01 the business
Multi-specialty outpatient group
140 clinicians across 9 clinics
Clinicians see 20 or more patients a day and finish their notes at home. They type during visits and patients notice. Two clinicians have cut their hours, citing documentation as the main reason.
02 before
The problem
Clinicians type while the patient talks, then finish their notes at night. The record gets the clinician's attention that the patient should have had, and documentation is one of the biggest drivers of burnout. Human scribes help but are expensive and hard to find.
- Notes are finished after hours, often from memory.
- Clinicians face the screen instead of the patient.
- Note quality and length vary widely between clinicians.
03 the build
What the AI does
- Step 1: Asks for and records the patient's consent at the start of the visit, and stops recording if either person says no.
- Step 2: Listens to the consultation on a phone or computer and writes a transcript as it goes.
- Step 3: Drafts the note in your specialty's template, such as history, examination, assessment and plan, using only what was said.
- Step 4: Marks anything it was unsure about, such as a medication name or dose, for the clinician to check.
- Step 5: Places the draft into Epic, Oracle Health or your practice system as an unsigned note, and deletes the audio after the agreed period.
paused: waiting for a person to approve
How it was put together
- Chose a scribe that records only with consent and deletes audio after an agreed period.
- Built note templates with each specialty's lead clinician.
- Placed drafts in the record as unsigned notes, with unclear terms such as drug names flagged.
- Signed business associate and data processing agreements before any patient data flowed.
04 human in the loop
Where a person stays in charge
The clinician reads, edits and signs every note; nothing is filed without their signature. The tool writes down what was said and never suggests a diagnosis or treatment.
- Patients are asked for consent at every visit and can say no without any effect on their care.
- Clinicians read, edit and sign every note; nothing is filed unsigned.
- The scribe documents what was said and never suggests a diagnosis or treatment.
05 rollout
From kickoff to live in 8–10 weeks
- Weeks 1–3Privacy and security review, consent wording, contracts and template design.
- Weeks 4–6Pilot with 15 volunteer clinicians; review a sample of notes for accuracy each week.
- Weeks 7–10Extend clinic by clinic, with a named clinical lead and ongoing note audits.
06 after
What changes
Clinicians look at the patient instead of the screen, and notes are finished before the next patient instead of at night. The note still belongs to the clinician, who checks every line.
Assume 140 clinicians each spending 60 minutes a day finishing notes after clinic, and the scribe cutting that by a third, over 220 clinic days.
140 × 20 minutes × 220 days = 616,000 minutes, or about 10,270 hours a year returned to clinicians.
What to measure
- Time spent in notes per visit and after hours.
- Share of notes signed the same day.
- Errors found in note audits, by type.
- Clinician and patient experience scores.
07 evidence
What the research says
Observed physicians spent 27% of their office day on direct time with patients and 49.2% on the electronic record and desk work, plus 1 to 2 hours of after-hours work each night.
In the first 10 weeks of a rollout, 3,442 physicians used ambient AI scribes in up to 303,266 patient encounters; use was linked with less time on documentation, though accuracy still needs a clinician's review.
43.2% of US physicians reported at least one symptom of burnout in 2024, down from 48.2% in 2023 and 53% in 2022.
08 lessons
Mistakes to avoid
- Skipping consent. Patients must be asked, every time.
- Signing without reading. Scribes can mishear names and doses.
- Ignoring specialties. A generic template frustrates everyone.
09 questions
Common questions
- Do AI scribes work at scale?
- Kaiser Permanente reported 3,442 physicians using ambient scribes in up to 303,266 encounters within 10 weeks, linked with less documentation time, with accuracy still needing review.
- Is the audio kept?
- Only for the period you agree, usually long enough to finish and sign the note, then it is deleted.