The summary that waited a week on a late note
A family-owned group of five specialty and emergency veterinary hospitals is hiring someone to keep referring veterinarians informed about the patients they sent. Here is how a referral goes quiet, what went wrong for others who let a machine write the summary, and a build that holds up.
How to use this page
Read the story, then the map. If no one in your business holds the middle square, start there, not with the build. If someone does, read what went wrong for others, then copy the build kit into your AI agent.
On 8 October 2026 a family-owned group of five specialty and emergency veterinary hospitals in Florida and South Carolina posted for a Veterinary Referral Coordinator at its Clearwater hospital. The lines that carry the job: “Review medical records from referring teams to ensure all necessary information is included”, “Create and send clinical summaries to referring doctors”, and “Conduct follow-ups after visits or hospitalization.” Pay not stated. The hospital already runs a portal for referring vets, and its own page says a record reaches the portal only once “finalized by the veterinarian seeing the patient.”
Here is how it goes today. On Monday at 9:10 a family vet faxes a referral to the internal medicine service: three pages, no bloodwork, no X-rays. The coordinator calls the clinic for them and gets voicemail. On Tuesday afternoon the dog is seen, and the specialist re-runs the bloodwork the clinic had already done.
On Thursday at 7:40 pm the specialist finalizes the note at the end of a 13-hour day. The portal now has it. Nobody has written the summary, the one page that answers the question the family vet asked. On day 8 the family vet calls: the dog is in for a follow-up and nothing has come. The coordinator pulls the note, writes the summary by hand and faxes it, with no way to tell whether it landed.
On day 14 the family vet sends the next case to the corporate hospital across town. A referring vet in one survey sent about 10 cases a year; at the 2026 median specialty invoice, that is about $12,500 a year of work, on an estimate.
Nobody here is careless. The note is late because the doctor is, after 60 patients in a 14-hour shift, and no summary can go before the note. The summary is late because the coordinator writes it by hand between the phone and the front desk. Hand the summary to a machine without a person reading it and you get the other failure: a drug name nobody said, in a letter that carries the hospital's name.
The family vet, the dog, the days and the times are an example built from the posting, which gives no counts. The 20 referrals a week, the 25 minutes a referral and the $12,500 a year are estimates from public figures.
The map: the same job as a system
The judgment it all runs on sits in the middle square, held by a person. Around it, the work in the order it moves, each square run by the machine or by a person. Along the bottom, what it runs on.
The middle is what the referring vet needs to hear about this patient, and when a call beats a letter. The referral coordinator holds it, with the attending specialist.
The same job as a system. The middle is the judgment about what the referring vet needs to hear and when to call, held by the coordinator. The referral comes in on the left; across the top the machine chases the gaps, drafts the summary from the finalized note and confirms the fax landed; on the right the coordinator reads each one and sends it. Along the bottom is what it runs on: the triggers and the switch, the counts, and the list and fields that tell it what a complete record and a complete summary look like.
- Runs on its own
- A person does it
- The judgment it all depends on
- What it runs on
Who holds the middle square
The referral coordinator, with the attending specialist. What each referring veterinarian needs to hear about the patient they sent, whether the summary says only what the doctor's finalized note says, and when a bad outcome calls for a phone call instead of a letter.
Before you build, these must already be true in your business:
- Every referred patient's record names the referring practice and vet, and the channel they chose: portal, fax or email.
- The doctor finalizes the note before anything about the case leaves the building, and the summary says only what the note says.
- One person reads every summary before it goes and owns the call when a case went badly.
Still deciding whether to do this, or no one holds this judgment yet? See the verdict: what it costs today, what to hand over, the bill and the owner
What went wrong for others, and the rules it gives the build
Five things that went wrong for people who did this job, or that tripped them up, and the rule each one gives the build.
“It is taking them days to send records and death notices. We will have patients in for follow-up visits days latter and the ER records aren't even finished when we call.”
A family veterinarian about a local emergency hospital, August 2024. Read it
The rule: Never draft a summary from a note the doctor has not finalized; a seen patient with no finalized note at 24 hours goes on the doctor's list, and the clinic hears from a person, not from the machine.
“We are sending the records multiple times but the email they have us send them is always a general email and they never get them.”
A family practice technician, replying to a specialty technician who had called a clinic three times for one patient's records, February 2024. Read it
The rule: Ask for records by the channel the clinic chose and the address on its record, attach what arrives to the patient the same hour, and send a request unanswered at 48 hours to the coordinator, never a third automatic ask.
“Some of our referral team members use AI to summarize medical notes... I can see in my head Vetmedin getting swapped for Vetsulin and it's genuinely giving me anxiety.”
A veterinarian whose referral team summarizes notes with a chatbot, March 2026. Read it
The rule: Every line of the summary comes from the finalized note, with drug names and doses copied character for character, and the coordinator reads each summary before it goes.
A dictation of “Baytril, enrofloxacin” charted as two drugs, “Baytril, and Roflexacin. Roflexacin does not exist.”
A scribe maker's own blind test of veterinary AI scribes, October 2026. Read it
The rule: The machine never takes a drug name from audio or memory; a name it cannot match to the note stays out and shows as a gap.
“We got a report from an ER that said that they were suspicious of an environmental issue (for the problem) because the lady at home had her period, but in reality the female dog was in estrus.”
A veterinarian replying in the same thread, March 2026. Read it
The rule: No summary is sent without a person's read, and the count of summaries sent without one is kept and stays at zero.
What it costs to run
About $0.10: the summary draft at about 15,000 tokens in ($0.03 at $2 per million tokens) and 1,500 out ($0.015 at $10 per million); the records check and chase messages at about $0.015; four fax pages at $0.007 each plus transmission ($0.03). About $9 a month for 90 referrals (20 a week), plus the runner ($20 a month, 2,500 workflow runs; this uses about 300: 90 referrals, 90 notes, 90 sends, 30 daily checks). Coordinator time: five minutes to read a summary, about $1.90 at $22.50 an hour, against about $9.40 for the whole referral by hand.
Estimate. The token counts, the five minutes a summary, the 90 referrals a month and the 300 runs are assumed. The timed week replaces them.
The build kit
One prompt to paste into Claude, ChatGPT or any AI agent that can build. It checks the middle square before anything else, builds the map square by square, carries the 5 rules above, and has the whole build: what starts it, every step, the data, the review, the alerts, what to do when it breaks, and what to count before you switch it on.
Before you build
- It may never, on its own: Send a summary or any message to a referring vet without a person's read; write a line the note does not contain; take a drug name, dose or side from anything but the finalized note; contact a pet's owner; send a notice that a pet has died; or change the medical record.
- Keep with a person: Every clinical word, because the summary may say only what the specialist's finalized note says and the coordinator reads each one before it goes; the phone call to the referring vet on a death, a bad outcome or a finding the referring vet will want to hear by voice; the follow-up call to the pet's owner; the lunch-and-learns, the practice visits and the relationship; and what to do about a practice that has gone quiet.
- Not yet: Sending any summary without a person reading it; writing a line the note does not contain; taking a drug name from speech rather than from the note; any message to a pet's owner on its own; any notice that a pet has died on its own; and scoring a referring practice as at risk.
Help me build this in my business: Keeping every referring veterinarian informed about the patient they sent. That means four things. Checking that the records came in before the visit, and chasing what did not. Writing the clinical summary back to the referring doctor once the specialist's note is finalized, and sending it. The follow-up call after the visit or the hospital stay. And the relationship: the visits and the education events that keep referrals coming. Before you build anything: this runs on one person's judgment, "What the referring vet needs to hear, and when a call beats a letter", held by the referral coordinator, with the attending specialist. Ask me whether each of these is true in my business, one at a time: 1. Every referred patient's record names the referring practice and vet, and the channel they chose: portal, fax or email. 2. The doctor finalizes the note before anything about the case leaves the building, and the summary says only what the note says. 3. One person reads every summary before it goes and owns the call when a case went badly. If any is not true, stop and tell me which, and what I need in place first. Do not build around it. Rules from others who built this and got it wrong. Keep every one: - Never draft a summary from a note the doctor has not finalized; a seen patient with no finalized note at 24 hours goes on the doctor's list, and the clinic hears from a person, not from the machine. - Ask for records by the channel the clinic chose and the address on its record, attach what arrives to the patient the same hour, and send a request unanswered at 48 hours to the coordinator, never a third automatic ask. - Every line of the summary comes from the finalized note, with drug names and doses copied character for character, and the coordinator reads each summary before it goes. - The machine never takes a drug name from audio or memory; a name it cannot match to the note stays out and shows as a gap. - No summary is sent without a person's read, and the count of summaries sent without one is kept and stays at zero. The map of this system, a 3x3: - The middle square, the judgment it all runs on: What the referring vet needs to hear, and when a call beats a letter (The referral coordinator, with the attending specialist). It stays with a person. - The work, in the order it moves: 1. Check the incoming records (runs on its own: Every new referral against the service's list); 2. Chase the missing records (runs on its own: By the clinic's chosen channel, again at 24 hours); 3. Draft the summary (runs on its own: The moment the note is finalized, every line from the note); 4. Confirm the fax landed (runs on its own: The fax status, the hours from note to summary); 5. Read and send the summary (a person does it: The coordinator reads every summary, sends it, and picks up the phone when a case went badly). - Along the bottom, what it runs on: Automation (The three triggers, the daily check and the off switch.); Measure (Hours from note to summary, summaries out within 24 hours, lines struck, referrals per practice.); Build (The records list for each service, the summary's fixed fields, which channel each practice chose.). Build the squares in that order, and keep the person's squares with a person. The working set to build from: - Trigger: A new referral lands (the portal's referral form, a fax to the referral number, or an email to the referral inbox); a specialist finalizes a note on a referred patient (the practice management system's event, or a 15-minute poll of finalized notes); a daily check at 7:00 am of open items. - Steps: On a new referral: read it and match the referring vet and practice to their record, including the preferred channel. Check what arrived against the service's list (history, bloodwork and its date, images, the reason for referral). Send the request for anything missing by the preferred channel; re-ask at 24 hours; flag the coordinator at 48 hours or the day before the appointment. Attach what arrives to the patient and mark the record complete. On a finalized note: draft the summary in fixed fields (patient and referring vet; the question asked; what was found; what was done; the plan and medications, as the note states them; what the referring practice should do and when the recheck is; who to call), every line from the note, gaps left as gaps. Put it in the coordinator's queue with the source lines beside it. After the coordinator's send: fax or email it by the channel of record, read the delivery status, retry a failed fax twice an hour apart, and log the hours from note to summary. On the daily check: list referred patients seen with no finalized note at 24 hours for the specialist's list; list patients discharged 48 hours ago for the coordinator's follow-up call; update the per-practice counts. - Data: One record per referral: referring practice and vet, channel, received at, records complete at, chases sent, appointment, seen at, note finalized at, summary drafted at, read by, lines struck, sent at, delivered at (and the fax status), hours from note to summary, follow-up call done, next referral from this practice. - Review step: The coordinator reads every summary before it goes. The medical director reads five a week against their notes. - Alerts: A summary with a line that has no source in the note (it is deleted, and the count is kept); a fax that failed twice; a note not finalized 24 hours after the visit; a records request unanswered at 48 hours; a referring practice with no referral in 90 days that sent three or more in the year before; and the wrong-but-green count, the lines the coordinator struck after a summary that looked fine. - If it breaks: What you see: summaries missing from the queue, faxes sitting at failed, or the same summary sent twice. Check first: the practice management system's connection and the finalized-note event are still firing (open a test note); the fax account has credit and the number is live; the referring practice's number of record is current. Safe fix: pause the three triggers; the coordinator writes and faxes by hand, and the portal keeps showing finalized records on its own. - Baseline to count before switch-on: One timed week by hand: minutes a referral (time it, do not ask), referrals a week, records complete before the appointment, hours from note to summary, summaries out within 24 hours, and the referring practices that sent a case. - Tools by name: The workflow runner n8n (Starter, $20 a month billed annually); the model Claude Sonnet 5.5 ($2 per million tokens in, $10 out); the fax service Telnyx ($0.007 a page either way, no monthly fee, plus a number and transmission; Phaxio at $0.07 a page as the simpler, dearer choice); the practice management system's API or export for finalized notes and referring practice records (the group's page names rVetLink as its portal, and rVetLink's maker lists ezyVet, Cornerstone, DVMAX and ImproMed Infinity as the systems it connects to; which one this hospital runs is not public). Inside the software: rVetLink (a setup fee and a monthly subscription, price not published; automated notifications and record upload on finalization). Standalone: VetLoop (free in beta; referral tracking, "Discharge summary flows back to the referring vet", commercial pricing to be set). People: Staffingly's remote veterinary scribes (price not published; drafts response summaries for the veterinarian to sign); Stealth Agents (from $1,600 a month, full time). It may never, on its own: Send a summary or any message to a referring vet without a person's read; write a line the note does not contain; take a drug name, dose or side from anything but the finalized note; contact a pet's owner; send a notice that a pet has died; or change the medical record. Keep with a person: Every clinical word, because the summary may say only what the specialist's finalized note says and the coordinator reads each one before it goes; the phone call to the referring vet on a death, a bad outcome or a finding the referring vet will want to hear by voice; the follow-up call to the pet's owner; the lunch-and-learns, the practice visits and the relationship; and what to do about a practice that has gone quiet. Not yet: Sending any summary without a person reading it; writing a line the note does not contain; taking a drug name from speech rather than from the note; any message to a pet's owner on its own; any notice that a pet has died on its own; and scoring a referring practice as at risk. Ask me for the tools and numbers you need from my business before you start. Then build it one step at a time, and show me each step working before the next.
No one in your business holds this judgment?
Then the first step is the expertise, not the build. Konstellation, Nick's advisory firm, judges one of your jobs with you, free: what it costs today, the verdict, the bill and who owns it.
Get the verdict on one jobKnow someone doing this job by hand? Send them this page.
Free, for one email
One email opens every job and every system.
Everything on instig8.ai is free. Your email, once, unlocks all of it on this device, and you hear when the next job is out.
Unsubscribe any time.