Dictate SOAP notes, progress notes, and referral letters in a fraction of the time it takes to type them.
Clinical documentation is one of the biggest time sinks in healthcare. Physicians spend an average of two hours on paperwork for every hour of patient care. Voice dictation changes that equation dramatically. With Steno on your Mac, you can dictate structured medical notes at the speed of speech, getting back to what matters most: your patients.
This guide walks you through setting up Steno for medical documentation, dictating different note types, and building habits that cut your charting time in half. Whether you use an EHR system, a simple text editor, or a notes app, Steno works wherever your cursor is.
The average clinician types at 40-60 words per minute. Speaking naturally, you produce 120-150 words per minute. That alone means a three-fold improvement in raw output. But the benefits go beyond speed:
Steno uses OpenAI's Whisper large-v3 model, which has been trained on hundreds of thousands of hours of audio, including medical lectures, clinical discussions, and scientific content. It handles terms like "hydroxychloroquine," "anteroposterior," and "sternocleidomastoid" with reliable accuracy.
1Install and Configure Steno
Download Steno from stenofast.com and run the installer. Once installed, Steno lives in your menu bar. Set your preferred hotkey in Settings — many clinicians prefer Right Option so they can hold it with one hand while reviewing charts.
2Position Your Cursor in Your EHR or Editor
Click into the text field where you want your note to appear. Steno types text at whatever cursor position is active, so it works with Epic, Cerner, Athenahealth, or any web-based EHR. It also works in TextEdit, Google Docs, Word, and any other application.
3Hold Your Hotkey and Speak
Press and hold your hotkey, then speak your note naturally. When you release the key, Steno transcribes your speech and types it at the cursor. There is no need to wait for a recording indicator — just hold, speak, and release.
4Dictate in Sections
For structured notes like SOAP, dictate one section at a time. Hold the hotkey, say "Subjective: Patient presents with a three-day history of productive cough and low-grade fever," then release. Move to the next field and dictate the Objective section. This approach keeps each transcription short and accurate.
5Review and Save
Scan the transcribed text for accuracy. Medical abbreviations and drug names are usually transcribed correctly, but always verify dosages and patient identifiers before finalizing the note.
The SOAP format is the backbone of clinical documentation. Here is how to dictate each section efficiently:
Subjective: "Patient is a 45-year-old male presenting with sharp epigastric pain radiating to the back, onset two days ago, worsening after meals. Denies nausea, vomiting, or hematemesis. Reports occasional antacid use with partial relief."
Objective: "Vitals: blood pressure 128 over 82, heart rate 76, temperature 98.6. Abdomen soft, tender in the epigastric region, no rebound or guarding. Bowel sounds active in all four quadrants."
Assessment: "Acute gastritis, rule out peptic ulcer disease."
Plan: "Start omeprazole 20 milligrams daily for 4 weeks. Order H. pylori stool antigen test. Follow up in 2 weeks or sooner if symptoms worsen. Advise avoidance of NSAIDs, alcohol, and spicy foods."
Progress notes for follow-up visits tend to be shorter but still benefit from dictation. Position your cursor, hold the hotkey, and narrate the visit:
"Follow-up visit for hypertension management. Patient reports compliance with lisinopril 10 milligrams daily. Home blood pressure readings averaging 132 over 84. No headaches, dizziness, or peripheral edema. Continue current regimen. Recheck in 3 months with basic metabolic panel."
Referral letters require a more conversational tone. Steno handles this naturally because you are literally speaking the letter:
"Dear Dr. Patel, I am referring Mrs. Johnson, a 62-year-old female with a 6-month history of progressive dysphagia. She reports difficulty swallowing both solids and liquids, with occasional regurgitation. Barium swallow showed a distal esophageal stricture. I would appreciate your evaluation and recommendations for further management. Please do not hesitate to contact me if you need additional information."
Speak numbers clearly. Say "one hundred twenty-eight over eighty-two" rather than mumbling through vitals. Steno will format these correctly.
Use generic drug names. Whisper recognizes generic names (metformin, atorvastatin) more reliably than some brand names.
Dictate in a quiet space. Close the exam room door or use a directional microphone. Background noise from hallways or equipment can affect accuracy. For microphone recommendations, see our guide on dictating while walking.
Keep segments under 60 seconds. Shorter dictations are transcribed faster and more accurately. Break long notes into logical sections.
Use Smart Rewrite for formatting. After dictating, you can use Steno's voice commands to reformat text, fix capitalization, or restructure sentences.
Steno sends audio to Groq's API for transcription using Whisper. The audio is processed in real time and is not stored after transcription. No recordings are saved on Steno's servers. That said, any tool that transmits patient data over the internet should be reviewed by your organization's compliance team before use in a clinical environment.
For maximum privacy, Steno also supports an offline mode using on-device transcription, though accuracy for specialized medical terminology may be slightly lower than the cloud-based model.
Yes. Steno uses Whisper large-v3, which has been trained on diverse audio including medical content. It handles most medical terminology, drug names, and anatomical terms accurately. Complex eponyms or very rare conditions may occasionally need manual correction.
Steno processes audio through encrypted API calls and does not store recordings or transcriptions on its servers. However, you should consult your compliance officer before using any voice tool with protected health information in a clinical setting.
Most clinicians speak at 120-150 words per minute versus typing at 40-60 WPM. Voice dictation can reduce documentation time by 50-70%, freeing up more time for patient care. A typical SOAP note that takes 5-8 minutes to type can be dictated in under 2 minutes.
Steno works with any application that accepts keyboard input. It types text at your cursor position, so it is compatible with Epic, Cerner, Athenahealth, and all web-based or native EHR systems. See our medical use case page for more details.
Join thousands of professionals who use Steno to write faster on Mac.
Download Steno Free