Lifespan, Rhode Island’s largest healthcare system, is using generative AI to transform surgical consent forms from dense medical-legal jargon into text that’s more accessible for all patients to read.
The pioneers of this initiative, Dr. Rohaid Ali (Neurosurgery) and Dr. Fatima Mirza (Dermatology), medical residents at Lifespan, started using ChatGPT when preparing for their medical board exams and realized its power.
Health literacy has been linked to patient outcomes, yet medical consent forms, which facilitate and document the doctor-patient conversation around consenting to a procedure, are notoriously complex. Dating back to 1980, the New England Journal of Medicine(opens in a new window) published research findings that surgical consent forms are written at a college reading level. Dr. Ali, Dr. Mirza, and their colleagues found that the same continued to be true in 2023 when they evaluated forms from over a dozen academic medical centers nationwide.
With over half of Americans reading at or below the 6th grade level(opens in a new window), Dr. Ali and Dr. Mirza proposed using GPT-4 to simplify surgical consent forms from a college reading level to a middle school reading level. To mitigate the risk of bias and hallucination, Lifespan leadership created a system where GPT-4 would do a first pass, and then legal and medical reviewers would check the output.
From left: Dr. Ziya Gokaslan, Dr. Dean Roye, Dr. Fatima N Mirza, Dr. Rohaid Ali, Mr. John Fernandez, Dr. Tiffany J Libby
The setup was simple. Dr. Ali and Dr. Mirza fed Lifespan’s surgical consent form into GPT-4, along with a short prompt: “While preserving content and meaning, convert this consent form to the average American reading level.” GPT-4 generated a draft of the surgical consent form at approximately a 6th grade reading level with a 25 percent reduction in word count. GPT-4 was so accurate that Lifespan’s clinicians only added one single modification: Anesthesiology leadership inserted the term "sleep medicine" next to the word “anesthesia” on the consent form.
In September 2023, Lifespan began deploying the revised surgical consent forms, reduced from three pages to one page, across the Lifespan health system. Dr. Dean Roye, Rhode Island Hospital’s Chief Medical Officer and an early supporter of the initiative, affirmed that the conciseness and simplicity was particularly enticing for physician buy-in, who felt that lengthy forms were less accessible for patients.
So far, the response among patients has also been overwhelmingly positive.
“Surgical consent conversations can be very overwhelming and emotionally charged for patients,” Dr. Mirza said. “Since we’ve implemented the simplified consent forms, countless patients have expressed how meaningful it is for them to have a one-page form they can understand. It’s a welcome source of comfort in a period of heavy uncertainty.”
Building on their initial success, Lifespan has now replicated this GPT-4 assisted process to deploy simplified medical documentation across its healthcare system, including patient intake forms and chemotherapy consent forms.
Lifespan President and CEO John Fernandez said, “Combining OpenAI’s technology with the expertise and human-centered approach of Lifespan clinicians is transforming medical documentation. Medical information becomes more accessible to patients, and in turn, patients become more empowered health care consumers.”
Dr. Ali, Dr. Mirza, and their colleagues have published their research in NEJM AI(opens in a new window), a new journal from the publishers of The New England Journal of Medicine, the same publication that flagged the need for more readable consent forms nearly half a century ago. As physicians dedicated to improving others’ lives, they hope sharing their efforts will encourage other hospitals to follow suit.
