Pilot operations · 41,000 annual discharges

Discharge workflow inbox

Role-scoped open and recently closed discharges across the two Heraklion pilot hospitals.

Open discharges

18

6 need action today

Completeness average

94.2%

+16.2 pts from 78% baseline

Within 24-hour delivery

92.8%

Pilot target 95%

Blocked by reconciliation

4

Pharmacist action required

Ward	Closure	Summary	Medication	Follow-up	Risk	Release
Harborview General Hospital · 3B	Closed	97%	1 blocker	Booked	High	Pending sign-off
Northgate District Hospital · 2A	Processing	89%	Verified	Retrying	Moderate	Assembling
Harborview General Hospital · 3B	Closed	98%	Verified	Booked	Low	Delivered
Northgate District Hospital · 2A	Closed	82%	3 blockers	Eligible	Low	Held

Agent assembly · chart closure 12 Jun 2025 09:42

Greek national discharge summary

Patient A · MRN 004821 · Harborview General Hospital General Hospital · Medical Ward 3B

Reference bank completeness

97%

Target achieved · baseline 78%

Source fields

32/33

1 missing, not inferred

Pending results

2

Troponin trend · culture

Document state

Approval held

Reconciliation blocker

National template sections

Agent v0.9.4

Admission course

Admitted on 08/06/2025 with acute decompensated heart failure and bilateral peripheral oedema. Responded to intravenous furosemide, oxygen therapy, and sodium restriction. Renal function remained stable.

Procedures and interventions

Transthoracic echocardiogram on 09/06/2025. No invasive procedure. Daily weight and fluid balance monitoring completed.

Pending results

Microbiology culture from 11/06/2025 remains pending. Responsible service: Cardiology. Result notification owner: Dr. C.

Discharge medication changes

Source change detected: Furosemide increased from 40 mg once daily pre-admission to 40 mg twice daily at discharge. Pharmacist verification is required before release.

Source provenance

Admission course · EHR encounter 88421Imported 12 Jun 2025 09:44 · signed by Dr. Vlachakis

Procedures · Cardiology procedure recordEcho report finalized 10 Jun 2025 16:20

Pending results · Laboratory serviceLast synchronized 12 Jun 2025 09:41 · status pending

Medication list · immutable snapshot #a82f19Pre-admission 07/06 · inpatient 11/06 · discharge draft 12/06

Missing field · community pharmacy contactNot present in source systems · no inferred value applied

Agent handover state

Assembly complete · LangGraph coordinator recorded

Release blocked · pharmacist verification pending

Pharmacist verification gate

Medication reconciliation review

Every unexplained change is withheld from the summary, after-visit summary, and community physician send until verified.

Release blocked. One unexplained medication change requires explicit pharmacist verification. Automated medication changes are rejected by policy.

Medication list comparison

Snapshot integrity verified

Medication / indication	Pre-admission · 07 Jun	Inpatient · 11 Jun	Discharge draft · 12 Jun	Decision
FurosemideHeart failure · renal function eGFR 58	40 mg once daily	40 mg IV twice daily	40 mg twice daily	Unexplained change
RamiprilHeart failure / hypertension	5 mg once daily	5 mg once daily	5 mg once daily	No change
BisoprololRate control	2.5 mg once daily	2.5 mg once daily	2.5 mg once daily	No change
SpironolactoneHeart failure · potassium 4.5 mmol/L	25 mg once daily	Held 10 Jun	25 mg once daily	Rationale missing

Blocking reconciliation item

Furosemide 40 mg BID

High clinical risk

Created 12 Jun 2025 09:46 · discharge in 5h 14m · confidence 0.74

Prescribing rationale is not present in the source chart. Do not infer intent. Contact attending physician if needed.

Audit and downstream effect

Discharge summary withheld

After-visit summary withheld

Community delivery withheld

A later medication change will invalidate any prior verification and return this item to the queue.

Attending Physician · authorized pharmacist

Pharmacist reconciliation queue

Prioritized by clinical risk, discharge imminence, and confidence in medication history.

My active items

7

3 due within 4 hours

Ward queue

14

Harborview General Hospital 3B · Northgate District Hospital 2A

Escalations overdue

2

Physician response required

Priority	Patient / item	Context	Confidence	Deadline	Owner	Escalation
1 · High	Patient AFurosemide 40 mg BID	HF · eGFR 58 · discharge today	74%	14:30	DS Dimitrios	Due soon
2 · High	Patient DInsulin glargine dose	Diabetes · 3 discrepancies	61%	15:10	Unassigned	Overdue
3 · Moderate	Patient EApixaban restart	AF · procedure completed	88%	Tomorrow	KA Katerina	None
4 · Moderate	Patient BTiotropium device	COPD · source conflict	79%	Tomorrow	DS Dimitrios	None

Controlled clinical action · immutable audit event

Verify medication decision

Patient A · Furosemide 40 mg twice daily · reconciliation item RX-1842

High-risk item

Dual control required. High-risk medication verification requires an authorized pharmacist and a second clinical reviewer before downstream release.

Provenance review

Pre-admission medication listFurosemide 40 mg once daily · patient-reported 07 Jun 08:12

Inpatient MARFurosemide 40 mg IV twice daily · 08–11 Jun · four administrations documented

Discharge draftFurosemide 40 mg orally twice daily · entered by Dr. Vlachakis 12 Jun 09:39

Clinical context

Indication: acute decompensated heart failure
eGFR: 58 mL/min/1.73m² · potassium: 4.2 mmol/L
Weight change: −3.4 kg during admission

Verification decision

Decision

Structured rationale *

Second reviewer

Actor: Attending Physician · role checked against hospital directory · timestamp and document hash will be recorded.

Chart closure scheduling agent

Follow-up scheduling

Eligible clinic capacity is checked once and idempotently returned on retrigger.

Capacity found. Cardiology clinic has a confirmed slot. A duplicate chart-closure trigger will not create another appointment.

Appointment

18 Jun

10:30 · Cardiology outpatient clinic

Location

Building B

Harborview General Hospital campus · Floor 2

Booking state

Confirmed

Booking ID CARD-29418

Eligible follow-up plan

Clinic	Reason	Capacity response	Patient details	State
Cardiology outpatient clinicHarborview General Hospital General Hospital	Heart failure medication review	18 Jun · 10:30	SMS reminder opted in	Booked
Renal medicineNorthgate District Hospital referral network	Renal function check	Capacity unavailable	Escalation owner: Ward coordinator	Retry 13 Jun

Patient communications agent · Greek

Review Greek instructions

Plain-language instructions with teach-back prompts for medications, pending results, follow-up, and contact responsibilities.

Clinical review needed

After-visit instructions

Ελληνικά · v1.2

Τι να κάνετε με τα φάρμακά σας

Εξετάσεις που εκκρεμούν

Επόμενο ραντεβού

Teach-back prompts

Ο ασθενής επανέλαβε πότε θα λάβει τη φουροσεμίδη.

Ο ασθενής γνωρίζει ποια συμπτώματα απαιτούν τηλεφώνημα.

Ο ασθενής μπορεί να αναφέρει το ραντεβού και την τοποθεσία.

Η ευθύνη για την κλήση 48 ωρών έχει εξηγηθεί.

Review note: confirm the high-dose instruction remains withheld until pharmacist verification is recorded.

Print status: Not released

Controlled output · shared ward printer

After-visit summary

Only approved content can be released to the secure printer and patient collection workflow.

Print release blocked

Two prerequisites must be complete before patient-identifiable output is produced.

Blocked

Pharmacist verification Pending

Physician sign-off Pending

Preview · Patient A

DRAFT PREVIEW · Not valid for patient collection

Medication changes

Furosemide: 40 mg twice daily Pending verification

Follow-up

Cardiology outpatient clinic · 18 June 2025 · 10:30 · Building B, Floor 2

Pending results

Microbiology culture from 11 June · Cardiology will notify patient.

Greek instructions

Reviewed draft includes medication teach-back, warning signs, and appointment details.

Print controls

Printer

Collection mode

Patient-identifiable output is retained for 60 seconds after release and requires secure collection.

Last print event: None

Readmission-risk agent · live membership

48-hour call list

High-likelihood patients requiring post-discharge outreach, prioritized for clinical risk and discharge imminence.

Live updates

High-likelihood patients

12

4 discharge within 6 hours

Consent coverage

100%

Preferred channel recorded

Calls completed today

8/14

6 remaining

Priority	Patient	Risk score / rationale	Discharge	Consent / channel	Owner	State
91 · urgent	Patient AMRN 004821 · Harborview General Hospital 3B	High · HF, prior admission, social support flag	Today 15:00	Opt-in · phone	Patient G
84 · high	Patient HMRN 004806 · Northgate District Hospital 2A	High · COPD, 2 ED visits, transport barrier	Today 17:30	Opt-in · SMS then phone	Unassigned
72 · high	Patient FMRN 004701 · Harborview General Hospital 3B	High · polypharmacy, renal impairment	Tomorrow 09:00	Opt-in · phone	Pharmacy team	Scheduled

Real-time rounds surface

Rounds risk alerts

Only high-likelihood readmission alerts are shown. Moderate and low scores remain recorded without interrupting attending workflow.

Connected · 4 sec latency

Prioritized by clinical risk and discharge imminence, not arrival order. Last event received 09:52:18.

URGENT · 91

Patient A · discharge today

Medical Ward 3B · Harborview General Hospital · HF exacerbation

Risk rationale

Prior admission within 30 days, heart failure, medication change, limited transport support.

Responsible role

Attending physician · Dr. C

Suggested action

Confirm 48-hour phone call and medication teach-back before release.

HIGH · 84

Patient H · discharge in 6h

Medical Ward 2A · Northgate District Hospital · COPD exacerbation

Two ED visits in 90 days · transport barrier · call opt-in recorded.

LangGraph coordinator · tamper-evident audit

Handover timeline

Patient A · discharge workflow state transitions from chart closure to downstream delivery.

Transitions

9

100% timestamped

Document hash

a82f19…7c2e

Verified against audit log

Current state

Held

Awaiting pharmacist

Chart closure received

12 Jun 2025 · 09:42:11 · Patient G · Hands-on operator

Idempotency key CL-004821-1206 accepted. Four downstream jobs enqueued.

Discharge summary assembly complete

09:44:37 · summary-agent · accountable: Dr. Vlachakis

Greek national template assembled. Completeness scored 97%; one missing source field displayed.

Medication reconciliation blocked

09:46:08 · medication-reconciliation-agent · accountable: Attending Physician

Furosemide dose change has no verified rationale. Downstream delivery withheld.

Scheduling retry recorded

09:47:22 · scheduling-agent · accountable: Patient G

Renal clinic capacity unavailable. Retry scheduled for 13 Jun; escalation owner recorded.

Greek communications generated

09:48:01 · communications-agent · accountable: ward nurse

Teach-back prompts generated in Greek. Clinical review pending.

Release gate evaluated

09:49:06 · coordinator · accountable: Dr. Vlachakis

Unsigned summary and outstanding reconciliation item prevent send and print.

Hands-on operator queue

Background jobs

Chart closure enqueues summary assembly, reconciliation, scheduling, communications, and after-visit-summary generation.

Queue healthy. Ward concurrency is within limits. Idempotency protects against duplicate chart-closure triggers.

Job	Patient	Started	State	Retry budget	Escalation owner
Summary assemblyCL-004821	Patient A	09:42	Complete	0/3	Attending physician
Medication reconciliationCL-004821	Patient A	09:42	Blocked	0/3	Clinical pharmacist
Follow-up schedulingCL-004821	Patient A	09:42	Retrying	1/3	Patient G
Greek communicationsCL-004821	Patient A	09:42	Complete	0/3	Ward nurse
After-visit summaryCL-004821	Patient A	Waiting	Held	—	Hands-on operator

Responsible attending · governed signature

Physician sign-off decision

One decision view for summary completeness, pending results, medication safety, risk alerts, and communication readiness.

Summary completeness

97%

Reference target met

Pending labs

2

Owner assigned

Reconciliation

1

Blocks release

Risk alert

High

48-hour call required

Decision checklist

National discharge template complete at 97%

Pending microbiology result responsibility confirmed

Furosemide dose change verified by pharmacist

Greek instructions reviewed with teach-back prompts

48-hour call opt-in and owner recorded

Release gate

Cannot release yet

The coordinator will reject this action until all prerequisites are met.

Pharmacist verification of furosemide change
Explicit clinician sign-off with rationale

Medication-change rationale

A late result or pharmacist rejection returns the document to pending approval and blocks delivery.

Patient G · hands-on operator

Discharge checklist

All operational prerequisites in one view before the patient leaves Ward 3B.

Patient

Patient A

MRN 004821 · discharge today

Target departure

15:00

5h 08m remaining

Overall state

Not ready

2 blockers

Discharge readiness

Summary assembled · 97% completenessComplete

Medication reconciliation · furosemide verification pendingBlocked

Appointment · Cardiology 18 Jun, 10:30Booked

48-hour call list · Patient G assignedEnrolled

Greek instructions · teach-back review pendingReview

Physician approval · Dr. Vlachakis not signedPending

Secure print collection · printer release unavailableWaiting

Dr. A · Heraklion referral scope

Community physician inbox

Only patients attributed to your authorized referral panel are visible. Delivery and receipt are measured against the 24-hour target.

Scope verified

Authorized patients

24

Across Harborview General Hospital and Northgate District Hospital

Received within 24 hours

95.1%

Pilot target achieved

Needs acknowledgment

3

New this morning

Patient	Discharged from	Delivered	Medication changes	Pending labs	Follow-up	Outreach
Patient CMRN 003774	Harborview General Hospital · 3B	11 Jun · 16:40	None	None	GP review 19 Jun	Acknowledge
Patient AMRN 004821	Harborview General Hospital · 3B	Held · not delivered	Furosemide 40 mg BID · verification pending	Culture pending	Cardiology 18 Jun	Ward owns call
Patient BMRN 005119	Northgate District Hospital · 2A	12 Jun · 09:18	Tiotropium device	None	Respiratory clinic 20 Jun	Community call

Referral scope protection

Access cannot be granted

This request is outside the patient scope assigned to your hospital-directory role.

⊘

Scope restriction, not a technical failure

Your current community viewer role only permits access to patients referred to your authorized panel. We cannot confirm or deny whether the requested record exists.

The access decision has been logged with your user, role, requested action, and timestamp. No patient-identifiable information was returned.

Access decision ID: ACL-2025-0612-884 · Greek jurisdiction controls active

Dr. B · executive sponsor

Pilot governance dashboard

Operational performance across Harborview General Hospital and Northgate District Hospital pilot medical wards, reconciled to timestamped handover events.

Summary completeness

94.2%

Baseline 78% · target 97%

24-hour delivery

92.8%

Baseline 61% · target 95%

Medication discrepancies

−43%

Target reduction −60%

Coordinator integrity

100%

1,284/1,284 timestamped

Baseline vs pilot performance

100%50%0%

78%Completeness
baseline

94%Completeness
pilot

61%24h baseline

93%24h pilot

Readmission and operations

30-day readmission trend−11.4%

High-risk patients on call list100%

Community escalations open6

Actionable exceptions

Metric at risk	Hospital / ward	Workflow state	Accountable role	Last event
24-hour delivery	Northgate District Hospital · 2A	Scheduling retry	Discharge coordinator	12 Jun · 09:47
Medication discrepancy	Harborview General Hospital · 3B	Pharmacist queue overdue	Clinical pharmacist	12 Jun · 09:46

Missed delivery target · evidence-linked case

Investigation: delayed community delivery

Trace from group metric to Northgate District Hospital Ward 2A, workflow state, failed job, and accountable role.

Case

INV-24H-0612

Opened 12 Jun · 09:50

Hospital / ward

Northgate District Hospital · 2A

Medical pilot ward

Patient-scoped evidence

1

Access controlled

Accountable role

Coordinator

Patient G

Evidence chain

Group metric crossed threshold

24-hour delivery fell to 92.8% · target 95%

Ward-level exception identified

Northgate District Hospital 2A · scheduling capacity unavailable

Job retry budget consumed

Scheduling agent · retry 3/3 · escalation recorded

Community physician notification pending

Delivery channel: scoped portal · no receipt yet

Accountability and next action

Escalation ownerPatient G · discharge coordinator · Northgate District Hospital 2A

Clinical escalationDr. A · community physician · scoped inbox

Investigation note

Hospital directory · least privilege

Role and delegation administration

Server-authoritative mappings for VP, physician, nurse, pharmacist, community viewer, and hands-on operator roles.

Active role mappings

User	Directory role	Organization / ward	Referral scope	Last access decision	Status
Dr. Beleni.papadakis	VP Care Continuum	Minoa Health Group	Both pilot hospitals · aggregate by default	Allowed · 09:51	Active
Dr. Cnikolaos.vlachakis	Physician	Harborview General Hospital · Ward 3B	Assigned inpatient panel	Allowed · 09:48	Active
Attending Physiciandimitrios.sotiriou	Pharmacist	Harborview General Hospital · pilot wards	Medication queue for pilot wards	Allowed · 09:49	Active
Dr. Aanastasia.markaki	Community viewer	Private practice · Heraklion	24 attributed referrals	Denied out-of-scope · 09:50	Active

Governed delegations

Dr. C → Dr. DCovering physician · 12 Jun 12:00–20:00 · sign-off permitted · revocable

Attending Physician → PharmacistPharmacist coverage · 12 Jun 14:00–22:00 · high-risk dual control maintained

Recent access decisions

Allowed · physician sign-off · 09:48

Denied · community scope · 09:50

Allowed · governance aggregate · 09:51

PDPA operations · Greek jurisdiction

Privacy, consent & data governance

Operational controls for consent, scoped disclosure, patient rights, residency, benchmarking, and breach readiness.

Data residency compliant

Admission consent

100%

In-scope cohort

External disclosure consent

98.7%

Pending review: 3

48-hour call opt-in

96.4%

Preferred channel captured

Correction requests

4

Oldest age: 12 days

Consent and rights queue

Record	State	Due
External disclosure · MRN 004821	Pending signature	Before community send
Patient correction request · MRN 003774	In progress	03 Jul 2025
Benchmarking written consent	Recorded	Reference bank cohort

Control status

Cloud Run / Cloud SQL: Greece region

Out-of-scope pediatric and psychiatric records: excluded

Analytics PHI scrubbing: enabled

Breach notification drill: ready · last tested 28 May

Clerk session · privileged action

Verify your identity

A step-up verification is required before chart closure, pharmacist verification, physician sign-off, delegation, or secure printing.

DS

Session active

Confirm pharmacist verification

You are about to verify Furosemide 40 mg twice daily for Patient A. This action creates an immutable audit event and may release medication content downstream.

Signed-in identityAttending Physician · Clinical pharmacist

Directory authorityHarborview General Hospital General Hospital · role verified

One-time verification code

Reason for step-up

Clerk session TTL: 18 minutes · MFA challenge bound to this browser and action context.

Discharge workflow inbox

Greek national discharge summary

National template sections

Admission course

Procedures and interventions

Pending results

Discharge medication changes

Source provenance

Agent handover state

Medication reconciliation review

Medication list comparison

Blocking reconciliation item

Audit and downstream effect

Pharmacist reconciliation queue

Verify medication decision

Provenance review

Clinical context

Verification decision

Follow-up scheduling

Eligible follow-up plan

Review Greek instructions

After-visit instructions

Teach-back prompts

After-visit summary

Print release blocked

Preview · Patient A

Medication changes

Follow-up

Pending results

Greek instructions

Print controls

48-hour call list

Rounds risk alerts

Patient A · discharge today

Patient H · discharge in 6h

Handover timeline

Background jobs

Physician sign-off decision

Decision checklist

Release gate

Cannot release yet

Discharge checklist

Discharge readiness

Community physician inbox

Access cannot be granted

Scope restriction, not a technical failure

Pilot governance dashboard

Baseline vs pilot performance

Readmission and operations

Actionable exceptions

Investigation: delayed community delivery

Evidence chain

Accountability and next action

Role and delegation administration

Active role mappings

Governed delegations

Recent access decisions

Privacy, consent & data governance

Consent and rights queue

Control status

Verify your identity

Confirm pharmacist verification

Discharge Workflow Inbox