Where Does Your Patient's Story Go? What 15 Evaluated AI Scribe Vendors Do With Clinical Data

Every AI scribe makes the same promise: your notes, handled. But "handled" covers a wide range of data practices. When we evaluated 15 AI scribes for behavioral health, privacy and security was a full fifth of our 100-point rubric, and it produced some of the widest gaps between vendors we found anywhere ^[7].

This post is the plain-English version: what actually happens to your patients' stories, what to ask before you sign, and where the vendors stand.

The BAA is the floor, not the ceiling

A Business Associate Agreement is the legal minimum for handling protected health information ^[1]. It is basic enough that we made a publicly documented BAA an eligibility requirement for ranking at all. Two vendors we tracked, Nabla and Tali AI, remain unranked because neither publishes one ^[7].

But a BAA only says the vendor agrees to safeguard your data. It says nothing about whether they train their models on it, how long they keep it, or who else touches it. Those answers live in privacy policies and Terms of Service: documents most clinicians never read, and some vendors make hard to read.

Training policies and the free-tier carve-out

The most important sentence in an AI scribe's privacy documentation is rarely the first one. Marketing pages say "we never train on your data." The Terms sometimes say something narrower.

Our top-ranked vendor, Heidi (88/100), is the clearest example of why you read both documents. Its privacy policy states that customer data doesn't train models, but its Terms allow de-identified data use on the free plan ^[5]. That's not a contradiction, exactly; it's a carve-out. And it's the kind of carve-out that matters most to the clinicians most likely to use a free tier: solo practitioners watching every dollar.

Doximity Scribe (60/100, #7) in our scorecard as of Oct 22, 2026, sits at the other end of the disclosure spectrum: a BAA is signed per-user at registration, but the model-training policy is not disclosed ^[6]. Not bad, not good, just unknown. And an undisclosed policy cannot be weighed in a purchasing decision about patient data.

What "de-identified" actually means

When vendors say "de-identified data," many clinicians hear "anonymous." Under HIPAA, de-identification has a specific technical meaning ^[2]. Properly de-identified data falls outside HIPAA's protections entirely, which means it can be used for purposes the patient never consented to, including product development.

In mental health, this deserves extra skepticism. A therapy note stripped of name and date of birth can still be re-identifiable from clinical detail (rare diagnoses, distinctive histories, small communities). Psychotherapy notes get special protection under HIPAA's definitions for a reason ^[3], and substance-use records under 42 CFR Part 2 carry even stricter limits ^[4]. A vendor's generic "we de-identify" statement wasn't written with your SUD patients in mind.

Five questions to get answered in writing

Before you sign up for any scribe, get these answered from the actual policy documents, not the sales page:

1. Is the BAA public? If you can't read it before signing, that's an answer.
2. Can my data train models, including in de-identified form? Ask about the free tier separately; carve-outs live there.
3. How long is audio and transcript data retained, and can I delete it? Some vendors keep recordings far longer than you'd guess.
4. Who are the subprocessors? Your data passes through transcription engines, cloud hosts, and analytics tools. The vendor should name them.
5. How are psychotherapy notes and Part 2 records handled? Generic HIPAA language doesn't cover these. If the vendor can't answer specifically, neither can you when your patient asks.

What the strongest vendors document

The vendors that scored best on privacy in our rubric share three traits: a public BAA, a training policy stated without carve-outs, and documentation written for clinicians rather than lawyers. The full privacy and security breakdown for all 13 ranked vendors is on our scorecard, and the scoring itself is on our methodology page.

No vendor we reviewed earned a perfect privacy score. The best ones are transparent about their limits. The ones that document nothing score lowest: under the rubric, undocumented scores zero ^[7].

The bottom line: a BAA gets a vendor in the door. Whether you should stay depends on the training, retention, subprocessor, and Part 2 answers, and on whether the vendor documents them plainly enough for you to check.

*This post is based on our documentation-based reviews of 15 AI scribes (13 ranked, 2 tracked). We don't test products hands-on. Some links may earn us a referral fee at no cost to you; fees never affect scores or rankings, and there is no paid placement. See how we score. General information only, not legal or compliance advice. Corrections: corrections.*

Sources

1. Business Associates fact sheet. U.S. Department of Health and Human Services, Office for Civil Rights. https://www.hhs.gov/hipaa/for-professionals/privacy/guidance/business-associates/factsheet/index.html (opened 2026-10-18)
2. 45 CFR 164.514, Other requirements relating to uses and disclosures of protected health information (de-identification standard). Legal Information Institute, Cornell Law School. https://www.law.cornell.edu/cfr/text/45/164.514 (opened 2026-10-20)
3. 45 CFR 164.501, Definitions (psychotherapy notes). Legal Information Institute, Cornell Law School. https://www.law.cornell.edu/cfr/text/45/164.501 (opened 2026-10-18)
4. Understanding Confidentiality of Substance Use Disorder (SUD) Patient Records ("Part 2"). U.S. Department of Health and Human Services. https://www.hhs.gov/hipaa/part-2/index.html (opened 2026-10-18)
5. Heidi Health review: privacy policy vs. Terms on de-identified data (free plan). ClinicalAIWeekly. https://www.clinicalaiweekly.com/reviews/heidi (opened 2026-10-18)
6. Doximity Scribe review: BAA per-user at registration; training policy not disclosed. ClinicalAIWeekly. https://www.clinicalaiweekly.com/reviews/doximity (opened 2026-10-18)
7. Methodology: privacy and security rubric (20 of 100 points; publicly documented BAA as ranking gate). ClinicalAIWeekly. https://www.clinicalaiweekly.com/methodology (opened 2026-10-18)