Editing PHKG Business Opportunities (section)

=== Clinical Safety — The Real Constraint ===

The evidence for AI chart summarisation is promising but has serious safety signals:

'''The promise:'''
* ChatGPT-4 adapted with in-context learning performed superior to physicians on both AI metrics and clinical expert evaluations.
* Best-in-class systems achieve 1.47% hallucination rate and 3.45% omission rate across 12,999 clinician-annotated sentences.

'''The risks:'''
* '''Omissions are worse than hallucinations:''' A 2026 study of an EHR-integrated AI chart review tool deployed nationally in the US found that missing/confusing information was more commonly reported than hallucinations. Errors of omission may be a larger threat than errors of commission.
* '''47% omission rate in ED summaries:''' A separate evaluation found 47% of 100 LLM-generated emergency department summaries omitted clinically relevant information.
* '''Automation bias:''' A 2025 study of Epic's GPT-4 summarisation tool at NYU Langone found 22.7% of providers reported sometimes skipping full-length notes in favor of the summary alone. If the summary omits a relevant finding, the tool causes the diagnostic miss it was supposed to prevent.
* '''Verification overhead erases time savings:''' PDSQI-9 validation required clinician evaluators averaging 10 minutes per evaluation. If GPs need to verify the summary against source notes, the time saving disappears.

'''Implication:''' The clinical safety case (omissions, automation bias, verification cost) is the binding constraint — not technology readiness or integration cost.