Cross-Persona End-to-End Flow

Mr. K's wife recommends the practice. He opens the public-facing Patient Portal on his phone, browses the provider directory, reads Dr. M's bio and patient reviews, and decides this is the right practice for his concern.

Mr. K creates a portal account and clicks "Book Appointment." The Scheduling module's resource-graph solver shows him real-time slot availability for Dr. M. He selects a 15-minute new-patient slot on Thursday at 10:15 AM. Demographics and insurance are collected on the booking form; Jordan's front-desk queue auto-populates the new-patient intake task. A copay estimate appears at confirmation.

The Eligibility module's three-gate verification fires: the X12 270/271 transaction runs automatically at scheduling. Coverage status, copay, deductible, and remaining OOP max are parsed and made visible to Jordan at the front desk. If prior authorization is required for the visit type or anticipated procedure, the ePA request is created and routed to Priya's queue for follow-up. A T-24h batch re-verification is queued automatically.

An SMS reminder fires 48 hours before the appointment, and a second one 2 hours before. Both include a deep link to the Patient Portal where Mr. K completes intake forms on his phone — demographics, medical history, current medications, and the chief complaint. On the practice side, Tasha (MA) sees a pre-visit prep task in her Task Management queue: review incoming intake data, flag any missing items, and prepare screening questionnaires.

Mr. K arrives at the front desk. Jordan verifies his identity and scans his insurance card — OCR parses the card image into payer ID and member ID, auto-populating the Coverage record. A real-time eligibility re-verification fires (the T-0h gate): coverage confirmed, copay calculated at $30. Jordan collects the copay via the integrated payment terminal. The Scheduling module marks the patient as "Checked In" and Tasha (MA) receives a rooming task.

Tasha rooms Mr. K on a single screen: she captures vitals (BP, HR, temp, SpO₂, weight), administers screening questionnaires (PHQ-2, fall risk, tobacco use), reviews immunization status, and documents device integration readings (glucometer, home BP cuff). All data flows directly into the Clinical Documentation encounter record. Her Task Management rooming task auto-completes when all required fields are captured and the patient is marked "Ready for Provider."

Dr. M opens the encounter. The pre-visit briefing surfaces three bullets: pending labs, open tasks, and the last-visit assessment/plan. She activates the structure-first ambient scribe — with Mr. K's explicit consent — and conducts the visit naturally. AI is imperfect, so the encounter is a versioned form: the scribe captures the conversation, diarizes speakers, and fills the form's bounded SOAP/APSO fields in real time. Each statement is audit-linked to the audio transcript timestamp, and the form template itself learns from this visit for the next one. As the note takes shape, the Coding / CDS module surfaces inline CPT, ICD-10-CM, and E/M level suggestions with evidence pointers. CDS Hooks 2.0 cards fire on order-entry events — drug-drug interaction checks, formulary alternatives via RTPB, and duplicate-order alerts. Dr. M reviews, accepts or overrides each suggestion with one click, and signs the note.

Dr. M sends prescriptions via the eRx / EPCS module: a NewRx transmission goes to Mr. K's preferred pharmacy through Surescripts, and RTPB confirms the medication is Tier 1 with a $5 copay. If a referral is needed, the Referrals module bundles relevant USCDI data — problem list, medications, recent labs — into a Direct Trust or FHIR ServiceRequest package and tracks it to closure. Lab requisitions are generated from the order set and routed to the lab interface. Every outbound action spawns a follow-up Task Management item so nothing is lost.

Within 30 minutes of encounter close, a plain-language After-Visit Summary is auto-generated and delivered to Mr. K's Patient Portal and email. The AVS includes diagnoses explained in lay terms, medication instructions, follow-up timeline, and contact instructions for worsening symptoms. On the practice side, Elena receives a follow-up task in her Task Management queue: callback in 48 hours if lab results are pending, or proactive outreach when results arrive.

The encounter's charge capture auto-populates from the coding module — CPT, ICD-10, and modifiers are already staged. Priya reviews the AI claim scrub: 2,000+ edit rules (NPI validity, modifier conflicts, place-of-service consistency, diagnosis specificity, NCCI bundling) run pre-submission. Clean claims are auto-submitted as X12 837P. Flagged claims route to Priya's denial-triage queue with AI-drafted appeal templates. A patient statement is generated showing the $30 copay collected, insurance payment, and any remaining balance — with an itemized explanation Mr. K can understand.

Lab results arrive as ORU/OML messages and auto-route to Elena's result-review queue in Task Management. She reviews the results, annotates abnormal values, and routes to Dr. M for co-signature if clinically indicated. Mr. K is notified via his Patient Portal that results are available with a plain-language interpretation. If a callback is needed, Elena documents the conversation in Clinical Documentation and updates the follow-up task status.

The X12 835 ERA (Electronic Remittance Advice) arrives from the payer. RCM auto-posts the payment to Mr. K's account with variance tracking against the billed amount. The payment is reconciled: insurance paid $148 allowed on the E/M, the $30 copay was collected at check-in, and the balance is zero. The Payer Optimization module benchmarks the reimbursement against the contracted rate — no underpayment detected. The clean-claim rate metric updates across the practice dashboard. The visit lifecycle is complete: from discovery to payment reconciliation, every handoff was explicit, every data point flowed forward, and nothing was re-keyed.