Case Study: Clinical Note Drafting at Lakeside
Explore the clinical note drafting case study at Lakeside Hospital to learn how to balance project goals with patient safety, regulatory boundaries, and stakeholder requirements in AI system deployment. Understand how to evaluate risks, design review workflows, and negotiate project scopes while preparing for the OpenAI FDE interview scenario.
This case stresses judgment and the mission questions that can come up in any final interview. It ends the chapter with a debrief of all three cases and a preparation plan.
The demo had gone well. Lakeside Hospital Network’s clinical sponsor watched an assistant turn a test encounter into a tidy draft visit note in seconds. Then came the request:
“Clinician review is the bottleneck. Let’s file the drafts straight into the patient record with an ‘AI-generated’ label. Clinicians can correct anything later. I accept the risk.”
The FDE asked for one more piece of evidence first. Lakeside replayed nine test encounters through the proposed shortcut, writing each draft to a mock record with no review. Two of the nine notes contained false statements. One said “No known medication allergies” when the encounter had no allergy history at all. Another recorded a fever that the patient had explicitly denied. Nobody had checked the other seven.
A false allergy statement in a real record is the kind of sentence that changes what a clinician prescribes. The question this case asks is how to decline the shortcut and still keep the project alive.
What is Lakeside asking for?
Lakeside is a US hospital network. Its clinicians write or dictate each visit note themselves, and the sponsor wants to cut that documentation burden. Lakeside has no measurement of how long documentation takes today, so the time saving is a goal to measure, not a result.
Three groups are affected by whatever gets built. Clinicians write and sign the notes and answer for what the record says. Patients’ words are captured and their information moves through new systems. And nurses, specialists, and on-call staff act on notes without knowing how they were drafted.
At a hospital, most decisions aren’t the FDE’s. Clinical leadership defines the intended use and who may file a note. Privacy and legal decide what may be recorded and processed, and what may be shared. Security and engineering assess access and the record-system integration. Operations runs the workflow and can switch it off. Naming these owners gives every open question somewhere to go. It doesn’t mean any of them has agreed to anything.
Two pieces of early evidence are easy to over-read.
In 14 sample notes from Lakeside’s current process, 3 have no allergy-status section. That shows something wasn’t documented. It says nothing about whether those patients had allergies, nothing about an assistant (none wrote these notes), and nothing about a rate.
In 5 demo drafts, one said “No known medication allergies” for an encounter with no allergy history. That is a concrete failure mode, and the grammar is perfect, which is why ...