AI scribe and clinic software for nephrology and kidney clinics

The nephrology note, staged the way KDIGO stages it

KDIGO classifies chronic kidney disease by cause, GFR category from G1 to G5 and albuminuria category from A1 to A3, written together as CGA.³ NICE uses the same grid, with A1 below 3 mg/mmol, A2 from 3 to 30 and A3 above 30, and G3a from 45 to 59 ml/min/1.73 m2.⁴ Built in wai's clinic template library, the template opens with that classification, then the eGFR and ACR trend with dates, blood pressure, the potassium, bicarbonate and haemoglobin the nephrologist reads aloud, the medicines that protect the kidney, the medicines to avoid, and the kidney failure risk the nephrologist states. Templates for transplant follow-up and glomerular disease sit beside it, and the Clinician Plus plan adds bespoke templates.

Risk is now part of the note. NICE says to give adults with CKD their 5-year risk of needing renal replacement therapy, using the 4-variable Kidney Failure Risk Equation, and to document the discussion and any decisions.⁴ KDIGO adds that a 2-year risk above 10% can time multidisciplinary care and above 40% can time modality education and preparation, including vascular access.³ wai suggests the risk score for the nephrologist to apply, and the draft records the figure the nephrologist states.

Codes are suggested from the note, each beside the line it rests on. In ICD-10, used in the UK and the Gulf, typical codes are N18.3, N18.4 and N18.5 for chronic kidney disease stages 3 to 5, E11.2 for type 2 diabetes mellitus with renal complications, I12.0 for hypertensive renal disease with renal failure, Z99.2 for dependence on renal dialysis and Z94.0 for kidney transplant status. US ICD-10-CM splits stage 3 into N18.31 for 3a and N18.32 for 3b, and adds N18.6 for end stage renal disease. SNOMED CT is suggested beside them, and procedure codes, CPT in the US and OPCS in the UK, stay with the clinic's coder.

The letters, from referral to dialysis planning

Most nephrology letters go to the patient with a copy to the GP. The Academy of Medical Royal Colleges recommends writing outpatient letters directly to the patient, makes that the default setting for an AI scribe, and says the clinician checks every document a scribe produces.⁶ A kidney letter explains the function and the trend in plain words, what the risk figure means, the medicines to continue, pause when unwell or avoid, and when the next blood test is due.

NICE says to start assessment for renal replacement therapy or conservative management at least 1 year before therapy is likely to be needed, including for a failing transplant, and to consider starting dialysis at an eGFR of around 5 to 7 ml/min/1.73 m2 when there are no symptoms.⁵ Planning creates its own letters, to the access surgeon with the question for them, to the transplant centre, and to the patient with the options discussed. The referral letter guide sets out what each referral needs.

Dialysis decisions in the patient's own language

Choosing between dialysis at home, dialysis in a unit, a transplant or conservative care is a decision a family often makes together. wai captures consultations in 60 languages, among them English, Arabic, Spanish, French, Portuguese, Italian, Russian, Polish, Turkish, Urdu and Mandarin. English can be mixed in one consultation with Spanish, French, Portuguese, Russian, Italian, Dutch, German, Hindi or Japanese, and the other languages are captured in that language.

The signed note is written in English for the record, or in another language the clinic chooses. The patient's summary, with the options and the next steps, can be translated into their language beside it, with emergency numbers kept exactly as written. The multilingual scribe page explains how each language is handled.

Clinic software for nephrology clinics, from monitoring bloods to transplant follow-up

Kidney care runs on repeat bloods and urine tests. wai Admin sends recalls for the eGFR and ACR, the potassium after a medicine change and the transplant bloods, each message approved by a person. In the UK, pathology orders go out and results come back through TDL, and each result reaches the patient with the nephrologist's own comment and a plain explanation of each marker.

Patients request reviews and modality education sessions through booking links that read each clinician's calendar, cancellations backfill from the waitlist and reminders go out. After the visit, the after-visit companion tracks the access referral, the transplant work-up and each follow-up until it is done. Family and carers can see letters and messages with the patient's consent, which matters when a family is planning dialysis together.

Calls, email, web forms and WhatsApp land in one thread per patient, and the patient memory brief shows the latest eGFR, the medicines and the last letter, each traced to its source. Private prescriptions in the UK are issued and signed through SignatureRx, and invoices to the insurer run through the clinic's own Stripe account. The clinic management software page covers the full front desk.

One CKD review, start to finish

Take a 67-year-old man with type 2 diabetes and chronic kidney disease, seen with his daughter. He speaks Portuguese and she moves between Portuguese and English. His eGFR has fallen from 31 to 22 over a year and his ACR is 120 mg/mmol. The nephrologist reads out his potassium, haemoglobin and blood pressure, states a 2-year kidney failure risk of 28%, and explains what that means. They talk through dialysis at home, dialysis in a unit, a transplant assessment and conservative care. He wants to know more about home dialysis and to think before deciding.

The draft records the cause, G4A3, the eGFR and ACR trend, the values read out, his medicines, the risk as stated, each option discussed in the words used, and the plan for a modality education session and an access assessment. wai suggests E11.2 and N18.4, each beside the line it came from. The nephrologist corrects one line, where the draft had recorded that he had chosen peritoneal dialysis, to show that no decision has been made, and signs.

The letter goes to the patient, copied to the GP, and his summary goes out in Portuguese beside the English. The referral letter to the access surgeon carries the question. The front desk sets the recall for bloods in three months through TDL, tracks the access referral, and his daughter, with his consent, sees the letters in the app.

The evidence behind wai's method

The note is one part of the day the evidence measures. In a randomised trial of 238 outpatient physicians across 14 specialties at UCLA Health, the ambient scribe with a significant effect cut the time spent writing each note by about 41 seconds, against 18 seconds in usual care.¹ At The Permanente Medical Group, 3,442 physicians used an ambient scribe across 303,266 encounters in its first ten weeks.² That is why wai takes on the recalls, the results and the referrals as well as the note.

Kidney guidance sets the content in figures. KDIGO and NICE share one classification and one risk equation,³⁴ and NICE sets the timing for planning kidney replacement therapy.⁵ wai drafts to that content and holds every draft until the nephrologist signs it.

Language changes outcomes. In a systematic review of 33 studies, 76% found at least one outcome better when patient and physician shared a language other than English.⁷

Measured in a working clinic. At The Wellness in London, which runs on wai every day, every clinician has 15 hours a week back, as published in the customer story.⁸

Where to start

Start with CKD reviews for one nephrologist. Build the template around the CGA classification, the trend, the values read out, the medicines and the stated risk, run it for two weeks, and count corrections to values, dates and decisions. In the second week, switch on the recall for monitoring bloods and results explained for the same patients.

Then add the planning and transplant templates. The wai Clinicians page shows the scribe, the specialties hub lists the other specialties, and endocrinology and vascular surgery cover the clinics that share diabetic kidney disease and access planning.

Frequently asked questions