The platform didn't know what the hospital knew

No. Pathways runs standalone from day one. The SMS-driven workflow needs no patient management or EMR integration to start, so a service can screen its next elective list without an IT project, an interface engine, or a change window. Integration is available later but is not a precondition.

This is usually the difference between a deployment measured in days and one measured in quarters. Most of the value — screening every booked patient early enough to act — does not depend on a bidirectional interface, so requiring one up front only delays the point at which the first cancellation is prevented.

When you do want it, integration is HL7 or FHIR against your patient administration and EMR systems: automated list ingestion from theatre scheduling in one direction, and write-back of the signed pre-operative summary to the patient record in the other. That is an Enterprise capability, available on Business, and it is scoped after the standalone deployment is running rather than before it.

Days rather than quarters. Because Pathways runs standalone over SMS with no PMS or EMR integration required, a service can begin sending assessments on its next elective list. There is nothing for patients to install and no software to deploy on hospital workstations — the platform runs in a browser.

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.

No. It decides who should be in it. Every completed profile carries a triage recommendation — anaesthetist review, pre-admission clinic, telephone review, or no further assessment — so clinic slots go to the patients who need them. The clinic keeps doing the same work, for a different and better-chosen set of patients.

Most pre-admission clinics are not short of clinical capability. They are short of a mechanism for allocating their capacity, so slots fill in the order bookings arrive — producing a clinic of largely well patients while a frail patient with poor functional capacity gets a short phone call.

Screening every booked patient early makes the queue orderable by risk. The clinic’s capacity does not change; what changes is who is in it.