wai alongside MEDITECH Expanse, what is built and what moves today

What is built today, and what is not

wai has no live connection to MEDITECH Expanse at any site today. What exists is a profile in wai's records layer, the part of wai built to read a patient's context from a record system and to write signed work back through the approval gate, falling back to copy and print where a system does not take the write. Every write waits for the clinician's approval first.

The profile is specific about reading. MEDITECH's own developer page says its US Core FHIR R4 APIs give view-only access to patient-facing data after the patient authorises the requesting app, and that only patient workflows are supported.² So the profile does not rely on them for the clinician. Clinician context comes from an HL7v2 ADT feed from the hospital.

It is just as specific about writing. The profile sends the signed note only, as an HL7v2 MDM^T02 message, an original document with its content, through an interface the hospital builds, and counts it delivered when the hospital's system acknowledges it. It also allows a note to go across as preliminary, for the clinician to sign inside Expanse.

Switching it on takes work at both ends. The profile lists registration in MEDITECH's Greenfield Workspace, which MEDITECH describes as a testing ground for app developers to test their integration with Expanse,² an Expanse customer to sponsor the connection, and the document interface built at that hospital. The typical time to a live write, in the profile, is 6 to 12 months, tied to the hospital's upgrade cycle. Until a hospital switches it on, the copy and PDF route below is how wai works beside Expanse. The integrations page lists the connections wai has live or built for clinics today.

A clinic day alongside Expanse

Take a consultant cardiologist who runs a private clinic two afternoons a week beside a hospital whose record is Expanse, and a 61-year-old referred with palpitations. The hospital's history sits in Expanse, and the clinician reads it there before the visit as usual.

In the room the clinician starts the capture in wai. wai drafts the note, and the clinician reads it in the problem-oriented view, corrects the caffeine intake the draft had halved, adds that the episodes last under a minute, confirms the suggested ICD-10 code and signs.

One click copies the signed note as plain text, and the clinician pastes it into the patient's Expanse record. The letter to the patient with a copy to the referring doctor, explaining the plan for an ambulatory heart monitor, is signed in wai, downloaded as a PDF with the signature and attached to the chart.

At the private desk, the monitor appointment and the deposit go through wai, and the follow-up is tracked until the result is back and explained to the patient with the clinician's comment. This is an illustrative example, not a real patient.

The note and the letters, signed by the clinician

Nothing reaches Expanse or the patient until the clinician signs it in wai. One captured note can be read as SOAP, problem-oriented, narrative, a bullet summary, a handover or in full detail, and the clinician copies the view the hospital's note template expects. The copy is plain text, so it pastes cleanly into any note field.

Letters come from the same consultation. A letter to the patient with a copy to the referrer or the regular doctor, referral letters that carry the questions for the specialist, results letters, medication change letters and medico-legal reports are drafted for the clinician to sign, and each signed letter downloads as a PDF with the signature.

Codes are suggested from the note, ICD-10 and SNOMED CT, each shown with the line of the consultation it rests on, for the clinician to confirm. Procedure codes, CPT and the E/M level stay with the hospital's or the practice's own coders. For the wider picture, see how AI scribes connect to an EHR and clinic AI without replacing the EHR.

What can run in wai beside Expanse

A hospital clinic keeps its scheduling and its chart in Expanse, and wai takes the note and the letters. A private clinic beside the hospital can run more in wai. Calls, email, web forms and WhatsApp land in one thread per patient, replies are drafted in the clinic's voice, and a person approves each one before it is sent.

wai booking links read each doctor's Google, Outlook or Apple calendar, cancellations backfill from the waitlist and reminders go out. Deposits, invoices, memberships and payment links run through the clinic's own Stripe account. Results reach the patient with the doctor's own comment and a plain explanation of each marker, recalls go out with each message approved by a person, and the patient app holds results, letters, messages and payments in the patient's language.

Nothing is switched off on the first day, and the hospital's record stays the hospital's record. The clinic management software page covers the desk in full.

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 others are captured in that language. The signed note is written in English for the record, and the patient's summary can be translated into their language beside it, with emergency numbers kept exactly as written.

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.³ At The Permanente Medical Group, 3,442 physicians used an ambient scribe across 303,266 encounters in its first ten weeks.⁴ wai is built on that finding, so it takes on the letters, the replies, the booking and the follow-up as well as the note.

A draft stays a draft until a person signs it. wai holds every draft until the clinician signs it, and the Expanse profile keeps that rule, since every write waits for clinician approval before it is sent.

The patient's own language matters. In a systematic review of 33 studies, 76% found at least one outcome better when patient and physician shared a language other than English.⁵

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.⁶

Where to start

Week one, one clinician, Expanse unchanged. Capture each consultation in wai, sign the note, copy it into Expanse and attach the signed letters as PDFs. Count the minutes from the end of each consultation to a signed note in the chart.

Week two, add the private desk if there is one, and talk to the hospital's interface team about the HL7v2 route if the hospital wants the direct write. wai signs a business associate agreement with US practices before go-live. The switching checklist covers what to agree first, wai Clinicians covers the scribe, and technical teams can read the developers and MCP page. Clinics on other systems can read wai alongside Kareo or wai alongside Doctolib.

Frequently asked questions