# SCRIMED OS Upgrade Batch

Status: scrimed-os-upgrade-batch-ready-no-phi
Updated: 2026-07-03
Data boundary: synthetic-metadata-only-no-live-phi
Production behavior: disabled
External model calls: disabled
Clinical authority: not-authorized

## Boundary
SCRIMED OS upgrade batch is synthetic and metadata-only. It does not call live models, process PHI, generate clinical recommendations, diagnose, treat, prescribe, interpret imaging, mutate EHRs, submit payer transactions, contact patients, activate production connectors, claim certification, validate clinical performance, or approve customer go-live.

## Runtime Optimizer
- Status: runtime-optimizer-metadata-ready
- Simulated cost savings: 30%
- Guardrail state: blocked
- Prompt compression: low; interactive; synthetic-only; fallback synthetic-fallback-provider -> no external model call
- Context compression: balanced; standard; human-review-required; fallback context-gateway-envelope -> reviewer queue
- Semantic caching: low; interactive; synthetic-only; fallback cache miss -> synthetic provider -> human review if risk rises
- Dynamic model routing: premium-controlled; batch; blocked-for-production; fallback enterprise-reasoning-synthetic -> local fallback -> no answer with escalation

## Prompt Evolution Engine
- clinical-summary-draft-synthetic@v0.4.0: clinical-summary-draft; review_ready; baseline 72; optimized 84; review true
- prior-auth-packet-draft@v0.3.2: prior-auth-evidence-prep; lab_only; baseline 69; optimized 81; review false
- diagnosis-finalizer@blocked-v0: clinical-final-decision; blocked; baseline 0; optimized 0; review true

## Clinical Judge Ensemble
- AI can pre-screen; clinician remains final authority.
- clinical_quality_judge: scores-and-rationale-hashes-only; blocked diagnosis, treatment recommendation, prescribing
- evidence_judge: scores-and-rationale-hashes-only; blocked uncited clinical assertion, fabricated evidence
- safety_judge: scores-and-rationale-hashes-only; blocked autonomous care, patient outreach, emergency triage
- payer_policy_judge: scores-and-rationale-hashes-only; blocked payer submission, coverage determination, reimbursement guarantee
- specialty_judge: scores-and-rationale-hashes-only; blocked specialist diagnosis, therapy selection
- patient_readability_judge: scores-and-rationale-hashes-only; blocked patient instruction delivery, patient messaging

## Human Oversight Queue
- d0f7d6211bd58685: clinical-summary-draft; high; blocked; allowed false; reviewer licensed clinician reviewer
- d31d4b6b9632114e: prior-auth-evidence-packet; medium; in_review; allowed false; reviewer payer operations reviewer
- 57e78b796848ef63: token-economics-review; low; human_reviewed; allowed true; reviewer operations owner

## Agent Lab
- clinical-intake-agent: owner Clinical Ops; risk high; data synthetic; audit c5cd26ff60de
- prior-auth-agent: owner Payer Ops; risk low; data synthetic; audit 95f296155c0c
- rcm-denials-agent: owner Revenue Cycle; risk low; data synthetic; audit 72599f299ce7
- population-health-agent: owner Population Health; risk high; data synthetic; audit d584071dc46c
- trust-verifier-agent: owner Trust/Safety; risk medium; data metadata; audit d53d67629860

## Cost Per Outcome
- cost_per_note: $0.38 per reviewable draft note; avoids tokens generated
- cost_per_claim_review: $0.22 per reviewable claim issue summary; avoids raw prompt count
- cost_per_prior_auth_draft: $0.44 per draft evidence packet; avoids model call volume
- cost_per_patient_summary: $0.31 per synthetic summary for review; avoids context window size
- cost_per_agent_run: $0.57 per audited synthetic run; avoids agent step count

## Long-Horizon Agent Registry
- Diabetes Coach: lab_only; human override true; memory Synthetic memory only; no live patient memory or cross-tenant recall.
- Heart Failure Monitor: lab_only; human override true; memory Synthetic memory only; no live patient memory or cross-tenant recall.
- Oncology Navigator: lab_only; human override true; memory Synthetic memory only; no live patient memory or cross-tenant recall.
- Population Health Agent: lab_only; human override true; memory Synthetic memory only; no live patient memory or cross-tenant recall.
- Hospital Operations Agent: lab_only; human override true; memory Synthetic memory only; no live patient memory or cross-tenant recall.

## Clinical Knowledge Fabric
- FHIR: mapped; Resource/profile metadata, provenance, audit, and source-contract mapping.
- SNOMED: requires_review; Clinical concept normalization metadata.
- LOINC: partially_mapped; Lab and observation concept metadata with unit awareness.
- RxNorm: requires_review; Medication concept metadata for reconciliation workflows.
- ICD-10: partially_mapped; Diagnosis and claims-aware metadata.
- CPT: requires_review; Procedure and service metadata for RCM workflows.
- payer policy: blocked; Policy evidence metadata only.
- clinical guidelines: requires_review; Guideline grounding metadata and version capture.

## Model Regression Watch
- synthetic-fast-router@2026-07-lab: regression 4; rollback true; auto-promote false
- enterprise-reasoning-synthetic@2026-07-review: regression 7; rollback true; auto-promote false
- future-clinical-model@candidate-blocked: regression 100; rollback true; auto-promote false

## Life Sciences / Drug Discovery Readiness
- literature synthesis: research_preview; blocked drug recommendation, molecule generation claim, therapeutic claim, clinical trial enrollment decision, clinical validation
- biomarker discovery: research_preview; blocked drug recommendation, molecule generation claim, therapeutic claim, clinical trial enrollment decision, clinical validation
- molecule ranking: research_preview; blocked drug recommendation, molecule generation claim, therapeutic claim, clinical trial enrollment decision, clinical validation
- protocol optimization: research_preview; blocked drug recommendation, molecule generation claim, therapeutic claim, clinical trial enrollment decision, clinical validation
- trial recruitment prediction: research_preview; blocked drug recommendation, molecule generation claim, therapeutic claim, clinical trial enrollment decision, clinical validation

## Public Trust / Investor Narrative
- healthcare-native AI: SCRIMED is built around healthcare workflows, evidence, reviewer gates, audit trails, and interoperability metadata rather than a generic chatbot surface. Blocked: clinical validation, FDA clearance, live clinical authority
- clinician-governed intelligence: SCRIMED can organize and pre-screen synthetic workflow evidence while qualified humans remain accountable for clinical, payer, and customer decisions. Blocked: autonomous care, diagnosis, treatment, prescribing
- measurable outcomes: SCRIMED tracks cost per outcome, review readiness, evidence completeness, and workflow friction so buyers can evaluate operational value before production risk. Blocked: ROI guarantee, reimbursement guarantee, customer revenue guarantee
- model-agnostic infrastructure: SCRIMED separates model routing, prompt registry, evaluation, governance, and fallback metadata so the platform is not hard-coded to one provider. Blocked: production model routing for PHI, provider certification
- privacy-first deployment: SCRIMED's current public and lab capabilities stay synthetic and metadata-only, with live PHI, raw connector payloads, and production connectors blocked by default. Blocked: HIPAA certification, SOC 2 certification, PHI processing approval

## Validation
- PASS high-risk-clinical-tasks-blocked-without-human-review: High-risk clinical-like tasks cannot execute unless marked human_reviewed.
- PASS agent-lab-records-fully-governed: Every synthetic agent has owner, risk tier, allowed data class, blocked actions, and deterministic audit hash.
- PASS unsafe-prompt-deployment-blocked: Blocked prompt deployment states cannot be promoted to production behavior.
- PASS model-upgrades-cannot-auto-promote-clinical-authority: Model regression watch records keep clinical authority blocked and rollback visible.
- PASS clinical-judges-output-scores-and-hashes-only: Clinical judge ensemble emits score metadata and rationale hashes only.
- PASS life-sciences-shell-research-preview-only: Life sciences and drug-discovery readiness remains research_preview with therapeutic claims blocked.
- PASS long-horizon-agents-lab-only-with-human-override: Long-horizon agent registry entries are synthetic, lab_only, expiring, and human-override required.

## NO-GO Boundaries
- no live PHI
- no autonomous clinical care
- no diagnosis/treatment/prescribing
- no imaging interpretation
- no EHR writeback
- no payer submission
- no production connector approval
- no certification claims
- no customer go-live approval
- no raw schemas, credentials, live tokens, or raw connector payloads in logs or UI