{"schema_version":1,"research_id":"eoa_inverse_innovation_exp03_external48_20260801","source_assessment_id":"eoa_inverse_innovation_exp03_opportunity320_20260801","cell_id":"layer_decay_and_expiration_management__veterinary_medicine","selection_stratum":"MIDDLE_BAND_AUDIT_Q1","search_queries":["site:help.ezyvet.com problem list active inactive patient clinical record","veterinary practice software \"problem list\" \"inactive\"","veterinary medical record software \"active problems\"","veterinary electronic patient records data quality completeness duplicate diagnoses study","veterinary clinical records documentation errors study electronic medical record quality","site:aaha.org veterinary medical records continuity care record keeping guidelines electronic","site:avma.org veterinary medical records retention electronic records audit trail","site:gov veterinary medical records retention veterinarian audit trail electronic records","site:hl7.org/fhir Condition clinicalStatus verificationStatus entered-in-error official","site:hl7.org/fhir MedicationRequest status stopped completed entered-in-error official","site:hl7.org/fhir DocumentReference status superseded entered-in-error official","automated stale problem list cleanup algorithm EHR inactive problems clinician review","EHR problem list cleanup stale diagnoses algorithm adjudication study"],"sources":[{"source_id":"S1","title":"Episode Problems and SOAPs in 5.0","publisher":"VetView","url":"https://vetview.atlassian.net/wiki/spaces/UG/pages/4093935617","source_class":"OFFICIAL_PRODUCT_DOCUMENTATION","publication_date":"","accessed_at":"2026-08-02","claims_supported":["VetView has a veterinary Master Problem List with active, inactive, resolved, and deleted states.","Inactive and resolved problems can be returned to active status.","Duplicate problems can be merged while prior history remains viewable.","The system records problem source and tracks users and timestamps for SOAP creation, saving, and verification."]},{"source_id":"S2","title":"IDEXX Cornerstone Electronic Medical Record and Whiteboard Setup 8.3","publisher":"IDEXX Laboratories","url":"https://software.idexx.com/sites/default/files/software-downloads/cornerstone-coach-electronic-medical-record-and-whiteboard-setup-83_0.pdf","source_class":"OFFICIAL_PRODUCT_DOCUMENTATION","publication_date":"2013","accessed_at":"2026-08-02","claims_supported":["Cornerstone supports Active, Acute, Chronic, Resolved, and Verified Incorrect problem states in patient records.","Problem and diagnostic-code catalogs have active and inactive statuses.","Documents can be linked to diagnostic codes."]},{"source_id":"S3","title":"Professional Practice Standard: Medical Records","publisher":"College of Veterinarians of Ontario","url":"https://www.cvo.org/standards/medical-records-professional-practice-standard","source_class":"GOVERNMENT_OR_REGULATOR","publication_date":"","accessed_at":"2026-08-02","claims_supported":["Veterinary records should provide an accurate, complete, and up-to-date profile supporting continuity of care.","Updates must preserve earlier content and establish an audit trail identifying author and date/time.","Changes require veterinarian approval, records must remain accessible, and Ontario records are retained for five years after the last entry."]},{"source_id":"S4","title":"Clinical and client records","publisher":"Royal College of Veterinary Surgeons","url":"https://www.rcvs.org.uk/veterinary-professionals/conduct-and-guidance/supporting-guidance/13-clinical-and-client-records","source_class":"OFFICIAL_GUIDANCE","publication_date":"2026-04-24","accessed_at":"2026-08-02","claims_supported":["Clinical records should give a complete and relevant history sufficient for continuity of care.","Amendments should not obscure the original entry and should identify their date and author.","Retention must account for applicable legal, regulatory, and indemnity obligations rather than a universal period."]},{"source_id":"S5","title":"Professional Practice: General Medical Records Requirements","publisher":"New York State Education Department, Office of the Professions","url":"https://www.op.nysed.gov/professions/veterinarian/professional-practice/professional-practice","source_class":"GOVERNMENT_OR_REGULATOR","publication_date":"","accessed_at":"2026-08-02","claims_supported":["Veterinary treatment records must be permanent, accurate, complete, properly filed, retained, accessible, and secure.","Electronic records require authenticated authorship, timestamps, and audit capability tracking access and edits.","New York requires three-year retention in original or legally reproduced form."]},{"source_id":"S6","title":"Development and evaluation of a survey instrument to assess veterinary medical record suitability for multi-center research studies","publisher":"Frontiers in Veterinary Science","url":"https://www.frontiersin.org/journals/veterinary-science/articles/10.3389/fvets.2022.941036/pdf","source_class":"PRIMARY_RESEARCH","publication_date":"2022-08-05","accessed_at":"2026-08-02","claims_supported":["Board-certified reviewers rejected 28% of 218 submitted veterinary records as unsuitable for the study for several reasons, including insufficient clinical information and identity or format problems.","Only 56.4% of the first 218 records passed both qualification and verification by two reviewers.","Record scoring averaged nine minutes in the first study; refined review averaged 11.5 minutes for nonzero-scored records.","Clarified instructions and standardized training improved reviewer agreement, supporting a bounded dual-review protocol."]},{"source_id":"S7","title":"A method for extracting electronic patient record data from practice management software systems used in veterinary practice","publisher":"BMC Veterinary Research","url":"https://pmc.ncbi.nlm.nih.gov/articles/PMC5073902/","source_class":"PRIMARY_RESEARCH","publication_date":"2016-10-21","accessed_at":"2026-08-02","claims_supported":["A veterinary XML extraction method retrieved 21 defined fields with 100% accuracy in a test system and extracted 4,946 records from 1,279 patients in one practice.","The study reported that differences among commercial veterinary practice-management-system database structures make cross-system extraction and linkage difficult."]},{"source_id":"S8","title":"FHIR R5 Condition: Detailed Descriptions","publisher":"HL7 International","url":"https://www.hl7.org/fhir/condition-definitions.html","source_class":"STANDARD","publication_date":"2023-03-26","accessed_at":"2026-08-02","claims_supported":["FHIR Condition defines active, recurrence, relapse, inactive, remission, resolved, and unknown clinical states.","It separately defines verification states including confirmed, refuted, and entered-in-error.","It preserves encounter, recorded-date, participant, and supporting-evidence relationships; the Patient or Group subject model expressly accommodates veterinary or public-health use."]  	}  ],"problem_evidence":{"support":"WEAK","rationale":"Veterinary research establishes that record quality, identity verification, clinical-information sufficiency, reviewer workload, and disagreement can be material, and veterinary software explicitly handles duplicated or no-longer-present problems. However, no opened veterinary study measured the candidate's specific condition: diagnoses, medications, alerts, instructions, results, and attachments remaining ambiguously active after context changes. Human evidence indicates structured, curated problem lists can improve decision accuracy and speed, but it cannot establish veterinary prevalence or effect size. The stated veterinary problem therefore remains plausible but unverified.","source_ids":["S1","S6","S11"]},"stakeholder_evidence":{"support":"MODERATE","rationale":"Regulators explicitly require accurate, current, accessible records that preserve history and support continuity, while two veterinary products already expose problem-state maintenance features. This demonstrates institutional relevance and credible clinical/records stakeholders, but the search found no veterinary purchasing demand, workflow complaint survey, willingness-to-review evidence, or budget commitment for record-wide lifecycle governance.","source_ids":["S1","S2","S3","S4","S5"]},"prior_art":{"proximity":"SUBSTANTIAL_COLLISION","closest_analogues":[{"name":"VetView 5.0 Master Problem List","similarity":"This deployed veterinary system already provides active, inactive, resolved, and deleted states; reactivation; duplicate merging; source display; retained history; and privilege-based SOAP review and verification.","remaining_difference":"The public documentation does not show automated stale-item detection or ranking across medication orders, alerts, instructions, results, and attachments, nor retention/dependency gates, archival tests, restore drills, or governed destructive disposition.","source_ids":["S1"]},{"name":"IDEXX Cornerstone problem and diagnostic-code management","similarity":"Cornerstone already applies multiple clinical problem states, including Resolved and Verified Incorrect, and supports active/inactive catalog status and document-to-diagnosis links.","remaining_difference":"The documented functionality is principally problem and diagnostic-code management, not a record-wide lifecycle service with detector-assisted adjudication, dependency analysis, retention holds, reversible archiving, and restoration validation.","source_ids":["S2"]},{"name":"HL7 FHIR clinical-resource lifecycle and provenance model","similarity":"FHIR already standardizes lifecycle states for conditions, medications, and documents, distinguishes clinical from verification status, models supersession and entered-in-error states, and supplies provenance and audit structures applicable to resources and past versions.","remaining_difference":"FHIR is a general interoperability model, not evidence of a veterinary implementation that detects stale active layers, routes them through veterinarian adjudication and local retention/dependency gates, and measures benefit against ordinary reconciliation.","source_ids":["S8","S9","S10"]}],"distinctive_claim_remaining":"The remaining testable claim is not that lifecycle states, history preservation, problem-list cleanup, or provenance are new. It is that a veterinary implementation applying detector-assisted review across heterogeneous record layers, followed by veterinarian confirmation, dependency and jurisdiction-specific retention gates, reversible disposition, and restoration checks, outperforms ordinary reconciliation without creating unacceptable workload or protected-record errors.","confidence":"HIGH"},"implementation_evidence":{"support":"MODERATE","rationale":"Working veterinary products demonstrate state transitions, history, duplicate merging, provenance-like source display, and review permissions. Primary research demonstrates accurate extraction of thousands of veterinary records from one practice, while FHIR supplies mature status and provenance patterns. These support a manual silent audit and a platform-specific prototype. They do not establish reliable cross-layer dependency discovery, archive/restore behavior, vendor write interfaces, protected-record classification, or safe multi-platform operation.","source_ids":["S1","S2","S7","S8","S9","S10"]},"scores":{"meaningful_impact":{"score":3,"rationale":"Accurate current-state displays plausibly matter for continuity and decision-making. A human crossover trial found better correct-answer performance and faster decisions with curated structured problem lists, but veterinary prevalence and clinical effect are unmeasured and the candidate covers more than problem lists.","source_ids":["S3","S11"]},"stakeholder_pull":{"score":3,"rationale":"Veterinary regulators require current, accurate, auditable records and vendors already offer state-maintenance functions, indicating a real institutional objective. Direct demand for the broader governed system, recurring-review willingness, or procurement interest was not found.","source_ids":["S1","S2","S3","S5"]},"incremental_advantage":{"score":3,"rationale":"The candidate adds detector-assisted review, cross-layer coverage, dependency and retention gates, reversible archiving, and restoration tests beyond the closest veterinary problem-list systems. Whether those additions outperform existing manual lifecycle maintenance enough to justify their workload remains untested.","source_ids":["S1","S2","S8","S9","S10"]},"distinctiveness_plausibility":{"score":2,"rationale":"Most constituent mechanisms already appear in veterinary products or healthcare standards: lifecycle states, merging, retained history, reactivation, provenance, supersession, auditability, and role-limited review. Only the governed veterinary combination and its cross-layer evaluation remain potentially distinctive.","source_ids":["S1","S2","S8","S9","S10"]},"technical_implementability":{"score":3,"rationale":"A non-mutating single-clinic audit is feasible, and both veterinary extraction research and existing products demonstrate important components. Production implementation still depends on platform interfaces, identity quality, semantic dependencies, protected classes, audit integrity, and archive/restore capabilities.","source_ids":["S1","S2","S7","S10"]},"adoption_authority_feasibility":{"score":3,"rationale":"Official requirements place record accuracy, approval, retention, access, and audit responsibility with veterinarians or practices, supporting the proposed authority model. Retention periods and amendment rules differ across jurisdictions, so the actual pilot policy and authorizers must be fixed locally.","source_ids":["S3","S4","S5"]},"evidence_readiness":{"score":4,"rationale":"The proposed silent 200-encounter study is measurable and non-destructive. Prior veterinary research demonstrates dual review, timing measurement, gold-standard specialist review, disagreement analysis, and improvement after standardized reviewer training.","source_ids":["S6"]},"safety_net_benefit":{"score":4,"rationale":"Silent operation, retained originals, independent adjudication, audit logs, role separation, and stop rules align with official requirements to preserve original content and trace edits. These controls strongly limit pilot harm, although they do not prove dependency detection or identity accuracy.","source_ids":["S3","S5","S6"]},"scalability":{"score":2,"rationale":"The mechanism may reuse standard status and provenance concepts, but primary veterinary research documents heterogeneous practice-management-system structures. Local retention rules, vendor interfaces, archive services, and clinician-review capacity would also require adaptation.","source_ids":["S4","S7","S8","S9","S10"]}},"score_confidence":"MODERATE","costs":{"first_evidence":{"band_2026_usd":"10K_TO_50K","scope":"One-clinic, non-mutating review of 200 closed encounters, including authorized extraction, secure workspace and limited software, rule implementation, stratified sampling, dual-veterinarian adjudication, reviewer training, records/compliance coordination, statistical evaluation, and reporting.","confidence":"MODERATE","assumptions":["The clinic can export required fields without paid custom vendor development.","No production record is changed and no destructive-disposition legal review is required.","Review is capped at 200 encounters and a predefined maximum of 300 candidate items.","Veterinary review time is broadly comparable to the bounded record-review effort reported by Praczko et al."],"source_ids":["S6","S7"]},"initial_deployment_startup":{"band_2026_usd":"50K_TO_250K","scope":"One-platform non-destructive prototype with lifecycle taxonomy, provenance mapping, detector rules, identity and dependency checks, jurisdiction-specific retention matrix, role controls, audit logging, secure development equipment, software integration, usability testing, and offline archive/restore validation.","confidence":"LOW","assumptions":["Existing authentication, storage, backup, and audit infrastructure can be reused.","The vendor supplies usable export or test-environment interfaces.","Only recommendations and shadow lifecycle states are created; clinical source records remain unchanged.","One clinic and one governing jurisdiction are in scope."],"source_ids":["S1","S3","S5","S7","S8","S9","S10"]},"operational_launch":{"band_2026_usd":"250K_TO_1M","scope":"Clinician-confirmed launch at one clinic or small homogeneous group, including production integration, validation, access controls, retained-history migration, archive and retrieval infrastructure, compliance and policy approval, training, coordination, monitoring, restore drills, safety evaluation, and vendor support.","confidence":"LOW","assumptions":["No autonomous deletion or treatment-changing action is enabled.","The core record platform supports extensions or sidecar state without replacing the EHR.","Protected-record and dependency rules can be validated for one jurisdiction.","The archive can meet required availability, integrity, and audit expectations."],"source_ids":["S3","S4","S5","S7","S8","S9","S10"]},"annual_recurring":{"band_2026_usd":"50K_TO_250K","scope":"Ongoing veterinarian and records-staff review, exception handling, policy and terminology maintenance, secure software and storage, monitoring, support, audit review, restore drills, equipment replacement allowance, periodic sampling, bias checks, and outcome revalidation for a limited deployment.","confidence":"LOW","assumptions":["Review volume remains manageable without a large dedicated team.","Only one principal platform and a small number of clinics are supported.","No major vendor-interface redevelopment or new jurisdiction is added.","Lifecycle labels are periodically sampled for maintenance failure and alert fatigue."],"source_ids":["S1","S3","S4","S5","S7"]}},"verified_pipeline_gates":{"externally_supported_problem":{"status":"UNCERTAIN","reason":"Veterinary sources confirm broader record-quality problems and the practical need to manage inactive, resolved, duplicated, and erroneous problems, but no opened veterinary study quantified ambiguous stale active layers or associated reconciliation time, disagreement, or clinical errors.","source_ids":["S1","S2","S6"]},"externally_credible_adopter_or_authorizer":{"status":"YES","reason":"Official standards make the veterinarian or practice responsible for accurate, current, retained, secure, and auditable records, and require veterinarian approval or authenticated authorship for changes. Veterinary vendors already expose related controls to clinical users.","source_ids":["S1","S2","S3","S5"]},"distinct_testable_incremental_claim":{"status":"YES","reason":"After accounting for substantial prior art, the bounded remaining claim compares detector-assisted, record-wide, gated lifecycle review with existing problem-list maintenance and ordinary reconciliation on precision, sensitivity, time, interpretation accuracy, workload, and protected-record or dependency failures.","source_ids":["S1","S2","S8","S9","S10"]},"bounded_next_evidence_step":{"status":"YES","reason":"A 200-encounter silent review with capped item volume, blinded dual adjudication, an age-only comparator, ordinary reconciliation, retained originals, and predefined stopping criteria is technically and methodologically bounded. Veterinary research supports dual-review and timed-record-assessment methods.","source_ids":["S6","S7"]},"no_unresolved_safety_or_authority_stop":{"status":"UNCERTAIN","reason":"The retrospective design is low risk, but the pilot jurisdiction, authorized access basis, retention matrix, amendment rules, legal or investigation holds, and permissible archive behavior have not been selected. Official sources demonstrate that these requirements vary and that original content and auditability may be mandatory.","source_ids":["S3","S4","S5"]},"credible_cost_scope_and_range":{"status":"UNCERTAIN","reason":"The bands include labor, data work, compliance, coordination, equipment, software, integration, storage, and evaluation, and primary studies inform review and extraction scope. No opened source supplies vendor interface pricing, local labor rates, review volume, archive costs, or dependency-rule complexity, so production bands remain low-confidence resource-equivalent estimates.","source_ids":["S6","S7"]}},"next_evidence_step":"At one authorized clinic, run a non-mutating retrospective study on 200 closed encounters, capped at 300 adjudicated items. Pre-register the lifecycle definitions and minimum acceptable prevalence, precision, sensitivity, reviewer agreement, and review-time thresholds. Blind two veterinarians to detector output while they independently establish item currentness and dependencies; resolve disagreements under a written protocol. Compare the proposed detector with both an age-only heuristic and ordinary unassisted reconciliation, using a random unflagged sample to estimate missed-currentness errors. Falsify or stop if baseline ambiguous-active prevalence is below the pre-registered decision threshold, the detector does not outperform age-only review on adjudicated precision or review time, sensitivity is inadequate, disagreement exceeds threshold, or any protected or dependent item is repeatedly classified as disposition-eligible. Make no record changes.","blocking_evidence":["Veterinary prevalence and distribution of ambiguously active diagnoses, medication orders, alerts, instructions, results, attachments, and behavior flags in representative records.","Evidence that ambiguity materially affects reconciliation time, clinician agreement, or correct interpretation of current clinical state in veterinary practice.","Detector performance versus both age-only rules and ordinary reconciliation, including precision, sensitivity from randomly sampled unflagged items, workload, and dependency failures.","A pilot-jurisdiction retention and authority matrix covering amendment, access, consent, medication records, investigations, legal holds, destruction, archive retrieval, and restoration.","Platform-specific evidence for identity integrity, provenance, dependency traversal, protected-record handling, audit logging, retrieval latency, and rollback."],"research_disposition":"PROBLEM_PREVALENCE_STUDY","world_novelty_boundary":"This bounded search covered public veterinary product documentation, veterinary record-quality and extraction research, official veterinary recordkeeping requirements, healthcare interoperability standards, and adjacent human problem-list studies. It found substantial collision for lifecycle states, duplicate merging, retained history, reactivation, provenance, supersession, and auditability. It did not inspect patents, private vendor capabilities, unpublished deployments, or every jurisdiction. The only remaining candidate distinction is the specific governed, detector-assisted, record-wide veterinary combination and its comparative performance; that distinction is unproven and is not a world-novelty claim."}