Inside the PAINITE pathway: four arms, one journey

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.

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.

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.

The tracker shows exactly where they stopped — sent, opened, part-way through, or expired — and automated reminders go out without anyone chasing. A link can be resent in one click. Because the status is visible per patient rather than inferred from silence, an incomplete assessment becomes a task on a list instead of a discovery on the day of surgery.

Non-completion is normal and expected — it is why the tracker exists. The failure mode worth designing against is not the patient who does not finish, but the service that does not know they did not finish until the pre-admission clinic.

Patients who genuinely cannot complete a remote assessment are then a known, named group who can be routed to a phone call or a clinic slot deliberately, rather than turning up unassessed.

They are identified as a group rather than missed. The assessment needs only a phone that receives SMS and opens a link — no app, no login, no account. Patients who cannot complete it that way show as incomplete on the tracker, so the service can route them to a telephone assessment or a clinic slot deliberately instead of discovering the gap later.

The design point is that remote assessment does not have to work for every patient to be worth doing. It has to work for enough of them that the clinic’s finite capacity can be pointed at the ones it does not work for — which includes patients without a suitable phone, patients who need an interpreter, and patients who would simply rather come in.

What Pathways changes is that this group is visible in advance and small enough to plan around, instead of being indistinguishable from everyone else on the list.