Comparison
Purpose-built AI scribes vs a private on-premise system
For clinical documentation specifically, purpose-built AI scribes are usually the right first choice — and this is the comparison where we least often win, honestly. The scribes are built for the workflow, integrate with clinical systems, and several have made serious commitments to Australian data handling. This page explains where each option actually fits.
Credit where it's due
Where Cloud AI scribes (Heidi, Lyrebird, etc.) genuinely wins
Australian-built AI scribes such as Heidi Health and Lyrebird are genuinely purpose-built for clinical workflow, have serious commercial commitments to Australian data handling, integrate directly with major practice management systems, and are typically faster to deploy than any general on-premise approach. For straightforward clinical documentation in a single-location practice, these are usually the right recommendation and we will say so plainly.
Side by side
Green = private on-premise wins on this dimension. Black = Cloud AI scribes (Heidi, Lyrebird, etc.) wins. Muted = it depends, or both have equivalent tradeoffs.
| Criterion | On-premise (OnPrem) | Cloud AI scribes (Heidi, Lyrebird, etc.) |
|---|---|---|
| Purpose-built for clinical documentation | General-purpose — usable but not workflow-optimised. | Yes — designed around the consult flow. |
| Integration with practice management systems | Requires configuration. | Often direct integration with Best Practice, Medical Director, Cliniko etc. |
| Time to deploy | Weeks — scoping, hardware, install. | Days or hours. |
| Data residency | Your building — the strictest possible answer. | Australian hosting is standard for the Australian scribes. |
| Downstream model provider | Runs locally — no downstream provider. | Varies. Some run inference on Australian infrastructure end-to-end; some route to overseas model providers behind Australian hosting. |
| Works offline | Yes — no internet dependency. | No — requires connectivity. |
| Beyond consult notes — practice-wide document tasks | Yes — general-purpose covers referrals, correspondence, protocols, research. | Scribes are increasingly expanding, but core use case is clinical notes. |
| Cost model | Capital + support. Fixed regardless of clinician count. | Per-clinician monthly. Scales with team size. |
| Deployment across multiple sites and regional clinics | Straightforward — one system per site, offline capable. | Requires connectivity at each site. |
Choose Cloud AI scribes (Heidi, Lyrebird, etc.) if…
When the competitor is the right call
A purpose-built scribe like Heidi or Lyrebird is likely the right call for most single-site practices where the primary AI need is consult documentation, connectivity is reliable, and the practice does not have unusual data residency requirements beyond what those vendors already meet. We would rather recommend a scribe you should use than sell you a system you shouldn't.
Choose on-premise if…
When we're the right answer
On-premise starts making sense when the practice has broader AI needs beyond consult notes (referrals, discharge summaries, research, protocols, plain-English patient handouts), operates across multiple or remote sites, has research or clinical trial obligations requiring stricter data control, or genuinely cannot rely on internet connectivity. Larger multi-doctor practices often benefit from the fixed-cost model too.
Questions we get asked
- Are AI scribes safe under Australian privacy law?
- The reputable Australian-built ones (Heidi, Lyrebird and similar) are designed to be — with data residency, retention limits, and explicit non-training commitments. Patient consent obligations remain yours regardless of which vendor you choose, and clinical accuracy responsibility for the resulting note remains with the clinician. Read each vendor's technical white paper rather than relying on marketing pages.
- Can we use both — scribes for consults, on-premise for everything else?
- Yes, and for larger multi-doctor practices this is often the sensible answer. Scribes handle the high-volume, workflow-specific consult documentation. On-premise handles everything else — plus practice management queries, protocol lookups, referral drafting, research summarisation. Total spend is usually less than a scribe subscription across a full clinician count.
No obligation
Not sure which side you're on?
Tell us where you are today with Cloud AI scribes (Heidi, Lyrebird, etc.) (or what's stopped you adopting it) and what work you actually need AI to do. We'll tell you honestly whether on-premise beats it for your situation — or whether you should just stay with what you've got.