Stanford Med · Unit 5B Medicine·Day shift·Mon · 9:42 AM

Patient Discharge Cockpit

Carlos Rivera · COPD exacerbation (J44.1)
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MC
CR
Carlos Rivera
58 M · MRN-58410 · COPD exacerbation (J44.1)
PlanningUnit 5BMedicineAetna PPOLOS 2d
ComorbiditiesType 2 diabetes mellitusMorbid obesityObstructive sleep apneaEssential hypertension
Estimated discharge
Tuesday 1:00 PM
MED delay risk
Six readiness dimensions

All six must align for discharge to actually happen

Open discharge map →
♡
Clinical readiness
75%Blocked
⚒
Functional & equipment readiness
90%Ready
℞
Medication readiness
88%Ready
$
Financial readiness
70%In progress
▦
Care coordination readiness
100%Ready
✿
Patient agreement & support readiness
50%Blocked
Unified readiness model

Three axes → one “ready” verdict

Not ready · 2 blockers
Axis 1 · Feasibility
Can this disposition happen? (engine = authority)
Clear
Target: HOME (provisional — unknown pending)
Binding: Clinical acuity · UNKNOWN
Axis 2 · Progress
How far along is the work? (tasks, not a score)
0/1 required
13% of execution tasks complete
Clinical readiness0/1
Medication readiness1/2
Patient agreement & support readiness0/5 ●
Axis 3 · Execution-staging
Is the bed actually secured? (acceptance pipeline)
No bed needed
Stage: Insurance Authorized
Home-track disposition · no external bed to confirm.
  • ●T2 gate not cleared: Patient/family OOP acceptance documented (if residual cost).
  • ●1 required execution task(s) still open.
Scalars (display-only): clinical 74 · operational 52 — non-authoritative; feasibility + progress above are the truth.
30-d readmission risk
LACE+ + HOSPITAL · HRRP-tracked
MODERATE

HRRP-tracked: COPD. Penalty applies if 30-d readmit exceeds risk-adjusted mean.

Drives pathway intensity tier — HIGH score adds Coleman / Naylor touchpoints automatically.

Active pathwayhigh risk

Home + CHF discharge bundle

disposition=HOME · services=HOME_DME+OUTPATIENT_PHARMACY

Open patient workflow →
7 / 22 steps
7 done3 in progress11 blocked1 pending

Intensity tier: LACE+ 7 (MODERATE) + HOSPITAL 1 (LOW) → MODERATE. · bumped by: HRRP-tracked condition

Engine-derived barriers

Top blockers · with one-click playbooks

0 barriers

No active barriers — every hard constraint for this patient is satisfied. Discharge reads on track.

Execution layer · HITL queue

Pending actions · awaiting clinician approval

0 open

Drafted by playbooks / AI · NOT sent until you approve. Approve fires the integration mock + writes a Submission audit row.

No pending actions. Click Run playbook on a barrier to draft one.
From the family · patient portal

What the caregiver has told us

Not started
Recovery preferenceWants to talk it through
TransportNot sure — wants a call
Home supportNeeds extra help
Preferred pharmacy—
Preferred languageEnglish
Discharge teaching0/3 videos watched
Workflow swim lanes

Tasks by role · cross-functional discharge orchestration

3 tasks
Hospitalist1
In progress
Hospitalist 'medically ready' attestation on file
Nursing0
No active tasks
Pharmacy0
No active tasks
PT / OT0
No active tasks
Case manager0
No active tasks
Social work1
In progress
Discharge preference form delivered to patient/caregiver
Event simulator · demo only

Fire a realistic event to watch the engine recompute

src/lib/engine/dispatcher.ts
Event feed · dynamic engine

What moved the pillars

0 total
No events yet. Use the simulator below to fire a payer decision, FHIR observation, or vendor callback and watch the pillars move.

AI chart summary · live via Anthropic Claude

Runs through runAgent · writes an AgentInference audit row with cost, latency, prompt hash.

Click Run chart summary to call Claude Sonnet 4.6 on this patient's record. The audit row will be visible in Neon's AgentInference table within ~3s.

Prior auth drafter · Claude → HITL → CoverMyMeds

Draft → review → approve → submit

Live wire

Drafts via src/lib/ai/agents/prior-auth-drafter.ts → submits via src/lib/integrations/cmm.ts (mock-contract). Both write audit rows.

Prior authorizations · M11

Each PA tracked Required → Submitted → Approved / Denied with the payer SLA clock. Runs concurrent with the referral, never serialized.

1 approved
Budesonide/formoterol (Symbicort)
160/4.5 mcg · INH
Approved
Aetna PPO· SLA 5d
→ Cleared — no action
SLA windows: Plan-specific (typical commercial PA SLA). Synthetic demo data.
Demo data · no PHI · mocked Epic + payer endpoints