Smaller emrs for small behavioral health practices tend to have text only LLM - headway has scribe, therapynotes has therapyfuel, simple practice has one too and I forget the name. All of these work by taking written session notes and generating a proper progress note, e.g. “client reports more positive mood, anxiety remains triggered by x, practiced breathing exercises” gets extrapolated out into “the client presented with improvements noted in mood and session focused on mindfulness strategies to manage anxiety related to x” (more in depth than that but you get it)

In my evaluation the LLMs worked fairly well but not always, they tended to shift “writing the note” to “evaluate the note”. I don’t use it for my practice for several reasons, primarily the allure of skipping the evaluation step and ending up with notes that potentially have irrelevant hallucinations/outright falsehoods that get included because a clinician got lazy. As the article states I also believe the process of writing the note serves for reflection on the case and a time to consider conceptualization, eliminating that is certainly convenient but a potential harm to successful outcomes

When it comes down to it I simply don’t trust this in a server sided application. The only way I would consider it is if I could run a local model, generate the note on a pc that has no internet access, and then upload it. It’s granted that bc it’s entered into the EMR it could certainly be harvested for llm training because AI fucks are without ethics and above the law, but the chances of that are far lower. A workaround for this that solves both of my issues actually came from the psychotherapy subreddit back when I still used reddit: just use a local speech transcription (though confirm it happens locally, which is the case on apple devices post ios 16 or so)

WRT Israeli companies twofold scribe is currently the one that bothers me the most about signing up. They are headquartered in NY but a subsidiary of Ravel Technologies, an Israeli company. If you look up the developer info on the Google play store the given address for the twofold app is “4 Gordon REHOVOT, 7629112 Israel”. In my experience it’s often done like this and you have to dig a bit.

They also bring up the other issue: these services are often expensive as shit. Therapynotes adds $40 onto your subscription for theirs, twofold is like $70/mo, etc and all charge additional user fees on top of that. The exception is headway and I think grow, which are free, but that passes on the cost to the consumer (and imo they’re currently propped up by VC capital, once that runs dry and they’re forced to be “profitable” this could change drastically). In a field where reimbursement rates are relatively high (80-130/hr ish) and yet still most clinicians make 40-60k/yr without benefits because of overheads it’s pretty foolish to add even more monthly costs, though tbf the overwhelming majority of overhead for 99% of clinicians is outrageous commercial real estate pricing