AI Scribes: Pearls and Pitfalls

This is the sixth in a series on AI in Emergency Medicine. You can find the previous posts here.

---

Key Takeaways

• AI scribes can save emergency clinicians up to 1–3 hours of documentation time per day
• Use of AI scribes has been associated with significant reductions in physician burnout
• Ambient AI notes are approaching human-level quality but still require physician review
• Legal responsibility remains with the physician, even when AI drafts the note
• Privacy, consent, and regulatory compliance must be addressed before deployment

---

The documentation burden in emergency medicine has steadily increased. Emergency clinicians often stay late finishing charts or feel distracted during patient care due to the constant pressure to document. AI scribe services aim to ease that burden by offering real-time transcription and note generation. These tools promise to help physicians reclaim time and focus more fully on patient care. But are there risks? Let’s take a closer look.

What Are AI Scribe Services?

AI scribes are software tools that process clinician-patient conversations and generate clinical notes. Some tools operate in real time, while others review recordings of the conversations after the visit. These tools use large language models to turn speech or summary text into structured documentation for the electronic health record. Understanding how these tools work is essential. Their effectiveness and limitations vary based on how they’re deployed and in what clinical environment.

The table below provides a list of current AI scribe services. Four of them advertise emergency medicine specific services.

Solution	Deployment Type	EHR Integration	Notable Features
Freed	Ambient, real-time	Device-agnostic	✅ ED-specific. Handles noisy, multi-voice ED workflows
ED Scribe AI	Ambient, app-based	Standalone	✅ ED-specific. Custom ED charting workflow with clinician edit tools
Ambience Healthcare	Ambient, system-level	Epic	✅ ED-specific. Supports stepwise, team-based ED use
Abridge Inside (Emergency Med)	Ambient	Epic ASAP/Haiku/Hyperdrive	✅ ED-specific. Built for emergency medicine; deep integration, measurable benefits
Nuance DAX	Ambient, real-time	Epic, Cerner	Broad hospital use; part of Microsoft’s DAX Copilot
Augmedix	Ambient + human review	EHR-agnostic	AI-driven with optional human oversight; supports care in acute settings
DeepScribe	Ambient	Major EHRs	SOAP-style notes, high KLAS ratings, customizable; HIPAA-compliant
Suki AI	Voice-driven	Epic, Cerner, Meditech, Athena	Highly accurate voice assistant; used in ED and ambulatory
Notable Health	Voice-powered AI	Custom APIs	Automates forms and tasks using natural speech
Sprypt AI Medical Scribe	Real-time	Multiple	Claims 95%+ accuracy; saves ~2 hrs/day
CureMD AI Scribe	Real-time	CureMD EHR	Fully integrated within CureMD clinical suite
Heidi Health	Ambient	Multi‑EHR	Global use; SOC 2, HIPAA, GDPR compliant
Nabla (Whisper-powered)	Ambient	NHS, global	PILOTed in NHS; ~$119/month; clinician-editable
Ezyscribe	Integrated stack	Varies	Emerging EHR-native platform
OmniMD AI Scribe	Integrated stack	OmniMD EHR	Focused on ambulatory and urgent care
Sunoh.ai	Real-time	Multiple	Featured in 2025 AI scribe rankings

Pearls: What Works

1. Time Savings
Clinicians using AI scribes often report recovering 1 to 3 hours of documentation time per day. Kaiser Permanente reported an average of 1 hour saved daily per clinician after implementing ambient scribe technology.

2. Burnout Reduction
At Massachusetts General Brigham, physicians using ambient AI scribes saw a 40% drop in self-reported burnout within six weeks.

3. Near-Human Note Quality
A blinded evaluation comparing AI-generated notes to expert-drafted ones found only a small difference in quality. Scores were 4.20 versus 4.25 out of 5 using a standardized note quality tool (PDQI-9). Other studies show strong agreement between AI and human scribes on objective elements like prescriptions.

4. Faster ED Documentation
AI-assisted discharge summaries were completed faster than manual notes in one small study of 19 emergency physicians.

5. Broader Clinical Benefits
A rapid review of ten studies found 67% showing efficiency gains, 79% reporting 

Pitfalls: What to Watch For

1. Incomplete or Inaccurate Notes
AI performance drops when conversations are complex, fast-paced, or include overlapping speech. Misinterpretation is more common in these environments.

2. Workflow Challenges
Technical issues and note generation delays can interrupt clinical flow. Atrium Health reported that while AI scribes helped with clinician well-being, they didn’t deliver consistent efficiency improvements.

3. Privacy and Compliance Risks
Vendors must follow HIPAA requirements and sign business associate agreements. Tools that transmit data off-site add risk. Consent requirements vary by state, and patients may need to be informed explicitly^,. One attorney recommended a triple consent: recording, transfer of data, and AI processing. 

4. Over-Reliance Without Review
Physicians may start trusting AI notes too much and stop reading them carefully. This creates a risk of missed or incorrect details in the final chart. Real world experience with speech-to-text software proved this occurs quickly. The standard “AI scribe services were used in the generation of this note” may help with grammatical mistakes, but will not alleviate any review responsibility for the clinician.

5. Shifting Regulatory Landscape
Recording laws and data privacy expectations are changing. Health systems must monitor these changes and adapt their policies accordingly.

Medico-Legal Considerations

1. Physician Responsibility Remains
Even if AI drafts the note, the physician is still responsible for its contents. Errors in the chart remain a liability.

2. Consent for Recording
Some states require two-party consent for audio recording. Even passive recording by AI tools can be a legal issue if patients are not notified.

3. HIPAA Compliance and Vendor Agreements
Health systems must ensure that any vendor handling protected health information complies with HIPAA and signs a business associate agreement.

4. Ethical Data Use
Some AI vendors use collected data to improve their models. If this isn’t clearly disclosed, it raises ethical and potentially legal concerns.

Final Thoughts

AI scribes offer real, measurable benefits in the emergency department. Clinicians can save time, reduce burnout, and improve note consistency. At the same time, these tools require active oversight. Clinicians still need to review what the AI generates, and organizations must ensure privacy, consent, and legal standards are met.These tools should be seen as assistants that support the clinician, not as replacements for clinical documentation responsibility.

References

1. Hartman, K. et al. (2024). AI-Generated ED Summaries Using T5 and BART. arXiv. https://arxiv.org/abs/2405.01368
2. Sasseville, M. et al. (2025). Impacts of AI Scribes on Clinician Workflow: A Rapid Review. Canada Health Infoway. https://doi.org/10.2196/ai-scribes-review
3. Menzies, A. et al. (2024). Pre-trained LLMs for ED Discharge Summaries. arXiv. https://arxiv.org/abs/2408.01372
4. Lee, H. et al. (2024). Improving Clinical Documentation: Sporo AI vs GPT-4o Mini. arXiv. https://arxiv.org/abs/2410.09221
5. Palm, R. et al. (2025). Quality of Ambient AI Notes Using PDQI-9 Scoring. arXiv. https://arxiv.org/abs/2505.07124
6. AMA. (2024). How Ambient AI Saves Time and Reduces Burnout. AMA Update Podcast. https://www.ama-assn.org/delivering-care/public-health/how-ambient-ai-saves-time-and-reduces-burnout
7. Avant Mutual. (2024). Legal Risks of AI Scribes in Clinical Practice. https://www.avant.org.au/news/ai-scribes-and-medico-legal-risk
8. HealthIT.gov. (2024). HIPAA and Emerging Technologies. https://www.healthit.gov/resource/hipaa-and-ai-guidance
9. The Medical Republic. (2024). Doctors Shouldn’t Trust AI Scribes Blindly. https://www.medicalrepublic.com.au/doctors-shouldnt-trust-ai-scribes-blindly/99220