Ambient artificial intelligence (AI) in healthcare starts with a microphone in the exam room. An AI scribe records the conversation between a doctor and a patient, writes a draft note from the audio and hands it to the doctor to review before it enters the medical record. The doctor doesn’t have to type, but the visit becomes a recording.
Abridge, maker of one of the most widely used AI scribes, is live in more than 300 health systems and supports upward of 100 million clinical conversations a year, Fortune reported in June. More than 100,000 clinicians use Microsoft’s Dragon Copilot scribe in daily practice, Microsoft said in March. Nearly two-thirds of hospitals that run Epic Systems’ electronic health record have adopted ambient AI, PYMNTS reported in February.
Cleveland Clinic brought more than 4,000 outpatient clinicians onto Ambience Healthcare’s scribe in about four months starting in March 2025, according to a paper its clinical leaders published in npj Health Systems. A year in, more than 4,800 clinicians had used it across more than 3.5 million encounters.
Doctors use the tools because the paperwork is heavy. Doximity, the professional network for U.S. physicians, surveyed 3,151 physicians in two waves, in March and April 2025 and from November 2025 to January 2026. Use of ambient listening and AI scribes rose to 29% from 20% between the two waves. Three-quarters of physicians who use AI said it has already cut their administrative work. That growing presence in the exam room is what lawmakers in three states have now moved to regulate.
Louisiana, Rhode Island and California Set Their Own Rules
Louisiana’s Act 649, which took effect Aug. 1, requires a licensed healthcare professional to verbally disclose the use of a recording device, software or service before recording any part of a visit for AI transcription. A professional who skips it can face discipline from their licensing board.
Rhode Island’s Use of Artificial Intelligence by Healthcare Providers Notification Act requires providers that use AI to document a visit to notify the patient and review the AI-written note for accuracy afterward. It took effect on passage in June and names no penalty. State Sen. Pamela Lauria, the bill’s sponsor and a nurse practitioner, said patients “want as much transparency as possible.”
Both laws are written around the scribe itself. Rhode Island’s legislation covers AI used “to document in-person or telehealth visits.” Louisiana’s law covers any recording device, software or service capturing an appointment “to be transcribed by artificial intelligence.”
California’s AB 3030, in effect since Jan. 1, 2025, requires a disclaimer on any message about a patient’s clinical information that generative AI produced, unless a licensed provider read it first. It covers the message, not the recording.
HIPAA Covers the Note, States Cover the Microphone
The Health Insurance Portability and Accountability Act, or HIPAA, governs how healthcare providers and their technology vendors handle protected patient information, but it does not establish a specific patient-notification requirement for AI scribes.
HIPAA’s Privacy Rule lets a hospital use patient information for treatment without the patient’s authorization. The Department of Health and Human Services also lists a transcription vendor as the kind of contractor that must sign a business associate agreement binding it to the same privacy rules.
That means the duty to tell the patient a recording is running comes from state laws such as Louisiana’s and Rhode Island’s, not from HIPAA. State recording laws can also add notice and consent duties for each visit on top of HIPAA, BakerHostetler noted in its 2026 Data Security Incident Response Report.
Inside hospitals, the rules are still taking shape. Nearly half of physicians in the Doximity survey, 47%, said the AI decision-making process at their institution is “still evolving.” Only 8% said it is clear.
Patients, for their part, are already comfortable running much of their care through digital channels. More than 6 in 10 consumers used at least one digital tool to manage their healthcare in the past year, and 36% used a provider portal, according to the PYMNTS Intelligence report “Three in 10 Gen Zers and Millennials Use Telehealth. But Paying the Doctor Is Full of Friction,” based on an April 2025 survey of 2,021 U.S. consumers.
That comfort could make the disclosure easier to deliver. Patients who already manage their care through an app or a portal are used to software sitting between them and their doctor. What Louisiana and Rhode Island now require is that providers acknowledge out loud when that software is also listening.
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