AI scribe and clinic software for palliative care

The palliative note, symptom by symptom

A palliative symptom review records each symptom in turn, its severity, how it has changed and what has helped. Many services use a structured measure such as the Integrated Palliative care Outcome Scale for symptoms and concerns, and the Australia-modified Karnofsky Performance Status for function, and a clinic template holds those fields. The draft carries the current medicines with doses, the number of breakthrough doses used, the changes agreed and the anticipatory medicines in place, so the physician can check every number before signing.

Advance care planning sits in the same note. The draft records what matters to the person, where they want to be cared for and to die, ceilings of treatment, and who holds a lasting power of attorney for health and welfare. NICE asks services to involve carers and others important to the person in advance care planning if the person agrees, and to make sure each person has a copy of their plan where they live or with them if admitted.³

In the UK, the ReSPECT process records personalised recommendations for care in a future emergency on a form that is not legally binding and can be reviewed as circumstances change.¹ The joint BMA, Resuscitation Council UK and RCN guidance says that when a decision not to attempt CPR is made because CPR would not succeed, there should be a presumption in favour of telling the patient and explaining why, that decisions must be documented fully and carefully, and that where a discussion is not practicable the reasons must be recorded.² The ReSPECT form or the local CPR form is still completed and signed on the official form. wai drafts the record of the conversation that sits behind it, in the words used. In the US, the Medicare hospice benefit requires certification of a life expectancy of 6 months or less,⁴ and portable orders for life-sustaining treatment follow each state's own rules.

Codes are suggested from the note with the line each rests on, for the physician to confirm. In ICD-10, the edition used in the UK and the Gulf, typical codes are Z51.5 Palliative care, C34.9 Malignant neoplasm of bronchus or lung, unspecified, C78.7 Secondary malignant neoplasm of liver and intrahepatic bile duct, R06.0 Dyspnoea and R11 Nausea and vomiting. In ICD-10-CM in the US, Z51.5 is titled Encounter for palliative care, and C34.90 replaces C34.9. SNOMED CT concepts are suggested alongside, and procedure codes, CPT in the US and OPCS in the UK, stay with the clinic's coder.

The letters palliative care sends, and to whom

The Academy of Medical Royal Colleges recommends writing most outpatient letters to the patient with a copy to the GP, and says this should be the default setting for an AI scribe.⁵ In palliative care the physician first asks whether the person wants a letter and how much detail it should hold. When they do, it sets out the plan in plain words, the medicine changes and who to call by day and by night, with the GP copied so that the practice and the out-of-hours service see the same plan.

Medication change letters go to the GP and the community nursing team with each new dose, the breakthrough dose and the anticipatory medicines, so a prescription can follow the same day. Referral letters go to a hospice, a hospice at home team, a specialist colleague or community therapy, each carrying the question and drafted from the whole record. With the patient's consent, a copy of the plan goes to the family. The structure is in the referral letter, and the frailty assessments that often come first in AI scribe for geriatrics.

End of life conversations in the family's own 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 the language spoken.

Conversations about dying are hard enough in a first language. A family that can hear the plan and ask its questions in its own language is part of the conversation, rather than waiting for it to be interpreted. The signed note is written in English for the record, or in another language the clinic chooses, and the patient's summary, with the medicines and the numbers to call, can be translated beside it. Crisis and emergency numbers stay exactly as written. More in multilingual consultations and on the multilingual AI scribe page.

Clinic software for palliative care clinics, between visits

Palliative care runs on what happens between visits. In wai Admin, calls, email, web forms and WhatsApp messages from the patient and the family land in one thread per patient, and replies are drafted in the clinic's voice for a person to approve before they are sent. Family and carer access is set up with the patient's consent. When a visit is not possible in person, the scribe joins the Google Meet, Zoom or Microsoft Teams call, so a review at home is recorded in the same way.

The after-visit companion sends the signed plan home in plain words and tracks each prescription, referral and follow-up until it is done. In the UK, private prescriptions are issued and signed through SignatureRx, and pathology orders go out and results come back through TDL. Proactive care sends the recall for the next review or the repeat prescription, each approved by a person. Each result reaches the patient with the doctor's own comment and a plain explanation of each marker.

Before each review the physician sees a sourced brief of the patient, each fact traced to the letter, result or visit it came from, from the oncology letters to the last advance care planning conversation. Invoices, memberships, payment links and insurer invoices run through the clinic's own Stripe account. The full front desk is on the clinic management software page.

One palliative review, start to finish

Take a 72-year-old man with lung cancer and liver metastases, reviewed at home by video with his wife on the call. He describes a constant ache under the right ribs, using breakthrough oral morphine 10 mg three or four times a day on top of modified-release morphine 30 mg twice daily, more breathless on the stairs, and constipated. He says he wants to stay at home. The physician explains that CPR would not work for him, he agrees, and they talk through a ReSPECT conversation. His wife holds a lasting power of attorney for health and welfare. They agree modified-release morphine 45 mg twice daily, breakthrough 15 mg, a laxative, and a referral to the hospice at home team.

The draft note holds each symptom with its severity, the current and new doses, the breakthrough use, the laxative, his wish to remain at home, the CPR conversation with his words and his agreement, and the lasting power of attorney. Suggested codes are Z51.5 Palliative care and C78.7 Secondary malignant neoplasm of liver and intrahepatic bile duct, each tied to its line. The physician corrects the breakthrough dose, which the draft had heard as 50 mg, confirms the codes and signs. The ReSPECT form is completed and signed separately on the official form.

Three documents go out. The letter to him, which he asked for, sets out the plan, the new doses and who to call day and night, copied to the GP and, with his consent, to his wife. The medication change letter goes to the GP and the district nurses with the new doses and the anticipatory medicines. The referral goes to the hospice at home team. The front desk gives his wife access, issues the prescription through SignatureRx, and sets a review recall for three days later, approved by a person.

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.⁶ At The Permanente Medical Group, 3,442 physicians used an ambient scribe across 303,266 encounters in its first ten weeks.⁷ wai is built on that finding, so it takes on the letters, the family messages and the follow-up as well as the note.

Palliative care guidance puts the weight on the record. The joint UK guidance asks that CPR decisions are documented fully and carefully, with the reasons when a discussion does not happen,² and NICE asks that each person has their advance care plan with them.³ A record drafted from the conversation itself keeps the person's own words.

A draft stays a draft until a person signs it. The Academy of Medical Royal Colleges says the clinician checks every document a scribe produces,⁵ and wai holds every draft until the physician signs it. In a systematic review of 33 studies, 76% found at least one outcome better when patient and physician shared a language other than English.⁸

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.⁹

Where to start

Start with symptom reviews for one physician. Build the template with fields for each symptom, the doses and breakthrough use, and the advance care planning items, run it for the first week, and count corrections to doses above all. In the second week add the family meeting note and the medication change letter, and switch on carer access and review recalls in wai Admin.

Read patient consent for AI scribes before the pilot, since families are often present, and compare other specialties on the specialties hub. The scribe is described on the wai Clinicians page.

Frequently asked questions