Using AI to run the practice

I treat an AI assistant as a part-time office manager for the business side of the practice. It reads and writes my files, drafts, researches, and reconciles. I approve anything that leaves the building, and it never touches clinical work.

The AI policy says what's allowed. This page shows what those uses look like day to day.

1. Ground rules

No client information, ever. No names, initials, dates, quotes, or combinations of details that could identify someone. A general-purpose assistant has no business associate agreement (BAA), which puts it in Category 1 of the AI policy. If a task needs client details, it isn't an AI task.
Business side only. Notes, treatment plans, and anything for the chart stay with you and your electronic health record (EHR).
It proposes, you approve. It drafts the email and you send it; it fills the cart and you check out. Anything outward-facing or hard to undo needs a human yes.
Check it against the source: numbers against the bank statement, rules against the regulation or the board's page, a scan against its contents rather than its filename.
Write decisions down ("superbills only, no insurance") in a file the assistant reads, or you'll explain them again next month.

2. The setup

Piece	What it is	Example
An assistant that can work with files	A chat app with a project or file feature, or a coding assistant on your computer	Claude, ChatGPT, or a terminal-based coding agent
A filing system	Numbered folders so every document has one home (see Johnny.Decimal filing)	`21.01 Bank statements`
A standing-instructions file	One page it reads every session: who you are, how the practice runs, your ground rules	`instructions.md`: "Solo private-pay practice, WA and RI. Fee $[X]. Never enter client info. Ask before sending anything."
One task list	A single plain-text file instead of five apps	`tasks.md`, a line per task and a tag per project
Written routines	Each recurring job as a checklist	"Monthly close," "file this scan," "quarterly marketing review"

The routines do the most work: once the monthly close is a checklist, "do the monthly close for March" runs the same way every time. Plain text (Markdown notes, CSV spreadsheets, plain-text accounting) is the easiest for an assistant to read, edit, and check.

3. Staying organized

Filing. Drop scanned mail in an inbox folder and ask the assistant to file it, e.g. 2026-03-14 [Insurer] - Liability policy renewal.pdf into 11.03 Malpractice insurance. Have it confirm vendor, date, and document type from the contents, because scanner filenames are often wrong.
Tasks. "What's open for the website project?" "I finished the BAA review; mark it done and remind me next March." "What's due this week?"
A weekly review. Have it read the task list and calendar and flag anything stale, slipped, or due in the next 2 weeks. It takes 5 minutes.
Email, carefully. If clients ever email you, the inbox holds protected information and a general-purpose assistant shouldn't read it. Either keep all client communication in the EHR's secure messaging, or leave email out of AI. If you do use it, have it produce a plan first ("archive these 40, filter these six senders, these three need you") and act only after you approve.

4. Research

This saves the most hours, and it's where AI is most often confidently wrong. Ask for citations, check the ones you'll act on, and save answers you'll need again, dated, in your filing system.

Regulatory questions: "What are Rhode Island's continuing education (CE) requirements for a licensed mental health counselor (LMHC)?" Then open the board's page yourself.
Vendor comparisons: "Which telehealth platforms will sign a BAA, and what does each cost?" Verify the finalists directly.
Clinical learning, de-identified: ask about the topic, never the person.
Purchases: "A document scanner for a home office, under $300, duplex, works with a Mac." You pick from three to five options.

5. Finances

AI is good at categorizing and matching, and bad at being the final authority on a number. The monthly close has the full routine; with an assistant it runs like this:

You download the month's bank and card CSVs.
It categorizes against your chart of accounts and flags what it's unsure of ("$84.00 to [Store]: office supplies or personal?").
It drafts the card-fee adjusting entry from the processor's report.
You type the ending balances from the bank statement yourself. A reconciliation only works if the check comes from outside the books it's checking.
It reports the tax reserve to move, and you make the transfer.

Everything goes through the routine. No quick one-off entries mid-month; note the item for the next close. For quarterly estimates, ask for a what-if ("based on year-to-date net income, what should my Q3 federal and state estimates be, versus a flat 25% reserve?") and take it to your certified public accountant (CPA), who decides (see quarterly taxes).

Plain-text accounting (Beancount or hledger) pairs best with AI, because the assistant can read the whole ledger and you can review its entries line by line.

6. Marketing and referrals

Drafting bios, outreach emails, letters, and site copy from your one-line positioning. Then edit.
Prospect lists: "From the National Provider Identifier (NPI) registry, find psychiatric prescribers within 15 miles of [town] and check them against my referral tracker." Review the batch before anyone gets a letter.
Monthly directory sweep: log each paid directory's inquiries by source in the tracker. Counts and sources only, never the inquirer's details (see the referral tracker).
Quarterly review: cost per inquiry by directory and upcoming renewals. The decision is yours.
Ideal client discovery: have it ask the questions one at a time, about patterns, never particular clients.

7. Website and tech

The website: a coding assistant can build it, explain each step, and help you publish on a free host (see building the practice website).
Email authentication: "Walk me through SPF, DKIM, and DMARC for my domain on [provider]." It names the domain name system (DNS) records and checks they're live (see email domain authentication).
HIPAA paperwork: the risk analysis, vendor BAA table, and process log are about your systems, not your clients, so they're AI-friendly.
Troubleshooting: paste the error message, never a screenshot with a client's name in it.

8. What stays off-limits

Don't	Why
Session notes, treatment plans, anything for the chart	Protected health information (PHI) in a tool with no BAA. An AI scribe is a Category 2 decision with its own checklist.
"How should I handle my client who…"	A case consult belongs with a colleague or supervisor, even de-identified. Ask about the topic instead.
Sending, paying, or deleting on its own	Keep a human yes on anything outward-facing or irreversible.
Final answers on law or tax	It's a first draft for the board's page, your attorney, or your CPA.
Screenshots of your EHR, calendar, or inbox	They're full of identifiers you won't notice.

Where to start

Write your ground rules into the practitioner-specific notes of your AI policy.
Create a standing-instructions file.
Pick one routine (usually the monthly close or filing), write it as a checklist, and run it with the assistant for 2 months.
Add one area at a time: filing, then money, then marketing.
Review it at your annual HIPAA review, confirm none of it touches client information, and update the AI policy to match.

Example requests

File the PDFs in my scan inbox. Read each one first and confirm vendor,
date, and document type from the contents rather than the filename. Then
show me the proposed names and folders before moving anything.

Do the monthly close for [Month]. Exports are in 21.01. Flag anything
you're not sure how to categorize. Don't write balance assertions; I'll
give you the statement balances.

Research CE requirements for a [license] in [state]: hours, cycle,
required topics, and my renewal date if it's based on birthday or issue
date. Link the board's page for each claim.

Draft a first-contact letter to [prescriber type] in [area], using my
positioning in instructions.md. Under 200 words. Offer a 15-minute call
instead of a lunch.

Quarterly marketing review: read the activity log and listing costs, give
me cost per inquiry by channel, and list renewals in the next 60 days.
Numbers only. I'll decide what to keep.

Part of the Private Practice Toolkit. Not legal, tax, clinical, or compliance advice.