Every signal we evaluate originates in one of these ingestion sources. The protocol column is what we listen to or query.
| Source | Protocol | What it provides | Depth |
|---|---|---|---|
| Epic FHIR R4 (primary ADT + clinical ingest) | FHIR R4 Subscription + SMART-on-FHIR | Primary admit/discharge/transfer + clinical event ingest for Epic hospitals. FHIR Subscription on Patient, Encounter, Observation, MedicationRequest, ServiceRequest, Condition, AllergyIntolerance. | Mock contract |
| Redox (multi-EHR connector) | Redox API (HL7 + FHIR normalized) | Cerner, Athena, Meditech connectivity via Redox abstraction layer. | UI copy only |
| HL7 v2 ADT listener (fallback ADT) | HL7 v2.x A01/A03/A08 over MLLP | Fallback admit/discharge/transfer feed for non-Epic / legacy EHRs without FHIR Subscriptions. A01/A03/A08 events over MLLP. | UI copy only |
| Eligibility (X12 270/271) | X12 270 request → 271 response | Real-time payer eligibility check via clearinghouse. | UI copy only |
| Surescripts (formulary + benefit) | NCPDP SCRIPT | Real-time medication formulary, benefit, and pharmacy stock lookup. | UI copy only |
| Naviguide capacity feed | Naviguide REST API | Real-time SNF / HH / Hospice / ARU bed + capacity from in-network facilities. | UI copy only |
| DME partner capacity (Lincare, Apria, Inogen) | Vendor REST / EDI / portal scrape | Delivery slot availability + inventory from primary DME networks. | UI copy only |
| ModivCare NEMT capacity feed (read) | ModivCare REST | Inbound capacity feed: wheelchair van + stretcher availability across CA. Paired with modivcare-out for the booking submission. | UI copy only |
| Patient portal events | Internal SSE + REST | Caregiver preference, SNF rank, transport, education ack, consent. | UI copy only |
| Voalte ack stream | Vocera/Voalte webhook | Nurse/PT/Pharmacy task completion acks from existing messaging. | UI copy only |
| Brain tick (scheduled detectors) | Inngest cron | Time-based detectors — 4pm pharmacy cliff, Fri AM weekend forecast, daily digest. | UI copy only |
Six pillars × six input categories. A filled cell means the evaluator for that pillar reads that input category. (Per Phase 7 the "Payer / authorization" pillar was renamed Cost & coverage; the Cost & coverage evaluator considers insurance + charity + manufacturer + waiver paths, not just insurance pre-auth.)
| Pillar | EHR · clinical signals | PT/OT + functional | Medication signals | Coverage & eligibility | Resource capacity feeds | Patient / caregiver portal |
|---|---|---|---|---|---|---|
Clinical readiness | · | · | · | · | ||
Functional & equipment readiness | · | · | · | · | ||
Medication readiness | · | · | · | · | ||
Financial readiness | · | · | · | · | ||
Care coordination readiness | · | · | · | · | ||
Patient agreement & support readiness | · | · | · | · | · |
The Medical pillar evaluator combines six classes of signal into a deterministic 0–100 score. AI is not in the scoring path; it's only in narrative refresh on demand.
Each check has status PASS / PENDING / FAIL with a citation. The score is a weighted aggregation; a single blocking FAIL forces the pillar to BLOCKED regardless of overall percentage.
Operational readiness is composite — four pillars (Medication + Cost & coverage + Resources + Patient agreement) each compute independently and the dispatcher re-runs them on every event. There is no single "operational score"; the operational state is the conjunction of those four pillars.
The dynamic engine (src/lib/engine/dispatcher.ts) re-evaluates all four on every event — task complete, payer decision, vendor callback, portal submit, simulated FHIR observation. The EventFeed shows the per-pillar diffs (Medication 50 → 72, +22) so day-by-day evolution is visible.
Per CLAUDE.md house rules: every integration is classified. 0 live wires (real fetch/SDK against real vendor), 6 mock-contract modules (typed code exists in src/lib/integrations/ with mockSend + Submission audit row), and 31 UI-only entries (described in architecture copy but no module yet).
| Component | Layer | Depth |
|---|---|---|
| Epic FHIR R4 (primary ADT + clinical ingest) | INGESTION | Mock contract |
| Voalte ONE (secure clinician messaging) | OUTBOUND | Mock contract |
| TigerConnect (paging / on-call routing) | OUTBOUND | Mock contract |
| Twilio Programmable Messaging (SMS outreach) | OUTBOUND | Mock contract |
| Epic MyChart (portal push + tasks) | OUTBOUND | Mock contract |
| CoverMyMeds (PBM prior auth) | OUTBOUND | Mock contract |
| Redox (multi-EHR connector) | INGESTION | UI copy only |
| HL7 v2 ADT listener (fallback ADT) | INGESTION | UI copy only |
| Eligibility (X12 270/271) | INGESTION | UI copy only |
| Surescripts (formulary + benefit) | INGESTION | UI copy only |
| Naviguide capacity feed | INGESTION | UI copy only |
| DME partner capacity (Lincare, Apria, Inogen) | INGESTION | UI copy only |
| ModivCare NEMT capacity feed (read) | INGESTION | UI copy only |
| Patient portal events | INGESTION | UI copy only |
| Voalte ack stream | INGESTION | UI copy only |
| Brain tick (scheduled detectors) | INGESTION | UI copy only |
| Six-Dimension Readiness Engine | CORE | UI copy only |
| PaCHE barrier ontology + FSM | CORE | UI copy only |
| Brain detectors | CORE | UI copy only |
| AI agent layer (Claude via runAgent) | CORE | UI copy only |
| Resource matcher (graph) | CORE | UI copy only |
| Task orchestrator | CORE | UI copy only |
| Audit spine (AgentInference + Submission) | CORE | UI copy only |
| Event bus (Inngest workflows) | CORE | UI copy only |
| EHR writeback | OUTBOUND | UI copy only |
| Availity (medical PA + EDI) | OUTBOUND | UI copy only |
| Naviguide e-referral | OUTBOUND | UI copy only |
| Parachute Health (DME orders) | OUTBOUND | UI copy only |
| ModivCare NEMT booking submission (write) | OUTBOUND | UI copy only |
| Twilio + Vapi/Retell (voice agents) | OUTBOUND | UI copy only |
| Documo (e-fax fallback) | OUTBOUND | UI copy only |
| Notification bus | OUTBOUND | UI copy only |
| CM Console | UI | UI copy only |
| MD Widget (Epic Sidebar) | UI | UI copy only |
| Patient + Family Portal | UI | UI copy only |
| Voalte-style task feed | UI | UI copy only |
| Admin / Throughput dashboard | UI | UI copy only |