System X: A Mobile Voice-Based AI System for EMR Generation and Clinical Decision Support in Low-Resource Maternal Healthcare

We present the design, implementation, and in-situ deployment of a smartphone-based voice-enabled AI system for generating electronic medical records (EMRs) and clinical risk alerts in maternal healthcare settings. Targeted at low-resource environments such as Pakistan, the system integrates a fine-tuned, multilingual automatic speech recognition (ASR) model and a prompt-engineered large language model (LLM) to enable healthcare workers to engage naturally in Urdu, their native language, regardless of literacy or technical background. Through speech-based input and localized understanding, the system generates structured EMRs and flags critical maternal health risks. Over a seven-month deployment in a not-for-profit hospital, the system supported the creation of over 500 EMRs and flagged over 300 potential clinical risks. We evaluate the system's performance across speech recognition accuracy, EMR field-level correctness, and clinical relevance of AI-generated red flags. Our results demonstrate that speech based AI interfaces, can be effectively adapted to real-world healthcare settings, especially in low-resource settings, when combined with structured input design, contextual medical dictionaries, and clinician-in-the-loop feedback loops. We discuss generalizable design principles for deploying voice-based mobile healthcare AI support systems in linguistically and infrastructurally constrained settings.