{"schema_version":1,"assessment_id":"eoa_inverse_innovation_exp03_opportunity320_20260801","source_experiment_id":"eoa_inverse_innovation_exp03_full320_20260801","cell_id":"layer_decay_and_expiration_management__speech_language_pathology","archetype_slug":"layer_decay_and_expiration_management","domain_slug":"speech_language_pathology","title":"Explicit lifecycle states for longitudinal swallowing recommendations","opportunity_summary":"Evaluate whether identity-linked lifecycle states and visibility tiering can reduce selection of stale dysphagia guidance while preserving source records, clinical lineage, recoverability, and authorized review. The safety consequence could be meaningful, but the frequency of consequential conflicts, comparative benefit over a single reconciled-order banner, workflow feasibility, and distinctiveness are unverified.","adopter_authorizer":"A treating speech-language pathology service and responsible medical team would adopt the clinical workflow; health-information-management, compliance, privacy, and EHR governance authorities would authorize record handling, display, and integration changes.","scores":{"meaningful_impact":{"score":4,"rationale":"Following an obsolete diet, liquid-consistency, supervision, or aspiration-precaution recommendation could create clinically important harm, and preserving current guidance and lineage addresses a meaningful objective. The packet does not establish how often such conflicts affect decisions, preventing a 5."},"stakeholder_pull":{"score":3,"rationale":"Patients, caregivers, SLPs, other clinicians, and records staff have plausible interests in clear current guidance and preserved history, but the sealed candidate supplies no observed demand, adoption commitment, complaint volume, or workflow burden measurement."},"incremental_advantage":{"score":3,"rationale":"Cross-artifact identity resolution, explicit supersession states, reversible visibility tiering, audits, and restore drills could outperform manual date comparison. However, the packet explicitly identifies a simpler reconciled current-order banner that may deliver the useful benefit with less complexity, and no comparison has been performed."},"distinctiveness_plausibility":{"score":3,"rationale":"The combination of recommendation lineage, authorized lifecycle adjudication, exception holds, reversible suppression, and dependency checks is structurally specific. Prior implementations and overlap with clinical reconciliation or EHR display systems are unsearched, so historical distinctiveness cannot be credited."},"technical_implementability":{"score":3,"rationale":"A read-only inventory, manual adjudication, and simulated display are feasible in bounded form, but reliable identity-linking across notes, orders, handoffs, and instructions may be difficult and is a stated failure condition. Production integration and dependency detection are unspecified."},"adoption_authority_feasibility":{"score":3,"rationale":"The packet assigns clinical currency to the treating SLP and medical team and record disposition to governance authorities, which makes an authorization path identifiable. Distributed authority, care-transition ownership, patient participation requirements, and retention obligations could still impede operational adoption."},"evidence_readiness":{"score":4,"rationale":"The proposal includes separate problem and intervention falsifiers, a four-week read-only shadow design, blinded expert adjudication, a baseline, a nearest rival, excluded actions, and halt conditions. It lacks supplied sampling details, outcome thresholds, and evidence that representative records are accessible."},"safety_net_benefit":{"score":4,"rationale":"Reversible suppression, preserved source records, conspicuous lineage, dependency checks, audit trails, restore drills, and immediate halt conditions provide proposal-specific safeguards against concealing current guidance. Residual risk remains because incorrect classification or tiering could delay access to safety-critical instructions."},"scalability":{"score":3,"rationale":"Explicit states and lineage rules could be reused across services and recommendation types, but heterogeneous artifacts, local EHR configurations, distributed clinical authority, governance rules, and recurring adjudication work may limit scaling. No multisite or cross-workflow evidence is supplied."}},"score_confidence":"MODERATE","costs":{"first_evidence":{"band_2026_usd":"10K_TO_50K","scope":"One-service, four-week read-only shadow review using closed or clinician-reviewed encounters, including cohort preparation, conflict flagging, blinded expert adjudication, simulated visibility states, baseline and single-banner comparison, privacy review, and analysis.","confidence":"LOW","assumptions":["Existing records can be accessed through an approved retrospective workflow.","The study uses a limited sample and mostly manual review rather than production-grade integration.","Clinical experts can adjudicate within allocated service time.","No live record, patient-facing guidance, or care decision is changed."]},"initial_deployment_startup":{"band_2026_usd":"250K_TO_1M","scope":"Design and build a limited production-capable service implementation covering cross-artifact identity resolution, lifecycle registry, role-based review, lineage links, reversible display tiering, audit logging, dependency checks, and EHR integration.","confidence":"LOW","assumptions":["Deployment is limited to one health system and a small number of dysphagia workflows.","Existing EHR extension and identity infrastructure can be reused.","Source records remain unchanged and no autonomous clinical invalidation is implemented.","Vendor licensing, security review, and interface complexity are not known from the packet."]},"operational_launch":{"band_2026_usd":"250K_TO_1M","scope":"Launch in an initial clinical service, including validation, governance approval, workflow configuration, reviewer training, change management, monitoring, support, restore drills, and comparative safety evaluation.","confidence":"LOW","assumptions":["Launch follows successful shadow and usability evidence.","Clinical and records authorities agree on lifecycle definitions and escalation ownership.","The launch does not include enterprise-wide historical backfill.","Additional remediation is required if live dependencies cannot be detected reliably."]},"annual_recurring":{"band_2026_usd":"50K_TO_250K","scope":"Annual operation for an initial service or limited program, including reviewer labor, exception handling, audits, access controls, software maintenance, model or rule monitoring, training, incident review, and restore testing.","confidence":"LOW","assumptions":["The conflict volume is moderate and does not require a dedicated large review team.","Core EHR hosting and identity services already exist.","Human authorization remains required for currency decisions.","Enterprise-wide expansion, major vendor fees, and extensive manual backfill are excluded."]}},"research_burden":"HIGH","earliest_credible_horizon":"3_TO_12_MONTHS","pipeline_gates":{"recognizable_externally_supportable_problem":{"status":"YES","reason":"The sealed candidate describes an externally recognizable state: conflicting generations of swallowing guidance coexist in active-facing longitudinal artifacts and users must infer authority from dates and document types. The frequency and realized consequences remain unverified, but the problem itself is concrete and falsifiable."},"identifiable_adopter_or_authorizer":{"status":"YES","reason":"Treating SLPs and the responsible medical team are identified as clinical currency authorities, while health-information-management and compliance authorities govern retention and disposition. These parties provide a defined adoption and authorization pathway."},"distinct_testable_incremental_claim":{"status":"YES","reason":"The proposal claims that identity-linked lifecycle states and tiered visibility improve correct selection of current guidance beyond manual comparison and a single current-order banner. Correct-selection rate, missed-current events, and selection time permit a direct comparative test."},"bounded_next_evidence_step":{"status":"YES","reason":"A four-week, one-service, read-only shadow review on closed or already reviewed encounters is specified, with blinded expert adjudication, simulated visibility changes, no alteration of care, and explicit halt conditions."},"no_unresolved_safety_or_authority_stop":{"status":"YES","reason":"For the proposed evidence step, records remain unchanged, pilot flags cannot become patient-facing advice, authorized clinicians retain clinical authority, and simulated states are discarded upon any unsafe demotion, obscured dependency, broken lineage, or unauthorized disclosure. Production safety and governance still require validation but do not stop the bounded shadow study."},"implementation_cost_scope_and_range":{"status":"UNCERTAIN","reason":"The candidate identifies components that would consume resources, but it does not specify record volume, EHR interfaces, vendor constraints, identity-linking performance, reviewer workload, governance effort, or deployment scale. Broad planning bands can be assigned only under substantial assumptions."}},"blocking_evidence":["A representative audit establishing whether materially conflicting active-facing swallowing recommendations occur often enough to warrant intervention.","Evidence that stale artifacts affect clinician or caregiver selection accuracy, decision time, errors, or delays rather than merely coexisting harmlessly.","Accuracy and coverage of identity-linking recommendation generations across notes, orders, handoffs, and patient instructions.","Reliability and inter-reviewer agreement of authorized clinical currency adjudication, including exception-held and historical states.","A controlled comparison showing lifecycle flags and tiered displays improve correct current-guidance selection over both the baseline and the simpler current-order banner without increasing missed-current events.","Usability evidence that lifecycle labels are more understandable than existing record conventions and do not add unacceptable review burden or alert fatigue.","Confirmation that display tiering, lineage storage, access controls, and retention handling comply with applicable local obligations.","Prior-art evidence concerning dysphagia reconciliation, copied-forward text controls, supersession displays, longitudinal recommendation registries, and clinical-record lifecycle governance."],"next_evidence_step":"In one service over four weeks, use a fixed sample of closed or clinician-reviewed encounters for a read-only shadow study. Blinded experts first adjudicate the current swallowing plan and material conflicts. Then compare current-record navigation, a simulated single current-order banner, and the proposed lifecycle-and-tiered display on correct current-guidance selection, missed-current events, and selection time. Falsify the problem if materially conflicting active-facing generations are absent or unrelated to errors or delays; reject the intervention if it does not outperform the baseline and nearest rival or if any simulated demotion targets adjudicated-current guidance, obscures a dependency, or loses recoverable lineage.","research_questions":["How frequently do materially conflicting swallowing recommendations coexist in active-facing records within a representative service sample?","Which artifacts do clinicians and caregivers actually consult, and when does stale guidance alter accuracy, time, or action?","Can recommendation generations be identity-linked across notes, orders, handoffs, and patient instructions with sufficient coverage and precision?","Can authorized reviewers resolve clinical currency consistently, and what cases remain disputed or exception-held?","Does lifecycle management outperform both manual comparison and a single reconciled-order banner on correct selection and missed-current events?","Do users understand current, superseded, exception-held, and historical labels without increased alert fatigue or delayed access to relevant history?","What live dependencies, patient-access pathways, retention obligations, and role-based permissions constrain tiering or suppression?","What existing clinical reconciliation, copied-text, supersession, registry, or records-lifecycle approaches overlap with the proposal?","What reviewer workload and exception volume would determine sustainable operating cost and scale?","Can restore drills reliably recover visibility and lineage after erroneous classification or configuration changes?"],"recommendation":"PRIOR_ART_RESEARCH","uncertainty_constraints":["No external sources were consulted.","Problem prevalence, stakeholder demand, realized impact, effect size, market size, and adoption willingness are unmeasured.","Prior art and historical novelty are unverified.","Cost bands are resource-equivalent planning ranges rather than quotes or point estimates.","Applicable retention, destruction, privacy, patient-access, and authorization requirements are not established.","Technical feasibility depends on cross-artifact identity resolution and dependency detection that have not been demonstrated.","The proposed clinical benefit may be matched by the simpler current-order banner.","The earliest horizon assumes timely access to approved retrospective records and clinical adjudicators."],"closed_book_prior_art_boundary":"Prior art was not searched and remains unverified. This closed-book assessment credits only the proposal's structural specificity and makes no claim of historical novelty, implementation novelty, market differentiation, or absence of overlapping clinical reconciliation and EHR lifecycle systems."}