AI Scribe — Product Access Model
Audience: Product, support, and customer success. Companion docs: Developer detail · QA guide
What it is
AI Scribe is a single billable feature sold per facility. A facility either has the AI Scribe bundle enabled or it doesn't. Within an enabled facility, an admin can choose which AI capabilities are active (transcription, suggestions, auto-documentation).
Bundling vs. self-serve
AI Scribe ships in two forms:
- Bundled with a facility's plan (sales-led, billing handled at the contract level).
- Self-serve add-on that a facility admin can turn on themselves from facility settings.
Both paths land at the same enforcement point: a row in facility_ai_settings with is_enabled = true. The product surface is what differs (sales tooling vs. self-serve toggle), not the gate.
Self-serve toggle location
CMS → Settings → Practice Settings → AI Scribe tab. Visible to tenant owners and admins (and any membership granted the manage_facilities permission). The page toggles the master + per-capability flags on facility_ai_settings for the currently selected facility.
What a facility admin controls
Once AI Scribe is enabled for a facility, the admin can independently toggle:
| Capability | Effect when off |
|---|---|
| Transcription | The AI Scribe sidebar in the encounter UI cannot start a new recording session. |
| Suggestions | No AI-generated clinical suggestions are produced or displayed. |
| Auto-documentation | Accepted suggestions are not auto-applied to encounter sections. |
Turning the master toggle off disables all three regardless of their individual state, and disables billing where applicable.
What a practitioner controls
A practitioner can override workflow preferences that don't affect what the facility is billed for or whether the feature is on:
- Preferred dictation language
- Medical-terminology mode
- Personal confidence threshold for surfacing suggestions
A practitioner cannot turn AI Scribe on or off, change the LLM provider, or alter retention. Those are facility-admin decisions.
Common questions
"AI Scribe stopped working for one of my doctors." First check whether the facility's AI settings still show transcription as on. A practitioner-level toggle cannot disable the feature, so this is almost always a facility-level change or a billing event.
"It works in dev but fails on staging with ai_scribe_disabled." That error means the facility on staging doesn't have AI Scribe enabled in facility_ai_settings. It is configuration, not a code bug. See the QA guide for the enablement recipe.
"Can we trial AI Scribe for a single doctor?" Not via the practitioner row — that controls preferences only. To pilot with a subset of clinicians, enable the facility and gate access in the clinical workflow (e.g., only certain practitioners get the encounter-side button shown). That is a UX decision, not a backend toggle.
Related
- ADRs: see
docs/guides/adrs/— none currently specific to AI Scribe gating; raise one if the model changes. - Developer doc: practitioner-overridable keys are listed in
Shared::AiSettingsResolver::PRACTITIONER_OVERRIDABLE_KEYS. Any change to that list is a product-relevant change.