{"service":"scrimed-trustops-intelligence-layer","status":"scrimed-trustops-synthetic-ready","route":"/scrimed-trustops","apiRoute":"/api/scrimed-trustops","positioning":"SCRIMED TrustOps Intelligence Layer is a synthetic-only architecture layer that prepares SCRIMED for safe healthcare agent orchestration by combining module governance, signal detection, structured validation, semantic intelligence, and human-in-the-loop remediation recommendations.","safetyBoundaryStatement":"Demo/synthetic only. SCRIMED TrustOps does not authorize live PHI, autonomous diagnosis, treatment, prescribing, patient outreach, payer submission, EHR writeback, billing submission, production connector use, certification claims, compliance completion claims, or customer go-live.","registrySummary":{"service":"scrimed-trustops-registry","existingScrimedModuleRegistryCount":19,"trustOpsModuleCount":15,"averageTrustScore":75,"validationStatus":"pass"},"scoringFormula":"total = safety*0.30 + governance*0.25 + evidence*0.18 + workflowValue*0.15 + interoperability*0.12 - riskPenalty*0.30","modules":[{"id":"patient-journey-memory","name":"Patient Journey Memory","category":"memory","description":"Purpose-bound synthetic memory for longitudinal journey context, handoff continuity, care-gap visibility, and reviewer-approved recall.","strategicValue":92,"capabilities":["Journey timeline synthesis","Handoff context recall","Care-gap context flags","Preference-safe memory scoping"],"requiredData":["Synthetic journey events","Synthetic encounter milestones","Consent and purpose placeholders"],"syntheticInputs":["Demo journey timeline","No-PHI care-gap fixture","Synthetic handoff note"],"structuredOutputs":["journey_memory_brief","care_gap_context_packet","memory_scope_audit"],"recommendedNextBuildStep":"Bind synthetic journey memory to module brief validation with purpose, TTL, reviewer, and deletion-event fields.","safetyBoundaries":["Demo/synthetic only; no live PHI or patient identifiers.","Human review required for clinical, payer, EHR, compliance, outreach, or billing-impacting work.","Recommendations only; no autonomous diagnosis, treatment, prescribing, outreach, payer submission, EHR writeback, billing submission, or production connector use.","Evidence, schema validation, and auditability required before any pilot-facing output.","No claim of HIPAA, SOC 2, HITRUST, FDA, ONC, clinical validation, or compliance completion."],"evidenceRequirements":["Synthetic input fixture","Structured output schema validation","Safety-boundary statement","Human-review disposition placeholder","Evidence and audit trace reference"],"trustScore":{"safety":89,"evidence":84,"workflowValue":92,"governance":88,"interoperability":78,"riskPenalty":42,"total":74,"formula":"total = safety*0.30 + governance*0.25 + evidence*0.18 + workflowValue*0.15 + interoperability*0.12 - riskPenalty*0.30"},"governanceScore":88,"automationRisk":42,"interoperabilityReadiness":78},{"id":"clinical-intelligence","name":"Clinical Intelligence","category":"clinical-intelligence","description":"Human-reviewed synthetic clinical reasoning support that surfaces evidence, uncertainty, missing data, and escalation criteria without clinical authority.","strategicValue":96,"capabilities":["Evidence synthesis","Missing-data risk flags","Clinical uncertainty reporting","Escalation criteria drafting"],"requiredData":["Synthetic clinical scenarios","Public guideline references","Reviewer rubric"],"syntheticInputs":["Synthetic note","Synthetic labs","Synthetic guideline card"],"structuredOutputs":["clinical_intelligence_brief","evidence_gap_report","human_review_packet"],"recommendedNextBuildStep":"Require ClinicalBench pass/fail evidence and Trust Score explanation before expanding any clinical-intelligence demo.","safetyBoundaries":["Demo/synthetic only; no live PHI or patient identifiers.","Human review required for clinical, payer, EHR, compliance, outreach, or billing-impacting work.","Recommendations only; no autonomous diagnosis, treatment, prescribing, outreach, payer submission, EHR writeback, billing submission, or production connector use.","Evidence, schema validation, and auditability required before any pilot-facing output.","No claim of HIPAA, SOC 2, HITRUST, FDA, ONC, clinical validation, or compliance completion."],"evidenceRequirements":["Synthetic input fixture","Structured output schema validation","Safety-boundary statement","Human-review disposition placeholder","Evidence and audit trace reference"],"trustScore":{"safety":91,"evidence":88,"workflowValue":95,"governance":90,"interoperability":74,"riskPenalty":48,"total":74,"formula":"total = safety*0.30 + governance*0.25 + evidence*0.18 + workflowValue*0.15 + interoperability*0.12 - riskPenalty*0.30"},"governanceScore":90,"automationRisk":48,"interoperabilityReadiness":74},{"id":"rcm-denials","name":"RCM / Denials","category":"revenue-cycle","description":"Synthetic denial-pattern intelligence for root-cause analysis, documentation packet readiness, and manual follow-up recommendations.","strategicValue":91,"capabilities":["Denial spike detection","Documentation gap mapping","Appeal packet draft requirements","RCM owner routing"],"requiredData":["Synthetic denial events","Synthetic claim metadata","Payer-rule placeholders"],"syntheticInputs":["Denied claim spike fixture","Missing modifier fixture","Synthetic denial reason codes"],"structuredOutputs":["denial_signal_report","documentation_gap_packet","manual_routing_recommendation"],"recommendedNextBuildStep":"Add no-submission denial packet generation with manual verification and payer-action hard stops.","safetyBoundaries":["Demo/synthetic only; no live PHI or patient identifiers.","Human review required for clinical, payer, EHR, compliance, outreach, or billing-impacting work.","Recommendations only; no autonomous diagnosis, treatment, prescribing, outreach, payer submission, EHR writeback, billing submission, or production connector use.","Evidence, schema validation, and auditability required before any pilot-facing output.","No claim of HIPAA, SOC 2, HITRUST, FDA, ONC, clinical validation, or compliance completion."],"evidenceRequirements":["Synthetic input fixture","Structured output schema validation","Safety-boundary statement","Human-review disposition placeholder","Evidence and audit trace reference"],"trustScore":{"safety":87,"evidence":82,"workflowValue":93,"governance":86,"interoperability":80,"riskPenalty":55,"total":69,"formula":"total = safety*0.30 + governance*0.25 + evidence*0.18 + workflowValue*0.15 + interoperability*0.12 - riskPenalty*0.30"},"governanceScore":86,"automationRisk":55,"interoperabilityReadiness":80},{"id":"prior-authorization","name":"Prior Authorization","category":"revenue-cycle","description":"Synthetic prior-authorization workflow intelligence for stalled tasks, missing packets, evidence requirements, and human-reviewed next steps.","strategicValue":90,"capabilities":["PA stall detection","Missing documentation checklist","Evidence packet regeneration","Manual verification queueing"],"requiredData":["Synthetic authorization events","Synthetic document checklist","Policy placeholders"],"syntheticInputs":["Prior auth stalled fixture","Missing packet fixture","Synthetic payer criteria"],"structuredOutputs":["prior_auth_status_packet","missing_packet_checklist","manual_review_queue_item"],"recommendedNextBuildStep":"Connect prior-auth recommendations to durable review packets without enabling payer submission.","safetyBoundaries":["Demo/synthetic only; no live PHI or patient identifiers.","Human review required for clinical, payer, EHR, compliance, outreach, or billing-impacting work.","Recommendations only; no autonomous diagnosis, treatment, prescribing, outreach, payer submission, EHR writeback, billing submission, or production connector use.","Evidence, schema validation, and auditability required before any pilot-facing output.","No claim of HIPAA, SOC 2, HITRUST, FDA, ONC, clinical validation, or compliance completion."],"evidenceRequirements":["Synthetic input fixture","Structured output schema validation","Safety-boundary statement","Human-review disposition placeholder","Evidence and audit trace reference"],"trustScore":{"safety":88,"evidence":83,"workflowValue":91,"governance":89,"interoperability":77,"riskPenalty":57,"total":69,"formula":"total = safety*0.30 + governance*0.25 + evidence*0.18 + workflowValue*0.15 + interoperability*0.12 - riskPenalty*0.30"},"governanceScore":89,"automationRisk":57,"interoperabilityReadiness":77},{"id":"patient-access","name":"Patient Access","category":"patient-access","description":"Synthetic access operations intelligence for intake friction, eligibility-ready packets, scheduling handoffs, and service-line routing.","strategicValue":87,"capabilities":["Access bottleneck detection","Eligibility packet readiness","Service-line routing recommendation","Intake completeness scoring"],"requiredData":["Synthetic access events","Synthetic intake forms","Eligibility placeholders"],"syntheticInputs":["Access delay fixture","Incomplete intake fixture","Synthetic eligibility metadata"],"structuredOutputs":["access_readiness_score","intake_gap_packet","manual_routing_recommendation"],"recommendedNextBuildStep":"Add synthetic access-score trend view with owner assignment and escalation boundaries.","safetyBoundaries":["Demo/synthetic only; no live PHI or patient identifiers.","Human review required for clinical, payer, EHR, compliance, outreach, or billing-impacting work.","Recommendations only; no autonomous diagnosis, treatment, prescribing, outreach, payer submission, EHR writeback, billing submission, or production connector use.","Evidence, schema validation, and auditability required before any pilot-facing output.","No claim of HIPAA, SOC 2, HITRUST, FDA, ONC, clinical validation, or compliance completion."],"evidenceRequirements":["Synthetic input fixture","Structured output schema validation","Safety-boundary statement","Human-review disposition placeholder","Evidence and audit trace reference"],"trustScore":{"safety":90,"evidence":79,"workflowValue":88,"governance":86,"interoperability":76,"riskPenalty":39,"total":73,"formula":"total = safety*0.30 + governance*0.25 + evidence*0.18 + workflowValue*0.15 + interoperability*0.12 - riskPenalty*0.30"},"governanceScore":86,"automationRisk":39,"interoperabilityReadiness":76},{"id":"scheduling","name":"Scheduling","category":"patient-access","description":"Synthetic scheduling intelligence for wait-time signals, capacity constraints, referral handoffs, and manual appointment-workflow recommendations.","strategicValue":86,"capabilities":["Wait-time signal detection","Capacity bottleneck summaries","Referral handoff readiness","Manual scheduling task routing"],"requiredData":["Synthetic scheduling events","Synthetic capacity slots","Synthetic referral statuses"],"syntheticInputs":["Referral delay fixture","Capacity squeeze fixture","Wait-time fixture"],"structuredOutputs":["scheduling_signal_report","capacity_gap_packet","manual_queue_recommendation"],"recommendedNextBuildStep":"Create synthetic scheduling replay scenarios before any calendar or patient-facing integration is considered.","safetyBoundaries":["Demo/synthetic only; no live PHI or patient identifiers.","Human review required for clinical, payer, EHR, compliance, outreach, or billing-impacting work.","Recommendations only; no autonomous diagnosis, treatment, prescribing, outreach, payer submission, EHR writeback, billing submission, or production connector use.","Evidence, schema validation, and auditability required before any pilot-facing output.","No claim of HIPAA, SOC 2, HITRUST, FDA, ONC, clinical validation, or compliance completion."],"evidenceRequirements":["Synthetic input fixture","Structured output schema validation","Safety-boundary statement","Human-review disposition placeholder","Evidence and audit trace reference"],"trustScore":{"safety":91,"evidence":78,"workflowValue":87,"governance":85,"interoperability":79,"riskPenalty":38,"total":74,"formula":"total = safety*0.30 + governance*0.25 + evidence*0.18 + workflowValue*0.15 + interoperability*0.12 - riskPenalty*0.30"},"governanceScore":85,"automationRisk":38,"interoperabilityReadiness":79},{"id":"referral-management","name":"Referral Management","category":"patient-access","description":"Synthetic closed-loop referral intelligence for leakage, delays, owner routing, wait-time risk, and feedback packet generation.","strategicValue":93,"capabilities":["Referral delay detection","Leakage risk scoring","Closed-loop status tracking","Provider-matching readiness"],"requiredData":["Synthetic referral events","Synthetic provider directory","Insurance verification placeholders"],"syntheticInputs":["Referral delay fixture","Referral leakage fixture","Provider matching fixture"],"structuredOutputs":["referral_signal_report","leakage_risk_packet","closed_loop_feedback_packet"],"recommendedNextBuildStep":"Bind referral intelligence to human-reviewed owner routing and no-outreach hard stops.","safetyBoundaries":["Demo/synthetic only; no live PHI or patient identifiers.","Human review required for clinical, payer, EHR, compliance, outreach, or billing-impacting work.","Recommendations only; no autonomous diagnosis, treatment, prescribing, outreach, payer submission, EHR writeback, billing submission, or production connector use.","Evidence, schema validation, and auditability required before any pilot-facing output.","No claim of HIPAA, SOC 2, HITRUST, FDA, ONC, clinical validation, or compliance completion."],"evidenceRequirements":["Synthetic input fixture","Structured output schema validation","Safety-boundary statement","Human-review disposition placeholder","Evidence and audit trace reference"],"trustScore":{"safety":89,"evidence":82,"workflowValue":94,"governance":88,"interoperability":83,"riskPenalty":47,"total":73,"formula":"total = safety*0.30 + governance*0.25 + evidence*0.18 + workflowValue*0.15 + interoperability*0.12 - riskPenalty*0.30"},"governanceScore":88,"automationRisk":47,"interoperabilityReadiness":83},{"id":"imaging-intelligence","name":"Imaging Intelligence","category":"imaging","description":"Synthetic imaging operations intelligence for turnaround delays, DICOM workflow status, report-readiness gaps, and manual escalation packets.","strategicValue":89,"capabilities":["Imaging turnaround detection","DICOM metadata readiness","Report-delay summaries","Radiology workflow escalation"],"requiredData":["Synthetic DICOM metadata","Synthetic imaging worklist events","Synthetic report status"],"syntheticInputs":["Imaging turnaround fixture","DICOM status fixture","Report delay fixture"],"structuredOutputs":["imaging_signal_report","turnaround_delay_packet","radiology_review_queue_item"],"recommendedNextBuildStep":"Add imaging-operation fixtures for modality, site, report status, and reviewer escalation without image diagnosis.","safetyBoundaries":["Demo/synthetic only; no live PHI or patient identifiers.","Human review required for clinical, payer, EHR, compliance, outreach, or billing-impacting work.","Recommendations only; no autonomous diagnosis, treatment, prescribing, outreach, payer submission, EHR writeback, billing submission, or production connector use.","Evidence, schema validation, and auditability required before any pilot-facing output.","No claim of HIPAA, SOC 2, HITRUST, FDA, ONC, clinical validation, or compliance completion."],"evidenceRequirements":["Synthetic input fixture","Structured output schema validation","Safety-boundary statement","Human-review disposition placeholder","Evidence and audit trace reference"],"trustScore":{"safety":90,"evidence":81,"workflowValue":88,"governance":87,"interoperability":86,"riskPenalty":44,"total":74,"formula":"total = safety*0.30 + governance*0.25 + evidence*0.18 + workflowValue*0.15 + interoperability*0.12 - riskPenalty*0.30"},"governanceScore":87,"automationRisk":44,"interoperabilityReadiness":86},{"id":"population-health","name":"Population Health","category":"population-health","description":"Synthetic population-risk intelligence for care-gap patterns, outreach-ready-but-blocked tasks, stratification explainability, and reviewer queues.","strategicValue":88,"capabilities":["Care-gap signal detection","Synthetic cohort stratification","Population trend summaries","Manual intervention queueing"],"requiredData":["Synthetic cohort events","Quality measure placeholders","Reviewer policy rules"],"syntheticInputs":["Care gap fixture","Synthetic cohort fixture","Risk trend fixture"],"structuredOutputs":["population_signal_report","care_gap_packet","manual_review_queue_item"],"recommendedNextBuildStep":"Add de-identification and consent-state placeholders before any non-synthetic population workflow design.","safetyBoundaries":["Demo/synthetic only; no live PHI or patient identifiers.","Human review required for clinical, payer, EHR, compliance, outreach, or billing-impacting work.","Recommendations only; no autonomous diagnosis, treatment, prescribing, outreach, payer submission, EHR writeback, billing submission, or production connector use.","Evidence, schema validation, and auditability required before any pilot-facing output.","No claim of HIPAA, SOC 2, HITRUST, FDA, ONC, clinical validation, or compliance completion."],"evidenceRequirements":["Synthetic input fixture","Structured output schema validation","Safety-boundary statement","Human-review disposition placeholder","Evidence and audit trace reference"],"trustScore":{"safety":89,"evidence":80,"workflowValue":89,"governance":87,"interoperability":78,"riskPenalty":50,"total":71,"formula":"total = safety*0.30 + governance*0.25 + evidence*0.18 + workflowValue*0.15 + interoperability*0.12 - riskPenalty*0.30"},"governanceScore":87,"automationRisk":50,"interoperabilityReadiness":78},{"id":"quality-hedis-star","name":"Quality / HEDIS / STAR","category":"quality","description":"Synthetic quality intelligence for measure-gap detection, evidence readiness, denominator/numerator traceability, and reviewer-owned remediation queues.","strategicValue":87,"capabilities":["Measure-gap detection","Evidence readiness scoring","Quality packet drafting","Reviewer disposition tracking"],"requiredData":["Synthetic quality events","Synthetic measure definitions","Evidence placeholders"],"syntheticInputs":["HEDIS gap fixture","STAR measure fixture","Synthetic evidence packet"],"structuredOutputs":["quality_signal_report","measure_gap_packet","reviewer_disposition_item"],"recommendedNextBuildStep":"Create measure-specific synthetic validation packs with no payer submission or performance-guarantee claims.","safetyBoundaries":["Demo/synthetic only; no live PHI or patient identifiers.","Human review required for clinical, payer, EHR, compliance, outreach, or billing-impacting work.","Recommendations only; no autonomous diagnosis, treatment, prescribing, outreach, payer submission, EHR writeback, billing submission, or production connector use.","Evidence, schema validation, and auditability required before any pilot-facing output.","No claim of HIPAA, SOC 2, HITRUST, FDA, ONC, clinical validation, or compliance completion."],"evidenceRequirements":["Synthetic input fixture","Structured output schema validation","Safety-boundary statement","Human-review disposition placeholder","Evidence and audit trace reference"],"trustScore":{"safety":90,"evidence":84,"workflowValue":87,"governance":89,"interoperability":81,"riskPenalty":45,"total":74,"formula":"total = safety*0.30 + governance*0.25 + evidence*0.18 + workflowValue*0.15 + interoperability*0.12 - riskPenalty*0.30"},"governanceScore":89,"automationRisk":45,"interoperabilityReadiness":81},{"id":"governance-compliance","name":"Governance / Compliance","category":"governance","description":"Synthetic governance intelligence for sensitive-task triage, audit readiness, policy gates, evidence completeness, and compliance escalation recommendations.","strategicValue":95,"capabilities":["Policy-gate enforcement","Sensitive-task detection","Evidence completeness checks","Compliance escalation packets"],"requiredData":["Synthetic policy decisions","Audit event metadata","Control checklist placeholders"],"syntheticInputs":["Compliance-sensitive task fixture","Missing evidence fixture","Policy exception fixture"],"structuredOutputs":["governance_decision_packet","compliance_escalation_packet","audit_readiness_report"],"recommendedNextBuildStep":"Make governance/compliance the required supervisor lane for every TrustOps recommendation.","safetyBoundaries":["Demo/synthetic only; no live PHI or patient identifiers.","Human review required for clinical, payer, EHR, compliance, outreach, or billing-impacting work.","Recommendations only; no autonomous diagnosis, treatment, prescribing, outreach, payer submission, EHR writeback, billing submission, or production connector use.","Evidence, schema validation, and auditability required before any pilot-facing output.","No claim of HIPAA, SOC 2, HITRUST, FDA, ONC, clinical validation, or compliance completion."],"evidenceRequirements":["Synthetic input fixture","Structured output schema validation","Safety-boundary statement","Human-review disposition placeholder","Evidence and audit trace reference"],"trustScore":{"safety":96,"evidence":87,"workflowValue":90,"governance":96,"interoperability":78,"riskPenalty":33,"total":81,"formula":"total = safety*0.30 + governance*0.25 + evidence*0.18 + workflowValue*0.15 + interoperability*0.12 - riskPenalty*0.30"},"governanceScore":96,"automationRisk":33,"interoperabilityReadiness":78},{"id":"signal-detection","name":"Signal Detection","category":"operations","description":"Synthetic event analysis that detects operational issues, low-confidence outputs, integration drift, and safety-sensitive workflow conditions.","strategicValue":94,"capabilities":["Synthetic event rule evaluation","Severity assignment","Owner routing","Human-review recommendation generation"],"requiredData":["Synthetic operational events","Threshold rules","Workflow owner map"],"syntheticInputs":["Signal fixture set","Threshold config fixture","Synthetic event stream"],"structuredOutputs":["synthetic_signal","owner_routing_packet","review_required_flag"],"recommendedNextBuildStep":"Promote signal rules into versioned policy-controlled fixtures with replayable synthetic traces.","safetyBoundaries":["Demo/synthetic only; no live PHI or patient identifiers.","Human review required for clinical, payer, EHR, compliance, outreach, or billing-impacting work.","Recommendations only; no autonomous diagnosis, treatment, prescribing, outreach, payer submission, EHR writeback, billing submission, or production connector use.","Evidence, schema validation, and auditability required before any pilot-facing output.","No claim of HIPAA, SOC 2, HITRUST, FDA, ONC, clinical validation, or compliance completion."],"evidenceRequirements":["Synthetic input fixture","Structured output schema validation","Safety-boundary statement","Human-review disposition placeholder","Evidence and audit trace reference"],"trustScore":{"safety":94,"evidence":85,"workflowValue":93,"governance":92,"interoperability":82,"riskPenalty":36,"total":79,"formula":"total = safety*0.30 + governance*0.25 + evidence*0.18 + workflowValue*0.15 + interoperability*0.12 - riskPenalty*0.30"},"governanceScore":92,"automationRisk":36,"interoperabilityReadiness":82},{"id":"self-healing-operations","name":"Self-Healing Operations","category":"operations","description":"Recommendation-only remediation planning for retry, validation, investigation, review, duplicate reconciliation, and automation pause workflows.","strategicValue":91,"capabilities":["Recommendation-only remediation","Human-review gating","Blocked-action enforcement","Operational owner routing"],"requiredData":["Synthetic signals","Workflow policy","Owner map","Run trace metadata"],"syntheticInputs":["Failed sync fixture","Duplicate context fixture","Low-confidence output fixture"],"structuredOutputs":["self_healing_recommendation","manual_verification_task","automation_pause_packet"],"recommendedNextBuildStep":"Connect recommendation outputs to human-run packets and keep all real-world execution disabled.","safetyBoundaries":["Demo/synthetic only; no live PHI or patient identifiers.","Human review required for clinical, payer, EHR, compliance, outreach, or billing-impacting work.","Recommendations only; no autonomous diagnosis, treatment, prescribing, outreach, payer submission, EHR writeback, billing submission, or production connector use.","Evidence, schema validation, and auditability required before any pilot-facing output.","No claim of HIPAA, SOC 2, HITRUST, FDA, ONC, clinical validation, or compliance completion."],"evidenceRequirements":["Synthetic input fixture","Structured output schema validation","Safety-boundary statement","Human-review disposition placeholder","Evidence and audit trace reference"],"trustScore":{"safety":93,"evidence":82,"workflowValue":92,"governance":94,"interoperability":80,"riskPenalty":41,"total":77,"formula":"total = safety*0.30 + governance*0.25 + evidence*0.18 + workflowValue*0.15 + interoperability*0.12 - riskPenalty*0.30"},"governanceScore":94,"automationRisk":41,"interoperabilityReadiness":80},{"id":"semantic-intelligence-graph","name":"Semantic Intelligence Graph","category":"semantic-infrastructure","description":"Synthetic semantic graph linking modules, signals, evidence requirements, safety controls, workflow owners, and remediation recommendations.","strategicValue":90,"capabilities":["Module-signal graphing","Evidence lineage","Safety-boundary traversal","Owner and workflow mapping"],"requiredData":["Module registry","Synthetic signals","Evidence requirements","Governance controls"],"syntheticInputs":["Registry fixture","Signal fixture","Evidence graph fixture"],"structuredOutputs":["semantic_graph_node","evidence_lineage_packet","trustops_dependency_map"],"recommendedNextBuildStep":"Use graph nodes to make every TrustOps output traceable to module, signal, evidence, and governance-control sources.","safetyBoundaries":["Demo/synthetic only; no live PHI or patient identifiers.","Human review required for clinical, payer, EHR, compliance, outreach, or billing-impacting work.","Recommendations only; no autonomous diagnosis, treatment, prescribing, outreach, payer submission, EHR writeback, billing submission, or production connector use.","Evidence, schema validation, and auditability required before any pilot-facing output.","No claim of HIPAA, SOC 2, HITRUST, FDA, ONC, clinical validation, or compliance completion."],"evidenceRequirements":["Synthetic input fixture","Structured output schema validation","Safety-boundary statement","Human-review disposition placeholder","Evidence and audit trace reference"],"trustScore":{"safety":92,"evidence":84,"workflowValue":88,"governance":91,"interoperability":84,"riskPenalty":35,"total":78,"formula":"total = safety*0.30 + governance*0.25 + evidence*0.18 + workflowValue*0.15 + interoperability*0.12 - riskPenalty*0.30"},"governanceScore":91,"automationRisk":35,"interoperabilityReadiness":84},{"id":"secure-middleware-gateway","name":"Secure Middleware Gateway","category":"secure-middleware","description":"Governed middleware abstraction for future MCP/tool access, authorization, schema validation, rate limits, audit logs, and no-direct-system access.","strategicValue":95,"capabilities":["Tool authorization map","Schema validation boundary","No direct LLM-to-system access","Audit and revocation readiness"],"requiredData":["Tool registry placeholders","Role scope placeholders","Synthetic tool-call traces"],"syntheticInputs":["Synthetic tool request","Permission scope fixture","Blocked connector fixture"],"structuredOutputs":["tool_authorization_decision","middleware_audit_event","blocked_action_packet"],"recommendedNextBuildStep":"Require middleware authorization decisions for every future tool call before real connector evaluation.","safetyBoundaries":["Demo/synthetic only; no live PHI or patient identifiers.","Human review required for clinical, payer, EHR, compliance, outreach, or billing-impacting work.","Recommendations only; no autonomous diagnosis, treatment, prescribing, outreach, payer submission, EHR writeback, billing submission, or production connector use.","Evidence, schema validation, and auditability required before any pilot-facing output.","No claim of HIPAA, SOC 2, HITRUST, FDA, ONC, clinical validation, or compliance completion."],"evidenceRequirements":["Synthetic input fixture","Structured output schema validation","Safety-boundary statement","Human-review disposition placeholder","Evidence and audit trace reference"],"trustScore":{"safety":97,"evidence":86,"workflowValue":91,"governance":96,"interoperability":87,"riskPenalty":31,"total":83,"formula":"total = safety*0.30 + governance*0.25 + evidence*0.18 + workflowValue*0.15 + interoperability*0.12 - riskPenalty*0.30"},"governanceScore":96,"automationRisk":31,"interoperabilityReadiness":87}],"moduleBriefs":[{"schemaVersion":"scrimed-trustops-schema-v2026-06-30","moduleId":"patient-journey-memory","moduleName":"Patient Journey Memory","syntheticOnly":true,"category":"memory","trustScore":{"safety":89,"evidence":84,"workflowValue":92,"governance":88,"interoperability":78,"riskPenalty":42,"total":74,"formula":"total = safety*0.30 + governance*0.25 + evidence*0.18 + workflowValue*0.15 + interoperability*0.12 - riskPenalty*0.30"},"strategicValue":92,"capabilities":["Journey timeline synthesis","Handoff context recall","Care-gap context flags","Preference-safe memory scoping"],"evidenceRequirements":["Synthetic input fixture","Structured output schema validation","Safety-boundary statement","Human-review disposition placeholder","Evidence and audit trace reference"],"safetyBoundaries":["Demo/synthetic only; no live PHI or patient identifiers.","Human review required for clinical, payer, EHR, compliance, outreach, or billing-impacting work.","Recommendations only; no autonomous diagnosis, treatment, prescribing, outreach, payer submission, EHR writeback, billing submission, or production connector use.","Evidence, schema validation, and auditability required before any pilot-facing output.","No claim of HIPAA, SOC 2, HITRUST, FDA, ONC, clinical validation, or compliance completion."],"recommendedNextBuildStep":"Bind synthetic journey memory to module brief validation with purpose, TTL, reviewer, and deletion-event fields."},{"schemaVersion":"scrimed-trustops-schema-v2026-06-30","moduleId":"clinical-intelligence","moduleName":"Clinical Intelligence","syntheticOnly":true,"category":"clinical-intelligence","trustScore":{"safety":91,"evidence":88,"workflowValue":95,"governance":90,"interoperability":74,"riskPenalty":48,"total":74,"formula":"total = safety*0.30 + governance*0.25 + evidence*0.18 + workflowValue*0.15 + interoperability*0.12 - riskPenalty*0.30"},"strategicValue":96,"capabilities":["Evidence synthesis","Missing-data risk flags","Clinical uncertainty reporting","Escalation criteria drafting"],"evidenceRequirements":["Synthetic input fixture","Structured output schema validation","Safety-boundary statement","Human-review disposition placeholder","Evidence and audit trace reference"],"safetyBoundaries":["Demo/synthetic only; no live PHI or patient identifiers.","Human review required for clinical, payer, EHR, compliance, outreach, or billing-impacting work.","Recommendations only; no autonomous diagnosis, treatment, prescribing, outreach, payer submission, EHR writeback, billing submission, or production connector use.","Evidence, schema validation, and auditability required before any pilot-facing output.","No claim of HIPAA, SOC 2, HITRUST, FDA, ONC, clinical validation, or compliance completion."],"recommendedNextBuildStep":"Require ClinicalBench pass/fail evidence and Trust Score explanation before expanding any clinical-intelligence demo."},{"schemaVersion":"scrimed-trustops-schema-v2026-06-30","moduleId":"rcm-denials","moduleName":"RCM / Denials","syntheticOnly":true,"category":"revenue-cycle","trustScore":{"safety":87,"evidence":82,"workflowValue":93,"governance":86,"interoperability":80,"riskPenalty":55,"total":69,"formula":"total = safety*0.30 + governance*0.25 + evidence*0.18 + workflowValue*0.15 + interoperability*0.12 - riskPenalty*0.30"},"strategicValue":91,"capabilities":["Denial spike detection","Documentation gap mapping","Appeal packet draft requirements","RCM owner routing"],"evidenceRequirements":["Synthetic input fixture","Structured output schema validation","Safety-boundary statement","Human-review disposition placeholder","Evidence and audit trace reference"],"safetyBoundaries":["Demo/synthetic only; no live PHI or patient identifiers.","Human review required for clinical, payer, EHR, compliance, outreach, or billing-impacting work.","Recommendations only; no autonomous diagnosis, treatment, prescribing, outreach, payer submission, EHR writeback, billing submission, or production connector use.","Evidence, schema validation, and auditability required before any pilot-facing output.","No claim of HIPAA, SOC 2, HITRUST, FDA, ONC, clinical validation, or compliance completion."],"recommendedNextBuildStep":"Add no-submission denial packet generation with manual verification and payer-action hard stops."},{"schemaVersion":"scrimed-trustops-schema-v2026-06-30","moduleId":"prior-authorization","moduleName":"Prior Authorization","syntheticOnly":true,"category":"revenue-cycle","trustScore":{"safety":88,"evidence":83,"workflowValue":91,"governance":89,"interoperability":77,"riskPenalty":57,"total":69,"formula":"total = safety*0.30 + governance*0.25 + evidence*0.18 + workflowValue*0.15 + interoperability*0.12 - riskPenalty*0.30"},"strategicValue":90,"capabilities":["PA stall detection","Missing documentation checklist","Evidence packet regeneration","Manual verification queueing"],"evidenceRequirements":["Synthetic input fixture","Structured output schema validation","Safety-boundary statement","Human-review disposition placeholder","Evidence and audit trace reference"],"safetyBoundaries":["Demo/synthetic only; no live PHI or patient identifiers.","Human review required for clinical, payer, EHR, compliance, outreach, or billing-impacting work.","Recommendations only; no autonomous diagnosis, treatment, prescribing, outreach, payer submission, EHR writeback, billing submission, or production connector use.","Evidence, schema validation, and auditability required before any pilot-facing output.","No claim of HIPAA, SOC 2, HITRUST, FDA, ONC, clinical validation, or compliance completion."],"recommendedNextBuildStep":"Connect prior-auth recommendations to durable review packets without enabling payer submission."},{"schemaVersion":"scrimed-trustops-schema-v2026-06-30","moduleId":"patient-access","moduleName":"Patient Access","syntheticOnly":true,"category":"patient-access","trustScore":{"safety":90,"evidence":79,"workflowValue":88,"governance":86,"interoperability":76,"riskPenalty":39,"total":73,"formula":"total = safety*0.30 + governance*0.25 + evidence*0.18 + workflowValue*0.15 + interoperability*0.12 - riskPenalty*0.30"},"strategicValue":87,"capabilities":["Access bottleneck detection","Eligibility packet readiness","Service-line routing recommendation","Intake completeness scoring"],"evidenceRequirements":["Synthetic input fixture","Structured output schema validation","Safety-boundary statement","Human-review disposition placeholder","Evidence and audit trace reference"],"safetyBoundaries":["Demo/synthetic only; no live PHI or patient identifiers.","Human review required for clinical, payer, EHR, compliance, outreach, or billing-impacting work.","Recommendations only; no autonomous diagnosis, treatment, prescribing, outreach, payer submission, EHR writeback, billing submission, or production connector use.","Evidence, schema validation, and auditability required before any pilot-facing output.","No claim of HIPAA, SOC 2, HITRUST, FDA, ONC, clinical validation, or compliance completion."],"recommendedNextBuildStep":"Add synthetic access-score trend view with owner assignment and escalation boundaries."},{"schemaVersion":"scrimed-trustops-schema-v2026-06-30","moduleId":"scheduling","moduleName":"Scheduling","syntheticOnly":true,"category":"patient-access","trustScore":{"safety":91,"evidence":78,"workflowValue":87,"governance":85,"interoperability":79,"riskPenalty":38,"total":74,"formula":"total = safety*0.30 + governance*0.25 + evidence*0.18 + workflowValue*0.15 + interoperability*0.12 - riskPenalty*0.30"},"strategicValue":86,"capabilities":["Wait-time signal detection","Capacity bottleneck summaries","Referral handoff readiness","Manual scheduling task routing"],"evidenceRequirements":["Synthetic input fixture","Structured output schema validation","Safety-boundary statement","Human-review disposition placeholder","Evidence and audit trace reference"],"safetyBoundaries":["Demo/synthetic only; no live PHI or patient identifiers.","Human review required for clinical, payer, EHR, compliance, outreach, or billing-impacting work.","Recommendations only; no autonomous diagnosis, treatment, prescribing, outreach, payer submission, EHR writeback, billing submission, or production connector use.","Evidence, schema validation, and auditability required before any pilot-facing output.","No claim of HIPAA, SOC 2, HITRUST, FDA, ONC, clinical validation, or compliance completion."],"recommendedNextBuildStep":"Create synthetic scheduling replay scenarios before any calendar or patient-facing integration is considered."},{"schemaVersion":"scrimed-trustops-schema-v2026-06-30","moduleId":"referral-management","moduleName":"Referral Management","syntheticOnly":true,"category":"patient-access","trustScore":{"safety":89,"evidence":82,"workflowValue":94,"governance":88,"interoperability":83,"riskPenalty":47,"total":73,"formula":"total = safety*0.30 + governance*0.25 + evidence*0.18 + workflowValue*0.15 + interoperability*0.12 - riskPenalty*0.30"},"strategicValue":93,"capabilities":["Referral delay detection","Leakage risk scoring","Closed-loop status tracking","Provider-matching readiness"],"evidenceRequirements":["Synthetic input fixture","Structured output schema validation","Safety-boundary statement","Human-review disposition placeholder","Evidence and audit trace reference"],"safetyBoundaries":["Demo/synthetic only; no live PHI or patient identifiers.","Human review required for clinical, payer, EHR, compliance, outreach, or billing-impacting work.","Recommendations only; no autonomous diagnosis, treatment, prescribing, outreach, payer submission, EHR writeback, billing submission, or production connector use.","Evidence, schema validation, and auditability required before any pilot-facing output.","No claim of HIPAA, SOC 2, HITRUST, FDA, ONC, clinical validation, or compliance completion."],"recommendedNextBuildStep":"Bind referral intelligence to human-reviewed owner routing and no-outreach hard stops."},{"schemaVersion":"scrimed-trustops-schema-v2026-06-30","moduleId":"imaging-intelligence","moduleName":"Imaging Intelligence","syntheticOnly":true,"category":"imaging","trustScore":{"safety":90,"evidence":81,"workflowValue":88,"governance":87,"interoperability":86,"riskPenalty":44,"total":74,"formula":"total = safety*0.30 + governance*0.25 + evidence*0.18 + workflowValue*0.15 + interoperability*0.12 - riskPenalty*0.30"},"strategicValue":89,"capabilities":["Imaging turnaround detection","DICOM metadata readiness","Report-delay summaries","Radiology workflow escalation"],"evidenceRequirements":["Synthetic input fixture","Structured output schema validation","Safety-boundary statement","Human-review disposition placeholder","Evidence and audit trace reference"],"safetyBoundaries":["Demo/synthetic only; no live PHI or patient identifiers.","Human review required for clinical, payer, EHR, compliance, outreach, or billing-impacting work.","Recommendations only; no autonomous diagnosis, treatment, prescribing, outreach, payer submission, EHR writeback, billing submission, or production connector use.","Evidence, schema validation, and auditability required before any pilot-facing output.","No claim of HIPAA, SOC 2, HITRUST, FDA, ONC, clinical validation, or compliance completion."],"recommendedNextBuildStep":"Add imaging-operation fixtures for modality, site, report status, and reviewer escalation without image diagnosis."},{"schemaVersion":"scrimed-trustops-schema-v2026-06-30","moduleId":"population-health","moduleName":"Population Health","syntheticOnly":true,"category":"population-health","trustScore":{"safety":89,"evidence":80,"workflowValue":89,"governance":87,"interoperability":78,"riskPenalty":50,"total":71,"formula":"total = safety*0.30 + governance*0.25 + evidence*0.18 + workflowValue*0.15 + interoperability*0.12 - riskPenalty*0.30"},"strategicValue":88,"capabilities":["Care-gap signal detection","Synthetic cohort stratification","Population trend summaries","Manual intervention queueing"],"evidenceRequirements":["Synthetic input fixture","Structured output schema validation","Safety-boundary statement","Human-review disposition placeholder","Evidence and audit trace reference"],"safetyBoundaries":["Demo/synthetic only; no live PHI or patient identifiers.","Human review required for clinical, payer, EHR, compliance, outreach, or billing-impacting work.","Recommendations only; no autonomous diagnosis, treatment, prescribing, outreach, payer submission, EHR writeback, billing submission, or production connector use.","Evidence, schema validation, and auditability required before any pilot-facing output.","No claim of HIPAA, SOC 2, HITRUST, FDA, ONC, clinical validation, or compliance completion."],"recommendedNextBuildStep":"Add de-identification and consent-state placeholders before any non-synthetic population workflow design."},{"schemaVersion":"scrimed-trustops-schema-v2026-06-30","moduleId":"quality-hedis-star","moduleName":"Quality / HEDIS / STAR","syntheticOnly":true,"category":"quality","trustScore":{"safety":90,"evidence":84,"workflowValue":87,"governance":89,"interoperability":81,"riskPenalty":45,"total":74,"formula":"total = safety*0.30 + governance*0.25 + evidence*0.18 + workflowValue*0.15 + interoperability*0.12 - riskPenalty*0.30"},"strategicValue":87,"capabilities":["Measure-gap detection","Evidence readiness scoring","Quality packet drafting","Reviewer disposition tracking"],"evidenceRequirements":["Synthetic input fixture","Structured output schema validation","Safety-boundary statement","Human-review disposition placeholder","Evidence and audit trace reference"],"safetyBoundaries":["Demo/synthetic only; no live PHI or patient identifiers.","Human review required for clinical, payer, EHR, compliance, outreach, or billing-impacting work.","Recommendations only; no autonomous diagnosis, treatment, prescribing, outreach, payer submission, EHR writeback, billing submission, or production connector use.","Evidence, schema validation, and auditability required before any pilot-facing output.","No claim of HIPAA, SOC 2, HITRUST, FDA, ONC, clinical validation, or compliance completion."],"recommendedNextBuildStep":"Create measure-specific synthetic validation packs with no payer submission or performance-guarantee claims."},{"schemaVersion":"scrimed-trustops-schema-v2026-06-30","moduleId":"governance-compliance","moduleName":"Governance / Compliance","syntheticOnly":true,"category":"governance","trustScore":{"safety":96,"evidence":87,"workflowValue":90,"governance":96,"interoperability":78,"riskPenalty":33,"total":81,"formula":"total = safety*0.30 + governance*0.25 + evidence*0.18 + workflowValue*0.15 + interoperability*0.12 - riskPenalty*0.30"},"strategicValue":95,"capabilities":["Policy-gate enforcement","Sensitive-task detection","Evidence completeness checks","Compliance escalation packets"],"evidenceRequirements":["Synthetic input fixture","Structured output schema validation","Safety-boundary statement","Human-review disposition placeholder","Evidence and audit trace reference"],"safetyBoundaries":["Demo/synthetic only; no live PHI or patient identifiers.","Human review required for clinical, payer, EHR, compliance, outreach, or billing-impacting work.","Recommendations only; no autonomous diagnosis, treatment, prescribing, outreach, payer submission, EHR writeback, billing submission, or production connector use.","Evidence, schema validation, and auditability required before any pilot-facing output.","No claim of HIPAA, SOC 2, HITRUST, FDA, ONC, clinical validation, or compliance completion."],"recommendedNextBuildStep":"Make governance/compliance the required supervisor lane for every TrustOps recommendation."},{"schemaVersion":"scrimed-trustops-schema-v2026-06-30","moduleId":"signal-detection","moduleName":"Signal Detection","syntheticOnly":true,"category":"operations","trustScore":{"safety":94,"evidence":85,"workflowValue":93,"governance":92,"interoperability":82,"riskPenalty":36,"total":79,"formula":"total = safety*0.30 + governance*0.25 + evidence*0.18 + workflowValue*0.15 + interoperability*0.12 - riskPenalty*0.30"},"strategicValue":94,"capabilities":["Synthetic event rule evaluation","Severity assignment","Owner routing","Human-review recommendation generation"],"evidenceRequirements":["Synthetic input fixture","Structured output schema validation","Safety-boundary statement","Human-review disposition placeholder","Evidence and audit trace reference"],"safetyBoundaries":["Demo/synthetic only; no live PHI or patient identifiers.","Human review required for clinical, payer, EHR, compliance, outreach, or billing-impacting work.","Recommendations only; no autonomous diagnosis, treatment, prescribing, outreach, payer submission, EHR writeback, billing submission, or production connector use.","Evidence, schema validation, and auditability required before any pilot-facing output.","No claim of HIPAA, SOC 2, HITRUST, FDA, ONC, clinical validation, or compliance completion."],"recommendedNextBuildStep":"Promote signal rules into versioned policy-controlled fixtures with replayable synthetic traces."},{"schemaVersion":"scrimed-trustops-schema-v2026-06-30","moduleId":"self-healing-operations","moduleName":"Self-Healing Operations","syntheticOnly":true,"category":"operations","trustScore":{"safety":93,"evidence":82,"workflowValue":92,"governance":94,"interoperability":80,"riskPenalty":41,"total":77,"formula":"total = safety*0.30 + governance*0.25 + evidence*0.18 + workflowValue*0.15 + interoperability*0.12 - riskPenalty*0.30"},"strategicValue":91,"capabilities":["Recommendation-only remediation","Human-review gating","Blocked-action enforcement","Operational owner routing"],"evidenceRequirements":["Synthetic input fixture","Structured output schema validation","Safety-boundary statement","Human-review disposition placeholder","Evidence and audit trace reference"],"safetyBoundaries":["Demo/synthetic only; no live PHI or patient identifiers.","Human review required for clinical, payer, EHR, compliance, outreach, or billing-impacting work.","Recommendations only; no autonomous diagnosis, treatment, prescribing, outreach, payer submission, EHR writeback, billing submission, or production connector use.","Evidence, schema validation, and auditability required before any pilot-facing output.","No claim of HIPAA, SOC 2, HITRUST, FDA, ONC, clinical validation, or compliance completion."],"recommendedNextBuildStep":"Connect recommendation outputs to human-run packets and keep all real-world execution disabled."},{"schemaVersion":"scrimed-trustops-schema-v2026-06-30","moduleId":"semantic-intelligence-graph","moduleName":"Semantic Intelligence Graph","syntheticOnly":true,"category":"semantic-infrastructure","trustScore":{"safety":92,"evidence":84,"workflowValue":88,"governance":91,"interoperability":84,"riskPenalty":35,"total":78,"formula":"total = safety*0.30 + governance*0.25 + evidence*0.18 + workflowValue*0.15 + interoperability*0.12 - riskPenalty*0.30"},"strategicValue":90,"capabilities":["Module-signal graphing","Evidence lineage","Safety-boundary traversal","Owner and workflow mapping"],"evidenceRequirements":["Synthetic input fixture","Structured output schema validation","Safety-boundary statement","Human-review disposition placeholder","Evidence and audit trace reference"],"safetyBoundaries":["Demo/synthetic only; no live PHI or patient identifiers.","Human review required for clinical, payer, EHR, compliance, outreach, or billing-impacting work.","Recommendations only; no autonomous diagnosis, treatment, prescribing, outreach, payer submission, EHR writeback, billing submission, or production connector use.","Evidence, schema validation, and auditability required before any pilot-facing output.","No claim of HIPAA, SOC 2, HITRUST, FDA, ONC, clinical validation, or compliance completion."],"recommendedNextBuildStep":"Use graph nodes to make every TrustOps output traceable to module, signal, evidence, and governance-control sources."},{"schemaVersion":"scrimed-trustops-schema-v2026-06-30","moduleId":"secure-middleware-gateway","moduleName":"Secure Middleware Gateway","syntheticOnly":true,"category":"secure-middleware","trustScore":{"safety":97,"evidence":86,"workflowValue":91,"governance":96,"interoperability":87,"riskPenalty":31,"total":83,"formula":"total = safety*0.30 + governance*0.25 + evidence*0.18 + workflowValue*0.15 + interoperability*0.12 - riskPenalty*0.30"},"strategicValue":95,"capabilities":["Tool authorization map","Schema validation boundary","No direct LLM-to-system access","Audit and revocation readiness"],"evidenceRequirements":["Synthetic input fixture","Structured output schema validation","Safety-boundary statement","Human-review disposition placeholder","Evidence and audit trace reference"],"safetyBoundaries":["Demo/synthetic only; no live PHI or patient identifiers.","Human review required for clinical, payer, EHR, compliance, outreach, or billing-impacting work.","Recommendations only; no autonomous diagnosis, treatment, prescribing, outreach, payer submission, EHR writeback, billing submission, or production connector use.","Evidence, schema validation, and auditability required before any pilot-facing output.","No claim of HIPAA, SOC 2, HITRUST, FDA, ONC, clinical validation, or compliance completion."],"recommendedNextBuildStep":"Require middleware authorization decisions for every future tool call before real connector evaluation."}],"topModulesByStrategicValue":[{"id":"clinical-intelligence","name":"Clinical Intelligence","category":"clinical-intelligence","description":"Human-reviewed synthetic clinical reasoning support that surfaces evidence, uncertainty, missing data, and escalation criteria without clinical authority.","strategicValue":96,"capabilities":["Evidence synthesis","Missing-data risk flags","Clinical uncertainty reporting","Escalation criteria drafting"],"requiredData":["Synthetic clinical scenarios","Public guideline references","Reviewer rubric"],"syntheticInputs":["Synthetic note","Synthetic labs","Synthetic guideline card"],"structuredOutputs":["clinical_intelligence_brief","evidence_gap_report","human_review_packet"],"recommendedNextBuildStep":"Require ClinicalBench pass/fail evidence and Trust Score explanation before expanding any clinical-intelligence demo.","safetyBoundaries":["Demo/synthetic only; no live PHI or patient identifiers.","Human review required for clinical, payer, EHR, compliance, outreach, or billing-impacting work.","Recommendations only; no autonomous diagnosis, treatment, prescribing, outreach, payer submission, EHR writeback, billing submission, or production connector use.","Evidence, schema validation, and auditability required before any pilot-facing output.","No claim of HIPAA, SOC 2, HITRUST, FDA, ONC, clinical validation, or compliance completion."],"evidenceRequirements":["Synthetic input fixture","Structured output schema validation","Safety-boundary statement","Human-review disposition placeholder","Evidence and audit trace reference"],"trustScore":{"safety":91,"evidence":88,"workflowValue":95,"governance":90,"interoperability":74,"riskPenalty":48,"total":74,"formula":"total = safety*0.30 + governance*0.25 + evidence*0.18 + workflowValue*0.15 + interoperability*0.12 - riskPenalty*0.30"},"governanceScore":90,"automationRisk":48,"interoperabilityReadiness":74},{"id":"governance-compliance","name":"Governance / Compliance","category":"governance","description":"Synthetic governance intelligence for sensitive-task triage, audit readiness, policy gates, evidence completeness, and compliance escalation recommendations.","strategicValue":95,"capabilities":["Policy-gate enforcement","Sensitive-task detection","Evidence completeness checks","Compliance escalation packets"],"requiredData":["Synthetic policy decisions","Audit event metadata","Control checklist placeholders"],"syntheticInputs":["Compliance-sensitive task fixture","Missing evidence fixture","Policy exception fixture"],"structuredOutputs":["governance_decision_packet","compliance_escalation_packet","audit_readiness_report"],"recommendedNextBuildStep":"Make governance/compliance the required supervisor lane for every TrustOps recommendation.","safetyBoundaries":["Demo/synthetic only; no live PHI or patient identifiers.","Human review required for clinical, payer, EHR, compliance, outreach, or billing-impacting work.","Recommendations only; no autonomous diagnosis, treatment, prescribing, outreach, payer submission, EHR writeback, billing submission, or production connector use.","Evidence, schema validation, and auditability required before any pilot-facing output.","No claim of HIPAA, SOC 2, HITRUST, FDA, ONC, clinical validation, or compliance completion."],"evidenceRequirements":["Synthetic input fixture","Structured output schema validation","Safety-boundary statement","Human-review disposition placeholder","Evidence and audit trace reference"],"trustScore":{"safety":96,"evidence":87,"workflowValue":90,"governance":96,"interoperability":78,"riskPenalty":33,"total":81,"formula":"total = safety*0.30 + governance*0.25 + evidence*0.18 + workflowValue*0.15 + interoperability*0.12 - riskPenalty*0.30"},"governanceScore":96,"automationRisk":33,"interoperabilityReadiness":78},{"id":"secure-middleware-gateway","name":"Secure Middleware Gateway","category":"secure-middleware","description":"Governed middleware abstraction for future MCP/tool access, authorization, schema validation, rate limits, audit logs, and no-direct-system access.","strategicValue":95,"capabilities":["Tool authorization map","Schema validation boundary","No direct LLM-to-system access","Audit and revocation readiness"],"requiredData":["Tool registry placeholders","Role scope placeholders","Synthetic tool-call traces"],"syntheticInputs":["Synthetic tool request","Permission scope fixture","Blocked connector fixture"],"structuredOutputs":["tool_authorization_decision","middleware_audit_event","blocked_action_packet"],"recommendedNextBuildStep":"Require middleware authorization decisions for every future tool call before real connector evaluation.","safetyBoundaries":["Demo/synthetic only; no live PHI or patient identifiers.","Human review required for clinical, payer, EHR, compliance, outreach, or billing-impacting work.","Recommendations only; no autonomous diagnosis, treatment, prescribing, outreach, payer submission, EHR writeback, billing submission, or production connector use.","Evidence, schema validation, and auditability required before any pilot-facing output.","No claim of HIPAA, SOC 2, HITRUST, FDA, ONC, clinical validation, or compliance completion."],"evidenceRequirements":["Synthetic input fixture","Structured output schema validation","Safety-boundary statement","Human-review disposition placeholder","Evidence and audit trace reference"],"trustScore":{"safety":97,"evidence":86,"workflowValue":91,"governance":96,"interoperability":87,"riskPenalty":31,"total":83,"formula":"total = safety*0.30 + governance*0.25 + evidence*0.18 + workflowValue*0.15 + interoperability*0.12 - riskPenalty*0.30"},"governanceScore":96,"automationRisk":31,"interoperabilityReadiness":87},{"id":"signal-detection","name":"Signal Detection","category":"operations","description":"Synthetic event analysis that detects operational issues, low-confidence outputs, integration drift, and safety-sensitive workflow conditions.","strategicValue":94,"capabilities":["Synthetic event rule evaluation","Severity assignment","Owner routing","Human-review recommendation generation"],"requiredData":["Synthetic operational events","Threshold rules","Workflow owner map"],"syntheticInputs":["Signal fixture set","Threshold config fixture","Synthetic event stream"],"structuredOutputs":["synthetic_signal","owner_routing_packet","review_required_flag"],"recommendedNextBuildStep":"Promote signal rules into versioned policy-controlled fixtures with replayable synthetic traces.","safetyBoundaries":["Demo/synthetic only; no live PHI or patient identifiers.","Human review required for clinical, payer, EHR, compliance, outreach, or billing-impacting work.","Recommendations only; no autonomous diagnosis, treatment, prescribing, outreach, payer submission, EHR writeback, billing submission, or production connector use.","Evidence, schema validation, and auditability required before any pilot-facing output.","No claim of HIPAA, SOC 2, HITRUST, FDA, ONC, clinical validation, or compliance completion."],"evidenceRequirements":["Synthetic input fixture","Structured output schema validation","Safety-boundary statement","Human-review disposition placeholder","Evidence and audit trace reference"],"trustScore":{"safety":94,"evidence":85,"workflowValue":93,"governance":92,"interoperability":82,"riskPenalty":36,"total":79,"formula":"total = safety*0.30 + governance*0.25 + evidence*0.18 + workflowValue*0.15 + interoperability*0.12 - riskPenalty*0.30"},"governanceScore":92,"automationRisk":36,"interoperabilityReadiness":82},{"id":"referral-management","name":"Referral Management","category":"patient-access","description":"Synthetic closed-loop referral intelligence for leakage, delays, owner routing, wait-time risk, and feedback packet generation.","strategicValue":93,"capabilities":["Referral delay detection","Leakage risk scoring","Closed-loop status tracking","Provider-matching readiness"],"requiredData":["Synthetic referral events","Synthetic provider directory","Insurance verification placeholders"],"syntheticInputs":["Referral delay fixture","Referral leakage fixture","Provider matching fixture"],"structuredOutputs":["referral_signal_report","leakage_risk_packet","closed_loop_feedback_packet"],"recommendedNextBuildStep":"Bind referral intelligence to human-reviewed owner routing and no-outreach hard stops.","safetyBoundaries":["Demo/synthetic only; no live PHI or patient identifiers.","Human review required for clinical, payer, EHR, compliance, outreach, or billing-impacting work.","Recommendations only; no autonomous diagnosis, treatment, prescribing, outreach, payer submission, EHR writeback, billing submission, or production connector use.","Evidence, schema validation, and auditability required before any pilot-facing output.","No claim of HIPAA, SOC 2, HITRUST, FDA, ONC, clinical validation, or compliance completion."],"evidenceRequirements":["Synthetic input fixture","Structured output schema validation","Safety-boundary statement","Human-review disposition placeholder","Evidence and audit trace reference"],"trustScore":{"safety":89,"evidence":82,"workflowValue":94,"governance":88,"interoperability":83,"riskPenalty":47,"total":73,"formula":"total = safety*0.30 + governance*0.25 + evidence*0.18 + workflowValue*0.15 + interoperability*0.12 - riskPenalty*0.30"},"governanceScore":88,"automationRisk":47,"interoperabilityReadiness":83}],"highestRiskModules":[{"id":"prior-authorization","name":"Prior Authorization","category":"revenue-cycle","description":"Synthetic prior-authorization workflow intelligence for stalled tasks, missing packets, evidence requirements, and human-reviewed next steps.","strategicValue":90,"capabilities":["PA stall detection","Missing documentation checklist","Evidence packet regeneration","Manual verification queueing"],"requiredData":["Synthetic authorization events","Synthetic document checklist","Policy placeholders"],"syntheticInputs":["Prior auth stalled fixture","Missing packet fixture","Synthetic payer criteria"],"structuredOutputs":["prior_auth_status_packet","missing_packet_checklist","manual_review_queue_item"],"recommendedNextBuildStep":"Connect prior-auth recommendations to durable review packets without enabling payer submission.","safetyBoundaries":["Demo/synthetic only; no live PHI or patient identifiers.","Human review required for clinical, payer, EHR, compliance, outreach, or billing-impacting work.","Recommendations only; no autonomous diagnosis, treatment, prescribing, outreach, payer submission, EHR writeback, billing submission, or production connector use.","Evidence, schema validation, and auditability required before any pilot-facing output.","No claim of HIPAA, SOC 2, HITRUST, FDA, ONC, clinical validation, or compliance completion."],"evidenceRequirements":["Synthetic input fixture","Structured output schema validation","Safety-boundary statement","Human-review disposition placeholder","Evidence and audit trace reference"],"trustScore":{"safety":88,"evidence":83,"workflowValue":91,"governance":89,"interoperability":77,"riskPenalty":57,"total":69,"formula":"total = safety*0.30 + governance*0.25 + evidence*0.18 + workflowValue*0.15 + interoperability*0.12 - riskPenalty*0.30"},"governanceScore":89,"automationRisk":57,"interoperabilityReadiness":77},{"id":"rcm-denials","name":"RCM / Denials","category":"revenue-cycle","description":"Synthetic denial-pattern intelligence for root-cause analysis, documentation packet readiness, and manual follow-up recommendations.","strategicValue":91,"capabilities":["Denial spike detection","Documentation gap mapping","Appeal packet draft requirements","RCM owner routing"],"requiredData":["Synthetic denial events","Synthetic claim metadata","Payer-rule placeholders"],"syntheticInputs":["Denied claim spike fixture","Missing modifier fixture","Synthetic denial reason codes"],"structuredOutputs":["denial_signal_report","documentation_gap_packet","manual_routing_recommendation"],"recommendedNextBuildStep":"Add no-submission denial packet generation with manual verification and payer-action hard stops.","safetyBoundaries":["Demo/synthetic only; no live PHI or patient identifiers.","Human review required for clinical, payer, EHR, compliance, outreach, or billing-impacting work.","Recommendations only; no autonomous diagnosis, treatment, prescribing, outreach, payer submission, EHR writeback, billing submission, or production connector use.","Evidence, schema validation, and auditability required before any pilot-facing output.","No claim of HIPAA, SOC 2, HITRUST, FDA, ONC, clinical validation, or compliance completion."],"evidenceRequirements":["Synthetic input fixture","Structured output schema validation","Safety-boundary statement","Human-review disposition placeholder","Evidence and audit trace reference"],"trustScore":{"safety":87,"evidence":82,"workflowValue":93,"governance":86,"interoperability":80,"riskPenalty":55,"total":69,"formula":"total = safety*0.30 + governance*0.25 + evidence*0.18 + workflowValue*0.15 + interoperability*0.12 - riskPenalty*0.30"},"governanceScore":86,"automationRisk":55,"interoperabilityReadiness":80},{"id":"population-health","name":"Population Health","category":"population-health","description":"Synthetic population-risk intelligence for care-gap patterns, outreach-ready-but-blocked tasks, stratification explainability, and reviewer queues.","strategicValue":88,"capabilities":["Care-gap signal detection","Synthetic cohort stratification","Population trend summaries","Manual intervention queueing"],"requiredData":["Synthetic cohort events","Quality measure placeholders","Reviewer policy rules"],"syntheticInputs":["Care gap fixture","Synthetic cohort fixture","Risk trend fixture"],"structuredOutputs":["population_signal_report","care_gap_packet","manual_review_queue_item"],"recommendedNextBuildStep":"Add de-identification and consent-state placeholders before any non-synthetic population workflow design.","safetyBoundaries":["Demo/synthetic only; no live PHI or patient identifiers.","Human review required for clinical, payer, EHR, compliance, outreach, or billing-impacting work.","Recommendations only; no autonomous diagnosis, treatment, prescribing, outreach, payer submission, EHR writeback, billing submission, or production connector use.","Evidence, schema validation, and auditability required before any pilot-facing output.","No claim of HIPAA, SOC 2, HITRUST, FDA, ONC, clinical validation, or compliance completion."],"evidenceRequirements":["Synthetic input fixture","Structured output schema validation","Safety-boundary statement","Human-review disposition placeholder","Evidence and audit trace reference"],"trustScore":{"safety":89,"evidence":80,"workflowValue":89,"governance":87,"interoperability":78,"riskPenalty":50,"total":71,"formula":"total = safety*0.30 + governance*0.25 + evidence*0.18 + workflowValue*0.15 + interoperability*0.12 - riskPenalty*0.30"},"governanceScore":87,"automationRisk":50,"interoperabilityReadiness":78},{"id":"clinical-intelligence","name":"Clinical Intelligence","category":"clinical-intelligence","description":"Human-reviewed synthetic clinical reasoning support that surfaces evidence, uncertainty, missing data, and escalation criteria without clinical authority.","strategicValue":96,"capabilities":["Evidence synthesis","Missing-data risk flags","Clinical uncertainty reporting","Escalation criteria drafting"],"requiredData":["Synthetic clinical scenarios","Public guideline references","Reviewer rubric"],"syntheticInputs":["Synthetic note","Synthetic labs","Synthetic guideline card"],"structuredOutputs":["clinical_intelligence_brief","evidence_gap_report","human_review_packet"],"recommendedNextBuildStep":"Require ClinicalBench pass/fail evidence and Trust Score explanation before expanding any clinical-intelligence demo.","safetyBoundaries":["Demo/synthetic only; no live PHI or patient identifiers.","Human review required for clinical, payer, EHR, compliance, outreach, or billing-impacting work.","Recommendations only; no autonomous diagnosis, treatment, prescribing, outreach, payer submission, EHR writeback, billing submission, or production connector use.","Evidence, schema validation, and auditability required before any pilot-facing output.","No claim of HIPAA, SOC 2, HITRUST, FDA, ONC, clinical validation, or compliance completion."],"evidenceRequirements":["Synthetic input fixture","Structured output schema validation","Safety-boundary statement","Human-review disposition placeholder","Evidence and audit trace reference"],"trustScore":{"safety":91,"evidence":88,"workflowValue":95,"governance":90,"interoperability":74,"riskPenalty":48,"total":74,"formula":"total = safety*0.30 + governance*0.25 + evidence*0.18 + workflowValue*0.15 + interoperability*0.12 - riskPenalty*0.30"},"governanceScore":90,"automationRisk":48,"interoperabilityReadiness":74},{"id":"referral-management","name":"Referral Management","category":"patient-access","description":"Synthetic closed-loop referral intelligence for leakage, delays, owner routing, wait-time risk, and feedback packet generation.","strategicValue":93,"capabilities":["Referral delay detection","Leakage risk scoring","Closed-loop status tracking","Provider-matching readiness"],"requiredData":["Synthetic referral events","Synthetic provider directory","Insurance verification placeholders"],"syntheticInputs":["Referral delay fixture","Referral leakage fixture","Provider matching fixture"],"structuredOutputs":["referral_signal_report","leakage_risk_packet","closed_loop_feedback_packet"],"recommendedNextBuildStep":"Bind referral intelligence to human-reviewed owner routing and no-outreach hard stops.","safetyBoundaries":["Demo/synthetic only; no live PHI or patient identifiers.","Human review required for clinical, payer, EHR, compliance, outreach, or billing-impacting work.","Recommendations only; no autonomous diagnosis, treatment, prescribing, outreach, payer submission, EHR writeback, billing submission, or production connector use.","Evidence, schema validation, and auditability required before any pilot-facing output.","No claim of HIPAA, SOC 2, HITRUST, FDA, ONC, clinical validation, or compliance completion."],"evidenceRequirements":["Synthetic input fixture","Structured output schema validation","Safety-boundary statement","Human-review disposition placeholder","Evidence and audit trace reference"],"trustScore":{"safety":89,"evidence":82,"workflowValue":94,"governance":88,"interoperability":83,"riskPenalty":47,"total":73,"formula":"total = safety*0.30 + governance*0.25 + evidence*0.18 + workflowValue*0.15 + interoperability*0.12 - riskPenalty*0.30"},"governanceScore":88,"automationRisk":47,"interoperabilityReadiness":83}],"orchestrationLayer":[{"id":"clinical-and-memory-supervision","name":"Clinical and Memory Supervision","trigger":"Synthetic clinical, journey, or population-health output needs evidence and reviewer disposition.","moduleIds":["patient-journey-memory","clinical-intelligence","population-health","governance-compliance"],"sequence":["classify synthetic context","validate structured brief","attach evidence requirements","route to human review"],"humanGate":"Qualified clinical or governance reviewer must approve before any pilot-facing claim.","safeOutputs":["validated synthetic brief","evidence gap report","review queue item"],"blockedActions":["diagnosis","treatment","prescribing","patient outreach","EHR writeback"]},{"id":"administrative-operations-supervision","name":"Administrative Operations Supervision","trigger":"Synthetic RCM, prior-auth, access, scheduling, referral, or quality signal crosses threshold.","moduleIds":["rcm-denials","prior-authorization","patient-access","scheduling","referral-management","quality-hedis-star"],"sequence":["detect synthetic signal","score workflow value","recommend owner","generate manual verification packet"],"humanGate":"Operational owner must review before any real payer, billing, outreach, or connector action.","safeOutputs":["manual verification packet","blocked-action note","owner routing recommendation"],"blockedActions":["payer submission","billing submission","patient outreach","production connector use"]},{"id":"platform-self-healing-supervision","name":"Platform Self-Healing Supervision","trigger":"Synthetic integration, confidence, duplicate-context, compliance-sensitive, or failed-sync signal appears.","moduleIds":["signal-detection","self-healing-operations","semantic-intelligence-graph","secure-middleware-gateway"],"sequence":["classify signal","validate recommendation schema","pause unsafe automation","open human-run packet"],"humanGate":"Platform or compliance owner must approve remediation before any production change.","safeOutputs":["recommendation-only remediation plan","investigation ticket draft","automation pause packet"],"blockedActions":["autonomous remediation","production connector mutation","PHI-impacting action"]}],"syntheticEvents":[{"id":"synthetic-event-denied-claim-spike","type":"denied_claim_spike","affectedWorkflow":"RCM / Denials","observedValue":22,"threshold":10,"unit":"denials per synthetic hour","synthetic":true,"occurredAt":"2026-06-30T09:00:00.000Z"},{"id":"synthetic-event-referral-delay","type":"referral_delay","affectedWorkflow":"Referral Management","observedValue":9,"threshold":4,"unit":"days in synthetic queue","synthetic":true,"occurredAt":"2026-06-30T09:05:00.000Z"},{"id":"synthetic-event-prior-auth-stalled","type":"prior_auth_stalled","affectedWorkflow":"Prior Authorization","observedValue":6,"threshold":2,"unit":"synthetic business days","synthetic":true,"occurredAt":"2026-06-30T09:10:00.000Z"},{"id":"synthetic-event-missing-documentation","type":"missing_documentation","affectedWorkflow":"Clinical Documentation / RCM","observedValue":7,"threshold":1,"unit":"missing packet fields","synthetic":true,"occurredAt":"2026-06-30T09:15:00.000Z"},{"id":"synthetic-event-imaging-turnaround-delay","type":"imaging_turnaround_delay","affectedWorkflow":"Imaging Intelligence","observedValue":48,"threshold":24,"unit":"synthetic hours","synthetic":true,"occurredAt":"2026-06-30T09:20:00.000Z"},{"id":"synthetic-event-care-gap-detected","type":"care_gap_detected","affectedWorkflow":"Population Health","observedValue":14,"threshold":3,"unit":"synthetic care gaps","synthetic":true,"occurredAt":"2026-06-30T09:25:00.000Z"},{"id":"synthetic-event-failed-api-sync","type":"failed_api_sync","affectedWorkflow":"Secure Middleware Gateway","observedValue":5,"threshold":1,"unit":"synthetic sync failures","synthetic":true,"occurredAt":"2026-06-30T09:30:00.000Z"},{"id":"synthetic-event-duplicate-patient-context","type":"duplicate_patient_context","affectedWorkflow":"Patient Journey Memory","observedValue":2,"threshold":1,"unit":"synthetic duplicate contexts","synthetic":true,"occurredAt":"2026-06-30T09:35:00.000Z"},{"id":"synthetic-event-low-confidence-agent-output","type":"low_confidence_agent_output","affectedWorkflow":"Clinical Intelligence","observedValue":42,"threshold":70,"unit":"confidence score","synthetic":true,"occurredAt":"2026-06-30T09:40:00.000Z"},{"id":"synthetic-event-compliance-sensitive-task","type":"compliance_sensitive_task","affectedWorkflow":"Governance / Compliance","observedValue":1,"threshold":1,"unit":"sensitive synthetic task","synthetic":true,"occurredAt":"2026-06-30T09:45:00.000Z"}],"syntheticSignals":[{"id":"denied_claim_spike","severity":"high","affectedWorkflow":"RCM / Denials","recommendedOwner":"Revenue Cycle Lead","recommendedAction":"Open a synthetic denial-pattern investigation packet for manual review.","automationEligibility":"manual-review-required","humanReviewRequired":true,"reason":"Synthetic denial volume exceeded the configured threshold and may indicate documentation or coding workflow friction. Observed 22 denials per synthetic hour; threshold 10.","safetyBoundary":"Synthetic/demo signal only; requires human review and does not authorize live PHI, clinical action, patient outreach, payer submission, EHR writeback, billing submission, or production connector use."},{"id":"referral_delay","severity":"high","affectedWorkflow":"Referral Management","recommendedOwner":"Referral Operations Lead","recommendedAction":"Request human review of delayed synthetic referrals and owner routing.","automationEligibility":"manual-review-required","humanReviewRequired":true,"reason":"Synthetic referral queue time exceeded the threshold and could become leakage risk in a governed pilot. Observed 9 days in synthetic queue; threshold 4.","safetyBoundary":"Synthetic/demo signal only; requires human review and does not authorize live PHI, clinical action, patient outreach, payer submission, EHR writeback, billing submission, or production connector use."},{"id":"prior_auth_stalled","severity":"high","affectedWorkflow":"Prior Authorization","recommendedOwner":"Prior Authorization Lead","recommendedAction":"Queue stalled synthetic prior-auth packets for manual verification.","automationEligibility":"manual-review-required","humanReviewRequired":true,"reason":"Synthetic authorization tasks remained unresolved beyond the safe review threshold. Observed 6 synthetic business days; threshold 2.","safetyBoundary":"Synthetic/demo signal only; requires human review and does not authorize live PHI, clinical action, patient outreach, payer submission, EHR writeback, billing submission, or production connector use."},{"id":"missing_documentation","severity":"medium","affectedWorkflow":"Clinical Documentation / RCM","recommendedOwner":"Clinical Documentation Lead","recommendedAction":"Regenerate the missing synthetic documentation packet for reviewer inspection.","automationEligibility":"manual-review-required","humanReviewRequired":true,"reason":"Required synthetic packet fields are missing and should not move forward without validation. Observed 7 missing packet fields; threshold 1.","safetyBoundary":"Synthetic/demo signal only; requires human review and does not authorize live PHI, clinical action, patient outreach, payer submission, EHR writeback, billing submission, or production connector use."},{"id":"imaging_turnaround_delay","severity":"medium","affectedWorkflow":"Imaging Intelligence","recommendedOwner":"Imaging Operations Lead","recommendedAction":"Retry the synthetic imaging-status workflow and route the result to manual review.","automationEligibility":"manual-review-required","humanReviewRequired":true,"reason":"Synthetic imaging turnaround exceeded the configured threshold. Observed 48 synthetic hours; threshold 24.","safetyBoundary":"Synthetic/demo signal only; requires human review and does not authorize live PHI, clinical action, patient outreach, payer submission, EHR writeback, billing submission, or production connector use."},{"id":"care_gap_detected","severity":"high","affectedWorkflow":"Population Health","recommendedOwner":"Population Health Lead","recommendedAction":"Request human review of the synthetic care-gap packet.","automationEligibility":"manual-review-required","humanReviewRequired":true,"reason":"Synthetic care-gap signals require review before any patient-facing or outreach-adjacent workflow is considered. Observed 14 synthetic care gaps; threshold 3.","safetyBoundary":"Synthetic/demo signal only; requires human review and does not authorize live PHI, clinical action, patient outreach, payer submission, EHR writeback, billing submission, or production connector use."},{"id":"failed_api_sync","severity":"medium","affectedWorkflow":"Secure Middleware Gateway","recommendedOwner":"Platform Reliability Lead","recommendedAction":"Re-run synthetic middleware validation and inspect the failed sync trace.","automationEligibility":"manual-review-required","humanReviewRequired":true,"reason":"Synthetic middleware sync failures may indicate connector readiness or schema drift issues. Observed 5 synthetic sync failures; threshold 1.","safetyBoundary":"Synthetic/demo signal only; requires human review and does not authorize live PHI, clinical action, patient outreach, payer submission, EHR writeback, billing submission, or production connector use."},{"id":"duplicate_patient_context","severity":"critical","affectedWorkflow":"Patient Journey Memory","recommendedOwner":"Data Governance Lead","recommendedAction":"Reconcile duplicate synthetic contexts through manual verification.","automationEligibility":"manual-review-required","humanReviewRequired":true,"reason":"Duplicate context signals are safety-sensitive even in synthetic mode and must block automation. Observed 2 synthetic duplicate contexts; threshold 1.","safetyBoundary":"Synthetic/demo signal only; requires human review and does not authorize live PHI, clinical action, patient outreach, payer submission, EHR writeback, billing submission, or production connector use."},{"id":"low_confidence_agent_output","severity":"critical","affectedWorkflow":"Clinical Intelligence","recommendedOwner":"Clinical QA Lead","recommendedAction":"Pause automation and route the synthetic agent output to qualified review.","automationEligibility":"manual-review-required","humanReviewRequired":true,"reason":"Low-confidence clinical-adjacent outputs must not continue without reviewer disposition. Observed 42 confidence score; threshold 70.","safetyBoundary":"Synthetic/demo signal only; requires human review and does not authorize live PHI, clinical action, patient outreach, payer submission, EHR writeback, billing submission, or production connector use."},{"id":"compliance_sensitive_task","severity":"critical","affectedWorkflow":"Governance / Compliance","recommendedOwner":"Compliance Lead","recommendedAction":"Escalate the synthetic sensitive task to compliance review.","automationEligibility":"manual-review-required","humanReviewRequired":true,"reason":"Compliance-sensitive task classification requires explicit human review and retained hard stops. Observed 1 sensitive synthetic task; threshold 1.","safetyBoundary":"Synthetic/demo signal only; requires human review and does not authorize live PHI, clinical action, patient outreach, payer submission, EHR writeback, billing submission, or production connector use."}],"selfHealingRecommendations":[{"id":"recommendation-denied_claim_spike","signalId":"denied_claim_spike","action":"open investigation ticket","recommendedOwner":"Revenue Cycle Lead","steps":["Create an investigation ticket draft.","Attach trend summary, threshold, and affected workflow.","Assign the owner for manual investigation."],"automationEligibility":"recommendation-only","humanReviewRequired":true,"expectedOutcome":"A human-reviewed open investigation ticket packet for RCM / Denials.","blockedActions":["Live PHI access","Autonomous diagnosis","Treatment recommendation","Prescribing","Patient outreach","Payer submission","EHR writeback","Billing submission","Production connector mutation"],"safetyBoundary":"Recommendation-only synthetic remediation; no real clinical, payer, EHR, billing, outreach, PHI-impacting, or production connector action may execute without explicit human approval and future authorization."},{"id":"recommendation-referral_delay","signalId":"referral_delay","action":"request human review","recommendedOwner":"Referral Operations Lead","steps":["Create a reviewer task with signal reason and source event.","Attach the synthetic evidence packet.","Block any downstream automation until disposition is recorded."],"automationEligibility":"recommendation-only","humanReviewRequired":true,"expectedOutcome":"A human-reviewed request human review packet for Referral Management.","blockedActions":["Live PHI access","Autonomous diagnosis","Treatment recommendation","Prescribing","Patient outreach","Payer submission","EHR writeback","Billing submission","Production connector mutation"],"safetyBoundary":"Recommendation-only synthetic remediation; no real clinical, payer, EHR, billing, outreach, PHI-impacting, or production connector action may execute without explicit human approval and future authorization."},{"id":"recommendation-prior_auth_stalled","signalId":"prior_auth_stalled","action":"queue for manual verification","recommendedOwner":"Prior Authorization Lead","steps":["Create a manual verification queue item.","Attach the stalled workflow trace.","Require owner disposition before any next step."],"automationEligibility":"recommendation-only","humanReviewRequired":true,"expectedOutcome":"A human-reviewed queue for manual verification packet for Prior Authorization.","blockedActions":["Live PHI access","Autonomous diagnosis","Treatment recommendation","Prescribing","Patient outreach","Payer submission","EHR writeback","Billing submission","Production connector mutation"],"safetyBoundary":"Recommendation-only synthetic remediation; no real clinical, payer, EHR, billing, outreach, PHI-impacting, or production connector action may execute without explicit human approval and future authorization."},{"id":"recommendation-missing_documentation","signalId":"missing_documentation","action":"regenerate missing packet","recommendedOwner":"Clinical Documentation Lead","steps":["Regenerate the synthetic evidence packet.","Validate required schema fields.","Queue the packet for human review."],"automationEligibility":"recommendation-only","humanReviewRequired":true,"expectedOutcome":"A human-reviewed regenerate missing packet packet for Clinical Documentation / RCM.","blockedActions":["Live PHI access","Autonomous diagnosis","Treatment recommendation","Prescribing","Patient outreach","Payer submission","EHR writeback","Billing submission","Production connector mutation"],"safetyBoundary":"Recommendation-only synthetic remediation; no real clinical, payer, EHR, billing, outreach, PHI-impacting, or production connector action may execute without explicit human approval and future authorization."},{"id":"recommendation-imaging_turnaround_delay","signalId":"imaging_turnaround_delay","action":"retry workflow","recommendedOwner":"Imaging Operations Lead","steps":["Replay the synthetic workflow trace.","Re-run structured-output validation.","Send the replay packet to the assigned owner."],"automationEligibility":"recommendation-only","humanReviewRequired":true,"expectedOutcome":"A human-reviewed retry workflow packet for Imaging Intelligence.","blockedActions":["Live PHI access","Autonomous diagnosis","Treatment recommendation","Prescribing","Patient outreach","Payer submission","EHR writeback","Billing submission","Production connector mutation"],"safetyBoundary":"Recommendation-only synthetic remediation; no real clinical, payer, EHR, billing, outreach, PHI-impacting, or production connector action may execute without explicit human approval and future authorization."},{"id":"recommendation-care_gap_detected","signalId":"care_gap_detected","action":"request human review","recommendedOwner":"Population Health Lead","steps":["Create a reviewer task with signal reason and source event.","Attach the synthetic evidence packet.","Block any downstream automation until disposition is recorded."],"automationEligibility":"recommendation-only","humanReviewRequired":true,"expectedOutcome":"A human-reviewed request human review packet for Population Health.","blockedActions":["Live PHI access","Autonomous diagnosis","Treatment recommendation","Prescribing","Patient outreach","Payer submission","EHR writeback","Billing submission","Production connector mutation"],"safetyBoundary":"Recommendation-only synthetic remediation; no real clinical, payer, EHR, billing, outreach, PHI-impacting, or production connector action may execute without explicit human approval and future authorization."},{"id":"recommendation-failed_api_sync","signalId":"failed_api_sync","action":"re-run validation","recommendedOwner":"Platform Reliability Lead","steps":["Re-run schema validation against the synthetic trace.","Capture validation errors.","Route failures to platform reliability review."],"automationEligibility":"recommendation-only","humanReviewRequired":true,"expectedOutcome":"A human-reviewed re-run validation packet for Secure Middleware Gateway.","blockedActions":["Live PHI access","Autonomous diagnosis","Treatment recommendation","Prescribing","Patient outreach","Payer submission","EHR writeback","Billing submission","Production connector mutation"],"safetyBoundary":"Recommendation-only synthetic remediation; no real clinical, payer, EHR, billing, outreach, PHI-impacting, or production connector action may execute without explicit human approval and future authorization."},{"id":"recommendation-duplicate_patient_context","signalId":"duplicate_patient_context","action":"reconcile duplicate records","recommendedOwner":"Data Governance Lead","steps":["Create a duplicate-context reconciliation packet.","Compare only synthetic context identifiers.","Require data-governance review before any merge-like recommendation."],"automationEligibility":"recommendation-only","humanReviewRequired":true,"expectedOutcome":"A human-reviewed reconcile duplicate records packet for Patient Journey Memory.","blockedActions":["Live PHI access","Autonomous diagnosis","Treatment recommendation","Prescribing","Patient outreach","Payer submission","EHR writeback","Billing submission","Production connector mutation"],"safetyBoundary":"Recommendation-only synthetic remediation; no real clinical, payer, EHR, billing, outreach, PHI-impacting, or production connector action may execute without explicit human approval and future authorization."},{"id":"recommendation-low_confidence_agent_output","signalId":"low_confidence_agent_output","action":"pause automation","recommendedOwner":"Clinical QA Lead","steps":["Mark the synthetic workflow as automation-paused.","Attach the confidence or safety reason.","Require qualified reviewer approval before continuing."],"automationEligibility":"recommendation-only","humanReviewRequired":true,"expectedOutcome":"A human-reviewed pause automation packet for Clinical Intelligence.","blockedActions":["Live PHI access","Autonomous diagnosis","Treatment recommendation","Prescribing","Patient outreach","Payer submission","EHR writeback","Billing submission","Production connector mutation"],"safetyBoundary":"Recommendation-only synthetic remediation; no real clinical, payer, EHR, billing, outreach, PHI-impacting, or production connector action may execute without explicit human approval and future authorization."},{"id":"recommendation-compliance_sensitive_task","signalId":"compliance_sensitive_task","action":"escalate to compliance","recommendedOwner":"Compliance Lead","steps":["Create a compliance escalation packet.","Attach policy boundary and signal details.","Pause related automation recommendations until compliance review completes."],"automationEligibility":"recommendation-only","humanReviewRequired":true,"expectedOutcome":"A human-reviewed escalate to compliance packet for Governance / Compliance.","blockedActions":["Live PHI access","Autonomous diagnosis","Treatment recommendation","Prescribing","Patient outreach","Payer submission","EHR writeback","Billing submission","Production connector mutation"],"safetyBoundary":"Recommendation-only synthetic remediation; no real clinical, payer, EHR, billing, outreach, PHI-impacting, or production connector action may execute without explicit human approval and future authorization."}],"reviewPacketSummary":{"service":"scrimed-trustops-review-packets","status":"trustops-review-packets-ready-for-aal2-protected-persistence","packetCount":10,"durableEnvelope":{"attemptId":"att_c457962a73ff","contractVersion":"scrimed-execution-attempt-envelope-v1","buildStatus":"metadata-only-accepted","lifecycleState":"review-required","workflowSlug":"trustops-signal-remediation-review","workflowVersion":"2026.06.no-phi","idempotencyKey":"idem_c457962a73ff77a59c0f5b5f","createdAt":"2026-06-27","tenantReference":"tenant-ref-synthetic-atlas","tenantBoundary":"tenant-reference-only-no-customer-data","callerRole":"trustops-reviewer","agentRuntimeId":"agent-runtime-trustops-supervisor","agentPermissions":["read-synthetic-context","read-approved-evidence-references","write-draft-review-packet","append-metadata-audit-event"],"deniedCapabilities":["autonomous diagnosis","autonomous treatment","prescribing","patient outreach","payer submission","claim submission","final coding","EHR writeback","production connector write","clinical triage replacement"],"dataBoundary":"synthetic-and-metadata-only","phiAuthority":"not-authorized-production-phi","clinicalCareAuthority":"not-authorized-live-care","inputDigest":"cab5bad92f6d33cdc6a05290ee1724fa095d033528d7f9c2991398328adbeeb4","contextFingerprint":"d7f0ab098482ad9655bb7e9961dd93d852690f9a2cfb552cd5091dbe7c27fff1","compressedContextRefs":["compressed:synthetic-trustops-signal-set-v1","compressed:synthetic-self-healing-recommendation-set-v1"],"evidenceRefs":["trustops-module-registry-v1","trustops-structured-validation-v1"],"policyRefs":["org-policy-human-trustops-review-required-v1"],"requestedActionSummary":"Create a reviewer-held TrustOps signal and recommendation packet with durable evidence binding for synthetic operations review.","modelRouteTelemetry":{"routeId":"route_cfb561cfa2","taskType":"trustops signal remediation review","providerClass":"open-weight","providerName":"SCRIMED local or open-weight route","modelVersion":"open-weight:registered-version-required-before-production","fallbackProviderClass":"frontier-closed","routeProfile":"workflow-planning-human-review-gated","riskTier":"moderate","estimatedCostUsd":0.028,"latencyBudgetMs":3200,"confidence":0.78,"routingRationale":"Route metadata is logged for synthetic evaluation only; production provider selection remains blocked until contracts, privacy, telemetry, fallback, and review controls are approved.","telemetryBoundary":"telemetry-only-not-production-routing"},"computeFabricTelemetry":{"fabricVersion":"scrimed-compute-fabric-v2026-07-05","fabricStatus":"synthetic-routing-only-no-live-model-calls","selectedModel":"private-sglang-compact-runtime-slot","modelTier":"COMPACT_REASONING_MODEL","provider":"scrimed_private_sglang","deploymentMode":"CUSTOMER_VPC","reason":"COMPACT_REASONING_MODEL selected for operations; CUSTOMER_VPC deployment mode; text modality; moderate clinical risk; metadata-only-no-public-phi PHI policy","riskLevel":"moderate","phiPolicy":"metadata-only-no-public-phi","requiresHumanReview":false,"fallbackModels":["pulsar-16b-compact-reasoning-synthetic-slot","llama-mistral-qwen-glm-open-routing-slot"],"estimatedCostClass":"LOW","estimatedLatencyClass":"INTERACTIVE","auditTags":["scrimed-compute-fabric","scrimed-compute-fabric-v2026-07-05","task:operations","modality:text","risk:moderate","deployment:CUSTOMER_VPC","tier:COMPACT_REASONING_MODEL","provider:scrimed_private_sglang","phi-policy:metadata-only-no-public-phi","human-review-not-required-for-metadata-only","no-live-model-call","no-autonomous-clinical-authority"],"auditHash":"scrimed-intel-9abbb131","confidenceScore":0.86,"confidenceCorrectnessBoundary":"confidence-is-not-correctness","correctnessEvidenceRequired":["schema validation","source attribution","benchmarkModelForTask","compareModels","human review for clinical recommendations"],"uncertaintyReasons":["Confidence score is routing confidence, not proof of clinical correctness.","Clinical correctness requires evidence review, external validation, and human signoff.","Benchmark scores are synthetic metadata until a governed validation dataset is approved."],"safetyBoundary":"metadata-only-no-live-model-call"},"humanApprovalGate":{"required":true,"reviewStatus":"held-for-human-review","requiredReviewers":["domain reviewer","TrustOS"],"gateReason":"Protected healthcare workflow output requires accountable human review before any release, connector, payer, record, or patient-facing action.","releaseCondition":"Release requires approved reviewer identity, evidence card, clinical-risk label, audit event, and retained no-PHI boundary.","deniedUntil":"Durable attempt store, customer authority, connector approval, PHI controls, and production review workflow are approved."},"auditTrail":{"auditEventId":"audit_61069a3ed8f7","traceId":"trace_2188d604f39a781b","eventHash":"2d8e3525e9c56c814b33d3d8bbe7568aeb4c3477a2a1372c7cdd3f0984a23647","immutableEventType":"execution-attempt-envelope-created","retainedFields":["attemptId","idempotencyKey","workflowSlug","tenantReference","callerRole","contextFingerprint","modelRouteTelemetry","computeFabricTelemetry","humanApprovalGate","replayMetadata","failureRecovery"],"prohibitedFields":["patient identifiers","raw chart text","member identifiers","production connector payloads","secrets","credentials"]},"replayMetadata":{"replayToken":"replay_b8c7009f50d041cc33d9967c","replayEligible":true,"idempotencyScope":"tenant-reference + workflow slug + workflow version + caller role + input digest","ttlHours":72,"deterministicInputs":["workflowSlug","workflowVersion","tenantReference","callerRole","agentRuntimeId","inputDigest","contextFingerprint","policyRefs"],"replayPolicy":"Replay returns the retained metadata envelope only and cannot repeat protected external actions.","conflictResponse":"Return conflict when the same idempotency key maps to a different input digest, context fingerprint, or caller role.","expirationBehavior":"Expired metadata-only keys require a new envelope and cannot revive protected execution."},"toolPlan":{"toolRegistryVersion":"scrimed-tool-registry-no-phi-v1","allowedTools":["synthetic-context-reader","evidence-card-builder","review-packet-drafter","metadata-audit-appender"],"blockedTools":["ehr-writeback","patient-messaging","payer-submission","claims-submission","production-connector-write"],"noConnectorAccess":true,"noRecordMutation":true},"failureRecovery":{"retryPolicy":"Retry metadata envelope creation only when validation, hash generation, or audit-link assembly fails before any protected action.","quarantineTriggers":["PHI-like input","protected action request","missing reviewer gate","missing context fingerprint","model route telemetry absent","idempotency conflict"],"fallbackBehavior":"Return a deny-by-default review packet and require human operator triage.","rollbackBehavior":"No external side effect exists to roll back; retain denial metadata and preserve prior workflow state.","deadLetterOwner":"TrustOS and platform reliability"},"evidenceAuditTrail":{"attempt_id":"att_c457962a73ff","user_session_tenant_context":{"tenantReference":"tenant-ref-synthetic-atlas","callerRole":"trustops-reviewer","agentRuntimeId":"agent-runtime-trustops-supervisor","sessionReference":"metadata-only-no-live-session"},"timestamp":"2026-06-27","route":"/api/workflows/execution-attempts/envelope","action":"Create a reviewer-held TrustOps signal and recommendation packet with durable evidence binding for synthetic operations review.","allowed_blocked_decision":"allowed","policy_version":"scrimed-safety-governance-v2026-06-29","input_classification":"synthetic-no-phi","phi_detected":false,"synthetic":true,"model_provider_selected":"synthetic-fallback","model_tier_selected":"FAST_LOW_COST","compute_fabric_audit_hash":"scrimed-intel-9abbb131","compute_fabric_selected_model":"private-sglang-compact-runtime-slot","compute_fabric_model_tier":"COMPACT_REASONING_MODEL","compute_fabric_provider":"scrimed_private_sglang","compute_fabric_deployment_mode":"CUSTOMER_VPC","compute_fabric_phi_policy":"metadata-only-no-public-phi","compute_fabric_human_review_required":false,"output_hash":"25637661bf746a6c51014d4f4ef9a5675acb8c6076f93b44d5817abc05fd4049","evidence_envelope_hash":"590ff91776c7eec0932a1dbffbcded47b4d9aa86de36d2c4db5f08f9e93fe131","status":"review-required","failure_reason":null},"evaluationBindings":{"syntheticScenarioRefs":["agent-scorecard-runtime-permission","hallucination-uncited-guideline","clinical-safety-prohibited-action","evidence-quality-stale-policy","regression-workflow-result-diff","synthetic-patient-missing-data","adversarial-prompt-injection-tool-override","sanar-conflict-temporal-escalation","clinical-copilot-unit-abbreviation-citation"],"scorecardRefs":["scorecard-idempotency-replay","scorecard-no-phi-boundary","scorecard-route-telemetry","scorecard-human-review","scorecard-audit-linkage","scorecard-protected-capability-denial","scorecard-failure-recovery","scorecard-context-fingerprint","clinical-robustness-scorecard-sanar-conflict-temporal-escalation","clinical-robustness-scorecard-clinical-copilot-unit-abbreviation-citation"],"clinicalRobustness":{"labRoute":"/clinical-robustness-lab","scenarioRefs":["sanar-conflict-temporal-escalation","clinical-copilot-unit-abbreviation-citation"],"scorecardRefs":["clinical-robustness-scorecard-sanar-conflict-temporal-escalation","clinical-robustness-scorecard-clinical-copilot-unit-abbreviation-citation"],"perturbationRefs":["missing-data","missing-labs-risk","conflicting-data","temporal-inconsistencies","data-freshness","human-review-requirement","abbreviations","wrong-units","hallucination-risk","citation-reference-quality","guideline-grounding","model-disagreement"],"averageClinicalReadinessScore":96,"reviewerQueues":["clinical-safety-review","clinical-copilot-review"],"dataBoundary":"synthetic-no-phi-only","clinicalAuthority":"not-authorized-live-care","phiAuthority":"not-authorized-production-phi","reviewerGate":"human-review-required"}},"retainedBoundary":"This envelope is a metadata-only, no-PHI, replayable contract. It is not live workflow execution, not production persistence, not model routing approval, and not clinical or payer authority."},"durableStoreRoutes":{"record":"/api/workflows/execution-attempts/durable-store/record","replay":"/api/workflows/execution-attempts/durable-store/replay","reviewDisposition":"/api/workflows/execution-attempts/durable-store/review-disposition"},"persistenceBoundary":"Review packets are ready for AAL2 protected durable-store record/replay/review-disposition routes, but this public TrustOps layer does not write protected storage or bypass authentication.","packets":[{"packetId":"trustops_packet_0d2297849796c5f2","packetVersion":"scrimed-trustops-review-packet-v1","createdAt":"2026-06-30T00:00:00.000Z","signalId":"denied_claim_spike","recommendationId":"recommendation-denied_claim_spike","moduleIds":["rcm-denials","governance-compliance","signal-detection","self-healing-operations"],"affectedWorkflow":"RCM / Denials","severity":"high","recommendedOwner":"Revenue Cycle Lead","reviewerQueue":"Revenue Cycle Lead human review queue","syntheticOnly":true,"humanReviewRequired":true,"automationExecutionAllowed":false,"signal":{"id":"denied_claim_spike","severity":"high","affectedWorkflow":"RCM / Denials","recommendedOwner":"Revenue Cycle Lead","recommendedAction":"Open a synthetic denial-pattern investigation packet for manual review.","automationEligibility":"manual-review-required","humanReviewRequired":true,"reason":"Synthetic denial volume exceeded the configured threshold and may indicate documentation or coding workflow friction. Observed 22 denials per synthetic hour; threshold 10.","safetyBoundary":"Synthetic/demo signal only; requires human review and does not authorize live PHI, clinical action, patient outreach, payer submission, EHR writeback, billing submission, or production connector use."},"recommendation":{"id":"recommendation-denied_claim_spike","signalId":"denied_claim_spike","action":"open investigation ticket","recommendedOwner":"Revenue Cycle Lead","steps":["Create an investigation ticket draft.","Attach trend summary, threshold, and affected workflow.","Assign the owner for manual investigation."],"automationEligibility":"recommendation-only","humanReviewRequired":true,"expectedOutcome":"A human-reviewed open investigation ticket packet for RCM / Denials.","blockedActions":["Live PHI access","Autonomous diagnosis","Treatment recommendation","Prescribing","Patient outreach","Payer submission","EHR writeback","Billing submission","Production connector mutation"],"safetyBoundary":"Recommendation-only synthetic remediation; no real clinical, payer, EHR, billing, outreach, PHI-impacting, or production connector action may execute without explicit human approval and future authorization."},"evidenceRefs":["scrimed-trustops-module-registry","scrimed-trustops-signal-engine","scrimed-trustops-self-healing-recommendation","scrimed-execution-attempt-durable-store"],"durableEvidenceBinding":{"attemptId":"att_c457962a73ff","idempotencyKey":"idem_c457962a73ff77a59c0f5b5f","replayToken":"replay_b8c7009f50d041cc33d9967c","workflowSlug":"trustops-signal-remediation-review","durableStoreRecordRoute":"/api/workflows/execution-attempts/durable-store/record","durableStoreReplayRoute":"/api/workflows/execution-attempts/durable-store/replay","durableStoreReviewDispositionRoute":"/api/workflows/execution-attempts/durable-store/review-disposition","recordRequest":{"workspaceSlug":"atlas-synthetic-evaluation","attemptId":"att_c457962a73ff","idempotencyKey":"idem_c457962a73ff77a59c0f5b5f","region":"us","retentionUntil":"2026-12-31T00:00:00.000Z"},"replayRequest":{"workspaceSlug":"atlas-synthetic-evaluation","replayToken":"replay_b8c7009f50d041cc33d9967c"},"reviewDispositionRequest":{"workspaceSlug":"atlas-synthetic-evaluation","attemptId":"att_c457962a73ff","disposition":"changes-requested","reviewerRole":"TrustOps reviewer","reasonCode":"trustops-denied-claim-spike","reviewNote":"Synthetic TrustOps packet for denied_claim_spike. Recommended owner: Revenue Cycle Lead. Recommended action: open investigation ticket. Human review is required before any protected workflow moves beyond synthetic mode.","humanReviewAttestation":"no-phi-human-review-no-clinical-authority"},"packetHash":"0d2297849796c5f28bbad86a5dedf4a49d4522b09807305b63d4ba4aead9964e","evidenceEnvelopeHash":"cc54148d5c497ff8d60bca5571755e270a441a36789d5c1885fdcbfc1a1a4d2b","persistenceStatus":"ready-for-aal2-protected-durable-store-not-persisted","safetyBoundary":"SCRIMED Execution Attempt Durable Store v1 is a tenant-scoped, no-PHI, metadata-only persistence contract for execution-attempt envelopes, idempotency, replay lookup, review dispositions, immutable audit events, regional retention, Compute Fabric routing evidence, and fail-closed protected route access. It does not authorize PHI processing, live patient data use, production model routing, autonomous diagnosis, autonomous treatment, prescribing, payer submission, claim submission, EHR writeback, patient outreach, production connector use, or clinical production approval."},"safetyBoundary":"Synthetic TrustOps review packet only. Recommendation-only remediation requires human review and does not authorize live PHI, autonomous clinical action, payer submission, billing submission, EHR writeback, patient outreach, production connector use, certification, clinical validation, or customer go-live."},{"packetId":"trustops_packet_c6d05d917a0835cd","packetVersion":"scrimed-trustops-review-packet-v1","createdAt":"2026-06-30T00:00:00.000Z","signalId":"referral_delay","recommendationId":"recommendation-referral_delay","moduleIds":["referral-management","patient-access","signal-detection","self-healing-operations"],"affectedWorkflow":"Referral Management","severity":"high","recommendedOwner":"Referral Operations Lead","reviewerQueue":"Referral Operations Lead human review queue","syntheticOnly":true,"humanReviewRequired":true,"automationExecutionAllowed":false,"signal":{"id":"referral_delay","severity":"high","affectedWorkflow":"Referral Management","recommendedOwner":"Referral Operations Lead","recommendedAction":"Request human review of delayed synthetic referrals and owner routing.","automationEligibility":"manual-review-required","humanReviewRequired":true,"reason":"Synthetic referral queue time exceeded the threshold and could become leakage risk in a governed pilot. Observed 9 days in synthetic queue; threshold 4.","safetyBoundary":"Synthetic/demo signal only; requires human review and does not authorize live PHI, clinical action, patient outreach, payer submission, EHR writeback, billing submission, or production connector use."},"recommendation":{"id":"recommendation-referral_delay","signalId":"referral_delay","action":"request human review","recommendedOwner":"Referral Operations Lead","steps":["Create a reviewer task with signal reason and source event.","Attach the synthetic evidence packet.","Block any downstream automation until disposition is recorded."],"automationEligibility":"recommendation-only","humanReviewRequired":true,"expectedOutcome":"A human-reviewed request human review packet for Referral Management.","blockedActions":["Live PHI access","Autonomous diagnosis","Treatment recommendation","Prescribing","Patient outreach","Payer submission","EHR writeback","Billing submission","Production connector mutation"],"safetyBoundary":"Recommendation-only synthetic remediation; no real clinical, payer, EHR, billing, outreach, PHI-impacting, or production connector action may execute without explicit human approval and future authorization."},"evidenceRefs":["scrimed-trustops-module-registry","scrimed-trustops-signal-engine","scrimed-trustops-self-healing-recommendation","scrimed-execution-attempt-durable-store"],"durableEvidenceBinding":{"attemptId":"att_c457962a73ff","idempotencyKey":"idem_c457962a73ff77a59c0f5b5f","replayToken":"replay_b8c7009f50d041cc33d9967c","workflowSlug":"trustops-signal-remediation-review","durableStoreRecordRoute":"/api/workflows/execution-attempts/durable-store/record","durableStoreReplayRoute":"/api/workflows/execution-attempts/durable-store/replay","durableStoreReviewDispositionRoute":"/api/workflows/execution-attempts/durable-store/review-disposition","recordRequest":{"workspaceSlug":"atlas-synthetic-evaluation","attemptId":"att_c457962a73ff","idempotencyKey":"idem_c457962a73ff77a59c0f5b5f","region":"us","retentionUntil":"2026-12-31T00:00:00.000Z"},"replayRequest":{"workspaceSlug":"atlas-synthetic-evaluation","replayToken":"replay_b8c7009f50d041cc33d9967c"},"reviewDispositionRequest":{"workspaceSlug":"atlas-synthetic-evaluation","attemptId":"att_c457962a73ff","disposition":"changes-requested","reviewerRole":"TrustOps reviewer","reasonCode":"trustops-referral-delay","reviewNote":"Synthetic TrustOps packet for referral_delay. Recommended owner: Referral Operations Lead. Recommended action: request human review. Human review is required before any protected workflow moves beyond synthetic mode.","humanReviewAttestation":"no-phi-human-review-no-clinical-authority"},"packetHash":"c6d05d917a0835cd150d2a92ff0c15904268f3990ced90b6947d4520bf1768cd","evidenceEnvelopeHash":"fa9fb7cca78846fb9779f34b8e5ceb2f36b4dd99ea02e9811e5c813cb1ca7235","persistenceStatus":"ready-for-aal2-protected-durable-store-not-persisted","safetyBoundary":"SCRIMED Execution Attempt Durable Store v1 is a tenant-scoped, no-PHI, metadata-only persistence contract for execution-attempt envelopes, idempotency, replay lookup, review dispositions, immutable audit events, regional retention, Compute Fabric routing evidence, and fail-closed protected route access. It does not authorize PHI processing, live patient data use, production model routing, autonomous diagnosis, autonomous treatment, prescribing, payer submission, claim submission, EHR writeback, patient outreach, production connector use, or clinical production approval."},"safetyBoundary":"Synthetic TrustOps review packet only. Recommendation-only remediation requires human review and does not authorize live PHI, autonomous clinical action, payer submission, billing submission, EHR writeback, patient outreach, production connector use, certification, clinical validation, or customer go-live."},{"packetId":"trustops_packet_a6ca92303fa59d72","packetVersion":"scrimed-trustops-review-packet-v1","createdAt":"2026-06-30T00:00:00.000Z","signalId":"prior_auth_stalled","recommendationId":"recommendation-prior_auth_stalled","moduleIds":["prior-authorization","rcm-denials","signal-detection","self-healing-operations"],"affectedWorkflow":"Prior Authorization","severity":"high","recommendedOwner":"Prior Authorization Lead","reviewerQueue":"Prior Authorization Lead human review queue","syntheticOnly":true,"humanReviewRequired":true,"automationExecutionAllowed":false,"signal":{"id":"prior_auth_stalled","severity":"high","affectedWorkflow":"Prior Authorization","recommendedOwner":"Prior Authorization Lead","recommendedAction":"Queue stalled synthetic prior-auth packets for manual verification.","automationEligibility":"manual-review-required","humanReviewRequired":true,"reason":"Synthetic authorization tasks remained unresolved beyond the safe review threshold. Observed 6 synthetic business days; threshold 2.","safetyBoundary":"Synthetic/demo signal only; requires human review and does not authorize live PHI, clinical action, patient outreach, payer submission, EHR writeback, billing submission, or production connector use."},"recommendation":{"id":"recommendation-prior_auth_stalled","signalId":"prior_auth_stalled","action":"queue for manual verification","recommendedOwner":"Prior Authorization Lead","steps":["Create a manual verification queue item.","Attach the stalled workflow trace.","Require owner disposition before any next step."],"automationEligibility":"recommendation-only","humanReviewRequired":true,"expectedOutcome":"A human-reviewed queue for manual verification packet for Prior Authorization.","blockedActions":["Live PHI access","Autonomous diagnosis","Treatment recommendation","Prescribing","Patient outreach","Payer submission","EHR writeback","Billing submission","Production connector mutation"],"safetyBoundary":"Recommendation-only synthetic remediation; no real clinical, payer, EHR, billing, outreach, PHI-impacting, or production connector action may execute without explicit human approval and future authorization."},"evidenceRefs":["scrimed-trustops-module-registry","scrimed-trustops-signal-engine","scrimed-trustops-self-healing-recommendation","scrimed-execution-attempt-durable-store"],"durableEvidenceBinding":{"attemptId":"att_c457962a73ff","idempotencyKey":"idem_c457962a73ff77a59c0f5b5f","replayToken":"replay_b8c7009f50d041cc33d9967c","workflowSlug":"trustops-signal-remediation-review","durableStoreRecordRoute":"/api/workflows/execution-attempts/durable-store/record","durableStoreReplayRoute":"/api/workflows/execution-attempts/durable-store/replay","durableStoreReviewDispositionRoute":"/api/workflows/execution-attempts/durable-store/review-disposition","recordRequest":{"workspaceSlug":"atlas-synthetic-evaluation","attemptId":"att_c457962a73ff","idempotencyKey":"idem_c457962a73ff77a59c0f5b5f","region":"us","retentionUntil":"2026-12-31T00:00:00.000Z"},"replayRequest":{"workspaceSlug":"atlas-synthetic-evaluation","replayToken":"replay_b8c7009f50d041cc33d9967c"},"reviewDispositionRequest":{"workspaceSlug":"atlas-synthetic-evaluation","attemptId":"att_c457962a73ff","disposition":"changes-requested","reviewerRole":"TrustOps reviewer","reasonCode":"trustops-prior-auth-stalled","reviewNote":"Synthetic TrustOps packet for prior_auth_stalled. Recommended owner: Prior Authorization Lead. Recommended action: queue for manual verification. Human review is required before any protected workflow moves beyond synthetic mode.","humanReviewAttestation":"no-phi-human-review-no-clinical-authority"},"packetHash":"a6ca92303fa59d72d27bb4c381467ec77e41ffa527328751357b5dabac235470","evidenceEnvelopeHash":"90f7dea5217dbf714bed528b0f5120994ca0d43a88fb5fb57b33912f9d3fd7f6","persistenceStatus":"ready-for-aal2-protected-durable-store-not-persisted","safetyBoundary":"SCRIMED Execution Attempt Durable Store v1 is a tenant-scoped, no-PHI, metadata-only persistence contract for execution-attempt envelopes, idempotency, replay lookup, review dispositions, immutable audit events, regional retention, Compute Fabric routing evidence, and fail-closed protected route access. It does not authorize PHI processing, live patient data use, production model routing, autonomous diagnosis, autonomous treatment, prescribing, payer submission, claim submission, EHR writeback, patient outreach, production connector use, or clinical production approval."},"safetyBoundary":"Synthetic TrustOps review packet only. Recommendation-only remediation requires human review and does not authorize live PHI, autonomous clinical action, payer submission, billing submission, EHR writeback, patient outreach, production connector use, certification, clinical validation, or customer go-live."},{"packetId":"trustops_packet_6990f626c58f9ec0","packetVersion":"scrimed-trustops-review-packet-v1","createdAt":"2026-06-30T00:00:00.000Z","signalId":"missing_documentation","recommendationId":"recommendation-missing_documentation","moduleIds":["clinical-intelligence","quality-hedis-star","signal-detection","self-healing-operations"],"affectedWorkflow":"Clinical Documentation / RCM","severity":"medium","recommendedOwner":"Clinical Documentation Lead","reviewerQueue":"Clinical Documentation Lead human review queue","syntheticOnly":true,"humanReviewRequired":true,"automationExecutionAllowed":false,"signal":{"id":"missing_documentation","severity":"medium","affectedWorkflow":"Clinical Documentation / RCM","recommendedOwner":"Clinical Documentation Lead","recommendedAction":"Regenerate the missing synthetic documentation packet for reviewer inspection.","automationEligibility":"manual-review-required","humanReviewRequired":true,"reason":"Required synthetic packet fields are missing and should not move forward without validation. Observed 7 missing packet fields; threshold 1.","safetyBoundary":"Synthetic/demo signal only; requires human review and does not authorize live PHI, clinical action, patient outreach, payer submission, EHR writeback, billing submission, or production connector use."},"recommendation":{"id":"recommendation-missing_documentation","signalId":"missing_documentation","action":"regenerate missing packet","recommendedOwner":"Clinical Documentation Lead","steps":["Regenerate the synthetic evidence packet.","Validate required schema fields.","Queue the packet for human review."],"automationEligibility":"recommendation-only","humanReviewRequired":true,"expectedOutcome":"A human-reviewed regenerate missing packet packet for Clinical Documentation / RCM.","blockedActions":["Live PHI access","Autonomous diagnosis","Treatment recommendation","Prescribing","Patient outreach","Payer submission","EHR writeback","Billing submission","Production connector mutation"],"safetyBoundary":"Recommendation-only synthetic remediation; no real clinical, payer, EHR, billing, outreach, PHI-impacting, or production connector action may execute without explicit human approval and future authorization."},"evidenceRefs":["scrimed-trustops-module-registry","scrimed-trustops-signal-engine","scrimed-trustops-self-healing-recommendation","scrimed-execution-attempt-durable-store"],"durableEvidenceBinding":{"attemptId":"att_c457962a73ff","idempotencyKey":"idem_c457962a73ff77a59c0f5b5f","replayToken":"replay_b8c7009f50d041cc33d9967c","workflowSlug":"trustops-signal-remediation-review","durableStoreRecordRoute":"/api/workflows/execution-attempts/durable-store/record","durableStoreReplayRoute":"/api/workflows/execution-attempts/durable-store/replay","durableStoreReviewDispositionRoute":"/api/workflows/execution-attempts/durable-store/review-disposition","recordRequest":{"workspaceSlug":"atlas-synthetic-evaluation","attemptId":"att_c457962a73ff","idempotencyKey":"idem_c457962a73ff77a59c0f5b5f","region":"us","retentionUntil":"2026-12-31T00:00:00.000Z"},"replayRequest":{"workspaceSlug":"atlas-synthetic-evaluation","replayToken":"replay_b8c7009f50d041cc33d9967c"},"reviewDispositionRequest":{"workspaceSlug":"atlas-synthetic-evaluation","attemptId":"att_c457962a73ff","disposition":"changes-requested","reviewerRole":"TrustOps reviewer","reasonCode":"trustops-missing-documentation","reviewNote":"Synthetic TrustOps packet for missing_documentation. Recommended owner: Clinical Documentation Lead. Recommended action: regenerate missing packet. Human review is required before any protected workflow moves beyond synthetic mode.","humanReviewAttestation":"no-phi-human-review-no-clinical-authority"},"packetHash":"6990f626c58f9ec00c53dd985e5cecdd5dcb0f7a5f9f1bf690c2777f7cca0b67","evidenceEnvelopeHash":"c4737d87728663ce199cd7eddb392ef638851830e10abbf77ff53391db8263ed","persistenceStatus":"ready-for-aal2-protected-durable-store-not-persisted","safetyBoundary":"SCRIMED Execution Attempt Durable Store v1 is a tenant-scoped, no-PHI, metadata-only persistence contract for execution-attempt envelopes, idempotency, replay lookup, review dispositions, immutable audit events, regional retention, Compute Fabric routing evidence, and fail-closed protected route access. It does not authorize PHI processing, live patient data use, production model routing, autonomous diagnosis, autonomous treatment, prescribing, payer submission, claim submission, EHR writeback, patient outreach, production connector use, or clinical production approval."},"safetyBoundary":"Synthetic TrustOps review packet only. Recommendation-only remediation requires human review and does not authorize live PHI, autonomous clinical action, payer submission, billing submission, EHR writeback, patient outreach, production connector use, certification, clinical validation, or customer go-live."},{"packetId":"trustops_packet_e3e651ef8489601a","packetVersion":"scrimed-trustops-review-packet-v1","createdAt":"2026-06-30T00:00:00.000Z","signalId":"imaging_turnaround_delay","recommendationId":"recommendation-imaging_turnaround_delay","moduleIds":["imaging-intelligence","signal-detection","self-healing-operations"],"affectedWorkflow":"Imaging Intelligence","severity":"medium","recommendedOwner":"Imaging Operations Lead","reviewerQueue":"Imaging Operations Lead human review queue","syntheticOnly":true,"humanReviewRequired":true,"automationExecutionAllowed":false,"signal":{"id":"imaging_turnaround_delay","severity":"medium","affectedWorkflow":"Imaging Intelligence","recommendedOwner":"Imaging Operations Lead","recommendedAction":"Retry the synthetic imaging-status workflow and route the result to manual review.","automationEligibility":"manual-review-required","humanReviewRequired":true,"reason":"Synthetic imaging turnaround exceeded the configured threshold. Observed 48 synthetic hours; threshold 24.","safetyBoundary":"Synthetic/demo signal only; requires human review and does not authorize live PHI, clinical action, patient outreach, payer submission, EHR writeback, billing submission, or production connector use."},"recommendation":{"id":"recommendation-imaging_turnaround_delay","signalId":"imaging_turnaround_delay","action":"retry workflow","recommendedOwner":"Imaging Operations Lead","steps":["Replay the synthetic workflow trace.","Re-run structured-output validation.","Send the replay packet to the assigned owner."],"automationEligibility":"recommendation-only","humanReviewRequired":true,"expectedOutcome":"A human-reviewed retry workflow packet for Imaging Intelligence.","blockedActions":["Live PHI access","Autonomous diagnosis","Treatment recommendation","Prescribing","Patient outreach","Payer submission","EHR writeback","Billing submission","Production connector mutation"],"safetyBoundary":"Recommendation-only synthetic remediation; no real clinical, payer, EHR, billing, outreach, PHI-impacting, or production connector action may execute without explicit human approval and future authorization."},"evidenceRefs":["scrimed-trustops-module-registry","scrimed-trustops-signal-engine","scrimed-trustops-self-healing-recommendation","scrimed-execution-attempt-durable-store"],"durableEvidenceBinding":{"attemptId":"att_c457962a73ff","idempotencyKey":"idem_c457962a73ff77a59c0f5b5f","replayToken":"replay_b8c7009f50d041cc33d9967c","workflowSlug":"trustops-signal-remediation-review","durableStoreRecordRoute":"/api/workflows/execution-attempts/durable-store/record","durableStoreReplayRoute":"/api/workflows/execution-attempts/durable-store/replay","durableStoreReviewDispositionRoute":"/api/workflows/execution-attempts/durable-store/review-disposition","recordRequest":{"workspaceSlug":"atlas-synthetic-evaluation","attemptId":"att_c457962a73ff","idempotencyKey":"idem_c457962a73ff77a59c0f5b5f","region":"us","retentionUntil":"2026-12-31T00:00:00.000Z"},"replayRequest":{"workspaceSlug":"atlas-synthetic-evaluation","replayToken":"replay_b8c7009f50d041cc33d9967c"},"reviewDispositionRequest":{"workspaceSlug":"atlas-synthetic-evaluation","attemptId":"att_c457962a73ff","disposition":"changes-requested","reviewerRole":"TrustOps reviewer","reasonCode":"trustops-imaging-turnaround-delay","reviewNote":"Synthetic TrustOps packet for imaging_turnaround_delay. Recommended owner: Imaging Operations Lead. Recommended action: retry workflow. Human review is required before any protected workflow moves beyond synthetic mode.","humanReviewAttestation":"no-phi-human-review-no-clinical-authority"},"packetHash":"e3e651ef8489601a71ee4c21721211b0bec1ad7e262a2e8399dc5e61c8acec6f","evidenceEnvelopeHash":"d00cc485d5864544bc04a6939e58f527922e749238ab076f190ba9619c67ad5d","persistenceStatus":"ready-for-aal2-protected-durable-store-not-persisted","safetyBoundary":"SCRIMED Execution Attempt Durable Store v1 is a tenant-scoped, no-PHI, metadata-only persistence contract for execution-attempt envelopes, idempotency, replay lookup, review dispositions, immutable audit events, regional retention, Compute Fabric routing evidence, and fail-closed protected route access. It does not authorize PHI processing, live patient data use, production model routing, autonomous diagnosis, autonomous treatment, prescribing, payer submission, claim submission, EHR writeback, patient outreach, production connector use, or clinical production approval."},"safetyBoundary":"Synthetic TrustOps review packet only. Recommendation-only remediation requires human review and does not authorize live PHI, autonomous clinical action, payer submission, billing submission, EHR writeback, patient outreach, production connector use, certification, clinical validation, or customer go-live."},{"packetId":"trustops_packet_fca92ef681d81a90","packetVersion":"scrimed-trustops-review-packet-v1","createdAt":"2026-06-30T00:00:00.000Z","signalId":"care_gap_detected","recommendationId":"recommendation-care_gap_detected","moduleIds":["population-health","quality-hedis-star","signal-detection","governance-compliance"],"affectedWorkflow":"Population Health","severity":"high","recommendedOwner":"Population Health Lead","reviewerQueue":"Population Health Lead human review queue","syntheticOnly":true,"humanReviewRequired":true,"automationExecutionAllowed":false,"signal":{"id":"care_gap_detected","severity":"high","affectedWorkflow":"Population Health","recommendedOwner":"Population Health Lead","recommendedAction":"Request human review of the synthetic care-gap packet.","automationEligibility":"manual-review-required","humanReviewRequired":true,"reason":"Synthetic care-gap signals require review before any patient-facing or outreach-adjacent workflow is considered. Observed 14 synthetic care gaps; threshold 3.","safetyBoundary":"Synthetic/demo signal only; requires human review and does not authorize live PHI, clinical action, patient outreach, payer submission, EHR writeback, billing submission, or production connector use."},"recommendation":{"id":"recommendation-care_gap_detected","signalId":"care_gap_detected","action":"request human review","recommendedOwner":"Population Health Lead","steps":["Create a reviewer task with signal reason and source event.","Attach the synthetic evidence packet.","Block any downstream automation until disposition is recorded."],"automationEligibility":"recommendation-only","humanReviewRequired":true,"expectedOutcome":"A human-reviewed request human review packet for Population Health.","blockedActions":["Live PHI access","Autonomous diagnosis","Treatment recommendation","Prescribing","Patient outreach","Payer submission","EHR writeback","Billing submission","Production connector mutation"],"safetyBoundary":"Recommendation-only synthetic remediation; no real clinical, payer, EHR, billing, outreach, PHI-impacting, or production connector action may execute without explicit human approval and future authorization."},"evidenceRefs":["scrimed-trustops-module-registry","scrimed-trustops-signal-engine","scrimed-trustops-self-healing-recommendation","scrimed-execution-attempt-durable-store"],"durableEvidenceBinding":{"attemptId":"att_c457962a73ff","idempotencyKey":"idem_c457962a73ff77a59c0f5b5f","replayToken":"replay_b8c7009f50d041cc33d9967c","workflowSlug":"trustops-signal-remediation-review","durableStoreRecordRoute":"/api/workflows/execution-attempts/durable-store/record","durableStoreReplayRoute":"/api/workflows/execution-attempts/durable-store/replay","durableStoreReviewDispositionRoute":"/api/workflows/execution-attempts/durable-store/review-disposition","recordRequest":{"workspaceSlug":"atlas-synthetic-evaluation","attemptId":"att_c457962a73ff","idempotencyKey":"idem_c457962a73ff77a59c0f5b5f","region":"us","retentionUntil":"2026-12-31T00:00:00.000Z"},"replayRequest":{"workspaceSlug":"atlas-synthetic-evaluation","replayToken":"replay_b8c7009f50d041cc33d9967c"},"reviewDispositionRequest":{"workspaceSlug":"atlas-synthetic-evaluation","attemptId":"att_c457962a73ff","disposition":"changes-requested","reviewerRole":"TrustOps reviewer","reasonCode":"trustops-care-gap-detected","reviewNote":"Synthetic TrustOps packet for care_gap_detected. Recommended owner: Population Health Lead. Recommended action: request human review. Human review is required before any protected workflow moves beyond synthetic mode.","humanReviewAttestation":"no-phi-human-review-no-clinical-authority"},"packetHash":"fca92ef681d81a9077107cd90cac0741a25bce9a96bad75267af1cb36e99367f","evidenceEnvelopeHash":"cb4fb2d285fda75d632731661abd66326db83fb46d99f70c4aa2713d844475e4","persistenceStatus":"ready-for-aal2-protected-durable-store-not-persisted","safetyBoundary":"SCRIMED Execution Attempt Durable Store v1 is a tenant-scoped, no-PHI, metadata-only persistence contract for execution-attempt envelopes, idempotency, replay lookup, review dispositions, immutable audit events, regional retention, Compute Fabric routing evidence, and fail-closed protected route access. It does not authorize PHI processing, live patient data use, production model routing, autonomous diagnosis, autonomous treatment, prescribing, payer submission, claim submission, EHR writeback, patient outreach, production connector use, or clinical production approval."},"safetyBoundary":"Synthetic TrustOps review packet only. Recommendation-only remediation requires human review and does not authorize live PHI, autonomous clinical action, payer submission, billing submission, EHR writeback, patient outreach, production connector use, certification, clinical validation, or customer go-live."},{"packetId":"trustops_packet_2ba402d0d6776b8b","packetVersion":"scrimed-trustops-review-packet-v1","createdAt":"2026-06-30T00:00:00.000Z","signalId":"failed_api_sync","recommendationId":"recommendation-failed_api_sync","moduleIds":["secure-middleware-gateway","semantic-intelligence-graph","signal-detection","self-healing-operations"],"affectedWorkflow":"Secure Middleware Gateway","severity":"medium","recommendedOwner":"Platform Reliability Lead","reviewerQueue":"Platform Reliability Lead human review queue","syntheticOnly":true,"humanReviewRequired":true,"automationExecutionAllowed":false,"signal":{"id":"failed_api_sync","severity":"medium","affectedWorkflow":"Secure Middleware Gateway","recommendedOwner":"Platform Reliability Lead","recommendedAction":"Re-run synthetic middleware validation and inspect the failed sync trace.","automationEligibility":"manual-review-required","humanReviewRequired":true,"reason":"Synthetic middleware sync failures may indicate connector readiness or schema drift issues. Observed 5 synthetic sync failures; threshold 1.","safetyBoundary":"Synthetic/demo signal only; requires human review and does not authorize live PHI, clinical action, patient outreach, payer submission, EHR writeback, billing submission, or production connector use."},"recommendation":{"id":"recommendation-failed_api_sync","signalId":"failed_api_sync","action":"re-run validation","recommendedOwner":"Platform Reliability Lead","steps":["Re-run schema validation against the synthetic trace.","Capture validation errors.","Route failures to platform reliability review."],"automationEligibility":"recommendation-only","humanReviewRequired":true,"expectedOutcome":"A human-reviewed re-run validation packet for Secure Middleware Gateway.","blockedActions":["Live PHI access","Autonomous diagnosis","Treatment recommendation","Prescribing","Patient outreach","Payer submission","EHR writeback","Billing submission","Production connector mutation"],"safetyBoundary":"Recommendation-only synthetic remediation; no real clinical, payer, EHR, billing, outreach, PHI-impacting, or production connector action may execute without explicit human approval and future authorization."},"evidenceRefs":["scrimed-trustops-module-registry","scrimed-trustops-signal-engine","scrimed-trustops-self-healing-recommendation","scrimed-execution-attempt-durable-store"],"durableEvidenceBinding":{"attemptId":"att_c457962a73ff","idempotencyKey":"idem_c457962a73ff77a59c0f5b5f","replayToken":"replay_b8c7009f50d041cc33d9967c","workflowSlug":"trustops-signal-remediation-review","durableStoreRecordRoute":"/api/workflows/execution-attempts/durable-store/record","durableStoreReplayRoute":"/api/workflows/execution-attempts/durable-store/replay","durableStoreReviewDispositionRoute":"/api/workflows/execution-attempts/durable-store/review-disposition","recordRequest":{"workspaceSlug":"atlas-synthetic-evaluation","attemptId":"att_c457962a73ff","idempotencyKey":"idem_c457962a73ff77a59c0f5b5f","region":"us","retentionUntil":"2026-12-31T00:00:00.000Z"},"replayRequest":{"workspaceSlug":"atlas-synthetic-evaluation","replayToken":"replay_b8c7009f50d041cc33d9967c"},"reviewDispositionRequest":{"workspaceSlug":"atlas-synthetic-evaluation","attemptId":"att_c457962a73ff","disposition":"changes-requested","reviewerRole":"TrustOps reviewer","reasonCode":"trustops-failed-api-sync","reviewNote":"Synthetic TrustOps packet for failed_api_sync. Recommended owner: Platform Reliability Lead. Recommended action: re-run validation. Human review is required before any protected workflow moves beyond synthetic mode.","humanReviewAttestation":"no-phi-human-review-no-clinical-authority"},"packetHash":"2ba402d0d6776b8b4ae6ca8e349b4fe28d79d00b5e0cd3f294385be558e3813a","evidenceEnvelopeHash":"c0ebfa00db3b72ad4d8f2a8bfec3512f805d38a849ba30710b5df78a2c7d02e3","persistenceStatus":"ready-for-aal2-protected-durable-store-not-persisted","safetyBoundary":"SCRIMED Execution Attempt Durable Store v1 is a tenant-scoped, no-PHI, metadata-only persistence contract for execution-attempt envelopes, idempotency, replay lookup, review dispositions, immutable audit events, regional retention, Compute Fabric routing evidence, and fail-closed protected route access. It does not authorize PHI processing, live patient data use, production model routing, autonomous diagnosis, autonomous treatment, prescribing, payer submission, claim submission, EHR writeback, patient outreach, production connector use, or clinical production approval."},"safetyBoundary":"Synthetic TrustOps review packet only. Recommendation-only remediation requires human review and does not authorize live PHI, autonomous clinical action, payer submission, billing submission, EHR writeback, patient outreach, production connector use, certification, clinical validation, or customer go-live."},{"packetId":"trustops_packet_0a9a6b12099a08a4","packetVersion":"scrimed-trustops-review-packet-v1","createdAt":"2026-06-30T00:00:00.000Z","signalId":"duplicate_patient_context","recommendationId":"recommendation-duplicate_patient_context","moduleIds":["patient-journey-memory","semantic-intelligence-graph","governance-compliance","self-healing-operations"],"affectedWorkflow":"Patient Journey Memory","severity":"critical","recommendedOwner":"Data Governance Lead","reviewerQueue":"Data Governance Lead human review queue","syntheticOnly":true,"humanReviewRequired":true,"automationExecutionAllowed":false,"signal":{"id":"duplicate_patient_context","severity":"critical","affectedWorkflow":"Patient Journey Memory","recommendedOwner":"Data Governance Lead","recommendedAction":"Reconcile duplicate synthetic contexts through manual verification.","automationEligibility":"manual-review-required","humanReviewRequired":true,"reason":"Duplicate context signals are safety-sensitive even in synthetic mode and must block automation. Observed 2 synthetic duplicate contexts; threshold 1.","safetyBoundary":"Synthetic/demo signal only; requires human review and does not authorize live PHI, clinical action, patient outreach, payer submission, EHR writeback, billing submission, or production connector use."},"recommendation":{"id":"recommendation-duplicate_patient_context","signalId":"duplicate_patient_context","action":"reconcile duplicate records","recommendedOwner":"Data Governance Lead","steps":["Create a duplicate-context reconciliation packet.","Compare only synthetic context identifiers.","Require data-governance review before any merge-like recommendation."],"automationEligibility":"recommendation-only","humanReviewRequired":true,"expectedOutcome":"A human-reviewed reconcile duplicate records packet for Patient Journey Memory.","blockedActions":["Live PHI access","Autonomous diagnosis","Treatment recommendation","Prescribing","Patient outreach","Payer submission","EHR writeback","Billing submission","Production connector mutation"],"safetyBoundary":"Recommendation-only synthetic remediation; no real clinical, payer, EHR, billing, outreach, PHI-impacting, or production connector action may execute without explicit human approval and future authorization."},"evidenceRefs":["scrimed-trustops-module-registry","scrimed-trustops-signal-engine","scrimed-trustops-self-healing-recommendation","scrimed-execution-attempt-durable-store"],"durableEvidenceBinding":{"attemptId":"att_c457962a73ff","idempotencyKey":"idem_c457962a73ff77a59c0f5b5f","replayToken":"replay_b8c7009f50d041cc33d9967c","workflowSlug":"trustops-signal-remediation-review","durableStoreRecordRoute":"/api/workflows/execution-attempts/durable-store/record","durableStoreReplayRoute":"/api/workflows/execution-attempts/durable-store/replay","durableStoreReviewDispositionRoute":"/api/workflows/execution-attempts/durable-store/review-disposition","recordRequest":{"workspaceSlug":"atlas-synthetic-evaluation","attemptId":"att_c457962a73ff","idempotencyKey":"idem_c457962a73ff77a59c0f5b5f","region":"us","retentionUntil":"2026-12-31T00:00:00.000Z"},"replayRequest":{"workspaceSlug":"atlas-synthetic-evaluation","replayToken":"replay_b8c7009f50d041cc33d9967c"},"reviewDispositionRequest":{"workspaceSlug":"atlas-synthetic-evaluation","attemptId":"att_c457962a73ff","disposition":"escalated","reviewerRole":"TrustOps reviewer","reasonCode":"trustops-duplicate-patient-context","reviewNote":"Synthetic TrustOps packet for duplicate_patient_context. Recommended owner: Data Governance Lead. Recommended action: reconcile duplicate records. Human review is required before any protected workflow moves beyond synthetic mode.","humanReviewAttestation":"no-phi-human-review-no-clinical-authority"},"packetHash":"0a9a6b12099a08a4f67848f6c2bc9e37f73e500452b936feb93a9bfb7501e941","evidenceEnvelopeHash":"64ab925d635bc5794953dd89ea7b876c7a516ad9fa27d1530783c6e34c9dcefc","persistenceStatus":"ready-for-aal2-protected-durable-store-not-persisted","safetyBoundary":"SCRIMED Execution Attempt Durable Store v1 is a tenant-scoped, no-PHI, metadata-only persistence contract for execution-attempt envelopes, idempotency, replay lookup, review dispositions, immutable audit events, regional retention, Compute Fabric routing evidence, and fail-closed protected route access. It does not authorize PHI processing, live patient data use, production model routing, autonomous diagnosis, autonomous treatment, prescribing, payer submission, claim submission, EHR writeback, patient outreach, production connector use, or clinical production approval."},"safetyBoundary":"Synthetic TrustOps review packet only. Recommendation-only remediation requires human review and does not authorize live PHI, autonomous clinical action, payer submission, billing submission, EHR writeback, patient outreach, production connector use, certification, clinical validation, or customer go-live."},{"packetId":"trustops_packet_66c9f6c71259c993","packetVersion":"scrimed-trustops-review-packet-v1","createdAt":"2026-06-30T00:00:00.000Z","signalId":"low_confidence_agent_output","recommendationId":"recommendation-low_confidence_agent_output","moduleIds":["clinical-intelligence","governance-compliance","signal-detection","self-healing-operations"],"affectedWorkflow":"Clinical Intelligence","severity":"critical","recommendedOwner":"Clinical QA Lead","reviewerQueue":"Clinical QA Lead human review queue","syntheticOnly":true,"humanReviewRequired":true,"automationExecutionAllowed":false,"signal":{"id":"low_confidence_agent_output","severity":"critical","affectedWorkflow":"Clinical Intelligence","recommendedOwner":"Clinical QA Lead","recommendedAction":"Pause automation and route the synthetic agent output to qualified review.","automationEligibility":"manual-review-required","humanReviewRequired":true,"reason":"Low-confidence clinical-adjacent outputs must not continue without reviewer disposition. Observed 42 confidence score; threshold 70.","safetyBoundary":"Synthetic/demo signal only; requires human review and does not authorize live PHI, clinical action, patient outreach, payer submission, EHR writeback, billing submission, or production connector use."},"recommendation":{"id":"recommendation-low_confidence_agent_output","signalId":"low_confidence_agent_output","action":"pause automation","recommendedOwner":"Clinical QA Lead","steps":["Mark the synthetic workflow as automation-paused.","Attach the confidence or safety reason.","Require qualified reviewer approval before continuing."],"automationEligibility":"recommendation-only","humanReviewRequired":true,"expectedOutcome":"A human-reviewed pause automation packet for Clinical Intelligence.","blockedActions":["Live PHI access","Autonomous diagnosis","Treatment recommendation","Prescribing","Patient outreach","Payer submission","EHR writeback","Billing submission","Production connector mutation"],"safetyBoundary":"Recommendation-only synthetic remediation; no real clinical, payer, EHR, billing, outreach, PHI-impacting, or production connector action may execute without explicit human approval and future authorization."},"evidenceRefs":["scrimed-trustops-module-registry","scrimed-trustops-signal-engine","scrimed-trustops-self-healing-recommendation","scrimed-execution-attempt-durable-store"],"durableEvidenceBinding":{"attemptId":"att_c457962a73ff","idempotencyKey":"idem_c457962a73ff77a59c0f5b5f","replayToken":"replay_b8c7009f50d041cc33d9967c","workflowSlug":"trustops-signal-remediation-review","durableStoreRecordRoute":"/api/workflows/execution-attempts/durable-store/record","durableStoreReplayRoute":"/api/workflows/execution-attempts/durable-store/replay","durableStoreReviewDispositionRoute":"/api/workflows/execution-attempts/durable-store/review-disposition","recordRequest":{"workspaceSlug":"atlas-synthetic-evaluation","attemptId":"att_c457962a73ff","idempotencyKey":"idem_c457962a73ff77a59c0f5b5f","region":"us","retentionUntil":"2026-12-31T00:00:00.000Z"},"replayRequest":{"workspaceSlug":"atlas-synthetic-evaluation","replayToken":"replay_b8c7009f50d041cc33d9967c"},"reviewDispositionRequest":{"workspaceSlug":"atlas-synthetic-evaluation","attemptId":"att_c457962a73ff","disposition":"escalated","reviewerRole":"TrustOps reviewer","reasonCode":"trustops-low-confidence-agent-output","reviewNote":"Synthetic TrustOps packet for low_confidence_agent_output. Recommended owner: Clinical QA Lead. Recommended action: pause automation. Human review is required before any protected workflow moves beyond synthetic mode.","humanReviewAttestation":"no-phi-human-review-no-clinical-authority"},"packetHash":"66c9f6c71259c99375e69bb53dd0fb7b0085089f368d579290f19575381bf1f2","evidenceEnvelopeHash":"9a7fe08186f056b4fd2c8ac2de7f96bd1198bf6bccae65cf846598e5c86b71d7","persistenceStatus":"ready-for-aal2-protected-durable-store-not-persisted","safetyBoundary":"SCRIMED Execution Attempt Durable Store v1 is a tenant-scoped, no-PHI, metadata-only persistence contract for execution-attempt envelopes, idempotency, replay lookup, review dispositions, immutable audit events, regional retention, Compute Fabric routing evidence, and fail-closed protected route access. It does not authorize PHI processing, live patient data use, production model routing, autonomous diagnosis, autonomous treatment, prescribing, payer submission, claim submission, EHR writeback, patient outreach, production connector use, or clinical production approval."},"safetyBoundary":"Synthetic TrustOps review packet only. Recommendation-only remediation requires human review and does not authorize live PHI, autonomous clinical action, payer submission, billing submission, EHR writeback, patient outreach, production connector use, certification, clinical validation, or customer go-live."},{"packetId":"trustops_packet_1c6f6133871dd400","packetVersion":"scrimed-trustops-review-packet-v1","createdAt":"2026-06-30T00:00:00.000Z","signalId":"compliance_sensitive_task","recommendationId":"recommendation-compliance_sensitive_task","moduleIds":["governance-compliance","secure-middleware-gateway","semantic-intelligence-graph","self-healing-operations"],"affectedWorkflow":"Governance / Compliance","severity":"critical","recommendedOwner":"Compliance Lead","reviewerQueue":"Compliance Lead human review queue","syntheticOnly":true,"humanReviewRequired":true,"automationExecutionAllowed":false,"signal":{"id":"compliance_sensitive_task","severity":"critical","affectedWorkflow":"Governance / Compliance","recommendedOwner":"Compliance Lead","recommendedAction":"Escalate the synthetic sensitive task to compliance review.","automationEligibility":"manual-review-required","humanReviewRequired":true,"reason":"Compliance-sensitive task classification requires explicit human review and retained hard stops. 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It is not live workflow execution, not production persistence, not model routing approval, and not clinical or payer authority."}}}],"durableReplayValidations":[{"ok":true,"value":{"workspaceSlug":"atlas-synthetic-evaluation","idempotencyKey":"","replayToken":"replay_b8c7009f50d041cc33d9967c"}},{"ok":true,"value":{"workspaceSlug":"atlas-synthetic-evaluation","idempotencyKey":"","replayToken":"replay_b8c7009f50d041cc33d9967c"}},{"ok":true,"value":{"workspaceSlug":"atlas-synthetic-evaluation","idempotencyKey":"","replayToken":"replay_b8c7009f50d041cc33d9967c"}},{"ok":true,"value":{"workspaceSlug":"atlas-synthetic-evaluation","idempotencyKey":"","replayToken":"replay_b8c7009f50d041cc33d9967c"}},{"ok":true,"value":{"workspaceSlug":"atlas-synthetic-evaluation","idempotencyKey":"","replayToken":"replay_b8c7009f50d041cc33d9967c"}},{"ok":true,"value":{"workspaceSlug":"atlas-synthetic-evaluation","idempotencyKey":"","replayToken":"replay_b8c7009f50d041cc33d9967c"}},{"ok":true,"value":{"workspaceSlug":"atlas-synthetic-evaluation","idempotencyKey":"","replayToken":"replay_b8c7009f50d041cc33d9967c"}},{"ok":true,"value":{"workspaceSlug":"atlas-synthetic-evaluation","idempotencyKey":"","replayToken":"replay_b8c7009f50d041cc33d9967c"}},{"ok":true,"value":{"workspaceSlug":"atlas-synthetic-evaluation","idempotencyKey":"","replayToken":"replay_b8c7009f50d041cc33d9967c"}},{"ok":true,"value":{"workspaceSlug":"atlas-synthetic-evaluation","idempotencyKey":"","replayToken":"replay_b8c7009f50d041cc33d9967c"}}],"durableReviewValidations":[{"ok":true,"value":{"workspaceSlug":"atlas-synthetic-evaluation","attemptId":"att_c457962a73ff","disposition":"changes-requested","reviewerRole":"TrustOps reviewer","reasonCode":"trustops-denied-claim-spike","reviewNote":"Synthetic TrustOps packet for denied_claim_spike. Recommended owner: Revenue Cycle Lead. Recommended action: open investigation ticket. Human review is required before any protected workflow moves beyond synthetic mode.","humanReviewAttestation":"no-phi-human-review-no-clinical-authority"}},{"ok":true,"value":{"workspaceSlug":"atlas-synthetic-evaluation","attemptId":"att_c457962a73ff","disposition":"changes-requested","reviewerRole":"TrustOps reviewer","reasonCode":"trustops-referral-delay","reviewNote":"Synthetic TrustOps packet for referral_delay. Recommended owner: Referral Operations Lead. Recommended action: request human review. Human review is required before any protected workflow moves beyond synthetic mode.","humanReviewAttestation":"no-phi-human-review-no-clinical-authority"}},{"ok":true,"value":{"workspaceSlug":"atlas-synthetic-evaluation","attemptId":"att_c457962a73ff","disposition":"changes-requested","reviewerRole":"TrustOps reviewer","reasonCode":"trustops-prior-auth-stalled","reviewNote":"Synthetic TrustOps packet for prior_auth_stalled. Recommended owner: Prior Authorization Lead. Recommended action: queue for manual verification. Human review is required before any protected workflow moves beyond synthetic mode.","humanReviewAttestation":"no-phi-human-review-no-clinical-authority"}},{"ok":true,"value":{"workspaceSlug":"atlas-synthetic-evaluation","attemptId":"att_c457962a73ff","disposition":"changes-requested","reviewerRole":"TrustOps reviewer","reasonCode":"trustops-missing-documentation","reviewNote":"Synthetic TrustOps packet for missing_documentation. Recommended owner: Clinical Documentation Lead. Recommended action: regenerate missing packet. Human review is required before any protected workflow moves beyond synthetic mode.","humanReviewAttestation":"no-phi-human-review-no-clinical-authority"}},{"ok":true,"value":{"workspaceSlug":"atlas-synthetic-evaluation","attemptId":"att_c457962a73ff","disposition":"changes-requested","reviewerRole":"TrustOps reviewer","reasonCode":"trustops-imaging-turnaround-delay","reviewNote":"Synthetic TrustOps packet for imaging_turnaround_delay. Recommended owner: Imaging Operations Lead. Recommended action: retry workflow. Human review is required before any protected workflow moves beyond synthetic mode.","humanReviewAttestation":"no-phi-human-review-no-clinical-authority"}},{"ok":true,"value":{"workspaceSlug":"atlas-synthetic-evaluation","attemptId":"att_c457962a73ff","disposition":"changes-requested","reviewerRole":"TrustOps reviewer","reasonCode":"trustops-care-gap-detected","reviewNote":"Synthetic TrustOps packet for care_gap_detected. Recommended owner: Population Health Lead. Recommended action: request human review. Human review is required before any protected workflow moves beyond synthetic mode.","humanReviewAttestation":"no-phi-human-review-no-clinical-authority"}},{"ok":true,"value":{"workspaceSlug":"atlas-synthetic-evaluation","attemptId":"att_c457962a73ff","disposition":"changes-requested","reviewerRole":"TrustOps reviewer","reasonCode":"trustops-failed-api-sync","reviewNote":"Synthetic TrustOps packet for failed_api_sync. Recommended owner: Platform Reliability Lead. Recommended action: re-run validation. Human review is required before any protected workflow moves beyond synthetic mode.","humanReviewAttestation":"no-phi-human-review-no-clinical-authority"}},{"ok":true,"value":{"workspaceSlug":"atlas-synthetic-evaluation","attemptId":"att_c457962a73ff","disposition":"escalated","reviewerRole":"TrustOps reviewer","reasonCode":"trustops-duplicate-patient-context","reviewNote":"Synthetic TrustOps packet for duplicate_patient_context. Recommended owner: Data Governance Lead. Recommended action: reconcile duplicate records. Human review is required before any protected workflow moves beyond synthetic mode.","humanReviewAttestation":"no-phi-human-review-no-clinical-authority"}},{"ok":true,"value":{"workspaceSlug":"atlas-synthetic-evaluation","attemptId":"att_c457962a73ff","disposition":"escalated","reviewerRole":"TrustOps reviewer","reasonCode":"trustops-low-confidence-agent-output","reviewNote":"Synthetic TrustOps packet for low_confidence_agent_output. Recommended owner: Clinical QA Lead. Recommended action: pause automation. Human review is required before any protected workflow moves beyond synthetic mode.","humanReviewAttestation":"no-phi-human-review-no-clinical-authority"}},{"ok":true,"value":{"workspaceSlug":"atlas-synthetic-evaluation","attemptId":"att_c457962a73ff","disposition":"escalated","reviewerRole":"TrustOps reviewer","reasonCode":"trustops-compliance-sensitive-task","reviewNote":"Synthetic TrustOps packet for compliance_sensitive_task. Recommended owner: Compliance Lead. Recommended action: escalate to compliance. Human review is required before any protected workflow moves beyond synthetic mode.","humanReviewAttestation":"no-phi-human-review-no-clinical-authority"}}]}},"governanceChecklist":["Every TrustOps module is demo/synthetic only.","Every module brief must pass structured-output validation.","Every signal requires human review.","Every self-healing output is recommendation-only.","No live PHI, diagnosis, treatment, prescribing, outreach, payer submission, EHR writeback, billing submission, or production connector action is authorized.","Safety and governance carry the highest weights in TrustOps scoring.","Secure Middleware Gateway remains the required future path between agents and systems of record.","Semantic Intelligence Graph links modules, signals, evidence, owners, safety controls, and recommendations."],"semanticIntelligenceGraph":[{"id":"module:patient-journey-memory","label":"Patient Journey Memory","kind":"module","connectsTo":["output:journey_memory_brief","output:care_gap_context_packet","output:memory_scope_audit"],"evidenceRequired":["Synthetic input fixture","Structured output schema validation","Safety-boundary statement","Human-review disposition placeholder","Evidence and audit trace reference"],"safetyBoundary":"Demo/synthetic only. SCRIMED TrustOps does not authorize live PHI, autonomous diagnosis, treatment, prescribing, patient outreach, payer submission, EHR writeback, billing submission, production connector use, certification claims, compliance completion claims, or customer go-live."},{"id":"module:clinical-intelligence","label":"Clinical Intelligence","kind":"module","connectsTo":["output:clinical_intelligence_brief","output:evidence_gap_report","output:human_review_packet"],"evidenceRequired":["Synthetic input fixture","Structured output schema validation","Safety-boundary statement","Human-review disposition placeholder","Evidence and audit trace reference"],"safetyBoundary":"Demo/synthetic only. SCRIMED TrustOps does not authorize live PHI, autonomous diagnosis, treatment, prescribing, patient outreach, payer submission, EHR writeback, billing submission, production connector use, certification claims, compliance completion claims, or customer go-live."},{"id":"module:rcm-denials","label":"RCM / Denials","kind":"module","connectsTo":["output:denial_signal_report","output:documentation_gap_packet","output:manual_routing_recommendation"],"evidenceRequired":["Synthetic input fixture","Structured output schema validation","Safety-boundary statement","Human-review disposition placeholder","Evidence and audit trace reference"],"safetyBoundary":"Demo/synthetic only. SCRIMED TrustOps does not authorize live PHI, autonomous diagnosis, treatment, prescribing, patient outreach, payer submission, EHR writeback, billing submission, production connector use, certification claims, compliance completion claims, or customer go-live."},{"id":"module:prior-authorization","label":"Prior Authorization","kind":"module","connectsTo":["output:prior_auth_status_packet","output:missing_packet_checklist","output:manual_review_queue_item"],"evidenceRequired":["Synthetic input fixture","Structured output schema validation","Safety-boundary statement","Human-review disposition placeholder","Evidence and audit trace reference"],"safetyBoundary":"Demo/synthetic only. SCRIMED TrustOps does not authorize live PHI, autonomous diagnosis, treatment, prescribing, patient outreach, payer submission, EHR writeback, billing submission, production connector use, certification claims, compliance completion claims, or customer go-live."},{"id":"module:patient-access","label":"Patient Access","kind":"module","connectsTo":["output:access_readiness_score","output:intake_gap_packet","output:manual_routing_recommendation"],"evidenceRequired":["Synthetic input fixture","Structured output schema validation","Safety-boundary statement","Human-review disposition placeholder","Evidence and audit trace reference"],"safetyBoundary":"Demo/synthetic only. SCRIMED TrustOps does not authorize live PHI, autonomous diagnosis, treatment, prescribing, patient outreach, payer submission, EHR writeback, billing submission, production connector use, certification claims, compliance completion claims, or customer go-live."},{"id":"module:scheduling","label":"Scheduling","kind":"module","connectsTo":["output:scheduling_signal_report","output:capacity_gap_packet","output:manual_queue_recommendation"],"evidenceRequired":["Synthetic input fixture","Structured output schema validation","Safety-boundary statement","Human-review disposition placeholder","Evidence and audit trace reference"],"safetyBoundary":"Demo/synthetic only. SCRIMED TrustOps does not authorize live PHI, autonomous diagnosis, treatment, prescribing, patient outreach, payer submission, EHR writeback, billing submission, production connector use, certification claims, compliance completion claims, or customer go-live."},{"id":"module:referral-management","label":"Referral Management","kind":"module","connectsTo":["output:referral_signal_report","output:leakage_risk_packet","output:closed_loop_feedback_packet"],"evidenceRequired":["Synthetic input fixture","Structured output schema validation","Safety-boundary statement","Human-review disposition placeholder","Evidence and audit trace reference"],"safetyBoundary":"Demo/synthetic only. SCRIMED TrustOps does not authorize live PHI, autonomous diagnosis, treatment, prescribing, patient outreach, payer submission, EHR writeback, billing submission, production connector use, certification claims, compliance completion claims, or customer go-live."},{"id":"module:imaging-intelligence","label":"Imaging Intelligence","kind":"module","connectsTo":["output:imaging_signal_report","output:turnaround_delay_packet","output:radiology_review_queue_item"],"evidenceRequired":["Synthetic input fixture","Structured output schema validation","Safety-boundary statement","Human-review disposition placeholder","Evidence and audit trace reference"],"safetyBoundary":"Demo/synthetic only. SCRIMED TrustOps does not authorize live PHI, autonomous diagnosis, treatment, prescribing, patient outreach, payer submission, EHR writeback, billing submission, production connector use, certification claims, compliance completion claims, or customer go-live."},{"id":"module:population-health","label":"Population Health","kind":"module","connectsTo":["output:population_signal_report","output:care_gap_packet","output:manual_review_queue_item"],"evidenceRequired":["Synthetic input fixture","Structured output schema validation","Safety-boundary statement","Human-review disposition placeholder","Evidence and audit trace reference"],"safetyBoundary":"Demo/synthetic only. SCRIMED TrustOps does not authorize live PHI, autonomous diagnosis, treatment, prescribing, patient outreach, payer submission, EHR writeback, billing submission, production connector use, certification claims, compliance completion claims, or customer go-live."},{"id":"module:quality-hedis-star","label":"Quality / HEDIS / STAR","kind":"module","connectsTo":["output:quality_signal_report","output:measure_gap_packet","output:reviewer_disposition_item"],"evidenceRequired":["Synthetic input fixture","Structured output schema validation","Safety-boundary statement","Human-review disposition placeholder","Evidence and audit trace reference"],"safetyBoundary":"Demo/synthetic only. SCRIMED TrustOps does not authorize live PHI, autonomous diagnosis, treatment, prescribing, patient outreach, payer submission, EHR writeback, billing submission, production connector use, certification claims, compliance completion claims, or customer go-live."},{"id":"module:governance-compliance","label":"Governance / Compliance","kind":"module","connectsTo":["output:governance_decision_packet","output:compliance_escalation_packet","output:audit_readiness_report"],"evidenceRequired":["Synthetic input fixture","Structured output schema validation","Safety-boundary statement","Human-review disposition placeholder","Evidence and audit trace reference"],"safetyBoundary":"Demo/synthetic only. SCRIMED TrustOps does not authorize live PHI, autonomous diagnosis, treatment, prescribing, patient outreach, payer submission, EHR writeback, billing submission, production connector use, certification claims, compliance completion claims, or customer go-live."},{"id":"module:signal-detection","label":"Signal Detection","kind":"module","connectsTo":["output:synthetic_signal","output:owner_routing_packet","output:review_required_flag"],"evidenceRequired":["Synthetic input fixture","Structured output schema validation","Safety-boundary statement","Human-review disposition placeholder","Evidence and audit trace reference"],"safetyBoundary":"Demo/synthetic only. SCRIMED TrustOps does not authorize live PHI, autonomous diagnosis, treatment, prescribing, patient outreach, payer submission, EHR writeback, billing submission, production connector use, certification claims, compliance completion claims, or customer go-live."},{"id":"module:self-healing-operations","label":"Self-Healing Operations","kind":"module","connectsTo":["output:self_healing_recommendation","output:manual_verification_task","output:automation_pause_packet"],"evidenceRequired":["Synthetic input fixture","Structured output schema validation","Safety-boundary statement","Human-review disposition placeholder","Evidence and audit trace reference"],"safetyBoundary":"Demo/synthetic only. SCRIMED TrustOps does not authorize live PHI, autonomous diagnosis, treatment, prescribing, patient outreach, payer submission, EHR writeback, billing submission, production connector use, certification claims, compliance completion claims, or customer go-live."},{"id":"module:semantic-intelligence-graph","label":"Semantic Intelligence Graph","kind":"module","connectsTo":["output:semantic_graph_node","output:evidence_lineage_packet","output:trustops_dependency_map"],"evidenceRequired":["Synthetic input fixture","Structured output schema validation","Safety-boundary statement","Human-review disposition placeholder","Evidence and audit trace reference"],"safetyBoundary":"Demo/synthetic only. SCRIMED TrustOps does not authorize live PHI, autonomous diagnosis, treatment, prescribing, patient outreach, payer submission, EHR writeback, billing submission, production connector use, certification claims, compliance completion claims, or customer go-live."},{"id":"module:secure-middleware-gateway","label":"Secure Middleware Gateway","kind":"module","connectsTo":["output:tool_authorization_decision","output:middleware_audit_event","output:blocked_action_packet"],"evidenceRequired":["Synthetic input fixture","Structured output schema validation","Safety-boundary statement","Human-review disposition placeholder","Evidence and audit trace reference"],"safetyBoundary":"Demo/synthetic only. SCRIMED TrustOps does not authorize live PHI, autonomous diagnosis, treatment, prescribing, patient outreach, payer submission, EHR writeback, billing submission, production connector use, certification claims, compliance completion claims, or customer go-live."},{"id":"governance-control:human-review","label":"Human-in-the-loop remediation review","kind":"governance-control","connectsTo":["module:governance-compliance","module:self-healing-operations","module:secure-middleware-gateway"],"evidenceRequired":["Reviewer disposition","Synthetic evidence packet","Blocked-action note"],"safetyBoundary":"Demo/synthetic only. SCRIMED TrustOps does not authorize live PHI, autonomous diagnosis, treatment, prescribing, patient outreach, payer submission, EHR writeback, billing submission, production connector use, certification claims, compliance completion claims, or customer go-live."},{"id":"governance-control:no-direct-system-access","label":"No direct LLM-to-system access","kind":"governance-control","connectsTo":["module:secure-middleware-gateway","module:semantic-intelligence-graph"],"evidenceRequired":["Middleware authorization decision","Tool scope placeholder","Audit event"],"safetyBoundary":"Demo/synthetic only. SCRIMED TrustOps does not authorize live PHI, autonomous diagnosis, treatment, prescribing, patient outreach, payer submission, EHR writeback, billing submission, production connector use, certification claims, compliance completion claims, or customer go-live."}],"validation":{"status":"pass","checks":[{"check":"all-required-trustops-modules-registered","passed":true,"detail":"All 15 requested TrustOps capability modules must be present."},{"check":"trust-score-ranges-valid","passed":true,"detail":"Every module trust score must stay within 0-100."},{"check":"safety-and-governance-weighted","passed":true,"detail":"TrustOps scoring must weight safety and governance highest."},{"check":"synthetic-only-boundaries-present","passed":true,"detail":"Every module must clearly state demo/synthetic only."},{"check":"no-autonomous-production-actions","passed":true,"detail":"Every module must block autonomous real-world clinical, payer, billing, EHR, outreach, or connector actions."},{"check":"module-briefs-schema-valid","passed":true,"detail":"Every generated module brief must pass lightweight structured-output validation."},{"check":"synthetic-signal-schema-valid","passed":true,"detail":"Every synthetic operational signal must validate and require human review."},{"check":"self-healing-recommendations-schema-valid","passed":true,"detail":"Every remediation recommendation must validate as recommendation-only."},{"check":"trustops-review-packets-durable-binding-valid","passed":true,"detail":"Every TrustOps signal/recommendation review packet must carry valid durable record, replay, and no-PHI review-disposition 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synthetic TrustOps signal has a replayable review packet."},{"check":"trustops-review-packets-schema-valid","passed":true,"detail":"Every TrustOps review packet passes structured validation."},{"check":"durable-record-payloads-valid","passed":true,"detail":"Every TrustOps review packet includes a durable-store record payload that references the server-known TrustOps envelope."},{"check":"durable-replay-payloads-valid","passed":true,"detail":"Every TrustOps review packet includes a valid metadata-only replay payload."},{"check":"durable-review-disposition-payloads-valid","passed":true,"detail":"Every TrustOps review packet includes a valid no-PHI human-review disposition payload."},{"check":"recommendation-only-no-execution","passed":true,"detail":"TrustOps review packets cannot execute real-world 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Recommended action: re-run validation. Human review is required before any protected workflow moves beyond synthetic mode.","humanReviewAttestation":"no-phi-human-review-no-clinical-authority"}},{"ok":true,"value":{"workspaceSlug":"atlas-synthetic-evaluation","attemptId":"att_c457962a73ff","disposition":"escalated","reviewerRole":"TrustOps reviewer","reasonCode":"trustops-duplicate-patient-context","reviewNote":"Synthetic TrustOps packet for duplicate_patient_context. Recommended owner: Data Governance Lead. Recommended action: reconcile duplicate records. Human review is required before any protected workflow moves beyond synthetic mode.","humanReviewAttestation":"no-phi-human-review-no-clinical-authority"}},{"ok":true,"value":{"workspaceSlug":"atlas-synthetic-evaluation","attemptId":"att_c457962a73ff","disposition":"escalated","reviewerRole":"TrustOps reviewer","reasonCode":"trustops-low-confidence-agent-output","reviewNote":"Synthetic TrustOps packet for low_confidence_agent_output. Recommended owner: Clinical QA Lead. Recommended action: pause automation. Human review is required before any protected workflow moves beyond synthetic mode.","humanReviewAttestation":"no-phi-human-review-no-clinical-authority"}},{"ok":true,"value":{"workspaceSlug":"atlas-synthetic-evaluation","attemptId":"att_c457962a73ff","disposition":"escalated","reviewerRole":"TrustOps reviewer","reasonCode":"trustops-compliance-sensitive-task","reviewNote":"Synthetic TrustOps packet for compliance_sensitive_task. Recommended owner: Compliance Lead. Recommended action: escalate to compliance. Human review is required before any protected workflow moves beyond synthetic mode.","humanReviewAttestation":"no-phi-human-review-no-clinical-authority"}}]},"moduleBriefValidation":[{"schemaVersion":"scrimed-trustops-schema-v2026-06-30","valid":true,"errors":[]},{"schemaVersion":"scrimed-trustops-schema-v2026-06-30","valid":true,"errors":[]},{"schemaVersion":"scrimed-trustops-schema-v2026-06-30","valid":true,"errors":[]},{"schemaVersion":"scrimed-trustops-schema-v2026-06-30","valid":true,"errors":[]},{"schemaVersion":"scrimed-trustops-schema-v2026-06-30","valid":true,"errors":[]},{"schemaVersion":"scrimed-trustops-schema-v2026-06-30","valid":true,"errors":[]},{"schemaVersion":"scrimed-trustops-schema-v2026-06-30","valid":true,"errors":[]},{"schemaVersion":"scrimed-trustops-schema-v2026-06-30","valid":true,"errors":[]},{"schemaVersion":"scrimed-trustops-schema-v2026-06-30","valid":true,"errors":[]},{"schemaVersion":"scrimed-trustops-schema-v2026-06-30","valid":true,"errors":[]},{"schemaVersion":"scrimed-trustops-schema-v2026-06-30","valid":true,"errors":[]},{"schemaVersion":"scrimed-trustops-schema-v2026-06-30","valid":true,"errors":[]},{"schemaVersion":"scrimed-trustops-schema-v2026-06-30","valid":true,"errors":[]},{"schemaVersion":"scrimed-trustops-schema-v2026-06-30","valid":true,"errors":[]},{"schemaVersion":"scrimed-trustops-schema-v2026-06-30","valid":true,"errors":[]}]},"roadmap":["Version TrustOps thresholds and owner maps.","Attach TrustOps summaries to investor and buyer diligence packets.","Persist accepted TrustOps review packets only through AAL2 protected durable-store record, replay, and review-disposition routes.","Promote Secure Middleware Gateway before any future tool or connector evaluation.","Keep all remediation recommendation-only until external legal, security, privacy, clinical, and customer approvals exist."],"recommendedNextBuildStep":"Promote Governance / Compliance, Signal Detection, Self-Healing Operations, Semantic Intelligence Graph, and Secure Middleware Gateway as the TrustOps supervisor layer before enabling any deeper workflow automation."}