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
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Carlos Rivera
58 M · MRN-58410 · COPD exacerbation (J44.1)
Unit 5BMedicineAetna PPOLOS 2d
ComorbiditiesType 2 diabetes mellitusMorbid obesityObstructive sleep apneaEssential hypertension
Estimated discharge
Tuesday 1:00 PM
MED delay risk
Comorbidity profile · multi-condition interactions

4 comorbid conditions · 1 active interaction

Coded conditions (ICD-10-CM)
Primary: COPD exacerbation (J44.1)E11.9Type 2 diabetes mellitusE66.01Morbid obesity, BMI 38G47.33Obstructive sleep apnea (CPAP-dependent)I10Essential hypertension
Active interactions · cited registry
  • COPD + Obesity + OSA (overlap syndrome)
    cite: GOLD 2024 Report §5 + AASM Clinical Practice Guideline for OSA
    Watch-out: DME setup must include BOTH home O₂ AND CPAP coordinated delivery — vendor mix-ups cause 7-day ED returns.
    Additional needs unlocked
    cpap bipapoxygeneducationfood nutrition
    Outpatient follow-up
    • · Pulmonology ≤ 14d
    • · Sleep medicine ≤ 30d
    • · PCP for weight management ≤ 30d
    2 contraindications & education modules
    Contraindications
    • · Sedating analgesics (opioids, benzodiazepines) risk hypoventilation — avoid or co-prescribe naloxone
    • · Avoid supine sedating positions during transport
    Education modules
    • · CPAP adherence (≥ 4h/night) coordinated with COPD inhaler regimen
    • · Recognize hypercapnic decompensation (morning headache, confusion)
    • · Weight management as part of pulmonary plan
Contraindications
2
Follow-ups required
3
Earliest follow-up
14d
Six readiness dimensions

All six must align for discharge to actually happen

Open discharge map →
♡
Medical readiness
Blocked
Readiness75%
⚒
Functional readiness
Ready
Readiness83%
℞
Medication readiness
Ready
Readiness88%
✓
Payer / authorization readiness
Ready
Readiness88%
▦
Resource availability
Ready
Readiness90%
✿
Patient + caregiver agreement
Blocked
Readiness50%
Discharge readiness
74%
Clinical
MD criteria, labs, vitals
52%
Operational
Auth, PT, transport, prefs
Operational readiness lifts as tasks complete. Goal: both ≥ 80% by 15:00 today to release tomorrow's discharge.
Predicted disposition
Home + Home Health
0.76 conf.
Rationale: prior CHF admission 2025-11, NYHA III, frailty score 0.43, caregiver POA available. Primary tilt → SNF for 7-day cardiac reconditioning; viable HH path if caregiver capacity confirmed.
Discharge timeline
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.
Decision engine

Needs × Coverage × Resources

1 mismatch
Needs
Clinical + functional set
Coverage
All authorized
Resources
Vendor / SNF gap
1 edge red-dashed — fallback path warming
  • · Needs ↔ Resources: caregiver / clinical need has no booked resource yet
PaCHE barriers

Top blockers

1 barriers
  • E — ExternalUnder resolutionOwner: case manager
    DME arrangement delay (O₂)

    Lincare ETA Wed 11 AM; Apria booked as backup.

Next best actions

Recommended by OpenBed AI

4 ranked
  • Before 2:00 PM
    Request PT mobility evaluation

    Required before SNF accepts; slot before 2:00 PM.

    via Internal · Rehab Services

  • Today
    Send patient/caregiver SNF preference form

    Push portal form to Carla (daughter, POA).

    via Patient Portal · SMS + email

  • Now
    Check medication coverage & pharmacy availability

    Verify Entresto formulary tier + CVS Mission St stock + PA TAT.

    via BlueShield MA · CoverMyMeds · CVS

  • Submit by 10:30 AM
    Start SNF authorization packet

    Submit prior auth via BlueShield MA. Avg TAT 22h — submit today.

    via BlueShield MA · CoverMyMeds

Active tasks

For this patient

Open full task board →
  • Waiting externalConfirm Lincare O₂ delivery windowVoice-Agent
Workflow swim lanes

Tasks by role · cross-functional discharge orchestration

1 tasks
Hospitalist0
No active tasks
Nursing0
No active tasks
Pharmacy0
No active tasks
PT / OT0
No active tasks
Case manager0
No active tasks

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.

Medical readiness · deterministic rule engine

Reads cited criteria from src/lib/discharge/compliance.ts · scores deterministically · no AI involvement in severity.

75%
BLOCKED

Medical readiness 75% · 0 criteria failing (1 blocking). Patient not yet medically dischargeable.

Functional readiness · deterministic rule engine

Reads cited criteria from src/lib/discharge/functional-criteria.ts · scores deterministically · no AI involvement in severity.

83%
READY

Functional readiness 83% · 4/6 criteria pass; PT/OT documented and within target.

Medication readiness · deterministic rule engine

Reads cited criteria from src/lib/discharge/medication-criteria.ts · scores deterministically · no AI involvement in severity.

88%
READY

Medication readiness 88% · 3/4 criteria pass; reconciled and PAs cleared.

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.

⚙How this screen works
Cockpit is the single-pane view of one patient's six-pillar state
Inputs
What this screen reads
  • Epic FHIR encounter + clinical signals + medications
  • Cross-references to barriers, tasks, resource matches, portal state
  • Six-pillar engine snapshot for this patient
Engine
What it computes
  • Re-computes pillars whenever an event tied to this patient lands
  • Re-ranks Next-Best-Actions based on current barriers + readiness
  • Triggers chart-summarizer agent (Claude) on demand for the summary refresh
Outputs
What it writes / routes
  • Action buttons dispatch into the task orchestrator
  • 'Send preference form' pushes to portal via SSE
  • 'Start prior auth' fires CoverMyMeds submission + writes Submission row
  • Every approved action writes an AgentInference + Submission audit pair
Refresh trigger
When it updates
  • Any new FHIR observation on this patient
  • Any task completion that mentions this patientId
  • Any payer webhook for this patient's auths
  • Any portal event from caregiver
Partners involved:Anthropic Claude (via runAgent)CoverMyMeds (PA submission)Naviguide (SNF referral)ModivCare (NEMT booking)
Demo data · no PHI · mocked Epic + payer endpoints