Sure, let’s send private medical data to a cloud server somewhere for processing, because a medical professional in 2025 can’t be expected to know how to use a keyboard. That’s absurd.

None of those options are off-device.

Medical companies could self host their speech to text translation. At the end the medical data is also on some servers stored. So doing speech -> text translation seems just efficient and not too much worrying if done properly.

So you think the better solution to doctors not being able to try is for them to self-host a speech to text translation systems, rather than teaching doctors to type faster?

Their healthcare/IT provider like Epic would do it. And in fact some have already done it, from what I can see.

Furthermore, preparing/capturing docs is just one type of task specialization and isn’t that crazy: stenographers in courtrooms or historically secretaries taking dictation come to mind. Should we throw away an otherwise perfectly good doctor just for typing skills?

Who is responsible when the speech-to-text model (which often works well, but isn’t trained on the thousands of similar-sounding drug names) prescribes Klonopin instead of Clonidine and the patient ends up in a coma?

These models definitely aren’t foolproof, and in fact have been known to write down random stuff in the absence of recognisable speech: https://koenecke.infosci.cornell.edu/files/CarelessWhisper_E...

This isn't a speech recognition problem per se. The attending physician is legally accountable regardless of who does the transcription. Human transcriptionists also make mistakes. That's why physicians are required to sign the report before it becomes a final part of the patient chart.

In a lot of provider organizations, certain doctors are chronically late about reviewing and signing their reports. This slows down the revenue cycle because bills can't be sent out without final documentation so the administrative staff have to nag the doctors to clear their backlogs.

I imagine where the speech to text listens to the final diagnosis (or even the consultation) and summarizes everything in a PDF. Of course privacy aware (maybe some local hosted form).

And then the doctors double checks and signs everything. I feel like, often you go to the doctor an 80% of the time they stare at the screen and type something. If this could get automated and more time is spent on the patient, great!

Most EHRs are sending that text input to the cloud for storage anyway. Voice transcription is already a feature of some EHRs.

I can type quite well. I can also troubleshoot minor IT issues. Neither is a better use of my time than seeing patients.

I’m in an unusual situation as an anesthesiologist; I don’t have a clinic to worry about, so my rate-limiting factor isn’t me, it’s the surgeon. EMR is extremely helpful for me because 90% of my preop workup is based on documentation, and EMR not only makes that easy but lets me do it while I still have the previous patient under anesthesia. I actually need to talk to 95% of patients for about 30 seconds, no more.

But my wife is primarily a thinking rather than doing doctor, and while she can type well, why in the hell do we want doctors being typists for dictation of their exams? Yes, back in the old days, doctors did it by hand, but they also wrote things like “exam normal” for a well-baby visit. You can’t get paid for that today; you have to generate a couple of paragraphs that say “exam normal”.

Incidentally, as for cloud service, if your hospital uses Epic, your patients’ info is already shared, so security is already out of your hands.

Macs have pretty decent on-device transcription these days. That’s what I set up for my wife and her practice’s owner for dictation because a whole lot of privacy issues disappear with that setup.

The absurdity is that doctors have to enter a metric shit ton of information after every single visit even when there’s no clearly compelling need for it for simple office visits beyond “insurance and/or Medicare” requires it. If you’re being seen for the first time because of chest pain, sure. If you’re returning for a follow up for a laceration you had sewn closed, “patient is in similar condition as last time, but the wound has healed and left a small scar” would be medically sufficient. Alas, no, the doctor still has to dictate “Crime and Punishment” to get paid.

This has been happening for years, long pre-dating LLMs or the current AI hype. There are a huge number of companies in the medical transcription space.

Some are software companies that ingest data to the cloud as you say. Some are remote/phone transcription services, which pass voice data to humans to transcribe it. Those humans then store it in the cloud when it is returned to a doctor's office. Some are EMR-integrated transcription services which are either cloud-based with the rest of the EMR or, for on-premise EMRs, ship data to/from the cloud for transcription.

> now that Dragon / Whisper / your phone can do Speech to text quickly and relatively reliably.

It’s less accurate and much slower than a human typist (or 3) typing dictated reports.

Tested over years in an MSK radiology clinic.