ASA Classification
Disposition & Required Workup
Medication Holds
Anesthetic Considerations
engine vX.X · clinical-config vX.X
reviewed and attested by [Physician], MD · [date]
reviewed and attested by [Physician], MD · [date]
PeriGate does two jobs in one two-gate workflow. It runs a deterministic clinical engine across pre-anesthesia evaluation — risk scores, medication safety, guideline timing — so your PAT clinic can clear, work up, or defer with confidence. Then it generates the chart-ready pre-operative note, assembled from sections a physician has individually reviewed and attested.
Same-day cancellations and preventable delays are among the most expensive failures in surgical operations — an empty OR slot, a wasted anesthesia team, a patient sent home. Most trace back to the same root cause: pre-anesthesia evaluation that is manual, inconsistent, and disconnected from current guidelines.
For ambulatory surgery centers the math is sharper still: a same-day cancellation is unrecoverable revenue on a schedule with no slack.
PeriGate is built on a principle most clinical AI products avoid: the physician is not a reviewer of last resort — the physician is the gate. And the gate is engineered to be light: the system does the reading, the math, and the writing; the clinical team does only the judgment. Review by exception, not click-through-everything.
Patient context arrives via FHIR from your EHR. Problems, medications, labs, and the surgical booking — normalized into a structured pre-anesthesia case. No chart hunting.
A deterministic clinical engine — not a language model — evaluates risk scores, medication safety, and guideline-based timing. Rules are versioned, auditable, and never improvised. AI drafts the judgment sections: the narrative reasoning a physician would otherwise type. AI is never permitted to override the engine.
A nurse or clinician confirms the case as assembled — the system has already done the chart-pulling. Garbage in stops here.
Review by exception: clean sections clear in a single action, while flagged sections — safety-critical findings, low-confidence drafts — demand individual attention and can never be bulk-accepted. Every decision is recorded.
A chart-ready pre-operative assessment note, assembled deterministically from the attested sections, with engine values reproduced verbatim and a provenance block recording exactly what was signed, by whom, under which engine and configuration version. Exports as text or FHIR DocumentReference.
A growing class of tools will summarize a chart and draft a note. A summary, however fluent, answers to no one.
PeriGate is built the other way around. Nothing reaches the chart that a physician has not individually signed. The deterministic engine provides the ground truth; the AI drafts only judgment narrative; the physician attests every section; and the final note carries a complete provenance record — model version, clinical-configuration version, and the per-section accept/modify/override lineage.
The result is a document your compliance office, your quality committee, and your malpractice carrier can actually interrogate.
Risk scores and safety logic come from versioned rules, never from a language model's recollection.
The model never learns from live clinical data. Improvements ship as discrete, re-validated version releases.
Every section of every note records who reviewed it and what they decided.
Integrates. Doesn't add a program.
PeriGate is designed for SMART-on-FHIR launch inside the EHR workflow your anesthesia and PAT teams already use. No parallel portal, no swivel-chair workflow. Deployment follows the standard Epic vendor pathway.
Built for the schedule with no slack.
Ambulatory surgery centers feel every cancellation. PeriGate gives anesthesia groups a consistent, guideline-current clearance workflow with a lightweight FHIR ingestion path — designed for the realities of ASC IT, not just academic medical centers.
PeriGate is architected as clinician-directed clinical decision support: the physician independently reviews the basis for every recommendation and attests every output before it is used. This two-gate design is aligned with the clinical decision support criteria described in Section 3060 of the 21st Century Cures Act. The system is conservative by default — where uncertainty exists, it recommends more workup and more monitoring, never less.
We are building the evidence base for attested clinical decision support the way it should be built: prospectively defined thresholds, per-feature concordance measurement, and clinician attestation on every case. We partner with anesthesia departments, private anesthesia groups, and ASCs on retrospective, de-identified validation studies — IRB-governed, with co-authorship on resulting publications.
If your group runs a pre-anesthesia clinic and wants a hand in shaping this category, we want to talk.
PeriOp AI was founded by Michael Grinn, MD MPH, a practicing cardiac anesthesiologist, with technical co-founder Farhan Baluch. The clinical advisory board is in formation.
Demos are live, guided walkthroughs using synthetic cases — no patient data, no marketing pitch. We'll follow up within two business days to schedule.