Tributary

Most scribes forget the client the moment the session ends

A transcription tool hears one hour and writes it up. It does not know what you were working toward, what happened three weeks ago, or whether the thing that just shifted has been building since intake. Every note starts from nothing, which is why so many of them read like a stranger's first impression.

Tributary is built the other way around. It works from the treatment plan, carries what it observed from one session into the next, and keeps a record of how each goal has actually moved.

What it does

Three things from one recording

A diarized transcript that knows who was speaking, a draft progress note, and a short list of clinical considerations — patterns, shifts and threads worth carrying into the next session. The considerations are prompts for your own thinking, not advice.

It knows who you are seeing

Tributary reads the client identifier straight from your open EHR tab. No retyping names, no copy-pasting IDs between windows, and no notes landing in the wrong chart because something was mistyped. It works with PracticeQ and TherapyNotes today.

It works from the treatment plan, not just the transcript

Diagnoses and treatment goals come across from your EHR automatically. When you update and lock a treatment plan, Tributary picks up the changes — so the note is written toward the goals you are actually working on.

It tracks progress across the episode of care

Tributary records what it observed about each goal, session by session, and builds a running evidence trail. Goals move through active, improving, achieved or stalled based on what happened in the room. At session five, ten, fifteen and beyond it drafts a milestone review from the whole arc of treatment — the kind of summary that usually means an hour with a stack of old notes.

It remembers the thread

Every session leaves a structured clinical memory: themes, affect, interventions, and what to follow up on. The next session starts with that context already in hand, which is how a note comes out sounding like continuing care.

Notes in the formats that actually get accepted

Output includes SOAP and the other formats agencies and payers take, plus custom templates your organization can define once and share across the team.

Your EHR holds the record

Tributary is a drafting tool, not a system of record. Your electronic health record holds the clinical record. Tributary holds working material — treatment plan information synced from your system, the drafts produced along the way, and the goal history behind them. The finished note reaches the chart because a clinician puts it there.

That working material is stored in Google Cloud Storage, in infrastructure Waterway operates, encrypted at rest and in transit. Each clinician's material is reachable only by that clinician — not a supervisor, not the practice owner, not another clinician at the same practice. Every read and write is logged with the identity behind it.

It is deleted on a schedule: unfinished drafts about 14 days after the last save, and everything for a clinician 30 days after their seat is terminated. Nothing is exported at termination, because the record is already in your chart system.

Who processes what

Session audio is transcribed and the note drafted by AssemblyAI, under a Business Associate Agreement signed with Waterway. The audio is not retained after transcription. Neither AssemblyAI nor Waterway uses the data to train models. Waterway signs a BAA with your practice before any client information is processed.

The judgment stays yours

Everything Tributary produces is a draft. You read it, change what is wrong, and sign it — nothing reaches the chart until you put your name on it. Goal statuses and milestone reviews are its reading of the record, offered for you to confirm or correct, not a clinical conclusion.

Nothing it writes is a diagnosis or a treatment recommendation.

Details

Who it is for

Mental health counselors and group practices.

Works with

PracticeQ and TherapyNotes.

Where data is stored

Google Cloud Storage, in infrastructure Waterway operates. Encrypted at rest and in transit, reachable only by the clinician it belongs to.

Requires

A Google account for sign-in, a seat assigned by your practice, and a Business Associate Agreement between your practice and Waterway.

Status

In pilot. Working with a limited number of practices.