Clinical session · 24 June 2026

Standards & export

How each encounter is captured, coded, and exported as a single self-contained, content-addressed record.

Clinical standard

every action written as a FHIR resource

FHIR R4US Core 7.0.0 profilesSigned note as DocumentReference (LOINC 11506-3)

Coding systems

LOINC	Labs, vitals, instruments, documents
RxNorm	Medications
ICD-10-CM	Diagnoses
SNOMED CT	Diagnoses (dual-coded)
CPT	Procedures & imaging
CVX	Immunizations

Recorded streams

three streams per encounter, aligned on a shared clock

Clinical screen

Screen capture of the EHR (rrweb).

Audio narration

Clinician reasoning, transcribed.

FHIR operations

Every system action, append-only log.

Event-to-event31 ms p95

Media-to-event78 ms p95

Clock offset37 ms

Clinic relay · four stations

one staff member holds the chart at a time

Step	Station	Role	Recorded at this station
1	Front desk · check-in	Receptionist	Registration, insurance coverage, arrival.
2	Intake room	Nurse / medical assistant	Vital signs, allergies, medication reconciliation, screening.
3	Consulting room	Provider	History, examination, diagnoses, orders, prescriptions, referrals, signed note.
4	Front desk · checkout	Receptionist	After-visit summary, follow-up, discharge.

Data export & integrity

one self-contained, content-addressed record per encounter

Export layout

gs://arcophos-exports/v1/<patient_journey_id>/<bundle_sha256>/

manifest.json            # the ONE hashed object (RFC 8785 JCS): journey + scenario pin + reward + pointers
records/
  trajectory.jsonl       # ordered interactions (segment + unassigned lanes)
  segments.jsonl         # seq, claim/release_master_ts, fhir_task_id
  checkpoint_results.jsonl  # passed, observed slice, scored_at
tables/
  interaction_log.parquet   # full op log incl. http_status + fhir_version_id
  heartbeat.parquet      # offset_ms / master_clock_ts / local_ts sync markers
  clock_offset_sample.parquet
rrweb/                   # chunk order + first/last_event_master_ts + sha256
fhir/
  terminal_bundle.json   # graded terminal chart ($everything for the Encounter)
  seed_bundle.json       # the planned Encounter at seed
  document_reference.json   # us-core-documentreference 11506-3 (reward-diffed note)
media/                   # screen|mic gcs_uri + sha256 + [started,ended]_master_ts
  audio/                 # mic artifact (transcript joined downstream)
reward.json              # total/max/normalized, breakdown, grader_version, version pins

Integrity

why each record can be trusted and reproduced

Formats

Streams as JSONL, tabular logs as Parquet; recordings referenced by storage location + content hash.

Integrity

Each bundle is addressed by the hash of its contents; re-exporting the same record produces the same result. Exported only when complete and reconciled.

Consent & PHI

Sample record; no PHI. Every recording consented. Consent rate 100%; reconciled records 16 of 16.

Vital-sign LOINC codes

BP 85354-9 (sys 8480-6 / dia 8462-4) · HR 8867-4 · RR 9279-1 · Temp 8310-5 · SpO₂ 59408-5+2708-6 · Height 8302-2 · Weight 29463-7 · BMI 39156-5