## Frequently Asked Questions

Learn how Pediatric Clinical Tools works and get the most out of it

### Getting Started

Pediatric Clinical Tools is an AI-powered clinical documentation tool designed specifically for pediatric medicine. It helps physicians generate structured clinical notes from voice recordings or typed text, saving time on documentation so you can focus on patient care.

It supports HPIs, SOAP notes, hospital courses, chart reviews, well visits, sick visits, developmental milestone assessments, and more.

The easiest way to start is with Live Encounter:

1. Go to the Encounter tab
2. Enter the patient's age and gender
3. Click Start Recording and speak naturally during your patient encounter
4. Click Stop when done — the audio is transcribed automatically
5. Click Generate HPI to create a structured note
6. Edit the note as needed, then Copy to paste into your EHR

Yes. Every transcript box is editable. You can type directly, paste from another source, or combine typed text with a recording. The AI works with whatever text is in the transcript area when you click Generate.

- HPI — from live encounters or dictation, with OLDCARTS structure
- SOAP Notes — full SOAP or subjective-only from dictation
- Hospital Course — from progress notes, in prose, day-by-day, or organ-system format
- Chart Review — summarize outpatient, subspecialty, or ED visits for precharting
- Well Visit — complete preventive care notes with SSHADESS, milestones, and vaccines
- Sick Visit — quick documentation with auto-suggested ROS and PE
- Milestone Assessment — developmental narrative from selected milestones

### AI & Models

Each tab has a model selector dropdown. All available models have been tested and configured by your administrator for clinical documentation quality. They are routed through HIPAA-compliant providers with signed Business Associate Agreements (BAAs).

All models are capable of generating accurate clinical notes. If you are unsure which to pick, start with the default. You can experiment with different models and see which output style you prefer — some may be faster, some more detailed, some more concise. You can choose a different model per tab depending on the task.

Administrators can edit all AI prompts from the Admin Panel > Settings > Prompts section. This lets you adjust the instructions the AI follows for each note type without changing any code. Changes take effect immediately.

After generating a note, you can give the AI plain-language instructions to modify it. For example:

- "Make it shorter"
- "Add that the patient has a history of asthma"
- "Summarize the labs"
- "Change the assessment to include bronchiolitis"

The AI references both its current output and your original source material (transcript, pasted notes, labs) when refining, so it can look up details from the original input.

### Voice & Transcription

When you stop recording, the audio is sent to a speech-to-text service that converts it to text. The app supports multiple transcription providers including Whisper, Deepgram, and Google Gemini. Your administrator configures which provider is used.

You will see a blue status bar at the top while transcription is in progress. You can continue working on the page while it processes.

Yes. The app is a Progressive Web App (PWA) that works in any modern browser. On mobile:

- Open the app in Chrome or Safari
- Tap "Add to Home Screen" to install it as a standalone app
- Recording works in the foreground, but audio stops if you lock the screen or switch apps on iOS and most Android devices — this is a browser limitation, not specific to this app

On desktop, recording continues normally when the browser is minimized or in the background.

If transcription fails, your audio is automatically backed up to the server for 24 hours. You can retry transcription from Settings > Audio Backups. If browser speech recognition was active during recording, the live transcript is preserved as a fallback.

Yes. Click the Read button on any generated note to hear it spoken aloud. This uses text-to-speech (TTS) powered by Google, OpenAI, or ElevenLabs depending on your setup. You can choose your preferred voice in Settings > Voice Preferences.

### Saving & Export

You can save encounters using the Save button at the top of each tab. Saved encounters include the transcript, generated note, and patient label. You can reload them later using the Load button.

Saved encounters are automatically deleted after 7 days (configurable by your administrator). This is intentional — the app is a documentation tool, not a medical record system. Copy your final notes to your EHR for permanent storage.

- Copy — one-click copy to clipboard, ready to paste into any EHR
- Nextcloud — export directly to your Nextcloud instance (configure in Settings)
- Documents — upload files to S3-compatible storage from Settings

All generated text is plain text with no markdown formatting, designed to paste cleanly into any EHR system.

### Privacy & Security

The app is designed with clinical privacy in mind:

- All connections use HTTPS/TLS encryption
- Audio and encounter data are temporary — auto-deleted within hours or days
- No patient data is stored long-term on the server
- Every action is audit-logged (who accessed what, when)
- Two-factor authentication (2FA) and session management are available
- Server transcription can be configured with HIPAA-eligible providers

For HIPAA compliance, ensure your administrator has configured a BAA-covered AI provider (such as AWS Bedrock, Google Vertex AI, or Azure OpenAI).

2FA adds an extra layer of security to your account. After entering your password, you also enter a 6-digit code from an authenticator app (like Google Authenticator or Authy). Enable it in Settings > Two-Factor Authentication.

Go to Settings > Active Sessions to see all devices where you are logged in. You can revoke any session individually or click Revoke All Other Sessions to log out every other device. Your current session is highlighted and cannot be revoked from this screen — use the Logout button instead.

When you change your password in Settings > Change Password, all other active sessions are automatically logged out for security. Only your current session remains active. The app also checks if your new password has appeared in known data breaches and warns you (but does not prevent you from using it).

### Well Visit & Sick Visit

The Well Visit tab follows the AAP Bright Futures periodicity schedule. It includes:

- Visit by Age — recommended screenings, vaccines, and anticipatory guidance for each visit age
- Milestones — developmental milestone tracker from birth through 11 years across multiple domains
- SSHADESS — adolescent psychosocial assessment (Strengths, School, Home, Activities, Drugs, Emotions, Sexuality, Safety) for ages 12+
- Visit Note — generates a complete well visit note combining ROS, PE, milestones, and SSHADESS data

In the ROS and Physical Exam sections, each system has three options:

- WNL / Normal — within normal limits, no concerns
- Abnormal — a text box appears so you can describe the finding
- Not Reviewed / Not Examined — explicitly not assessed

Use All WNL to quickly mark everything normal, then click individual systems to change specific ones. Use Clear to reset all selections.

### Learning Hub

The Learning Hub is an educational platform integrated into the app. It contains articles, clinical pearls, quizzes, and slide presentations created by moderators and administrators. You can browse by category, search content, and take quizzes to test your knowledge.

Quizzes include multiple-choice, multi-select, and true/false questions. After submitting your answers, you see your score along with explanations for each question. Your past attempts and scores are tracked so you can monitor your progress over time.

Moderators and administrators can create content using the CMS tab. You can write articles manually, or use AI to generate content from a topic description, uploaded PDFs, or files from Nextcloud. The CMS also supports Marp-based slide presentations with PPTX export.

### Pediatric Calculators

The Calculators tab includes clinical tools commonly used in pediatric practice:

- Blood Pressure Percentile — AAP 2017 guidelines using the Rosner quantile spline regression method. Requires age, sex, height, and BP. Provides exact systolic and diastolic percentiles adjusted for height, with AAP classification (Normal, Elevated, Stage 1, Stage 2). Includes definitions of hypertension and hypotension.
- BMI Percentile — CDC 2000 growth reference with extended obesity classification (Class 1, 2, 3 using % of 95th percentile). Shows BMI chart with percentile curves.
- Growth Charts — Visual percentile curves (3rd through 97th) with your patient plotted. Includes Weight-for-Age, Length/Height-for-Age (with mid-parental height), Head Circumference, Weight-for-Length, and Fenton preterm charts.
- Bilirubin — AAP 2022 phototherapy threshold calculator and Bhutani hour-specific nomogram with risk zone classification. Includes Nelson Table 137.1 risk factors.
- Vital Signs by Age — Harriet Lane reference table for HR, RR, BP, and weight by age from preterm through 18 years. Includes quick formulas for estimated weight, minimum SBP, ETT size, and maintenance fluids.
- Body Surface Area — Mosteller formula for BSA calculation.
- Weight-Based Dosing — Dose per kg with frequency, max dose cap, and volume calculation from concentration.

The BP calculator uses the same Rosner quantile spline regression method as the Baylor College of Medicine reference calculator. It computes exact percentiles (1st-99th) based on your patient's age, sex, and height using published regression coefficients. This is the same methodology underlying the AAP 2017 normative tables. Results are height-adjusted and clinically accurate.

The growth charts display WHO/CDC percentile curves (3rd, 5th, 10th, 25th, 50th, 75th, 90th, 95th, 97th percentiles) with your patient's measurement plotted as a blue dot. The 50th percentile is shown as a bold green line. Shaded bands show the normal range between symmetric percentiles.

For Length/Height-for-Age, you can optionally enter both parents' heights to see the mid-parental target height range plotted on the chart.

### Troubleshooting

AI-generated notes should always be reviewed before use. If the output is incorrect:

1. Edit the note directly in the output area — it is fully editable
2. Use the Refine button with specific instructions (e.g., "remove the fever mention" or "change the diagnosis")
3. Try a different AI model using the model selector — Premium models may produce more accurate results
4. Save your corrected version — the app learns from your edits and will improve over time

Common causes:

- Microphone permission denied — check your browser's site permissions
- Recording too short — very short recordings (under 1 second) may not contain enough audio
- Screen was locked (mobile) — iOS and Android stop recording when the screen locks. Keep the screen on while recording.
- Network issue — cloud transcription requires an internet connection

If transcription fails, your audio is automatically backed up. Check Settings > Audio Backups to retry.

Some features are role-restricted:

- Admin Panel — visible only to administrators
- CMS (Content Management) — visible to moderators and administrators
- Registration — may be disabled by your administrator

Contact your administrator if you need access to a restricted feature.