P
Pickle
Clinic Setup
Setup Progress
20%
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1
Clinic Profile
Name, address, timezone
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2
Invite Team
Add doctors and staff
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3
Procedures
Select operation types
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4
Documents
Clinical resources and guides
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5
Review & Launch
Confirm and go live
Welcome to Pickle
Tell us about your clinic. Most practices are configured and live in under 10 minutes.
Clinic Information
Primary Contact
Invite Your Team
Add colleagues who will monitor patient recovery. Each receives a personalized invitation link.
Team Members (3)
TW
Dr. Thomas Walsh
t.walsh@riversideortho.com
SM
Dr. Sarah Miller
s.miller@riversideortho.com
JR
Jennifer Rodriguez
j.rodriguez@riversideortho.com
Additional team members can be invited anytime from Settings.
Procedure Types
Select the operations your clinic performs. Recovery templates, data collection schedules, and AI context will be pre-configured for each.
Total Knee Replacement
42-day protocol
Total Hip Replacement
42-day protocol
Knee Arthroscopy
21-day protocol
Rotator Cuff Repair
56-day protocol
ACL Reconstruction
90-day protocol
Spinal Fusion
84-day protocol
Custom procedure types can be created later from Settings.
Clinical Documents
Upload wound care guides, exercise protocols, and patient education materials. These are loaded into the AI assistant's context and linked to specific operations.
Drop files here or click to browse
PDF, DOCX, or images up to 50 MB each
Uploaded (3 files)
1.2 MB · Linked to Total Knee Replacement
2.4 MB · Linked to Total Knee Replacement
890 KB · General (all procedures)
Documents are automatically indexed for AI context. Manage assignments in Settings after launch.
Ready to Launch
Review your configuration below. All settings can be adjusted after launch from the Settings page.
What happens next
1
Team invites sent immediately
Each member receives a personalized activation link
Each member receives a personalized activation link
2
Recovery templates auto-configured
Data collection schedules generated for selected procedures
Data collection schedules generated for selected procedures
3
AI assistant initialized
Clinical documents loaded into patient-facing chatbot context
Clinical documents loaded into patient-facing chatbot context
Good morning, Dr. Walsh
Monday, April 28 · Riverside Orthopedics
2 patients need attention · 30 on track
Set up your clinic
Complete these steps to start managing patients
2 of 5
Create your clinic
Riverside Orthopedics
Add clinic details
Address and contact information saved
Create your first operation
Define a procedure type with recovery pathways and collection templates
Invite a team member
Add doctors, nurses, or office managers
Add your first patient
Import from EHR or enter manually
You can dismiss this and return to it anytime from Settings.
Needs your attention
2
Sarah Mitchell · Rt. Total Knee Replacement · POD 5
Pain score elevated to 8/10, up from a baseline of 3. Wound photo shows increased redness.
Reported Saturday morning. Dr. Miller acknowledged but deferred clinical review to you.
James Cooper · Total Hip Arthroplasty · POD 14
Non-responsive for 4 days. Missed all weekend collections despite automated reminders.
Last response Wednesday, April 23. Was previously on track with 91% compliance.
30 patients are on track. Average compliance 94%.
Today
28 collections scheduled · 2 pending · 3 overdue
No surgeries today
This week
E. Chen likely discharge Tuesday
S. Mitchell follow-up Thursday
Patients
38 patients across 2 clinics
Today's Patient Status
Friday, Apr 25 · 32 active patients · Last updated 09:15 AM
24 checked in today
·
8 pending
Needs Attention
2
SM
Sarah Mitchell
TKR · POD 5
8/10
pain spike
JC
James Cooper
THR · POD 12
2d
no check-in
Monitor
5
RT
Rachel Torres
Arthroscopy · POD 3
wound photo
flagged
LJ
Linda Jackson
TKR · POD 7
redness
stable
+3 more patients in monitoring
On Track
25
Average pain score
2.4/10
Average compliance
94%
Nearing discharge
3
1 new alert
Sarah Mitchell pain spike
2 callbacks pending
medication · wound concern
24 collections completed
75% completion rate so far
1 surgery today
Emily Chen, TKR at 11:00 AM
| Patient | Procedure | Status | Recovery Progress | Last Check-in | Compliance | Surgeon |
|---|---|---|---|---|---|---|
SM Sarah Mitchell 1 flag 68 yrs | Rt. Total Knee Replacement | Active | Day 5 | Today, 09:01 | 92% | Dr. Walsh |
JC James Cooper 1 flag 42 yrs | Lt. Total Hip Replacement | Active | Day 12 | Apr 23 | 68% | Dr. Walsh |
EC Emily Chen 71 yrs | Rt. Total Knee Replacement | Pre-Op | Scheduled | — | — | Dr. Walsh |
RT Rachel Torres 55 yrs | Knee Arthroscopy | Active | Day 3 | Today, 08:45 | 100% | Dr. Miller |
DP David Park 61 yrs | Lt. Total Knee Replacement | Active | Day 8 | Today, 09:15 | 88% | Dr. Walsh |
LM Linda Martinez 73 yrs | Rt. Total Hip Replacement | Active | Day 21 | Today, 07:30 | 95% | Dr. Miller |
Operations
Procedure types, recovery pathways, and clinical documents
Total Knee Replacement
Active
14 patients assigned
Total Hip Replacement
Active
8 patients assigned
Arthroscopy
Draft
0 patients
Total Shoulder Replacement
Archived
0 patients
Alerts
3 unresolved alerts
Critical1
Pain score spike — Sarah Mitchell
Score increase from 3 to 8 within 24h. 5-day mean: 3.2. POD 5 Rt. TKR.
5 min ago
Critical Alert: Pain Score Spike
Triggered 5 min ago · Auto-generated by pain threshold rule (>7)
SM
Sarah Mitchell · 68 yrs
Right Total Knee Replacement
Day 5 post-op
Dr. Thomas Walsh
Penicillin
Latex
Triggering Data Point
8/10
Current pain
3/10
Yesterday
3.2
5-day avg
Pain Trend
4
Day 13
Day 23
Day 33
Day 48
Today
Threshold: 7
Other Data Points (today)
AI Chat Excerpt
Today, 09:01
Good morning, Sarah! How are you doing today? On a scale of 1-10, how would you rate your pain right now?
8, it really hurts today
I'm sorry to hear that. Where exactly are you feeling the most pain?
Behind my knee, bending is the worst
Patient reports medication is losing effectiveness — consider dosage review
Take Action
Schedule Callback
Call the patient to assess pain
Acknowledge
Monitor in next check-in cycle
Adjust Medication
Review pain management protocol
Escalate
Refer to specialist or urgent visit
Warning2
Missed check-ins — James Cooper
2 consecutive days without collection response. Last submission Apr 23.
2 hours ago
Wound photo flagged — Rachel Torres
Erythema exceeding expected parameters. POD 3 arthroscopy.
3 hours ago
Responses
24 collected today, Apr 25
24
Collected today
3
Partial / incomplete
2
Flagged values
1
Pushed to EHR
Recent Responses
24 todaySM
Sarah Mitchell
Total Knee · Day 5
Pain Assessment · 7 of 7 fields
Pain: 8/10
was 3 yesterday
JC
James Cooper
Total Hip · Day 12
Pain Assessment · 4 of 7 fields
Stopped at: Swelling
no response after 12 min
RT
Rachel Torres
Arthroscopy · Day 3
Pain Assessment · 7 of 7 fields
Pain: 3/10
within range
DP
David Park
Total Knee · Day 8
Wound Assessment · 4 of 4 fields · 1 photo
Healing normally
photo reviewed
LM
Linda Martinez
Total Hip · Day 21
Mobility Check · 5 of 5 fields
Walking 20 min
Synced to ModMed
RW
Ryan Walsh
Arthroscopy · Day 18
Pain Assessment · 7 of 7 fields · requested callback
Callback requested
routed to Dr. Walsh
Pain score 8/10 triggered a critical alert
View alert
Collected Data
Pain History (7 days)
2
3
2
3
3
3
8
Apr 19
20
21
22
23
24
Today
AI Conversation Excerpt
Pickle AI
Good morning, Sarah! On a scale of 1-10, how would you rate your pain?
Sarah Mitchell
8, the pain has gotten much worse since last night
Pickle AI
I'm sorry to hear that. Where exactly are you feeling the pain?
Templates
4 active collection templates
4
Active Templates
76%
Average Compliance
3.9m
Mean Completion Time
32
Patients Assigned
Mental Health Screen
Active Low compliance3 fields · Weekly (Monday) · All operations · 32 patients assigned
Compliance is 52% — significantly below clinic target (80%)
Patients are completing this template at less than half the expected rate. The most common drop-off point is the "anxiety level" field. Consider simplifying the question or adjusting the schedule to a less busy time slot.
52%
Compliance Rate
32
Patients Assigned
2.4m
Avg Completion
Mon 09:00
Scheduled
15
Skipped This Month
AI Assistant
Configure, monitor, and test the patient-facing AI
2
Active right now
18
Conversations today
3
Escalated to human
24
Data points collected
Conversations
TodayRT
Rachel Torres
Live
Arthroscopy · Day 3 · General question about physiotherapy exercises
Started 2 min ago
4 messages
JC
James Cooper
Live
Collection
Total Hip · Day 12 · Pain Assessment · field 4 of 7
Started 5 min ago
8 messages
RW
Ryan Walsh
Callback requested
Arthroscopy · Day 18 · Patient concerned about persistent swelling, requested doctor call
08:22
12 messages · 6 min
SM
Sarah Mitchell
Collection
Alert triggered
Total Knee · Day 5 · Pain Assessment completed · 7/7 fields · pain 8/10
09:01
14 messages · 4 min
DP
David Park
Total Knee · Day 8 · Asked about medication side effects and swimming timeline
08:55
6 messages · 3 min
LM
Linda Martinez
Collection
Total Hip · Day 21 · Mobility Check completed · 5/5 fields · all normal
07:30
10 messages · 3 min
SM
Sarah Mitchell
Escalated to Dr. Walsh
Total Knee · Day 5 · Patient asked about changing pain medication, AI deferred to doctor
Yesterday
8 messages · 5 min
Documents
Clinical resources, best practices, and patient-facing materials
Library
All Documents 23
Categories
Wound Care 6
Rehabilitation 5
Medication Guides 4
Consent Templates 3
Patient Education 5
By Procedure
Total Knee 9
Total Hip 7
Arthroscopy 4
Storage
2.4 GB / 10 GB
Documents
All Documents
23 files
PDF
PDF, 1.2 MB
Wound Care
TKR, THR
PDF
PDF, 2.4 MB
Rehabilitation
Total Knee
PDF
PDF, 890 KB
Medication
All procedures
DOC
DOCX, 340 KB
Consent
Total Knee
PDF
PDF, 3.1 MB
Patient Education
Total Knee
PDF
PDF, 560 KB
Wound Care
TKR, THR, Arthroscopy
PDF
PDF, 1.8 MB
Rehabilitation
Total Hip
PDF
PDF, 720 KB
Medication
TKR, THR
PDF
PDF, 4.2 MB
Patient Education
TKR, THR
PDF
PDF, 480 KB
Wound Care
All procedures
DOC
DOCX, 310 KB
Consent
Total Hip
PDF
PDF, 1.5 MB
Rehabilitation
TKR, THR
Recovery Intelligence
AI & Platform Performance
How the platform is impacting your practice (last 30 days)
Provider Hours Saved
47
hrs
~11.8 hrs/week vs. manual workflow
AI Conversations
412
342 autonomous, 70 escalated (17%)
Early Interventions
8
Complications caught before escalation
Patient Engagement
87%
Daily check-in completion rate
Patients with pain >5/10 at POD 5 had 3.2x higher complication rate (p=0.04, n=32)
TKR patients resolve pain faster than THR patients at matched timepoints. Consider earlier follow-up for THR patients with elevated day-3 scores.
Pain Trajectory
Median pain score with IQR band, n=18
10
8
6
4
2
0
Day 1
Day 3
Day 7
Day 14
Day 21
Day 30
Clinic median
Expected baseline
IQR (25th-75th)
Benchmark Comparison
Complication rate2.8% vs 4.5% national
Mean recovery time12d vs 14d national
Patient satisfaction4.7/5.0
Avg pain at D72.8 vs 3.6 national
Wound Status Distribution
Normal / Healing14 (78%)
Redness / Inflammation3 (17%)
Swelling / Effusion1 (6%)
Recovery Milestones
Percentage of patients achieving each milestone by expected POD
On track
Delayed
Not yet due
Independent walking
Pain below 4/10
ROM 90 degrees
Wound fully closed
Discharge ready
D1D3D5D7D10D14D21D30
By Surgeon
TW
Dr. Walsh
10 patients
2.6
Pain D7
0%
Complc.
93%
Collect.
AM
Dr. Miller
8 patients
3.1
Pain D7
6.3%
Complc.
88%
Collect.
Current Risk Distribution
High risk (2)
S. Mitchell (pain spike), J. Cooper (non-responsive)
Moderate risk (4)
Wound concerns, delayed milestones, low compliance
On track (12)
Meeting or exceeding expected recovery trajectory
Recent Alerts
2 open
S. Mitchell -- Pain 8/10
POD 5 · 2h ago · Unresolved
L. Jackson -- Wound redness
POD 7 · 6h ago · Under review
E. Chen -- Missed collection
POD 2 · Yesterday · Resolved
Clinical Insights
AI-generated from cohort data
Pain spikes at POD 5 correlate with PT intensity increase
3 of 18 patients (17%) reported pain above 7/10 at POD 5. All three had PT sessions within 2 hours of reporting. Consider pre-medicating before POD 5 PT.
Patients with >90% compliance reach ROM targets 2 days earlier
High-compliance patients (n=12) reached 90-degree ROM at median POD 8 vs POD 10 for lower compliance patients (n=6). Collection engagement is predictive of recovery pace.
Wound redness reports peak at POD 7-8
Most wound concerns are flagged between POD 7-8 when staples are still present. 83% resolved without intervention. Consider proactive wound care messaging at POD 6.
Common Patient Questions
From AI chat, last 30d
34
When can I drive / return to normal activity?
28
Is this amount of swelling normal?
21
My pain medication isn't working as well
15
When do I need to come in for follow-up?
12
Can I shower / get the incision wet?
SM
Sarah Mitchell
Rt. Total Knee Replacement · POD 5 · Dr. Thomas Walsh
Active Alert
Standard Recovery
8/10
Current Pain
3.2
5-Day Mean
92%
Compliance
4/5
Swelling
11/12
Collections
Daily pain scores vs. TKR cohort average
Patient
Cohort avg
10
7
4
1
Alert threshold (8)
8/10
POD 1POD 2POD 3POD 4POD 5
Cohort Comparison
vs. 18 TKR patients at POD 5
Pain scoreP95
BetterWorse
ComplianceP82
WorseBetter
SwellingP71
BetterWorse
Alert History
Pain spike: 3 to 8
Today 09:01 · Auto-generated
Unresolved
Post-op day 1 check-in
Apr 21 · Routine
Resolved
Recovery Milestones
First mobilization
POD 1 · On schedule
Independent walking
POD 3 · 1 day early
90-degree flexion
Expected POD 7 · At risk
Stair climbing
Expected POD 14
TW
Dr. Thomas Walsh
t.walsh@riversideortho.com
Riverside Orthopedics
Admin
On call until 18:00
14 active patients
Post-Op Rounds
Friday, April 25 · 1:00 PM · Ward B
1 of 4 seen
Estimated time remaining: 15 min
Average 5 min per patient based on your history
Users
Staff accounts and on-call coverage
Invite New User
Role determines access to features and patient data.
| User | Role | Last Active | Patients | Status | |
|---|---|---|---|---|---|
TW Dr. Thomas Walsh | Admin | t.weber@riversideortho.com | Now | 14 | Active |
AM Dr. Andrea Miller | Doctor | a.miller@riversideortho.com | 2 hours ago | 12 | Active |
LC Lisa Chen | Nurse | l.chen@riversideortho.com | 1 hour ago | 18 | Active |
JW Julia Wolf | Office Mgr | j.wolf@riversideortho.com | Today, 08:15 | — | Active |
AM
Dr. Andrea Miller
ActiveOrthopedic Surgeon · Riverside Orthopedics · Member since Jan 2024
a.miller@riversideortho.com
(503) 555-0142
Last active 2 hours ago
12
Active Patients
47
Total Operations
94%
Collection Rate
2.4
Avg Pain (D7)
1.9%
Complication Rate
Audit Log
Complete activity record for compliance and security review
Anomaly: Off-hours PHI access by Lisa Chen (Apr 22, 11:47 PM)
Medical assistant accessed records for 4 patients outside normal shift hours (6 AM - 6 PM). Three of these patients are not on her assigned care team. This pattern was auto-flagged by the access monitoring system.
Settings
Clinic
General clinic configuration
Clinic Name
Displayed in patient communications
Time Zone
Used for scheduling
Default Recovery Duration
Days to continue data collection
Notifications & Escalation
How alerts reach your team and when patients hear from you
Provider Channels
Email notifications
Alert summaries and daily digests to assigned providers
Push notifications
Real-time alerts to Pickle mobile app
SMS fallback
Text message if push not acknowledged within 5 min
Patient Communication
SMS collection reminders
Remind patients to complete their daily check-in
Reminder timing
When to send the first reminder if patient hasn't responded
Maximum reminders per day
Stop reminding after this many attempts
Quiet hours
No patient messages during these hours
to
Escalation Chain
Determines who gets notified and when
1
Assigned provider
Immediate notification via push + email
2
On-call provider
If no acknowledgment from step 1
3
Clinic admin (all)
SMS blast to all admin-role users
Escalation applies to critical alerts only. Standard alerts notify the assigned provider without escalation.
Collection Schedule
When and how patients are asked to report their recovery data
Default Schedule
Collection frequency
How often patients are asked to check in
Default collection time
When the AI initiates the check-in conversation
Weekend collections
Continue check-ins on Saturday and Sunday
Adaptive Frequency
Reduce frequency for stable patients
Switch to every-other-day after 7 consecutive normal readings
Increase frequency for flagged patients
Switch to twice-daily after a critical alert
Collection Window
Timeline showing when collections are active for a typical 42-day recovery
POD 1POD 7POD 14POD 21POD 30POD 42
Daily (critical window)
Daily (standard)
Every other day (stable)
AI Assistant
Configure how the AI communicates with your patients
Safety Rules
These rules override all other AI behavior and cannot be disabled
Self-harm detection
Bypass AI entirely, show crisis hotline immediately
Crisis language detection
Detect urgent distress signals and escalate to on-call provider
Safety rules are locked on. Contact support to modify compliance requirements.
Alert Thresholds
Pain score auto-escalation
Create critical alert when patient reports pain above threshold
Threshold
7
1 (any pain)
10 (max only)
Missed collection escalation
Alert after consecutive missed check-ins
Wound photo auto-flag
Flag wound photos showing erythema, discharge, or dehiscence
Conversation Behavior
Communication tone
How the AI addresses patients
Language complexity
Reading level for patient-facing text
Data collection persistence
How firmly the AI pursues unanswered collection fields
Allow general health questions
Let patients ask questions outside of data collection
Auto-defer medication questions
Route dosage and medication change requests to provider
Boundaries
Topics the AI will never engage with
Diagnosis or prognosis
Medication dosage changes
Legal or malpractice topics
Alternative medicine advice
Insurance or billing questions
Add boundary
Integrations
External system connections
EHR
ModMed (Modernizing Medicine)
FHIR R4 · Patient records, PRO documents, medications
Connected
28 of 32 patients linked
Connected
Last health check: 2 min ago
28 / 32
Patients linked
142
PROs pushed this month
3
Pending entries
Patient Links
Showing 4 of 32 patients · View all
Sync Activity
View all logs
push_proSarah Mitchell → DocumentReference09:02
push_proDavid Park → DocumentReference09:16
push_proLinda Martinez — 401 Unauthorized: token expired07:31
refresh_notesRachel Torres — 2 notes updatedYesterday
Pain Trend (7 days)
Apr 19
20
21
22
23
24
Today
Recent Activity
Today, 09:01
Pain reported 8/10 — critical alert created
Today, 09:01
Pain Assessment completed (4.2 min)
Yesterday, 18:04
Mobility Check completed — can walk with crutches
Yesterday, 09:00
Pain Assessment — 3/10, within normal range
Apr 23, 08:55
Wound photo submitted — healing as expected
Care Team
TW
Dr. T. Walsh
Surgeon
LC
Lisa Chen
Nurse
MM
Michael Mitchell
Caregiver
Patient Info
MRN
MOD-2024-8834
DOB
03/15/1958 (68 yrs)
Insurance
Blue Cross Blue Shield (BCB-2024-8834)
Phone
(555) 234-1892
Allergies
Penicillin, Latex
Surgery
Right Total Knee Replacement (04/20/2026)
Recovery
Standard Recovery, 42 days
Total Knee Replacement
Operation type · Active
Recovery Pathways
Standard Recovery
Default
42 days · 2 docs
Accelerated Recovery
28 days · 3 docs
Documents
Total Knee Patient Guide.pdf
Processed
Standard Recovery Plan.pdf
Processed
riversideortho.com/knee-replacement-info
Processing
Collection Templates
Post-Op Pain Assessment7 fields · Daily
Wound Assessment4 fields · Every 2d
Mobility Check5 fields · Daily
Default Patient Instructions
AI Chatbot Context
This context is injected into the AI assistant's system prompt when chatting with patients assigned to this operation.
RT
Rachel Torres
Arthroscopy · POD 3 · Dr. Walsh
Reviewed by 0 of 1 team members
Wound Photo — POD 3
Apr 26, 2026 · 09:14
Flagged
POD 1
POD 2
POD 3
Comparing POD 3 (current) to POD 1 (baseline)
AI Analysis
Flagged for review
Finding
Increased erythema detected around incision site, extending approximately 2cm beyond wound margin.
Confidence
Medium
Context
Expected healing at POD 3: mild redness within 1cm of incision. This photo shows redness beyond expected parameters.
AI analysis assists clinical judgment. Final assessment requires provider review.
Your Assessment
Within normal limits
Redness is consistent with expected healing at this stage
Monitor closely
Recommended
Schedule follow-up photo in 24 hours
Clinical concern
Requires in-person evaluation or intervention
EC
Emily Chen
Right Total Knee Replacement · POD 7 · Dr. Walsh
Standard Recovery
Day 7 of 42
5 of 7 criteria met
2 items require attention before discharge
Pain management
Below 4/10 for 72 hours. Current: 2/10
Wound healing
No signs of infection. Last photo reviewed Apr 25
Range of motion
95 degrees achieved (target: 90 degrees)
Independent mobility
Walking independently since POD 5
Medication reconciliation
Opioid taper plan not yet documented
Follow-up appointment
2-week post-op visit not yet scheduled
Discharge instructions
Standard TKR discharge packet delivered via app
All criteria must be met or overridden to proceed with discharge.
April 2026
Monthly Performance Report · Riverside Orthopedics
You treated 14 patients this month with zero readmissions and a 4.2% complication rate — well below the national average of 6.8%.
47
provider hours saved
412
AI conversations handled
87%
patient compliance rate
What went well
Wound assessment compliance improved 15% after adding the proactive ice protocol reminder at POD 2. Three fewer swelling-related callbacks this month.
Emily Chen achieved ROM target 3 days ahead of schedule on the accelerated pathway. This is the second patient this quarter to exceed milestones on this pathway.
What needs attention
3 patients disengaged from collections after POD 14. James Cooper, Ryan Walsh, and Linda Jackson all dropped below 65% compliance in their third week. Consider adding a "week 3 check-in" touchpoint.
Callback volume increased 22% over March, primarily for pain management concerns (38% of callbacks). The current pain threshold of 7/10 may be triggering too late — consider lowering to 6/10 for the first 7 days.
Report covers April 1–30, 2026. Data includes all active patients during this period.
JC
James Cooper
Total Hip Arthroplasty · POD 14 · Dr. Miller
Non-responsive · 4 days
Engagement timeline
1
2
3
4
5
6
7
8
9
10
11
12
13
14
Responded
Late response
Missed
No collection
Responded 10 of 14 days. Last response: Wednesday, April 23.
What we know
Recommendation
Recommended action: Phone call
James's engagement was strong before the gap. A direct phone call is more appropriate than additional automated reminders, which he hasn't responded to. Ask about barriers to access.
Confidence: High — based on 93 similar engagement patterns in the platform
Take action
Patient informed staff of absence
Afternoon Callbacks
3 calls scheduled · April 26, 2026
0 of 3 completed
James Cooper
Non-responsive 4 days · Total Hip Arthroplasty · POD 14
Est. 3 min
Rachel Torres
Wound photo concern · Arthroscopy · POD 3
Est. 5 min
Estimated total: 16 minutes
SM
Sarah Mitchell's Recovery
Right Total Knee Replacement · Dr. Walsh · Riverside Orthopedics
Day 5 of 42
12% complete
Surgery Apr 21
Today POD 5
Target discharge Jun 2
Sarah is 5 days post-op with strong compliance (92%) and was progressing well until today's pain spike to 8/10. Range of motion is ahead of schedule at 85 degrees. One open alert for the pain escalation requires attention.
Today — POD 5
Needs attention
April 25 — POD 4
Pain increasing, mobility progressing
Pain assessment: 5/10, up from 3 the day before. Patient noted discomfort during evening exercises. Completed mobility check — walking independently with crutches, 15 min session. Range of motion measured at 80 degrees.
2 collections completed
Chat duration: 3 min 12 sec
April 24 — POD 3
Stable recovery, first wound photo
Pain: 3/10, well controlled. First wound photo submitted — healing as expected, no signs of infection. Patient reported sleeping better. Completed all scheduled exercises. Range of motion: 70 degrees (target: 60).
3 collections completed
Wound photo reviewed by Dr. Walsh
April 23 — POD 2
Good progress, starting exercises
Pain: 3/10. First mobility check completed — patient walked 20 feet with walker assistance. Started range of motion exercises. Reported mild nausea from pain medication, resolved after switching to take with food. Range of motion: 55 degrees.
2 collections completed
Chat duration: 4 min 45 sec
April 22 — POD 1
First post-op day, baseline established
Initial pain assessment: 4/10, well managed with prescribed analgesics. Patient completed onboarding and first data collection via the app. Oriented to recovery pathway. Discharge instructions reviewed.
1 collection completed
Onboarding completed
April 21 — Surgery
Right Total Knee Replacement
Procedure completed without complications. Duration: 1 hr 45 min. Patient enrolled in Pickle recovery pathway. 42-day standard TKR protocol assigned.
MT
Care Plan for Marcus Thompson
ACL Reconstruction · Dr. Walsh · Surgery scheduled April 28
Configure which data collections Marcus will receive during his 90-day recovery pathway. The AI assistant will conduct these conversations automatically at the scheduled times.
Suggested plan
Based on ACL Reconstruction protocol
The standard ACL protocol includes 5 templates across 3 phases: Acute (Days 1-14), Recovery (Days 15-42), and Strengthening (Days 43-90). This plan is pre-configured based on clinic best practices and can be adjusted per patient.
1
Acute Phase
Days 1-14 · Daily collections
Pain Assessment
4 questions · ~2 min · Daily at 09:00
Wound Photo Check
Photo + 2 questions · ~1 min · Every other day at 18:00
Mobility Check
3 questions · ~2 min · Daily at 17:00
2
Recovery Phase
Days 15-42 · Collections every 2-3 days
Pain Assessment
4 questions · ~2 min · Every 3 days at 09:00
Mental Health Screen
3 questions · ~1 min · Weekly on Monday at 10:00
3
Strengthening Phase
Days 43-90 · Weekly collections
Progress Assessment
5 questions · ~3 min · Weekly on Wednesday at 09:00
Plan summary
6
Templates active
90
Days total
~74
Collections expected
Cohort Overview
32 active patients · Riverside Orthopedics · April 2026
28 of 32 patients are recovering on or ahead of schedule. 3 patients show declining engagement, and 1 patient has an active clinical concern. Average compliance across the cohort is 91%.
Recovery status
On track (28)
Declining engagement (3)
Clinical concern (1)
Patients needing attention
SM
Sarah Mitchell
Rt. TKR · POD 5 · Dr. Walsh
Pain 8/10
Pain escalated from 3 to 8 over two days. Wound photo flagged for erythema. Medication adjustment pending — switched to Tramadol 50mg, monitoring tomorrow's assessment.
JC
James Cooper
Total Hip · POD 14 · Dr. Miller
4 days silent
Was at 91% compliance through POD 10, then sudden disengagement. Pattern suggests external factor, not care fatigue. Phone call attempted — reached voicemail.
RT
Rachel Torres
Arthroscopy · POD 3 · Dr. Walsh
Wound flagged
Wound photo shows erythema exceeding expected parameters. AI confidence: medium (60%). Currently being monitored closely. No signs of systemic infection.
DP
David Park
Rotator Cuff · POD 21 · Dr. Walsh
Compliance 64%
Compliance has gradually declined from 95% in week 1 to 64% in week 3. Responds to morning collections but consistently skips evening ones. Mental health screen scores have also declined.
Patterns this month
Next Week's Surgeries
April 28 – May 2, 2026 · 4 procedures scheduled
3 ready
1 pending
Monday, April 28
Wednesday, April 30
Friday, May 2
End of Day
Saturday, April 26, 2026 · Riverside Orthopedics
You managed 32 active patients today. One escalation required your attention (Sarah Mitchell, pain 8/10). All other patients remained on track. 7 data collections were completed across your panel with 94% average compliance.
What you handled
Still open
James Cooper remains non-responsive after phone call
Reached voicemail. Left message asking him to call back or complete his next check-in via the app. Will follow up Monday if no response.
Sarah Mitchell's medication adjustment needs monitoring
Switched to Tramadol 50mg. Expect the next pain assessment tomorrow morning. If pain remains above 6/10, consider scheduling an in-person visit.
Tonight
2 patients have evening data collections scheduled (Sarah Mitchell at 20:00, Mark Thompson at 19:30). The AI assistant will handle these automatically. You will only be notified if a response triggers a clinical alert.
On-call coverage: Dr. Miller is available tonight. He has been briefed on Sarah Mitchell's pain situation and the medication change.
Tomorrow
14 morning collections scheduled across your panel. Emily Chen's discharge is pending final criteria completion. No surgeries scheduled.
7
Collections today
94%
Compliance rate
1
Escalation
SM
Pain Assessment — Sarah Mitchell
Today, 09:01 · Duration: 4 min 12 sec · POD 5
Alert triggered
Good morning, Sarah. How are you feeling today? I'd like to check in on your pain level and how your recovery is going.
09:02
Sarah Mitchell
SM
Not great honestly. The pain got really bad last night. I took the extra dose you mentioned but it didn't help much.
I'm sorry to hear that. On a scale of 0 to 10, where would you rate your pain right now?
09:02
Sarah Mitchell
SM
I'd say an 8. It's sharp, right around the incision.
DATA COLLECTED:
Pain score: 8/10 · Location: incisional · Quality: sharp
Thank you for telling me. I noticed you mentioned the area around the incision. Could you take a photo of it so Dr. Walsh can take a look?
09:04
Sarah Mitchell
SM
The area around the incision looks red to me.
Wound photo attached
ALERT CREATED:
Pain 8/10 exceeds threshold (6). Wound photo flagged for erythema. Routed to Dr. Walsh.
Thank you, Sarah. I've sent the photo and your pain report to Dr. Walsh. Someone from the care team will follow up with you today. In the meantime, continue taking your medications as prescribed and apply ice for 15-20 minutes if it helps with the discomfort.
Data collected
Pain score
8/10
Pain location
Incisional
Pain quality
Sharp
Wound photo
Flagged
Medication taken
Yes (ineffective)
Conversation quality
Empathy
Good
Data completeness
Complete
Escalation handling
Appropriate
Patient context
Rt. Total Knee Replacement · POD 5 · Dr. Walsh
Previous pain: 3/10 (POD 4), 3/10 (POD 3)
Medications: Oxycodone 5mg q6h, Ibuprofen 600mg q8h
View full record →
Alert Configuration
Define when the system creates alerts for your clinical team. Thresholds apply to all patients assigned to the selected procedure protocol.
Protocol
Current impact: 14 TKR patients
With these thresholds, 2 patients would currently have active alerts. Changing pain threshold from 7 to 6 would add 1 more.
Pain Escalation
Alerts when reported pain exceeds safe thresholds or changes rapidly
Wound Assessment
Controls when wound photos and patient-reported wound symptoms generate alerts
Patient Engagement
Detects declining patient participation before it becomes a clinical risk
Clinical Milestones
Alerts based on expected recovery benchmarks for this procedure type
Recent alerts from these rules
Last modified Apr 14, 2025 by Dr. Walsh · View change history
Staff Performance
Team activity and responsiveness across your 4 active providers this month.
Avg. Alert Response
12 min
▼ 3 min from last month
Callback Completion
94%
▲ 6% from last month
Patient Compliance
87%
Stable (86% last month)
Active Caseload
32
Across 4 providers
Provider Breakdown
Alert Response Time — 4 Week Trend
W1
W2
W3
W4
Walsh
Miller
Chen
Rivera
Observations
Dr. Walsh's patients have the highest compliance rate at 92%. He sends a personalized welcome message during onboarding, which correlates with stronger early engagement.
Marcus Rivera's response time has improved from 28 min to 22 min this month, but remains the highest on the team. His 3-patient caseload is the smallest, suggesting the delay is process-related, not volume.
Team response time has decreased by 3 minutes overall since enabling push notification fallback last month.
Recent Activity
Active Prescriptions
3 active · 1 taper in progress
Clinical Consideration
Sarah's opioid usage increased back to 4 doses on POD 5, exceeding the expected q8h taper schedule. Combined with her pain spike to 8/10, this may indicate inadequate pain control at the current taper step. Consider:
- Pausing taper and returning to q6h until pain stabilizes below 5/10
- Adding acetaminophen 1000mg q6h as adjunct (no current contraindication)
- Reviewing wound status — pain increase may correlate with wound concern flagged today
Interaction Check
No significant interactions detected between current medications.
Note: Ibuprofen + Enoxaparin has a minor interaction (increased bleeding risk). This is standard for post-TKR protocols and is being monitored. Patient has been instructed to report unusual bruising.
SM
Sarah Mitchell — Communication Log
18 touchpoints over 5 days · Right TKR · Dr. Walsh
Today · Apr 26 · POD 5
5 events
Critical Alert Created
11:42 AM
Pain score spike detected: 8/10 (previous: 3/10). Auto-generated by pain threshold rule. Notified Dr. Walsh via push notification.
View alert details →
AI Pain Assessment — Completed
11:30 AM · 3 min 12 sec
Morning pain assessment via AI chat. Patient reported 8/10 pain, described as "sharp and throbbing around the incision." Wound photo submitted showing redness. Data collected: pain score, pain description, wound photo, medication adherence.
SMS Sent — Collection Reminder
11:28 AM
"Hi Sarah, it's time for your morning check-in. Tap the link to start: [link]" — Responded within 2 minutes.
Pain Assessment collection scheduled — 09:00 AM slot
09:00 AM
Wound Photo Reviewed by Dr. Walsh
08:15 AM
Photo from yesterday's collection reviewed. Noted increased redness around incision site. Added to callback list for follow-up discussion.
Yesterday · Apr 25 · POD 4
4 events
AI Wound Photo Check — Completed
6:00 PM · 2 min 45 sec
Evening wound photo collection. Patient submitted photo of incision site. AI flagged mild redness for provider review. Data collected: wound photo, wound description, temperature.
AI Mobility Check — Completed
5:00 PM · 2 min 18 sec
Walking with crutches around the house. ROM 80 degrees. Pain during movement: 5/10. Exercises completed: 3 of 4 prescribed sets.
AI Pain Assessment — Completed
9:15 AM · 2 min 30 sec
Pain 5/10, described as "aching." Medication adherence confirmed. No new concerns reported. Data collected: pain score, pain location, medication check.
SMS collection reminder sent — Responded within 5 minutes
9:00 AM
Apr 24 · POD 3
4 events
AI Wound Photo Check — Completed
6:00 PM · 2 min 10 sec
First wound photo submitted. Healing as expected. No concerns flagged.
AI Mobility Check — Completed
5:00 PM · 3 min 5 sec
First mobility assessment. ROM 70 degrees (target 60). Starting exercises as prescribed. Pain during movement: 3/10.
AI Pain Assessment — Completed · Pain 3/10, stable
9:20 AM · 2 min
SMS collection reminder sent — Responded within 3 minutes
9:00 AM
Recovery Protocols
Standardized recovery pathways for each procedure type. Each protocol defines the care plan, templates, alert thresholds, and expected milestones.
Protocol Performance Comparison
TKR patients show a 12% compliance drop at week 3 across all providers. ACL patients maintain compliance more consistently through their longer pathway. Consider adjusting TKR week 3 collection frequency.
Referral Tracking
Outbound referrals for physical therapy, home health, and specialist follow-up across your active patients.
4
Pending
1
Overdue
3
Scheduled
8
Completed
Needs Attention
JC
James Cooper — Physical Therapy
Referred to Riverside PT on Apr 18. No acknowledgment received after 8 days. Patient is POD 12 and disengaging from home exercises. PT evaluation critical for re-engagement.
8 days overdue
Riverside Physical Therapy
SM
Sarah Mitchell — Wound Care Specialist
Referred today following wound photo concern and pain escalation. Pending acceptance from Dr. Patricia Hayes at Riverside Wound Care Center.
Sent today
Riverside Wound Care
DP
David Park — Home Health Assessment
Referred Apr 24 for home health evaluation. Compliance declining, lives alone. Pending scheduling from Comfort Home Health Services.
2 days pending
Comfort Home Health
Scheduled
Recently Completed
Patient Experience
Satisfaction data from discharge surveys and mid-recovery check-ins. 47 responses collected this quarter.
Net Promoter Score
72
Excellent (industry avg: 38)
Promoters 78%
Passives 16%
Detractors 6%
Satisfaction by Category
Overall care experience
4.6 / 5
Communication & responsiveness
4.5 / 5
AI check-in experience
4.3 / 5
Pain management satisfaction
3.8 / 5
Feedback Themes
What patients appreciate
Daily check-ins feel caring
23 mentions
"I felt like someone was watching over me every day, even from home."
Fast response to concerns
18 mentions
"When my pain spiked, the doctor called me within an hour. I didn't have to chase anyone."
Clear recovery expectations
15 mentions
"Knowing I was on day 12 of 42 and that my ROM was ahead of schedule gave me confidence."
Where patients want improvement
Evening check-in timing
9 mentions
"The 6 PM check-in is right when I'm trying to eat dinner. Could it be at 7 or 8?"
AI feels repetitive in later weeks
7 mentions
"By week 4 I was answering the same questions. Could the system learn that I'm doing fine?"
Pain management expectations
6 mentions
"I wish someone had told me that day 3-5 pain is normal. I thought something was wrong."
Recommended Actions
Based on this quarter's feedback: (1) Shift default evening collection from 6 PM to 7:30 PM — 9 patients flagged timing as a friction point, and cohort data confirms 72% vs 96% morning completion. (2) Add a "pain is normal at this stage" reassurance message to POD 3-5 AI conversations — 6 patients reported unnecessary anxiety about expected pain patterns. (3) Reduce collection frequency for patients with 95%+ compliance after week 3 — consider switching from daily to every-other-day to address repetition fatigue.
Billing & Insurance
Pre-authorization status, RPM billing codes, and reimbursement tracking for April 2025.
RPM Revenue (MTD)
$18,420
32 patients billed
Pending Claims
$3,840
6 claims submitted
Collection Rate
94%
Last 90 days
Pre-Auth Pending
2
1 overdue
Pre-Authorizations Needing Action
LN
Linda Nakamura — Shoulder Arthroscopy
RPM pre-authorization submitted to Aetna on Apr 16. No response after 10 days. Surgery scheduled May 5 — auth required before admission. Procedure code: 99458 (RPM additional 20 min).
10 days overdue
Aetna PPO
99458
MT
Marcus Thompson — ACL Reconstruction
RPM pre-authorization submitted to UnitedHealthcare on Apr 24. Expected response within 5 business days. 90-day monitoring protocol.
Submitted 2 days ago
UHC
99457 + 99458
RPM Billing Codes — April
Eligibility Alerts
3 patients may lose RPM billing eligibility this month
RPM requires 16+ days of data transmission per 30-day billing cycle (CMS requirement). These patients are below pace:
JC
James Cooper
— 8 of 16 required days (4 days remaining in cycle)
Will miss
DP
David Park
— 12 of 16 required days (4 days remaining)
At risk
AG
Angela Gutierrez
— 13 of 16 required days (4 days remaining)
At risk
Payer Mix
Medicare 38%
UHC 28%
Aetna 18%
BCBS 10%
Other 6%
TKR Recovery Pathway — Sarah Mitchell
Generated Apr 21, 2025 · PDF · 4 pages · Last viewed by Dr. Walsh today
Riverside Orthopedics
Total Knee Replacement
Recovery Pathway & Home Instructions
Patient
Sarah Mitchell
Surgeon
Dr. Thomas Walsh
Procedure
Right TKR
Surgery Date
April 21, 2025
Protocol
42-Day Standard
Target Discharge
June 2, 2025
Phase 1: Acute Recovery (Days 1-14)
During the first two weeks following surgery, your primary goals are managing pain, preventing blood clots, and beginning gentle range-of-motion exercises. You will receive daily check-ins via our AI assistant to monitor your progress.
Daily Expectations:
- Complete morning pain assessment via text message
- Take prescribed medications on schedule (see medication card)
- Perform prescribed exercises 3x daily
- Submit wound photo every other day when requested
- Walk with assistive device at least 3 times daily
Page 1 of 4
Phase 2: Recovery (Days 15-42)
As you enter the recovery phase, monitoring frequency decreases. Pain assessments move to every 3 days. Your focus shifts to building strength and increasing range of motion toward your 90-degree flexion target.
ROM Milestones:
Week 2
60°
Week 4
90°
Week 6
110°
When to Contact Us Immediately
- Fever above 101.5°F (38.6°C)
- Sudden increase in swelling, redness, or warmth around incision
- Calf pain, tenderness, or swelling (possible blood clot)
- Pain that is not controlled by prescribed medications
Page 2 of 4
Document Details
Type
Recovery Pathway Instructions
Created
Apr 21, 2025 at intake
Shared With Patient
Yes — sent via SMS Apr 21
AI Context
This document is included in the AI assistant's context during patient conversations.
View History
Dr. Walsh viewed · Today 08:12 AM
Sarah Mitchell opened via SMS · Apr 21 3:45 PM
System generated at intake · Apr 21 11:00 AM
Related Documents
On-Call Schedule
After-hours coverage rotation for Riverside Orthopedics. All alerts outside business hours route to the on-call provider.
RM
Currently On-Call
Dr. Rachel Miller
Since 5:00 PM today · Until 8:00 AM Monday
Contact
(555) 234-5678
Push notifications active
This Week — Apr 21-27
Next Week — Apr 28 - May 4
TW
Dr. Walsh
Mon-Wed evenings
Apr 28-30
JC
Jessica Chen
Thu-Fri evenings
May 1-2
TW
Dr. Walsh
Weekend
May 3-4
Pending Swap Request
JC
Jessica Chen
TW
Dr. Walsh
Jessica requests to swap her Thu May 1 evening shift with Dr. Walsh's Wed Apr 30 shift. Reason: "Conference travel Thursday."
Coverage Distribution — April
TW
11 nights
Dr. Walsh
RM
10 nights
Dr. Miller
JC
6 nights
J. Chen
MR
3 nights
M. Rivera