AI scribe and clinic software for pulmonology and respiratory clinics

The respiratory note, built on numbers

An asthma review follows the joint NICE, BTS and SIGN guideline. Symptom control is scored with a validated questionnaire such as the Asthma Control Test, and adherence and inhaler technique are checked at every asthma review and before any change of treatment.¹ In adults with a history suggesting asthma, a FeNO of 50 ppb or more, or an eosinophil count above the laboratory reference range, confirms the diagnosis.¹ The draft records each value with its unit, the exacerbations and oral steroid courses since the last visit, and the treatment step agreed.

A COPD review grades breathlessness on the MRC dyspnoea scale, records post-bronchodilator spirometry with FEV1 as a percentage of predicted and the FEV1/FVC ratio, and covers smoking, vaccinations, pulmonary rehabilitation and the self-management plan, inhaler technique included.² An ILD note records the exposures, drugs and connective tissue symptoms asked about, FVC and gas transfer with their trend, and the imaging as the physician describes it. NICE advises that idiopathic pulmonary fibrosis is diagnosed only by consensus of the multidisciplinary team, and that spirometry and gas transfer are repeated at 6 and 12 months after diagnosis to measure the rate of decline.³

wai does not connect to spirometers or lung function systems. The numbers enter the draft when the physician reads them out with the patient, and the template holds a field for each one, so a missing gas transfer value shows as a gap rather than a guess. A safety-netting check runs on the draft, and risk scores are suggested for the clinician to apply.

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 J45.9 Asthma, unspecified, J44.9 Chronic obstructive pulmonary disease, unspecified, J44.1 Chronic obstructive pulmonary disease with acute exacerbation, unspecified, J84.1 Other interstitial pulmonary diseases with fibrosis and J47 Bronchiectasis. US practices see ICD-10-CM forms such as J45.909 Unspecified asthma, uncomplicated, and J84.112 Idiopathic pulmonary fibrosis. SNOMED CT concepts are suggested alongside, and procedure codes for bronchoscopy or lung function testing, CPT in the US and OPCS in the UK, stay with the clinic's coder.

The letters a respiratory clinic 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 a respiratory clinic that letter explains what the breathing tests showed in plain words, names the new inhaler and how to use it, and says what to do if breathing worsens. The GP copy matters because the GP usually takes over the prescription.

The personalised asthma action plan and the COPD self-management plan go to the patient on the clinic's own template, with the doses and the signs of worsening agreed in the room. Referral letters go to pulmonary rehabilitation, to the ILD multidisciplinary team, to a thoracic surgeon or to a sleep service, each carrying the question for the specialist and drafted from the whole record. Medication change letters cover a step up or down in inhaled treatment or a new antifibrotic.

Fit-to-fly letters matter in a respiratory practice, for patients with lung disease planning a flight, and record the diagnosis, current treatment and any oxygen need as the physician stated it. UK fit notes go out on the official form. For the structure of the referral itself, see the referral letter, and for patients whose breathlessness is part of a sleep problem, AI scribe for sleep medicine.

Respiratory care in the patient'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.

Inhaler technique and action plans are where language decides the outcome. A patient who hears the steps in their own language, and takes home a summary of them in that language, has a better chance of following them. The signed note is written in English for the record, or in another language the clinic chooses, and the patient's summary, with the inhaler steps and the signs of worsening, can be translated beside it. Crisis and emergency numbers stay exactly as written. The detail is on the multilingual AI scribe page.

Clinic software for pulmonology clinics, around the review cycle

A respiratory clinic runs on reviews that recur. In wai Admin, calls, email, web forms and WhatsApp messages land in one thread per patient, and replies are drafted in the clinic's voice for a person to approve before they are sent. Patients request the lung function slot and the clinic appointment through booking links that read each physician's calendar, cancellations backfill from the waitlist, and reminders go out. Deposits, invoices, payment links and insurer invoices run through the clinic's own Stripe account.

Proactive care sends the recall for the annual asthma or COPD review, the ILD lung function at 6 and 12 months and the repeat bloods, each message approved by a person. In the UK, pathology orders such as eosinophils, IgE or alpha-1 antitrypsin go out and results come back through TDL, and private prescriptions for inhalers are issued and signed through SignatureRx. Each result reaches the patient with the physician's own comment and a plain explanation of each marker.

The after-visit companion sends the signed plan home in plain words and tracks the rehabilitation referral, the new prescription and the follow-up until each is done. Before the next review the physician sees a sourced brief of the patient, with every exacerbation, steroid course and lung function result traced to the letter or visit it came from. For patients with severe disease, a family member or carer can have access with the patient's consent. The full front desk is on the clinic management software page.

One COPD review, start to finish

Take a 61-year-old former smoker with COPD, 40 pack-years, who has needed oral steroids twice since the spring. The physician asks about breathlessness, cough, sputum and sleep, grades breathlessness at MRC 3, reads the post-bronchodilator spirometry aloud, FEV1 52% of predicted and an FEV1/FVC ratio of 0.58, and watches the patient use a dry powder inhaler without breathing out first. They agree a change to a single triple-therapy inhaler, demonstrate it, refer to pulmonary rehabilitation and check flu and pneumococcal vaccination.

The draft note holds the history, the MRC grade, both spirometry values, the exacerbation count, the technique error observed and the plan. The suggested code is J44.9 Chronic obstructive pulmonary disease, unspecified, tied to the line where the diagnosis was discussed. The physician corrects the smoking history, which the draft had heard as 14 pack-years, names the new device exactly, confirms the code and signs.

Three documents go out. The letter to the patient explains the spirometry in plain words, the new inhaler and the steps to use it, and what to do at the start of a flare, with a copy to the GP to take over the prescription. The rehabilitation referral states the MRC grade and the goal of walking to the shops without stopping. A medication change letter records the switch. The front desk sends a booking link for an inhaler technique check in four weeks and sets the annual review recall, each 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 recalls and the bookings as well as the note.

Respiratory medicine has a documented gap that a written record helps close. Across 144 studies of directly observed inhaler use, 31% of patients showed correct technique and 31% poor technique, with no improvement over 40 years.⁴ NICE, BTS and SIGN ask for technique to be checked at every asthma review,¹ and a template field for the technique observed makes that check part of every note.

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 one physician's COPD and asthma review list. Build the review template with the control score, the spirometry fields, the exacerbation count and a field for inhaler technique, run it for the first week, and count corrections to values, devices and doses. In the second week add the letter to the patient and the action plan, and switch on the annual review and ILD lung function recalls in wai Admin.

Read what the research says about AI scribe errors before the pilot, and compare other specialties on the specialties hub. The scribe is described on the wai Clinicians page.

Frequently asked questions