The Ontario and British Columbia Information and Privacy Commissioners each released new AI medical scribes guidance on Privacy Day (January 28, 2026). This means that along with Alberta and Saskatchewan, a total for four provincial information and privacy commissioners have now issued similar guidance. BC’s guidance is aimed at health care practitioners running their own practices and governed by the province’s Personal Information Protection Act. It does not extend to health authorities and hospitals that fall under the province’s Freedom of Information and Protection of Privacy Act. Ontario’s guidance is for both public institutions and physicians in private practice who are governed by the Personal Health Information Protection Act.
This flurry of guidance on AI Scribes shows how privacy regulators are responding to the very rapid adoption in the Canadian health sector of an AI-tool that raises sometimes complicated privacy issues with a broad public impact.
At its most basic level, an AI medical scribe is a tool that records a doctor’s interaction with their patient. The recording is then transcribed by the scribe, and a summary is generated that can be cut and pasted by the doctor into the patient’s electronic medical record (EMR). The development and adoption of AI scribes has been rapid, in part because physicians have been struggling with both significant administrative burdens as well as burnout. This is particularly acute in the primary care sector. AI scribes offer the promise of better patient care (doctors are more focused on the patient as they are freed up from notetaking during appointments), as well as potentially significantly reduced time spent on administrative work.
AI medical scribes raise a number of different privacy issues. These can include issues relating to the scribe tool itself (for example, how good is the data security of the scribe company? What kind of personal health information (PHI) is stored, where, and for how long? Are secondary uses made of de-identified PHI? Is the scribe company’s definition of de-identification consistent with the relevant provincial health information legislation?) They may also include issues around how the technology is adopted and implemented by the physician (including, for example” whether the physician retains the full transcription as well as the chart summary and for how long; what data security measures are in place within the physician’s practice; and how consent is obtained from patients to the use of this tool). As the BC IPC’s guidance notes, “What distinguishes an AI scribe’s collection of personal information from traditional notetaking with a pen and notepad is that there are many processes taking place with an AI scribe that are more complex, potentially more privacy invasive, and less obvious to the average person” (at 5).
AI scribes raise issues other than privacy that touch on patient data. In their guidance, Ontario’s IPC notes the human rights considerations raised by AI scribes and refers to its recent AI Principles issued jointly with the Ontario Human Rights Commission (which I have written about here). The quality of AI technologies depends upon the quality of their training data. Where training data does not properly represent the populations impacted by the tool, there can be bias and discrimination. Concerns exist, for example, about how well AI scribes will function for people (or physicians) with accents, or for those with speech impaired by disease or disability. Certainly, the accuracy of personal health information that is recorded by the physician is a data protection issue; it is also a quality of health care issue. There are concerns that busy physicians may develop automation bias, increasingly trusting the scribe tool and reducing time spent on reviewing and correcting summaries – potentially leading to errors in the patient’s medical record.
AI scribes are being adopted by individual physicians, but they are also adopted and used within institutions – either with the engagement of the institution, or as a form of ‘shadow use’. A recent response to a breach by Ontario’s IPC relating to the use of a general-purpose AI scribe illustrates how complex the privacy issues may be in such as case (I have written about this incident here). In that case, the scribe tool ‘attended’ nephrology rounds at a hospital, transcribed the meeting, sent a summary to all 65 people on the mailing list for the meeting and provided a link to the full transcript. The summary and transcript contained the sensitive personal information of the patients seen on those rounds. Complicating the matter was the fact that the physician whose scribe attended the meeting was no longer even at the hospital.
Privacy commissioners are not the only ones who have stepped up to provide guidance and support to physicians in the choice of AI scribe tools. Ontario MD, for example, conducted an evaluation of AI medical scribes, and is assisting in assessing and recommending scribing tools that are considered safe and compliant with Ontario law.
Of course, scribe technologies are not standing still. It is anticipated that these tools will evolve to include suggestions for physicians for diagnosis or treatment plans, raising new and complex issues that will extend beyond privacy law. As the BC guidance notes, some of these tools are already being used to “generate referral letters, patient handouts, and physician reminders for ordering lab work and writing prescriptions for medication” (at 2). Further, this is a volatile area where scribe tools are likely to be acquired by EMR companies to integrate with their offerings, reducing the number of companies and changing the profile of the tools. The mutable tools and volatile context might suggest that guidance is premature; but the AI era is presenting novel regulatory challenges, and this is an example of guidance designed not to consolidate and structure rules and approaches that have emerged over time; but rather to reduce risk and harm in a rapidly evolving context. Regulator guidance may serve other goals here as well, as it signals to developers and to EMR companies those design features which will be important for legal compliance. Both the BC and Ontario guidance caution that function creep will require those who adopt and use these technologies to be alert to potential new issues that may arise as the adopted tools’ functionalities change over time.
Note: Daniel Kim and I have written a paper on the privacy and other risks related to AI medical scribes which is forthcoming in the TMU Law Review. A pre-print version can be found here: Scassa, Teresa and Kim, Daniel, AI Medical Scribes: Addressing Privacy and AI Risks with an Emergent Solution to Primary Care Challenges (January 07, 2025). (2025) 3 TMU Law Review, Available at SSRN: https://ssrn.com/abstract=5086289
