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

Patient Discharge Cockpit

Frank DelaCruz · STEMI s/p PCI (I21.3)
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MC
FD
Frank DelaCruz
69 M · MRN-58118 · STEMI s/p PCI (I21.3)
Unit 5BCardiologyMedicare FFSLOS 4d
Estimated discharge
Tuesday 12:00 PM
LOW delay risk
Six readiness dimensions

All six must align for discharge to actually happen

Open discharge map →
♡
Medical readiness
Blocked
Readiness92%
⚒
Functional readiness
Blocked
Readiness67%
℞
Medication readiness
Blocked
Readiness88%
✓
Payer / authorization readiness
Blocked
Readiness50%
▦
Resource availability
In progress
Readiness50%
✿
Patient + caregiver agreement
Blocked
Readiness50%
Discharge readiness
80%
Clinical
MD criteria, labs, vitals
80%
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 (independent)
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

All edges aligned
Needs
Clinical + functional set
Coverage
All authorized
Resources
Booked
All three dimensions aligned. Disposition path is executable; transport + meds-to-beds queued.
PaCHE barriers

Top blockers

0 barriers
    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 →
    • CompleteCardiac rehab Phase II referralMaria Chen, RN
    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 manager1
    Done
    Cardiac rehab Phase II referral
    Maria Chen, RN

    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.

    92%
    BLOCKED

    Medical readiness 92% · 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.

    67%
    BLOCKED

    Functional readiness 67% · 0 criteria failing (1 blocking). Patient not yet functionally dischargeable to proposed setting.

    Medication readiness · deterministic rule engine

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

    88%
    BLOCKED

    Medication readiness 88% · 0 criteria failing (1 blocking). Patient not yet medication-safe for discharge.

    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