Explainer
Enter, never save
Mesio fills the fields and stops. A person reviews and commits. On every route, on every system, without exception.
There is one sentence that governs everything Mesio puts into your practice system.
Mesio enters. It does not save.
It fills the fields and stops. A person reads what is there and commits it. That is true on every route in, on every practice system, for notes, charts and planned procedures alike.
Why it is not a limitation waiting to be lifted
The obvious question is whether this is temporary, something that goes away once the software is trusted enough.
It does not, because the signature is not a formality. A clinical record is an assertion by a named clinician about a patient they saw. Software can draft that assertion, and it can put it in the right box for you. It cannot make it, because it was not there and it does not carry the consequence.
Moving the boundary would not make Mesio more capable. It would make it something else.
What it looks like in practice
Work appears in your system, in the right place, with the right values, marked as entered and pending your save. Everything Mesio wrote shows in one list, including the writes that refused themselves and the ones that paused because you started typing.
A partial write says so. Thirty-four written and two refused reads as exactly that, rather than as a tick.
The exception that proves it
There is one place Mesio presses save, and the reason is mechanical rather than philosophical. On some browser systems, navigating away from a perio chart discards pending edits. Since the next piece of work navigates, not saving would mean losing the chart you just dictated.
So it saves, and if that save fails it says so rather than reporting success.
Your cursor outranks it
A related rule. If you start working in a tab while Mesio is midway through writing, it stands down and offers you the rest.
Being able to drive and being entitled to drive right now are different questions. A person being present settles the second one, every time, even on a system Mesio knows perfectly.
It also refuses rather than approximating. Where Mesio is not certain which field or which patient it is looking at, the write does not happen. Relaxing how it navigates never relaxes how certain it has to be about where the work is landing.
What you can turn on
Practices running unattended can make signing a note the moment it is filed, because for them signing genuinely is the finish line. It is off until someone turns it on, and it does not change the rule. The person signing is still the person approving.