From the hospital door to the next visit
Alicia goes home today. Her three medicine lists already disagree.
Alicia S., 56, is leaving hospital after a COPD flare-up that also hurt her kidneys. The hospital started a third inhaler and a steroid course, held her lisinopril and stopped the naproxen she buys over the counter. Her home list and her pharmacy don't know yet.
Three facts, in three different places
Creatinine …
Kidney injury, eGFR …. A hospital lab,
Hold lisinopril
“HOLD. Do not take until kidney function is rechecked.” The discharge summary
Lisinopril 10 mg
Still on her home list, with naproxen, and on refill. Her home list and pharmacy
Between-Visit compares the three lists, joins her chart to the guidelines and the medicine labels, finds the handful that matter for Alicia, and keeps watch at home until the next visit. Dana, her nurse care manager, makes every decision.
Alicia S., 56
Going home after a COPD flare-up
On her chart
Her medicines at discharge
1 · The clinician's problem
The answers are in the guidelines. Finding Alicia's is a needle in a haystack.
No one can hold hundreds of recommendations against every chart in a short visit. So the few that matter for Alicia sit in plain sight, unread.
26.7 hours a day to follow every guideline for a typical primary care panel.
Porter et al., JGIM 202255% of recommended care is what adults actually receive.
McGlynn et al., NEJM 20031 in 5 have an adverse event within three weeks of going home, most involving a medicine.
Forster et al., Annals of Internal Medicine 2003The guidelines, growing
Every guideline we read, as one network
It starts from the condition most recommendations point at and grows link by link: into each guideline, the studies behind every recommendation, the places guidelines agree, differ or conflict, and the FDA label cautions every plan is checked against. Hover anything to pause and read it.
Reading the graph…
2 · Where Alicia stands today
Before any map: her results, and the few things that are open.
3 · How it connects
Alicia's open problems, each tied to its source
One line per problem: what it is, and the guideline or FDA label behind it. Open one to see the path through the graph and the exact words.
4 · Going home, and the month after
The map doesn't stay in the hospital. Every text, lab and pharmacy fill walks it again.
Alicia's month as the six agents ran it, read from the engine's ledger: the same month as her guided week on Try it. Nobody played Dana here, so the cards wait on her list.
Our promises
- The clinician decides. Nothing reaches a patient without them.
- Every suggestion shows its source: the guideline, the page, the exact words.
- A warning sign gets a safety reply in the same minute.
- It does not diagnose. What it notices, a clinician confirms.