SPOC-CO
Synthetic data prototype — no PHI. Numbers, names, and IDs are fabricated for design review only.

Patient 360

Longitudinal Episode View

Search a synthetic patient or episode to inspect discharge → TCM → PCM → billing → outcomes end-to-end.

WK

William Kim

PT-000010 · USC-900010 · EPI-2026-0010

DischargedMedium riskMedicareStones
Generalist Hospital-InitiatedGeneralist Acute CareEHR Diagnosis SignalAI 78%Syncope / Arrhythmia PathwayTriggeredTCMRPMIPCSpecialist Referral

NBA: Ship RPM device + activate transmissions

Reason codes: PRIOR_READMIT_30D, ABNORMAL_LABS, PAYER_TCM_ELIGIBLE, POLYPHARMACY

Outreach

0

PCM Min.

0

Paid $

$0

Age / Sex

48 · M

ZIP

90073

Language

English

Payer

Medicare FFS

Procedure

Ureteroscopy

Surgeon

Dr. Janet Okafor

Surgery Site

Keck Hospital of USC

Surgery Date

Jan 31, 2026

Discharge

Jan 31, 2026

LOS

0d

Status

Discharged

Consent

On file

Episode Timeline

15 events

Surgery · Ureteroscopy

2026-01-31

Dr. Janet Okafor

Discharge · LOS 0d

2026-01-31

Program Assignment · RPM · Eligible

2026-01-31 00:00

Accepted (assigned by STF-004)

Program Assignment · IPC · Eligible

2026-01-31 00:00

Accepted (assigned by STF-008)

Order Set · Syncope Monitoring Bundle · Activated

2026-01-31 00:00

3 orders · review complete

Intake Trigger · EHR Diagnosis Signal · USC EHR Problem List Watcher

2026-01-31 12:15

Routed at 2026-01-31 00:00

AI Detection · AI score 78%

2026-01-31 12:15

PRIOR_READMIT_30D, ABNORMAL_LABS, PAYER_TCM_ELIGIBLE, POLYPHARMACY

Program Assignment · TCM · Eligible

2026-02-01 00:00

Accepted (assigned by AI Engine)

Program Assignment · Specialist Referral · Eligible

2026-02-02 00:00

Accepted (assigned by STF-009)

RPM Enrollment · BP cuff · CPT 99453/99454/99457/99470

2026-02-04

14/30 transmission days

RPM Alert · 1 alert(s) in last 30d

2026-02-04

BP cuff

Steerage · Pharmacy → External

2026-02-07

Community Health LA (External)

Exception · TCM Overdue · High · Open

2026-02-08 17:00

Felix Stone

TCM Encounter · Telehealth · CPT 99495

2026-02-09

Note sent to USC

IPC Consult · Endocrinology · CPT 99445

2026-02-11 00:00

Report complete

Outreach Attempts

No outreach logged

TCM Encounters

IDEncounterTypeCPTDoc CompleteNote → USCStaff
TCM-00342026-02-09Telehealth99495YesYesNaomi Reyes

Actionable Chat

Synthetic
I can answer questions about this patient's EPIC workflow, intake trigger, pathway, programs, order set, tasks, and billing evidence. Try one of the suggested prompts below.

Next Best Actions

Rule-based recommendations derived from the patient's current state.

  • Resolve exception: TCM Overdue

    Critical

    Open 54d, assigned to Felix Stone

    Owner: RN

  • Initiate TCM outreach

    High

    63d post-discharge, no outreach attempts logged

    Owner: RN

  • Offer PCM enrollment

    Medium

    TCM completed; patient not yet enrolled in PCM

    Owner: NP

  • Activate RPM device

    Medium

    BP cuff transmitting only 14/30 days — confirm setup

    Owner: RN

  • Resolve RPM alert(s)

    High

    1 unresolved BP cuff alert(s) in last 30d

    Owner: RN

  • Backfill PCM Monthly Activity RWE

    Low

    PCM Monthly Activity only 30% complete

    Owner: Ops Coordinator

Open Exceptions

  • TCM Overdue

    54d open · Open

    High