Telephone pre-assessment

Socrates Pre-Op is the Pathways voice agent that takes a structured anaesthetic history from a patient by phone. It is delivered as a secure, time-limited SMS link — no app, no login, no paper questionnaire — and covers 12 clinical domains conversationally, producing structured, severity-tagged findings that feed the risk engine directly.

It is a purpose-built anaesthetic variant rather than a generic intake bot. The distinction matters in practice: a general-purpose intake tool collects answers to the questions it was given, whereas an anaesthetic interview needs to follow up on a positive family history of anaesthetic problems, probe functional capacity when a patient says they are “fine”, and recognise when a described medication is worth photographing.

Completion is tracked, and a finished interview automatically triggers a fresh risk analysis.

How this compares with the two methods it usually replaces — paper questionnaires and telephone pre-assessment — including where each of those still wins.

Yes. The interview opens by identifying Pathways as an automated assistant working on behalf of your practice or hospital, and tells the patient that a clinician will review everything discussed. Patients can ask to speak to a person at any point rather than continue with the assessment.

Disclosure is not a compliance box here, it is what makes the answers usable. A patient who thinks they are filling in a form gives form-shaped answers; a patient who understands they are being interviewed, and that a clinician will read it, tends to volunteer the thing that matters — the stent nobody recorded, the sleep study that was never followed up.

Telling them a clinician reviews the result is also simply accurate. Pathways issues no orders and clears no patients; the summary is a draft until someone qualified signs it.

The Socrates Pre-Op interview covers 12 domains — surgical context, presenting symptoms, prior anaesthetics, systems review, functional capacity and frailty, airway assessment, medications and allergies, social and risk factors, implanted devices, pre-op investigations, a red-flag screen, and safety and shared decisions.

Every domain produces structured, severity-tagged findings rather than free text, which is what allows the risk engine to screen on them directly instead of re-parsing a narrative.

Pathways is clinical decision support intended for use by qualified clinicians within Australian clinical governance frameworks. It is clinician-in-the-loop by design — it issues no automated orders, and every recommendation is reviewable and auditable. The treating clinician remains solely responsible for all clinical decisions.

The positioning is deliberate and is reflected in the architecture rather than only in the terms of service. Pathways produces risk flags with severity tiers, the evidence that triggered them, a guideline reference and a recommended action. It does not place orders, it does not clear patients, and it does not route anyone to theatre on its own authority.

Pathways screens each case with deterministic, versioned rules referenced to perioperative guidelines. Every flag carries a severity tier, the clinical rationale, the triggering evidence, the guideline reference and a recommended action, plus the rule version that produced it. The same inputs always produce the same flags, months later.

Screening covers the domains that drive perioperative outcomes: unstable cardiac symptoms, marked hypertension, diabetes control and SGLT2 management, obstructive sleep apnoea, frailty, malnutrition, functional capacity, smoking and discharge support.

Pathways also states what it does not know. Missing investigations and unconfirmed timings are listed explicitly on every profile, and extraction confidence is shown rather than hidden — a profile that is 86% confident about a patient-reported HbA1c says so.

Yes. Pathways keeps org-wide and per-patient audit logs with full workflow tracing on every risk analysis — the inputs used, the rule version that fired, the output produced, and the human who reviewed it, all timestamped. Logs are exportable for governance committees, M&M review and accreditation.

Because the safety-critical rules are deterministic and versioned, an audit is reproducible rather than merely archived: re-running a case against the rule version recorded at the time produces the same flags. That is the property that lets a decision made in March be examined in September without argument about whether the system “would have said something different”.

They proceed. Every completed profile carries a triage recommendation — anaesthetist review, pre-admission clinic, telephone review, or no further assessment — so clinic slots go to moderate-risk patients and anaesthetist time goes to red flags. Low-risk patients are not routed into a clinic appointment they do not need.

This is the throughput argument, and it runs in both directions. A pre-admission clinic booked out three weeks ahead with mostly healthy ASA 1 patients is not short of capacity so much as misallocating it. Screening every patient at booking makes the queue orderable by risk rather than by whoever called first.

No. Patients receive a signed, time-limited SMS link and complete the assessment in their phone's browser. There is no app, no login and no password. Links expire, and expired links are visibly dead rather than silently reusable.

Links are signed with HMAC-SHA256 and time-limited. The visible-expiry behaviour matters more than it sounds: a link that silently still works is a data exposure, and a link that fails with no explanation generates a phone call to the practice.