Listen to the podcast here: Our Favorite AI Scribes and How To Use Them
Episode Summary: In this episode, Phil Boucher and Marina explore how AI scribes are transforming everyday pediatric practice. What once required hiring and managing a human scribe can now be handled by tools that integrate directly into the clinical workflow.
They share their experiences with different platforms and emphasize that there’s no one-size-fits-all solution—getting the most out of these tools requires some customization and experimentation. A key benefit is the ability to shift attention back to patients, with less time spent on the computer and more meaningful interaction during visits.
They also discuss the importance of reviewing AI-generated notes for accuracy, along with the relatively low cost and accessibility compared to traditional scribes—especially for DPC and independent practices.
Overall, AI scribes are quickly becoming a practical, patient-centered tool for improving efficiency while maintaining high-quality care.
Welcome to DPC Pediatrician. We’re Dr. Phil Boucher and Dr. Marina Capella, two DPC pediatricians who are on a mission to share our love of direct primary care with you.
Hey everyone, welcome to another episode of DPC Pediatricians. I will say that, I don’t know if you noticed, if you watch these on YouTube or Substack, you’ll notice that we wear the same clothes for several episodes because we record these in bulk, but we were looking at our list and kind of started our conversation before we actually started hitting record about scribes. And it is something that I realized that there’s a lot of different choices out there.
And Marina had to really quickly look up the settings for, and I did too, for my Heidi to see what we were doing because we were doing vastly different things. Today we’re talking about AI scribes.
And for me, this has been a game changer i will take you back to 2016 ish when i was at my busy pediatric private practice and i was like i think people are using scribes let’s get some scribes i got them to start a program we would have a computer on wheels which was like laptop on a little stand with wheels on it and i had a medical or a pre-medical student come in with me for every visit and he would like wheel his little cart in and he got really good at doing the notes.
Before I even said what I was going to do, I could tell he was clicking to put in like a specific antibiotic or something that I was going to do because he got so used to it and despite being not even in medical school yet he would come out and be like do you think that kid has autism um and things along those lines.
Wow that’s impressive i know he had such good like because he had like 4 000 clinical visits per year for two or three years and so he saw just so much clinical pediatric medicine And then he went off to medical school and I just got a text from him actually the other day and he’s a second year internal medicine resident right now.
And then we have another scribe and another scribe. When I started my new DPC practice, there wasn’t enough of a volume to necessitate having somebody follow me from room to room. Like it just wouldn’t. to have somebody on the payroll to do that.
They would be twiddling their thumbs most of the day. And in DPC, as we know, the notes, you have to communicate with yourself and anyone that’s seeing your patient and your medical legal requirements rather than getting these really complicated notes to satisfy billing requirements.
All that to be said, now that AI scribes are on the block and so good, it has really revolutionized the way that I am able to chart and document and see patients. And so we wanted to have a discussion today just around like what AI scribes are like or how you use them in your practice.
I’ll share first that I, don’t typically use an AI scribe for the bread and butter regular checkups simply because copying and pasting the all normal vitals, all normal everything from one system to another is just not worth anything. it for me to go through that hassle. My notes are pretty templated.
I know what’s typically done at a well check now. I know what the parents are going to say. If it’s something off the beaten path, then I’ll just write it down so that I remember to ask them about it next time. I’ll put in their weight and height and head circumference as I do them and then
just go on my merry way. So I don’t spend a lot of time with those straightforward checkups or like a runny nose cold those sorts of things but i’ve started doing a lot more visits because i’ve learned so much from dr capella here about ehd and
autism and all those sort of things those can be really complicated visits and so for those i don’t want to try and catch everything or i don’t want to be sitting on my computer typing the whole time i’m trying to have this conversation about all
the behaviors and things that a family is experiencing and so that’s the perfect opportunity for the ai scribe to really be there by my side, catching all of those things so that I can focus on the conversation flow, asking the questions of the things that I’m thinking about and have it be much more organic feeling.
And so that’s my typical time where I use an AI scribe in my practice. And it’s been quite revolutionary for actually documenting those things. How about you, Marina? When do you find yourself using one or do you use one?
I do. And it was actually the DPC docs and the online Facebook groups for DPC docs that really got me interested in AI scribes. I started to hear a lot of physicians talking about them and how amazing they were and this one and that one and the other one.
And so the very first one that I tried was called Freed AI, F-R-E-E-D AI. And it had a free trial. Most of them have free trials that you can use or like really basic versions that you can use for free. And so I tried Freed, but the notes were too simple, too simplistic for me.
They didn’t have enough detail. And then I tried another one. It was actually an osteopathic medical student who was rotating through my clinic and said, oh, I have a classmate who has his own company already. That’s AI Scribe. And so I think I tried that one called ScribeMatic. And same thing, it wasn’t enough detail, wasn’t robust enough.
And then in the DPC women group, I heard someone mention Heidi AI and they were like, oh, I really like this one compared to the others I’ve tried because it’s more detailed and it’s more robust. So I switched over to Heidi and it still wasn’t perfect, but I liked it better than the other ones.
And so I use Heidi a lot like you, Phil, where for the simple bread and butter visits, like the kid coming in for an ear check or for a cold or eczema or just like the typical like well child exams where there’s not a lot going on.
I don’t feel like I need to use it because that note takes me like three minutes to write after the visit. And I get to write it the way that I like it with my template already in place. And it’s just so easy. So I don’t really need it, right? However, I also…
do a lot of integrative consults and I do autism evaluations and I do just the very initial first visit for a new member that has a lot of complex concerns. That’s when it’s a beautiful, beautiful thing. And I do bring it into the room with me just on my phone.
I set it down on the table where it can pick up the audio from the parent and me. And I explained to the parent, Hey, I hope you don’t mind. I use this to record our session so that I don’t have to spend 20 minutes writing a note afterwards. And I’ve never had a parent complain.
They’re like, oh, yeah, that’s totally fine. Right. People are used to technology. Right. And so those are the ones where it really saves me a lot of time, because some of those new intakes, when I’m spending a full hour getting information from the family, that’s a lot of information that’s been collated and a lot of information that
needs to be transferred into a note. And even though none of these tools write the note exactly how I want it, they do a good enough job to get me about 70% of the way there. And then I have to go through and just edit it.
So overall, it still saves me 70% of the time I would have been expending. I also, interestingly, in my MBA program, I took a class on AI. The class, there were a lot of people in the class who were very into AI and they requested that they change the curriculum.
So they created a course taught by an information systems guy specifically on AI and how to understand it, like the things that it can do and the things that it cannot do. And also like the ethics and the governance around AI in large organizations.
But we also had to do some projects that helped us understand how AI actually works and how you train these neural networks to work, basically. And so through that process, I actually learned how to train Heidi templates so that they actually write the note in a way that fits better for me. So during class one day,
I opened my Heidi account and I was like, oh, now I know how to actually train this to write the note. more aligned with how I like my note. And I went ahead and I changed a bunch of things and I created new templates. And now I find that it’s working much better for me.
And it saves me now 80 or 90% of the time and much less editing that I have to do. How about you, Phil? Do you train any of your AI tools at all?
Well, the discussion that we were having was the fact that I’ve never paid for Heidi and that still is the truth. I double checked. I use the free trial version and so you can’t train it quite as much, but on the flip side, it doesn’t cost
you anything either my emr elation offers ai scribe as well but it’s a hundred or a couple hundred dollars extra per month and so i’ve just kind of been stuck on how can i do it for free and heidi has so far a allowed for that.
And so I don’t typically ask it to do extra things because I don’t expect it to do other things at the current price point. But if I was more serious about it, that is what I would do is train Heidi to do that. The other tool that the nurse practitioner in office
really likes and uses is open evidence which has a free scribe built into it as well and so there’s so many different options out there it’s mostly finding the one that fits your budget and fits your preferences and then just figuring out how to
most easily get it into your emr because the majority of them are outside of the emr and so you do at some point have to like copy and paste and transfer it in
there exactly It’s a little extra work. My EMR Atlas MD also has an AI tool, but I think you have to hit record and then you have to still somehow transfer it in, which is a little bit of a workaround. Basically, most EMRs nowadays are going to have a built-in AI tool.
I know that Hint has an AI tool also. And what’s the other one? Sigma. Sigma MD also has an AI tool. Now, how robust they are, I’m not sure. Obviously, when it’s something that’s included for free, it’s going to be more basic functionality. If it’s something that you’re paying for,
it’s probably going to have more options and more customizability. Phil uses the free version of Heidi. I use the paid one, which is something like 650 or 700 a year. But for me, because I liked that customizability, I felt like it was worth it because of the time and peace of mind that it saves me.
And now that I know how to train those templates, I can make it work for me even more. I have even been able to use it to help write some of my autism evaluations that used to take hours for me to like sit down and write kind of like a term paper. And now that saves me.
It’s cut the time in half or more that it takes me to write those.
Those are probably the best use case that I’ve had for saving so much time is for autism evaluations. Like you, I would have to spend forever and it took forever and I never looked forward to it. It always took forever to get it done. And now I’ve just uploaded
this is how I like it written, that sort of thing. And it makes it so much faster to be able to take the actual transcript of the multiple conversations that we’ve had. And what I’ll do, since I don’t have the paid version of Heidi, is I just strip the transcript of any identifying information so that there’s
nothing that they have. And then I can take those transcripts and plug those into any of the AI, like Gemini has a BAA, but even if you don’t, if you don’t have any PHI or anything like that, put that all in there put their gars in there put their ados in there have it put a
report for you together and it’s so much faster so that’s been really transformational oh yeah for me to do that i want to show you one thing if i can switch my camera over for one second i’m going to show you what i do at an adhd visit or something along those lines
So when I’m doing a ADHD evaluation or discussing with parent behavioral things or something that’s more complicated, it’s gonna be a 20 to 60 minute plus visit. What I do is I turn on whatever scribe I’m using And then I also have this little handy dandy iPad that I take in with me so that I
can jot notes. This allows me to capture the big picture bullet point things so that I don’t forget. And as we’re going through to the discussion, like it is nice to have it transcribed at the end, but if I’m not taking any sort of notes,
then it’s hard for me to remember what we’ve already said or those sorts of things. So basically I have this little PDF that I have created. I blocked out the patient’s name, but up here, it just kind of has their chief complaint HPI over here on the right-hand side.
It has like the, the, they like Nintendo they’re in fourth grade. They go to this school, the family history, those sorts of things. And then I always, so that I don’t forget have little boxes down here. Oops. Well, I don’t know what that did. That’s messing it up. So the blue one is sleep.
The green one is diet. The pink one is therapy. And then here at the bottom, this is the assessment, like what diagnoses they have. These are all the questions that I’m generating as we’re talking, but some of them I’ll answer or questions of things that we don’t know. And then my plan right here.
And Marina’s like, wow, I can’t believe people are so organized at his clinical degree. some of that energy to other aspects a little bit of a surprise i know right can you believe it but it’s really helped me to make sure that like i have a consistent
experience with the patients i don’t forget oh we didn’t even talk about sleep or we didn’t talk about what are the therapies they do or those sorts of things and then what i do is i take that document that i’ve handwritten on my ipad there and just upload it to the patient’s chart and that
is as much for me what i read rather than necessarily all of the note that’s been generated if i have more questions i’ll go back to the note if i have more questions i’ll look through that but the big picture of okay i’m wondering if we
should start them on methylphenidate and i wrote no next to that i wonder what that was about i want to get labs and i want to make sure and get a celiac panel because they haven’t had that done and i want to send them a vanderbilt those sorts of
things then when i leave the visit i have those kind of notes of what i’m doing yeah the other nice thing to do Yeah, the to-do. The Heidi has the really nice tasks that lets you see, okay, these are the things that I said during the visit that I’m going to actually do so
that I can checkbox those off of. Okay, I sent them that form. I sent in that prescription. That sort of thing gets all done there. I will say Alation does a really nice job now with their scribe tool. That it’ll put things in the correct boxes.
If I shout out that the patient is 46 pounds, it’ll put it into the weight box. So then it’ll show up in the growth chart. If I say I’m going to order a medicine, it will actually put on the task list, like order.
And then I can click a button and it will open the prescribing little box so that I can actually prescribe that or order a lab or to let me like, I’m going to tell my nurse to send a, a headstart sort of evaluation sort of thing,
it’ll create that and I can hit office message and then it’ll say, send headstart evaluation, that sort of thing. So there are a lot of nice features that you then pay more for, for using that integrated in there that saves you from having to transpose the information.
Yeah, definitely. Yeah. When it comes to, you know, the tool that we both use, Heidi, I guess I’m going to go out on a limb here, Phil, and say that I probably am a little pickier about how my notes are written than you are. But, you know, just like wanting a specific level of detail.
For example, I talk a lot to my families about nutrition. And so I’m like, okay, what are they eating for breakfast, for lunch, for dinner, beverages, snacks? Is it white bread? Is it wheat bread? Like, are these whole grains versus refined grains?
microbiome fermented foods and so i want that level of detail and a lot of the ai tools they’re like basic templates are going to just delete or they’re like not going to go into that much detail about those things so for anyone who’s in like functional medicine integrative medicine where we’re asking like those
in the weeds questions about lifestyle, that’s where I think the more customizable templates really come in handy because we want that level of detail. And, you know, I just want it somewhere. I’m not necessarily going to, you know, go back and refer to it frequently, but I want that initial intake note,
especially to be really comprehensive and have all those details so that if ever down the line, I’m like, wait, did we talk about this yet? I can just go back and refer to that original note and and make sure that I asked the question or that I followed through with something or I gave them the right recommendation,
et cetera.
I think one of the really powerful things about using a tool like this isn’t so much at the, like it’s nice, the documentation and those sorts of things and having, but being able to reference back and know what you talked about before and regain that information that otherwise would have been lost if you were just trying
to type everything out you would be you’d get distracted or the kid would sneeze and you’d get him a tissue and you’d forget to document the the very specific nuanced thing that you wanted to ask and just having somebody that’s constantly listening and catching all those details makes for such a more robust documentation
that then can be used down the line not that this is an ad for any particular ai scribe or for any particular emr but one of the really nice things in elation is you can ask the chart questions and it will tell you stuff so if you had documented
that previously and it was two years ago you could say like what kind of bread do they eat it would be able to look back through your old notes find that information and then they say well in in 2026 you actually asked them that and they said that they eat enriched white bread or something along those lines
Let’s talk a little bit before we close our conversation about kind of special cases with AI, because it can, you have a tool that’s listening to your conversation and anyone in pediatrics knows that that exam room can get chaotic at times. You can have like, you know, just the other week I had a kid,
a new patient who’s autistic and, you know, he was pretty loud and like banging toys and interjecting comments or like interjecting some things throughout the visit. And of course, As pediatricians, we’re very used to this and we’re able to focus on the parent while making sure the
kid is safe to the side and is getting his needs attended to intermittently. But AI scribes can have a little bit of difficulty when it comes to parsing out what was going on during the visit. Sometimes they can get confused, which is why it’s really important to review your note after and make the necessary edits.
But also in pediatrics, we often are seeing multiple kids in a family at the same time. And that’s where it gets tricky. Have you had any experiences where that works? Actually, yes.
Using Heidi just a couple of weeks ago, I thought, oh, let’s just do a double ADHD. They’re siblings. They’ll have enough of the same story that it’ll be fine. It wasn’t fine. But eventually I was like, fine, I’m just going to take notes on my iPad and we’ll see what Heidi comes up with. And I asked it.
go through one of the kids’ names is Jane. One of the kids’ names is John. Those are just made up names. Parse it together, make the notes. It did perfectly. Like it was able to track what the parents were saying without any trouble at all. And I even double checked because I was like,
this is going to be awful and I’m just going to use my iPad notes for this. But I asked it to reconstruct the notes as two separate kids and it did perfectly fine. So I think that that, I mean, like… If I can mentally put those things into buckets based on hearing them,
then I’m sure I can do just as well with kind of reconstructing those notes if you ask it. And the nice thing is you could always take the transcript, cut out all the PHI, put it into chat GPT or Claude or whatever you use and say, hey, this was two different patients, but it was a jumbled mess.
Work your way through the transcript, figure out which kid goes with what story and create some some notes for me. And I think that that would turn out fine, too.
Yeah. I guess the only case where I might see that being a little more problematic is like if you have a boy and a girl that might work out because parents are saying he or she appropriate. Right. versus if you had like twin boys right and they’re he he he like i don’t know that
ai would do as great of a job but that’s really cool that it did in that particular
circumstance the other make sure that it wasn’t a lot of like inaudible sorts of ref like if they’re just looking at one of the kids and expecting you to know that lucas versus benjamin then you’d have to make sure okay so lucas is the one that
likes to play basketball and benjamin like you could do that it would be imperfect but but i think you could probably get it pretty close if you were
Uh huh. Yeah. But you have to do some of that repetition in order to make sure it’s picking it up. Yeah. The other cool thing about a lot of these AI tools is multiple languages. So I have Spanish speaking patients and it has done a good job.
I think I’ve only used it like twice with a Spanish speaking family, but it’s done a really good job. So It’s really cool. I don’t know how many languages, obviously probably doesn’t have every language, but for more of the common languages that we see here in the US, it has some pretty robust functionality, which is really cool.
And also one of those interactions was the parent was kind of switching back and forth from English to Spanish, and it was still able to do a good job, which I was impressed with.
That is impressive then for sure.
Yeah.
I was going to say, so pick a tool, try it, see what works for you. Ask friends, don’t spend too much money on it and realize that it’s going to get better the more effort that you put into it. And if you can take the time to kind of customize it and figure out how it works.
then you’ll see how much time you recoup. But it’s not like you just plug it in and expect it to be perfect for you. Just like any employee, you’re going to have to work with them. You’re going to have to kind of fine tune things,
but that it’ll be worth it in the end to give it the time that it needs to really save you a lot of documentation and be able to allow you to focus on what’s most important, which is, in my opinion, not documentation.
Amen. I don’t think any of us love that documentation time. That is not why we became doctors. All right, everyone. Thanks for listening. Until next time.
