When Sabrina L. Nii walked into her new role as clinic director at Fresno State's speech program in 2015, she knew what she was looking at the moment she saw it: paper charts.
"Here we go again," she thought. "But this time I'm in charge of making sure it happens right."
The Challenge
Sabrina had spent years as a medical-based speech-language pathologist in hospital settings, living through three separate transitions from paper charts to EMRs. She knew exactly what good looked like — and what she'd inherited was not it.
Starting in 2015, she began researching options. She attended CSHA and ASHA conferences, watched demos, called other California speech programs to find out what they were using. But something kept getting in the way.
"Meanwhile, we lost all of our funding," she recalls. "Making that commitment financially when it wasn't a one-and-done purchase was not in the cards at the moment."
Then COVID-19 hit. Overnight, a clinic that had always been face-to-face had to become fully remote — while still maintaining HIPAA compliance for every client record. Sabrina had to solve both problems at once.
The only HIPAA-compliant option available quickly enough was Amazon WorkDocs — a tool Sabrina's clinic was never meant to use. "We were a Google suite at the time. So anyway, so we're also here we are, square peg, round hole, creating a solution that wasn't meant for this purpose."
Files were uploaded to the cloud as a stopgap. It worked. But Sabrina knew it wasn't sustainable. And she knew what was at stake if they stayed on paper — even digitized paper. Students potentially could take files home when they shouldn't.
Regardless of the policy, students could lose paper files creating a significant confidentiality concern.
Finding ClinicNote
Sabrina first encountered ClinicNote at a speech pathology conference — CSHA or ASHA, she can't recall exactly which one — sometime around 2017 or 2018. She didn't move forward immediately. Funding wasn't there yet.
She evaluated five other platforms before making her decision: WebPT, TalkTrack, Practice Perfect, Medical Mastermind, and ChartLinks. WebPT was dismissed almost immediately. "I already didn't like it because it had PT in the name," she says. TalkTrack came closest — it was her second choice.
But Sabrina kept coming back to ClinicNote. She eventually did two demos: one during her initial research phase, and another years later when the clinic was finally ready to move forward.
Her requirements were specific. After years of being the "extras" in larger hospital EMR systems, she was not willing to fit a square peg into a round hole again. "Speech never fit," she explains. "We were always trying to finagle things. I wanted something meant specifically for us."
ClinicNote was speech-specific. That alone got her attention. But what sealed it was the interface — and what the interface would mean for her workload.
"I don't actually use it," she says plainly. "My assistant uses it. My students and supervisors use it. But I was somehow responsible for making sure that everyone knew what to do." She didn't want to become the resident trainer, responsible for onboarding a revolving cohort of students every semester. She needed something people could learn on their own.
"The students are savvier than I'll ever be tech wise, right? So I just guide their onboarding and help tools directly in the program."
The help documentation — written articles and video tutorials covering every feature — made that possible. So did the responsive customer support, and the ability to hide sections the clinic didn't need. "We don't do the billing aspect of it," she notes, "but we can mock it if we wanted to."
Implementation and Onboarding
Sabrina didn't run a formal onboarding. There were no all-hands training sessions, no outside consultants, no weeks spent in workshops.
Instead, she built a folder in Google Drive. Step-by-step instructions. Links to ClinicNote's training videos. A short reference sheet she developed over time as common questions came up — "This is a common problem and this is how to solve it in the moment."
From there, she assigned ClinicNote modules on a timeline that matched the rhythm of the clinic semester. Students weren't handed everything at once.
"I only assigned the modules that were appropriate for what they were going to need to use at that time of that part of the semester," she explains. "So that people weren't overwhelmed with an entire introduction to everything."
At the start of the semester, students learned goal creation. Once goals were established, SOAP notes training followed. Advanced features came later, when they were actually needed. "I'd be like, okay, now this is how you create goals, because that's where we are right now," she recalls.
By the time students finished that first semester, they were on their own.
The Results
Client placement dropped from three weeks to three days. Before ClinicNote, placing clients for a new semester required phone calls, waiting, callbacks, and manual confirmation — a process that could stretch two to three weeks. Now, the clinic sends invitations through the patient portal and clients respond through it. "We're placing an entire clinic in just three days," Sabrina says. "And it used to take two to three weeks."
HIPAA compliance is no longer a source of anxiety. Files don't leave the building in backpacks anymore. Students can't accidentally take records home, lose them, or expose them to risk. The days of worrying about a stolen car containing a client file are gone.
Everyone can work from anywhere. Staff turnover is common. Schedules shift. With ClinicNote, none of that stops the work. "Everybody can do their job, regardless if they're in the office or not — the student supervisor, me, my assistant, the faculty," she says.
The training burden on the director dropped significantly. Sabrina built a one-time Google Drive resource folder and assigned modules. After that first semester, students self-onboard using ClinicNote's built-in help documentation — and Sabrina is no longer the person fielding every question.
Reporting is now a real tool, not a wish. Need to find clients within a specific age range who have stuttering as a primary concern? The clinic can pull that list. Searchable records, demographic filtering, and reporting by condition have made client matching and grant documentation genuinely manageable.
The platform keeps getting better. Sabrina had been requesting a waitlist feature for some time — and once we added it, she started using it right away. "I like that they're still building and making adjustments," she says. An external waitlist program the clinic currently uses will soon be replaced by a native ClinicNote feature.
Looking Ahead
Running a university speech clinic is not just about documentation. It's about training the next generation of speech-language pathologists — giving them real tools, real workflows, and real experience with the systems they'll use everywhere they go after graduation.
"Everywhere they're going to go, they're going to experience that," Sabrina says of EMR systems. "Even in the schools, they have their own version of digital files."
ClinicNote has become part of that training. Students leave Fresno State's program having used an actual speech-specific EMR — not a general-purpose workaround, not a Google Drive folder jerry-rigged for HIPAA compliance, but a purpose-built system designed for what they do.
For Sabrina, the relief is both practical and philosophical. After years of fitting square pegs into round holes, the clinic finally has a tool that belongs to it.
About Fresno State Speech and Hearing Clinic
The Speech and Hearing Clinic at California State University, Fresno is a university training clinic within the Department of Communicative Sciences and Deaf Studies. The clinic serves clients across the Fresno community while providing supervised clinical experience for graduate students in speech-language pathology. Sabrina L. Nii serves as clinic director.
"We're placing an entire clinic in just three days. And it used to take two to three weeks."
— Sabrina L. Nii, Clinic Director, Fresno State Speech and Hearing Clinic