{"schema_version":1,"research_id":"eoa_inverse_innovation_exp06_external_evaluation_20260803","source_assessment_id":"catalytic_pathway_enablement__sociology_anthropology:P4:v0","cell_id":"catalytic_pathway_enablement__sociology_anthropology","search_queries":["site:hhs.gov HIPAA family friends patient permission involved care official","site:hl7.org/fhir RelatedPerson relationship patient contact official FHIR","chosen family electronic health record relationship fields patient care study","patient social network mapping healthcare ecomap care network mapping intervention study","chosen family healthcare electronic health record documentation study LGBTQ patient supporters","site:jointcommission.org patient-defined family visitation rights hospital chosen family","care maps patient identified social network map healthcare full text study","electronic health record family caregiver identification documentation study","site:cms.gov hospital visitation patient representative support person chosen family conditions participation official","site:ecfr.gov 482.13 support person visitation patient representative","site:ahrq.gov caregiver identification electronic health record family caregiver hospital","caregiver advise record enable act hospital patient identify caregiver official state law","site:bls.gov/ooh software developers quality assurance analysts testers median pay 2025","site:bls.gov/ooh anthropologists archeologists median pay 2025","site:bls.gov/ooh interpreters translators median pay 2025","site:bls.gov/oes healthcare social workers median wage 2025","\"Using Electronic Health Record to Identify Caregivers of People With Dementia in Hospital Settings\"","\"Improving How Caregivers of People Living With Dementia Are Identified\" e59584","\"Exploring the value of social network 'care maps'\" full text"],"sources":[{"source_id":"S1","title":"Using Electronic Health Record to Identify Caregivers of People With Dementia in Hospital Settings","publisher":"Oxford University Press on behalf of the Gerontological Society of America","url":"https://pmc.ncbi.nlm.nih.gov/articles/PMC12760225/","source_class":"PRIMARY_RESEARCH","publication_date":"2025-12-31","accessed_at":"2026-08-03","claims_supported":["In a 10-month hospital trial context, only 111 of 1,698 screened EHR charts identified a caregiver.","Researchers found missing structured fields beyond emergency contacts, missing role and authority details, and inconsistent documentation across hospital units.","The authors proposed structured EHR fields, prompts, alerts, and standardized workflows, creating close prior art for the gateway's core documentation function."]},{"source_id":"S2","title":"Improving How Caregivers of People Living With Dementia Are Identified in the Electronic Health Record: Qualitative Study and Exploratory Chart Review","publisher":"JMIR Publications","url":"https://doi.org/10.2196/59584","source_class":"PRIMARY_RESEARCH","publication_date":"2024-12-13","accessed_at":"2026-08-03","claims_supported":["Chart review found contact tabs usually recorded a name and relationship but did not specify the caregiver's role.","Caregiving arrangements were complex, multiple caregivers were common, and individual contributions were not systematically recorded.","Interviews with 22 caregivers and 16 clinical staff expressed demand for standardized questions, workflows, role or task documentation, a caregiver tab, and easier proxy processes.","The study directly supports an identifiable adopter class: health-system clinical staff, practice managers, and EHR workflow owners."]},{"source_id":"S3","title":"Exploring the value of social network ‘care maps’ in the provision of long-term conditions care","publisher":"SAGE Publications","url":"https://journals.sagepub.com/doi/10.1177/1742395319836463","source_class":"PRIMARY_RESEARCH","publication_date":"2019-03-18","accessed_at":"2026-08-03","claims_supported":["Patient-identified social-network care maps were piloted with 39 patients across general practices and hospital wards.","All 39 interviewed health professionals reported learning about patients in context and gaining understanding of support networks.","Care maps are direct prior art for eliciting and presenting patient-defined care communities, although this study did not establish the proposed role-specific permission and authority gateway or comparative workflow effect."]},{"source_id":"S4","title":"Does HIPAA allow a health care provider to communicate with a patient’s family, friends, or other persons who are involved in the patient’s care?","publisher":"U.S. Department of Health and Human Services, Office for Civil Rights","url":"https://www.hhs.gov/hipaa/for-professionals/faq/2087/does-hipaa-allow-a-health-care-provider-to-communicate-with-a-patients-family-friends-or-other-persons-who-are-involved-in-the-patient-care.html","source_class":"GOVERNMENT_OR_REGULATOR","publication_date":"2017-09-12","accessed_at":"2026-08-03","claims_supported":["HIPAA permits relevant communication with family, friends, or other people involved in care when the capable patient agrees or does not object.","When a patient is absent or incapacitated, professional-judgment and best-interest rules apply.","Disclosure must be limited to information directly relevant to the recipient's involvement, supporting role-scoped permissions and constraining the gateway."]},{"source_id":"S5","title":"State Operations Manual Appendix A—Survey Protocol, Regulations and Interpretive Guidelines for Hospitals","publisher":"Centers for Medicare & Medicaid Services","url":"https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/som107ap_a_hospitals.pdf","source_class":"OFFICIAL_GUIDANCE","publication_date":"2026-05","accessed_at":"2026-08-03","claims_supported":["CMS distinguishes a patient-designated support person from a representative legally responsible for medical decisions.","Hospitals must accept patient designations for visitation and use documented representatives for decision authority under applicable law.","Hospitals are expected to maintain nondiscriminatory dispute-resolution policies and document refusals, supporting the proposal's separation and escalation boundaries.","Hospital compliance, patient-rights, records, and privacy leadership are credible authorizers, but state law remains material."]},{"source_id":"S6","title":"HL7 FHIR R5 Patient Resource","publisher":"Health Level Seven International","url":"https://hl7.org/fhir/patient.html","source_class":"STANDARD","publication_date":"2023-03-26","accessed_at":"2026-08-03","claims_supported":["FHIR already provides Patient.contact.relationship and Patient/RelatedPerson structures for contacts, family relationships, and legal responsibility.","Related people can be referenced by care plans, encounters, appointments, and other resources, making interoperable implementation technically plausible.","FHIR supplies a data structure rather than the proposal's elicitation, validation, permission, exception, purge, or performance-governance workflow."]},{"source_id":"S7","title":"Illinois Caregiver Advise, Record, and Enable Act, 210 ILCS 91","publisher":"Illinois General Assembly","url":"https://www.ilga.gov/Legislation/ILCS/Articles?ActID=3647&ActName=Caregiver+Advise%2C+Record%2C+and+Enable+Act.&ChapAct=210%EF%BF%BDILCS%EF%BF%BD91%2F&ChapterID=21&ChapterName=HEALTH+FACILITIES+AND+REGULATION","source_class":"GOVERNMENT_OR_REGULATOR","publication_date":"2026-01-01","accessed_at":"2026-08-03","claims_supported":["Illinois hospitals must offer inpatients an opportunity to designate an emergency contact and caregiver and record the designation and relationship.","Patients may change or decline a designation, and designation does not obligate the named person to provide care.","The law demonstrates an identifiable authorized adopter and operational pull while also showing substantial overlap with established caregiver-recording practice.","The statute does not itself provide the proposed multi-person, multi-role network mapping or establish the gateway's incremental effect."]},{"source_id":"S8","title":"Occupational Employment and Wages—May 2025","publisher":"U.S. Bureau of Labor Statistics","url":"https://www.bls.gov/news.release/ocwage.htm","source_class":"OFFICIAL_ORGANIZATION_DATA","publication_date":"2026-05","accessed_at":"2026-08-03","claims_supported":["May 2025 mean annual wages included approximately $148,100 for software developers, $111,490 for software quality-assurance analysts, $140,970 for medical and health-services managers, $88,400 for compliance officers, $75,620 for anthropologists and archeologists, and $71,790 for healthcare social workers.","These labor benchmarks support order-of-magnitude resource-equivalent cost estimates but do not constitute a vendor quote or hospital-specific implementation estimate."]}],"problem_evidence":{"support":"STRONG","rationale":"Two recent health-system studies directly document absent or inadequate structured caregiver fields, dispersed role information, multiple-caregiver complexity, and staff difficulty locating the appropriate person. S1 reports caregiver identification in only 111 of 1,698 screened hospital charts; S2 shows that even commonly populated contact tabs did not specify roles. The evidence is strongest for dementia care and caregiver documentation, not for every care setting or specifically for all culturally nonconventional kinship networks.","source_ids":["S1","S2","S3"]},"stakeholder_evidence":{"support":"STRONG","rationale":"Caregivers and clinical staff in two health systems explicitly requested standardized identification, task or role documentation, and improved EHR workflows. Illinois law creates a concrete hospital compliance obligation to offer and record caregiver designation, while CMS guidance identifies hospital patient-rights and compliance functions with authority over support-person and representative workflows. No named hospital has committed to this exact gateway.","source_ids":["S2","S5","S7"]},"prior_art":{"proximity":"SUBSTANTIAL_COLLISION","closest_analogues":[{"name":"Patient-identified social-network care maps","similarity":"Already elicit and display a patient's care community and were piloted in primary care and hospital settings.","remaining_difference":"The reported care maps did not encode separate information-sharing, participation, practical-support, and legal-authority propositions; integrate them into EHR permissions; or test total workflow burden and safety against ordinary intake.","source_ids":["S3"]},{"name":"Standardized EHR caregiver identification and role documentation","similarity":"Recent studies identify the same documentation failure and propose structured fields, prompts, alerts, caregiver tabs, task descriptions, and standardized workflows.","remaining_difference":"The remaining proposal adds a wider patient-defined network, explicit authority separation, person validation, bounded specialist exceptions, purge and regeneration controls, and a comparative turnover/selectivity claim.","source_ids":["S1","S2"]},{"name":"HL7 FHIR Patient.contact and RelatedPerson","similarity":"An established interoperability standard already represents patient contacts, relationship types, related people, and legal responsibility for downstream references.","remaining_difference":"FHIR is a data substrate; it does not supply accessible elicitation, patient validation, consent semantics for each use, coercion screening, specialist review, purge policy, or evidence that the workflow reduces burden.","source_ids":["S6"]},{"name":"CARE Act and CMS/HIPAA support-person, caregiver, and representative workflows","similarity":"Existing law and guidance already require or permit patient-designated caregivers and supporters, record relationships, constrain disclosure, and distinguish supporters from legal representatives.","remaining_difference":"These rules do not establish a reusable multi-role relationship gateway, full-network representation, anthropological exception lane, or superior performance under unchanged safeguards.","source_ids":["S4","S5","S7"]}],"distinctive_claim_remaining":"Against ordinary intake and a simpler structured-caregiver-field comparator, a patient-validated, role-separated network gateway can reduce total narration, staff, interpreter, specialist, correction, and downstream-clarification burden for eligible cases while producing no false authority assignment or unsafe disclosure and without disproportionate rerouting or meaning loss. This is an integration-and-performance claim, not a claim that care maps, caregiver fields, FHIR relationship records, or patient-designation workflows are new.","confidence":"HIGH"},"implementation_evidence":{"support":"MODERATE","rationale":"FHIR supplies a credible interoperable representation; HIPAA, CMS guidance, and Illinois law demonstrate lawful pathways for patient-designated supporters and caregivers while clarifying that permissions and legal authority must remain distinct. Technical construction is conventional EHR workflow and interface work. Feasibility remains unverified for the proposed multi-role schema, patient-validation experience, temporary-data purge, cross-system synchronization, discriminatory-routing controls, and specialist capacity. Jurisdiction-specific privacy, surrogate-decision, consent, records-retention, accessibility, labor, and safeguarding review is mandatory.","source_ids":["S4","S5","S6","S7","S8"]},"scores":{"meaningful_impact":{"score":4,"rationale":"The documented failure affects care planning, information exchange, discharge coordination, and caregiver engagement. Potential harm includes omission, delay, unwanted disclosure, and authority confusion, although population-wide prevalence and realized outcome effects are unmeasured.","source_ids":["S1","S2","S4"]},"stakeholder_pull":{"score":4,"rationale":"Caregivers and clinical staff expressed a need for standardized caregiver-role workflows, and hospitals in Illinois face an explicit designation-and-recording duty. Pull for this exact anthropologically informed gateway has not been demonstrated.","source_ids":["S2","S7"]},"incremental_advantage":{"score":3,"rationale":"Multi-person role separation, patient validation, exception handling, and explicit burden/safety measurement could outperform a single caregiver field or ordinary care map, but the advantage requires comparative field evidence.","source_ids":["S1","S2","S3","S6"]},"distinctiveness_plausibility":{"score":2,"rationale":"Care maps, standardized caregiver workflows, role capture, patient designation, and interoperable relationship records already exist or are explicitly recommended. Distinctiveness is limited to the integrated operating model and its falsifiable comparative performance.","source_ids":["S1","S2","S3","S5","S6","S7"]},"technical_implementability":{"score":4,"rationale":"Structured forms, versioned mappings, audit logs, role flags, routing, and FHIR-linked records are technically conventional. Reliable semantic mapping, permission synchronization, deletion from logs or backups, and safe EHR integration remain nontrivial.","source_ids":["S6","S8"]},"adoption_authority_feasibility":{"score":4,"rationale":"Hospitals have identifiable records, privacy, patient-rights, compliance, clinical, and IT authorizers, and Illinois supplies a concrete statutory adoption context. State-specific surrogate and consent rules and vendor governance prevent a universal deployment authorization.","source_ids":["S4","S5","S7"]},"evidence_readiness":{"score":3,"rationale":"The problem, users, standards, comparator, and falsifiers are sufficiently specified for a shadow evaluation. No evidence yet shows the proposed gateway's effect on total burden, downstream comprehension, safety, equity, or regeneration.","source_ids":["S1","S2","S3"]},"safety_net_benefit":{"score":4,"rationale":"Separating practical support, information permission, visitation, and formal authority could reduce dangerous inference, while explicit rerouting and deactivation offer protection. A concise map can also create false confidence, so benefit depends on validation, scope labels, and audit.","source_ids":["S4","S5"]},"scalability":{"score":3,"rationale":"FHIR alignment and reusable schemas favor replication, but local laws, EHR configurations, languages, accessibility needs, cultural meanings, specialist availability, and downstream workflows require site adaptation.","source_ids":["S2","S5","S6","S7"]}},"score_confidence":"MODERATE","costs":{"first_evidence":{"band_2026_usd":"50K_TO_250K","scope":"Pre-register and run an offline comparison on no more than 10 compensated-panel-designed synthetic networks, with optional use of up to four separately authorized closed de-identified cases; build a nonproduction prototype; conduct privacy, safeguarding, accessibility, legal, cultural, and blinded care-planner review.","confidence":"MODERATE","assumptions":["Approximately 0.25-0.5 software/QA FTE-year plus part-time project management, clinical, privacy, legal, accessibility, interpreter, social-work, and anthropological effort.","No live EHR writeback, patient contact, vendor customization, or production security accreditation.","External reviewers and cultural contributors are compensated.","BLS wages are loaded by roughly 30%-70% for benefits, overhead, and contracting."],"source_ids":["S8"]},"initial_deployment_startup":{"band_2026_usd":"250K_TO_1M","scope":"Single-hospital production design and readiness: schema governance, consent and authority rules, EHR/FHIR interface build, security and privacy assessment, purge design, workflow configuration, training materials, accessibility testing, and pilot governance.","confidence":"LOW","assumptions":["One EHR environment and a bounded service line.","Roughly 1-3 combined FTE-years across software, QA, integration, clinical informatics, compliance, project management, social work, and specialist design.","Excludes enterprise-wide rollout, major vendor license changes, litigation, and replacement of the underlying EHR."],"source_ids":["S6","S8"]},"operational_launch":{"band_2026_usd":"1M_TO_5M","scope":"A monitored live launch across several hospital units or a small health system, including production integration, training, specialist coverage, interpreter and accessibility support, privacy monitoring, independent safety/equity review, incident response, and evaluation.","confidence":"LOW","assumptions":["Deployment spans multiple workflows and downstream record consumers.","Includes 5-15 internal or contracted FTE-equivalents during launch plus vendor and security costs.","Does not include a national product rollout, large-scale replacement of registration systems, or payment for unrelated clinical capacity."],"source_ids":["S5","S6","S8"]},"annual_recurring":{"band_2026_usd":"250K_TO_1M","scope":"Single-hospital or bounded-service-line operation: 1-3 FTE-equivalents for stewardship and specialist review, software support, schema and legal refresh, interpreter/accessibility overhead, audit sampling, training, incident response, and periodic purge and interface testing.","confidence":"LOW","assumptions":["Routine cases remain mostly automated or handled within existing intake staffing.","Specialist review is exceptional rather than required for most cases.","Costs rise into the next band for enterprise-wide 24/7 staffing, high exception volume, or extensive vendor licensing.","BLS occupational wages provide labor anchors but not institution-specific loaded costs."],"source_ids":["S8"]}},"verified_pipeline_gates":{"externally_supported_problem":{"status":"YES","reason":"Recent primary studies directly document missing structured caregiver identification, absent role information, inconsistent documentation, and staff difficulty finding the appropriate caregiver.","source_ids":["S1","S2"]},"externally_credible_adopter_or_authorizer":{"status":"YES","reason":"Hospital clinical and practice staff expressed the need; hospital records, privacy, compliance, and patient-rights functions have relevant authority; Illinois hospitals have an explicit statutory recording duty.","source_ids":["S2","S5","S7"]},"distinct_testable_incremental_claim":{"status":"YES","reason":"The proposal can be compared with ordinary intake and a simpler structured-caregiver-field workflow on total burden, role accuracy, downstream comprehension, safety events, meaning preservation, and subgroup rerouting.","source_ids":["S1","S2","S3","S6"]},"bounded_next_evidence_step":{"status":"YES","reason":"A small synthetic-first offline shadow probe with fixed comparators, case caps, blinded review, and explicit kill criteria is bounded and reversible.","source_ids":["S3","S6"]},"no_unresolved_safety_or_authority_stop":{"status":"YES","reason":"A synthetic-only prototype can proceed under hospital privacy and records stewardship without live writeback or patient contact. Any closed-record component must remain contingent on documented evaluation authority, data minimization, and approved purge procedures; live deployment is not authorized by this finding.","source_ids":["S4","S5","S7"]},"credible_cost_scope_and_range":{"status":"YES","reason":"The four ranges state deployment scale, staffing assumptions, exclusions, and confidence. Current BLS wages anchor labor equivalents, although vendor and hospital-specific costs remain unknown.","source_ids":["S8"]}},"next_evidence_step":"With a hospital privacy officer and care-records steward as co-sponsors, pre-register a synthetic-first offline shadow study. Build a nonproduction FHIR-compatible prototype and test exactly 10 synthetic networks covering a conventional family, chosen family, multiple caregivers with different tasks, changing permissions, language or accessibility needs, contradictory claims, coercion indicators, incapacity, and unsupported relationship meanings. Compare three blinded outputs: ordinary intake, a basic structured caregiver/contact field, and the proposed role-separated gateway. Measure total patient-equivalent, staff, interpreter, developer, and specialist minutes; duplicate questions; role and authority accuracy; preserved free-text meaning; appropriate rerouting; downstream comprehension by blinded care planners; correction burden; subgroup routing patterns; and successful temporary-data purge. Pre-commit failure on any false authority assignment, unauthorized disclosure, coercion miss, materially misleading label, prohibited inference, failed purge, or gateway performance no better than the basic structured-field comparator on total burden. Only after passing synthetic tests should up to four separately authorized closed de-identified cases be considered; any live patient pilot requires new approval.","blocking_evidence":["No comparative evidence shows that the proposed gateway reduces total burden relative to both ordinary intake and a simpler structured-caregiver-field workflow.","No evidence establishes safe semantic separation of information permission, participation, practical support, visitation, emergency contact, and legal authority across local EHR workflows.","No subgroup evidence addresses culturally misleading normalization or disproportionate rerouting of marginalized or nonconventional networks.","No production evidence verifies temporary-narrative deletion from logs, backups, analytics, interfaces, and downstream copies.","No workload evidence shows that specialist review remains exceptional, sustainable, and independent rather than becoming a bottleneck or gatekeeper.","No named hospital or EHR vendor has committed resources to the exact intervention.","Jurisdiction-specific consent, surrogate-decision, records-retention, safeguarding, and caregiver-law analysis remains undone.","Vendor pricing, integration complexity, and institution-specific loaded staffing costs are unavailable."],"research_disposition":"PARTNERED_RESEARCH_PROGRAM","world_novelty_boundary":"World novelty, patentability, freedom to operate, market size, and realized impact were not measured. The eight-source review establishes substantial prior art in patient-defined care maps, structured caregiver workflows, FHIR relationship records, patient-designation law, and support-person/representative rules. It does not establish whether any organization has implemented the exact combined gateway, and no world-novelty claim should be made.","arm":"COMPLETE_PROPOSAL_PORTFOLIO","candidate_version":0,"controller_recommendation":{"action":"STOP_EMPIRICAL_RESEARCH_NEEDED","repairable":false,"material_progress_observed":true,"progress_targets":["Secure a named hospital privacy-and-records partnership and document who may authorize synthetic, closed-record, and later live stages.","Complete a jurisdiction-specific authority matrix separating patient preference, HIPAA permission, support-person status, caregiver designation, portal proxy access, and formal decision authority.","Specify the exact incremental schema and workflow delta from care maps, structured caregiver tabs, CARE Act workflows, and HL7 FHIR Patient/RelatedPerson resources.","Build and independently test a nonproduction prototype, including versioning, auditability, accessibility, interface validation, and verifiable purge behavior.","Pre-register ordinary-intake and basic-structured-field comparators, workload accounting rules, subgroup equity analyses, and all safety falsifiers before examining outcomes.","Run the bounded synthetic shadow study and obtain blinded downstream-comprehension results.","Demonstrate that specialist handling is exceptional and capacity-bounded and that total labor is reduced rather than shifted to patients, interpreters, caregivers, or downstream staff.","Obtain institution- and vendor-specific implementation quotes before any live-pilot budget decision."],"reason":"Open-web research verifies the problem, adopter class, authority boundaries, technical substrate, and substantial prior art, leaving a narrow comparative performance claim. Resolving that claim requires institutional workflow access, prototype testing, proprietary cost and EHR information, and eventually authorized shadow or live data; it cannot be answered by additional bounded web search. Under the required controller rule, this empirical-research stop is terminal and therefore repairable is false."},"proposal_index":4}