I know some European "automatic scribe" projects of the government sector. Their IT buys a physical GPU server hosted locally. Pretty sure it wouldn't be accepted otherwise (or maybe I'm just naive, but it sure is a topic they care about). The software stack is mostly open source, I think. It sure as hell doesn't talk to a big American cloud provider. (Well, the transcription service doesn't. Who knows what they do with the automated transcript. Probably the same thing they did with the manual transcript.)