{"service":"scrimed-governance-learning-loop","mission":"SCRIMED governance turns memory, auditability, policy enforcement, learning artifacts, value pricing, regulatory watch, and interoperability readiness into a healthcare AI operating advantage.","status":"active-synthetic-no-phi-governance-layer","activeModules":["Governance + Learning Loop Control Plane","Contextual Agent Policy Engine","A2A + MCP Readiness Layer","AI Visibility Layer","Value-Based Pricing Framework","Healthcare AI Governance Dashboard","Radiology Imaging-to-Action Workflow","Wearables Intelligence Foundation","Regulatory Watch Layer","Agent Observability + Audit Trail","Skills Activation Registry"],"policyVersion":"scrimed-safety-governance-v2026-06-29","clinicalBoundaries":["No live PHI or source patient records.","No autonomous clinical decisioning.","No diagnosis, treatment, prescribing, or final triage authority.","No EHR writeback, order entry, chart mutation, or payer submission.","Clinical-facing outputs stay decision support, education, workflow support, or administrative automation.","Human review, audit evidence, and escalation remain required for clinical-facing and irreversible workflows."],"policyLevels":[{"level":"public_safe","decision":"allow","description":"Synthetic, public-safe, no-PHI educational or governance content.","requiredControl":"Audit hash and boundary statement."},{"level":"review_required","decision":"require_review","description":"Clinical-facing, confidential, external-action, or high-cost work that stays inside no-PHI limits.","requiredControl":"Human approval before external use or artifact promotion."},{"level":"blocked","decision":"deny","description":"PHI export, payer submission, EHR writeback, diagnosis, treatment, prescribing, or irreversible production action.","requiredControl":"Fail closed and route to boundary-release approvals."}],"learningLoopStages":[{"stage":"observe","purpose":"Capture metadata-only traces, policy decisions, reviewer notes, route outcomes, and safety flags.","output":"Memory artifact"},{"stage":"evaluate","purpose":"Score schema fidelity, evidence quality, safety, workflow value, and reviewer disposition.","output":"Evaluation packet"},{"stage":"correct","purpose":"Create a correction artifact only after the failure mode is understood.","output":"Correction artifact"},{"stage":"approve","purpose":"Require human approval before changing prompts, policies, workflows, demos, or buyer-facing claims.","output":"Approval record"},{"stage":"update_artifact","purpose":"Update the prompt, policy, workflow, registry, benchmark, or documentation artifact.","output":"Versioned artifact"},{"stage":"retest","purpose":"Run contract, smoke, benchmark, and regression checks before promotion.","output":"Retest evidence"},{"stage":"monitor","purpose":"Track drift, cost, latency, reviewer outcomes, safety flags, and buyer-value metrics.","output":"Monitoring signal"}],"pricingModel":[{"metricId":"denial-risk-reduction","name":"Denial risk reduction","buyerValue":"Find missing documentation, policy-risk language, and appeal-readiness gaps before submission.","pricingSignal":"Price by recovered staff time, reduced rework, and prevented avoidable denials.","measuredWith":"Synthetic prior-auth and documentation-before-authorization scorecards.","boundary":"No payer submission or reimbursement guarantee."},{"metricId":"documentation-time-saved","name":"Documentation time saved","buyerValue":"Reduce review, packet assembly, and handoff effort for human-reviewed workflows.","pricingSignal":"Price by workflow volume, role burden, and validated time-saved estimate.","measuredWith":"No-PHI task timing, reviewer disposition, and acceptance criteria.","boundary":"No autonomous chart filing, diagnosis, treatment, or EHR writeback."},{"metricId":"workflow-throughput","name":"Workflow throughput","buyerValue":"Increase referral, scheduling, intake, and care-coordination visibility without live patient automation.","pricingSignal":"Price by routed workflow count, dashboard readiness, and governance overhead reduced.","measuredWith":"Synthetic queue, status, and escalation metrics.","boundary":"No patient outreach or live clinical action."},{"metricId":"governance-readiness","name":"Governance readiness","buyerValue":"Give leadership an audit-ready operating model for AI review, safety, and evidence.","pricingSignal":"Price as recurring readiness retainer, evidence packet, or governance implementation work.","measuredWith":"Policy coverage, smoke coverage, boundary register, and audit hash completeness.","boundary":"No certification, legal approval, security assurance, or customer go-live claim."}],"regulatoryWatchScope":[{"domain":"HIPAA privacy and security readiness","watchItems":["BAA readiness","minimum necessary principle","audit trail","de-identification","retention"],"currentUse":"Readiness monitoring only; no certification claim."},{"domain":"HTI-6 and ONC interoperability signals","watchItems":["FHIR APIs","USCDI alignment","algorithm transparency","information blocking risk"],"currentUse":"Product roadmap and evidence-gap tracking."},{"domain":"FHIR and identity rules","watchItems":["FHIR R4/R5 readiness","SMART launch","patient matching","HHS identity policy"],"currentUse":"Synthetic validation and architecture planning."},{"domain":"OCR and HHS enforcement signals","watchItems":["privacy enforcement","AI guidance","cybersecurity guidance","patient access rules"],"currentUse":"Governance watch only; legal review required before claims or production use."}],"a2aMcpReadiness":{"status":"metadata_ready_no_production_connectors","a2a":{"purpose":"Allow SCRIMED agents to hand off tasks with identity, scope, risk, memory summary, and approval state.","requiredControls":["agent identity","permission scope","audit event","human review for high-risk work"]},"mcp":{"purpose":"Expose governed tool access through scoped middleware instead of direct agent-to-system access.","requiredControls":["deny-by-default tools","scoped tokens","tool-level authorization","revocation","audit logs"]},"boundary":"No production connector approval, raw schema exposure, payer submission, EHR writeback, or live PHI access."},"skillsActivated":[{"id":"governance-skill","name":"Governance Skill","purpose":"Route every sensitive SCRIMED action through policy, review, audit, and retained boundaries.","inputs":["agent session","requested action","tool scope","safety policy"],"outputs":["policy decision","risk score","audit event"],"guardrails":["No live PHI or source patient records.","No autonomous clinical decisioning.","No diagnosis, treatment, prescribing, or final triage authority.","No EHR writeback, order entry, chart mutation, or payer submission.","Clinical-facing outputs stay decision support, education, workflow support, or administrative automation.","Human review, audit evidence, and escalation remain required for clinical-facing and irreversible workflows."],"activationStatus":"active","maturityLevel":"review_ready","nextAction":"Bind governance decisions to every future clinical-facing route and demo artifact."},{"id":"agent-learning-skill","name":"Agent Learning Skill","purpose":"Turn reviewed failures into correction artifacts, retests, and monitored improvements.","inputs":["trace metadata","reviewer note","benchmark result"],"outputs":["correction artifact","regression test candidate","learning update"],"guardrails":["Memory is not learning until evaluated, approved, retested, and monitored."],"activationStatus":"active","maturityLevel":"lab_ready","nextAction":"Promote failed synthetic traces into reusable regression cases."},{"id":"clinical-safety-skill","name":"Clinical Safety Skill","purpose":"Keep clinical-facing content in decision-support and human-review lanes.","inputs":["clinical-facing flag","risk score","evidence status"],"outputs":["review requirement","red flag","boundary statement"],"guardrails":["No live PHI or source patient records.","No autonomous clinical decisioning.","No diagnosis, treatment, prescribing, or final triage authority.","No EHR writeback, order entry, chart mutation, or payer submission.","Clinical-facing outputs stay decision support, education, workflow support, or administrative automation.","Human review, audit evidence, and escalation remain required for clinical-facing and irreversible workflows."],"activationStatus":"active","maturityLevel":"review_ready","nextAction":"Map every clinical module to reviewer role, escalation reason, and benchmark domain."},{"id":"regulatory-watch-skill","name":"Regulatory Watch Skill","purpose":"Track HIPAA, HTI-6, FHIR, OCR, HHS identity, and adjacent AI governance signals.","inputs":["regulatory domain","source category","impact note"],"outputs":["watch item","owner","roadmap implication"],"guardrails":["Legal review required before claims, policy changes, or production release."],"activationStatus":"lab_only","maturityLevel":"defined","nextAction":"Attach owners and update cadence for each watch domain."},{"id":"ai-visibility-skill","name":"AI Visibility Skill","purpose":"Help AI search engines describe SCRIMED accurately using public boundaries and canonical routes.","inputs":["llms.txt","canonical page map","approved claims"],"outputs":["AI-safe overview","product map","description guardrails"],"guardrails":["No autonomous clinical care framing, no certification claim, no live PHI claim."],"activationStatus":"active","maturityLevel":"lab_ready","nextAction":"Add structured page metadata recommendations to high-value public routes."},{"id":"value-pricing-skill","name":"Value Pricing Skill","purpose":"Tie price to measurable workflow value rather than token usage or generic chatbot access.","inputs":["workflow metric","buyer segment","proof route"],"outputs":["pricing signal","pilot offer","margin guardrail"],"guardrails":["No ROI guarantee, revenue guarantee, reimbursement assurance, or audited financial claim."],"activationStatus":"active","maturityLevel":"review_ready","nextAction":"Create audience-specific pricing proof packets for clinics, health systems, and strategic partners."},{"id":"radiology-workflow-skill","name":"Radiology Workflow Skill","purpose":"Convert imaging workflow metadata into follow-up, routing, documentation, and review readiness.","inputs":["synthetic imaging metadata","turnaround status","follow-up flag"],"outputs":["workflow action recommendation","review requirement","audit event"],"guardrails":["No final imaging interpretation or diagnostic authority."],"activationStatus":"lab_only","maturityLevel":"defined","nextAction":"Bind imaging-to-action scenarios to DICOM metadata, specialist review, and closed-loop follow-up status."},{"id":"wearables-intelligence-skill","name":"Wearables Intelligence Skill","purpose":"Prepare no-PHI trend, adherence, access, and escalation workflows for wearable and remote monitoring data.","inputs":["synthetic time-series","device status","trend summary"],"outputs":["review signal","accessibility note","workflow escalation"],"guardrails":["No diagnosis, emergency triage replacement, or patient outreach automation."],"activationStatus":"lab_only","maturityLevel":"defined","nextAction":"Define synthetic time-series scenarios and human escalation thresholds."},{"id":"interoperability-skill","name":"Interoperability Skill","purpose":"Keep A2A, MCP, FHIR, HIE, and identity integration plans governed and connector-safe.","inputs":["standard","tool scope","identity context"],"outputs":["readiness status","blocked action","integration boundary"],"guardrails":["No production connector activation or raw system-of-record access."],"activationStatus":"active","maturityLevel":"lab_ready","nextAction":"Map MCP tools to explicit per-agent authorization scopes."},{"id":"observability-skill","name":"Observability Skill","purpose":"Trace cost, latency, tool calls, policy events, reviewer outcomes, and safety signals.","inputs":["agent trace","policy event","benchmark result"],"outputs":["trace summary","audit hash","monitoring signal"],"guardrails":["No token, secret, PHI, or raw connector payload logging."],"activationStatus":"active","maturityLevel":"review_ready","nextAction":"Attach learning-loop stages to AI Flight Recorder outputs."},{"id":"devsecops-skill","name":"DevSecOps Skill","purpose":"Protect the build with contract checks, smoke tests, boundary scans, and route integrity.","inputs":["source diff","contract check","smoke result"],"outputs":["pass/fail evidence","blocker","release note"],"guardrails":["No deployment promotion without explicit human approval."],"activationStatus":"active","maturityLevel":"review_ready","nextAction":"Add governance-learning loop to nonsecret and public smoke coverage."},{"id":"investor-narrative-skill","name":"Investor Narrative Skill","purpose":"Translate governance, safety, workflow value, and platform architecture into a diligence-ready story.","inputs":["proof route","scorecard","value metric"],"outputs":["pitch point","demo path","safe claim"],"guardrails":["No securities advice, valuation assurance, certification claim, or customer go-live claim."],"activationStatus":"active","maturityLevel":"review_ready","nextAction":"Build a founder run-of-show connecting value pricing, governance, and proof routes."}],"radiologyImagingToAction":{"status":"lab_only_workflow_metadata","purpose":"Convert synthetic imaging workflow signals into routing, follow-up, documentation, and specialist-review readiness without final interpretation.","actions":["flag delayed imaging turnaround","route to human imaging reviewer","prepare follow-up checklist","bind provenance to synthetic DICOM metadata","track closed-loop follow-up status"],"boundary":"No final medical interpretation, diagnosis, treatment, or autonomous patient outreach."},"wearablesIntelligence":{"status":"lab_only_synthetic_time_series","purpose":"Prepare future RPM and wearable-data workflows around trends, access, adherence, and review queues.","signals":["device connectivity gap","trend anomaly","adherence risk","accessibility barrier","review threshold reached"],"boundary":"No emergency triage replacement, diagnosis, prescribing, patient outreach, or live-monitoring claim."},"sampleCorrectionArtifact":{"artifactId":"correction-synthetic-policy-review-001","sourceTraceId":"trace-synthetic-agent-review-001","correctionType":"policy","memorySummary":"The trace stored what happened: an agent attempted a clinical-facing output after reading untrusted content.","learningUpdate":"The next attempt must require human review, evidence grounding, prompt-injection risk elevation, and retest before artifact promotion.","approvalRequired":true,"retestRequired":true,"monitorMetric":"clinical-facing outputs with reviewer approval before promotion","auditHash":"scrimed-intel-8bbedab3"},"recommendedNextBuildStep":"Bind the governance-learning loop to AI Flight Recorder traces so failed synthetic traces can become reviewed regression cases before any artifact promotion.","productionReadiness":false,"noPhiConfirmed":true,"safetyStatement":"Research/demo use only. SCRIMED supports human-reviewed decision support, education, workflow support, and administrative automation only."}