AI scribe and clinic software for urology clinics

The urology note, pathway by pathway

The lower urinary tract symptom note starts with the score. NICE recommends a validated symptom score such as the International Prostate Symptom Score at baseline so that later change can be measured, and a urinary frequency volume chart at initial assessment.² It defines mild as an IPSS of 0 to 7, moderate as 8 to 19 and severe as 20 to 35.² wai's template keeps the total, the band and the chart findings in fixed fields, with the examination, the PSA and the treatment options after them.

The PSA note needs the age. NICE NG12 sets thresholds for people with possible symptoms of prostate cancer, more than 2.5 micrograms per litre from 40 to 49, more than 3.5 from 50 to 59, more than 4.5 from 60 to 69 and more than 6.5 from 70 to 79, with clinical judgement below 40 and above 79.¹ NICE NG131 offers multiparametric MRI as the first-line investigation, reported on a 5-point Likert scale, offers an MRI-influenced biopsy at a Likert score of 3 or more, and asks the urological cancer MDT to assign a Cambridge Prognostic Group to each new localised or locally advanced cancer.³ The draft keeps the value, the date, the threshold and the MRI result together.

Haematuria and stones have their own lines. NG12 refers people aged 45 and over with unexplained visible haematuria without urinary tract infection, or visible haematuria that persists or recurs after treated infection, on a suspected bladder cancer pathway, as well as people aged 60 and over with unexplained non-visible haematuria and either dysuria or a raised white cell count.¹ For suspected renal colic NICE offers urgent low-dose non-contrast CT within 24 hours, considers alpha blockers for distal ureteric stones under 10 mm, and measures serum calcium in adults with stones.⁴

wai suggests ICD-10 and SNOMED CT codes from the note, each shown with the line it rests on, for the urologist to confirm. In the WHO edition of ICD-10 used in the UK and the Gulf, typical codes are N40 for hyperplasia of prostate, C61 for malignant neoplasm of prostate, R31 for unspecified haematuria, N20.0 for calculus of kidney, N20.1 for calculus of ureter and N39.0 for urinary tract infection, site not specified. US practices code in ICD-10-CM, where benign prostatic hyperplasia with lower urinary tract symptoms is N40.1 and a raised PSA is R97.20. Procedure codes for cystoscopy or ureteroscopy, OPCS-4 in the UK and CPT in the US, stay with the clinic's coder.

Letters to the patient, the GP and the MDT

The Academy of Medical Royal Colleges recommends that most outpatient letters are written to the patient with a copy to the GP, and that this should be the default for an AI scribe.⁵ A urology letter explains the result, the threshold it was judged against, the next test and when it will happen, in words the patient can act on.

Some letters go to colleagues. NICE notes that PSA tests during active surveillance could be done in primary care where there are agreed shared-care protocols and recall systems,³ so the GP letter states the schedule and the level that should prompt a call. A new cancer goes to the MDT with a referral letter that carries the questions for the meeting, drafted from the whole record, as described in the referral letter. Results letters explain each PSA, MRI and biopsy result, and medication change letters set out an alpha blocker or a 5-alpha reductase inhibitor with the dose and review date.

Stone letters carry prevention advice with numbers. NICE advises adults to drink 2.5 to 3 litres of water a day, keep salt to no more than 6 g a day and keep a normal calcium intake of 700 to 1,200 mg.⁴ The template holds those figures so the urologist checks them rather than retypes them. After a procedure, a UK fit note goes out on the official form. Every letter downloads as a PDF once signed.

Intimate symptoms, in the patient's own language

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 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.

Urology asks about urine, erections and continence, and patients describe those most precisely in the language they think in. A man who explains his nocturia and stream in Polish or Mandarin gets a note written in English and a patient summary in his own language beside it, with crisis and emergency numbers kept exactly as written. The plan for his MRI and his next PSA reads the same way. More is on the multilingual AI scribe page and in the guide to multilingual consultations.

Clinic software for urology clinics, built around PSA and surveillance

Active surveillance is a calendar. NICE suggests PSA every 3 to 4 months in the first year, a digital rectal examination at 12 months and multiparametric MRI at 12 to 18 months, then PSA every 6 months and an examination every 12 months from the second year.³ wai's proactive care sends each recall at the interval the urologist signed, a person approves every message, and in the UK the PSA is ordered through TDL with the result back in the record.

Each result reaches the patient with the urologist's own comment and a plain explanation of what the number means. Before every visit the urologist sees a sourced brief of the patient, so the PSA values line up with their dates, each traced to the result or letter it came from. The after-visit companion tracks each MRI referral, biopsy and follow-up until it is done.

The rest of the desk runs in the same place. Calls, email, web forms and WhatsApp messages land in one thread per patient, with replies drafted in the clinic's voice for a person to approve. Booking links read each urologist's calendar in Google, Outlook or Apple, cancellations are offered to the waitlist, and reminders go out. Invoices, deposits and payment links go through the clinic's own Stripe account, insured patients get insurer invoices, and private prescriptions are issued and signed through SignatureRx. The full set is on the clinic management software page.

One LUTS and PSA consultation, start to finish

Take a 66-year-old man with two years of getting up three times a night, a weak stream and hesitancy. His GP measured a PSA of 5.1 micrograms per litre three weeks ago, above the threshold of 4.5 for his age. He filled in the symptom questionnaire in the waiting room. On examination the prostate feels smooth and moderately enlarged. The urologist explains that the PSA could reflect the enlargement and that an MRI is the next step, talks through what a biopsy would involve if the MRI shows a concern, and offers an alpha blocker for his symptoms. He asks whether the tablets will affect his driving at night.

The draft is ready when he leaves. It holds the symptoms, the IPSS as he read his answers aloud, the examination, the PSA with the GP's test date, the MRI plan, the biopsy discussion, the medicine offer and his question. The urologist checks the score against the paper form. The draft had totalled his spoken answers as 18, and the form reads 19 because he changed one answer, so she corrects the total, which stays in the moderate band. ICD-10 N40 is suggested beside the line where she named the enlargement, and she confirms it and signs.

The letter goes to him with a copy to his GP, with a medication change letter for the alpha blocker. The after-visit companion opens the MRI referral and the follow-up appointment and tracks both until they are done. The front desk sends the booking link for the results visit and the reminder, and when the MRI result arrives it reaches him with the urologist'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.⁶ wai is built on that finding, so it takes on the letters, the recalls, the booking and the follow-up as well as the note.

Urology guidance depends on a reliable record. NICE asks for a baseline symptom score so that later change can be assessed,² and sets PSA thresholds by age,¹ which only work if the value, the date and the age sit together in the note. Template fields for each make that the default.

A draft stays a draft until the urologist signs it. wai holds every draft until the clinician signs it, and every reply until a person at the clinic sends 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.⁷

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.⁸

Where to start

Start with one urologist's new LUTS and raised PSA clinic. In the first week, build the letter template with fields for IPSS total and band, PSA value, date and age threshold, MRI plan and agreed treatment, and run it for every new patient. Measure the time from the end of clinic to signed letters, and count corrections to scores and dates.

In the second week, add the haematuria, stone and active surveillance templates, and turn on PSA recalls at the front desk. The guides to AI scribe accuracy and oncology cover the checks and the cancer pathway after the MDT. Other specialties are on the specialties page, and plans are on the pricing page.

Frequently asked questions