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

Patient Discharge Cockpit

Maria Hernandez · CHF exacerbation (I50.9)
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MC
MH
Maria Hernandez
67 F · MRN-58332 · CHF exacerbation (I50.9)
PlanningUnit 5BCardiologyUninsured (charity-care pending)LOS 3d
ComorbiditiesHFpEFType 2 diabetes mellitusEssential hypertension
Estimated discharge
Tuesday 4:00 PM
HIGH delay risk
Six readiness dimensions

All six must align for discharge to actually happen

Open discharge map →
♡
Clinical readiness
83%Blocked
⚒
Functional & equipment readiness
70%Blocked
℞
Medication readiness
64%Blocked
$
Financial readiness
50%Blocked
▦
Care coordination readiness
50%In progress
✿
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)
0/2 required
0% of execution tasks complete
Clinical readiness0/1
Medication readiness0/2 ●
Patient agreement & support readiness0/5 ●
Axis 3 · Execution-staging
Is the bed actually secured? (acceptance pipeline)
No bed needed
Stage: Referral Drafted
Home-track disposition · no external bed to confirm.
  • ●2 engine constraint(s) violated: FUNCTIONAL, SOCIAL_SDOH.
  • ●T2 gate not cleared: Hospitalist 'medically ready' attestation on file.
  • ●T2 gate not cleared: Patient/family OOP acceptance documented (if residual cost).
  • ●2 required execution task(s) still open.
  • ●6 readiness gate(s) unmet: PT evaluation completed and documented; Prior auth approved for Sacubitril/valsartan (Entresto); Prior auth approved for Empagliflozin (Jardiance); Real-time payer eligibility + benefit detail verified at admit; Prior auth status for Sacubitril/valsartan (Entresto); Prior auth status for Empagliflozin (Jardiance).
Scalars (display-only): clinical 79 · operational 32 — non-authoritative; feasibility + progress above are the truth.
30-d readmission risk
LACE+ + HOSPITAL · HRRP-tracked
HIGH

HRRP-tracked: Heart failure. 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=REMOTE_MONITORING+HOME_DME+OUTPATIENT_PHARMACY · rules=rule-chf-discharge-bundle

Open patient workflow →
0 / 22 steps
0 done3 in progress18 blocked1 pending

Intensity tier: LACE+ 10 (HIGH) + HOSPITAL 1 (LOW) → HIGH. · bumped by: HRRP-tracked condition; coverage eligibility unresolved

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
Pharmacy1
In progress
Discharge medication reconciliation completed by pharmacist
PT / OT1
In progress
PT evaluation completed and documented
Case manager0
No active tasks
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.

2 to submit
Sacubitril/valsartan (Entresto)
49/51 mg · PO
Required
Uninsured (charity-care pending)· SLA 5d
→ Submit prior auth
Empagliflozin (Jardiance)
10 mg · PO
Required
Uninsured (charity-care pending)· SLA 5d
→ Submit prior auth
SLA windows: Plan-specific (typical commercial PA SLA). Synthetic demo data.
Demo data · no PHI · mocked Epic + payer endpoints