# Pediatric AI Scribe — Improvement Roadmap

A non-technical overview of what the app does today and how it can be taken further.

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## What the App Does Today

Pediatric AI Scribe is a clinical documentation tool for pediatric physicians. It listens to doctor-patient encounters (or accepts typed/pasted notes) and uses AI to generate structured medical notes — HPIs, SOAP notes, hospital courses, chart reviews, well visit and sick visit documentation.

It also includes pediatric calculators (blood pressure percentiles, BMI, growth charts, bilirubin nomograms, vital signs reference), a Learning Hub for educational content and quizzes, and a full security layer (two-factor authentication, session management, audit logging, single sign-on).

The app runs as a self-hosted web application with a mobile-friendly PWA interface.

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## Areas for Improvement

### 1. Visual Growth Charts

**Current state:** Growth percentiles are displayed as numbers (e.g., "75th percentile, Z-score 0.67").

**Improvement:** Plot actual WHO/CDC percentile curves (the familiar growth chart lines pediatricians use) with the patient's data point shown on the chart. This would make results immediately interpretable at a glance, matching the paper charts physicians are trained on. Support for plotting multiple visits over time would make it even more useful for tracking growth trends.

### 2. Blood Pressure Calculator Accuracy

**Current state:** The BP calculator uses simplified reference values at the 50th height percentile only.

**Improvement:** Implement the full Rosner quantile spline regression method (the same math used by the Baylor College of Medicine reference calculator). This would give exact BP percentiles adjusted for the patient's actual height, not just an approximation. The regression coefficients are publicly available and can be integrated directly.

### 3. Multi-Visit Tracking

**Current state:** Each encounter is independent. There is no way to see a patient's history across visits.

**Improvement:** Allow physicians to associate notes with a patient identifier (MRN, initials, or a pseudonym) and view previous encounters for that patient. This would enable:
- Growth tracking over time (plot multiple points on growth curves)
- Trend monitoring (weight gain/loss, blood pressure trends)
- Quick access to past notes during follow-up visits

This would need careful design around data retention and privacy since it changes the app from a transient tool to one that stores longitudinal data.

### 4. EHR Integration

**Current state:** Notes are copied manually and pasted into the EHR.

**Improvement:** Direct integration with common EHR systems:
- **FHIR API** — connect to Epic, Cerner, or other FHIR-enabled EHRs to push notes directly into the patient chart
- **HL7 messaging** — for institutions using traditional interfaces
- **Smart on FHIR** — launch the app from within the EHR as an embedded tool

This is the highest-impact improvement for adoption but also the most complex to implement (requires EHR vendor partnerships and institutional approval).

### 5. Offline Mode

**Current state:** The app requires configured server-side providers for AI generation and final transcription. Browser Whisper has been removed from the runtime.

**Improvement:** Add a local AI model option (e.g., a small medical LLM running on the device or local server) so the entire workflow — record, transcribe, generate note — can happen without any network calls. This would be valuable for:
- Rural clinics with unreliable internet
- Maximum privacy (no data leaves the building)
- Disaster/field medicine scenarios

### 6. Specialty Expansion

**Current state:** Focused on general pediatrics with some subspecialty support in chart review.

**Improvement:** Add specialty-specific note templates and AI prompts for:
- Pediatric cardiology (echo reports, cath summaries)
- Pediatric neurology (EEG reports, seizure logs)
- Neonatology (daily progress notes, discharge summaries)
- Pediatric surgery (operative notes, pre-op assessments)
- Pediatric psychiatry (intake assessments, progress notes)

Each specialty has unique documentation requirements that could be addressed with tailored prompts and input forms.

### 7. Billing Code Suggestions

**Current state:** Post-note billing suggestions are active as clinician-facing helper panels on supported note outputs.

**Further improvement:** Improve payer-specific rules, add institution-specific favorites, and add export formats that match common EHR coding workflows.

### 8. Quality Metrics Dashboard

**Current state:** Admin panel shows basic usage statistics (total API calls, users).

**Improvement:** Add a dashboard showing:
- Average note generation time by type
- Most-used AI models and their accuracy (based on how often users edit the output)
- Transcription quality metrics from explicit user feedback or retry outcomes
- Usage patterns by time of day and day of week
- Cost tracking across AI providers

This would help administrators optimize model selection and identify training opportunities.

### 9. Patient Education Materials

**Current state:** Patient education handouts are active as post-note helpers. Generated notes can open a Handout panel that creates a parent-facing plain-text draft from the clinician note, with optional diagnosis, medication, patient age, and preferred language context. The Learning Hub remains the physician-facing education/CMS area.

**Further improvement:** Add handout templates, saved handout history, institution-approved language libraries, and printable/PDF export.

### 10. Multi-Language Support

**Current state:** English only.

**Improvement:** Add support for:
- Generating notes in other languages (Spanish, French, Arabic, etc.)
- Transcribing encounters conducted in other languages
- Patient education materials in the family's language
- UI translation for non-English-speaking staff

Medical Spanish alone would significantly expand the app's reach in the United States.

### 11. Voice Commands During Recording

**Current state:** Recording is continuous — the physician presses start and stop.

**Improvement:** Add voice command recognition during recording:
- "New section" — marks a section break in the transcript
- "Off the record" — pauses transcription temporarily (for sidebar conversations)
- "Add diagnosis: [condition]" — tags a diagnosis without typing
- "Skip" — ignores the last segment

This would make the recording workflow more natural and reduce post-generation editing.

### 12. Collaborative Notes

**Current state:** Single-user editing. Notes are created and edited by one physician.

**Improvement:** Allow multiple team members to work on the same encounter:
- Attending reviews and co-signs a resident's note
- Nurse adds vital signs and chief complaint before the physician sees the patient
- Specialist adds their consultation note to the same encounter

This mirrors the real workflow in training institutions and group practices.

### 13. Mobile-Optimized Recording

**Current state:** Recording works on mobile but stops when the screen locks or the app is backgrounded (browser limitation).

**Improvement:** Build a native mobile wrapper (using Capacitor or React Native) that can record audio in the background even when the screen is off. This is the single biggest usability improvement for mobile users and removes the most common complaint.

### 14. Template Library

**Current state:** Physician templates and prompt preferences provide per-user personalization. Legacy correction-learning rows may exist but are no longer active behavior.

**Improvement:** Add a shared template library where physicians can create, share, and browse note templates:
- "My asthma follow-up template"
- "Standard newborn discharge summary"
- "ED laceration repair template"
- Import/export templates between institutions

### 15. Audit and Compliance Reporting

**Current state:** Audit logs exist in the database but there is no reporting UI.

**Improvement:** Add an admin-facing compliance dashboard:
- Who accessed what, when (filterable by user, date, action)
- Export audit logs to CSV/PDF for compliance reviews
- Automated alerts for unusual access patterns
- HIPAA compliance checklist with green/red status indicators
- BAA tracking (which providers have signed BAAs)

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## Priority Recommendations

If resources are limited, focus on these high-impact improvements first:

| Priority | Improvement | Impact | Effort |
|----------|-------------|--------|--------|
| 1 | Visual growth charts | High — physicians expect visual curves | Medium |
| 2 | Accurate BP calculator | High — clinical accuracy matters | Medium |
| 3 | Billing code suggestions | High — direct revenue impact | Medium |
| 4 | Multi-language support | High — expands reach significantly | Large |
| 5 | Audit/compliance reporting | Medium — required for institutional adoption | Small |
| 6 | EHR integration (FHIR) | Very high — but requires partnerships | Very large |

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## What Makes This App Unique

Compared to existing medical scribes and documentation tools:

- **Pediatric-specific** — prompts, calculators, milestones, and growth charts designed for children, not adapted from adult tools
- **Self-hosted** — runs on your own infrastructure, not a SaaS that holds your data
- **Provider-flexible** — routes through OpenRouter, Bedrock, Azure, Vertex, or LiteLLM depending on deployment configuration
- **Privacy-conscious** — self-hosted app, encrypted sensitive fields, auto-expiring encounter/audio recovery data, and configurable BAA-eligible providers
- **Template-aware** — user templates and prompt preferences can shape output without relying on automatic correction learning
- **All-in-one** — documentation, calculators, education, and administration in a single platform
