At Nashville, Tenn.-based Centerstone, ambient AI is unlocking potential for providers to stay more engaged with patients as demand for services continues to rise and workforce shortages persist.
From October 2025 to October 2026, the Nashville, Tenn.-based organization generated about 510,000 notes with ambient documentation, saving roughly 85,000 hours of clinician time, according to data Centerstone shared with Becker’s. Providers rated the AI-generated notes an average 4.3 out of 5. About 1,300 providers used ambient AI during that period, and about 67% of them used it regularly.
Mackenzie Schild, Centerstone’s vice president of data and artificial intelligence, said that ambient listening is especially critical in behavioral health, where the conversation is the therapy.
“It’s a lot to expect someone to sit behind a keyboard and pound out every single note that is happening inside of a conversation,” Mr. Schild said. “Conversations are complex; they’re nuanced. They require tone shifting, demeanor shifting, a lot of things that need to be picked up on.”
Taking that burden off clinicians frees up their mental bandwidth to stay present in the session and catch what they might otherwise miss, he said.
Matching the tool to the setting
Centerstone has seen strong results in outpatient therapy and psychiatry. Group therapy, one of the most difficult settings to document, has also improved with technology that captures every participant in the room. Patients who come through crisis intake and are routed to psychiatry or therapy are documented effectively as well, he said.
No single product covers all of it. Centerstone runs about nine EHR instances and roughly five ambient listening and voice dictation tools, and the right fit depends on both the EHR and the type of care. Psychiatry tends to use EHR-native tools because its documentation follows a segmented, question-by-question format. Therapy notes, which read more like a single block of narrative text, have done better with third-party tools, he said.
That distinction led to one of Centerstone’s more productive pivots, Mr. Schild said. The EHR-native workflow for therapy wasn’t nimble enough for clinicians in the field, so the team turned to a third-party web platform that let them begin capturing notes in a few clicks in a secure environment and integrate them back into the EHR. He said the tool continues to gain traction.
Pilot small, pivot fast
The technology has hit road bumps. Some EHR-native tools need long processing time to clean up a note after the visit ends, and that wait can make providers anxious about whether the tool captured the session.
Change management is the other hurdle.
“These providers, especially the more tenured ones, have a kata and a style of documentation that they have made throughout their career,” Mr. Schild said. “Some of them get worried about whitewashing or having that cleansed away from them and losing that experience inside of that documentation.”
Newer clinicians, who have not yet built those habits, are more easily persuaded to adopt the technology. Across the board, Mr. Schild said Centerstone’s job is to prove the juice is worth the squeeze.
Its approach: start with small groups and be ready to pull a tool that isn’t working.
“I’m not going to go get a technology and integrate it just for the sake of integrating a technology,” he said. “We like to pilot and test small with groups that we know are going to give us open and honest feedback. … We are more than willing to bring the technology to the party as long as we get candid feedback around how the technology performs.”
When the right tool lands with the right group in the right setting, results from the small pilot have held up at scale, he said. That has helped Centerstone avoid launches that fall flat — and has produced adoption numbers that surprised even him.
Beyond time savings
Mr. Schild sees the next wave of adoption coming from what the notes can reveal, not only the time they save. Behavioral health notes are dense, and Centerstone is in early alpha testing to mine them for medication compliance, referral follow-up and social determinants of health — details typically captured separately in the EHR. Once clinicians see ambient documentation surface clinical insight they didn’t have before, he said, adoption spreads on its own.
Looking further out, and speaking for himself rather than Centerstone, Mr. Schild pointed to nonverbal cues as the biggest opportunity.
“We’ve all been in those instances of trying to relay sarcasm over a text message that doesn’t actually land effectively,” he said. “It creates a ton of confusion, and conversations are nuanced in that regard. Tone matters, nonverbal matters, using air quotes matters.”
Picking up on those signals could add context and support diagnosis, he said. The technology already exists: Centerstone partners with Snowflake, whose native AI tools can analyze multimedia when given access to it. The barrier, he said, is trust. Listening and surveillance tools have historically been used more to market to people than to help clinicians, he said, and introducing anything like that in behavioral health would require great care in how patients are notified. For now, Centerstone is focused on ambient listening and voice dictation.
The priority Mr. Schild returns to most is data integration. A single behavioral health episode can move from a crisis center to an inpatient stay to outpatient therapy, and missing context along the way carries risk. He acknowledged there are good reasons to guard behavioral health data to protect patient privacy, but cautioned against collecting data only to lock it in bigger, inaccessible silos.
“I want to make sure that we don’t miss the forest for the trees whenever we’re looking at these use cases that are really good inside of our walls,” he said. “Let’s make sure that we create a good integrated health system as well.”
At the Becker's Fall Behavioral Health Summit, taking place November 4–5 in Chicago, behavioral health leaders and executives will explore strategies for expanding access to care, integrating services, addressing workforce challenges and leveraging innovation to improve outcomes across the behavioral health continuum. Apply for complimentary registration now.
