text: **JAMA Network Open | Emergency Medicine** Developing and Evaluating LLM-Generated Emergency Medicine Handoff Notes 
  
  records and perform manual comparative evaluations of 50 LLM-generated and 50 clinician- 
  
  generated summary notes within the context of complex ED encounters. This approach is unlikely 
  
  scalable, invoking complex postimplementation governance questions that remain unanswered in 
  
  the medical literature and invoke the need for future research focused on the possibility of AI 
  performing the clinical evaluations.56 Lastly, the relatively infrequent but potentially significant 
  patient safety implications of model output incorrectness and incompleteness warrants further 
  
  model refinement and repeat clinical evaluation, as described in the eAppendix 1 in Supplement 1 
  
  overview of our rigorous preimplementation model development and testing framework. 