Ambient clinical documentation without sending patient audio anywhere
Freed is $59 a month, or $39 billed annually. Heidi's Clinician plan is $150 a month, or $110 billed annually. Dragon Copilot, Abridge and Suki publish no price and quote through sales. All process audio in the cloud. Vocemo transcribes and drafts SOAP notes on the Mac for $15 a month.
- Published scribe prices
- Freed from $39 a month annually, Heidi Clinician $150 a month
- Not published at all
- Dragon Copilot, Abridge and Suki quote through sales only
- The local option
- $15 a month, flat, no per encounter or per seat charge
- What it is not
- No certification, no EHR integration, clinician review required
Is there an ambient scribe that does not send patient audio to the cloud?
Not among the named ambient documentation products. Dragon Copilot, Abridge, Suki, Freed, Ambience, Nabla and Heidi all capture the encounter on a phone or a laptop and process it on the vendor's infrastructure. That is how they can run models too large for a clinic laptop and update them every few weeks.
What does exist is a smaller category: a recorder and summariser that runs entirely on the machine in front of you. It does the two computable parts of the job, speech to text and text to a structured draft, and it does nothing else. It is not an ambient scribe in the product sense, because it does not sit in your workflow, does not know your patient list and does not write into the chart. It is worth understanding as a different tool rather than a cheaper version of the same one.
The general principle is covered in running AI on your own Mac, and if you want to check where any app actually sends data, is your AI app uploading your data gives you a method.
How much do AI medical scribes cost per clinician per month?
Two of the five publish a price. Three do not, and it is worth stating that plainly rather than repeating figures from comparison blogs, because those figures vary by a factor of four and none of them are on a vendor page.
| Tool | Where the audio goes | Published price |
|---|---|---|
| Dragon Copilot (formerly Nuance DAX Copilot) | Microsoft's cloud | None published. Microsoft's product page routes to contact us and pricing is quoted through sales |
| Abridge | Abridge's cloud | None published. There is no pricing page on abridge.com and contracts are quoted by sales |
| Suki | Suki's cloud | None published. There is no pricing page on suki.ai |
| Freed | Freed's cloud | Starter $59 a month, or $39 a month billed annually, up to 40 notes. Premier $119 a month, or $104 billed annually. 7 day trial |
| Heidi | Heidi's cloud | Free plan available. Clinician $150 a month, or $110 a month billed annually, in US dollars. 14 day trial on paid plans |
| Vocemo | Stays on your Mac | $15 a month, or $144 a year, which is $12 a month. 7 day trial |
If you would rather this ran on your own Mac, that is what Vocemo does. Free for 7 days, then $15 a month for 3 Macs.
Download free for MacPrices checked on each vendor's own site in September 2026. Where a vendor publishes nothing, this page says nothing. Third party estimates for the enterprise products range from roughly $200 to $600 per clinician per month, but they are estimates by people who are not the vendor, so treat them as gossip rather than as figures.
The shape of the market is clear even without those three numbers. Ambient documentation is sold per clinician per month, for ever, and a mid range plan costs more per year than the laptop it runs on. For a health system with two thousand physicians, that is a line item measured in millions. For a solo practitioner, Heidi's Clinician plan at $150 a month is $1,800 a year.
Why is every ambient scribe cloud based?
Four reasons, and none of them is laziness.
- Model size. The models that produce a genuinely good clinical note are large. Running one at speed needs more memory than most clinic hardware has. A cloud vendor can put it on hardware built for it.
- EHR integration. The value of an ambient scribe is mostly in where the note lands. Writing into Epic, Cerner or athenahealth needs a server side integration, credentials and a partnership. That work happens in the cloud by definition.
- Devices. Clinicians carry iPhones and Android phones and use shared workstations. A server keeps every device in sync and lets the note follow the clinician.
- Iteration. Specialty templates, coding suggestions and quality checks improve weekly. Shipping that to a server is faster than shipping it to thousands of laptops.
These are real engineering reasons. They also mean that a recording of a patient consultation travels to a third party and is processed there, which is the trade the rest of this page is about.
Are ambient scribes secure and do they sign BAAs?
The established ones generally are, and they do. Freed's own site states that it is HIPAA compliant, SOC 2 Type 1 and Type 2 certified and HITECH compliant, and its FAQ says audio recordings are held temporarily in a compliant manner until the note and quality checks are complete and are then deleted automatically. Its group plans include an organisation wide BAA. Heidi publishes a trust centre with HIPAA, GDPR, UK, Canadian and Australian pages. Dragon Copilot runs on Microsoft's healthcare infrastructure with the contractual apparatus that comes with it. Abridge and Suki sell to health systems whose procurement teams put them through security review before signature.
So the argument here is not that any of them is careless or non-compliant. It is narrower. A BAA is a contract that allocates responsibility for data a vendor holds. Encryption in transit and at rest protects data a vendor holds. Automatic deletion shortens how long a vendor holds it. All of that is worth having, and if you use a cloud scribe you should insist on all of it. It is still a different thing from the data never being held by anyone but you.
For some clinicians that distinction is academic and the integration is worth far more. For others, particularly in psychiatry, sexual health, occupational health, immigration medicine and any setting where the patient asks who else will hear this, it is the whole question.
What can a Mac actually do on its own?
The two computable parts of the job, and no more.
Transcription. Record the consultation, or import audio you recorded another way. Speech to text runs on the Mac's own processor with speaker separation, so clinician and patient turns are distinguishable. Nothing is uploaded.
Drafting. A local language model turns the transcript into a structured summary using a template. SOAP is included, along with DAP and BIRP for mental health work. The draft appears on screen. You edit it and press copy, and it goes onto the clipboard for pasting into your record system.
Vocabulary. Nine editable vocabulary presets ship with the app, including medical, veterinary and dental lists. They bias the recogniser towards terms it would otherwise get wrong. You can edit them, so a cardiology clinic and a dermatology clinic can each add their own drug names and abbreviations.
Requirements are macOS 13 or later on Apple silicon. The installer is 5.5 MB because no model ships inside it. Models download when you first use a feature and shut down after 120 seconds idle, so nothing sits in memory between patients.
What does the local option not do?
The honest list, because the gaps decide whether this is usable in your setting.
- No certifications. Vocemo is not HIPAA certified, not GDPR certified, holds no SOC 2 report, is not HITRUST certified, is not a medical device and has not been cleared, approved or registered by the FDA, the MHRA, the EMA or any other regulator. Nothing on this page is a claim of compliance with anything.
- No Business Associate Agreement, because there is no business associate. A vendor that never receives protected health information is not processing it on your behalf, so there is no data relationship for a BAA to describe. That is a statement about where the audio goes. It is not a legal opinion, and it does not complete your own analysis.
- You own the compliance assessment. HIPAA in the United States, the GDPR and UK GDPR in Europe and Britain, your national or state health privacy law, your employer's information governance policy and your professional regulator all still apply to you. So does the security of the Mac itself: disk encryption, screen lock, patching, backups and what happens when the machine is lost. Local processing moves the boundary onto your device. It does not remove it.
- Every note must be reviewed and signed by the clinician. Language models produce errors, and the dangerous ones are confident and fluent. A model can attribute a symptom to the wrong speaker, state a laterality it never heard, drop a negative, invent a dose or omit a red flag. Nothing in a generated draft is clinically reliable until a clinician has read it against the encounter. This applies to every product in the table, including the cloud ones.
- No EHR integration of any kind. No write back to Epic, Cerner, athenahealth, Meditech, EMIS, SystmOne, Best Practice or anything else. No patient list, no problem list, no orders, no coding suggestions, no ICD-10, CPT or E/M output, no billing, no claim submission, no dashboards. The note reaches your record system when you paste it.
- No ambient workflow. It does not know who your next patient is, does not prepare a visit summary from prior notes, does not answer clinical questions and does not follow you between rooms on a phone. You start a recording and you stop it.
- Mac only. Apple silicon, macOS 13 or later, three Macs on one subscription. No iPhone app, no web version, no Windows, no Android, no shared workstation login.
- Consent still applies. Recording a consultation needs the patient's agreement, and in some jurisdictions their explicit consent in writing. Where the file is processed changes what you tell them. It does not change whether you have to ask.
Who is a local tool actually right for?
A narrow group, and it is better to say so than to oversell it.
It fits a solo or small practice on Macs, with a record system you are content to paste into, where the objection to a cloud scribe is the audio leaving rather than the price. It fits psychotherapy and psychiatry, where the content of the recording is the most sensitive category of health data there is. It fits clinicians in jurisdictions where cross border transfer is the sticking point, since nothing crosses any border. It fits anyone whose patients ask directly who else hears this, because the answer is short. And it fits a clinician who wants a flat $15 a month rather than a per seat contract that grows with the practice.
It does not fit a hospital, a large group, anyone who needs coding support, anyone who needs the note in the chart without a paste, anyone on Windows, or anyone whose information governance department requires a named processor with an audit report. In those settings a cloud scribe with a BAA is the right answer, and Freed at $39 a month billed annually is a reasonable place to start looking at the self serve end.
Whichever you choose, the last step is the same. Read the draft, correct it, and sign it yourself. Prices verified September 2026.
Questions
How much does an AI medical scribe cost per month?
Freed publishes $59 a month, or $39 a month billed annually, for its Starter plan, and $119 a month, or $104 billed annually, for Premier. Heidi's Clinician plan is $150 a month, or $110 a month billed annually, in US dollars. Dragon Copilot, Abridge and Suki publish no price and quote through sales. Prices checked on vendor pages in September 2026.
Is there an offline AI medical scribe?
None of the named ambient scribes runs offline. What exists is on-device transcription and summarising, such as Vocemo on Apple silicon Macs, which records the consultation and drafts a SOAP note locally. It has no EHR integration and no certifications, and every note needs clinician review before it enters the record.
Does Dragon Copilot publish its price?
No. Microsoft's Dragon Copilot product page routes enquiries to a contact form, and pricing is agreed through sales and procurement. Figures circulating in comparison articles are third party estimates rather than published rates, so they should not be treated as the vendor's price.
Is an on-device scribe HIPAA compliant?
No tool is HIPAA compliant on its own, and Vocemo makes no compliance claim and holds no certification. What is factual is that the audio stays on the Mac, so no vendor receives protected health information and no Business Associate Agreement is needed with a party that never receives it. The compliance assessment, your local law and your device security remain yours.
Can AI-generated clinical notes be trusted without review?
No. Language models make errors, and the most dangerous ones are fluent and confident: a wrong laterality, a dropped negative, an invented dose, a missed red flag. Every draft from every product in this category is a starting point. The clinician must read it against the encounter and sign it.
Will a local tool put the note into Epic or my EHR?
No. There is no integration with Epic, Cerner, athenahealth, EMIS, SystmOne or any other record system, and no coding or billing output. The note is copied to the clipboard with one button and you paste it in. If write back to the chart is the point of buying a scribe, a cloud product with an EHR partnership is what you need.
Sources
Every price on this page was read from the vendor's own page on the date shown above. Prices change; if you find one out of date, tell us and we will correct it.
Competitor prices in this article were checked in September 2026. Prices change; if you find one out of date, write to us and we will correct it.