Guardoc Health says it processes over one million clinical documents daily using Amazon Nova models through Bedrock.
Bringing AI into clinical documentation comes down to a specific kind of risk calculation. Get it wrong and the errors compound into denied Medicare claims under the Patient-Driven Payment Model, audit fines, litigation exposure, and in the worst cases, a missed condition that changes how a patient gets treated.
However, get it right and the payoff shows up in fewer corrections, fewer hospital transfers, and lower compliance costs. Guardoc Health, which builds documentation software for long-term care providers, has published deployment figures it says support that outcome.
The scale of the underlying problem
Guardoc Health’s pipeline has to handle documents that arrive in nearly every format a clinical setting can produce: multi-page PDFs with handwritten physician annotations layered over printed text, prior authorisation forms where a checkbox state alone determines a coverage decision, medication lists that show up as clean tables in one chart and free text in the next, and patient intake forms mixing typed fields with rubber stamps and handwriting on the same page.
Research published in BMJ Quality and Safety puts the number of US outpatients affected by diagnostic error at around 12 million a year, with information-handling failures cited as a contributing factor. At the volume Guardoc processes, a one percent error rate in condition detection alone would generate thousands of incorrect records daily. Each one carries its own patient safety or compliance consequence.
Guardoc reports a 46 percent reduction in documentation errors, a 70 percent drop in audit fines, and more than $400,000 in annual ROI for a single facility, without publishing the baseline period or methodology behind those calculations.
In a quarterly deployment spanning two facilities and 200 patients, the company says its system drove 847 documentation corrections, flagged 86 issues tied to PDPM reimbursement accuracy, and was associated with a 74 percent reduction in hospital transfers per 100 admissions. A separate case study covering seven facilities and 1,618 residents identified 10,612 issues, according to Guardoc.
A retrieval pipeline built around cost as much as accuracy
Guardoc’s architecture runs condition classification through retrieval augmented generation, pulling evidence from a patient’s own documentation before reasoning across it to produce a final answer.
Amazon Textract extracts text and structural metadata from each incoming page first, at what the company treats as the lowest per-page cost point in the pipeline. That output gets chunked along clinical boundaries, so a medication list or a diagnosis section stays intact rather than getting split by arbitrary character count.
Each chunk is embedded using Amazon Titan Text Embeddings V2 and stored in Amazon DynamoDB, partitioned by patient so retrieval never crosses patient boundaries. A custom pre-filter narrows the candidate set by document type and recency before a k-nearest neighbour search retrieves the chunks most relevant to a given classification query, returning page references only at this stage to keep data transfer light.
Amazon Nova 2 Lite then runs a text-based pass to remove obvious non-matches. Only the pages that survive every prior filter reach Amazon Nova Pro, which receives the raw PDF bytes and reasons over layout, handwriting, signatures, and stamps to produce the classification that downstream systems act on.
The design follows a cost-tiering logic throughout: cheap components handle high-volume work like embedding and coarse filtering, and the more computationally intensive multimodal reasoning gets reserved for the final stage where it’s actually required.
The hard clinical documentation cases
Two document types account for most of what earlier pipeline versions missed, according to Guardoc. The first is physician attestation fields on prior authorisation forms, where a handwritten note can override a printed checkbox. The second is patient-reported symptom sections, where handwriting often carries information that doesn’t appear anywhere else in the record.
Medication extraction presents a related problem. Drug names, dosages, routes, and frequencies show up in structured tables, in prose buried inside physician notes, in handwritten additions to printed lists, and in scans that have been faxed through multiple hands. Guardoc’s hybrid pipeline runs Amazon Textract first for clean printed tables, then passes both the original PDF and the Textract output to Amazon Nova Pro to resolve wrapped table columns, handwritten additions, and non-standard formats that OCR alone can’t parse correctly.
“With the Nova family, we’re making it easier for healthcare organisations to detect high-risk cases earlier and act before issues become costly,” said Assaf Amiaz, Director of Product at Guardoc Health. “By automating workflows that once required manual oversight, the Nova family helps teams reduce compliance gaps, prevent errors, and focus more of their time on improving patient outcomes.”
See also: How AI is shortening drug discovery timelines in China
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