Kaiser Permanente’s use of an artificial intelligence tool to document patient visits is drawing concern from some mental health clinicians, including providers in Southern California, who say patients may not be getting enough information before agreeing to have sensitive therapy and psychiatric appointments recorded.
In 2024, Kaiser announced it was rolling out Abridge, an AI-powered clinical documentation system the health system described as “ambient listening technology.” The tool is intended to help doctors and other clinicians, including mental health providers, generate clinical notes during appointments.
But some Kaiser therapists and social workers say the public description does not fully convey what happens during visits: The tool records entire appointments, including mental health sessions where patients may discuss trauma, family conflict, substance use, medical diagnoses or other deeply personal matters.
Clinicians are required to obtain patient consent before using Abridge, according to Kaiser. However, multiple providers say the consent process does not clearly explain how the recordings are stored, how long they are kept, who can access them or how the data may be used. Some say they have asked Kaiser leadership for those details and have not received adequate answers.
Ilana Marcucci-Morris, a licensed clinical social worker in Kaiser’s psychiatry department in Oakland, said she has chosen not to use Abridge with her patients. Marcucci-Morris also serves on a bargaining committee and said she has repeatedly raised questions with Kaiser representatives about privacy protections, HIPAA compliance and safeguards for AI tools.
She said the responses have amounted to assurances that the system is compliant and has been reviewed by technology experts, without providing the documentation clinicians have requested.
“They won’t show us,” Marcucci-Morris said in an interview with American Community Media. “If you have nothing to hide and you’re doing it ethically, then you would show us, prove it.”
Similar concerns have surfaced in Southern California. Ligia Pacheco, a psychiatric social worker who provides remote therapy services for Kaiser patients in the region, said she also sought more information about Abridge and did not receive the explanations she believes providers need to properly inform patients.
Pacheco said a colleague who raised concerns to a supervisor was told that expressing personal views about AI in the workplace was unprofessional. She said that kind of response makes providers feel they have little room to advocate for patients.
“We’re supposed to be the voice of patients who are coming in their most vulnerable state,” Pacheco said. “And we can’t even be that voice for them, so we feel discouraged.”
The dispute comes as many mental health professionals say they are facing rising workloads and heavy documentation demands. Marcucci-Morris said clinicians may see patient after patient with little time between appointments, making it difficult to keep up with notes and other administrative tasks.
She said providers who fall behind can face workplace investigations or discipline, and that management often recommends Abridge as a way to reduce delays in documentation. In her view, that creates pressure on clinicians to use the technology even if they have unanswered concerns.
“I consider that to be coercive,” she said, “because you’re putting someone in a position to either lose their job or use the software.”
Kaiser has promoted the tool as a way to reduce administrative burdens and improve the patient experience. In a Kaiser news release, Brian Hoberman, chief information officer for The Permanente Medical Group, said Abridge helps support physician well-being by easing documentation demands. He said the technology was implemented after careful review and testing and had been well received by patients and doctors.
A Kaiser Permanente spokesperson said in an emailed statement to American Community Media that clinicians must obtain consent before using Abridge and that “no one is recorded without their knowledge and consent.” The statement said recordings are stored for no more than 14 days and that processing of the data meets HIPAA requirements as well as Kaiser’s privacy and security standards.
The spokesperson also said Abridge allows clinicians to spend more time focused on patients and less time on administrative work. Kaiser says data collected through the tool is not used to train AI models.
Still, some patients and providers remain uneasy, especially when the appointment involves mental health care. One Kaiser patient, who asked not to be named because of privacy concerns, said they feared intimate conversations with doctors or therapists could somehow be exposed.
“I may not want my employers, I may not want my family members, I might not want people to know some of these very intimate conversations and deep conversations I have with my doctors [and] with my mental health provider,” the patient said.
Adriana Webb, a social worker at Kaiser Panorama City in Los Angeles, said the concern is especially serious for patients with highly sensitive medical conditions.
“I work with patients who have sensitive medical diagnoses, like HIV and AIDS,” Webb said, adding that some patients do not even want those diagnoses documented in their charts.
Privacy experts say mental health information carries a particular risk because of the stigma and consequences patients may face if details are disclosed or misused. Nicole Alvarez, senior analyst for technology policy at the Center for American Progress, said records of a person’s most vulnerable moments can be used against them in ways that routine medical information, such as a blood pressure reading, generally cannot.
Alvarez said mental health records may affect employment, child custody disputes, immigration proceedings, security clearances and personal relationships. She said health systems should be clear with patients about how their information is stored, shared and used.
Agreements between health care providers and AI vendors can differ significantly, Alvarez said. Key questions include whether recordings or transcripts can be used to train AI models, whether data is de-identified, how long it is retained, whether it can be shared with other entities and what happens when a vendor contract ends.
Patients often have little visibility into those arrangements, she said. While most patients have the right to refuse recordings, Alvarez said the option to decline is not always presented clearly. In some cases, consent may be requested directly; in others, information may be included in intake paperwork that patients may not closely read.
Meaningful consent, she said, requires more than simply informing patients that a recording will occur. Patients should understand that they can say no and should be told what will happen to their information afterward.
Pacheco said she encountered the issue during her own appointment at Kaiser. She said her doctor did not ask whether Abridge could be used but instead told her it would be used. After a pause, she declined. The doctor stopped the recording, she said, but she felt a noticeable change in the doctor’s demeanor afterward. Pacheco later changed doctors.
Marcucci-Morris said she worries that patients may feel pressured to agree when the tool is framed as something that helps doctors avoid burnout, complete paperwork and spend more time with their families. Patients who care about their clinicians, she said, may feel guilty refusing.
Kaiser has said Abridge is available in 40 hospitals and more than 600 medical offices in eight states and the District of Columbia. The tool operates in more than 14 languages and is part of a broader push by the health care industry to adopt AI systems for clinical support and documentation.
American Community Media said it contacted Abridge AI Inc. multiple times for comment but received no response. On its website, Abridge describes itself as a “Business Associate” to health care providers and directs patients to consult their providers’ privacy policies for information on how their data is protected.
For Marcucci-Morris, the central concern is the relationship between patient and therapist. She said privacy and trust are essential to effective care and that recording a session can alter the dynamic.
“Therapy is most effective in privacy and when trust is achieved through two human beings,” she said. “I believe recording a therapy session changes human behavior. It changes the patient’s demeanor.”
Original source: CalMatters
