AI Scribe - Auto-Generate Notes from Client Sessions

AI Scribe - Auto-Generate Notes from Client Sessions

Overview

AI Scribe is a powerful feature in ICANotes+ that automatically drafts a clinical note using ambient listening for in-person and telehealth sessions or clinician dictation.

For in-person and telehealth sessions, AI Scribe uses ambient voice capture technology to listen to the conversation in the background, helping providers reduce manual typing and maintain focus on the client. When using Dictation, providers can speak clinical information about the client for AI Scribe to use when generating the note.

Note: Dictation is planned in the upcoming v10.4.0 release.

In addition to clinicians, case managers, interns, and paraprofessionals can use AI Scribe to generate these notes. For these roles, AI-generated notes use client-focused, non-prescriber language appropriate to their responsibilities.

You can record both in-person and telehealth sessions using AI Scribe.

NotesCurrently, this is available for the following note types. Support for additional note types will be introduced in future updates.
  1. Progress Note
  2. Complete Evaluation
  3. Quick Note (Coming in v10.4.0 release)

⚠️ Provider Responsibility Disclaimer

Use of the AI Scribe feature acknowledges that your practice will obtain patient consent where applicable. ICANotes does not monitor or enforce consent collection. By enabling and using this feature, your practice acknowledges full responsibility for:

  • Informing patients of AI usage

  • Obtaining and documenting informed consent

  • Reviewing all AI-generated content before finalizing clinical notes

Use of AI tools is at your discretion and should not replace clinical judgment.


Important Notes

  • Recorded sessions and local transcriptions are device- and browser-specific.
    • For example, if a session is recorded on an office laptop, it will not be available on a home laptop.
    • Similarly, sessions recorded in one browser will not appear in another browser.

  • A local transcription is the transcript text saved in the web browser on the device being used. Local transcriptions are automatically deleted after 72 hours (3 days). This cleanup occurs automatically in the background as part of routine compliance and storage maintenance. No notification is displayed when the cleanup occurs.

Best Practices

  • Speak clearly and provide information in a structured manner. Clear and detailed speech helps AI Scribe accurately generate and organize your documentation.

  • Avoid background noise as much as possible.

  • If your microphone is not connected or detected, a microphone troubleshooting popup appears with detailed instructions.

  • Always review the note before finalizing. Although AI-generated, the provider is responsible for the clinical content.

  • When using Dictation, clearly describe the clinical information you want included in the note. AI Scribe organizes the dictated information into the appropriate sections of the note.


AI Scribe Eligibility

AI Scribe is available to users with eligible clinical plan types.

Supported user roles include:

  • Prescribing clinicians

  • Non-prescribing clinicians

  • Notes-only clinicians

  • Case managers

  • Interns

  • Paraprofessionals


InfoImportant: Having an eligible plan type does not by itself enable AI Scribe. The user must also have the required permissions and the Clinician role assigned in Account Management.

Step 1: Enable AI Scribe

To enable this feature for your practice, fill out the form using this link: Plus - AI Scribe Feature

Once the form is received by our team, and your access is turned on, you will receive an email confirmation. Take the following steps after receiving the email to finalize access.

Step 2: Grant Access to the Feature 

Access to the AI Scribe feature is restricted to authorized users. Admins can access the feature by default, but they must assign permissions for other users.

NotesAI Scribe is available only for specific plan types. To check which users are eligible for AI Scribe, refer to the AI Scribe Eligibility section before Step 1.

To grant access:

  1. Go to Settings > Practice Settings > Roles & Permissions.

  2. Create a new role or edit an existing role.

  3. Expand the Notes tab.

  4. Select the AI Scribe checkbox.



Step 3: Confirm Clinician Role Assignment

For AI Scribe to function correctly, the user must have an eligible clinical plan type and the Clinician role assigned in Account Management. Even if the user has Administrator access, AI Scribe will not activate unless the Clinician role is also enabled.

To verify and assign the Clinician role:

  1. Go to Settings > Account Management.

  2. Locate the user’s account in the list.

  3. Under Roles, ensure that Clinician is selected (in addition to any administrative role).

  4. Click Save to apply the changes.



Step 4: Set Microphone Permission to Default

Ensure that your microphone permission is set to prompt automatically:

  • Go to your browser's Site Settings > Privacy and Security > Microphone.

  • Set the permission to Ask (default).






Step 5: Allow Microphone Access

When prompted by your browser while initiating AI Scribe:

  • Allow while visiting this site – Grants access every time you use this site.

  • Allow this time – Grants access only for the current session.

  • Never allow – Denies access and disables the feature. 






Selecting Never allow prevents the feature from functioning.

To proceed with recording, you must allow microphone access. The following screen allows you to adjust permissions.




Click Try Again to re-enable microphone access.

Step 6: Select a Session Type

Before starting AI Scribe, select the appropriate session type:

  1. In-Person Session: Use for sessions where the clinician and client are speaking in person.

  2. Telehealth Session: Use for sessions conducted remotely.

  3. Dictation: Use when you want to dictate clinical information about the client instead of recording a conversation.

When Dictation is selected, AI Scribe treats the recording as clinician narration and uses the dictated information to generate the clinical documentation.

Select the session type before clicking Start Listening.


Step 7: Select Tab for Telehealth Session

When you select Telehealth from the session type dropdown, choose which tab or screen to share. The following sharing options are available:

  • Chrome Tab

  • Window

  • Entire Screen

Warning
Important: To include audio in the session, make sure to turn on the Also share tab audio switch.




Step 8: Verify System Sound Settings

If your system detects silence after selecting a session type, a pop-up prompts you to verify your sound settings. For Telehealth sessions, the silence check applies to the clinician's microphone.

  • Click Open Sound Settings to confirm your device’s microphone is working. Mac users will have to perform this step manually. 

  • Select the checkbox to suppress the pop-up in future sessions.









Step 9: Start Recording

Once microphone access is granted:

  1. Select the appropriate session type.

  2. Click Start Listening.

  3. Begin speaking clearly. Transcription occurs in real time.

  4. A green indicator in the audio level meter confirms successful input.

  5. Use Pause to temporarily stop recording if needed.

When using Dictation, describe the clinical information you want documented. AI Scribe uses your dictated narration to generate and organize the note.




Step 10 (Optional): Hide/Show Transcript

During your recording session:

  • Click Show Transcript to view the transcription in progress.

  • Click Hide Transcript to collapse it during your session.


Show Transcript option



Hide Transcript option


Step 11 (Optional): Pause/Resume Session

During your recording session:

  • Use Pause to temporarily stop audio capture.

  • Click Resume when you're ready to continue.

NotesIf you try to navigate away while the session is paused, the system notifies you that the recording will be saved and stopped.


Pause Session option

Resume Session option


Notification on Exiting an Active Session

If you attempt to leave the AI Scribe session before the transcription is saved, a confirmation message appears.

Alert
Keep the AI Scribe session open until Step 2/2 is reached. Step 2/2 indicates that the transcription has been saved in the browser. You can safely leave the session after reaching Step 2/2. If you try to leave during Step 1/2, the transcription will be lost.






Step 12 (Optional): Restart Session

If you wish to begin a new recording from scratch, click Restart Session. A confirmation dialog will appear.

Warning
Restarting will delete the recorded session and its transcript.





Step 13: Finish Session and Create Note

Once the session is complete:

  1. Click Finish Session and Create Note.

  2. The system processes the session and generates a draft note.

  3. Review the transcribed content and make necessary edits before finalizing.

Warning
If you do not create the note immediately, make sure the transcription has reached Step 2/2 before leaving the session. The saved transcription can be used to create the note later.



FAQs

You are. As the provider or practice administrator, you are responsible for obtaining informed patient consent before using either AI feature with a patient. This includes explaining:
  1. That the session may be recorded (audio + metadata) 
  2. That AI may be used to help draft the clinical note
  3. That third-party processors will help power these features
If you are not able to obtain consent, you should not use the AI features for that patient.

What Data Is Captured?

When using the AI features, the following types of data may be collected:
  1. Text you enter
  2. Your voice and your patient’s voice 
  3. Session metadata required to properly structure the documentation
This data may include PHI (Protected Health Information).

How Is Data Handled?

  1. Data is processed by third-party AI providers:
    1. AWS Bedrock for Note Readability
  1. ICANotes maintains Business Associate Agreements (BAAs) with these vendors.
  2. All processing is conducted in accordance with HIPAA requirements.
  3. Data and AI-generated output may be used to improve model quality, under HIPAA-compliant safeguards.

Will AI Notes Be Automatically Saved to the Patient’s Chart?

No. All AI-generated output is saved as a draft and must be reviewed and accepted by the clinician before it becomes part of the patient’s medical record.

You are solely responsible for reviewing, editing, and finalizing the content.

Can I Use the AI Output As-Is?

We do not recommend relying on AI output without review. The AI tools are designed to assist you—not replace clinical judgment. Output may contain inaccuracies or require editing to meet your documentation standards.

Important Reminders

  1. You must obtain patient consent before using AI Scribe.
  2. ICANotes does not verify consent—this is your responsibility.
  3. Review all AI-generated notes before saving them to the chart.
  4. These features are designed to assist, not diagnose or treat.


Common Questions About AI Scribe

Does the client know they are being recorded?
AI Scribe records audio locally in the browser and sends it to our servers for processing. The audio is not retained on our servers.

When can I leave the AI Scribe session?
Keep the AI Scribe session open until Step 2/2. Step 2/2 indicates that the transcription has been saved in the browser. Once Step 2/2 is reached, you can leave the session and return later to create the note from the saved transcription.

How long are local transcriptions stored?
A local transcription is the transcript text saved in the web browser on the device being used. Local transcriptions are automatically deleted after 72 hours (3 days) as part of routine compliance and storage maintenance. This cleanup occurs automatically in the background without a notification.

Is the note generated immediately after the session?
The draft is typically available within a few minutes after stopping the AI Scribe session, depending on the length of the session.

Can I edit the auto-generated note?
Yes, you can and should review and edit the draft for accuracy before finalizing.

What happens if I forget to stop the listening session?
If you forget to manually stop it, the system will automatically time out after a pre-configured duration. However, it’s recommended to stop listening manually for better accuracy.

Can I use AI Scribe on mobile devices?
AI Scribe is currently supported only in the web application on desktop or laptop devices.

Can I access a note during the session?
Yes. While the session is running, you can navigate to the note to review details such as the client’s current medications, diagnoses, services, and more.

Can case managers, interns, and paraprofessionals use AI Scribe?
Yes. Case managers, interns, and paraprofessionals can use AI Scribe to generate notes. The generated notes use client-focused, non-prescriber language appropriate to these roles. Users must have the required access and permissions to use AI Scribe.

What is Dictation in AI Scribe?
Dictation is a session type that allows you to speak clinical information about a client for AI Scribe to use when generating documentation. Unlike an In-Person or Telehealth session, Dictation is intended for clinician narration rather than a conversation between the clinician and client.

When should I select Dictation?
Select Dictation when you want to verbally document information about a client instead of recording a conversation with the client.

Can I use the same recording controls when using Dictation?
Yes. You can use the same AI Scribe recording controls, including Pause, Resume, Restart Session, Show Transcript, and Finish Session and Create Note.


Need Help?

For further assistance, contact:
📞 Phone: 443-203-5857
📱 Text: 866-301-0085
📧 Email: ticket@icanotes.com
💬 Chat: https://app.icanotes.com


Proprietary Notice Information: This article is provided for informational purposes only, and the information herein is subject to change without notice. While every effort has been made to ensure that the information contained within this article is accurate, ICANotes cannot and does not accept any type of liability for errors in, or omissions arising from the use of this information.