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 (including the records of any merged duplicate patients). The AI converses about the case, drafts a prescription, case sheet, 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 case sheet is the one exception to finalising — it is final as soon as it is saved, because NICE HMS assembles it from the encounter's own entries.

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 clinical tests in the order (optional — a learned per-test habit fills it silently).

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".

For /create service request, put the tests right after the command — /create service request CBC, RFT, LFT (comma-, semicolon-, plus-, slash- or newline-separated). Those names are matched directly against your lab master, so the AI cannot rename or drop a test; anything that does not match is resolved by the AI. If no tests are named, PatientOS asks you to list them.

The case sheet

The case sheet is PatientOS's default clinical document: if you dictate a note without choosing a document type (for example "fever since 2 days, temp 101, start paracetamol 650"), it is recorded on the case sheet rather than as a separate OP consultation.

• One per encounter. The case sheet is assembled from the encounter's own entries — your note, vitals, medicines, and procedures — so everything recorded during a visit lands in the same sheet.
• Always final. There is nothing to finalise; a case sheet is final as soon as it is saved. Each save appends a dated progress note, so the sheet reads as a day-by-day record.
• Vitals are written in your hospital's terms. Shorthand is expanded before saving — BP → Blood pressure, PR / HR / pulse → Heart rate, RR → Respiratory rate, SpO2 → Oxygen saturation (SpO2), temp → Body temperature, HT / WT → Body height / Body weight, GCS → Glasgow Coma Scale — so "temp 101" and "bp 120/80" land on the right rows instead of being rejected.
• Procedures are clarified first. A procedure is never saved with a guessed time or an unknown performer. PatientOS asks "What time was "…" done?" and, for each staff name that does not match someone in the hospital's doctor list, who the primary operator (or assistant, anaesthetist, technician) was. Reply with a number or the exact name, or say cancel to leave them off. A day on its own is not enough — PatientOS asks again, saying which part is still missing and quoting the day it already has; "just now" works when it was done during the consultation.
• An earlier operation is history, not a procedure. Anything you name that was done before this visit — "appendicectomy 3 years back", "CABG in March" — is written into the medical history in your own words with the day you gave. PatientOS never asks for the clock time of an operation from months ago, and never invents one.
• Editing keeps the rest. /edit case sheet shows what you recorded on this encounter — other doctors' entries are not yours to change. Describe the correction in the chat: an entry you do not mention is kept, a correction is applied to that entry, and new entries are added.
• Internal Id on the printed sheet. The face sheet prints your organisation's own patient number as Internal Id, between Facility ID and ABHA. When the patient has no internal Id, the row is left out rather than printed blank.

Ordering tests

• Who signs or performs. Laboratory tests — and anything filed under Radiology, Blood Bank or Pharmacy — carry no performer, so NICE HMS records your organisation. A hospital service such as ECHO, TMT or endoscopy does need one, and PatientOS resolves it without asking: a consultant you name in the request wins; otherwise the consultant you habitually send that test to; otherwise, when the order has a single clinical test, your usual consultant. If none applies, the line reads "- ECHO — no performer (billing will assign)" and the order goes out unassigned for billing to fill in.
• Already ordered in this encounter. If the test is already on this visit, PatientOS asks "CBC, RFT were already ordered in this encounter. Repeat them?" Reply yes to order them again as repeats, or no to skip.
• Not in your lab master. A test the hospital's lab has no entry for is offered as a referral letter: "MRI-PROSTATE isn't in your lab master. Draft a referral letter to get it done outside?" Reply yes and PatientOS drafts the letter naming the test.

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. Relative phrases work too ("in 2 weeks", "30 days", "1 month", or "next Monday" in chat): PatientOS resolves them against today's date and, for day/week/month offsets, moves the result forward to the next working day if it lands on a Saturday or Sunday. If you ask for a follow-up without saying when (e.g. "review after blood test"), PatientOS prefills your usual interval and labels it (Your usual interval: …) — give an interval to override it.

Your usual practice (learned prefill)

PatientOS remembers the choices you make repeatedly and offers them back as a starting point on later consultations. Five things are learned, per doctor:

• Per-test performer — the consultant you send a given test to (ECHO → Dr B). This is the habit that lets a familiar order be assigned without any ask;
• Signing consultant / performer — the doctor-wide fallback, used when a single clinical test has no per-test habit;
• Referral recipient — the "To:" physician and hospital on referral letters;
• Test panels — combinations of tests you order together;
• Follow-up interval — how far ahead you usually review.

How it behaves:

• A choice must be used at least twice before it is treated as a habit.
• Habits are recency-weighted: a recently used choice outranks an older one, even if the older one has been used more overall. A habit not used for a year is forgotten.
• When PatientOS applies one of these, the proposal shows it — e.g. - ECHO — Dr X on a test order, (Referred to: … — your usual; reply "refer to <other>" to change.), or Your usual add-ons for this panel: … (not added — say "add …"). The performer shows silently: there is no picker to answer, and naming a different consultant in the request overrides it.
• Whatever you state in the current consultation always wins. The learned values are only used when you have not named a different one. A test-panel suggestion is never added automatically.
• Overriding a prefill is enough to start a new habit: confirm the different consultant, place, or interval and it is recorded like any other choice.
• Nothing is learned from records that fail to save, and nothing needs to be configured.

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 confirmation bar appears above the message box, labelled for the document you are about to write — e.g. "Save changes to this Referral letter?" for an edit, "Save this Prescription?" for a new draft, "Place this test order?" for a lab order. It has three buttons:

• Confirm / Save — write the record.
• Keep editing — edit the record directly: for a prescription or a consultation / referral letter / medical certificate you are changing, a form opens pre-filled with the document's current medications, notes or body, and follow-up; change the fields you want and click Save. Medications use the same picker as Prescribe medication — select from your own list or a previous visit. PatientOS tidies what you entered — spelling fixed, fields arranged — and re-proposes the same document for confirmation. Nothing is written until you confirm on that card. For a brand-new draft, Keep editing instead keeps the draft and takes your correction in the chat.
• Discard — drop the draft entirely.

5. Confirm to write

Only when you click Confirm / Save (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. The edit form then opens by itself, pre-filled with that record (or describe the change in the chat instead). Fix the fields you want and press Save; PatientOS tidies spelling and arrangements, then shows the complete final version for your confirmation. An emptied follow-up date removes the follow-up from the record; leaving it as it is carries it forward unchanged.

• Prescription — current medications, notes, and follow-up vs what will be saved. Medications use the same picker as Prescribe medication: select a medicine from your own list or load a previous visit's medications instead of typing them; the dose is part of the medicine name. 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. On a consultation edit, the fields you do not change (chief complaints, medical history, physical examination) and the existing follow-up date and comment are carried forward unchanged.
• 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.

You can also search older records by document type, date, or keyword — e.g. "show me the prescription from 2023", "any history of diabetes?", or "how many CBC orders?". PatientOS searches the loaded history and returns the matching dates, document types, and short snippets; ask to open any of them in full.

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.

After you save or update a prescription or an OP consultation, PatientOS already reports "… saved as draft." in the chat and shows a bar above the message box reading Draft saved. with two buttons:

• Finalize — runs /finalize for you, so a single draft is finalised without typing.
• Keep as draft — dismisses the bar. You can still type /finalize at any time.

Any new message clears the bar, and it is offered only for prescriptions and OP consultations — referral letters, medical certificates and lab orders use /finalize directly.

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.
• "Could not save the consultation: …" or "Could not save the prescription: …" — the server rejected the save, and the text after the colon is the server's own reason. The commonest causes are a missing open encounter (every record must attach to an encounter, so open one for the patient first) and an edit to a record that has already moved past draft. Nothing is written when a save fails — fix the cause above and confirm again. If the message begins with a bracketed code such as [ENCOUNTER_REQUIRED], quote that code in your ticket.
• "Could not validate access. Please try again." — PatientOS could not reach the server to verify subscription, tokens, and patient status. Retry; if it persists, raise a ticket.
• "I couldn't reach the model. Please try again." — the AI service timed out. Retry the message; the draft is preserved.

Reporting a problem

PatientOS reports its own failures — a failed save, an unreachable model, a record it could not read — to the NICE HMS team automatically, against your organisation and the consultation it happened in. You do not need to reproduce an error for us to see it. When you raise a ticket (see Raising Tickets and Reporting Issues), add:

• the document type — prescription, OP consultation, referral letter, medical certificate, or lab order;
• the exact message PatientOS showed, including any [CODE] prefix and the text after the colon;
• whether you were creating or editing, and if editing, which record you picked;
• the approximate time you tried.

The full conversation is stored with the consultation — open it from the Conversations sidebar to copy the exact exchange into the ticket.

FAQ

Q: Does PatientOS write anything automatically? A: No. It only proposes. A record is written only after you click Confirm / Save (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), or click Finalize on the Draft saved. bar that appears after a prescription or OP consultation is saved. 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: Does PatientOS read records from merged duplicate patients? A: Yes. If a patient has been merged with duplicates, PatientOS reads the duplicates' compositions, previous medications, and vitals as well — automatically, with nothing to configure. History recorded before a merge is not lost.

Q: If I edit an OP consultation, will it erase the parts I did not change? A: No. PatientOS carries forward the consultation's chief complaints, medical history, physical examination, and existing follow-up date and comment exactly as they are, and replaces only the content you edited.

Q: Does PatientOS remember my usual consultant, referral place, tests, or follow-up interval? A: Yes — and performers are remembered per test, so an ECHO you always send to Dr X stays with Dr X without changing who signs a TMT. After you use the same choice at least twice, PatientOS applies it on later consultations — for example - ECHO — Dr X or (Your usual interval: 2 weeks …). State a different choice in the current message to override it; whatever you say in the conversation always wins, and the override becomes your new habit. Learned habits fade with time and are forgotten after a year of disuse.

Q: Will PatientOS add tests to my order because I usually order them? A: No. It may show a line such as Your usual add-ons for this panel: HbA1c, Lipid (not added — say "add HbA1c"), but nothing is added unless you ask for it.

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.