SCRIMED Work & Intelligence Platform

Governed long-running healthcare work sessions with verification-first autonomy.

SCRIMED Work consolidates workspaces, agents, model routing, context retrieval, approvals, verification, artifact generation, schedules, voice simulation, learning loops, rollback, and value telemetry into one synthetic/no-PHI operating surface.

Inspect API Download Brief Providers Agents Tools Hardening Gate

Statusscrimed-work-intelligence-platform-active-synthetic-no-phi

Workspaces5

Sessions2

Agents11

Tools7

Providers4

Schedules5

Consequential actionsdisabled

Hardening gateoperator_action_required

Lifecycle policyfail-closed

Governance Status

Every run starts with Definition of Done, then earns autonomy through verification.

SCRIMED Work & Intelligence Platform is a synthetic/no-PHI, verification-first control plane for workspace sessions, model/tool routing, agent orchestration, context retrieval, artifacts, schedules, voice simulation, learning loops, governance, auditability, rollback, and value telemetry. It does not authorize live PHI, autonomous clinical care, diagnosis, treatment, prescribing, patient outreach, payer submission, EHR writeback, final imaging interpretation, production connector approval, certification claims, customer go-live, or external model calls.

Definition of Done required: yes
Verification blocks completion: yes
Schedules disabled by default: yes
Voice simulation only: yes

Production Hardening Gate

Evidence-ready controls are separated from operator-required release steps.

operator_action_required

Strict durable-store readiness

SCRIMED Work can progress only through approved non-production migration, strict AAL2 smoke, and no-PHI canary evidence. This gate does not approve production use.

Readiness

Evidence-ready gates: 11/14
Operator-required gates: 3
Strict smoke eligible: no
Canary eligible: no

Commands

npm run smoke:scrimed-work:durable-store-preflight:strict
npm run smoke:scrimed-work:strict
npm run smoke:scrimed-work:two-identity:strict

evidence_ready

Safety boundaries remain enforced

Any SCRIMED Work demo, buyer diligence, or protected non-production smoke.

Evidence

X-SCRIMED-Clinical-Care-Authority=not-authorized-live-care
X-SCRIMED-EHR-Writeback=not-authorized
X-SCRIMED-Payer-Submission=not-authorized
X-SCRIMED-Consequential-Actions=disabled-by-default

Next action

Keep boundary headers and fail-closed checks in every new SCRIMED Work route.

evidence_ready

Definition-of-Done and verification are mandatory

Agentic session planning, artifact generation, and completion decisions.

Evidence

DefinitionOfDoneContract
verifyScrimedWorkResult
detectDoomLoop
human-approval-state check

Next action

Keep completion blocked unless schema, citation, policy, rollback, budget, loop, and approval checks pass.

evidence_ready

Protected write feature flag

Authenticated protected session, transition, and artifact write smokes.

Evidence

SCRIMED_WORK_PROTECTED_WRITES_ENABLED=true

Next action

Enable SCRIMED_WORK_PROTECTED_WRITES_ENABLED=true only in an approved non-production target.

evidence_ready

Authoritative lifecycle and independent review

Every protected session transition and completion decision.

Evidence

evaluateWorkSessionTransition
authoritative durable read before mutation
database row lock and append-only status history
tenant-scoped transition idempotency ledger
independent reviewer separation of duties

Next action

Keep the TypeScript policy and database transition matrix aligned through the lifecycle behavior test and migration preflight.

evidence_ready

Durable independent artifact review binding

Verified internal completion of any protected SCRIMED Work artifact.

Evidence

reviewer-only AAL2 durable RPC
creator/reviewer separation of duties
database-verifiable reviewer and decision hashes
immutable artifact mutation scope
mandatory verification before internal-use approval
external distribution and payer submission fixed false

Next action

Keep review and completion behind separate AAL2 reviewer identity, idempotency, authoritative durable state, and mandatory verification.

evidence_ready

Reviewer-only artifact queue

Operationally usable separation of duties for protected SCRIMED Work artifacts.

Evidence

reviewer-only AAL2 and tenant-scoped queue RPC
bounded synthetic/no-PHI metadata response
creator/reviewer exclusion in application and database policy
audit event on every queue read
no raw artifact payload or free-text reviewer input
external distribution and payer submission fixed false

Next action

Retain reviewer-queue migration and advisor evidence, then validate the queue with a separately enrolled reviewer identity.

evidence_ready

Durable store feature flag

Supabase RPC-backed SCRIMED Work persistence.

Evidence

SCRIMED_WORK_DURABLE_STORE_ENABLED=true
storageMode=protected-supabase-rpc-aal2

Next action

Enable SCRIMED_WORK_DURABLE_STORE_ENABLED=true only after the non-production migration is applied.

evidence_ready

Supabase runtime configuration

AAL2 RBAC/RLS protected durable-store smoke.

Evidence

NEXT_PUBLIC_SUPABASE_URL configured
NEXT_PUBLIC_SUPABASE_PUBLISHABLE_KEY configured

Next action

Configure only the approved non-production Supabase URL and publishable key.

evidence_ready

Server-held runtime authorization token

Protected Supabase RPC mutation routes.

Evidence

SCRIMED_PILOT_INTAKE_PERSISTENCE_TOKEN configured

Next action

Set the runtime token through secure local or Vercel environment handling; never commit it.

operator_required

Fresh AAL2 operator bearer session

Strict authenticated durable-store smoke.

Evidence

SCRIMED_BEARER_TOKEN is missing or expired.

Next action

Generate a fresh short-lived tenant-admin or pilot-lead AAL2 bearer token immediately before strict smoke.

operator_required

Distinct AAL2 reviewer bearer session

Reviewer-only queue, independent approval, artifact review, and completion evidence.

Evidence

A distinct SCRIMED_REVIEWER_BEARER_TOKEN is missing or expired.

Next action

Enroll a genuinely separate reviewer, activate reviewer membership, then capture a fresh reviewer AAL2 token without printing it.

evidence_ready

Tenant workspace scope

Tenant-isolated SCRIMED Work durable mutation routes.

Evidence

SCRIMED_WORKSPACE_SLUG or SCRIMED_WORK_DEFAULT_WORKSPACE_SLUG configured

Next action

Set the approved non-production workspace slug, usually atlas-synthetic-evaluation.

evidence_ready

Non-production migration application

Real Supabase durable-store validation.

Evidence

supabase/migrations/20260709193000_scrimed_work_durable_store.sql exists
supabase/migrations/20260713160000_scrimed_work_lifecycle_hardening.sql exists
supabase/migrations/20260713163000_scrimed_work_advisor_index_hardening.sql exists
supabase/migrations/20260713210000_scrimed_work_artifact_review_binding.sql exists
supabase/migrations/20260714163930_scrimed_work_reviewer_queue.sql exists
supabase/migrations/20260715143000_scrimed_work_review_queue_approval_step.sql exists
scripts/scrimed-work-durable-store-preflight.mjs validates migration posture
migrationEvidenceId=supabase-yxacqdf-scrimed-work-20260713
reviewApprovalMigrationEvidenceId=scrimed-work-review-queue-approval-20260715-verified

Next action

Retain migration history, RLS/grant checks, and post-migration advisor evidence with this release.

operator_required

No-PHI canary workspace

Buyer-facing protected workflow readiness.

Evidence

Canary requires strict preflight plus two-identity authenticated lifecycle success.

Next action

Run one no-PHI protected workspace canary with distinct operator and reviewer identities, then bind reviewed evidence before buyer-facing mutations.

Workspace Selector

Domain views keep clinical, executive, research, operations, and Studio work separated by boundary.

clinical

Clinical Work

Decision-support preparation, care coordination drafts, education drafts, and synthetic clinical context review.

Allowed data

synthetic-no-phi, metadata-only, deidentified
Default risk: high
Human review default: yes

Boundary

No diagnosis, treatment, prescribing, triage, final imaging interpretation, or live patient care.

executive

Executive Work

Board, investor, buyer, value, and operating reports with evidence and claims controls.

Allowed data

metadata-only, synthetic-no-phi
Default risk: moderate
Human review default: yes

Boundary

No audited financials, securities material, valuation assurance, or customer go-live approval.

research

Research Work

Cited research briefs, contradiction detection, trial-readiness summaries, and evidence grading.

Allowed data

metadata-only, synthetic-no-phi
Default risk: moderate
Human review default: yes

Boundary

No therapeutic claims, enrollment decisions, or clinical validation claims.

operations

Operations Work

Operational playbooks, patient access workflows, scheduling simulations, and service delivery reports.

Allowed data

metadata-only, synthetic-no-phi
Default risk: moderate
Human review default: yes

Boundary

No autonomous outreach, booking, external communication, or production mutation.

trust-governance

SCRIMED Studio

Read-only registries for agents, tools, providers, policies, artifact templates, and schedule templates.

Allowed data

metadata-only, synthetic-no-phi
Default risk: low
Human review default: no

Boundary

Registry visibility only; not tool execution or approval authority.

Active Work Sessions

Persistent sessions carry scope, risk, autonomy, context, plans, approvals, artifacts, telemetry, cancellation, and rollback metadata.

awaiting_approval

Synthetic Care Coordination Work Session

Prepare a verified synthetic care coordination brief with citations and human review.

Definition of Done

Goal: Prepare a verified synthetic care coordination brief with citations and human review.
Maximum steps: 8
Maximum tool calls: 10
Human approval required: yes

Autonomy

Requested: prepare
Approved: observe
Risk: high
Rollback: available

awaiting_approval

Executive Board Brief Work Session

Prepare claims-safe board brief from verified SCRIMED Work telemetry.

Definition of Done

Goal: Prepare a verified synthetic care coordination brief with citations and human review.
Maximum steps: 8
Maximum tool calls: 10
Human approval required: yes

Autonomy

Requested: recommend
Approved: observe
Risk: moderate
Rollback: available

Agent Plan and Step Timeline

Planner, specialist, verifier, and reviewer roles operate with bounded steps and approval checkpoints.

completed

Confirm Definition of Done and retained safety boundary

Agent: safety-policy

Controls

Depends on: none
Approval required: yes
Deadline: 120000ms
Audit: scrimed-intel-867eefd7

pending

Retrieve trusted context and citations

Agent: clinical-context

Controls

Depends on: step_1
Approval required: yes
Deadline: 120000ms
Audit: scrimed-intel-67469244

pending

Prepare draft artifact from verified evidence

Agent: artifact-writer

Controls

Depends on: step_2
Approval required: yes
Deadline: 120000ms
Audit: scrimed-intel-1965fca7

pending

Run verification checks and loop guard

Agent: verification

Controls

Depends on: step_3
Approval required: yes
Deadline: 120000ms
Audit: scrimed-intel-88aca326

pending

Queue human review for consequential or high-risk output

Agent: reviewer

Controls

Depends on: step_4
Approval required: yes
Deadline: 120000ms
Audit: scrimed-intel-40210e74

Lifecycle Control

Authoritative state, independent approval, and durable idempotency prevent impossible or duplicated work histories.

awaiting_approval

work_session_care_coordination_synthetic

Every protected mutation re-reads the tenant-scoped durable record. The database locks the session, validates the transition, preserves append-only history, and checks the idempotency ledger.

Available now

reject, cancel, fail
Terminal: no
Policy: scrimed-work-lifecycle-v2026-07-13

Fail-closed examples

plan: plan is not permitted from awaiting_approval.
run: run is not permitted from awaiting_approval.
pause: pause is not permitted from awaiting_approval.
resume: resume is not permitted from awaiting_approval.

awaiting_approval

work_session_executive_board_brief

Every protected mutation re-reads the tenant-scoped durable record. The database locks the session, validates the transition, preserves append-only history, and checks the idempotency ledger.

Available now

approve, reject, cancel, fail
Terminal: no
Policy: scrimed-work-lifecycle-v2026-07-13

Fail-closed examples

plan: plan is not permitted from awaiting_approval.
run: run is not permitted from awaiting_approval.
pause: pause is not permitted from awaiting_approval.
resume: resume is not permitted from awaiting_approval.

Context and Citations

Agents retrieve ranked context with citations, trust tiers, recency, and tenant metadata instead of guessing.

policy-document

Care coordination review SOP

Care coordination briefs require source citations, unresolved risk flags, and human review before patient-facing use.

Scores

Retrieval: 70
Semantic: 69
Lexical: 57
Trust: reviewed-reference

Citation

SCRIMED synthetic SOP CC-001

fhir-preview

FHIR R4 preview contract

FHIR bundle previews are read-only and never write to an EHR without future connector approval.

Scores

Retrieval: 51
Semantic: 41
Lexical: 29
Trust: reviewed-reference

Citation

SCRIMED synthetic FHIR preview FP-001

payer-rule

Prior authorization draft documentation rule

Prior authorization packets must identify missing symptom language, functional status, visit timing, and medical necessity support before submission.

Scores

Retrieval: 48
Semantic: 41
Lexical: 29
Trust: synthetic-fixture

Citation

SCRIMED synthetic payer-rule PA-004

internal-document

Board brief evidence template

Board briefs must separate verified evidence, assumptions, unresolved risks, and next approvals.

Scores

Retrieval: 30
Semantic: 12
Lexical: 0
Trust: reviewed-reference

Citation

SCRIMED synthetic executive template BB-002

Approval Queue + Verification Results

High-risk work pauses for human review, and completion is blocked when mandatory verification fails.

pending

review care coordination artifact before external or clinical-facing use

High-risk clinical-support artifact remains decision-support only.

Reviewer

Role: clinician-reviewer
Token status: not-issued
Audit: scrimed-intel-d15dd2b7

human_review_required

Synthetic Care Coordination Brief

pause_for_review

Verification

All pass: no
Pass rate: 91%
Completion eligible: no
Failed criteria: human-approval-state

Model Routing + Value Telemetry

Routing records privacy, risk, cost, latency, provider status, and fallback rationale without external calls.

reasoning

scrimed-synthetic-no-call

Selected the strongest policy-compliant provider that preserves privacy, residency, budget, and task capability requirements.

Route

Provider: synthetic-fallback
Deployment: SCRIMED_CLOUD
Cost: low
Latency: fast
Human review: yes

balanced

scrimed-synthetic-no-call

Selected the strongest policy-compliant provider that preserves privacy, residency, budget, and task capability requirements.

Route

Provider: synthetic-fallback
Deployment: SCRIMED_CLOUD
Cost: low
Latency: fast
Human review: yes

local-private

blocked-no-model-selected

Routing is blocked because safety, cost, risk, provider, or residency policy cannot be satisfied.

Route

Provider: none-policy-blocked
Deployment: AIR_GAPPED
Cost: low
Latency: balanced
Human review: yes

Value telemetry

work_session_care_coordination_synthetic

No raw prompts, PHI, tokens, or sensitive document text are stored in telemetry.

Outcome economics

Botsitting ratio: 0.18
Net time saved: 17
Cost per verified artifact: 0.0000
First-pass verification: 100%

Value telemetry

work_session_executive_board_brief

No raw prompts, PHI, tokens, or sensitive document text are stored in telemetry.

Outcome economics

Botsitting ratio: 0.18
Net time saved: 17
Cost per verified artifact: 0.0000
First-pass verification: 100%

Schedules + Voice Simulation

Scheduled work is defined but disabled by default; voice remains simulation-only with no raw audio storage.

disabled

Morning oncology review preparation

Prepare synthetic oncology review queue with citation and human-review gates.

Policy

Cadence: 0 6 * * 1-5
Approval: clinician-review-required
Maximum cost: $0.25
Simulation only: yes

disabled

Hourly critical-lab monitoring simulation

Simulate critical-lab signal detection without live patient data or outreach.

Policy

Cadence: 0 * * * *
Approval: simulation-only-no-alerting
Maximum cost: $0.05
Simulation only: yes

disabled

Nightly risk-score refresh preview

Refresh synthetic risk-score preview and generate verification report.

Policy

Cadence: 0 2 * * *
Approval: operator-review-required
Maximum cost: $0.15
Simulation only: yes

disabled

Weekly payer report preparation

Prepare payer documentation gap report with no submission authority.

Policy

Cadence: 0 8 * * 1
Approval: rcm-compliance-review-required
Maximum cost: $0.2
Simulation only: yes

disabled

Monthly executive dashboard generation

Prepare executive dashboard from verified metadata and retained boundaries.

Policy

Cadence: 0 9 1 * *
Approval: executive-review-required
Maximum cost: $0.3
Simulation only: yes

simulation

Voice-session state machine

Voice workflow is simulation-only and does not diagnose, treat, prescribe, triage emergencies, outreach patients, or store raw audio.

States

idle -> listening -> processing -> speaking -> ended
Raw audio stored: no
Consent acknowledged: yes
Emergency language detected: no

SCRIMED Studio

Read-only registries expose agents, tools, providers, artifact templates, schedules, policies, and ontology concepts.

review_ready

Work Coordinator

Builds bounded plans, enforces Definition of Done, and coordinates specialist handoffs.

Least privilege

plan and coordinate synthetic work only
Blocked: autonomous clinical care, payer submission, EHR writeback, external communication
Human escalation: yes

protected_operator_required

Clinical Context Agent

Retrieves synthetic clinical context and flags human-review requirements.

Least privilege

decision-support context retrieval only
Blocked: diagnosis, treatment selection, prescribing, final imaging interpretation
Human escalation: yes

review_ready

Interoperability Agent

Maps FHIR, payer, scheduling, and ontology concepts into safe previews.

Least privilege

FHIR preview and validation metadata only
Blocked: production connector activation, EHR writeback, raw connector payload logging
Human escalation: yes

review_ready

Patient Access Agent

Prepares scheduling, referral, and access workflow recommendations.

Least privilege

synthetic patient-access workflow preparation
Blocked: patient outreach, appointment booking without approval
Human escalation: yes

review_ready

Research Agent

Prepares cited research briefs and contradiction checks.

Least privilege

synthetic research synthesis only
Blocked: clinical recommendation, therapeutic claim, trial enrollment decision
Human escalation: yes

protected_operator_required

Revenue Cycle Agent

Prepares prior authorization and appeal drafts without submission.

Least privilege

documentation and draft packet support only
Blocked: claim submission, payer submission, coverage determination, payment execution
Human escalation: yes