// clinical note operations

One note in.
Four portals out.
Watched live.

Synthure de identifies a clinical note on your device, codes it against the official ICD 10 CM index, writes four role specific portals, and audits every line. The whole backend runs in front of you in the ops console.

synthure backendPOST /api/synthesize streaming
de identification142ms
biomedical ner318ms
code linkingE11.9
readiness0.86
constitution auditpass
write patient
98,186
ICD 10 CM codes, never generated
13
pipeline stages, streamed live
4
portals from one shared encounter
41%
trained coder acc@1 on CodiEsp
// under the hood

The actual backend, end to end.

On device models, an edge pipeline of Claude agents, an optional trained coder service, per run guardrails and an audit chain, and a CI gate on every change. No black boxes.

In your browser
On device extraction
  • openmed pii clinicale5 33m · de identification
  • openmed disease + pharma tinymed 65m · NER

The raw note never leaves the device. Only de identified text is sent on.

Edge function
/api/synthesize
  • constrained ICD linking · reranker over the official index
  • four portal writers · claude haiku 4.5
  • verifier, constitution critic, orchestrator · claude sonnet 4.6

Streamed back to the browser as server sent events, stage by stage.

Model service
Trained coder
  • bi encoder retriever + cross encoder reranker
  • cross encoder faithfulness scorer

A Hugging Face Space. When it is not wired in, the lexical linker runs instead.

Every run
Guardrails + audit
  • 12 deterministic checks across 6 layers
  • SHA 256 audit chain, replay verifiable
  • selective prediction · abstains below 0.60 confidence

The output is gated and sealed before it reaches a portal.

On every PR
Eval gate
  • provenance gate · no number without a backing record
  • regression gate · no metric below its committed floor
  • guardrail and harness red team graders

CI blocks a merge that would regress the evals.

// four portals, one encounter

The same coded record, rewritten for each reader.

An action in one portal ripples through the others. Approve a prior authorization in the clinic and it clears the claim, advances reimbursement, and flips the patient view to covered.

Patient
Patient Advocate

Plain language explanation, costs, and next steps.

Physician
Care Navigator

Coding, prior authorization, and clinical workflow support.

Hospital
Revenue Cycle

Claim routing, prior authorization, and reimbursement.

Employer
Benefits Analyst

Population health, cost exposure, and compliance.

// guardrails, not vibes

Codes cannot be invented

Every code is retrieved from the official ICD 10 CM index and revalidated against the CMS tabular before it appears.

Writers are audited

A verifier and a constitution critic check every report against the extracted facts, and a revise pass removes violations.

It abstains when unsure

Below a confidence threshold the pipeline escalates to a human coder instead of auto routing.

Run a note through it.

No account. Paste any clinical note and watch the backend execute, stage by stage, in the ops console.

Launch the ops console