Chart write-back
A decision exists at the payer; the chart does not know. Closing that gap is the bottom of the flow, and every part of it is gated or bounded.
#Three kinds of write
| Write | Gate | Why |
|---|---|---|
ehr_attach_referral | Always a licensed human | Attaching an authorization to an appointment is a clinical record change with billing consequences. |
ehr_write_comment | Conditional | A factual payer-status note may be autonomous if the practice enables it. A clinical assertion never is. |
ehr_create_task | Ungated, rate-limited | A task asks a human to act rather than acting. Bounded at 40/practice/hour against worklist flooding. |
#Consent is separate from permission
A practice enabling the connector has not thereby enabled writes. Every EHR write tool declares requires_write_consent, checked once centrally rather than in each handler.
if statements and two of them dropped the explanation, so the same denial meant different things depending on which tool you hit. Declaring it on the spec means a fourth write tool cannot forget it - the check is a property of the capability, not something a case remembers.#An AI note says so in the chart
Not only in our audit trail - in the record itself, where a clinician reading it six months later will see it.
[Automated - PriorAuth AI] Prior authorization AUTH-500001 approved by BCBSF.#A chart has no undo
An unwanted entry in a legal medical record is removed by amendment, not deletion. So writes are content-addressed and idempotent - the same note twice is written once - and a second, different authorization on one appointment is a conflict rather than last-write-wins.
ehr.attachReferral({ appointmentRef: 'APT-59315', authorizationNumber: 'AUTH-1' });
ehr.attachReferral({ appointmentRef: 'APT-59315', authorizationNumber: 'AUTH-2' });
// EhrError: two different authorizations on one appointment must be resolved by a human.
// The first one stands.#Approved but no number
If a payer approves without returning an authorization number, the write-back stops and hands off. A referral without the number is not a referral, and leaving the chart without one is better than attaching a placeholder somebody later reads as real.