Klinička okosnica

Spine overview

The encounter (ADR 0003)

A clinical encounter is the parent of everything that happens in one visit for one patient. It is deliberately thin: it owns identity, binding and lifecycle, while each capability keeps its own session table. Entry runs in a single transaction under an advisory lock keyed on clinic, clinician and patient, so two devices opening the same visit converge on one encounter instead of creating two.

Governed artifact lifecycle

Every clinically meaningful AI output is stored as a clinical artifact with a kind and a state. Kinds include SOAP notes, Scribe dossiers, perio staging and reports, document extracts and interpretations, Copilot reports, chairside suggestions, imaging findings, memory summaries, completion outputs and clinical documents. Only backend lifecycle services change state; clients request transitions.

ai_draft               → needs_clinician_review | clinician_accepted | clinician_modified | clinician_rejected | superseded
needs_clinician_review → clinician_accepted | clinician_modified | clinician_rejected | superseded
clinician_modified     → clinician_accepted | clinician_modified | clinician_rejected | locked | superseded
clinician_accepted     → locked | clinician_modified | superseded
clinician_rejected     → superseded
locked                 → amended            (correction creates a successor draft)
amended                → superseded
superseded             → (terminal)

• Acceptance, rejection, modification, locking and amendment require an authenticated, authorised actor, and a reason where the lifecycle demands one (ART-03).
• Locked content is immutable. Correction creates a successor and keeps the prior row and its transition history (ART-05).
• An overwrite that changes source content supersedes the previous artifact in the same transaction, so a stale acceptance can never vouch for new content (ART-06).
• Every transition is idempotent or explicitly version-producing, and audit publication never reports success for a write that rolled back (ART-12).

Clinical facts and projections

Facts are the structured, longitudinal record: medications, conditions, allergies, tooth states, periodontal findings. Writers in Scribe, Perio and Document Intelligence emit them; every machine-derived fact is born proposed, and only an audited clinician confirmation makes it part of the confirmed record (ART-07). Corrections use supersession or entered_in_error, never mutation.

Confirmed facts are published on an in-process event bus to a projection worker that maintains the patient timeline, per-tooth state and the patient memory used as Copilot context. A contradiction engine with medication, pregnancy and periodontal rules surfaces conflicts between facts; resolving one changes the owning fact through its audited path, and dismissing it in the UI erases nothing.

• ProductionScribe and Perio fact writers
  Enabled in the production configuration
• ShadowContradiction engine
  Evaluates on real data and records results; does not yet block
• ShadowTimeline dual-read
  New projection read alongside the legacy timeline and compared

Review and finalization

Review composes the artifacts of an encounter into one place where the clinician accepts, edits or rejects them, individually or in a batch, with a cross-encounter queue for anything left open. Finalization is blocked by rules, not by a score: an unresolved required-review artifact, an unconfirmed critical fact, a high-risk contradiction, an ambiguous patient binding or an active persistence failure each prevents it (ART-10).

Provenance and audit

hash_n = SHA-256( canonical(entry_n) ‖ hash_(n−1) )