Offline dictation for therapy and clinical notes on Mac

If you see clients all day, notes are the work that follows you home. A 50-minute session can take 10 to 15 minutes to write up by hand, and those minutes add up to hours every week.

Dictating notes is much faster. Saying “Client reported improved sleep, about six hours most nights, and fewer intrusive thoughts at work” takes a few seconds; typing it takes most of a minute. The hesitation most clinicians have isn’t speed. It’s where the audio goes.

Where does your dictated audio go?

Many popular dictation tools, including several “AI dictation” apps, transcribe in the cloud. When you dictate, your audio is sent to the vendor’s servers, turned into text there, and sent back. Some keep the audio or text for a period, some use it to improve their models unless you opt out, and their policies can change.

For clinical notes that’s a meaningful question. You’d be describing a client’s history, symptoms and what they told you in confidence. If a third party processes that audio, it becomes part of your compliance picture: you’d want to know what they store, for how long, and whether they’ll sign the agreements your regulations require.

On-device dictation sidesteps the question. If speech is recognised on your own computer and nothing is uploaded, there’s no outside service handling the audio in the first place.

What to look for

When you’re comparing dictation apps for clinical work, ask:

1. Is speech recognised on the device? Not “encrypted in transit”, not “deleted after processing”. On the device.
2. Does it work with the internet off? That’s the simplest way to check the claim yourself. Turn off Wi-Fi and dictate.
3. Is AI cleanup also local? Some apps recognise speech locally but send the text to a cloud language model to tidy it up. That’s still your client’s information leaving your Mac.
4. Does it need an account? An account means the vendor knows who you are and can link usage to you.
5. What does it store locally, and can you control it? Recordings and text history should stay on your machine, and you should be able to turn off saving audio.
6. Does it work in the app you actually write notes in? Your EHR’s web portal, a practice-management app, or a document.

How spellsafe handles this

spellsafe is a dictation app for Mac built around that first question.

• Speech recognition runs on your Mac. It uses NVIDIA’s Parakeet model on your Mac’s Neural Engine. Your audio is never uploaded.
• AI cleanup runs on your Mac too. The optional cleanup that removes “um”s and self-corrections, and the “rewrite that” command, use a language model that runs locally.
• It works offline. After a one-time model download, you can dictate with Wi-Fi off.
• No account, no analytics. There’s nothing to sign up for, and the app sends no usage data or crash reports.
• Recordings are optional. spellsafe keeps a local history of your dictations so you can review what it heard. Turn off “Save recordings” in Settings and each audio file is deleted as soon as the dictation ends.
• It types into any app. Click into a note field in your browser-based EHR, a Word document or a practice-management app, hold Right Option, speak, and let go.

Is it HIPAA compliant?

We want to be careful here. HIPAA compliance (and its equivalents elsewhere, like GDPR for health data) is about how your practice handles information, not a badge a piece of software can carry by itself.

What we can say is this: spellsafe doesn’t send your audio or text to us or anyone else, so there’s no spellsafe server that ever holds patient information, and nothing for us to sign a business associate agreement about. The dictation history and any saved recordings live on your Mac, so they’re covered by the same safeguards as the rest of your files. That means you should use FileVault disk encryption, a strong login password and a screen lock, as you would for any computer that holds clinical notes.

If your organisation has specific rules about software on clinical machines, check with whoever manages compliance for you.

Tips for dictating notes

• Use hold-to-talk for notes. Hold Right Option, say a full thought, then let go. The whole clip is transcribed in one pass, which is slightly more accurate than live mode.
• Teach it your vocabulary. Medication names, assessment names (PHQ-9, GAD-7) and client initials can be added to Vocabulary so they’re spelled right every time.
• Fix mistakes by voice. “Scratch that” removes the last sentence. “Replace Tuesday with Wednesday” swaps a word.
• Structure afterwards. Select a rough paragraph, hold Right Command and say “turn this into a list”. It’s rewritten in place, and ⌘Z undoes it.
• Numbers come out as digits. “Six out of ten” and “twenty milligrams” are typed as 6 out of 10 and 20 milligrams.

Limits to know about

• English only, for now.
• Mac only: Apple silicon Macs with macOS 14 or later.
• It’s a dictation tool, not a note template or a scribe. It won’t listen to your session and write notes for you, and it doesn’t record anything unless you’re holding the key.

Try it

spellsafe has a 7-day free trial with every feature, then costs $9 a year. You can check the privacy claims yourself: install it, download the models, turn off Wi-Fi, and dictate. Download spellsafe or read the privacy policy.