Milestones
A milestone is a specific point in the surgical workflow where a timestamp is recorded. Examples include “Patient in room,” “Incision,” “Closing,” and “Patient out of room.” Each facility defines its own set of milestones. These are tracked per case — when a case is created, ORbit pre-populates the expected milestones with empty timestamps that get filled in as the case progresses.Phases
A phase is a named grouping of consecutive milestones that represents a stage of surgery. For example:| Phase | Milestones |
|---|---|
| Pre-Op | Patient in room, Anesthesia start |
| Intra-Op | Incision, Closing |
| Post-Op | Patient out of room, Room cleaned |
Templates
A milestone template defines the complete set of milestones and phases tracked for a case. Templates support:- Required milestones that every template must include (locked, cannot be removed)
- Custom milestones added by the facility
- Phase grouping with drag-and-drop ordering
Template cascade
When ORbit creates a case, it resolves which template to use:
The resolved template is stamped on the case at creation time and doesn’t change if templates are modified later.
ORbit Score
The ORbit Score is a composite metric (0–100) measuring a surgeon’s operational efficiency. It uses four weighted pillars:| Pillar | Weight | What it measures |
|---|---|---|
| Profitability | 30% | Margin per minute compared to peers in the same procedure cohort |
| Consistency | 25% | Variability of case duration per procedure type |
| Schedule adherence | 25% | How closely actual timing matches the booked schedule |
| Availability | 20% | Prep-to-incision gap and surgeon delay rate |
ORbit uses median absolute deviation (MAD) instead of standard deviation. MAD is more resistant to outliers, which is important when a single extremely long case shouldn’t tank a surgeon’s score.
Scoring methodology
- Three MAD bands classify performance into severity tiers
- Volume weighting adjusts for case volume differences across procedure types
- Graduated decay emphasizes recent performance over older data
- Grade thresholds translate the numeric score into letter grades (A+ through F)
Flags
A flag is an automated alert raised when a case metric falls outside expected thresholds. Flags help surface operational issues without manual review.How flags work
- Rules define what triggers a flag — a metric, a comparison operator, and a threshold value
- Detection runs when a case is completed and validated
- Severity is assigned per rule (low, medium, high)
- Pattern analysis identifies recurring flags across surgeons, rooms, or time periods
Flag rule types
ORbit supports rules based on:- Timing metrics — milestone intervals, total duration, turnover time
- Financial metrics — cost per case, profit margin, reimbursement
- Quality metrics — data completeness, milestone recording gaps
Soft deletes
ORbit uses soft deletes across 20+ tables. Records are never physically removed — they’re marked withis_active = false and a deleted_at timestamp. All queries filter by is_active = true by default.
Facility scoping
Every query in ORbit filters byfacility_id. This is enforced at the database level through row-level security (RLS) policies. Users can only see data belonging to their assigned facility.