"When AI Gets Creative: The Hidden Risks in Documentation"

Artificial intelligence has officially rolled into the skilled nursing world—charting your notes, transcribing your patient encounters, and promising to free up more time for actual patient care.

But there’s a hitch. Sometimes, AI doesn’t just record what you say… it makes stuff up. And in healthcare, that’s not just awkward—it can be dangerous.

In AI-speak, this is called a “hallucination.” In SNF-speak, it’s the moment your chart goes from clinical documentation to choose-your-own-adventure.

The Plot Twist You Didn’t Ask For

Recent reports show AI transcription tools like OpenAI’s Whisper sometimes drop false details into patient charts. And not the harmless “Oops, they said Tylenol” kind of false—think:

• Diagnoses that were never discussed

• Medications no one prescribed

• Odd comments that sound like they came from a bad medical drama

An Associated Press investigation found hallucinations in about 1.4% of cases—and nearly 40% of those could actually cause harm. The risk jumps when patients have speech difficulties. The AI hears silence, shrugs, and says, “I got this”… then fills in the blanks with pure fiction.

Imaginary Anatomy: Now Playing in a Chart Near You

It’s not just transcription. Google’s Med-Gemini AI once confidently diagnosed a patient with a “basilar ganglia infarct.” Sounds serious—except the “basilar ganglia” isn’t a real body part. (It’s Basal Ganglia)

The best part? It made it through peer review before anyone noticed. Yes… a fake brain structure nearly made it into the medical literature.

Why SNFs Should Care (and Laugh Nervously)

In skilled nursing, every note matters—especially when surveys, billing, and care plans are on the line. A single hallucinated detail could mean:

• Wrong meds: The AI invents an allergy, and suddenly your patient’s prescription changes

• Billing chaos: Auditors see the chart and start asking very uncomfortable questions

• Survey headaches: A made-up symptom triggers a state inspection deep dive

• Care confusion: Nurses waste time treating a phantom condition

The AI Cleanup Crew

The tech world knows this is a problem, and they’re trying to fix it:

• CHECK framework – Verifies AI output against trusted medical databases, slashing hallucinations from 31% to 0.3%.

• Retrieval-Augmented Generation (RAG) – Makes AI “look up” answers from verified sources instead of guessing.

Positive Impacts of AI in Healthcare

While the risks are real, so are the rewards. Across the healthcare industry, AI is already:

• Improving cancer survival predictions from 61% to 80% accuracy in certain prognostic tools.

• Guiding targeted prostate cancer treatment, reducing five-year mortality from 17% to 9% in high-risk patients.

• Enhancing Parkinson’s care through adaptive brain stimulation, reducing medication needs.

• Streamlining care in large health systems, with AI recommendations rated optimal 77% of the time compared to 67% for physicians.

• Assisting pathologists by identifying key areas on slides, helping manage workload and reduce burnout.

• Acting as a medical scribe to reduce documentation burden, with 4 in 5 clinicians reporting time savings.

Looking Ahead

While today’s AI still has its fair share of “creative writing” moments, these systems are evolving fast. As the technology improves, hallucinations should become far less common, and documentation tools will get better at capturing the real story without fabrications. The ultimate goal is simple: make charting so efficient and accurate that clinicians can spend less time typing and more time with their patients. But this will be a continuous process—AI will keep learning, and so will we. Staying engaged in that evolution is the best way to make sure the machines help us, not trip us up.

Bottom line: AI in skilled nursing can be a game-changer, but if you trust it blindly, you might end up with a patient who has a diagnosis straight out of Star Trek. We should anticipate AI becoming a bigger part of our professional lives, at least until the day the machines decide to take over. So, enjoy it while you can.

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All the best!

Christopher DeNapoles M.D.

Chief Medical Officer

Physicians Services Group of Florida

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