Improving Occupational Therapy Efficiency through AI Therapy Note Automation: The Experience of Julia Wang, OT at YWCA

Abstract

This case study examines how Julia Wang, an Occupational Therapist at the YWCA, leveraged CliniScripts’ AI therapy note technology to enhance clinical efficiency and documentation quality. Julia provides mobile occupational therapy services across diverse settings including homes, schools, and offices. By integrating CliniScripts into her workflow, she achieved an average time reduction of approximately 15 minutes per session while maintaining comprehensive and accurate documentation. The results highlight the potential of AI-driven note generation and goal-tracking technologies to improve clinical productivity, reduce cognitive load, and support continuity of care.

Introduction

Documentation is a core component of clinical practice in occupational therapy, serving as a legal record and a foundation for treatment planning and communication among multidisciplinary teams. However, excessive documentation time remains a significant challenge in community-based rehabilitation contexts, particularly for mobile practitioners who provide therapy across multiple locations. The introduction of AI therapy note systems represents a promising innovation to alleviate administrative burden and enhance the quality of clinical documentation.

This study explores the implementation of CliniScripts’ AI-powered transcription and goal-tracking features within Julia Wang’s mobile occupational therapy practice at the YWCA, a community organization known for its evidence-based programs in mental health, rehabilitation, and wellness.

Methods

Participant and Context
Julia Wang is a licensed Occupational Therapist with the YWCA, where she delivers community-based interventions for clients experiencing functional challenges that impact work, school, and daily life participation. Her work is inherently mobile, involving daily travel between homes, educational institutions, and workplaces.

Challenges Prior to Implementation
Before adopting CliniScripts, Julia’s documentation process relied heavily on manual note-taking and retrospective data entry. Each session required an estimated 10 to 20 minutes of additional documentation time, compounded by inconsistent network availability across sites. Tracking multiple individualized goals for different clients also demanded considerable administrative attention.

Intervention
CliniScripts was introduced as a digital solution integrating AI therapy note generation, automatic goal tracking, and offline session recording. Julia received brief training on using the system on both tablet and mobile devices. Data collection was conducted through usage logs and clinician feedback during the initial implementation period.

Results

Julia reported completing most documentation immediately following sessions rather than postponing it to the evening. This change substantially improved her workflow continuity and reduced after-hours administrative time.

Qualitative Findings

Clinician Perspective

“The offline recording and automatic goal tracking features make CliniScripts a game-changer for OTs and PTs working in schools and homes.”
— Julia Wang, OT, YWCA

Observed Benefits

• The offline recording function allowed uninterrupted note capture in settings with limited or no internet connectivity.

• The AI therapy note generation feature structured clinical information according to SOAP and DAP formats, improving coherence and reducing manual effort.

• The goal-tracking module automatically updated progress indicators, enhancing longitudinal monitoring and interdisciplinary communication.

Discussion

The implementation of CliniScripts significantly reduced Julia’s documentation workload while preserving the integrity and comprehensiveness of her clinical notes. The 15-minute time saving per session represents approximately 20–25 percent of total clinical time per client encounter, aligning with findings from recent studies on AI documentation tools in healthcare (see JAMA Network Open, 2024).

The ability to work offline was particularly beneficial for mobile practitioners whose service environments vary in connectivity quality. Furthermore, automated goal tracking supported data-driven decision-making and facilitated communication among occupational therapists, teachers, and caregivers.

These outcomes suggest that AI therapy note systems can be effectively integrated into mobile occupational therapy models without compromising clinical standards.

Conclusion

The CliniScripts platform provided measurable benefits to Julia Wang’s occupational therapy practice at the YWCA. By enabling faster, more structured documentation and minimizing after-session workload, the tool enhanced both efficiency and work-life balance. The experience underscores the broader potential of AI-assisted clinical documentation to improve healthcare delivery in community-based rehabilitation contexts.

Future research could explore larger-scale implementations across multidisciplinary teams to further validate the impact of AI therapy note automation on patient outcomes and organizational efficiency.