06.02
Scribe
Executive summary
Scribe turns the conversation in the chair, or a dictation, into a structured clinical note and visit dossier. The model drafts; the note becomes part of the record only through a clinician save that carries a verifiable attestation. Recording survives interruptions, device changes and lost connections without losing captured audio or transcript.
Overview
- ProductionCapture · ScribeProduce a reviewed SOAP note and structured dossier from encounter audio without the clinician typing, and without inventing anything that was not said.
Pipeline
- Audio streams through Voice OS to streaming recognition; transcript segments are stored as working recovery data as they arrive.
- At stop, structuring turns the transcript into a SOAP note and dossier under a strict schema at low temperature, with PII scrubbing and schema repair.
- An optional critic pass reviews the draft; output validation routes unsupported, sparse or conflicting content to review rather than through it.
- The draft is stored as a clinical artifact with its AI decision record.
- The clinician reviews and saves. Finalization checks the acceptance attestation and entity verification, then accepts and locks the note.
- Fact writers emit medications, conditions and findings as proposed facts; Clinical Documents picks the accepted note up as a source.
Data owned
- Clinical sessions, events and segments
- Holds
- The capture session and its incremental transcript
- Voice records
- Holds
- The finalized canonical transcript row
- Note versions and amendments
- Holds
- Every saved version; corrections are additive amendments
- Diarization confirmations
- Holds
- Which speaker was the clinician, when diarization is used
- Unbound dictations
- Holds
- Dictation captured before a patient is bound, transcribed in the EU and attached later
| Store | Holds |
|---|---|
| Clinical sessions, events and segments | The capture session and its incremental transcript |
| Voice records | The finalized canonical transcript row |
| Note versions and amendments | Every saved version; corrections are additive amendments |
| Diarization confirmations | Which speaker was the clinician, when diarization is used |
| Unbound dictations | Dictation captured before a patient is bound, transcribed in the EU and attached later |
Models and engines
- Structuring and dossier
- Model or engine
- Gemini 3 Flash (pro tier)
- Notes
- Extraction temperature 0.1; schema-constrained
- Critic pass
- Model or engine
- Qwen3-8B with a critic adapter (self-hosted)
- Notes
- Optional second read; can only route to review
- Note structuring (sovereign)
- Model or engine
- Qwen3-8B with a SOAP adapter (self-hosted)
- Notes
- Routed through the clinical LLM worker when enabled, with Vertex fallback
| Step | Model or engine | Notes |
|---|---|---|
| Structuring and dossier | Gemini 3 Flash (pro tier) | Extraction temperature 0.1; schema-constrained |
| Critic pass | Qwen3-8B with a critic adapter (self-hosted) | Optional second read; can only route to review |
| Note structuring (sovereign) | Qwen3-8B with a SOAP adapter (self-hosted) | Routed through the clinical LLM worker when enabled, with Vertex fallback |
Guardrails
- Structuring never fabricates missing content; unsupported or sparse output goes to review or is rejected (SCRIBE-07).
- A clean AI note is accepted only when the save carries the server-verifiable clinician attestation; generation alone is never review (SCRIBE-08).
- Finalize is idempotent: a lost response and a retry return the same canonical record (SCRIBE-09).
- Recording consent is captured before capture, with a shadow mode for rollout.
- Patient binding is fixed for the whole save transaction; a patient change invalidates in-flight results (SCRIBE-05).
Rollout and status
- ProductionStreaming capture, finalize, dossier v2, resumeEnabled in the production configuration
- ProductionScribe fact writerWrites proposed facts from accepted notes
- ShadowRecording-consent enforcementConsent captured; enforcement mode in shadow
- Rolling outCritic passImplemented; enabled with the self-hosted critic adapter
- PlannedSpeaker diarizationImplemented behind a flag that defaults off
- PilotUnbound dictation trayADR 0032; enabled per clinic
Interfaces
- Consumes
- What
- Voice OS transcripts
- Consumes
- What
- Encounter binding from the clinical spine
- Emits
- What
- SOAP note and dossier artifacts
- Emits
- What
- Proposed clinical facts
- Emits
- What
- Accepted sources for Clinical Documents
- Emits
- What
- Chairside suggestions for the HUD
| Direction | What |
|---|---|
| Consumes | Voice OS transcripts |
| Consumes | Encounter binding from the clinical spine |
| Emits | SOAP note and dossier artifacts |
| Emits | Proposed clinical facts |
| Emits | Accepted sources for Clinical Documents |
| Emits | Chairside suggestions for the HUD |
Invariants
- SCRIBE-01…10 — capture, structuring, acceptance, idempotent finalize, additive amendment
- Unbound dictation invariants (ADR 0032)
Known limits
- Audio retention is implemented behind a flag that defaults off; by default only transcripts persist.
SOURCE OF TRUTH
server/routes/private/scribe.tsserver/routes/ai/scribe.tsserver/services/scribe/src/components/scribe/docs/clinical-invariants/scribe.md