EpicPRODUCTION · NEPHROLOGY AMBULATORY
Westlake Medical Center · Clinician 1
Nephrology AmbulatoryWestlake Medical Center
Signed in: CLINICIAN1
Demo Patient 1 58 F · DOB 05/14/1968 · MRN 0048219 Priority 1 · renal decline + fluid signal
Epic patient activity

Chart Review

EpicResults Review
Basic metabolic panelJul 17 · 6:31 AMFinal
InflaHormony GENiousTM (IH-GENiousTM) SummaryPatient chart + home evidence
AI-assisted · clinician reviewsIH-GENiousTM assessed E5 at 9:19 AM
Possible fluid accumulation with worsening kidney functionWeight +4.2 lb in 72 hours · home BP 166/94 · eGFR 26 → 22
Risk-adjustment documentation review2 HCC documentation gaps require clinician reviewProgram context, prior-year history, model mapping, and evidence are available in Notes.
Epic patient activity

Episode

EpicActive Episodes
CKD care managementJul 6–Aug 5Active
InflaHormony Signals (IH-Signals)Labs + wearables + check-ins
Embedded in Episode6 received · 2 missing · updated 9:18 AM

IH-Signals Timeline

Urine ACR resulted at 420 mg/g

Final laboratory result is in the A3 albuminuria range and is awaiting clinician review.

Epic laboratory · E5
Patient reported ankle swelling

Linked to E4. Weight and BP signals elevated during the same 72-hour window.

Patient check-in
Menstrual health update received

Period reported today with heavier-than-usual flow. Patient-reported context only; not an independent kidney-risk or diagnosis signal.

Optional patient check-in · E6
eGFR declined to 22

Down from 26 at the last nephrology visit. Potassium increased to 5.3.

Epic laboratory · E1
Medication dose changed

Diuretic adjustment documented; home medication confirmation remains incomplete.

Epic medication order
Home monitoring connected

Scale, BP cuff, and symptom check-in began sending patient-authorized signals.

Connected devices + patient app
Epic patient activity

Notes

EpicRecent Notes
Nephrology progress noteJun 28 · Clinician 1Signed
InflaHormony GENiousTM (IH-GENiousTM) InsightsEvidence-grounded documentation
Embedded in Notes5 evidence sources linkedLatest assessment · clinician review required
2026 documentation period

HCC recapture and specificity review

0 of 2 addressed
Program contextSynthetic MA risk contractModel reference2024 CMS-HCC (V28) · 2026 policySource checkOutpatient nephrology encounter · eligibility requires validation
Confirmed this yearPrior-year capture comparison
2024202520262 / 22 / 20 / 2
2024✓ Completed2025✓ Completed20260 of 2 · Pending
Confirmed documentation count, not a RAF or payment forecast.
2025 captured historyAccepted source and model still require program validation
N18.4CKD stage 4 · May 14 nephrology noteV28 HCC 327
E11.22Type 2 diabetes with diabetic CKD · May 14 noteV28 HCC 37
I12.9 + N18.4Hypertensive CKD, stage 4 · May 14 noteClinical context
HCC-mapped diagnosis candidatesNever auto-added
Annual recapture gapN18.4 · CKD stage 4Last supported May 14, 2025 · eGFR 22 [E1] + urine ACR 420 [E5] · V28 HCC 327MEAT-style support: Monitor + Evaluate available; assessment and plan remain clinician controlled.
Needs review
Specificity and relationship gapE11.22 · Type 2 diabetes with diabetic CKDLast supported May 14, 2025 · historical T2D + CKD · V28 HCC 37CGM 54% time in range [W1] is monitoring context only; it cannot establish the diabetic CKD relationship.
Relationship review required

Guardrail: The configured program, model, collection period, provider type, encounter source, documentation, and final code all require validation. MEAT is a support heuristic, not an automatic compliance determination.

Changed from the latest patient signals

Periodic ICD-10-CM update review

2 decisions pending
New after E5
R80.9 · Proteinuria, unspecifiedUrine ACR 420 mg/g [E5] may support a documentation query only after the clinician assigns clinical significance.
Signal review
R60.0 · Localized edemaPatient-reported ankle swelling [E4] is the candidate source; connected weight change [E2] is supporting context, not diagnostic proof.
No change
N18.4 and E11.22 mappings remain stableNew evidence updated the analysis but did not automatically replace the existing CKD or diabetic CKD candidates.
Current

Coding boundary: R80.9 and R60.0 are diagnosis candidates, not payment HCCs or submitted billing codes. Review opens the Epic diagnosis workflow; nothing is added without physician assessment and attestation.

IH-GENiousTM-assisted nephrology noteEvidence-grounded draft · clinician can edit or add notes before filing
Plain-text Epic note write-back is simulated in this wireframe.
Epic patient activity

Treatments

EpicOrders and Medications
7 active medications · 2 open ordersReconciled Jul 10Current
InflaHormony GENiousTM ActionsEvidence-supported suggested actions
Embedded in TreatmentsClinician decides every action
Clinical follow-up queue

Review four suggested actions

0 of 4 reviewed

Recent action history

Diuretic dose change recordedClinician 1 · Epic medication orderCompleted
Home BP and scale connectedNephrology RN pool · device enrollmentCompleted
Epic patient activity

Wrap-Up

EpicEncounter Wrap-Up
Follow-up and patient instructions2 Epic items openIn progress
InflaHormony Continuous CareClinical handoff + patient plan + rewards + operations
Embedded in Wrap-UpPatient plan + rewards + operations
Close the visit without another workspace

Continuous kidney care wrap-up

3 items need review

Clinical handoff

  • Evidence assembled5 sources linked · latest assessment
  • Patient outreach dispositionAssign or defer before closing
  • Repeat laboratory dispositionPend or defer before closing
  • Latest IH-GENiousTM assessment reviewedLatest assessment requires clinician review
Documentation and diagnosis review2 annual HCC reviews pending · 2 diagnosis decisions pendingVisible at close, but it does not override clinical readiness.

Patient plan

Today
Care-team call about swelling and medications
Next measurement
Weight and BP tomorrow morning
Next check-in
Symptoms and meal check-in tonight
Follow-up
Nephrology appointment · Jul 24

Patient Rewards (IH-Rewards)

Engagement, adherence, and verified points
Engagement8230-day
Adherence76assigned plan
Points2,450verified

Eligible next: Complete 7 days of BP and weight readings · +350 points

Physicians do not approve cash or settle rewards. Sponsor rules verify activities outside this chart workflow.

Operational capture

Workflow evidence for billing and value measurement
Active review time
4m 18s
Actions completed
0
Latest IH-GENiousTM assessment
Latest · not filed
Annual HCC review
2 conditions need review
Non-HCC diagnosis decisions
2 decisions pending
Medication review
Not actioned
Billing candidate
Not added

InflaHormony records supporting workflow events; hospital billing staff validate codes, model-year mappings, and claims. HCC status does not directly determine the KCC quarterly capitation payment.

Epic Lab Order

Pend laboratory order

PatientDemo Patient 1
EncounterNephrology · Today
Ordering clinicianClinician 1
SourceInflaHormony suggestion
Evidence carried into Epic Lab OrdereGFR 22, potassium 5.3, weight +4.2 lb, and elevated home BP remain available for review.

Unsigned order: InflaHormony prefilled the draft from cited evidence. The clinician must verify the order, priority, diagnosis, and routing before signing in Epic.
Evidence provenance

Source details

Identifiers stay in the hospital-controlled environment. This wireframe shows synthetic evidence assembled for the selected patient context.

E1
FHIR Observation · final · Epic sandbox · mapped 8:33 AM
E2
Scale reading · device timestamp 7:58 AM · 7/7 expected readings
E3
BP cuff · two readings · device timestamp 8:04 AM
E4
Patient-reported symptom · submitted 8:12 AM
E5
FHIR DiagnosticReport + Observation · urine ACR 420 mg/g · final · resulted 9:18 AM
HORMONY Rewards

How scores and points work

Engagement score82 / 100

Participation in assigned, accessible activities over the last 30 days.

Requested check-ins
30%
Connected-signal freshness
25%
Care-task responses
20%
Education and appointments
15%
Care-team message response
10%
Adherence score76 / 100

Completion of the care plan the patient and care team agreed to.

Medication-plan confirmation
35%
Labs and appointments
25%
Prescribed measurements
25%
Nutrition and fluid plan
15%
Reward points2,450

Points come from verified actions, never from achieving a clinical result.

Laboratory visit completed
+500
7 days BP and weight
+350
Nutrition lesson completed
+200
5 meal check-ins
+100

Fairness rule: Activities that were not assigned, accessible, or available are excluded from the denominator. Missing device access is not scored as failure.
Clinician-controlled risk documentation

Review condition

ICD-10-CM candidateN18.4 · CKD stage 4
2026 MA · V28 HCC 327

Why this needs review

    Supported documentation elementsMEAT-style evidence builder
    Only completed facts are added
    M · MonitorE · EvaluateA · AddressT · Treat

    Clinician attestation: Confirm only when the condition was assessed during this encounter. Wellness data may prompt review but cannot independently establish a diagnosis or causal relationship. MEAT-style support is an internal review aid, not a substitute for official coding and program rules.
    Epic Diagnosis Association

    Review diagnosis candidate

    New evidence candidateR80.9 · Proteinuria, unspecified
    Encounter diagnosis

    Evidence available for clinician review

      Boundary: IH-GENiousTM provides evidence and a candidate code. It does not establish the diagnosis, alter the signed note, or submit a claim. Adding a diagnosis reopens note review for alignment.