AI scribe and clinic software for rheumatology clinics

The rheumatology note, from joint count to target

Built in wai's clinic template library, the inflammatory arthritis template opens with the diagnosis and its duration, then morning stiffness, pain and function, the tender and swollen joint counts by joint and side, the CRP or ESR, the patient global assessment and the disease activity score the rheumatologist states. Then come the current drugs and doses, the monitoring results, infections and vaccinations, the treat-to-target decision and the plan. Templates for psoriatic arthritis add skin and nails, axial disease adds spinal mobility and the clinic's activity score, and lupus and vasculitis templates follow the organs involved. The clinic's template and phrase library are shared, and the Clinician Plus plan adds bespoke templates.

NICE sets the rhythm for rheumatoid arthritis. It says to treat to a target of remission or low disease activity, and to measure CRP and disease activity, using a composite score such as DAS28, monthly in specialist care until the target is reached.³ Its committee gives a DAS28 below 2.6 as an example of remission and below 3.2 as low disease activity, and NICE's appraisals use 3.2 to 5.1 for moderate disease and above 5.1 for severe.³ The draft records the score the rheumatologist states, and wai does not calculate it by itself.

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 M05.9 for seropositive rheumatoid arthritis, unspecified, M06.9 for rheumatoid arthritis, unspecified, L40.5 for arthropathic psoriasis, M45 for ankylosing spondylitis, M32.9 for systemic lupus erythematosus, unspecified, and M10.9 for gout, unspecified. US ICD-10-CM subdivides several of these, M45 by spinal region and L40.5 by pattern, and adds codes such as Z79.631 for long-term current use of an antimetabolite agent. SNOMED CT is suggested beside them, and procedure codes, CPT in the US and OPCS in the UK, stay with the clinic's coder.

Letters that set out the drug and its monitoring

Most rheumatology 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.⁵ A rheumatology letter explains the diagnosis and the target, the drug and dose, the side effects to report, and exactly who arranges each blood test.

Monitoring is where letters matter most. The 2025 British Society for Rheumatology guideline for conventional synthetic DMARDs recommends, for patients without risk factors for toxicity, a full blood count, electrolytes, renal function, liver enzymes and albumin at week 2 and then monthly for the first 3 to 6 months, then every 3 months once stable, with more frequent tests for those at higher risk.⁴ The medication change letter carries that schedule from the same consultation. Referral letters carry the question for the specialist, as the referral letter guide sets out.

Long-term treatment explained in the patient's own language

A patient on methotrexate needs to know the weekly dose, the folic acid day and when to stop for an infection. 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 dose and the blood test schedule, can be translated into their language beside it, with emergency numbers kept exactly as written. The guide to multilingual consultations explains how mixed-language consultations are captured.

Clinic software for rheumatology clinics, from monitoring bloods to reviews

Drug monitoring is the front desk's largest rheumatology task. wai Admin sends each monitoring recall on the schedule the rheumatologist set, at week 2, monthly and then every 3 months, 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 rheumatologist's own comment and a plain explanation of each marker.

Patients request the monthly treat-to-target review through booking links that read each rheumatologist's calendar, cancellations backfill from the waitlist and reminders go out. Private prescriptions in the UK are issued and signed through SignatureRx. Calls, email, web forms and WhatsApp land in one thread per patient, so a message about a flare or a raised liver test sits beside the record, and the patient memory brief shows the current drugs and last results, each traced to its source.

After the visit, each prescription, referral and follow-up is tracked until it is done. Invoices to the insurer and payment links run through the clinic's own Stripe account. The clinic management software page covers the full front desk.

One rheumatoid arthritis review, start to finish

Take a 47-year-old woman with seropositive rheumatoid arthritis, four months on methotrexate. She has ninety minutes of morning stiffness and struggles with jar lids. The rheumatologist counts five tender and three swollen joints, including the right wrist, reads out a CRP of 18, and states a DAS28 of 4.1, above target. They agree to add sulfasalazine and hydroxychloroquine, and she asks about alcohol and her holiday vaccinations.

The draft records the joint counts by joint and side, the CRP, the score as stated, her function, methotrexate tolerance, the alcohol and vaccination advice, the decision to step up and the monitoring schedule. wai suggests M06.9, beside the line it came from. The rheumatologist changes it to M05.9 because she is seropositive, corrects the swollen wrist from left to right, and signs.

The medication change letter and the letter to the patient, copied to the GP, set out each drug and dose and who arranges which blood test. The front desk sets the recalls for the week 2 and monthly bloods, ordered through TDL, and the review in one month, and the private prescription goes through SignatureRx.

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 monitoring recalls, the results and the letters as well as the note.

Rheumatology guidance sets the content and the clock. NICE asks for monthly CRP and disease activity until target,³ and the British Society for Rheumatology sets the monitoring schedule for conventional DMARDs.⁴ wai drafts to that content and holds every draft until the rheumatologist 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.⁶

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.⁷

Where to start

Start with treat-to-target reviews for one rheumatologist. Build the template around joint counts, markers, the stated score, the drugs and the monitoring plan, run it for two weeks, and count corrections to joints, sides and doses. In the second week, switch on the monitoring recalls and results explained for the same patients.

Then add the new referral, lupus and gout templates. The wai Clinicians page shows the scribe, the specialties hub lists the other specialties, and MSK, dermatology and physiotherapy cover the teams that share many rheumatology patients.

Frequently asked questions