# SCRIMED Intelligence & Safety Stack

Status: scrimed-intelligence-safety-stack-sentinel-ready-synthetic-only
API: /api/scrimed-intelligence-safety-stack
Evaluator: /api/scrimed-intelligence-safety-stack/evaluate

## Boundary
SCRIMED Intelligence & Safety Stack is a synthetic and metadata-only governance layer. It does not process live PHI, execute autonomous clinical care, diagnose, treat, prescribe, submit payer transactions, write to EHRs, rotate real credentials, change cloud IAM, execute payments, deploy production, send external communications, claim certification, or approve customer go-live.

## Project SENTINEL
- sentinel-allow-synthetic-read: allow; action synthetic_metadata_read; tool synthetic_registry; hash scrimed-intel-d219bc77
- sentinel-human-approval-production-deploy: human_approval_required; action production_deploy; tool synthetic_registry; hash scrimed-intel-b1d2afbf
- sentinel-kill-switch-cloud-iam: kill_switch_triggered; action cloud_iam_change; tool cloud_iam; hash scrimed-intel-f57200b2

## Sentinel Review Packets
- sentinel-review-packet-sentinel-human-approval-production-deploy: human_approval_required; priority urgent; missing explicit human approval disposition; hash scrimed-intel-bb376e86
- sentinel-review-packet-sentinel-kill-switch-cloud-iam: kill_switch_triggered; priority critical; missing explicit human approval disposition, kill-switch investigation notes, root-cause classification; hash scrimed-intel-efb364c8

## Sentinel Regression Manifest
- Manifest: sentinel-regression-manifest-synthetic-v1.
- Status: candidate_manifest_ready_review_only.
- Cases: 2.
- Scope: synthetic metadata only; no PHI, no secrets, no tool execution, no external calls, and no autonomous clinical or payer action.

## Sentinel Regression Promotion Gate
- Gate: sentinel-regression-promotion-gate-v1.
- Status: promotion_gate_ready_review_only.
- Blocked cases: 2.
- Allowed target: nonsecret_pytest_regression_metadata.
- No execution authority: true.

## Sentinel Regression Disposition Preview
- Route: /api/scrimed-intelligence-safety-stack/regression-disposition-preview.
- Samples: 2.
- Purpose: validate reviewer disposition metadata without persistence, PHI, secrets, tool execution, external calls, or production authority.

## AI Flight Recorder
- flight-trace-sentinel-allow-synthetic-read: allow; outcome completed; latency 18ms; hash scrimed-intel-d219bc77
- flight-trace-sentinel-human-approval-production-deploy: human_approval_required; outcome queued_for_review; latency 29ms; hash scrimed-intel-b1d2afbf
- flight-trace-sentinel-kill-switch-cloud-iam: kill_switch_triggered; outcome queued_for_review; latency 40ms; hash scrimed-intel-f57200b2

## Clinical Safety
- clinical-correctness-envelope-001: confidence 0.74; evidence moderate; groundedness partly_inferred; clinician review true

## Data Infrastructure
- FHIR: canonical_semantic_metadata; raw payload logging blocked
- HL7_V2: canonical_semantic_metadata; raw payload logging blocked
- CDA_CCDA: canonical_semantic_metadata; raw payload logging blocked
- DICOM_METADATA: canonical_semantic_metadata; raw payload logging blocked
- CSV: canonical_semantic_metadata; raw payload logging blocked
- JSONL: canonical_semantic_metadata; raw payload logging blocked
- SCANNED_DOCUMENT_OCR: canonical_semantic_metadata; raw payload logging blocked
- FREE_TEXT_CLINICAL_NOTES: canonical_semantic_metadata; raw payload logging blocked

## Outcomes
- documentation_time_saved: review after 100-200 patients; minutes saved per signed human-reviewed workflow
- denial_reduction: review after 100-200 patients; avoidable denial rate after documentation completeness review
- readmission_reduction: review after 100-200 patients; human-reviewed care-transition gap closure rate
- referral_completion: review after 100-200 patients; closed-loop referral completion with documented owner
- medication_availability: review after 100-200 patients; availability issue routed to human medication support owner
- patient_comprehension: review after 100-200 patients; teach-back comprehension checkpoint completion

## Validation
- PASS sentinel-deny-by-default: Sentinel blocks irreversible actions without approval and triggers kill switches for suspicious access.
- PASS all-agent-actions-are-audited: Every sample action passes through identity, policy, permission, scoped tool access, execution, and audit log.
- PASS flight-recorder-has-local-wal: Flight recorder records are designed for metadata-only local write-ahead logs and later sync.
- PASS clinical-correctness-is-not-capability: Clinical outputs separate capability from correctness and route high-risk material to clinicians.
- PASS data-adapters-block-raw-payload-logging: FHIR, HL7 v2, CDA/C-CDA, DICOM metadata, CSV, JSONL, OCR, and notes adapters block raw payload logs.
- PASS outcomes-review-after-100-200-patients: Outcome tracking prioritizes pilot review after the first 100-200 patients rather than vanity metrics.
- PASS orchestration-exposes-plan-state-budget-risk: Agents expose current plan, tool history, state, remaining steps, budget, and risk level.
- PASS compliance-and-emotional-ai-guardrails-present: Compliance scaffolds and anthropomorphic AI safeguards are present.
- PASS sentinel-review-packets-cover-blocked-events: Every blocked or review-required Sentinel event has a read-only review packet with protected persistence blocked.
- PASS sentinel-review-packets-cannot-dispose-to-execution: Review packets allow pass/fail/needs-more-evidence only; they cannot execute production actions or store PHI.
- PASS sentinel-regression-manifest-covers-candidates: Every review packet flagged as a regression candidate appears in the synthetic Sentinel regression manifest.
- PASS sentinel-regression-manifest-is-nonsecret-review-only: Regression candidates are nonsecret, metadata-only, human-review-gated, and blocked from clinical or payer execution.
- PASS sentinel-regression-promotion-gate-blocks-unreviewed-cases: Regression cases cannot be promoted until a human reviewer passes the failed trace.
- PASS sentinel-regression-promotion-gate-has-no-execution-authority: Promotion decisions can only produce nonsecret regression metadata and never authorize clinical, payer, EHR, or PHI-impacting actions.
- PASS sentinel-regression-disposition-preview-is-nonpersistent: Reviewer disposition previews validate metadata only and do not persist decisions or grant execution authority.
- PASS sentinel-regression-disposition-preview-rejects-secrets-and-phi: Disposition previews reject token-like fields and PHI-like notes before any regression promotion preview.

## Next Build Step
Persist Sentinel audit events to the protected durable store only after the same AAL2, tenant-role, RLS, and boundary-release approvals used by other protected SCRIMED operator flows are fresh.