From GP referral to signed letter. The work around the note, done.
Twenty-two agents run the specialist outpatient clinics and the Clinical Trials Unit of Kestrel Bay Hospital, a fictional Australian public hospital with synthetic patients. Agents listen, read and draft. Code checks what is safe and when it is due. Clinicians decide and sign.
Referral to follow-up. Every step tracked.
Each stage hands over its quoted evidence, so nobody asks the patient or the GP twice. Every step is written to a hash-chained audit trail.
Referral
Referral AgentReads the GP's referral, by secure message or a faxed scan, and quotes each fact. Code checks identity, validity, duplicates and gaps.
Urgency and booking
Triage and Booking AgentsA category is proposed with the referral's words; a clinician confirms it. Code finds times inside the window on the clinician's real calendar.
Before the visit
PreVisit AgentA prep note from the chart and the patient's intake form: result trends, medicines, changes. Every point cited.
Live consult
Scribe and Safety AgentsConsent first. The note updates while the clinician and patient talk, every line quoting the transcript, and the hospital's rules raise flags as words are said.
Sign
The treating clinicianEdits the note, decides on every flag and signs. Nothing is sent, booked or ordered before this.
After the visit
Letter and acting agentsGP letter, patient summary, orders, review booking and internal referrals, each tracked until it closes.
Booking, the scribe, clinical notes and trials.
Writing the note was never the whole job. The hours go into the work around it: the referral, the booking, the letter, the result, the follow-up.
Referral to booking
NSW-style urgency categories: category 1 within 30 days, 2 within 90, 3 within 365. Red-flag words can only raise the category, and a clinician confirms it. Bookings are checked against each clinician's real calendar (theatre lists, ward rounds, leave), never just the clinic template. A cancelled slot is offered to the next waiting patient of the same category, one at a time.
The agentic scribe
Recorded live through the appointment. Speech-to-text (Mistral Voxtral) runs in the Health Desk, and the Scribe Agent on watsonx Orchestrate keeps the note up to date as people speak. When the patient corrects something, the line changes and both quotes are shown. One signature then releases the follow-up work, tracked until it closes.
Clinical notes and trials
For the specialist teams and the Clinical Trials Unit: case summaries for team meetings, trial pre-screening, source data verification and queries, serious adverse event narratives on a 24-hour clock, and protocol sections drafted against an ICH M11-style template.
A day at Kestrel Bay. Six outcomes.
Each story is ready to run end to end in the Health Desk.
Chest pain on exertion
GP referral, secure messageThe Triage Agent proposes category 1 with the GP's own words and the cardiologist confirms. Three cardiology times are offered, all inside 30 days, with slots her cath lab list blocks kept out. The patient picks one from a single-use link.
A faxed referral with gaps
Read from the scanMedicines, allergies and recent results are missing, so a request is faxed to the GP and tracked. The reply is merged into the original referral, a category is proposed and the patient is booked.
A diabetes review, live
The note writes itselfThe patient corrects "my right foot" to "my left foot, not the right", and the note changes with both quotes. Metformin at an eGFR of 28 is flagged the moment it's said, and "tightness on the stairs" raises a red flag. The note can't be signed while a blocking flag is open.
Every action, tracked
After the consultThe GP letter, the patient summary, a pathology order, the 3-month review and referrals to the high risk foot clinic and cardiology. The GP's fax is busy, so the letter is retried until it is delivered.
A cardiologist's sudden leave
The 847-patient lessonA widely shared story has a scheduling agent moving 847 patients overnight. Here, three weeks of leave produce a preview plan with category 1 patients first, and nothing moves until the clinic manager approves, 10 at a time, each re-checked by the hospital system.
A trial patient admitted
Serious adverse eventThe admission is spotted, the 24-hour clock starts and the narrative is drafted from the record without mentioning the treatment arm. Only the principal investigator can sign, and the sponsor receives it inside the clock.
Same rules. A named person signs.
Agents draft and quote, code decides, and the consultant, coordinator, investigator or medical writer signs off.
Case summaries for team meetings
Labs, imaging, pathology and treatment to date in one narrative, each fact cited to the record. The consultant edits and signs.
Trial pre-screening
Code matches the structured criteria; the Eligibility Agent quotes chart evidence for each free-text criterion. A criterion with no evidence stays open, and the coordinator decides whether to approach.
Source data verification
Trial data is compared with the hospital record: every critical field and a sample of the rest. An HbA1c of 7.2 entered against 7.8 in the source becomes a neutral query the coordinator approves.
Serious adverse events
A trial subject's admission starts a visible 24-hour clock. The narrative is drafted from the record and checked for anything that could unblind the study.
Protocol drafting
Sections drafted against a structured, ICH M11-style template, with citations. The medical writer edits and approves.
The trials system
A trial data capture stand-in with studies, criteria, subjects, case report forms, queries and a sponsor inbox, so the whole loop runs end to end.
Sixteen that think. Six that act.
Thinking agents read and draft but never decide. Acting agents have one tool each, and the tool re-checks the rules before anything changes. Orchestrate agents take text, not audio, so speech-to-text runs in the Health Desk.
Thinking agents
Listen, read and draft; never decideReferral Agent
Reads a GP referral (secure message or fax) and quotes each fact.
Triage Agent
Proposes an urgency category with the referral's own words; a clinician confirms.
PreVisit Agent
Prep note from the chart and the intake form, every point cited.
Scribe Agent
Keeps the consult note up to date while the clinician and patient talk.
Safety Agent
Explains the hospital-rule flags raised on a draft note; never clears one.
Actions Agent
Lists the tasks the clinician said will happen, with their words.
Coding Agent
Suggests problem terms and the clinic class; code checks them.
Letter Agent
Drafts the GP letter, the patient summary and requests for missing referral information.
Results Agent
Explains an abnormal result against the patient's trend.
Case Summary Agent
Drafts the case summary for a team meeting from imaging, pathology and results.
Learning Agent
Suggests style lessons from clinician edits; never relaxes a check.
Trials Eligibility Agent
Quotes chart evidence for each trial criterion.
Trials SDV Agent
Explains differences between trial data and the hospital record.
Trials Query Agent
Words a neutral data query for the site.
Trials Narrative Agent
Drafts a serious adverse event narrative for the investigator.
Trials Protocol Agent
Drafts protocol sections against the structured template.
Acting agents
One tool eachBooking Agent
Books one appointment; the tool re-checks the window and the calendar.
Dispatch Agent
Sends a signed letter by secure messaging, or fax if needed.
Order Agent
Places a signed pathology or imaging order.
Notification Agent
Sends patient emails: booking links, reminders, summaries.
Health Desk Agent
Answers staff questions from the patient file, respecting restrictions.
Trials EDC Agent
Submits approved queries, SAE reports and protocol drafts to the trial system.
Clinic, booking office, trials unit.
Follow one patient all the way through.
Referrals and bookings
The referral inbox and triage queue, the booking board, the waitlist by category, cancellations and backfill, and bulk changes waiting for approval. Each referral shows its journey against the hospital's targets, every step timed by code.
The consult room
Record live or play a prepared consult. The transcript (filter it by speaker or search it), the note with every line linked to its words, the safety flags, the proposed actions and Sign.
The tracker
Every action from every visit: sent to delivered, ordered to resulted to acknowledged, booked to attended. Overdue items escalate.
Trials and team meetings
Pre-screening, source data checks and queries, adverse events with their clock, protocol drafts and case summaries.
Patient links
Single-use links with no sign-in: choose an appointment, fill in the intake form, read the visit summary.
Hospital and trials systems
Stand-ins for the systems of record: patients, clinic templates and calendars, results, a GP directory and a delivery gateway that behaves like secure messaging and fax, failures included.
The work done. Clinicians in charge.
These rules are in the code, not in a prompt, so no agent can talk its way around them. The agents add no clinical content: the note holds only what was said or is in the chart, and safety checks are the hospital's own rules, shown as flags for the clinician to decide on.
Agents listen and draft. Code decides.
Urgency windows, slots, safety flags, gates and due dates are plain code. Agents listen, read, quote and draft.
Every line quotes its words.
Each statement in a note cites the transcript or the chart. Code checks every quote; a line whose quote isn't found is dropped.
Clinicians decide and sign.
A clinician confirms every urgency category. Nothing is sent, booked or ordered before the treating clinician signs.
Real calendars. Capped bulk moves.
Every booking is checked against the clinician's real calendar. Bulk changes are previewed, capped and approved by the clinic manager.
End to end, in the Health Desk.
Confirm a chest-pain referral as category 1 and book it, play a diabetes review and watch the note change as the patient speaks, sign it and follow every action to closed, then raise a trial query and an adverse event report.
- 01Referral and Triage AgentsRead the referral and propose a category, quotedAgents
- 02Booking engineCategory window, real calendars, waitlistCode
- 03Scribe AgentThe note updates as they speakAgent
- 04Live checksQuotes found, hospital rules raised as flagsCode
- 05Clinician signsEdits, decides on the flags, signsPerson
- 06Dispatch, Order and Booking AgentsLetters, orders and reviews, each re-checkedAgents
- 07TrackerDue dates, retries and escalationCode