AI Medical Scribe for Pulmonology & Critical Care

Critical care documentation is uniquely challenging. During ICU rounds, you’re managing eight ventilated patients with multi-system organ failure, adjusting vasopressors, interpreting arterial blood gases, and making life-or-death decisions every fifteen minutes. Meanwhile, you’re expected to document comprehensive daily progress notes, procedure reports, ventilator weaning protocols, family discussions, and code status conversations.

Traditional documentation systems fail in the ICU environment. You can’t type during emergent intubations. EHR templates don’t capture the rapid clinical evolution of ARDS patients. Copy-forward notes miss critical ventilator setting changes. And spending 20 minutes per patient on documentation means you’re charting until midnight after a full day of clinical care.

OrbDoc transforms critical care documentation through voice-first AI designed specifically for the complexity and time-pressure of pulmonology and intensive care medicine. Whether you’re rounding in a 24-bed medical ICU, performing bronchoscopy in the interventional suite, or managing complex interstitial lung disease in your outpatient clinic, OrbDoc captures your clinical reasoning in real-time without interrupting patient care.

ICU Rounds Documentation

ICU rounds demand simultaneous assessment of multiple organ systems while synthesizing data from ventilators, monitors, lab results, imaging, and nursing reports. Traditional documentation requires mental juggling: remember all the details until rounds finish, then spend hours recreating your thought process in the EHR.

OrbDoc enables real-time documentation during ICU rounds. As you review each patient, simply speak your assessment naturally: “Patient is day three of ARDS secondary to COVID pneumonia. Currently on AC mode, tidal volume 380 mL for ideal body weight of 75 kilograms, plateau pressure 28, driving pressure 14, PEEP 14, FiO2 60 percent. P-to-F ratio improved from 120 to 180 overnight. Proning protocol completed yesterday with good response. Plan to continue lung-protective ventilation, target plateau pressure less than 30, continue neuromuscular blockade for another 24 hours, repeat ABG this afternoon.”

The AI structures this into proper progress note format while you’re already moving to the next patient. Multi-system assessment flows naturally: respiratory status, cardiovascular support, renal function, infectious disease issues, nutrition, sedation management, and goals of care. You document the complexity without the cognitive load of formatting.

Ventilator management documentation becomes seamless. Instead of clicking through multiple EHR screens to document mode changes, setting adjustments, and weaning protocols, you simply state: “Decreased PEEP from 12 to 10, maintaining adequate oxygenation. Will continue PEEP reduction trial, targeting PEEP of 8 by tomorrow if P-to-F ratio remains above 200.” OrbDoc captures the clinical reasoning behind every ventilator adjustment, creating defensible documentation that reflects your expert decision-making.

Hemodynamic monitoring documentation follows the same natural workflow. Vasopressor adjustments, fluid management, cardiac output optimization—you speak your clinical thought process and OrbDoc structures it appropriately. “Norepinephrine weaned from 12 to 8 micrograms per minute with MAP maintaining above 65. Central venous pressure 8, lactate trending down from 3.2 to 1.8. Patient appears adequately resuscitated, will continue vasopressor wean as tolerated.”

Family meeting documentation often gets rushed or omitted entirely due to time constraints. With OrbDoc, you can document immediately after difficult conversations: “Spoke with patient’s spouse and two adult children for 45 minutes regarding worsening multi-organ failure despite maximal support. Discussed poor prognosis with acute on chronic respiratory failure, worsening renal function now requiring CRRT, and progression of shock requiring three vasopressors. Family wishes to continue full support for now but understands the gravity of the situation. Will reconvene tomorrow to reassess.”

Procedure Documentation

Pulmonology and critical care involve numerous procedures, each requiring detailed documentation for billing, quality assurance, and medical-legal purposes. Bronchoscopy reports, chest tube placements, thoracentesis procedures, emergency intubations—comprehensive documentation is mandatory but time-consuming.

OrbDoc captures procedure details in real-time using voice. During bronchoscopy, you can document findings as you visualize them: “Bronchoscopy performed using flexible bronchoscope through endotracheal tube. Vocal cords visualized and normal. Trachea patent with mild erythema. Carina sharp, no masses. Right mainstem entered, significant purulent secretions in right lower lobe. BAL performed in right lower lobe with 150 mL sterile saline, samples sent for culture and cell count. Airways thoroughly suctioned. Procedure well-tolerated.”

The AI understands pulmonary anatomy and procedure terminology, properly formatting your spoken documentation into structured procedure notes with appropriate sections: indication, consent, sedation, technique, findings, specimens, complications, post-procedure assessment. You speak naturally while performing the procedure; the documentation appears ready for attestation.

Emergency intubation documentation becomes straightforward even during high-stress situations. After securing the airway, you can document: “Rapid sequence intubation performed for acute hypoxemic respiratory failure. Pre-oxygenation with non-rebreather, oxygen saturation 88 percent. Etomidate 20 milligrams IV and rocuronium 100 milligrams IV administered. Direct laryngoscopy with Macintosh 3 blade, grade 2 view. Seven-and-a-half endotracheal tube placed on first attempt, confirmed by capnography and bilateral breath sounds. Tube secured at 22 centimeters at the teeth. Post-intubation chest X-ray pending.”

Thoracentesis and paracentesis procedures are documented with equal ease: “Ultrasound-guided right-sided thoracentesis performed. Patient positioned upright, site identified at right posterior axillary line eighth intercostal space. Timeout performed. Sterile prep and drape. One percent lidocaine local anesthesia. Eighteen-gauge needle inserted, pleural fluid aspirated. 1,200 mL of straw-colored fluid removed and sent for diagnostic studies including cell count, differential, chemistry, cultures, cytology. No pneumothorax on post-procedure lung ultrasound. Patient tolerated well.”

Chest tube placement documentation flows naturally: “Bedside chest tube placement on the left. Indication pneumothorax with respiratory compromise. Informed consent obtained. Timeout performed. Patient positioned supine. Site selected at fifth intercostal space mid-axillary line. Sterile technique throughout. Local anesthesia with 20 mL one percent lidocaine. Blunt dissection through subcutaneous tissue and muscle. Pleural space entered, immediate rush of air. Twenty-eight French chest tube advanced posteriorly and superiorly. Tube sutured in place and connected to negative 20 centimeters water suction. Immediate chest X-ray shows appropriate positioning and re-expansion of left lung.”

Academic Medical Center ICU Results

An ICU director at a major academic center manages a 20-bed medical ICU with the sickest patients: severe ARDS, multi-organ failure, complex ventilator management. Before implementation, documentation consumed as much time as direct patient care.

Morning rounds involved reviewing patients, adjusting plans, and teaching. The cognitive load of remembering details for later documentation was overwhelming. Three to four hours each afternoon were spent completing progress notes from memory.

After implementing voice-first documentation, real-time documentation occurs during rounds. As each patient is examined, assessments are spoken aloud and the system structures them immediately. Notes are essentially complete by the time the team moves to the next patient.

Results after implementation:

• Reduced afternoon charting time from 3-4 hours to under 30 minutes
• Reclaimed hours daily for patient care, family meetings, and teaching
• Improved procedure documentation quality
• Better capture of critical care decision-making complexity
• Improved ventilator bundle, sedation protocol, and mobility assessment documentation
• Reduced burnout and improved work-life balance
• Enhanced teaching mission during rounds

Procedure documentation improved dramatically. Emergent bronchoscopy findings documented in real-time allow immediate focus on coordinating further care rather than delayed documentation.

Intensivists describe improved documentation quality that better reflects expert clinical reasoning. Families and outside physicians reviewing records see comprehensive assessments. The teaching mission benefits when attendings can focus on education rather than documentation concerns.

Outpatient Pulmonology

While critical care represents the most time-pressured environment, outpatient pulmonology brings its own documentation challenges. Complex pulmonary function test interpretation, asthma action plans, interstitial lung disease management, sleep study reviews, pulmonary hypertension workups—each requires detailed documentation.

Pulmonary function test interpretation becomes straightforward with voice documentation. “PFTs today show severe obstruction with FEV1 42 percent predicted, FEV1-to-FVC ratio 0.52. Significant bronchodilator response with 15 percent improvement post-albuterol. DLCO reduced at 58 percent predicted. Findings consistent with severe COPD with emphysematous changes. Will initiate triple therapy with LABA-LAMA-ICS combination, provide inhaler teaching, schedule pulmonary rehabilitation, recommend smoking cessation program.”

Asthma management documentation captures action plans, trigger identification, and medication adjustments efficiently. “Patient’s asthma control has worsened over the past three months with increased rescue inhaler use and nocturnal symptoms twice weekly. Methacholine challenge confirms bronchial hyperreactivity. Plan to step up therapy from low-dose ICS to medium-dose ICS-LABA combination. Provided written asthma action plan. Discussed trigger avoidance, particularly seasonal allergens. Will reassess in six weeks.”

Interstitial lung disease requires comprehensive documentation of imaging findings, biopsy results, treatment plans, and monitoring protocols. “High-resolution CT chest shows usual interstitial pneumonia pattern with basilar-predominant reticulation, honeycombing, and traction bronchiectasis. Multidisciplinary discussion supports diagnosis of idiopathic pulmonary fibrosis. Discussed prognosis with patient and family. Starting antifibrotic therapy with nintedanib. Baseline six-minute walk test shows 380 meters with oxygen desaturation to 88 percent. Will monitor with serial PFTs and imaging every three to six months.”

Sleep medicine documentation flows naturally. “Polysomnography shows severe obstructive sleep apnea with AHI 48 events per hour, lowest oxygen saturation 78 percent during REM sleep. Significant oxygen desaturations throughout the night. Started CPAP therapy at 10 centimeters water pressure with excellent compliance data showing AHI reduction to 3 events per hour. Patient reports dramatic improvement in daytime somnolence and morning headaches. Will continue CPAP with follow-up in three months.”

Pulmonary hypertension workups involve coordination of multiple diagnostic studies and detailed documentation of findings. “Right heart catheterization shows mean PA pressure 45, pulmonary capillary wedge pressure 12, PVR 4.8 Wood units, cardiac output 4.2 liters per minute. Findings consistent with WHO Group 1 pulmonary arterial hypertension. Vasoreactivity testing negative. CT chest ruled out chronic thromboembolic disease. Started on ERA therapy with close monitoring. Patient educated about medications, lifestyle modifications, and warning signs. Will coordinate with PH specialty pharmacy and schedule follow-up in four weeks.”

ROI for Pulmonology Practices

The financial and quality-of-life benefits of OrbDoc for pulmonology and critical care practices are substantial and measurable. Documentation efficiency directly impacts revenue capture, physician capacity, burnout reduction, and patient satisfaction.

Time savings translate immediately to increased clinical capacity. Pulmonologists typically spend 2-3 hours daily on documentation—progress notes, procedure reports, test interpretations, care coordination. OrbDoc reduces this to 20-30 minutes for review and attestation. Those reclaimed hours allow additional patient encounters, more thorough consultations, or earlier departure from the hospital.

A pulmonary critical care physician seeing 12-15 ICU patients daily can add consultations without extending work hours. At typical professional fees for critical care consultations, this generates substantial additional annual revenue per physician. For multi-physician groups, the annual impact from better time utilization is significant.

Procedure documentation accuracy improves billing compliance and reduces denials. Comprehensive bronchoscopy reports, properly documented indications, complete procedural details, and appropriate CPT code support ensure defensible documentation for every procedure. Groups report reduced procedure claim denials after implementing voice AI documentation.

Critical care time-based billing requires meticulous documentation. OrbDoc makes it effortless to document exact time spent on each patient’s care: “Critical care time today 45 minutes, including review of overnight events, ventilator adjustment, family discussion, and care coordination with nephrology regarding CRRT.” Accurate time capture prevents revenue leakage and ensures appropriate reimbursement for critical care services.

Quality metric documentation improves dramatically. ICU bundles—ventilator-associated pneumonia prevention, catheter-associated infection protocols, early mobility, spontaneous awakening trials, sedation optimization—are consistently documented when integrated into natural workflow. Pay-for-performance programs and quality bonuses depend on documented adherence to these protocols.

Physician burnout reduction has profound practice stability benefits. Recruiting and training new critical care physicians involves substantial costs in recruiting fees, lost productivity, and training time. Retaining physicians by reducing documentation burden prevents costly turnover. Pulmonary critical care groups report improved physician satisfaction and retention after implementation.

Patient throughput optimization creates additional revenue opportunities. When documentation occurs in real-time during rounds, physicians can sign notes earlier. This facilitates faster care transitions, earlier discharges, and better bed utilization—critical metrics for hospital-employed physicians.

Academic practices benefit from preserved teaching time. When attendings aren’t overwhelmed by documentation, they can dedicate more time to resident and fellow education. This improves program quality, trainee satisfaction, and recruitment—maintaining the strength of academic pulmonary critical care programs.

Medicolegal risk reduction provides hard-to-quantify but substantial value. Comprehensive documentation of clinical reasoning, shared decision-making discussions, informed consent, and goals of care conversations protects physicians during litigation. OrbDoc’s ability to capture detailed contemporaneous notes reduces malpractice exposure.

The subscription cost represents a minimal investment against substantial returns. Additional consultations per week generate significant ROI. Reduced claim denials alone often justify the cost. The time savings, burnout reduction, and quality improvements create compounding value.

For critical care practices managing high-acuity patients under intense time pressure, OrbDoc isn’t just a convenience—it’s a strategic advantage. The ability to deliver excellent patient care while maintaining comprehensive documentation without sacrificing personal well-being transforms professional satisfaction and practice sustainability.

Voice-first AI documentation aligns perfectly with the workflow of pulmonology and critical care. You’re already examining patients, interpreting data, making decisions, and communicating plans verbally. OrbDoc simply captures that existing workflow and transforms it into complete, compliant, high-quality documentation. No workflow disruption. No additional cognitive load. Just medicine practiced the way it should be: focused on patients, powered by technology.