About — Cagnea

Why I built Cagnea

I spent 5 years as an Emergency Department scribe at San Antonio Regional Hospital, documenting thousands of patient encounters in a high-volume ED. I saw firsthand how much time physicians spent charting instead of caring for patients — and how often documentation didn't capture the full complexity of their clinical decision-making.

I watched attendings stay late every shift to finish charts. I saw brilliant clinicians under-document complex cases because they were exhausted. I heard the frustration when billing didn't match the actual work they did.

But there was another problem — one that was structural, and one that nobody was fixing.

Scribing attracts pre-med students. Driven, smart, and completely temporary. Every few months, a new cohort would rotate in.

They'd make mistakes that experienced scribes wouldn't — missed details, wrong structure, incomplete MDM. And every time, it was the physician who caught it. Doctors already working exhausting shifts were now double-checking scribe work on top of everything else. The tool designed to reduce their burden was quietly adding to it.

I saw this cycle repeat itself for five years. New scribe, same mistakes, same added work for the physician. The system assumed a consistency it could never deliver.

The worst part? I knew exactly what was missing. After writing thousands of MDM sections manually, I understood the three E/M complexity pillars by heart. I knew which details mattered for billing and which didn't. I knew the difference between a well-documented chart and one that would get audited.

So I built Cagnea — but not alone. I partnered with the emergency physicians I'd worked with for years. They told me what they actually needed, not what I assumed they wanted. Together, we built the AI scribe that works the way ED physicians actually work. One that doesn't rotate out. One that doesn't have a first week. One that just works — accurately, consistently, every session.

We're not a tech company trying to understand healthcare. We're medical professionals who turned to technology to fix something we lived through. The result is software that understands how doctors actually work — not another tool that requires a training program before it's useful.

Zaid Shaikh

Founder & CEO

Former ED Scribe · 5 years

San Antonio Regional Hospital

Chart quality matters for billing

Under-documenting complex cases costs physicians money. I saw it happen every shift. Proper MDM structure is the difference between accurate reimbursement and leaving money on the table.

MDM is everything

That's where E/M level coding happens. Miss one of the three complexity pillars and you're under-coding. I wrote thousands of these sections manually — I know what auditors look for.

Physicians hate assumptions

If it wasn't said, don't write it. One wrong detail can sink a chart. The fastest way to lose a physician's trust is to add information they didn't provide.

Re-evals get missed

Leading to incomplete timelines and compliance issues. Tracking every patient interaction with proper timestamps isn't optional — it's required documentation.

Speed matters, but accuracy matters more

Fast notes are useless if they're wrong. The goal isn't to document quickly — it's to document correctly, efficiently. That's what Cagnea does.

Scribes are always new — and that's the problem

The role is temporary by design. Most scribes are pre-med students rotating through before medical school, which means there's a permanent cycle of onboarding, mistakes, and correction — and it's the physician who pays the price. The tool built to reduce burden was quietly creating one.

The story behind Cagnea