De Novo Orthopedics
Brief — Doctor's Operations Manual
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Brief — Doctor's Operations Manual

The doctor's guide to iRehab's Brief feature — printing the QR poster, reading the Brief queue, choosing the right closing option, recovering a missed record with the confirmation code, and six FAQs. Why we built it: so more of your time goes to the patient, not the keyboard.

irehabuser-manualbriefdoctorclinical-workflow

Why this manual exists

iRehab's Brief feature is built on one design principle: AI isn't here to write prose for you — it's here to give time back to you. When the patient sits down, the screen already has a structured summary. You don't spend five minutes collecting basics — you spend those five minutes listening, examining, deciding. The full design rationale lives in Pre-Visit Brief: When the Patient Can't Tell You Whether It's Tendon or Nerve.

This manual is for the doctor who actually uses the feature. Print and post at your desk.

Before you start: first-time setup

Everything from Section 1 onward assumes your questionnaire is already live. If this is your first time setting it up, walk through these six steps first — about 15 minutes, with a few steps handled on our end.

We deliberately built this as try-before-you-commit: you fill out the questionnaire once as a patient would (or review a draft first), and only switch it on once it looks right. No contract or payment required to get there.

  1. Get an account (invite-only). iRehab runs on invitations. Contact the De Novo team and we'll activate your doctor account with your email, then send you a registration invite link. If your specialty needs a custom questionnaire — for example, OB-GYN merging gynecology, obstetrics, and urogynecology into one form — we'll first walk you through a review page item by item, collect your decisions, and finalize it (usually one or two rounds of tweaks).
  2. Register your doctor account. Open the invite link and fill out your details at doctor.denovortho.com/#/register (the email must match the invite; enter your specialty accurately). Use the invite link — a bare registration page won't have the invite code.
  3. Confirm your questionnaire in Composer. Sign in to the Doctor PWA, open Composer, and check every field against the version you finalized.
  4. Generate a QR in the Dispatch Center. Once it checks out, go to the Dispatch Center, generate a QR code for the questionnaire, and print it for your clinic or front desk. (One poster is reusable — no need to reprint daily; see Section 1 below.)
  5. Dogfood it yourself. Scan your own QR with your phone and fill out the questionnaire from start to finish as a patient would. This is your last check before going live — you'll see exactly what the patient experience looks like.
  6. Check the Brief tab for the result. Your test submission appears in the Brief queue about 30 seconds later — open it, and that's the structured summary you'll see for real patients. Once it looks right, you're done; everyday use starts at Section 1.

Once it's set up, the daily routine is simple: patients scan the poster QR and fill out the form, and you read the Brief queue at a glance (Sections 1–2 below).

1. Before clinic: generate your QR poster in the Dispatch Center

  1. Open the Doctor PWA (doctor.denovortho.com) and sign in
  2. Go to the Dispatch Center tab
  3. Find your specialty's questionnaire template and tap "Generate poster QR"
  4. Tap "Print A4 poster" to open the A4 preview — then Print or save as PDF
Notes:
  • Use a desktop browser in the clinic if you can. iPhone Safari sometimes breaks the layout — if you must use a phone, save as PDF first and print from there
  • One poster is reusable (default ~200 uses or 60 days). It stops working automatically once the cap or expiry is reached; you can regenerate or revoke it anytime
  • Post it where patients can easily see it — waiting area or reception counter. If patients can't scan, the front-desk assistant can help

2. Reading the Brief queue

After the patient submits the form, within about 30 seconds their record appears in your Brief queue. Each card shows:

  1. Name + birth year + sex (for young children, it displays "X years Y months")
  2. Chief complaint in one line — patient's own words, preserved verbatim
  3. VAS pain score (0–10)
  4. Sensation-type chip (pain / numbness / weakness / multiple / other)
  5. Red advisory bar — appears if the symptom combination warrants extra attention; look at these first
  6. ⚠️ "Manually added" chip — means the record was pulled in using the code, often from another doctor's queue; ask a few extra questions

Expand the card and you'll see the full intake summary draft in two formats:

  • Telegraphic summary — one-tap copy for pasting into the S-line of HIS (R't knee, B/L, F/M/N)
  • Prose paragraph — use when writing IRB reports or referrals

3. Decision tree during the visit

At the end of each visit, press one close-out button. Three options:

Closing buttonWhat the system does next
Conservative follow-upPatient enters iRehab's follow-up list; VAS + GROC survey auto-sent once, 3 days before the return visit
Surgery or rehabCreates a formal care record; you select the pathway (TKA / THA / Shoulder / General rehab)
No follow-upRecord kept 180 days for later retrieval; system sends zero further notifications

Every button shows a confirmation dialog listing exactly what the system will do next — confirm before it fires.

4. Manual lookup with the confirmation code

When to use:
  • Your queue looks empty but the patient insists they filled the form
  • Patient hands you a code PC-XXXXXX
  • You're covering for another doctor (patient scanned the other doctor's QR)
  • Cross-clinic assist
How:
  1. Top-right of the queue, tap "⊕ Add manually"
  2. Enter the 6 characters the patient reads to you: PC- [ _ _ _ _ _ _ ] (case-insensitive; if they paste from LINE the system cleans it up)
  3. Submit → the record joins your queue, tagged ⚠️ Manually added
  4. If the record was originally filed under another doctor, the card carries an Original doctor tag — a reminder this isn't your original patient, so ask a bit more

Limitation: Only works within the same hospital. No cross-hospital lookup.

5. Common questions

Q: The patient says they filled it, but my queue is empty. What now? A: First, check timing — submit to appearance is about 30 seconds. Still nothing? Ask for the code PC-XXXXXX and use Section 4's manual lookup.

Q: What about confusable characters like O vs 0? A: The system deliberately excludes ambiguous characters (no O / 0 / I / 1 in generated codes). What the patient reads to you will not be ambiguous.

Q: I'm covering for Dr. X. How do I see their queue? A: Use Section 4 to pull the record into your own queue with the code — the card will carry an Original doctor tag. Close out normally; the care record correctly attributes to you, since you're the one who actually saw the patient.

Q: Patient filled half the form and left. What happens? A: The record stays in "unsubmitted" state and never reaches the queue. If they return and rescan the same QR from the same phone, the system resumes from the last step.

Q: I clicked "No follow-up" by mistake — how do I undo? A: Closed records are kept 180 days. Open the record, top-right "Reopen", then pick "Conservative follow-up" or "Surgery or rehab". A new care record is created; the original closure is marked "withdrawn".

Q: What does the red advisory bar mean? A: The patient's answers match a combination the system flags as warranting extra attention (example: "weakness + worsening + persistent"). It's not a diagnosis, just a prompt to ask those warning-sign questions during your exam. Whether it's actually urgent is still your call.

6. AI Translation (optional) — Bring Your Own Gemini Key (BYOK)

Optional feature. If you don't enable it, day-to-day use is unaffected; you'll see the patient's chief complaint in their original language without auto-translation. This is the BYoAI design (Bring-your-own-AI): the doctor uses their own Gemini API quota, bearing the (very low) cost. iRehab's servers do not retain any LLM response.

When to enable it

  • You see non-Chinese-native patients regularly (Vietnamese, Indonesian, Japanese, Korean, English…)
  • You want a one-tap button to translate the patient's foreign-language complaint into a language you read easily

Setup (5 minutes)

Step 1 — Get a key from Google AI Studio

  1. Browser → https://aistudio.google.com/app/apikey
  2. Sign in with your Google account (use a personal one, not your hospital account)
  3. Click "Create API key" → you'll get a string starting with AQ.Ab...
  4. Don't close the tab yet; copy that string

Step 2 — Confirm billing is active (critical)

  • Click the new key → or the left sidebar "Billing" → enable billing
  • Even for the free tier, Google requires a credit card on the project before giving you normal quota
  • Without billing, registration will fail (you'll see "quota exceeded")

Step 3 — Register the key in Doctor PWA

  1. Switch to the "✨ AI" tab at the bottom (not Profile; BYOK settings moved from Profile to the AI tab)
  2. Find the "AI Translation (Optional)" card
  3. Tap "Enable & enter key"
  4. Read the purpose explanation → Continue
  5. Check all three consent items (data goes to Google, hospital allows it, iRehab is not responsible for Google-side handling) → Continue
  6. Paste AQ.Ab... → press "Save key"
  7. Success shows a green indicator "Configured (usable)"

Common registration errors

ErrorWhyFix
Wrong formatCopy-paste has extra whitespace or missing charactersRecopy the full AQ.Ab... and paste again
Key invalid or revokedKey was actually deleted or permission-restrictedRegenerate at AI Studio
Quota used up, try laterGoogle-side quota triggeredWait 1–2 min, confirm billing is on, or rotate to a new key
Google responded abnormallyMalformed response from GoogleWait 1 min and retry; if it keeps failing, contact engineering
Service unstableiRehab's backend KMS temporarily unavailableWait 1 min and retry
Too many attemptsMore than 20 registrations in an hourWait 1 hour

How to use after enabled

Expand a patient card in the Brief queue → the Path B area will show a "Translate CC" button (only shown when the patient's CC language ≠ your UI language). Tap it and the complaint is sent to your own Gemini API; a one-line translation appears on the card within seconds.

Important:
  • The translation is a reading aid; it does not overwrite the HIS S-line. The S-line still pastes the original telegraphic summary.
  • The patient's original text is preserved 100% in the record — unmodified, unsummarized, unrewritten.
  • The translation runs only when you tap — it does not auto-trigger. You decide when to translate.

Security assurances (hospital IT may ask)

  • Your key never leaves your browser + iRehab backend; it does not enter logs, error messages, or support systems
  • Backend storage uses Google KMS envelope encryption (double-wrapped); not even iRehab engineers can decrypt it directly
  • Every key decryption event writes a Google Cloud Audit Log (anomalous use is traceable)
  • iRehab servers do not retain LLM response content; translation output renders only in your browser
  • You can tap "Remove" in the AI tab anytime — the encrypted secret is deleted immediately
  • Historical usage logs are retained for audit; they are not deleted

What to tell hospital IT

  • Data travels over HTTPS to Google Gemini API (generativelanguage.googleapis.com)
  • Each request carries only the patient's chief complaint text — no name, no national ID, no chart number
  • Google's retention policy on this path: commercial API route, not used to train models (contractually guaranteed)
  • If hospital policy prohibits it, IT can notify the department head and we will disable this feature for the whole institution from the backend