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ORbit’s voice command system lets OR staff record milestones, control cases, and query case information entirely hands-free. Voice commands are available in Room Mode on iPad — optimized for the sterile field where touch interaction isn’t always practical.
Voice commands are an iPad-only feature. Room Mode and voice activation are not available on iPhone.

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How it works

ORbit uses a two-stage voice architecture for reliable, low-power wake word detection:
StageTechnologyPurpose
Stage 1Picovoice PorcupineAlways-on wake word detection — listens for “Orbit” at very low CPU usage
Stage 2Apple Speech RecognitionActivates only after “Orbit” is detected — captures and processes the command
This means ORbit is always listening for its name but only processes speech after hearing “Orbit.” Stage 2 deactivates automatically after a 1.5-second silence, returning to low-power wake word listening.
All voice processing happens on-device. Audio never leaves the iPad. The only network call is to classify unrecognized phrases via a secure edge function.

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Getting started

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Enable voice commands

  1. Open any active case in Room Mode on iPad
  2. Grant microphone and speech recognition permissions when prompted
  3. The voice indicator in the header shows the current state:
    • Listening — ready for wake word
    • Recognizing — capturing your command
    • Processing — classifying an unrecognized phrase

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Choose a voice

ORbit speaks back confirmations and prompts using text-to-speech. You can choose which voice is used:
  1. Go to Profile → Room Mode → Voice Selection
  2. Browse available voices grouped by type:
    • Siri Voices — Apple’s Siri voices (if downloaded on your device)
    • English voices — system voices sorted by quality (Premium → Enhanced → Default)
  3. Tap any voice to hear a preview and select it
  4. Use Reset to Default to revert to the system default (Samantha Premium)

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Feedback levels

Control how much audio feedback ORbit provides:
LevelBehavior
Full VerbalChime + spoken confirmation for every action
Sounds OnlyChime on success, spoken feedback only for errors and prompts
SilentVisual feedback only — no audio
Set the feedback level in Profile → Room Mode → Voice Feedback.

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Command reference

Say “Orbit” followed by any of these commands:

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Recording milestones

Record a milestone timestamp by saying the milestone name naturally. ORbit matches your phrase against configured aliases. 
"Orbit, patient in room"
"Orbit, anesthesia start"
"Orbit, incision"
"Orbit, closing"
"Orbit, patient out"
ORbit uses two matching strategies:
  1. Fast path — instant exact match against known aliases (no network needed)
  2. Slow path — AI classification via Claude for unrecognized phrases (requires network)
When the AI successfully classifies a new phrase, it’s auto-learned and added to the alias dictionary. The next time you say the same phrase, it matches instantly without AI classification.
You don’t need to memorize exact phrases. Say milestones naturally — “the patient is in the room”, “we’re making incision”, “starting to close” — and the AI will learn your preferred phrasing over time.

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Canceling milestones

Clear a recorded milestone timestamp: 
"Orbit, cancel patient in"
"Orbit, undo the incision"

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Undo last action

Undo the most recently voice-recorded milestone. This always requires verbal confirmation to prevent accidental undos: 
You: "Orbit, undo"
ORbit: "Undo Patient In? Say confirm or cancel."
You: "Confirm"

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Call next patient

Trigger the “call next patient” workflow: 
"Orbit, call the next patient"
"Orbit, next patient"

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Surgeon left

Mark the surgeon as having left the OR: 
"Orbit, surgeon left"
"Orbit, the surgeon has left"

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Cement timer

Start or stop a floating cement timer overlay: 
"Orbit, start a cement timer"
"Orbit, stop the cement timer"
The timer counts up from 00:00 with color transitions at configurable thresholds (green → yellow → red). The timer overlay is draggable and persists until dismissed.

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Query commands

Ask ORbit about the current case without touching the screen: 
"Orbit, when did the patient come in?"
"Orbit, how long has the case been going?"
"Orbit, who is the surgeon?"
"Orbit, what procedure is this?"
ORbit responds verbally with the requested information.

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Out-of-order protection

ORbit validates milestone sequence before recording. If you try to record a milestone out of order, the system requires verbal confirmation:
ScenarioBehavior
All prior milestones recordedRecords immediately with confirmation
Any prior milestones missingHolds command pending — announces what’s missing and asks for confirmation
Milestone already recordedHolds command pending — announces existing time and asks to confirm update

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Example: out-of-order command

You: "Orbit, closing"
ORbit: "Closing out of order. Missing: Anesthesia Complete, Incision. Confirm or cancel."
You: "Confirm"     → records the milestone
You: "Cancel"      → discards the command
(15 seconds pass)  → auto-cancels if no response
Voice commands never skip milestones silently. Any missing prior milestones will always trigger a confirmation prompt. This prevents accidental gaps in your case timeline.

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Confirm and cancel

When ORbit holds a command pending (out of order, already recorded, or undo), you have 15 seconds to respond:
CommandEffect
”Confirm” / “Yes”Executes the pending command
”Cancel” / “No”Discards the pending command
No response (15s)Auto-cancels with a timeout notification
Confirm and cancel phrases don’t require the “Orbit” wake word — they work directly while a command is pending.

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Managing voice aliases

Voice command aliases (the phrases ORbit recognizes) are managed in the web app settings, not on the iPad. This keeps the OR workflow clean and gives admins centralized control.

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How aliases work

Each alias maps a spoken phrase to a milestone and action type:
PhraseMilestoneAction
”patient in”Patient InRecord
”cancel patient in”Patient InCancel
”undo”—Undo last
”next patient”—Call next patient

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Auto-learned aliases

When ORbit’s AI classifies a new phrase with high confidence, it automatically saves that phrase as a new alias. Auto-learned aliases:
  • Are tagged as auto_learned in the database
  • Are facility-scoped (only apply to your facility)
  • Strip the “Orbit” wake word before saving (so “Orbit, patient is ready” is stored as “patient is ready”)
  • Take effect immediately — the next time you say the same phrase, it matches instantly

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Managing aliases in settings

Go to Settings → Voice Commands in the web app to:
  • View all aliases (manual + auto-learned) for your facility
  • Add new custom aliases
  • Delete aliases that aren’t useful
  • See which aliases were auto-learned vs. manually created

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Voice log

Every voice command is logged in the Voice Log panel within Room Mode. The log shows:
ColumnDescription
TimeWhen the command was spoken
PhraseWhat was recognized
ActionWhat ORbit did (recorded, pending, cancelled, unrecognized)
PathHow it was matched — dictionary (fast) or AI (slow)
Use the voice log to verify commands were processed correctly and to identify phrases that should be added as aliases.

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Troubleshooting

Check that:
  1. You’re in Room Mode on an iPad
  2. Microphone permissions are granted (Settings → ORbit → Microphone)
  3. Speech recognition permissions are granted (Settings → ORbit → Speech Recognition)
  4. The voice indicator shows “Listening” — if it shows “Unavailable”, check your microphone connection
  5. You’re saying “Orbit” clearly before your command
The milestone may be out of order. Listen for the confirmation prompt — ORbit will tell you which milestones are missing and ask you to confirm. Say “Confirm” to proceed.
The phrase may not have been auto-learned. This happens when:
  • The AI returned low confidence (below 85%)
  • The network was unavailable during classification
  • The phrase was too ambiguous to cache
You can manually add the phrase as an alias in Settings → Voice Commands on the web app.
ORbit uses the iPad’s system volume for voice feedback. Adjust the volume using the physical volume buttons or Control Center. You can also switch to Sounds Only or Silent feedback mode in Profile → Room Mode.
This shouldn’t happen — ORbit pauses command recognition during speech playback. If it does occur, try switching to Sounds Only feedback mode, which reduces spoken output.
Siri voices must be downloaded on your iPad first. Go to Settings → Accessibility → Spoken Content → Voices → English and download the Siri voices you want. They’ll appear in the ORbit voice picker after download.Note: The newer “Siri Voice 1-5” voices are not available to third-party apps due to Apple restrictions. The classic named Siri voices (Aaron, Nicky, Martha, Arthur) are available.
Yes. ORbit detects external audio inputs and uses them automatically. The voice indicator will show the connected device name when a Bluetooth or wired microphone is active.

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Privacy and security

ConcernHow ORbit handles it
Audio storageAudio is never stored or transmitted. All speech processing happens on-device.
Wake word detectionUses Picovoice Porcupine, which runs entirely on-device with no cloud dependency.
AI classificationWhen a phrase isn’t recognized locally, only the text transcription (not audio) is sent to a secure edge function for classification.
HIPAA complianceNo patient data is included in AI classification requests. The edge function receives only the transcription text, facility ID, and case ID for milestone matching.

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Next steps

Room management

Learn about the Room Mode interface and case tracking.

Milestone settings

Configure milestone templates and ordering.

Voice command settings

Manage voice aliases in the web app.

Notifications

Configure how ORbit alerts you about case events.