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Ambient AI Documentation in Mixed-Language Encounters: A Heuristic Evaluation of Spanish-English and Mandarin-English Conversations

Hu, D.; Flores, D.; Flores, L.; Chien, R.; Lam, K.; Chow, E.; Guo, Y.; Tam, S.; Perret, D.; Pandita, D.; Zheng, K.

2026-05-22 health informatics
10.64898/2026.05.19.26353603 medRxiv
Show abstract

Ambient AI documentation systems rely on automatic speech recognition to transcribe patient-provider conversations before generating clinical notes. However, little empirical evidence exists on how these systems perform in mixed-language clinical encounters. We conducted a mixed-method heuristic evaluation of an ambient AI documentation tool using 24 reenacted primary care conversations involving Spanish-English and Mandarin-English code-switching. Quantitative analyses measured mixed error rate (MER) and code-switching detection. Overall MER was low, with a median of 4% and less variation in Spanish-English conversations, and 9% in Mandarin-English conversations, but with outliers reaching 67%. The system generally detected language switches reliably, although deletions occurred frequently in Mandarin-English transcripts at switch points. Qualitative analysis revealed transcription errors related to phonetic similarity, automatic language translation, clinical terminology recognition, and language-specific challenges. These findings highlight considerations for improving ambient AI clinical documentation systems to support multilingual providers in delivering care for linguistically diverse populations.

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