Produto3 de novembro de 2026

Why we rebuilt the EHR around the note

Clinicians spend about a third of their working week on documentation. We rebuilt the electronic health record around the visit note, so Salisan helps with that work and nothing joins the record until you sign.

Mohammed Al-AzzaniFundador · 5 min de leitura

Este artigo está em inglês

It's half past six. The last patient left an hour ago, and you're still at your desk. The visit itself took fifteen minutes. Writing the note, then adding the same medication, diagnosis and follow-up again, each in its own tab, takes almost as long.

If that sounds familiar, you're far from alone. In a 2022 survey of 966 NHS clinicians, Nuance found that documentation takes 13.5 hours of the working week, more than a third of it. More than three of those hours happen in the clinicians' own time.

Where the time goes

Most electronic health records weren't designed for the person writing in them. They grew out of billing and reporting, so they think in forms: a box for the diagnosis, a tab for medications, a screen for readings, another one for appointments.

That design has a cost, and clinicians pay it every day.

The same fact, typed again and again. You write in the note that you started ramipril. Then you open the medications tab and add it there. The diagnosis goes in another tab, the blood pressure in another, the follow-up in the calendar.
The story is in pieces. The note is in one tab, the medications in another, the readings in a third. The same survey found clinicians spend an hour a day just looking for information that's missing.
Half listening, half typing. During the visit your eyes are on the screen, looking for the right field, instead of on the person in front of you.
The record drifts. When the note says one thing and the medication list says another, nobody notices until it matters.

None of this comes from a lack of effort. It's what happens when software asks people to work the way a database does.

The note is the page

We started from a simple question: what if all of the documentation was just the note?

In Salisan, each visit gets one note: a single page, like a page in Notion or a Google Doc. You click and type, in sentences, under your own headings. No fields to fill in first, no tabs to switch between.

The structured parts of the visit, like a diagnosis, a new medication or a blood pressure reading, live inside the note as lines of their own. They read as part of the text, and they're also real entries the patient record understands.

So you document the visit once. The note is the documentation, and the medications, diagnoses and readings in the patient record are kept up to date from it.

A signed visit note in Salisan. Under Assessment and Plan, written in plain sentences, sit record lines for hypertension, ramipril 2.5 mg, a blood pressure of 152/94 and a follow-up appointment, each with a time stamp from the recording. A bar at the bottom says Signed, 3 added to the record. — One visit, one note. The diagnosis, the medication and the reading sit in the note as lines of their own.

Record the visit, read the draft

Most of the time, you don't have to write the note yourself. Press Record visit, talk with your patient as you normally would, and press Stop when you're done. With Write up when I stop turned on, the Agent starts writing the note for you the moment you stop.

The draft appears in the note while you watch, in the structure you use. What the Agent writes is marked as its own until you keep it, so you can always tell its words from yours. And if you record again later in the same visit, it adds only what's new. It never rewrites what you wrote.

The plan of a visit note with its record lines, and under it the bar while a visit is being recorded: the running time, Pause, Stop and the option Write up when I stop. — Record from the note itself. When you stop, the Agent starts writing.

Every fact has a source

A draft you can't check isn't much help. So every line the Agent takes from a recording carries a small time stamp, like ▶ 1:21. Open it and you see the exact words from the visit that the line is based on, with a button to hear that moment again.

Checking a draft becomes reading, not remembering. And when the Agent heard something but can't match it to the recording word for word, it doesn't put it in the note. It lists it apart as not verified, so you can listen and add it yourself if it's right.

Record lines the Agent proposed after a visit, each marked Proposed with a time stamp. The time stamp of the ramipril line is open and shows where it was heard, Recording 1 at 1:32, and the sentence: Let's start ramipril, 2.5 mg, once a day. A Play button replays that moment. — Every line from a recording shows where it was said. Open the time stamp to read the words.

Nothing joins the record until you sign

What the Agent finds stays a proposal until you decide. Each record line it adds is marked Proposed. Keep the ones that are right, remove the ones that aren't, or keep them all at once from the bar under the note.

When you sign, Salisan shows you exactly what will be added to the patient record: the diagnosis, the medication, the reading. Only then do they become part of it. If a signed note is changed later, it shows that it was edited after signing.

The Sign this visit panel, open over a visit note. Under Adds to the record it lists hypertension, ramipril 2.5 mg and a blood pressure of 152/94, with Sign and Not yet buttons, and below them the option Record 3 now, sign later. — Before you sign, you see exactly what will join the patient record.

Type / for everything else

Not everything comes from a recording. For the rest, there's one key to remember, and if you've used Notion, you already know it. Type / anywhere in the note and a short menu opens. It starts with what fits the section you're in, like a medication or an appointment under Plan, and then has everything else:

Write: headings, lists, quotes and the rest of what makes a note readable.
Record: readings, a medication, a diagnosis or an allergy, straight into the note as record lines.
Act: book the next appointment, or start a check-in so the patient sends readings from home.
Insert: a file, an image or one of your own templates.

No tabs to hunt through, no forms to open. You stay on the same page, often in the same sentence. And when you have a question about the patient, the Agent is in the bar under the note, one click away.

The slash menu open under the plan of a visit note. It starts with For Plan: Medication, Appointment, Check-in and Checklist, then the Write group with Text, Heading, List and Numbered list. Below the note sits the bar with Record visit, Add and Agent. — Type / anywhere in the note to write, record, book or attach, without leaving the page.

Less typing, more looking up

We didn't set out to build a better form. We set out to give clinicians their evenings back, and to let them look at their patients during the visit instead of at a screen. The note is where care gets documented, so that's where Salisan helps.

Want to see it on a visit like yours? Book a 15-minute demo and bring your questions. We'll take one visit from the first word to the signature.