{"service":"scrimed-trustos-v1","route":"/trust-os","apiRoute":"/api/trust-os","evaluationApiRoute":"/api/trust-os/evaluate","status":"executable-synthetic-governance-ready","boundary":"SCRIMED TrustOS evaluates synthetic pilot and enterprise assessment requests only. It does not authorize live PHI processing, autonomous diagnosis or treatment, patient outreach, payer submission, production connector writes, or unreviewed clinical action.","components":[{"name":"Clinical Guardian","purpose":"Escalates clinical, patient-facing, payer-facing, and high-uncertainty actions to accountable human reviewers."},{"name":"Agent Firewall","purpose":"Blocks prohibited tools, production writes, prompt-boundary overrides, and unsafe agent actions."},{"name":"PHI Shield","purpose":"Rejects live healthcare data, patient identifiers, and clinical free text from synthetic evaluation paths."},{"name":"Policy Engine","purpose":"Applies execution mode, action-risk, evidence, human-review, and data-boundary policy."},{"name":"Explainability Engine","purpose":"Produces control-level reasons, uncertainty, evidence attribution, and required next actions."},{"name":"Audit Engine","purpose":"Creates metadata-only Clinical Trace records without retaining raw request context."},{"name":"Compliance Monitoring","purpose":"Keeps production use gated behind tenant, privacy, security, BAA, connector, and regional controls."},{"name":"Agent Registry","purpose":"Requires governed agent, tool, model-profile, workflow, and evidence-source registration."}],"modelRouteProfiles":[{"profile":"balanced-enterprise","selectedRoute":"vendor-neutral balanced reasoning route","fallbackRoute":"sovereign/local evaluation route","scores":{"taskSuitability":86,"latency":82,"costEfficiency":80,"complianceReadiness":68},"rationale":"Balances workflow reasoning, latency, and evaluation cost for general enterprise assessments."},{"profile":"evidence-reasoning","selectedRoute":"vendor-neutral evidence-intensive reasoning route","fallbackRoute":"balanced enterprise evaluation route","scores":{"taskSuitability":94,"latency":66,"costEfficiency":62,"complianceReadiness":70},"rationale":"Prioritizes evidence synthesis, uncertainty handling, and complex policy reasoning."},{"profile":"low-latency-operations","selectedRoute":"vendor-neutral low-latency operations route","fallbackRoute":"balanced enterprise evaluation route","scores":{"taskSuitability":78,"latency":95,"costEfficiency":88,"complianceReadiness":64},"rationale":"Prioritizes fast operational classification and routing for low-risk synthetic tasks."},{"profile":"sovereign-local","selectedRoute":"sovereign/local model evaluation route","fallbackRoute":"approved regional managed-model route","scores":{"taskSuitability":72,"latency":74,"costEfficiency":76,"complianceReadiness":84},"rationale":"Prioritizes regional control and future sovereign-cloud deployment requirements."}],"scenarios":[{"slug":"prior-authorization-support","name":"Prior Authorization Evidence Review","workflow":"Prior authorization support","objective":"Prepare a synthetic evidence-gap and policy-review packet for an RCM reviewer.","requestedAction":"Draft a review-only missing-evidence checklist and policy trace.","actionRisk":"moderate","requestedTools":["evidence-retrieval","document-parser","workflow-planner"],"requestedModelProfile":"evidence-reasoning","evidenceSourceIds":["cms-interoperability-prior-auth-2024","buyer-policy-repository"],"humanReviewRole":"RCM reviewer"},{"slug":"documentation-review","name":"Documentation Quality Review","workflow":"Ambient documentation review","objective":"Create draft-only documentation quality prompts from a synthetic packet.","requestedAction":"Draft review prompts with source trace and missing-context flags.","actionRisk":"moderate","requestedTools":["document-parser","evidence-retrieval"],"requestedModelProfile":"balanced-enterprise","evidenceSourceIds":["clinical-guideline-repository","buyer-policy-repository"],"humanReviewRole":"Licensed clinician reviewer"},{"slug":"production-boundary-test","name":"Production Boundary Test","workflow":"Production clinical action request","objective":"Demonstrate that TrustOS blocks an unsafe live execution request.","requestedAction":"Write a final clinical recommendation to a production record.","actionRisk":"prohibited","requestedTools":["connector-write"],"requestedModelProfile":"evidence-reasoning","evidenceSourceIds":[],"humanReviewRole":""}],"evidenceSources":[{"id":"cms-interoperability-prior-auth-2024","title":"CMS Interoperability and Prior Authorization Final Rule","type":"policy","owner":"Centers for Medicare & Medicaid Services","url":"https://www.cms.gov/priorities/key-initiatives/burden-reduction/interoperability/policies-and-regulations/cms-interoperability-and-prior-authorization-final-rule-cms-0057-f","version":"CMS-0057-F","validationTimestamp":"2026-06-02T00:00:00.000Z","usageBoundary":"Used for interoperability and prior authorization operating-context awareness, not payer submission authority."},{"id":"cms-access-model","title":"CMS ACCESS Model","type":"policy","owner":"Centers for Medicare & Medicaid Services Innovation Center","url":"https://www.cms.gov/priorities/innovation/innovation-models/access-model","version":"CMS Innovation Center public model page","validationTimestamp":"2026-06-02T00:00:00.000Z","usageBoundary":"Used for reimbursement-layer posture and outcome-reporting awareness, not reimbursement guarantees."},{"id":"hl7-fhir-standard","title":"HL7 FHIR Standard","type":"standard","owner":"HL7 International","url":"https://hl7.org/fhir/","version":"FHIR standard reference","validationTimestamp":"2026-06-02T00:00:00.000Z","usageBoundary":"Used for interoperability planning and connector contract design."},{"id":"buyer-policy-repository","title":"Buyer Policy and Protocol Repository","type":"buyer-source","owner":"Enterprise buyer governance owner","url":"tenant://knowledge/policies","version":"Tenant-managed","validationTimestamp":"2026-06-02T00:00:00.000Z","usageBoundary":"Requires tenant source ownership, version metadata, and TrustQA validation before use."},{"id":"clinical-guideline-repository","title":"Approved Clinical Guideline Repository","type":"guideline","owner":"Clinical governance owner","url":"tenant://knowledge/guidelines","version":"Tenant-approved","validationTimestamp":"2026-06-02T00:00:00.000Z","usageBoundary":"Guideline-backed outputs remain review-only and require licensed clinician review."}],"decisionStates":["allow-synthetic","escalate-human-review","deny"],"updated":"2026-06-11"}