# SCRIMED TrustOps Intelligence Layer

Status: scrimed-trustops-synthetic-ready
Route: /scrimed-trustops
API: /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.

## Safety Boundary
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.

## Registry Summary
- Existing SCRIMED module registry count: 19
- TrustOps module count: 15
- Average TrustOps score: 75
- Validation status: pass

## Top Strategic Modules
- Clinical Intelligence: strategic value 96; trust score 74
- Governance / Compliance: strategic value 95; trust score 81
- Secure Middleware Gateway: strategic value 95; trust score 83
- Signal Detection: strategic value 94; trust score 79
- Referral Management: strategic value 93; trust score 73

## Highest Automation Risk Modules
- Prior Authorization: automation risk 57; next step Connect prior-auth recommendations to durable review packets without enabling payer submission.
- RCM / Denials: automation risk 55; next step Add no-submission denial packet generation with manual verification and payer-action hard stops.
- Population Health: automation risk 50; next step Add de-identification and consent-state placeholders before any non-synthetic population workflow design.
- Clinical Intelligence: automation risk 48; next step Require ClinicalBench pass/fail evidence and Trust Score explanation before expanding any clinical-intelligence demo.
- Referral Management: automation risk 47; next step Bind referral intelligence to human-reviewed owner routing and no-outreach hard stops.

## Synthetic Signals
- denied_claim_spike: high; Open a synthetic denial-pattern investigation packet for manual review.
- referral_delay: high; Request human review of delayed synthetic referrals and owner routing.
- prior_auth_stalled: high; Queue stalled synthetic prior-auth packets for manual verification.
- missing_documentation: medium; Regenerate the missing synthetic documentation packet for reviewer inspection.
- imaging_turnaround_delay: medium; Retry the synthetic imaging-status workflow and route the result to manual review.
- care_gap_detected: high; Request human review of the synthetic care-gap packet.
- failed_api_sync: medium; Re-run synthetic middleware validation and inspect the failed sync trace.
- duplicate_patient_context: critical; Reconcile duplicate synthetic contexts through manual verification.
- low_confidence_agent_output: critical; Pause automation and route the synthetic agent output to qualified review.
- compliance_sensitive_task: critical; Escalate the synthetic sensitive task to compliance review.

## Recommendation-Only Self-Healing
- denied_claim_spike: open investigation ticket; owner Revenue Cycle Lead
- referral_delay: request human review; owner Referral Operations Lead
- prior_auth_stalled: queue for manual verification; owner Prior Authorization Lead
- missing_documentation: regenerate missing packet; owner Clinical Documentation Lead
- imaging_turnaround_delay: retry workflow; owner Imaging Operations Lead
- care_gap_detected: request human review; owner Population Health Lead
- failed_api_sync: re-run validation; owner Platform Reliability Lead
- duplicate_patient_context: reconcile duplicate records; owner Data Governance Lead
- low_confidence_agent_output: pause automation; owner Clinical QA Lead
- compliance_sensitive_task: escalate to compliance; owner Compliance Lead

## Durable Review Packet Binding
- Packet count: 10
- Status: trustops-review-packets-ready-for-aal2-protected-persistence
- Record route: /api/workflows/execution-attempts/durable-store/record
- Replay route: /api/workflows/execution-attempts/durable-store/replay
- Review disposition route: /api/workflows/execution-attempts/durable-store/review-disposition
- Boundary: 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.

## Governance Checklist
- 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.

## Next Build Step
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.