PatientOS — AI Consultation Assistant

Overview

PatientOS is an AI consultation assistant for doctors. Instead of filling forms by hand, the doctor chats with an AI that has already read the patient's full record — demographics, vitals, past encounters, compositions, and lab orders. The AI converses about the case, drafts a prescription, OP consultation, referral letter, medical certificate, or lab order, and shows the doctor exactly what it will write before anything is saved. Nothing is written to the record until the doctor confirms.

Every document type follows the same lifecycle: create a draft, edit it in place, and finalise it when ready. Referral letters and medical certificates are first-class records (not plain consultation notes), and lab orders can be created and edited too.

The AI never writes to the database directly. Every save goes through the same FHIR-native doctor APIs the rest of NICE HMS uses, on the doctor's own authenticated session.

Prerequisites

• An open OPD encounter for the patient. PatientOS attaches new records to the latest open encounter. If none is open, the assistant shows a warning (but still lets you converse).
• AI credit tokens. PatientOS runs on your organisation's AI token balance. If tokens are exhausted, access is blocked with a prompt to purchase more.
• Active subscription and an active, in-organisation patient.
• PatientOS permission. Available to admin, director, doctor, accountant, receptionist, receptionist_accountant, visitor, HR, insurance_executive, insurance_lead, and nurse roles.

Opening PatientOS

1. Open the patient's management page (search the patient, then click their ID).
2. Click Open PatientOS. PatientOS opens in a new tab as a three-pane screen:
   • Conversations (left) — past consultations for this patient.
   • Chat (centre) — the streaming conversation with the AI.
   • Documents (right) — the patient's real documents (reuses the standard Patient Composition view).

Workflow

1. Start a consultation

Click + New (or just type) and describe the patient's complaint. PatientOS first validates access (subscription, tokens, patient status) and loads the full record before the AI responds.

2. Converse with the AI

Ask questions, summarise findings, or give instructions in plain language. The AI reads the loaded record and responds in the chat. Use Consider new docs at any time to re-scan the patient record for newly added documents.

3. Draft a document

The quick-action buttons above the message box speed up the common actions:

• Prescribe… — opens the medication picker with your personal medicine library plus the patient's previous medications (from prior prescriptions, OP consultations, and discharge summaries) so you can copy a prior line instead of retyping it. Choose medicines and click Add — the selected lines are sent into the chat as structured MED: lines for the AI to draft the prescription.
• Order tests… — opens the lab test picker, grouped into Tabular and Descriptive tests. Tick the tests and click Order selected.
• Signing consultant… — pick the practitioner who will perform/sign the lab order.

Type / to open the command picker. Each command puts PatientOS into a specific document mode:

You can also type the instruction directly, e.g. "save this prescription" or "order CBC and LFT".

Recording a diagnosis and follow-up

• Diagnosis (ICD-11) — a button in the left patient panel opens an ICD-11 search. Selecting a code adds it to the diagnosis list and saves it to the open encounter immediately (a "Saving…" indicator shows progress). Remove an entry with Remove.
• Follow-up date — the date field next to the message box sends a follow-up: instruction to the AI, which records it on the encounter.

4. Review the proposal before it saves

When you ask to save, edit, or order, the AI extracts a structured draft and shows it back to you as a proposal (for edits, a before/after of the current content vs what will change) — nothing is written yet. A Save this draft? bar appears with three buttons:

• Confirm — write the record.
• Edit — keep the draft and describe the change in the chat; nothing is written yet.
• Cancel — drop the draft entirely.

5. Confirm to write

Only when you click Confirm (or reply "confirm") does PatientOS write the record:

6. Edit an existing record

Use the /edit … commands to change a record you already have. PatientOS lists your editable records most-recent-first (with date, author, and a short summary) and asks you to pick — reply with the number, or "latest" for the most recent. It then reads the current content and shows the complete final version as a before/after:

• Prescription — current medications, notes, and follow-up vs what will be saved. Appending a drug, removing one, and replacing the whole list are all handled the same way: the AI produces the full final list for your approval.
• Consultation / referral letter / medical certificate — current body text vs the edited body.
• Service request — the current test list vs the edited list. A request that has already been billed or has a diagnostic report cannot be edited (the edit is refused with a clear message).

Confirm to update the record in place — no duplicate is created.

7. View a record

Ask to see a specific record in full — e.g. "show me the last prescription" or "open the referral letter". PatientOS prints the full text of that record. If there are several matches it lists them and waits for you to pick.

8. Finalise

When a record is ready, type /finalize to set it to final so it can be shared (for example via ABDM):

• If there is exactly one draft this session, it finalises immediately.
• If there are several, PatientOS lists them (e.g. 1. Prescription — …, 2. Referral letter — …) and you reply with the number, or /finalize <number>.
• Only the main practitioner (the doctor who owns the encounter) can finalise; anyone else gets a rejection message relayed from the server.

9. Discard a draft

Type /discard to remove a draft you created this session from the session's working set. Like finalise, it targets the single draft directly or lists several for you to pick (/discard <number>). Discarding is local to the session — it removes the entry from PatientOS's list of drafts to finalise/edit; it does not delete the underlying record from the patient's file.

Common Issues

• "No active encounter found" — open an OPD encounter for the patient first, then re-enter.
• "Insufficient AI tokens" — the organisation's AI token balance is empty; purchase more.
• Blocked on subscription — the organisation's subscription validity has lapsed.
• "Cannot edit — this service request has already been billed" — the lab order has moved past draft; it can no longer be changed.

FAQ

Q: Does PatientOS write anything automatically? A: No. It only proposes. A record is written only after you click Confirm (or reply "confirm").

Q: Where do the saved records go? A: To the patient's record via the same doctor APIs the browser uses — prescriptions, consultation notes, referral letters, medical certificates, and lab orders appear in the patient's documents and encounters as drafts, then final when you finalise.

Q: Can I edit a record after saving it? A: Yes. Use /edit prescription, /edit consultation, /edit referral letter, /edit medical certificate, or /edit service request; pick the record, review the before/after, and confirm.

Q: How do I finalise a record? A: Type /finalize (or /finalize <number> when several drafts are listed). Finalising sets the record to final.

Q: What's the difference between discard and delete? A: /discard removes a draft from the current session's working list only; the underlying record stays in the patient's file.

Q: Can I resume a past consultation? A: Yes. Select it from the Conversations sidebar; the full chat history is restored.

Q: Is my data safe? A: PatientOS acts on your own session token and never stores credentials. Records are written through NICE HMS's existing authenticated endpoints.