Signed instruction · Elena Riverav
Trigger · Ovidrel 250 micrograms subcutaneous, once
PDT · Oct 30
Signed by Dr. Mira Lee · 17:10 PDT
v2 · 20:30 PDT · retrieval 07:30 PSTSuperseded · kept for history
For REI physicians
Signing stays yours. Everything around it stays in view.
You review the evidence, make the decision and sign. OvaFlow captures what you ask it to, checks that it was saved, and keeps proposals apart from what you have signed.
- Recorded on Apple WatchA visible recording state, pause one tap away.
- Kept until the iPhone confirmsA draft or recording stays where it is until the next device confirms it arrived.
- Draft waits at your deskNext to the transcript, never placed for you.
- You review and signNothing is signed for you. A draft is never a signature.
Who this is for
Reproductive endocrinologists and other authorized clinicians who review evidence, make decisions and sign.
What gets in the way
4 moments physicians know too well.
Each one, and exactly how OvaFlow is designed to answer it. Work changes hands only when someone accepts it.
- Today
Placed dictation assumed saved.
With OvaFlowA check that Save Draft in the EMR actually happened.
- Today
Side conversations captured without a clean pause.
With OvaFlowConsult capture that starts only after consent, pauses cleanly and shows the draft next to the transcript.
- Today
Unsigned proposals applied to EMR fields too early.
With OvaFlow“Awaiting clinician approval” kept separate from what you signed.
- Today
Physician review accidentally closed by a nursing callback.
With OvaFlow“Clinical review pending” that no message or handoff can close.
Everything else mapped for this role9 more
Also gets in the way
- Procedure notes forgotten between rooms when hands are busy.
- Dose changes that skip the clinic's prescribing controls.
- Two-person workups that stall in separate charts.
- Preservation windows lost to handoffs nobody owns.
Also designed in
- Named-field dictation that doesn't steal focus.
- Phone and Watch capture that hands the draft to the desk.
- Dose changes handed to the clinic's own e-prescribing workflow.
- Each person's workup tracked in parallel.
- Preservation windows accepted by both teams.
[ Signed change ]
You sign once. Every commitment hears it.
Sign a new version and OvaFlow shows what changed, keeps the old version visible but retired, and flags each linked commitment for the person who owns it. Your signature stays the source.
Trigger to retrieval36h 00m
From 20:00 PDT October 30 to 07:00 PST November 1. Counted across the clock change at 02:00 on Nov 1. Every clinical decision stays with the care team.
- Patient instructionRe-prepared from version 3 for ElenaFlagged for Nora Ruiz, RN
- Procedure slotRetrieval Nov 1 · 07:30 → 07:00 PSTFlagged for Procedure desk
- AnesthesiaPre-op instructions follow the 07:00 PST retrievalFlagged for Anesthesia team
- Embryology labChange order acknowledgment pending for 07:00 PSTFlagged for Embryology
From the daily-care walkthrough.Fictional patient data
A shift with OvaFlow
How the day actually goes.
Drawn from the prototype walkthroughs. Times are from the fictional demonstration day.
Fictional patient data
Across a clinic day · Ultrasound rooms, consults, afternoon sign-offs & evening review
REI physicians move rapidly between morning ultrasound rooms, diagnostic and return-visit consults, procedure blocks, and late-afternoon stimulation/trigger sign-offs. ASRM 2026 evaluation and ICSI guidance, ASRM OHSS prevention guidelines, and the 2026 BMJ natural-versus-programmed FET trial highlight how individualized each decision is—while ONC SAFER CPOE guidance emphasizes keeping unsigned support separate from clinician-signed orders [1, 2, 3, 5].
- 0108:15Between ultrasound rooms · Wrist note captureWhat comes in
Dr. Mira Lee records a quick room observation on Apple Watch
Where it can slip todayVoice notes recorded in hallway transitions vanish if Wi-Fi drops or transcribe into an unverified background buffer.
How OvaFlow keeps it in viewSaves locally on the Watch first, shows storage location plainly, and hands draft to desk
Draft staged · Never auto-committed to chart - 0210:30Consult room · Consent-gated visit captureWhat comes in
Dr. Mira Lee & Maya Chen return consult; physical exam mid-visit
Where it can slip todayAmbient microphones started before explicit patient consent or left running during a pelvic exam capture private side talk.
How OvaFlow keeps it in viewStarts only after recorded consent, pauses cleanly for exam, shows draft beside transcript
Save check · Confirms Save Draft in the EMR - 0313:15Two-person diagnostic & oncology preservation intakeWhat comes in
Partner workups in separate charts + urgent oncology referral before gonadotoxic therapy
Where it can slip todayOne partner's missing infectious-disease or semen lab stalls cycle readiness unseen; oncology timelines slip between clinics.
How OvaFlow keeps it in viewTracks both charts in parallel and holds preservation window until both teams accept
Parallel readiness · Both teams committed - 0417:10Afternoon stimulation review & signed trigger v3What comes in
Estradiol, progesterone, and follicle measurements reviewed for Elena Rivera
Where it can slip todayUnsigned note proposals or verbal changes reach nursing tasks before the physician signs, or eRx steps are bypassed.
How OvaFlow keeps it in viewKeeps 'Awaiting clinician approval' separate; signing v3 cascades to nursing, OR, and lab
Signed source v3 · Downstream tasks flagged - 0520:28Evening discrepancy & OHSS / freeze-all judgmentWhat comes in
Elena Rivera's 20:20 PDT injection report arrives; nursing accepts callback at 20:28 PDT
Where it can slip todayWhen a nurse closes the patient callback ticket, the physician's clinical review item accidentally closes with it.
How OvaFlow keeps it in view'Clinical review pending' stays open on Dr. Mira Lee's queue until she reviews and decides
Clinician authority · Never closed by callback
Worked clinician example · Dr. Mira Lee & Dr. Priya Shah
From exam-room capture to a signed evening change—without blurred authority.
See how OvaFlow supports Dr. Mira Lee across a consultation with Maya Chen, a parallel partner/preservation workup with Dr. Priya Shah, and Elena Rivera's 17:10 PDT signed trigger change.
Fictional patient data
Why this moment matters in an IVF clinic
Physicians make dozens of high-consequence choices daily: whether to convert to freeze-all for OHSS risk [2], whether ovulatory FET patients should follow a natural or programmed protocol [3], whether non-male-factor ICSI is indicated [1], and whether a placed EMR note draft actually saved before the room turns over [5].
- Step 01Dr. Mira Lee & Maya Chen
10:30 · Consent-first capture, clean exam pause, and EMR Save Check
In consult, recording cannot start until Maya's consent is logged. When Dr. Mira Lee steps to the exam table, one tap pauses capture cleanly. Afterward, the structured draft appears beside the verbatim transcript. After placement into nAbleIVF, OvaFlow verifies that Save Draft in the EMR actually completed rather than assuming paste equaled save.[5]
- Step 02Dr. Priya Shah & Oncology / Fertility Teams
13:15 · Parallel partner workup and urgent oncology preservation window
Consistent with ASRM 2026 evaluation guidance (evaluating both partners in parallel) and ASCO 2025 fertility preservation guidance before gonadotoxic therapy, OvaFlow shows both partners' diagnostic checklists side by side and requires explicit acceptance from both oncology and REI coordinators on the preservation start window.[1][4]
- Step 03Dr. Mira Lee · eIVF / nAbleIVF workflow
17:10 · 'Awaiting clinician approval' vs. Signed Trigger v3
Prepared protocol adjustments remain labeled 'Awaiting clinician approval' and cannot drive patient instructions. Once Dr. Mira Lee signs Trigger v3 (20:00 PDT on Oct 30, replacing v2 at 20:30 PDT) and completes any dose change in the clinic's own e-prescribing system, OvaFlow retires v2 and flags every linked nursing, OR, and embryology commitment.[2][5]
- Step 04Alex Kim, RN & Dr. Mira Lee
20:28 · Nursing callback separated from physician clinical review
When Elena reports her 20:20 PDT injection, Alex Kim, RN accepts the evening patient callback at 20:28 PDT. OvaFlow keeps Dr. Mira Lee's 'Clinical review pending' item open on her queue so a nursing phone call never silently resolves a physician's timing judgment.[5]
How the safeguard works
Fictional patient recordHow a visit draft and a signed change reach each team
01 · Starts after consent · Checked when saved
Visit notes from room, phone, or Watch
- Patient consent
- Recorded before the microphone startsPauses in one tap for the physical exam or a private moment
- Draft beside transcript
- Each section linked to what was saidLeaves blanks rather than guessing when details are missing
- EMR save check
- Confirms Save Draft completed in the EMRAlerts you before you leave the room if the save did not go through
02 · What requires your signature
A draft is not an order, and a nursing call never closes your review
Unsigned items stay labeled 'Awaiting clinician approval.' Prescribing stays in the clinic's e-prescribing system, and nursing callbacks cannot close 'Clinical review pending.'
03 · Dr. Mira Lee signs version 3 at 17:10 PDT (for 20:00 PDT)
How a signed change reaches each team
- Superseded version 2
- 20:30 PDT retired in historyKept in the audit trail and blocked from being resent to Elena
- Teams notified
- Nursing, operating room, anesthesia, and labEach team sees what changed from the signed 20:00 PDT instruction
- 20:20 PDT report
- Clinical review stays with Dr. Mira LeeRemains open for her review after Alex Kim, RN accepts the 20:28 call
OvaFlow never diagnoses, recommends doses, ranks embryos, or writes unsigned text into signed EMR fields.
Every visit note draft, transcript, and schedule update shows where it came from and waits for the physician's signature in the EMR.
Prototype walkthroughs
See it in the prototype.
Recorded from the interactive design prototype with fictional patient data. Open one to play it here with chapters and captions.
Clinician iPhone: in-room capture, consent and an offline desk
Confirm the patient and consent before the mic turns on, pause for the exam, and hand the draft to the desk even while the desk is offline.
Apple Watch: wrist capture, offline retention and privacy
Between ultrasound rooms, a wrist note saves on the Watch first, says plainly where it is, and hides the patient's name when the wrist drops.
eIVF: note save, financial blocker, e‑prescribing handoff, PGT stop
A note isn't done until it's saved, a cycle doesn't start with prior authorization unresolved, dose changes go to eIVF's own e-prescribing, and a PGT label mismatch stops the review.
Common questions & sources
Questions from REI physicians.
How OvaFlow handles edge cases, clinical authority, and source-system boundaries for this role.
Q01What happens if my EMR tab loses focus or fails to save after I place a consult draft?
OvaFlow uses named-field placement that does not rely on blind cursor focus, and then runs a Save Check against the EMR. If Save Draft in the EMR did not complete, OvaFlow alerts you immediately while the patient's context is still in front of you rather than assuming the note was saved.[5]
Q02How does Watch or mobile voice capture handle an unstable hallway Wi-Fi connection?
On Apple Watch and mobile, capture saves locally on the device first and displays where the audio is stored. If connectivity drops between ultrasound rooms, nothing is lost; the draft hands off to your desktop workspace once the connection returns.
Q03Can a nurse coordinator prepare a protocol or trigger update before I sign it?
Staff can stage operational prep, but any unsigned item is explicitly badged 'Awaiting clinician approval' and blocked from being published to the patient or treated as an active clinical order until your signature is recorded in the source system.[5]
Q04Does OvaFlow suggest gonadotropin doses, trigger regimens, or FET protocols?
Next step
Bring the decisions that wait on your signature.
See consent-gated visit capture, EMR save checks, and how one signed amendment cascades across nursing, OR, and lab commitments.