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

Patient Discharge Cockpit

Linda Kowalski · Hip fx, POD-3 (S72.001A)
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LK
Linda Kowalski
68 F · MRN-58104 · Hip fx, POD-3 (S72.001A)
Ready · pending logisticsUnit 5BOrthoMedicare FFSLOS 5d
ComorbiditiesAtrial fibrillationCOPDType 2 diabetes mellitusPersonal history of TIA/cerebral infarction
Estimated discharge
Tuesday 11:00 AM
HIGH delay risk
Six readiness dimensions

All six must align for discharge to actually happen

Open discharge map →
♡
Clinical readiness
100%Ready
⚒
Functional & equipment readiness
50%In progress
℞
Medication readiness
79%Blocked
$
Financial readiness
63%Blocked
▦
Care coordination readiness
83%Ready
✿
Patient agreement & support readiness
50%Blocked
Unified readiness model

Three axes → one “ready” verdict

Not ready · 5 blockers
Axis 1 · Feasibility
Can this disposition happen? (engine = authority)
2 blocker(s)
Target: HOME
Binding: Functional status · VIOLATED
Axis 2 · Progress
How far along is the work? (tasks, not a score)
0/1 required
22% of execution tasks complete
Clinical readiness1/1
Medication readiness1/2
Patient agreement & support readiness0/6 ●
Axis 3 · Execution-staging
Is the bed actually secured? (acceptance pipeline)
Awaiting bed
Stage: Insurance Authorized
Facility-bound · not yet bed-confirmed (blocks completion).
  • ●2 engine constraint(s) violated: FUNCTIONAL, SOCIAL_SDOH.
  • ●Acceptance pipeline not at Bed Confirmed (currently INSURANCE_AUTHORIZED).
  • ●T2 gate not cleared: Patient/family OOP acceptance documented (if residual cost).
  • ●1 required execution task(s) still open.
  • ●3 readiness gate(s) unmet: Prior auth approved for Apixaban (Eliquis); Prior auth status for Apixaban (Eliquis); Post-acute service auth (SNF) initiated within payer SLA.
Scalars (display-only): clinical 92 · operational 38 — non-authoritative; feasibility + progress above are the truth.
30-d readmission risk
LACE+ + HOSPITAL · HRRP-tracked
HIGH

HRRP-tracked: THA/TKA (hip fx). Penalty applies if 30-d readmit exceeds risk-adjusted mean.

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

Active pathwayhigh risk

SNF skilled rehab

disposition=SNF · services=OUTPATIENT_PT_OT · rules=rule-medicare-snf-skilled,rule-hip-fx-snf-rehab

Open patient workflow →
6 / 16 steps
6 done2 in progress8 blocked0 pending

Intensity tier: LACE+ 11 (HIGH) + HOSPITAL 4 (LOW) → HIGH. · 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

4 tasks
Hospitalist0
No active tasks
Nursing0
No active tasks
Pharmacy1
In progress
Prior auth approved for Apixaban (Eliquis)
PT / OT0
No active tasks
Case manager3
Waiting
Schedule MD peer-to-peer (SNF denial)
Maria Chen, RN
Assigned
Post-acute service auth (SNF) initiated within payer SLA
In progress
Prior auth status for Apixaban (Eliquis)
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 to submit
Apixaban (Eliquis)
5 mg · PO
Required
Medicare FFS· SLA 14d
→ Submit prior auth
SLA windows: Medicare FFS · Local Coverage Determinations. Synthetic demo data.
Resource referral · HITL gate

Registry-matched post-acute site. Sending writes the legally-load-bearing Submission (licensed reviewer) and opens the acceptance loop.

Stanford Health Care Skilled Nursing
SNF · Santa Clara CountyUNVERIFIED· 5★· 25 candidates
Channel decision
Community Resource Registryrecommended
Structured referral with a tracked acceptance loop + audit row; closes back via the acceptance webhook.
Direct fax to facility
No acceptance tracking, no structured response — bed-days lost in the gap.
Phone to intake
Verbal only — no defensible artifact of what was sent.
Compliance evidence1 blocking issue · action gated
  • Accepting provider identifiedblocking
    Stanford Health Care Skilled Nursing matched from the registry for this disposition + coverage.
    cite: 42 CFR §482.43(c) · accepting provider documented
  • Patient choice documentedblocking
    No recovery preference captured yet — send the preference form and wait for the family before referring.
    cite: 42 CFR §482.43(c) · patient freedom of choice
  • Coverage path confirmed
    Eligibility verified (X12 270/271) — the payer path is open.
    cite: X12 270/271 eligibility
  • Required capabilities met
    No special capabilities required for this placement.
    cite: IMPACT Act 2014 · PAC capability match
  • Reviewer is licensed to submitblocking
    Submitting reviewer carries an active credential — the referral is on their license.
    cite: State board · HITL submission gate
A blocking rule failed — most often the family hasn't confirmed a recovery preference yet. The referral waits on the patient's choice (their portal).
Demo data · no PHI · mocked Epic + payer endpoints