Perioperative operations and value

Run the OR better. Manage the whole episode. Prove the savings.

Kairos gives the anesthesia team that follows each patient from the decision to operate through recovery one place to run the operating rooms, manage every step of the surgical episode, and show a hospital CFO validated savings with the arithmetic behind every dollar.

The demonstration runs on synthetic data only. No real patient information.

Sierra Pacific Health · Main campus

Illustrative synthetic data

78.4%

Block utilization

+6.1 pts(improvement)vs baseline

86.0%

First-case on-time starts

+12 pts(improvement)vs baseline

27 min

Median turnover

−4 min(improvement)vs baseline

2.6%

Same-day cancellations

−1.5 pts(improvement)vs baseline

First-case on-time starts, by month

First-case on-time starts by month (illustrative) data
Period	On-time starts
Jan	71%
Feb	72%
Mar	74%
Apr	76%
May	79%
Jun	82%
Jul	84%
Aug	86%

The platform

Why this is bigger than block scheduling

Block-scheduling tools optimize one lever — OR block time — and sell it to the periop director. Kairos treats OR utilization as one of five levers and gives accountability for the whole episode to the team that can change it.

Block-scheduling tools compared with Kairos
Dimension	Block-scheduling tools	Kairos
Unit of optimization	OR block minutes	The surgical episode, from decision to recovery
Buyer	Perioperative director	Health system and anesthesia partnership, under a value contract
Economic story	Recovered OR capacity	Validated episode savings, shared with the clinical team
Clinical scope	Scheduling	Risk screening, optimization, testing stewardship, enhanced recovery, recovery and discharge
Incentive alignment	None	Scorecard-driven compensation: base, bonus and a share of validated savings
AI	Predictive scheduling	Predictive scheduling and a copilot over the whole episode: briefs, recommendations, savings narratives

Unit of optimization
Block-scheduling tools: OR block minutes
Kairos: The surgical episode, from decision to recovery
Buyer
Block-scheduling tools: Perioperative director
Kairos: Health system and anesthesia partnership, under a value contract
Economic story
Block-scheduling tools: Recovered OR capacity
Kairos: Validated episode savings, shared with the clinical team
Clinical scope
Block-scheduling tools: Scheduling
Kairos: Risk screening, optimization, testing stewardship, enhanced recovery, recovery and discharge
Incentive alignment
Block-scheduling tools: None
Kairos: Scorecard-driven compensation: base, bonus and a share of validated savings
AI
Block-scheduling tools: Predictive scheduling
Kairos: Predictive scheduling and a copilot over the whole episode: briefs, recommendations, savings narratives

Farm to OR Table

One accountable team follows the patient through five stages

Kairos is built around an anesthesia-led perioperative model. Every upcoming case sits on a pathway board with its stage, risk tier, open optimization items, testing flags and discharge plan.

1Plan
Risk screen at the moment of scheduling, not the day of surgery.
2Prepare
Optimize anemia, diabetes, smoking, frailty, sleep apnea and anticoagulation. Evidence-based testing: no duplicate tests, no low-value consults.
3Deliver
Enhanced recovery pathways, safe anesthesia, reliable first-case starts and turnovers.
4Recover
Multimodal analgesia and complication prevention: DVT/PE, reintubation, kidney injury, nausea and vomiting.
5Transition
Discharge destination planned before surgery, not after.

Balanced scorecard

A balanced scorecard with a safety gate

Five domains, risk-adjusted, per facility and service line, month over month. The rules below are enforced by the software, not just written down.

Illustrative attainment

AccessOn target
Days from surgeon decision to procedure; case capture
Who cares: Surgeons, patients
ReliabilityOn target
Same-day cancellations; first-case on-time starts; turnover
Who cares: OR, surgeons
RecoveryWatch
Risk-adjusted length of stay; discharge-home rate
Who cares: Capacity, episode cost
SafetyGate passed
DVT/PE, reintubation, kidney injury, PONV, readmission
Who cares: Patients, CMS programs
StewardshipOn target
Opioid exposure; protocol-based testing and consults
Who cares: Avoided harm and cost

Rules the software enforces

Safety gate
No value payment in a period where a minimum safety or compliance threshold is missed.
Risk adjustment
Outcomes are adjusted for procedure, acuity (ASA) and patient factors outside the team's control.
No single-metric payment
Payment rests on a balanced scorecard; weights are configurable per hospital.
Indicated-only stewardship
Stewardship counts only tests and consults the protocol says were not indicated, so avoiding necessary care is never rewarded.
No payment without validation
Every savings line passes clinical review and finance review before it is shared.

Savings ledger

Every dollar shows its basis

Each line carries its baseline rate, observed rate, volume, unit cost and the arithmetic. Lines move through clinical review and finance review, and nothing counts toward the shared-savings pool until it is validated.

Savings ledger · one service line · 12 months

Illustrative numbers, not from any hospital

Illustrative savings ledger
Category	Baseline	Observed	Volume	Unit cost	Gross	Status	Basis
Preoperative tests not indicated	0.38	0.22	1,240	$146	$28,966	Validated	Preoperative tests not indicated How this number was calculated Preoperative tests not indicated: savings against the agreed 12-month baseline for this service line. Illustrative numbers. Inputs Baseline rate 0.38 tests per case Observed rate 0.22 tests per case Volume 1,240 cases Unit cost (cost reference) $146 per test Arithmetic units avoided = max(0, 0.38 − 0.22) × 1,240 = 0.16 × 1,240 = 198.4 gross = 198.4 × $146 = $28,966 Counts toward the shared-savings pool only once status is Validated (clinical review, then finance review). Stewardship lines count only tests the protocol marks as not indicated. Source: Illustrative example — not data from any hospital
Same-day cancellations	4.1%	2.6%	1,240	$2,150	$39,990	Validated	Same-day cancellations How this number was calculated Same-day cancellations: savings against the agreed 12-month baseline for this service line. Illustrative numbers. Inputs Baseline rate 4.1% Observed rate 2.6% Volume 1,240 cases Unit cost (cost reference) $2,150 per cancellation Arithmetic units avoided = max(0, 4.1% − 2.6%) × 1,240 = 1.5% × 1,240 = 18.6 gross = 18.6 × $2,150 = $39,990 Counts toward the shared-savings pool only once status is Validated (clinical review, then finance review). Stewardship lines count only tests the protocol marks as not indicated. Source: Illustrative example — not data from any hospital
Risk-adjusted length of stay	2.4	2.1	610	$2,300	$420,900	Finance review	Risk-adjusted length of stay How this number was calculated Risk-adjusted length of stay: savings against the agreed 12-month baseline for this service line. Illustrative numbers. Inputs Baseline rate 2.4 bed-days per inpatient case Observed rate 2.1 bed-days per inpatient case Volume 610 inpatient cases Unit cost (cost reference) $2,300 per bed-day Arithmetic units avoided = max(0, 2.4 − 2.1) × 610 = 0.3 × 610 = 183 gross = 183 × $2,300 = $420,900 Counts toward the shared-savings pool only once status is Validated (clinical review, then finance review). Stewardship lines count only tests the protocol marks as not indicated. Source: Illustrative example — not data from any hospital
PONV rescue treatment	18%	12%	1,240	$480	$35,712	Clinical review	PONV rescue treatment How this number was calculated PONV rescue treatment: savings against the agreed 12-month baseline for this service line. Illustrative numbers. Inputs Baseline rate 18% Observed rate 12% Volume 1,240 cases Unit cost (cost reference) $480 per rescue Arithmetic units avoided = max(0, 18% − 12%) × 1,240 = 6% × 1,240 = 74.4 gross = 74.4 × $480 = $35,712 Counts toward the shared-savings pool only once status is Validated (clinical review, then finance review). Stewardship lines count only tests the protocol marks as not indicated. Source: Illustrative example — not data from any hospital

From identified savings to the validated pool

Illustrative

Savings
Reduction
Total

Savings waterfall (illustrative) data
Step	Change	Running total
Preoperative tests not indicated	$29K	$29K
Same-day cancellations	$40K	$69K
length of stay	$420.9K	$489.9K
PONV rescue treatment	$35.7K	$525.6K
Gross identified	—	$525.6K
Awaiting validation	-$456.6K	$69K
Validated pool	—	$69K

Claude, with guardrails

A copilot that answers questions over the live data, a daily brief, block-release recommendations with reasoning, and a savings narrative written for a CFO — inside rules a hospital privacy officer can check.

De-identified context only
The AI layer can only receive de-identified aggregates. A structural type and a guard on every outbound request block identifiers, and a blocked call is logged.
Tool traces you can read
Every answer stores the queries that produced it, one click from the answer.
Estimates you check
AI-generated numbers are labelled as estimates, shown in a distinct colour, and carry their basis.
Nothing auto-applied
Recommendations wait for a person. Releasing a block, booking a case or validating a saving is always a human action.
Data, not instructions
Free-text fields never enter system prompts; they are passed as tool results explicitly framed as data.

Example answerIllustrative synthetic data

Why did first-case on-time starts improve at the main campus last month?

Generated by Claude · an estimate you check

First-case on-time starts rose from 79.1% to 86.0% (+6.9 points) across 164 first cases. Most of the gain is in late patient arrivals, which fell by nine cases after readiness calls moved to the day before. Anesthesia-readiness delays were unchanged.

Recommended for review: extend day-before readiness calls to the two rooms not yet using them.

Tool trace · 3 calls

get_kpi(metric="fcots", facility="MAIN", period="2026-08")→ 164 first cases · 141 on time · 86.0%
get_kpi(metric="fcots", facility="MAIN", period="2026-07")→ 158 first cases · 125 on time · 79.1%
get_delay_reasons(scope="first_case", period="2026-08", compare="2026-07")→ patient arrival −9 · anesthesia ready ±0 · room ready −2

Standards

Built against the standards hospitals ask for

Every control carries cross-framework keys, so one implementation produces evidence for HIPAA, HITRUST, SOC 2 and ISO at once. The product reports its own control status at runtime.

Designed & evidenced: Implemented in the product; where a runtime check exists, it produces evidence continuously.
Infrastructure: Implemented by the cloud infrastructure stack: encryption, backups, TLS, image scanning.
At pilot: Required before real patient data enters the system. Tracked, and not needed for the synthetic demonstration.

HIPAA and HITECH
Privacy, Security and Breach Notification Rules · implemented per NIST SP 800-66 r2
Every Security Rule safeguard is mapped to where it lives: role-based access, a 15-minute automatic logoff, an encrypted identifier vault and an append-only audit trail.
Designed & evidenced
HITRUST CSF v11
e1 → i1 → r2
Controls carry HITRUST domain tags so one implementation produces evidence for the assessment hospitals ask vendors for. Target: e1 readiness at pilot, i1 in year one.
At pilot
SOC 2 Type II
Security · Availability · Confidentiality · Privacy
Controls map to the Trust Services Criteria and evidence is collected automatically where possible. No audit has been performed yet; the first window opens after the pilot.
Designed & evidenced
ISO/IEC 27001, 27002 and 27799
ISMS · Annex A · health informatics
Annex A tagging yields a Statement of Applicability, and the health-informatics additions — patient-record audit trails, pseudonymisation, clinical-system availability — are built in.
Designed & evidenced
ISO/IEC 42001 and NIST AI RMF
AI management system · AI risk
An inventory of every AI use with its intended purpose, a human decision on every recommendation, stored tool traces, and a bias review of risk adjustment.
Designed & evidenced
NIST CSF 2.0 and HHS 405(d)
Govern · Identify · Protect · Detect · Respond · Recover
The executive view of the register, with the health-sector cybersecurity practices for vulnerability management, backups, access and incident response.
Infrastructure
California CMIA, H&SC §1280.15 and CCPA/CPRA
Civil Code §56 · Health & Safety Code §1280.15 · Civil Code §1798.82
The pilot state's stricter medical-privacy law, the 15-business-day clock for reporting unlawful access to the state health department, and consumer privacy for non-medical personal data.
At pilot
21st Century Cures Act
ONC information blocking
Kairos never blocks export: every dataset is downloadable as a FHIR Bundle, NDJSON or CSV.
Designed & evidenced
FDA Clinical Decision Support guidance
Non-device CDS (2022)
Kairos stays non-device software: it shows the basis for every recommendation, supports rather than replaces clinician judgment, and never analyses medical images or physiological signals.
Designed & evidenced
Anti-Kickback Statute, Stark Law and CMP gainsharing
OIG gainsharing safeguards
The safeguards are enforced in software: a safety gate, indicated-only stewardship, caps, independent validation, a documented method and attorney review before any program activates.
Designed & evidenced
WCAG 2.1 AA and Section 508
Accessibility
Keyboard navigation, 4.5:1 text contrast, visible focus and labelled controls on every page — a hospital procurement requirement.
Designed & evidenced

Honest status. Kairos is designed and evidenced against these frameworks; it is not yet certified. Live control status is published inside the product and summarised on the Compliance page. Read the compliance posture.

Interoperability

Interoperable from day one

A perioperative platform lives or dies on whether it can read the OR schedule out of the EHR and write decisions back. Kairos is a FHIR-native façade over its own domain, with adapters to the systems hospitals actually run.

HL7 FHIR R4 and US Core
The canonical exchange format. Every Kairos entity has a FHIR mapping, served for read and search and validated against the base and US Core profiles.
SMART Backend Services
How Kairos authenticates to an EHR as a system client, with a signed JWT client assertion and system-level scopes.
Bulk Data ($export)
Baseline loads of twelve or more months of history for the value program, and asynchronous NDJSON export of the de-identified dataset.
HL7 v2 SIU and ADT
Most OR systems still emit v2 scheduling feeds through an integration engine. SIU creates, updates and cancels cases; ADT marks admission and discharge.
Standard terminologies
CPT and SNOMED CT for procedures, ICD-10-CM/PCS, LOINC for tests, RxNorm for opioid dosing, NUCC taxonomy and NPI.
No information blocking
Everything is exportable as a FHIR Bundle, NDJSON or CSV. External identifiers are kept alongside Kairos ids, never overloaded into them.

Infrastructure

Infrastructure that scales with your system

Built on an established cloud infrastructure provider, with the same architecture for one hospital as for a multi-hospital system.

Containers that scale out
The API runs as containers across two availability zones behind a load balancer, with autoscaling as load grows.
Managed, encrypted database
PostgreSQL on a managed service, encrypted at rest, with automated snapshots copied to a second region and point-in-time recovery.
TLS everywhere
TLS 1.2 or later with HSTS; HTTPS-only, httpOnly session cookies; no identifiers in URLs.
Field encryption with managed keys
Patient identifiers are encrypted field by field (AES-256-GCM) under keys held in a cloud key-management service, versioned for rotation.
Append-only, hash-chained audit
Every change writes an audit row chained to the one before it. The database itself refuses updates and deletes on audit tables.
Multi-facility tenancy from day one
Every query is scoped by organization and facility, so a second hospital — or a second health system — is configuration, not engineering.
Portable by design
Infrastructure is code, tagged end to end, and moves to a dedicated cloud account without a code change.
99.9% availability target
Health checks, alarms and a quarterly restore test. This is a design target, not yet a measured service level.

Pilot path

Start with one hospital, one service line

If the pilot succeeds, the same deployment extends to more service lines and more hospitals. The first twelve months, in four steps:

01 · 0–90 days
Baseline and set-up
- One hospital, one high-volume elective service line with measurable variation and engaged surgeons
- Connect the OR schedule feed (HL7 v2 or FHIR) and load a 12-month baseline
- Agree metrics, exclusions and safety thresholds; data-use agreement and business associate agreements
- Legal review of the value program before it activates
02 · Months 4–6
Run the OR and the pathway
- Block release recommendations and the open-time exchange
- Day-of command center and anesthesia coverage board
- Risk screen at scheduling; pathway board for every upcoming case
- Monthly scorecard with the safety gate
03 · Months 7–12
Prove the value
- Savings ledger through clinical and finance validation
- First validated shared-savings pool
- Compensation statements: base, incentive and savings share
- A savings narrative written for the CFO, with its basis
04 · Year 2
Scale
- Second service line, then a second hospital — as configuration
- Multi-facility benchmarks across the system
- HITRUST i1 assessment and SOC 2 Type II audit window

See it on a facility in ten minutes.

Pick a facility and walk the OR, the pathway, the scorecard, the savings ledger and the copilot — on synthetic data built to look like a real service line.

Run the OR better. Manage the whole episode. Prove the savings.

Why this is bigger than block scheduling

One accountable team follows the patient through five stages

A balanced scorecard with a safety gate

Rules the software enforces

Every dollar shows its basis

Claude, with guardrails

Built against the standards hospitals ask for

HIPAA and HITECH

HITRUST CSF v11

SOC 2 Type II

ISO/IEC 27001, 27002 and 27799

ISO/IEC 42001 and NIST AI RMF

NIST CSF 2.0 and HHS 405(d)

California CMIA, H&SC §1280.15 and CCPA/CPRA

21st Century Cures Act

FDA Clinical Decision Support guidance

Anti-Kickback Statute, Stark Law and CMP gainsharing

WCAG 2.1 AA and Section 508

Interoperable from day one

Infrastructure that scales with your system

Start with one hospital, one service line

See it on a facility in ten minutes.