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These are the core concepts you’ll encounter throughout ORbit. Understanding them helps you get the most out of the platform.

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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.
Milestones always reference facility_milestone_id, not the global milestone_type_id. This is a critical architectural detail for anyone building integrations or custom queries.
Milestone types are global definitions (e.g., “Incision” as a concept). Facility milestones are specific instances of those types within a facility, with facility-specific display names, ordering, and configuration. The facility_milestone_id is what gets referenced in case data.
ORbit validates milestone sequence — you’ll see a warning if a later milestone is recorded before an earlier one. However, timestamps can be edited after the fact to correct recording errors.

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Phases

A phase is a named grouping of consecutive milestones that represents a stage of surgery. For example:
PhaseTypical milestonesWhat it tracks
Pre-OpPatient in room, Anesthesia startPreparation time
Intra-OpIncision, ClosingSurgical duration
Post-OpPatient out of room, Room cleanedRecovery and turnover
Phases are defined by their boundary milestones (start and end). Adjacent phases share boundary milestones — the end of one phase is the start of the next.
Phase boundaries are derived from the milestone template, not stored separately. This means changing the milestone order in a template automatically updates the phase boundaries for future cases.

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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

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Template cascade

When ORbit creates a case, it resolves which template to use:
1

Surgeon override

If the surgeon has a template override for this procedure, use that template.
2

Procedure template

Otherwise, if the procedure type has an assigned template, use that.
3

Facility default

Otherwise, use the facility’s default template.
The resolved template is stamped on the case at creation time and doesn’t change if templates are modified later. This ensures historical data remains consistent even as your facility evolves its workflow.

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ORbit Score

The ORbit Score is a composite metric (0–100) measuring a surgeon’s operational efficiency. It uses four weighted pillars:
PillarWeightWhat it measures
Profitability30%Margin per minute compared to peers in the same procedure cohort
Consistency25%Variability of case duration per procedure type
Schedule adherence25%How closely actual timing matches the booked schedule
Availability20%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.

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Scoring methodology

Three MAD bands classify performance into severity tiers. Values within 1 MAD of the median are considered normal. Between 1–2 MAD is a moderate deviation. Beyond 2 MAD is a significant deviation.
Adjusts for case volume differences across procedure types. A surgeon with 50 knee replacements has a more statistically reliable consistency score than one with 3 cases, and the weighting reflects this.
Emphasizes recent performance over older data. Cases from the last 30 days carry full weight, with graduated decay applied to older data. This means improvements (or regressions) show up quickly.
The numeric score (0–100) translates into letter grades: A+ (95+), A (90–94), B+ (85–89), B (80–84), C (70–79), D (60–69), F (below 60).

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Flags

A flag is an automated alert raised when a case metric falls outside expected thresholds. Flags help surface operational issues without manual review.

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How flags work

1

Rules define triggers

Each rule specifies a metric, a comparison operator, and a threshold value. For example: “Total case duration > 120 minutes.”
2

Detection runs automatically

The flag engine evaluates rules when a case is completed and validated.
3

Severity is assigned

Each rule has a severity level: low, medium, or high. This helps teams prioritize which flags to review first.
4

Patterns are analyzed

ORbit identifies recurring flags across surgeons, rooms, or time periods, surfacing systemic issues rather than one-off anomalies.

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Flag rule types

Rules based on timing metrics:
  • Milestone intervals — time between any two milestones
  • Total case duration — end-to-end case time
  • Turnover time — gap between cases in the same room
  • First case on-time start — deviation from scheduled start

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Data principles

Soft deletes

ORbit uses soft deletes across 20+ tables. Records are never physically removed — they’re marked with is_active = false and a deleted_at timestamp. All queries filter by is_active = true by default.

Facility scoping

Every query filters by facility_id, enforced at the database level through row-level security (RLS) policies. Users can only see data belonging to their assigned facility.

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Next steps

Cases

See how these concepts come together in the case management workflow.

Analytics

Explore the analytics suite that uses milestones and scoring.

Milestone settings

Configure milestones, phases, and templates for your facility.

ORbit Score deep dive

Full explanation of the scoring methodology and pillar calculations.