The verdict in three sentences
In a New York multispecialty clinic seeing 300 visits a day, 8 minutes of documentation per patient adds up to 40 physician hours a day spent at a keyboard. An AI medical scribe listens to the visit, drafts a structured note and prefills the EHR, which the physician always reviews and signs before it is filed. A custom build costs around 50,000 to 90,000 USD, saving 4 to 5 minutes per visit with go-live in 12 weeks, provided HIPAA obligations and patient consent are handled properly.
How the pipeline works, from voice to chart
The physician starts recording on a tablet or desk microphone after informing the patient. Audio is transcribed, then a language model turns it into a structured note following the specialty template: chief complaint, history, exam, assessment, plan, proposed orders and prescriptions.
The physician reviews, edits and signs. Nothing enters the chart without that step. Audio is deleted after a short window set by the clinic, often 7 to 30 days.
The delicate point in New York is the real language mix of visits. Many patients speak Spanish, Mandarin, Russian or Haitian Creole, sometimes through an interpreter. The tool must be tested on local recordings, and the note stays in English even when part of the conversation is not.
| Step | Today | With the AI scribe |
|---|---|---|
| Note taking | During the visit, eyes on the screen | Listening to the patient, recording in background |
| Writing the note | 5 to 6 min after the patient | Draft generated in 30 to 60 seconds |
| Coding and orders | 2 to 3 min | Suggestions to confirm |
| Review and sign-off | No dedicated step | 2 to 3 min |
| Total time per patient | 8 min | 3 to 4 min |
| Chart quality | Varies with workload | Consistent structure per specialty |
2026 budget and architecture
| Item | 2026 order of magnitude (US) | Comment |
|---|---|---|
| Custom AI scribe build | 50,000 to 90,000 USD | Transcription, structuring, EHR integration |
| EHR integration (FHIR or vendor API) | Included or 10,000 to 25,000 USD | Depends on Epic, athenahealth, eClinicalWorks access |
| Off-the-shelf ambient scribe, for comparison | 100 to 400 USD per physician per month | Less control over templates and data |
| Transcription and model usage | 1,500 to 3,500 USD per month | For 6,000 to 7,000 visits |
| HIPAA-eligible hosting | 600 to 1,500 USD per month | Encryption, audit logs, BAA |
| Delivery time | 12 weeks | Including a 3 week pilot |
At Kolonell, this project sits at the complex level of our custom application grid: 7,000,000 to 15,000,000+ FCFA (10,670 to 22,870+ EUR), the exact figure depending on the number of specialties, EHR integration and hosting requirements. Maintenance is then 35,000, 75,000 or 120,000 FCFA per month (53, 114 or 183 EUR).
HIPAA, consent and liability
Under HIPAA, audio and notes are protected health information. Every vendor touching them, from the transcription engine to the cloud host, must sign a Business Associate Agreement. New York is a one-party consent state for recordings, but trust and good practice call for explicit patient consent in clinic policy.
The project includes four safeguards. Recorded verbal consent or a checkbox at the start of each visit, with refusal never affecting care. Encrypted hosting with role-based access and an audit log of every chart access. A BAA with the model provider that excludes training on your data. Mandatory physician sign-off, keeping clinical responsibility with the clinician.
The three week pilot with 4 to 6 volunteer physicians measures the edit rate on drafts. A reasonable target is under 10 % of the text changed by the end of the pilot.
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Dr. Rivera, medical director of the clinic, starts from 300 visits a day and a measured saving of 4.5 minutes per visit during the pilot. That is 1,350 minutes, or 22.5 physician hours freed per day.
She reallocates one third to new appointments: 7.5 hours, about 30 extra visits a day at 15 minutes. At an average net collection of 120 USD per visit, that is 3,600 USD a day, about 86,000 USD a month over 24 working days.
The project costs 75,000 USD, plus 4,000 USD a month for usage and hosting. Net monthly gain: about 82,000 USD. Payback comes in roughly one month, and the remaining two thirds of freed time goes to less rushed visits and fewer late-evening charting sessions.
FAQ
Must the patient agree to recording?
Yes, always. Patients are informed at check-in and at the start of the visit, and a refusal simply means manual documentation. In pilots, refusal rates typically stay under 5 %.
Can the AI make a diagnosis?
No. It restates what the physician said and examined. Assessments and proposed orders are drafts that only exist once the clinician signs them.
Do we need to change EHR?
No, if your EHR supports FHIR or a vendor API. Otherwise, an assisted copy interface works from week one, with about 30 seconds of handling per patient.
Where are recordings stored?
On encrypted HIPAA-eligible servers, deleted after 7 to 30 days according to your policy. Only the signed note stays in the chart.
How many specialties can we cover at launch?
Start with 3 to 4 high-volume specialties such as primary care, pediatrics and OB-GYN, then add one note template per specialty in 1 to 2 weeks.
Let's scope your project. We define with you the pilot specialties, EHR integration and consent workflow, for go-live in about twelve weeks. Detailed quote within 48 h. WhatsApp +221 77 596 93 33.
Mohamed Bah
Fondateur, Kolonell
Passionate about digital and entrepreneurship in Africa, Mohamed has been helping Sénégalese businesses with their digital transformation since 2020. Founder of Kolonell, he believes every SME deserves a professional and accessible online présence.
