaining and documenting consent

Consent must be explicitly obtained if AI is used during a consultation:

• Verbal consent must be given at the start of each consultation. This is documented in the clinical record.
• Verbal consent is obtained for each subsequent consultation where AI is used, on a case-by-case basis.
• If consent isn't given, AI tools are not used during consultations.
• Patients may withdraw consent for AI use at any time.
• Where AI is used within our organisation, information is provided openly and transparently using a layered approach.

  Best practice is to build patient understanding of AI use by providing information in a number of different ways.

  For example:

  • statement on the enrolment form
  • verbal consent at the start of each consultation, documented in writing
  • continued verbal consent for subsequent consultations, at the clinician's discretion
  • signage in the waiting area
  • information on the website
  • creation of an FAQ document.
• If an AI tool being used stores or processes data overseas, this is explained as part of the consent process.

See also Informed Consent.

Ensuring data accuracy

Information generated by AI tools must be reviewed and validated by the relevant clinical or team member, before being saved or stored. The relevant clinician is responsible for the accuracy of clinical notes created using AI.

Before saving AI-generated information, ensure clinical information is accurate, complete, and adequately reflects the care provided:

• Edit or correct errors, discrepancies, or inaccuracies.

  Common errors with AI transcription:

  • misheard or misinterpreted information
  • "hallucinations" or fabricated information
  • difficulty distinguishing between speakers
  • background noise or poor acoustics
  • accent or dialect recognition
  • false positives/negatives.
• Add any missing information.

  Ensure the AI summary includes:

  • information not explictly discussed, e.g. hospital discharge summaries or imaging reports
  • non-verbal cues from the patient
  • examination findings, if not spoken out loud
  • data from medical devices.
• Check medication names are correct.
• Correct the spelling of Māori or Pacific words if there are errors.
• Be careful that bias and/or inequities haven't been introduced.

  AI models are likely to have been trained on data with underlying biases, especially if it hasn't been trained using New Zealand data, te reo Māori, or local cultural considerations.

  Be careful that AI-generated clinical records don't perpertuate biases or reinforce inequities.

Audits

Use of AI is monitored and audited as part of clinical governance.

Regularly review AI use to ensure:

• any AI use is appropriate and necessary
• Privacy Impact Assessments (PIAs) are current
• consent is obtained and recorded before each consultation
• clinical information is accurately recorded
• biases and inequities are not being introduced.

See also Clinical Governance.

Further information

• General Practice New Zealand: How is AI evolving in primary care
• Royal Australian College of General Practitioners: Artificial Intelligence (AI) Scribes
• WellSouth: Generative AI Setup Checklist