AI scribe and clinic software for speech and language therapy

The note in each clinic, dysphagia, voice and children

Dysphagia notes turn on the diet levels. The International Dysphagia Diet Standardisation Initiative framework has 8 levels, 0 to 7, with drinks measured at levels 0 to 4 and foods at levels 3 to 7, and it says the clinician recommends levels from a comprehensive clinical assessment.¹ The drink levels run from thin at 0 through slightly thick, mildly thick, moderately thick and extremely thick at 4, and the food levels from liquidised at 3 through pureed, minced and moist, soft and bite-sized to regular at 7. A swallowing template carries the history, chest health, oral motor examination, each trial with its consistency and response, the recommended levels and the strategies, and the draft names both the number and the word for each level.

Stroke care sets the clock. NICE asks for people to be screened for communication difficulties within 72 hours of stroke onset and referred to a speech and language therapist when difficulties are suspected, and asks for people with dysphagia, and their families and carers, to be told what the condition is and its risks.³ Voice notes follow a different shape, the voice demands, onset, a perceptual description, the patient's own rating of the impact, and the ENT findings that usually come before voice therapy, which the ENT guide covers from the other side.

Some of the work is not speech the scribe should interpret. wai captures the conversation, so it drafts the parent's history, the therapist's spoken observations and the plan. It does not score a standardised test, transcribe a child's speech sounds phonetically, or read a videofluoroscopy or endoscopic swallow study. The therapist enters scores and transcription and dictates instrumental findings, and the draft holds them in place.

Codes come from the note. wai suggests ICD-10 and SNOMED CT codes, each beside the line of the consultation it rests on, for the therapist to confirm. In the WHO ICD-10, typical ones are R13 for dysphagia, F80.1 for expressive language disorder, F80.2 for receptive language disorder, F98.5 for stuttering, R49.0 for dysphonia and R47.0 for dysphasia and aphasia. US ICD-10-CM differs in places, with R13.12 for oropharyngeal dysphagia, I69.391 for dysphagia following cerebral infarction and F80.81 for childhood onset fluency disorder. CPT evaluation and treatment codes stay with the clinic's biller.

Reports to carers, GPs and schools

Swallowing recommendations go to the people at the table. The Academy of Medical Royal Colleges recommends writing most outpatient letters directly to the patient with a copy to the GP, and says writing to patients should be the default for an AI scribe.⁷ For a swallowing assessment, that letter is the mealtime plan, the drink and food levels in plain words, posture, pacing and what to do if the person coughs or chokes, and the GP copy carries any request, such as reviewing tablets the person can no longer swallow. Referral letters for an instrumental assessment or to ENT carry the question, as the referral letter sets out.

School reports have their own rules in England. The SEND Code of Practice says speech and language therapy should normally be recorded as special educational provision in an education, health and care plan, and that provision must be detailed and specific and should normally be quantified, for example by type, hours and frequency of support and level of expertise.⁴ A report written to that standard runs as a clinic template, or a bespoke template on the Clinician Plus plan, and wai drafts it from the assessment for the therapist to sign. With parental consent it goes to the school as a signed PDF.

The patient's own language, and where an interpreter is still needed

Language is the clinical subject in this profession, so the rule matters more here. The Royal College of Speech and Language Therapists says it is essential to work with professional interpreters when supporting children in their home language, and HCPC standard 13.20 asks speech and language therapists to assess and plan interventions in the service user's home language with the assistance of professional interpreters.⁵ wai is not an interpreter. Where the therapist and the family share a language, it records the session in that language. Where they do not, the interpreter stays.

wai works in 60 languages, among them English, Arabic, Spanish, French, Portuguese, Italian, Russian, Polish, Turkish, Urdu and Mandarin. English can be mixed in one session 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, and the mealtime plan or the parents' summary can be translated into their language beside it, with emergency numbers kept exactly as written. The dysphagia framework publishes its own detailed definitions in many languages, including Arabic, Spanish, French, Portuguese, Italian, Russian, Polish, Turkish and simplified Chinese, so a therapist can check the level names in a translated plan against the official wording.² The multilingual consultations guide covers the detail.

Clinic software for speech and language therapy clinics, from therapy block to review

SLT practices run on blocks of therapy. Parents and patients request appointments through booking links that read each therapist's calendar, a block of weekly sessions is booked and reminded, and cancellations are offered to the waitlist. Many sessions run by video, and the scribe joins Google Meet, Zoom and Microsoft Teams calls.

Family and carer access, with the patient's consent, lets a spouse or care home see the mealtime plan and a parent see the report and the letters. Calls, email, web forms and WhatsApp land in one thread per patient, so a school's question and a parent's question sit together, and a person approves every drafted reply. Payments run through the clinic's own Stripe account, with deposits, payment links, memberships for therapy blocks and insurer invoices.

Swallowing plans need review. wai's proactive care sends a recall when a swallowing review or a block review is due, each message approved by a person, and the after-visit companion tracks each referral, such as an instrumental assessment or ENT, until it is done. Before each session the therapist sees a sourced brief, the current diet levels, the last scores and the goals, each traced to its source. The clinic management software page shows the full front desk.

One swallowing assessment, start to finish

Take a 72-year-old man three months after a left-sided stroke, seen at home because he coughs when he drinks and had a chest infection last month. His wife is with him. Both speak Spanish and English, the therapist is bilingual, and the session moves between the two languages.

The therapist narrates as she works. Reduced lip and tongue strength on the right, a delayed swallow, and a cough with a wet voice after thin water from a cup. Mildly thick drinks, level 2, from a cup with small sips are clear on three trials. He chews slowly and tires on a cracker but manages soft and bite-sized food, level 6. They agree level 2 drinks, level 6 food, sitting fully upright for meals, small sips, his wife present at meals, and mouth care twice a day, with a review in four weeks.

The draft note set out the history, the oral motor findings, each trial with its consistency and response, the recommendations and the plan. It had written the drinks as moderately thick, and the therapist corrected it to mildly thick, level 2, as she had said. wai suggested R13 for dysphagia and I69.3 for sequelae of cerebral infarction, and she confirmed both and signed.

What went out was a mealtime plan addressed to the patient and his wife, with a Spanish translation beside the English, setting out the levels, the strategies and what to do if he coughs or chokes, and a copy to the GP asking for a review of his tablets, which he finds hard to swallow. The front desk gave his wife carer access with his consent and set the four-week review recall.

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 Speech and language therapists were not studied, and their hours sit in reports and plans that others follow, so wai drafts those from the same session.

Precision is the safety issue. The dysphagia framework exists to give everyone the same words for drink thickness and food texture, and it leaves the recommendation to the clinician's assessment.¹ wai holds every draft until the therapist signs it, so a misheard level can be caught before the plan reaches anyone who pours a drink.

The patient's own language. 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 swallowing assessments for one therapist. In week one, build the template with a line for each trial, fixed fields for the drink and food level by number and name, and the strategies, and measure the time from the end of each session to a signed note and mealtime plan. In week two, add the translated mealtime plan, carer access and review recalls, and count corrections to levels.

Then add the paediatric and school report templates, with fields for the therapist's scores and quantified provision. Compare the workflow with the paediatrics guide and the neurology guide, see every profession on the specialties hub, and read how the scribe works on the wai Clinicians page.

Frequently asked questions