SCRIMED TrustOps Intelligence Layer

Governed module scoring, synthetic signal detection, and recommendation-only remediation for SCRIMED agents.

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.

Inspect TrustOps API Download Brief Review Packets Module Registry Robustness Lab

Statusscrimed-trustops-synthetic-ready

Modules15

Avg trust75

Signals10

Validationpass

Packets10

Safety boundary

TrustOps can recommend and validate, but it cannot execute real-world healthcare actions.

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.

Scoring formula: total = safety*0.30 + governance*0.25 + evidence*0.18 + workflowValue*0.15 + interoperability*0.12 - riskPenalty*0.30

Module scoring

Every TrustOps module has trust scoring, governance scoring, interoperability readiness, evidence requirements, and automation-risk posture.

memory

Patient Journey Memory

Purpose-bound synthetic memory for longitudinal journey context, handoff continuity, care-gap visibility, and reviewer-approved recall.

Trust 74; governance 88; automation risk 42

Capabilities: Journey timeline synthesis, Handoff context recall, Care-gap context flags, Preference-safe memory scoping
Structured outputs: journey_memory_brief, care_gap_context_packet, memory_scope_audit
Evidence: Synthetic input fixture, Structured output schema validation, Safety-boundary statement, Human-review disposition placeholder, Evidence and audit trace reference
Next step: Bind synthetic journey memory to module brief validation with purpose, TTL, reviewer, and deletion-event fields.

clinical-intelligence

Clinical Intelligence

Human-reviewed synthetic clinical reasoning support that surfaces evidence, uncertainty, missing data, and escalation criteria without clinical authority.

Trust 74; governance 90; automation risk 48

Capabilities: Evidence synthesis, Missing-data risk flags, Clinical uncertainty reporting, Escalation criteria drafting
Structured outputs: clinical_intelligence_brief, evidence_gap_report, human_review_packet
Evidence: Synthetic input fixture, Structured output schema validation, Safety-boundary statement, Human-review disposition placeholder, Evidence and audit trace reference
Next step: Require ClinicalBench pass/fail evidence and Trust Score explanation before expanding any clinical-intelligence demo.

revenue-cycle

RCM / Denials

Synthetic denial-pattern intelligence for root-cause analysis, documentation packet readiness, and manual follow-up recommendations.

Trust 69; governance 86; automation risk 55

Capabilities: Denial spike detection, Documentation gap mapping, Appeal packet draft requirements, RCM owner routing
Structured outputs: denial_signal_report, documentation_gap_packet, manual_routing_recommendation
Evidence: Synthetic input fixture, Structured output schema validation, Safety-boundary statement, Human-review disposition placeholder, Evidence and audit trace reference
Next step: Add no-submission denial packet generation with manual verification and payer-action hard stops.

revenue-cycle

Prior Authorization

Synthetic prior-authorization workflow intelligence for stalled tasks, missing packets, evidence requirements, and human-reviewed next steps.

Trust 69; governance 89; automation risk 57

Capabilities: PA stall detection, Missing documentation checklist, Evidence packet regeneration, Manual verification queueing
Structured outputs: prior_auth_status_packet, missing_packet_checklist, manual_review_queue_item
Evidence: Synthetic input fixture, Structured output schema validation, Safety-boundary statement, Human-review disposition placeholder, Evidence and audit trace reference
Next step: Connect prior-auth recommendations to durable review packets without enabling payer submission.

patient-access

Patient Access

Synthetic access operations intelligence for intake friction, eligibility-ready packets, scheduling handoffs, and service-line routing.

Trust 73; governance 86; automation risk 39

Capabilities: Access bottleneck detection, Eligibility packet readiness, Service-line routing recommendation, Intake completeness scoring
Structured outputs: access_readiness_score, intake_gap_packet, manual_routing_recommendation
Evidence: Synthetic input fixture, Structured output schema validation, Safety-boundary statement, Human-review disposition placeholder, Evidence and audit trace reference
Next step: Add synthetic access-score trend view with owner assignment and escalation boundaries.

patient-access

Scheduling

Synthetic scheduling intelligence for wait-time signals, capacity constraints, referral handoffs, and manual appointment-workflow recommendations.

Trust 74; governance 85; automation risk 38

Capabilities: Wait-time signal detection, Capacity bottleneck summaries, Referral handoff readiness, Manual scheduling task routing
Structured outputs: scheduling_signal_report, capacity_gap_packet, manual_queue_recommendation
Evidence: Synthetic input fixture, Structured output schema validation, Safety-boundary statement, Human-review disposition placeholder, Evidence and audit trace reference
Next step: Create synthetic scheduling replay scenarios before any calendar or patient-facing integration is considered.

patient-access

Referral Management

Synthetic closed-loop referral intelligence for leakage, delays, owner routing, wait-time risk, and feedback packet generation.

Trust 73; governance 88; automation risk 47

Capabilities: Referral delay detection, Leakage risk scoring, Closed-loop status tracking, Provider-matching readiness
Structured outputs: referral_signal_report, leakage_risk_packet, closed_loop_feedback_packet
Evidence: Synthetic input fixture, Structured output schema validation, Safety-boundary statement, Human-review disposition placeholder, Evidence and audit trace reference
Next step: Bind referral intelligence to human-reviewed owner routing and no-outreach hard stops.

imaging

Imaging Intelligence

Synthetic imaging operations intelligence for turnaround delays, DICOM workflow status, report-readiness gaps, and manual escalation packets.

Trust 74; governance 87; automation risk 44

Capabilities: Imaging turnaround detection, DICOM metadata readiness, Report-delay summaries, Radiology workflow escalation
Structured outputs: imaging_signal_report, turnaround_delay_packet, radiology_review_queue_item
Evidence: Synthetic input fixture, Structured output schema validation, Safety-boundary statement, Human-review disposition placeholder, Evidence and audit trace reference
Next step: Add imaging-operation fixtures for modality, site, report status, and reviewer escalation without image diagnosis.

population-health

Population Health

Synthetic population-risk intelligence for care-gap patterns, outreach-ready-but-blocked tasks, stratification explainability, and reviewer queues.

Trust 71; governance 87; automation risk 50

Capabilities: Care-gap signal detection, Synthetic cohort stratification, Population trend summaries, Manual intervention queueing
Structured outputs: population_signal_report, care_gap_packet, manual_review_queue_item
Evidence: Synthetic input fixture, Structured output schema validation, Safety-boundary statement, Human-review disposition placeholder, Evidence and audit trace reference
Next step: Add de-identification and consent-state placeholders before any non-synthetic population workflow design.

quality

Quality / HEDIS / STAR

Synthetic quality intelligence for measure-gap detection, evidence readiness, denominator/numerator traceability, and reviewer-owned remediation queues.

Trust 74; governance 89; automation risk 45

Capabilities: Measure-gap detection, Evidence readiness scoring, Quality packet drafting, Reviewer disposition tracking
Structured outputs: quality_signal_report, measure_gap_packet, reviewer_disposition_item
Evidence: Synthetic input fixture, Structured output schema validation, Safety-boundary statement, Human-review disposition placeholder, Evidence and audit trace reference
Next step: Create measure-specific synthetic validation packs with no payer submission or performance-guarantee claims.

governance

Governance / Compliance

Synthetic governance intelligence for sensitive-task triage, audit readiness, policy gates, evidence completeness, and compliance escalation recommendations.

Trust 81; governance 96; automation risk 33

Capabilities: Policy-gate enforcement, Sensitive-task detection, Evidence completeness checks, Compliance escalation packets
Structured outputs: governance_decision_packet, compliance_escalation_packet, audit_readiness_report
Evidence: Synthetic input fixture, Structured output schema validation, Safety-boundary statement, Human-review disposition placeholder, Evidence and audit trace reference
Next step: Make governance/compliance the required supervisor lane for every TrustOps recommendation.

operations

Signal Detection

Synthetic event analysis that detects operational issues, low-confidence outputs, integration drift, and safety-sensitive workflow conditions.

Trust 79; governance 92; automation risk 36

Capabilities: Synthetic event rule evaluation, Severity assignment, Owner routing, Human-review recommendation generation
Structured outputs: synthetic_signal, owner_routing_packet, review_required_flag
Evidence: Synthetic input fixture, Structured output schema validation, Safety-boundary statement, Human-review disposition placeholder, Evidence and audit trace reference
Next step: Promote signal rules into versioned policy-controlled fixtures with replayable synthetic traces.

operations

Self-Healing Operations

Recommendation-only remediation planning for retry, validation, investigation, review, duplicate reconciliation, and automation pause workflows.

Trust 77; governance 94; automation risk 41

Capabilities: Recommendation-only remediation, Human-review gating, Blocked-action enforcement, Operational owner routing
Structured outputs: self_healing_recommendation, manual_verification_task, automation_pause_packet
Evidence: Synthetic input fixture, Structured output schema validation, Safety-boundary statement, Human-review disposition placeholder, Evidence and audit trace reference
Next step: Connect recommendation outputs to human-run packets and keep all real-world execution disabled.

semantic-infrastructure

Semantic Intelligence Graph

Synthetic semantic graph linking modules, signals, evidence requirements, safety controls, workflow owners, and remediation recommendations.

Trust 78; governance 91; automation risk 35

Capabilities: Module-signal graphing, Evidence lineage, Safety-boundary traversal, Owner and workflow mapping
Structured outputs: semantic_graph_node, evidence_lineage_packet, trustops_dependency_map
Evidence: Synthetic input fixture, Structured output schema validation, Safety-boundary statement, Human-review disposition placeholder, Evidence and audit trace reference
Next step: Use graph nodes to make every TrustOps output traceable to module, signal, evidence, and governance-control sources.

secure-middleware

Secure Middleware Gateway

Governed middleware abstraction for future MCP/tool access, authorization, schema validation, rate limits, audit logs, and no-direct-system access.

Trust 83; governance 96; automation risk 31

Capabilities: Tool authorization map, Schema validation boundary, No direct LLM-to-system access, Audit and revocation readiness
Structured outputs: tool_authorization_decision, middleware_audit_event, blocked_action_packet
Evidence: Synthetic input fixture, Structured output schema validation, Safety-boundary statement, Human-review disposition placeholder, Evidence and audit trace reference
Next step: Require middleware authorization decisions for every future tool call before real connector evaluation.

Signal Engine

Synthetic-only signals identify operational risk without touching PHI, EHRs, payers, outreach systems, or production connectors.

high

denied_claim_spike

Synthetic denial volume exceeded the configured threshold and may indicate documentation or coding workflow friction. Observed 22 denials per synthetic hour; threshold 10.

RCM / Denials

Owner: Revenue Cycle Lead
Action: Open a synthetic denial-pattern investigation packet for manual review.
Eligibility: manual-review-required
Human review required: yes

high

referral_delay

Synthetic referral queue time exceeded the threshold and could become leakage risk in a governed pilot. Observed 9 days in synthetic queue; threshold 4.

Referral Management

Owner: Referral Operations Lead
Action: Request human review of delayed synthetic referrals and owner routing.
Eligibility: manual-review-required
Human review required: yes

high

prior_auth_stalled

Synthetic authorization tasks remained unresolved beyond the safe review threshold. Observed 6 synthetic business days; threshold 2.

Prior Authorization

Owner: Prior Authorization Lead
Action: Queue stalled synthetic prior-auth packets for manual verification.
Eligibility: manual-review-required
Human review required: yes

medium

missing_documentation

Required synthetic packet fields are missing and should not move forward without validation. Observed 7 missing packet fields; threshold 1.

Clinical Documentation / RCM

Owner: Clinical Documentation Lead
Action: Regenerate the missing synthetic documentation packet for reviewer inspection.
Eligibility: manual-review-required
Human review required: yes

medium

imaging_turnaround_delay

Synthetic imaging turnaround exceeded the configured threshold. Observed 48 synthetic hours; threshold 24.

Imaging Intelligence

Owner: Imaging Operations Lead
Action: Retry the synthetic imaging-status workflow and route the result to manual review.
Eligibility: manual-review-required
Human review required: yes

high

care_gap_detected

Synthetic care-gap signals require review before any patient-facing or outreach-adjacent workflow is considered. Observed 14 synthetic care gaps; threshold 3.

Population Health

Owner: Population Health Lead
Action: Request human review of the synthetic care-gap packet.
Eligibility: manual-review-required
Human review required: yes

medium

failed_api_sync

Synthetic middleware sync failures may indicate connector readiness or schema drift issues. Observed 5 synthetic sync failures; threshold 1.

Secure Middleware Gateway

Owner: Platform Reliability Lead
Action: Re-run synthetic middleware validation and inspect the failed sync trace.
Eligibility: manual-review-required
Human review required: yes

critical

duplicate_patient_context

Duplicate context signals are safety-sensitive even in synthetic mode and must block automation. Observed 2 synthetic duplicate contexts; threshold 1.

Patient Journey Memory

Owner: Data Governance Lead
Action: Reconcile duplicate synthetic contexts through manual verification.
Eligibility: manual-review-required
Human review required: yes

critical

low_confidence_agent_output

Low-confidence clinical-adjacent outputs must not continue without reviewer disposition. Observed 42 confidence score; threshold 70.

Clinical Intelligence

Owner: Clinical QA Lead
Action: Pause automation and route the synthetic agent output to qualified review.
Eligibility: manual-review-required
Human review required: yes

critical

compliance_sensitive_task

Compliance-sensitive task classification requires explicit human review and retained hard stops. Observed 1 sensitive synthetic task; threshold 1.

Governance / Compliance

Owner: Compliance Lead
Action: Escalate the synthetic sensitive task to compliance review.
Eligibility: manual-review-required
Human review required: yes

Self-Healing Workflow

Remediation is recommendation-only and always routed through a human review gate.

recommendation-only

open investigation ticket

A human-reviewed open investigation ticket packet for RCM / Denials.

Revenue Cycle Lead

Signal: denied_claim_spike
Steps: Create an investigation ticket draft., Attach trend summary, threshold, and affected workflow., Assign the owner for manual investigation.
Blocked actions: Live PHI access, Autonomous diagnosis, Treatment recommendation, Prescribing, Patient outreach, Payer submission, EHR writeback, Billing submission, Production connector mutation

recommendation-only

request human review

A human-reviewed request human review packet for Referral Management.

Referral Operations Lead

Signal: referral_delay
Steps: Create a reviewer task with signal reason and source event., Attach the synthetic evidence packet., Block any downstream automation until disposition is recorded.
Blocked actions: Live PHI access, Autonomous diagnosis, Treatment recommendation, Prescribing, Patient outreach, Payer submission, EHR writeback, Billing submission, Production connector mutation

recommendation-only

queue for manual verification

A human-reviewed queue for manual verification packet for Prior Authorization.

Prior Authorization Lead

Signal: prior_auth_stalled
Steps: Create a manual verification queue item., Attach the stalled workflow trace., Require owner disposition before any next step.
Blocked actions: Live PHI access, Autonomous diagnosis, Treatment recommendation, Prescribing, Patient outreach, Payer submission, EHR writeback, Billing submission, Production connector mutation

recommendation-only

regenerate missing packet

A human-reviewed regenerate missing packet packet for Clinical Documentation / RCM.

Clinical Documentation Lead

Signal: missing_documentation
Steps: Regenerate the synthetic evidence packet., Validate required schema fields., Queue the packet for human review.
Blocked actions: Live PHI access, Autonomous diagnosis, Treatment recommendation, Prescribing, Patient outreach, Payer submission, EHR writeback, Billing submission, Production connector mutation

recommendation-only

retry workflow

A human-reviewed retry workflow packet for Imaging Intelligence.

Imaging Operations Lead

Signal: imaging_turnaround_delay
Steps: Replay the synthetic workflow trace., Re-run structured-output validation., Send the replay packet to the assigned owner.
Blocked actions: Live PHI access, Autonomous diagnosis, Treatment recommendation, Prescribing, Patient outreach, Payer submission, EHR writeback, Billing submission, Production connector mutation

recommendation-only

request human review

A human-reviewed request human review packet for Population Health.

Population Health Lead

Signal: care_gap_detected
Steps: Create a reviewer task with signal reason and source event., Attach the synthetic evidence packet., Block any downstream automation until disposition is recorded.
Blocked actions: Live PHI access, Autonomous diagnosis, Treatment recommendation, Prescribing, Patient outreach, Payer submission, EHR writeback, Billing submission, Production connector mutation

recommendation-only

re-run validation

A human-reviewed re-run validation packet for Secure Middleware Gateway.

Platform Reliability Lead

Signal: failed_api_sync
Steps: Re-run schema validation against the synthetic trace., Capture validation errors., Route failures to platform reliability review.
Blocked actions: Live PHI access, Autonomous diagnosis, Treatment recommendation, Prescribing, Patient outreach, Payer submission, EHR writeback, Billing submission, Production connector mutation

recommendation-only

reconcile duplicate records

A human-reviewed reconcile duplicate records packet for Patient Journey Memory.

Data Governance Lead

Signal: duplicate_patient_context
Steps: Create a duplicate-context reconciliation packet., Compare only synthetic context identifiers., Require data-governance review before any merge-like recommendation.
Blocked actions: Live PHI access, Autonomous diagnosis, Treatment recommendation, Prescribing, Patient outreach, Payer submission, EHR writeback, Billing submission, Production connector mutation

recommendation-only

pause automation

A human-reviewed pause automation packet for Clinical Intelligence.

Clinical QA Lead

Signal: low_confidence_agent_output
Steps: Mark the synthetic workflow as automation-paused., Attach the confidence or safety reason., Require qualified reviewer approval before continuing.
Blocked actions: Live PHI access, Autonomous diagnosis, Treatment recommendation, Prescribing, Patient outreach, Payer submission, EHR writeback, Billing submission, Production connector mutation

recommendation-only

escalate to compliance

A human-reviewed escalate to compliance packet for Governance / Compliance.

Compliance Lead

Signal: compliance_sensitive_task
Steps: Create a compliance escalation packet., Attach policy boundary and signal details., Pause related automation recommendations until compliance review completes.
Blocked actions: Live PHI access, Autonomous diagnosis, Treatment recommendation, Prescribing, Patient outreach, Payer submission, EHR writeback, Billing submission, Production connector mutation

Durable evidence binding

TrustOps review packets are ready for AAL2 protected record, replay, and review-disposition persistence without public writes.

high

trustops_packet_0d2297849796c5f2

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.