Buy an ambient scribe if your consultations are mostly conversation and you can spend roughly $80 to $110 per clinician a month. Choose dictation if you mostly write letters, procedure notes and quiet-room summaries and want to spend little or nothing. Both still need the clinician to read and sign every note.
Most listicles stop at feature lists. The number that separates the two is the running cost per signed note, which includes the subscription, the minutes spent correcting, and the days someone spends setting templates up. A free tool that costs six minutes of correction per note can be dearer than a paid one that costs one.
What each tool does to a consultation
Dictation means the clinician speaks the note after (or between) patients, usually with spoken punctuation, and the software turns it into text in the record. The clinician decides what goes in. An ambient scribe listens to the whole conversation, with the patient's agreement, and drafts a structured note, so the clinician decides what stays in.
That difference drives everything else. Dictation puts the effort in the clinician's mouth during the working day. Ambient puts it in the clinician's eyes afterwards, as a review. Dictation rarely invents anything because the clinician said every word; an ambient draft can include something that was only mentioned in passing, or leave out something that was said quietly.
| Question | Dictation | Ambient scribe |
|---|---|---|
| Who creates the wording | The clinician, aloud | The tool, from the conversation |
| When the effort lands | During or just after the visit | At review, usually after the visit |
| Patient involvement | None needed if dictated alone | Patient must be told and agree to recording |
| Typical failure | Misheard drug name or number | Missing or invented detail, wrong negation |
| Best for | Letters, procedures, results, quiet consultations | Talk-heavy review, history and counselling visits |
| Price shape | Free to low per user, or quote-only enterprise | Free tier to roughly $110 per user a month |
The Complete Excel Course with AI Integration
From formulas and pivot tables to Power Query, DAX, VBA and AI with Copilot, ChatGPT and Claude — hands-on from the first lesson.
By Sagnik Bhattacharya and Virginia Thorn, Primetime Emmy Award winner
Buy nowPer-user running cost, from the vendors' own pages
Prices below were read from each vendor's page on 4 November 2026 in USD. They move, so treat them as a starting point and re-check before you commit. Freed's page shows the figures below by default, but Premier reads $119 when its monthly-billing toggle is selected, so confirm which billing term any quote assumes.
| Option | Published price | What it covers |
|---|---|---|
| Heidi Free | $0 | Unlimited ambient documentation and cited clinical answers |
| Heidi Clinician | $110 per user a month, billed annually | Adds custom templates, pre-charting and billing-code support routines |
| Freed Starter | $39 a month | One clinician, up to 40 notes a month |
| Freed Core | $79 a month | Unlimited notes, template builder |
| Freed Premier | $104 a month | Adds dictation and saved phrases, letters, EHR push and ICD-10 coding support |
| Dragon Copilot | No public price | Sold through Microsoft's sales team to health systems and provider organisations |
| Phone or desktop voice typing | $0 | Plain text only, no clinical structure, privacy terms to check |
Dragon Copilot is enterprise-only in practice. Microsoft's page is written for health systems and provider organisations, describes the tool as embedded within supported EHRs such as Epic, and shows no price, trial or self-serve sign-up; the route in is a sales contact. If you run a practice of five or fewer, ask Microsoft's sales team if you are curious, but do not plan around it.
Two things in the table are easy to miss. Freed's cheapest plan caps notes at 40 a month, which a clinician seeing 15 patients a day uses up in under three working days. And Heidi's free tier is free for the ambient note itself, so the paid step is for templates, routines and team features. Ask what you lose if you stay on the free plan before you pay.
The sums for a four-clinician practice
Illustration: a general practice with four clinicians, each seeing 18 patients a day over 20 working days, so 360 notes a clinician a month. Assume typing a note after the visit takes six minutes. Dictation, including fixing mistakes, brings that to 3.5 minutes. An ambient draft that needs a one-and-a-half minute review brings it to 1.5. These timings are assumptions to replace with your own measurements.
- Typing: 360 notes at 6 minutes = 36 hours a month per clinician.
- Dictation: 360 at 3.5 = 21 hours, saving 15 hours.
- Ambient: 360 at 1.5 = 9 hours, saving 27 hours.
Now the money. Four clinicians on Freed Core is 4 x $79 = $316 a month. Four on Premier is 4 x $104 = $416. Four on Heidi Clinician is 4 x $110 = $440 a month, or $5,280 over a year. Dictation on built-in voice typing costs nothing in subscription but saves 15 hours a clinician rather than 27, a gap of 12 hours.
If you value a clinician hour at $100, those 12 extra hours are $1,200 a month a clinician. Even if only a third of the time saving turns into something real, such as finishing on time or seeing another patient, an $80 to $110 subscription still pays back. The sum flips when your clinicians write short notes already, when most visits are procedures, or when review takes four minutes because the drafts are poor. Run the sum with your own minutes.
Cost per saved hour
Divide the monthly price by the hours saved: $79 / 27 hours is about $2.93 an hour on Core, and $110 / 27 is about $4.07 on Heidi Clinician. Both are small beside any clinician's hourly cost. The decision therefore rests on safety and fit more than price, which is where practices go wrong when they chase the cheapest line.
Which consultations suit which tool
Look at one week of your appointment book and sort visits into three piles. Talk-heavy visits (new problems, long-term condition reviews, counselling) go to ambient. Short, examination-led or procedural visits go to dictation. Paperwork (referral letters, insurance reports, results letters) goes to dictation or a template, because the content comes from your judgement rather than from what was said in the room.
Example: a procedure list
A minor-surgery clinic running eight procedures a morning has little conversation to capture. The useful note is the consent, the technique, the closure, the specimen and the aftercare. A clinician dictating 40 seconds per procedure, using a saved phrase for the consent wording, finishes faster than reviewing a draft the scribe built from a nervous patient's small talk.
Example: a diabetes review
A twenty-minute review mixes home readings, diet, medication adjustments and a foot check. An ambient scribe captures the discussion and the plan, and the clinician adds the examination findings. Dictation would mean repeating all of it.
Example: a telephone consultation
Ambient works here if the tool accepts a phone or speaker input. A telephone consult has no examination, so the transcript carries nearly everything, which is the best case for a scribe. Check that the vendor supports your phone setup, because some tools only record in-room audio.
What a dictated note and an ambient draft look like
Illustrative dictation, as spoken: "Referral to cardiology, new paragraph. [first name] [surname], fifty-eight, three weeks of exertional chest tightness, no rest pain, comma, no syncope. Examination, colon, blood pressure one forty over ninety, heart sounds normal. Request exercise ECG and review, full stop."
Typical errors to catch in that clip: an age heard as "fifteen" for "fifty", a drug or condition turned into a similar-sounding word, and punctuation commands typed out as words. Dictation errors are word-level and easy to spot on a read-through.
Illustrative ambient draft from a conversation where the patient said "I haven't had any chest pain, but my breathing is worse on stairs":
History: Patient reports worsening breathlessness on stairs over three weeks.
Denies chest pain.
Medication: Continues ramipril 5 mg daily. <-- never mentioned; check
Plan: Chest X-ray requested; review in two weeks.The fix is in the line marked by the arrow: the drug appeared in the draft because it was in the record, not because it was said. Ambient errors are meaning-level: a negation flipped, a medication carried over, a plan stated by the patient recorded as the clinician's. They need a slower read than dictation errors, so build review time into the cost, and see the six note errors to catch before you sign.
Privacy, consent and where the audio goes
Ambient capture means a patient's voice, and sometimes a family member's, passes through a vendor. Before a trial, get three answers in writing: will the vendor sign a business associate agreement (BAA), is audio deleted or kept, and are conversations used to train models. Vendors differ. Heidi's help article says live sessions are transcribed in real time and the audio is never stored; Nabla's privacy article says it processes audio in chunks, discards them, and keeps transcripts and notes for 14 days by default; Freed's FAQ says recordings are saved temporarily until the note and quality checks finish and are then deleted automatically. Those were the vendors' statements when last checked, and a statement on a web page is not a contract.
Dictation avoids the third-party-voice problem only if the clinician dictates alone. The audio is still personal data, so the same BAA and retention questions apply to a dictation vendor. The practical difference is consent: dictating alone needs no patient permission to record, which makes dictation the simpler option for a practice that is nervous about patient reaction. The vendor security questions tutorial has a full list.
Consent wording that works
Put a sentence on the booking confirmation and repeat it at the start: "We use a tool that listens to the consultation and drafts the notes. I check every note myself. Tell me if you would rather I didn't, and I will type them." Keep a record of refusals, and keep the typing fallback working so that nobody feels pressured.
Picking by practice size and habits
A solo clinician who dislikes technology and writes few notes should start with free dictation plus a template for common letters, then trial one ambient free tier on the talk-heavy afternoon list. A practice of two to five clinicians usually gets the best result from one paid ambient plan with dictation included (Premier-style), because staff move between modes without a second subscription. A practice of six or more, with a shared EHR and templates, should ask each shortlisted vendor about team plans, audit logs and EHR integration, since a custom-price team plan is where those features live.
If you also need a phone assistant or a website chatbot, check whether to buy one suite or separate tools before you sign a long scribe contract, and compare the scribe costs against the wider small-clinic price comparison.
A two-week trial you can run on Monday
Choose two clinicians who disagree about technology. Give each the same tool for a fortnight, covering a mix: five talk-heavy visits, five short ones, three letters. Before starting, time how long they spend on notes now, for one normal day.
- Day 1: set one template for each of the three visit types and confirm the consent wording is in use.
- Days 2 to 5: use the tool on every eligible visit and log, for each note, the review minutes and the number of corrections.
- Week 2: add the paperwork pile and test the weakest area, such as a noisy room or a patient with a strong accent.
- Day 10: compare against the baseline day, then read ten signed notes side by side with what the clinician remembers saying.
Pass marks, which you should set before you start: review time under two minutes a note, fewer than one meaning-level correction in five notes, and no patient complaint about recording. A tool that misses on corrections, not price, goes to the bottom of the shortlist.
Example: a trial that exposed a hardware problem
Illustration: a four-clinician practice tried an ambient tool with a phone propped on the desk across the consultation room. Drafts missed whatever the patient said from the couch. The fix was a small clip microphone near the patient and a short script asking patients to speak up, after which corrections roughly halved. Ask the vendor what microphone setup it expects, and budget a small amount for hardware.
Costs that never appear on the price page
The subscription is the visible part. Four other lines decide whether a practice is happy at month six, and each can be estimated before you buy.
- Template set-up. Budget two to four hours per clinician to build the three or four note layouts they use. Say 3 hours x 4 clinicians = 12 hours, which at the $100 an hour used above is $1,200 once. Ambient tools with a template builder reward this time; tools with fixed formats can leave clinicians editing the same headings daily.
- Integration. A tool that pushes the note into your EHR saves a copy-and-paste per patient, roughly 20 to 30 seconds. Over 360 notes that is two to three hours a clinician a month. If a vendor charges extra for the connection, put the fee next to those hours.
- Hardware. A clip-on or table microphone for each room, and a headset for each dictating clinician. Ask the vendor what it supports, because some dictation software only works well with specific microphones.
- Exit cost. Annual billing, as Heidi's $110 price uses, locks in twelve months. Ask whether notes and templates can be exported if you leave, and how long the vendor keeps transcripts afterwards.
Saved phrases and voice commands that make dictation faster
Dictation gets quicker the moment a clinician stops speaking whole sentences for routine text. Tools that include dictation with saved phrases, such as Freed's Premier plan, let you say a short trigger and drop in a block. A filled-in starter list for a general practice:
| Spoken trigger | Text inserted | Saves |
|---|---|---|
| "Safety net standard" | Advised to return or call urgently if symptoms worsen, new symptoms develop, or no improvement within the stated time. | About 12 seconds |
| "Consent minor procedure" | Risks, benefits and alternatives discussed; patient understood and gave verbal consent to proceed. | About 15 seconds |
| "Work note usual" | Work absence note issued; patient advised on phased return and review date. | About 10 seconds |
| "Results normal letter" | Dear [first name], your recent test results are within the expected range. No further action is needed. Please contact us if symptoms change. | About 25 seconds |
Ten triggers like these, used four times a day each, are 40 insertions at roughly 15 seconds saved apiece: about 10 minutes a day, or close to an hour across a five-day week. The risk is a phrase inserted into the wrong note. Keep triggers short but distinctive, keep the wording clinically neutral, and review the list every quarter so nobody keeps a phrase that no longer reflects practice policy.
A scoring sheet for the trial
A sheet on one page stops the trial turning into an argument about impressions. Score each clinician, each tool and each visit type, using the same five measures. A filled-in example for one clinician after the first week on an ambient tool:
| Measure | Typed notes (baseline) | Ambient week 1 | Pass mark |
|---|---|---|---|
| Minutes on notes after clinic | 74 | 31 | Under half the baseline |
| Review minutes per note | 6.0 typing | 1.8 | Under 2.0 |
| Meaning-level corrections in 20 notes | n/a | 6 | Fewer than 4 |
| Patients who declined recording | n/a | 2 of 90 | No complaints |
| Clinician would keep using it (1 to 5) | n/a | 3 | 4 or more |
This clinician passes on time but fails on corrections and on their own verdict, so the follow-up is not a purchase but a second week with a tighter template and a microphone change, then a re-score. The numbers are invented for illustration; your own sheet will differ. What matters is that the pass marks were written down before the trial started and that two people, not one enthusiast, fill them in.
Keep the sheet after the decision. Six months on, repeat the same five measures on one clinician for one week. Drift is common: templates go stale, new staff skip the consent sentence, and review gets quicker only because people stop checking.
When to stay with dictation, and when to leave it
Stay with dictation if your clinicians already dictate fluently, if your visits are short, or if patients often object to recording. Move to ambient when the typing backlog is the problem and the notes are conversational. If you try ambient and your corrections stay high, going back to dictation is a sensible result, not a failure.
If you would rather map this against your own appointment book, that is what my AI implementation consultation covers.
Questions practices ask before choosing
Can I use free phone dictation for patient notes?
Only if the vendor will sign a business associate agreement (BAA) or your privacy rules otherwise allow it, and few consumer dictation tools do. Check the terms for where audio is processed and whether it is kept. If you cannot confirm that in writing, use a clinical tool that offers a BAA.
Does an ambient scribe replace dictating a referral letter?
Not entirely. Most ambient tools can draft a letter from the consultation, but a letter that needs your reasoning, not just the conversation, is often quicker to dictate. Premier-style plans that bundle both let you switch per task.
Is Dragon Copilot an option for a three-doctor practice?
Microsoft positions Dragon Copilot at health systems and larger groups, with no public price and no self-serve sign-up on its page. A small practice can ask Microsoft's sales team, but should expect to compare it against tools with published prices.
How long should a trial run before I decide?
Two weeks per tool, with the same two or three clinicians and a fixed mix of consultation types. Shorter trials only measure novelty. Record minutes spent on notes after clinic and the number of corrections per note.
What if some patients refuse to be recorded?
Offer an opt-out at the start of each consultation and keep a simple fallback, such as typing or dictating that note afterwards. Never record without telling the patient, and keep the fallback available to every clinician.
Further reads
- Is an AI Scribe Worth It for a Small Private Clinic? — Whether any scribe pays back for a private clinic.
- How to Roll Out an AI Scribe Without Losing Patient Trust — Introducing recording without losing patients' confidence.
- AI Scribe for Medical Practices: Pick by Country and EHR — Choose a scribe by EHR and country.
- Best AI Scribe for Urgent Care: Fast-Visit Notes and Coding Checks — Scribe choice when visits are fast and coding matters.
- AI Medical Transcription Services vs Human Transcribers for Small Clinics — The outsourced alternative to both options here.
- What Is an AI Scribe and How Does It Work in a Consultation? — How an ambient scribe works inside a consultation.
- Can AI Dictation Replace the Dictaphone in a Law Firm? — Compare AI dictation for a law firm, test it on your own legal vocabulary, settle confidentiality and set up a correction workflow.
- AI Scribe for GPs: Costs, Free Tiers and the NHS Pilot Limit — A GP scribe budget with free and paid options, hidden review time and the four-month pilot boundary.
- Best AI Scribe for Paediatrics: What to Check Before You Pick — A paediatric practice's checklist for choosing an AI scribe: speakers, consent, templates and cost, with notes on Heidi, Freed and others.
- Best AI Scribe for Veterinarians? A Ten-Consult Test and Scorecard — A ten-consult trial plan and scorecard for vet practices: SOAP accuracy, PIMS export, species terminology, consent wording and price per vet.
- Cliniko for Doctors: Fit, Cost and the AI Tools That Sit Around It — Cliniko is built for allied health. What that means for a doctor's practice, what it costs, and the AI scribes and phone tools that connect to it.
- Dermatology EHR With AI: What Is Real for a Small Clinic — Dermatology EHRs sorted into real AI (ambient notes, code suggestions) and marketing (diagnosis from photos), with a cost sum for a small clinic.
- Twofold AI Medical Scribe for Clinicians: Trial Checklist and Cost — Twofold's Free, Personal and Group plans as published, what the page says about audio and data, and a trial checklist to run before a small clinic pays.
- AI App for Medical Providers: Standalone, Add-On or Built-In? — Standalone app, add-on or built-in feature? A vendor-neutral look for small medical practices on cost, data flow, switching and fit, with a decision table.
- AI Policy for General Practice: A Template for UK Surgeries — A fill-in AI policy for a GP surgery: approved tools, patient data rules, DCB0160 and DPIA sign-off, incident handling and a review cycle.
- AI Secretary for Doctors: Referral Letters, Inbox, Insurer Forms — Set up three secretary jobs for a solo doctor: referral letters, inbox triage and insurer forms, with templates, a review step and a no-paste list.
- AI Tools and AI Development: The Complete 2026 Guide — the AI hub, including every tutorial in the AI-for-business series.
Sources: Heidi pricing page and data-security help article, Freed pricing page and FAQ, Nabla's privacy and security article, and Microsoft's Dragon Copilot page, checked 4 November 2026.