Inside 847 Production Clinical AI Notes — Sebastian Fox, Composo
Aug 22, 2026 · 19:48
Sebastian Fox of Composo argues that AI clinical notes from production ambient scribes carry serious errors—1 in 20 could cause significant harm, nearly 1 in 5 had an important omission, more than 1 in 10 contained a hallucination—and the common fix, a rubric-based checker, fails: his best judge waved a fifth of serious errors through. The hard part is not spotting transcript-note differences but judging which matter—a tacit, contextual standard that can't be written down. Fox shows examples: a missed jaw pain signals giant cell arteritis; a note flips a 'wait and see' plan into 'arrange tests today.' His answer is a loop: discover failure modes from real outputs, capture clinicians' free-form judgments, and retrieve similar cases per note to calibrate each check and keep it evolving.
