Key takeaways
- Human scribes and AI scribes both aim to cut charting time, and both are legitimate options.
- A human scribe brings judgment and a working relationship, while an AI tool can be rolled out to many clinicians at once.
- Whichever you choose, the physician reviews and signs every note and stays responsible for the record.
- A scribe company or AI vendor that handles patient information for you generally needs a business associate agreement.
- Some states require every party to agree before a visit is recorded, and some require telling patients when AI is used in their care.
- Pilot with a few physicians and compare note quality, review time and total cost before you decide.
When physicians are finishing notes after clinic, practices often look at two common kinds of help: a medical scribe, who is a trained person, and an AI scribe, which is software. This guide compares the two on how they work, where each fits, accuracy, privacy, patient consent and cost.
What is the difference between a medical scribe and an AI scribe?
A medical scribe is a trained person who documents the visit in the EHR while the physician sees the patient, either in the exam room or remotely. An AI scribe is software that captures the conversation through a phone or computer microphone and drafts a note. Either way, the physician reviews, edits and signs the final note.
Human scribes: in person or remote
An in-person scribe works in the exam room. A remote scribe joins the live visit over an audio or video connection, and some remote services work from a recording after the visit instead. Over time, a scribe learns each physician's templates, phrasing and preferences.
AI scribes: ambient documentation tools
Ambient AI tools capture and transcribe the visit, then draft a structured note, either inside the EHR or as text to copy into the chart. At The Permanente Medical Group, 7,260 physicians used an ambient AI scribe in more than 2.5 million patient encounters between October 2023 and December 2024, according to Kaiser Permanente's Division of Research.
How do human and AI scribes compare?
The main differences are who does the work, what gets captured and how it is paid for. A human scribe brings judgment and a working relationship, an AI tool can reach many clinicians quickly, and in both cases the physician must review and sign the note before it is final.
| Compare | Human scribe | AI scribe |
|---|---|---|
| How it works | A trained person documents the visit in the EHR, in the room or remotely | Software captures the conversation and drafts a note |
| Physician role | Reviews and signs the note, and gives feedback the scribe learns from | Reviews, edits and signs the draft |
| What it captures | What the scribe hears and sees; a remote scribe may need exam findings said aloud | Mainly what is said aloud; unspoken findings may need adding |
| EHR fit | Usually works inside your EHR with their own login | Varies, from built-in EHR integration to copying text into the chart |
| Cost structure | Wages for scribes you employ, or a service priced by scribe time or provider coverage | Often licensed per clinician, sometimes bundled with other software |
Which visits and physicians suit each option?
Fit depends on how your visits run and how each physician likes to work. AI tools tend to suit conversation-heavy visits and physicians who are happy to edit a draft. Human scribes tend to suit physicians who want a person they can train and give feedback to. A short pilot is the clearest way to find out.
Specialty plays a part too. In the Kaiser Permanente rollout, physicians in mental health, emergency medicine and primary care were among the most likely to use the AI scribe, and those in infectious disease, obstetrics and gynecology, and urology were the least likely. Also consider:
- Visit type. Conversation-heavy follow-ups suit AI tools well. In procedures, wound care and exam-heavy visits, the physician may need to say key findings aloud for an AI tool or a remote scribe.
- Several speakers. With interpreters or family members in the room, check that the note attributes each statement to the right person.
How accurate are the notes, and who is responsible?
Both human and AI scribes make mistakes at times, and neither takes responsibility for the record away from the physician. Under CMS Medicare review guidance, a scribe does not need to sign the note, the treating physician's signature affirms that the note adequately documents the care provided, and the same concurrence is required when AI captures the entries.
That guidance is in chapter 3, section 3.3.2.4 of the Medicare Program Integrity Manual, which tells Medicare review contractors how to check signatures. Research so far shows benefits and limits for both options:
- A 2025 randomized trial in NEJM AI, led by UCLA researchers, of 238 physicians across 14 specialties found that one of the two AI tools tested modestly cut time spent writing notes compared with usual care, while the other showed no significant difference. Physicians reported occasional clinically significant inaccuracies, most often omissions and pronoun errors.
- A study at six U.S. health systems in JAMA Network Open found that the share of clinicians reporting burnout fell from 51.9% to 38.8% after 30 days of using an ambient AI scribe. It had no control group, so other factors may have played a part.
- A 2017 randomized trial in the Annals of Family Medicine, with four family physicians, found that human scribes improved physician satisfaction and the share of charts closed within 48 hours, without affecting patient satisfaction.
- A 2017 simulation study in JMIR Medical Informatics, in which five experienced scribes documented the same recorded visits, found significant variability in note structure and accuracy. The assessment and plan was the least accurate section.
Whichever you choose, read the assessment and plan closely, check medications and doses, confirm diagnoses and codes, and spot-check notes in the first weeks.
What about patient privacy and consent?
Two sets of rules matter most. HIPAA governs how any outside vendor, human or AI, handles patient information on your behalf, which usually means a business associate agreement. State laws govern whether everyone in the room must agree before a visit is recorded or listened to remotely, and some also cover telling patients when AI is used.
Vendor agreements under HIPAA
Under 45 CFR 160.103, a vendor that creates, receives, maintains or transmits protected health information on your behalf is a business associate. A scribe you employ directly is part of your workforce, not a business associate. HHS guidance on business associates explains that the vendor's promise to safeguard that information must be in writing, usually as a business associate agreement (BAA), so put it in place before the vendor handles any patient data.
HHS cloud computing guidance adds that a cloud provider that stores patient data is still a business associate even if the data is encrypted and the provider cannot view it. Compare contracts with the HHS sample BAA provisions.
State recording, consent and AI disclosure laws
Some states require every party to agree before a private conversation is recorded or intercepted. California Penal Code section 632 bars using an electronic amplifying or recording device to eavesdrop on or record a confidential communication without the consent of all parties, and Florida Statutes section 934.03 allows interception when all parties have given prior consent. These laws can apply to an AI tool that records the visit and to a remote scribe who listens in.
Some states also require telling patients about AI. Since January 1, 2026, Texas law has required health care providers to tell patients when an AI system is used in relation to their care or treatment. Ask your attorney whether a law like this covers your AI tool.
A simple approach is to tell patients at check-in, document their answer and make declining easy. The AMA principles for augmented intelligence also call for appropriate disclosure and documentation when AI directly affects patient care or the medical record.
Questions to ask any vendor
- Will you sign a BAA before any access, and which subcontractors will handle our data?
- Where are audio, transcripts and notes stored, who can access them, and how long are they kept?
- Is our data used to train your product, and can we opt out?
- How do we report an error in a note, and how is it fixed?
How do the costs compare?
Costs are structured differently, so compare totals rather than headline prices. Scribes you employ cost wages, training and supervision, and scribe services are often priced by scribe time or provider coverage. AI tools are often licensed per clinician, sometimes bundled with other software. Either way, include setup, EHR integration, support and the physician time spent reviewing notes.
How should your practice decide? A decision checklist
Start with how your physicians work and what your visits look like, then run a short pilot with a few physicians before you commit. Compare note quality, the time physicians spend reviewing and editing, patient feedback and total cost, and settle the contract, BAA and patient notice before the pilot starts.
Work through these with your physicians, practice manager and compliance lead:
- Physicians, visit types and locations in scope
- Whether each physician prefers editing a draft or working with a person
- How notes reach your EHR, and what access each option needs
- A signed BAA, plus contract terms on data storage, retention and training use
- A patient notice and consent process that fits your state's laws, including how patients can decline
- Who reviews notes, and how errors are reported back
- Total cost, including physician review time
- A pilot with a few physicians before you decide
To see what a finished scribe note can look like, view our sample SOAP note.
How Masscare can help
Masscare provides real-time online scribing for U.S.-based physicians and specialists. A person from our clinically informed team joins live encounters remotely and documents the visit in your EHR.
Before we start, we learn each provider's templates, phrasing and specialty requirements. Patient information is shared with us only under an agreed engagement with your practice. If you need a scribe in the exam room, we may not be the right fit. Our support includes:
- SOAP notes written in each provider's style
- EHR documentation with ICD-10 diagnosis coding
- Notes reviewed for accuracy, then uploaded for physician review and e-signature
- A conversation before we start about how patients are told a remote scribe is present
Frequently asked questions
Is an AI scribe better than a human medical scribe?
Neither is better for every practice. AI scribes tend to fit physicians who are comfortable editing drafts and visits where most findings are spoken aloud, and they scale quickly. Human scribes tend to fit physicians who want a person they can train and give feedback to. A short pilot with a few physicians is the clearest way to decide.
Does a physician have to review notes written by an AI scribe?
Yes. The physician reviews, edits and signs every note, whether a person or software drafted it. For Medicare medical review, CMS guidance says the treating physician's signature affirms that the note adequately documents the care provided, and that the same concurrence is required when AI is used to capture medical record entries.
Do patients need to consent to an AI scribe or a remote scribe?
It depends on state law and your policies. California and Florida, for example, require every party to agree before a private conversation is recorded or intercepted, and Texas requires providers to tell patients when AI is used in relation to their care. A simple approach is to tell patients at check-in, document their answer and let them decline.
Does an AI scribe company need to sign a BAA?
Generally, yes. Under HIPAA, a vendor that creates, receives, maintains or transmits protected health information on your behalf is a business associate, and a business associate agreement should be in place before it handles that information. The same applies to a human scribe company. Also review the terms on data storage, retention and use of your data for training.
Can a practice use both a human scribe and an AI scribe?
Yes. A practice can offer an AI tool to physicians who like editing drafts and a human scribe to those who prefer working with a person, or match the option to the clinic and visit type. The same basics apply to both: a BAA with each vendor, a clear patient notice and physician review of every note.
This page is general information, not legal, compliance or billing advice. State recording, consent and AI disclosure laws differ and change over time, so check with your attorney or compliance lead before any visit is recorded or listened to remotely. Sources last checked in October 2026.