Patient 360
Longitudinal Episode View
Search a synthetic patient or episode to inspect discharge → TCM → PCM → billing → outcomes end-to-end.
Kira Lambright
PT-000061 · USC-900110 · EPI-2026-0061
NBA: Resolve documents/intake blocker before outreach
Reason codes: CARDIO_RISK, DOCS_INCOMPLETE, RPM_CANDIDATE
Outreach
3
PCM Min.
41
Paid $
$73
Age / Sex
76 · F
ZIP
90034
Language
English
Payer
Medicare FFS
Procedure
Robotic Prostatectomy
Surgeon
Dr. Eliot Kashani
Surgery Site
USC Urology Beverly Hills
Surgery Date
Jan 23, 2026
Discharge
Jan 23, 2026
LOS
0d
Status
Referral Blocked
Consent
On file
Episode Timeline
57 eventsSurgery · Robotic Prostatectomy
2026-01-23Dr. Eliot Kashani
Discharge · LOS 0d
2026-01-23Intake Trigger · Specialty Referral · Community PCP
2026-01-23 17:15Not yet routed
Program Assignment · Specialist Referral · Eligible
2026-01-23 17:15Not accepted (Pass payer check)
Referral Received · Cardiology · Syncope evaluation
2026-01-23 17:15External System · Eastside Internal Medicine
Intake Created · Intake REF-0011
2026-01-23 17:15Urgency: Routine
PCM Offered · Pre-visit PCM offered
2026-01-23 17:15Order Set Generated · Pre-Specialty Cardiology Bundle
2026-01-23 17:15Workup Ordered · Records request
2026-01-24Records
Exception · Pre-Visit Readiness Blocked · Low · In Progress
2026-01-24 10:15Jamal Carter
Exception Opened · Pre-Visit Readiness Blocked
2026-01-24 10:15Low · In Progress
Outreach · Attempt 1 · TCM Accepted
2026-01-24 13:15Sofia Diaz
Outreach Started · First contact attempt
2026-01-24 15:151d from referral
Program Assignment · RPM · Eligible
2026-01-24 17:15Accepted (assigned by AI Engine)
Order Set · Pre-Specialty Cardiology Bundle · Cancelled
2026-01-24 17:154 orders
Program Assignment · PCM · Eligible
2026-01-25 17:15Not accepted (Pass payer check)
Workup Ordered · 12-lead EKG
2026-01-26EKG
Workup Scheduled · 12-lead EKG
2026-01-27Workup Ordered · BMP
2026-01-27Lab
Workup Ordered · Lipid panel
2026-01-28Lab
Workup Scheduled · Lipid panel
2026-01-29RPM Enrollment · BP cuff · CPT 99453/99454/99457
2026-01-3021/30 transmission days
Workup Scheduled · BMP
2026-02-01Steerage · Procedure → USC
2026-02-03USC Urology Beverly Hills
Steerage · Lab → External
2026-02-03Pacific Imaging (External)
Workup Completed · 12-lead EKG
2026-02-03Final
Workup Completed · Lipid panel
2026-02-03Final
Downstream USC Service · Procedure
2026-02-03Program Assignment · Specialist Referral · Eligible
2026-02-03 16:15Accepted (assigned by AI Engine)
Program Assignment · IPC · Eligible
2026-02-03 16:15Not accepted (Pass payer check)
Program Assignment · PCM · Ineligible - Coverage
2026-02-05 16:15Not accepted (Fail payer check)
Steerage · Lab → USC
2026-02-06USC Norris Cancer Hospital
Workup Completed · BMP
2026-02-06Final
Downstream USC Service · Lab
2026-02-06Readiness Updated · Score 29% · Blocked
2026-02-07 17:151 pending workups; Outside records; PCM enrolment; RPM device activation
Outreach · Attempt 1 · TCM Accepted
2026-02-08 11:00Felix Stone
IPC Consult · Oncology · CPT 99445
2026-02-13 16:15Report complete
Workflow Task · Referral navigation: Oncology · Done
2026-02-27 16:15Intake · RN
Program Assignment · PCM · Eligible
2026-03-18 13:45Accepted (assigned by STF-002)
Program Assignment · Specialist Referral · Eligible
2026-03-18 13:45Accepted (assigned by AI Engine)
Order Set · Pre-Specialty Urology Bundle · Activated
2026-03-19 13:454 orders
Workup Ordered · Renal ultrasound
2026-03-23Imaging
Workup Ordered · Records request
2026-03-23Records
Outreach · Attempt 1 · TCM Accepted
2026-03-23 11:15Liam Chen
Workup Scheduled · Renal ultrasound
2026-03-24Workup Ordered · UA
2026-03-25Lab
Workup Ordered · PSA
2026-03-26Lab
PCM Enrollment · Enrolled · consent signed
2026-03-27Workup Scheduled · PSA
2026-03-27Steerage · Lab → External
2026-03-29Pacific Imaging (External)
Workup Completed · PSA
2026-03-29Final
Steerage · Imaging → External
2026-03-30Pacific Imaging (External)
Workup Completed · Renal ultrasound
2026-03-30Final
PCM Activity · Specialist Coordination · 17m
2026-04-03 14:00Naomi Reyes
PCM Activity · Specialist Coordination · 15m
2026-04-04 14:00Naomi Reyes
PCM Activity · Specialist Coordination · 9m
2026-04-05 12:00Naomi Reyes
Billing · PCM Monthly · CPT 99426 · Paid
2026-04-15$73 / $73
Outreach Attempts
| ID | Attempt | Datetime | Outcome | Staff | Min |
|---|---|---|---|---|---|
| OUT-0141 | #1 | 2026-01-24 13:15 | TCM Accepted | Sofia Diaz | 6 |
| OUT-0178 | #1 | 2026-02-08 11:00 | TCM Accepted | Felix Stone | 12 |
| OUT-0218 | #1 | 2026-03-23 11:15 | TCM Accepted | Liam Chen | 11 |
TCM Encounters
No TCM encounter yet
Actionable Chat
SyntheticNext Best Actions
Rule-based recommendations derived from the patient's current state.
Schedule TCM encounter
HighPatient accepted 71d ago, encounter not yet completed
Owner: NP
Review exception: Pre-Visit Readiness Blocked
LowLow severity · 70d open
Owner: RN
Route intake trigger
HighSpecialty Referral from Community PCP not yet routed
Owner: Ops Coordinator
Resolve eligibility for PCM
HighIneligible - Coverage (payer check Fail)
Owner: Ops Coordinator
Backfill Pre-Visit Workup RWE
LowPre-Visit Workup only 33% complete
Owner: Ops Coordinator
Request missing referral documents
HighReferring office has not sent required clinical documents
Owner: Ops Coordinator
Obtain PCM consent
MediumPatient is PCM-eligible but consent has not been captured
Owner: RN
Schedule records: Records request
MediumWorkup ordered but not yet scheduled
Owner: MA
Schedule lab: UA
MediumWorkup ordered but not yet scheduled
Owner: MA
Schedule records: Records request
MediumWorkup ordered but not yet scheduled
Owner: MA
Resolve low readiness items
HighReadiness score 29% — 1 pending workups; Outside records; PCM enrolment; RPM device activation
Owner: RN
Mitigate leakage risk
HighReferral flagged as at-risk for leaving the USC network
Owner: Ops Coordinator
Open Exceptions
- Low
Pre-Visit Readiness Blocked
70d open · In Progress