AI scribe and clinic software for neurology clinics

The neurology note, from history to localisation

Built in wai's clinic template library, the neurology template opens with the presenting problem in the patient's own words, the onset and tempo, and the witness account where there is one. Then come the examination by system, cranial nerves, motor, reflexes, sensation, coordination and gait, the localisation, the differential and the investigations. Clinic templates add the parts each subspecialty needs, the seizure description and frequency for epilepsy, the headache pattern for headache clinic, relapses and disability scores such as EDSS for MS, and the NIH Stroke Scale where a stroke clinic uses it.

The guidance sets what the history must hold. NICE says to take a detailed history after a first suspected seizure, from family and carers where appropriate, and to use eyewitness accounts and video of the event where possible.⁵ For headache, NICE suggests a diary kept for at least 8 weeks, recording frequency, duration, severity, associated symptoms and every medicine taken.⁶ For MS, NICE says to diagnose by the 2024 revised McDonald criteria and to give every person a comprehensive review at least once a year.⁷

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 G40.9 for epilepsy, unspecified, R56.8 for other and unspecified convulsions after a first event, G43.0 for migraine without aura, G44.2 for tension-type headache, G35 for multiple sclerosis and G20 for Parkinson disease. US ICD-10-CM subdivides G35 by disease course and G20 by dyskinesia, so a US clinic confirms the full code. 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, including the driving advice in the UK

Most neurology 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.⁸ A neurology letter explains the working diagnosis, the investigations and why, any medicine and how to start it, the safety advice and the next review. NICE says to discuss the impact on daily life, including driving, at the first epilepsy appointment and to give the person a copy of their care plan.⁴

In the UK the driving advice must be exact. Licence holders have a legal duty to tell the DVLA of a condition likely to affect safe driving, clinicians should advise them of that duty, and the GMC guidance the DVLA reproduces says to note any advice on fitness to drive in the medical record.³ For car and motorcycle drivers, the DVLA says driving must stop for 6 months after a first unprovoked seizure, or 12 months where an underlying factor raises the risk, and for 12 months after the most recent seizure in epilepsy.² wai records the advice as the neurologist gives it, and the letter repeats it. Fit notes go on the official UK form, and the medico-legal guide covers how that record is used.

A neurological history in the patient's own language

A seizure history is often told by a parent, a partner or a colleague, and they may not share the clinician's first language. 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 safety and driving advice, 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 neurology clinics, from investigations to annual reviews

A new neurology patient usually leaves with investigations to arrange. The after-visit companion tracks each MRI, EEG, referral and follow-up until it is done, and patients request the results review through booking links that read each neurologist's calendar. Cancellations backfill from the waitlist and reminders go out.

Recalls cover the long-term clinics, the annual MS review NICE expects,⁷ the monitoring bloods for disease-modifying treatment and the repeat cycle for headache injections, each message approved by a person. In the UK, pathology orders go out and results come back through TDL, each result reaching the patient with the neurologist's own comment, and private prescriptions are issued and signed through SignatureRx. Medication change letters go out from the same consultation when an anti-seizure medicine is started or adjusted.

Calls, email, web forms and WhatsApp land in one thread per patient, so a message about a new seizure sits beside the last letter, and the patient memory brief shows the date of the last event and the current medicines, each traced to its source. Carers can see letters and messages with the patient's consent. The clinic management software page covers the full front desk.

One first seizure consultation, start to finish

Take a 29-year-old man seen three weeks after a witnessed convulsion at work. His colleague's account is that he went stiff, fell and shook for about a minute, and his partner filmed the end of it. He had slept four hours the night before. He drives a car and operates a forklift at work. The examination is normal. The neurologist plans an MRI and an EEG, and explains that under DVLA rules he must stop driving and tell the DVLA, and that after a first unprovoked seizure the usual period off driving is 6 months, depending on the investigations.

The draft records the event in the colleague's words, the video, the sleep loss, the normal examination by system, the differential, the investigations, and the driving and safety advice as given, including showers rather than baths. wai suggests R56.8, beside the line it came from. The neurologist corrects the date of the seizure, which the draft had taken from the day he saw his GP, because the driving period runs from the seizure itself, and signs.

The letter goes to the patient, copied to the GP, with the advice in plain words. A UK fit note on the official form covers amended duties away from the forklift. The front desk tracks the MRI and EEG, sends the reminder for the results review, and the results reach him with the neurologist's comment.

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 Neurology notes are long, so wai also takes on the letters, the investigations and the recalls.

Neurology guidance asks for specific content. NICE asks for the witness account and video after a first seizure,⁵ a diary of at least 8 weeks for headache,⁶ and a yearly comprehensive review in MS.⁷ The DVLA asks clinicians to advise patients of their duty to notify and to record that advice.³ wai drafts to that content and holds every draft until the neurologist 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.⁹

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.¹⁰

Where to start

Start with new patient and first seizure consultations for one neurologist. Build the template around the history, the witness account, the examination by system and the driving advice, run it for two weeks, and count corrections to dates, sides and the advice recorded. In the second week, switch on tracking for MRI and EEG requests for the same patients.

Then add the subspecialty templates, headache, MS and movement disorders. The wai Clinicians page shows the scribe, the specialties hub lists the other specialties, and sleep medicine and geriatrics cover clinics that share many neurology patients.

Frequently asked questions