For dermatology · Built in a dermatology clinic

Charting steals your day.One patient at a time.

Seeing patients doesn't drain you. What comes after does — three minutes of typing and templating for every three-second decision, forty times a day, half of it written for an auditor who'll never read it. Presto turns your shorthand, typed or dictated, into a thorough, consultant‑grade letter with a complete management plan, at the speed you reached the diagnosis. No ambient recording.

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Your shorthand

The letter

PrestoWritten in 0.0 s

Real shorthand, real letter. Fictional patient, fictional physician.

Built for a visual specialty

The diagnosis happens in your eyes. It was never in the conversation.

Dermatology is pattern recognition. By the time the patient has sat down you've read the morphology, placed the distribution and chosen the plan. An ambient scribe transcribes the room — and the room never contained any of that.

Presto reads the language you already think in — Ex, Dx, Mx — and writes the letter the way you would have, if you'd had the time.

What an ambient scribe heard

“Hi — so, this patch here. How long has it been like this?”

“About three weeks.”

“Any itch?”

“No.”

What you saw

31F, alopecia patch occiput 3wk. Ex: 3x2cm patch. Dx: exclamation mark hairs. Mx: ILT.

What Presto wrote

Examination revealed a 3 × 2 cm well-circumscribed patch of non-scarring alopecia over the occiput. Dermoscopy demonstrated exclamation-mark hairs consistent with active alopecia areata. Following informed consent regarding injection-related pain, dermal atrophy and depigmentation, intralesional triamcinolone was administered…

3 seconds

to diagnose

15 seconds

to the letter

0

recordings

Where the time goes

Half of what you write isn't for the patient. It's for the audit.

The consent you documented.

The counselling you noted.

The rationale you spelled out —
for a plan you decided in seconds.

Every chart is written twice in one sitting. Once for the colleague who will read it. Once for the reviewer who might — the payer, the regulator, the lawyer none of us plans to meet.

That defensive layer is where the minutes go. In every clinic, in every country that audits its doctors. And nobody says it out loud.

Presto writes the thorough letter by default. Consent before every procedure. Counselling documented. Allergies asked, never assumed. The plan reasoned and complete. Not because someone might read it — because that is what a consultant's letter is. Complete for the colleague. Sound under review. Finished before the next patient.

The letter that protects you shouldn't cost you the evening.

Presto is a documentation assistant. You review and sign every document and remain responsible for its content and your billing.

Say it once. Read it. Next patient.

The whole thing fits in the gap between two patients.

  1. 1

    Say it the way you'd hand over to a resident.

    Dictate the case or type your shorthand — Ex, Dx, Mx. No template to click through. No form to fill.

  2. 2

    Presto asks only what matters, then writes.

    A missing drug allergy or duration earns one question. Then the letter streams onto the page in your format — history, examination, a complete management plan.

  3. 3

    Read it. Insert it. Next patient.

    One click inserts it into the EMR. The patient is still putting their coat on.

Real shorthand, real letter, fictional patient. Runs beside OSCAR; works with any EMR via copy.

The panel, explained

Twelve controls. You’ll use four of them.

Presto lives in one panel beside your chart. Here’s every button — and which ones actually matter on a Tuesday.

The Presto panel, from the shorthand box at the top to the finished letter and Refine row below

    That’s the whole panel. The four you’ll actually use: the box, Generate, Copy, and Next patient.

    The evidence

    Every claim on this page is in the letter you just watched it write.

    Three lines from it.

    Letter excerpt: item 3, teratogenicity counselled in detail with the pregnancy prevention framework

    It counsels like a consultant.

    Isotretinoin means teratogenicity, two forms of contraception, monthly testing, lipids, liver, mood, no blood donation, no waxing. Presto wrote all twelve items from six words of shorthand — because a plan that skips one isn't a plan you'd sign.

    Letter excerpt: items 11 and 12 with [CONFIRM dose] and [REVIEW INTERVAL] brackets

    It elaborates. It never invents.

    The dose wasn't in your shorthand, so it isn't in the letter — a bracket is. A missing allergy becomes a question before drafting, never an assumption. Everything in the letter traces back to something you said.

    The one-line brief strip: 25F nod.cystic severe acne recalcitrant failed Doxycycline, wants to…

    Nothing recorded. Nothing stored.

    The entire letter came from that one line — your words, dictated or typed. No microphone listened to the patient. Nothing about them is kept. You review. You sign.

    Your voice, your format, your judgement — finished.

    Two hours a day, returned. Spend them however you like.

    Before

    Patients · 6 h
    Charting · 2 h

    With Presto

    Patients · 6 h
    Yours · 2 h

    2 hours1

    of EHR and desk work for every hour with patients

    85 min2

    a day inside the EHR, the average for medical specialists

    86 min3

    a night of ‘pyjama time’ — family physicians charting after clinic

    From peer-reviewed studies of physician EHR time; sources in the footer.

    More patients.

    The letters that used to close your day now close themselves. In my own clinic, the time Presto returned let me see enough additional patients to raise my daily billings by 67% — the same clinic, the same hours, without the pyjama time.

    More life.

    Or take the hours home. Leave at three. Presto doesn't decide what the time is for — it just gives it back.

    Figure reflects the founder's own practice; individual results vary. Presto is a documentation assistant — every document requires physician review and signature.

    From the one who built it — and two who use it

    Built in a clinic. Used in others.

    I trained as a surgeon in England, became a Member of the Royal College of Surgeons, chose family medicine — and then chose skin. Seventeen years later, that's still where I am.

    The work is the same in any skin clinic. You read the morphology in seconds, you decide — and then you spend the evening writing it down. A letter written the way it should be written took me five minutes. And I refused to put a microphone in my consulting room; my patients came to be seen, not recorded.

    So I built the tool I couldn't buy: one that writes the way I write, from the shorthand I was already scribbling between patients. It has run in my clinic every working day since. The letters are better than the ones I used to type, and I'm home for dinner.

    If it does the same for you, tell me. I read every message myself.

    Dr. W. Ahmad Thiryayi

    MBBS MSc MRCS (Eng) MRCGP CCFP

    Dip Clin Derm (Queen Mary University of London) · Dip Dermoscopy

    Member, European Association of Dermato-Oncology

    Focused practice in skin, hair and nail disorders · Mississauga, Ontario

    1,000+Letters · August

    I run high-volume clinics — sixty or more patients on a clinic day — and in August Presto wrote over a thousand letters for me. What surprised me was the quality. I expected a time-saver; I got letters I'd be proud to have typed myself — thorough, properly structured, with the counselling and the plan in the order a referring physician wants them, from a line of shorthand. At the volume I see, that changed my week. I stopped charting at home, and I'm not sure how I managed before.
    Dr. Khalad Maliyar Assistant Professor of Dermatology · University of Toronto
    Presto has been an excellent addition to my clinical workflow. It generates clear, well-organized consult notes and has significantly reduced the time I spend on documentation — which lets me give more of my attention to patient care. It is intuitive, reliable, and has quickly become an invaluable part of my practice.
    Dr. Asfandyar Mufti Assistant Professor of Dermatology · University of Toronto

    1,412 letters written by Presto so far this month

    One consult a month covers it. The hours are yours.

    Every plan pays for itself with a single additional consultation — and returns hours every week after that. Every clinical feature, on every plan; you're never cut off mid-clinic.

    How much of your month comes back?

    Drag to your volume. Three minutes of typing per letter · a six-hour clinic day · twenty clinic days a month.

    600 about 30 hours · Plus fits
    MONTUEWEDTHUFRI

    An estimate, shown plainly. Hours based on about three minutes of typing per letter.

    Core

    $69 /month

    or $690 a year — save $138

    300 letters a month

    ≈ 15 hours back — half a clinic week, returned.

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    Most popular

    Plus

    $99 /month

    or $990 a year — save $198

    600 letters a month

    ≈ 30 hours back — a full clinic week, returned.

    Founding 25: Pro for $99, for life

    Start free trial

    Pro

    $149 /month

    or $1,490 a year — save $298

    Unlimited letters, fair use

    At 1,000 letters, 50+ hours back — close to two clinic weeks, returned.

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    Residents & fellows: Core $39 · Plus $59 · Pro $99 — verified with your hospital email. Detailed letters by default.

    Letters never stop mid-clinic — going over your allowance simply bills the overage, and it can never cost more than the next tier.

    A deductible practice expense for most incorporated physicians — confirm with your accountant.

    Before you ask

    Questions, answered plainly.

    Still wondering? Email me — I read every message myself.

    Your last letter of the day should take ten seconds.

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    14-day free trial · Plus is $99 CAD/month after · cancel in one click.