One surgical platform. Two connected workflows.
PatientTrac Surg delivers AI-assisted, clinician-reviewed surgical documentation, smart consent, standards-based coding, and recovery tracking. PatientTrac OR extends the platform into surgery centers and operating rooms with case flow, room utilization, and perioperative coordination.
PatientTracSurg.com markets two distinct products: the surgeon-facing documentation platform, and the surgery-center operating-room workflow application.
AI-assisted surgical documentation
For surgeons and specialty practices that need faster, cleaner, more complete clinical documentation with smart consent, standards-based coding, and specialty-specific workflows. This is the app on this page.
Surgery-center and operating-room workflow
A separate product for ASCs, surgical centers, OR managers, and perioperative teams that need visibility across rooms, cases, staff, and facility-level performance. Available at patienttracsurgery.com.
Every AI feature drafts, summarizes, suggests, or flags for clinician review. API keys stay server-side in Netlify Functions and never reach the browser, and PHI is stripped before AI calls. Clinicians make every clinical and coding decision.
Server-side, streaming draft operative notes from structured case data, plus dictation cleanup and note review. Drafts are starting points the surgeon edits and signs.
Suggested ICD-10 and CPT codes with RVUs, modifiers, and laterality for the clinician to confirm. Suggestions support documentation completeness — they never determine or guarantee reimbursement.
Drug-interaction checking and risk scoring run server-side to surface surgical safety flags for the care team. Alerts inform clinicians; they do not diagnose or decide.
Assistive extraction of structured fields for registries such as NSQIP, MBSAQIP, NCDR CathPCI, and STS — designed to reduce duplicate abstraction while keeping a human in the loop.
Each shipping module maps a real surgical workflow — from pre-procedure evaluation through the operative record to recovery — with validated clinical scores, specialty classifications, and coding support.
Cath-lab documentation for interventional cardiology — not open-heart surgery — from pre-procedure through hemostasis and discharge.
Coding support for interventional/cath procedures with modifier and documentation-completeness checks.
Procedure documentation with interactive lesion mapping and standardized photo capture for skin surgery.
Excision- and Mohs-aware coding support tied to lesion size, site, and specimen documentation.
Structured endoscopy reporting with a built-in quality-metrics dashboard for GI programs.
Supports quality and value-based reporting (GIQuIC-style) alongside procedure coding capture.
End-to-end ophthalmic surgical documentation with rigorous laterality and biometry handling.
Laterality-aware coding support (LT/RT modifiers) to keep eye-specific claims documentation complete.
Evaluation to operative note to recovery, with PROMs and implant tracking built in.
Implant tracking connects to implant charge capture so device documentation supports the claim.
The deepest module: one anesthesia record per case spanning pre-op, intra-op, and PACU, plus nine procedure-specific extensions.
Time-based anesthesia units calculator supports accurate, documentation-backed anesthesia billing.
The general operative core: surgeon exam through operative note, with a Universal Protocol time-out and a surgical drawing tool.
AI code suggestion and pre-submission checks help keep operative documentation and claims complete.
Pre-op to PACU, one anesthesia record.
AI-assisted pre-operative airway and risk assessment with ASA, STOP-BANG, and RCRI scoring, a structured intra-operative anesthesia record, and PACU recovery tracking with Aldrete discharge scoring — extended by nine procedure-specific anesthesia verticals. All scores inform the clinician; they never decide.
Capture, validate, and submit with standards-based tooling. Nothing here guarantees payment — the goal is complete documentation and clean, standards-compliant claims that give payers what they need.
Structured CPT/ICD capture with AI coding suggestions for clinician review.
Standards-based X12 837P generation with superbill and EDI submission.
Insurance verification and a patient-responsibility calculator for transparent estimates.
We describe the mechanisms we implement — not compliance labels. Security is enforced in the architecture, from the database row up.
PatientTrac Surg is a member of the PatientTrac Clinical Intelligence Network. Clinicians can launch a surgical encounter directly from other network apps on a shared record.
Route into surgery from Forge, Revela, or Mind with checkin_and_route and a short-lived, cross-app JWT — all on the shared encounter_id.
A shared clinical-viewer chart keeps the same patient context visible as the encounter moves between network apps.
Because the network shares a single encounter_id, surgical documentation joins the broader clinical story instead of living in a silo.
These specialties are planned, not yet shipping. They do not have dedicated documentation modules today — we are being upfront about what is live versus what is on the way.
Bariatric-specific documentation is on the roadmap. No dedicated bariatric module ships today.
Plastic and reconstructive workflows are planned for a future release, not currently available.
Oral and maxillofacial documentation is on the roadmap and not a shipping module at this time.
Performance and ROI figures referenced anywhere on this page are internal design goals and projections, not measured or guaranteed outcomes.
See PatientTrac Surg for surgeon documentation, or PatientTrac OR for surgery-center and operating-room workflow — both part of the PatientTrac Clinical Intelligence Network.