{"patient_id":"P33","encounter_id":"KE-P33","note_id":"KN-P33-1","signed":false,"ignored_instructions":[],"origin":"ai_scribe","origin_label":"AI-drafted","origin_note":"as declared by the source system","needs_look":1,"extended":{"on":false,"front":[],"library":[],"banner":"Extended capabilities: published criteria cited by title and restated in our own words, no text reproduced; a licence or permission is needed before commercial use.","title":"Extended capabilities","n":0,"n_hidden":0},"check_current":true,"needs_look_kidney":0,"surfaced":[{"source":"front","family":"heart_failure"},{"source":"kidney","family":"kidney"}],"model":{"off":false,"failed":false,"degraded":false},"run_id":"RUN-00033","replay_hash":"cc8218621fc510624501d6a0ce0456f2f2636fa169484ee603b3716f24b79f5a","measurement_replay_hash":"377e640c2c78ed7395730c34ebaa3d05f90aeb52c92e25b404b59007a8944ef8","engine":"kidney-engine 2.0","rules":[{"rule":"ckd_epi_2009@1.0","source":"Levey et al., Ann Intern Med 2009;150:604-12 (2009 eGFR equation, drift check)","url":"https://www.acpjournals.org/doi/10.7326/0003-4819-150-9-200905050-00006"},{"rule":"ckd_epi_2021@1.0","source":"Inker et al., N Engl J Med 2021;385:1737-49 (2021 race-free eGFR equation)","url":"https://www.kidney.org/ckd-epi-creatinine-equation-2021"},{"rule":"kdigo_aki_2012@1.1","source":"KDIGO 2012 guideline, Kidney Int Suppl 2012;2:1-138 (Rec 2.1.1-2.1.2, Table 2)","url":"https://kdigo.org/guidelines/acute-kidney-injury/"},{"rule":"kdigo_ckd_2024@1.1","source":"KDIGO 2024 guideline, Kidney Int 2024;105(4S):S117-S314 (G/A categories, >3 months)","url":"https://kdigo.org/guidelines/ckd-evaluation-and-management/"},{"rule":"kidney_compare@1.1","source":"Two-sided comparison (this tool); ICD-10-CM guideline I.A.19; ACDIS/AHIMA compliant query practice, 2026 update","url":"https://www.cms.gov/medicare/coding-billing/icd-10-codes"},{"rule":"kidney_exclusions@1.0","source":"KDIGO 2024 guideline, limitations of creatinine-based eGFR (muscle mass, pregnancy, kidney replacement); local list","url":"https://kdigo.org/guidelines/ckd-evaluation-and-management/"},{"rule":"lab_units@1.1","source":"KDIGO 2012 and 2024 guidelines, unit conversion (creatinine 1 mg/dL = 88.4 umol/L; ACR 1 mg/mmol = 8.84 mg/g)","url":"https://kdigo.org/guidelines/ckd-evaluation-and-management/"}],"last_replay":null,"library":{"run_id":"LRUN-00033","encounter_id":"KE-P33","note_id":"KN-P33-1","config":"library_default_set@1.1","engine":"library-engine 1.1","replay_hash":"3de143939a36cea6a00727eda0d4955163375bedd80b929757e013afdc515bc6","measurement_replay_hash":"ae8614626b37cecca207dabff6f6184a52cc8fdc2d921020d6598591c9ca6499","surfaced":[],"more":[],"extended":[],"extended_on":false,"n_hidden_extended":0,"n_extended_needs":0,"n_needs":0,"limit":3,"dismissed":0,"ctcae_on":false,"draft_label":"Draft definition: pending clinical and coding review","dismiss_reasons":{"addressed_elsewhere":"Already addressed elsewhere in the record","not_representative":"Values not representative (for example acute illness or a lab error)","not_relevant":"Not relevant to this visit","definition_not_applicable":"The definition does not apply to this patient","other":"Other (explain)"}},"findings":[{"family":"kidney","topic":"Kidney filtering rate (eGFR) over time","status":"agrees","label":"Agrees: nothing to do","sentence":"Kidney results 200 days apart are 60 or above (filtering rate 80.4 on 2026-04-26 and 80.4 on 2026-11-12) and the note doesn't mention kidney function.","quote":null,"threshold":"Threshold: filtering rate below 60 on two results at least 90 days apart, none of 60 or more between them.","span":null,"note_mentions":false,"lab_ids":["L-0075","L-0076"]}],"front":{"run_id":"FRUN-00033","cards":[{"family":"heart_failure","topic":"Heart pumping fraction (ejection fraction, EF)","status":"needs_look","label":"Needs a look","sentence":"The note says “Heart failure with reduced ejection fraction”; the latest ejection fraction is 48% on 2026-10-13, which does not fit the type written (needs 40% or lower). An earlier value was 30% on 2025-05-21.","quote":"Heart failure with reduced ejection fraction","threshold":"Categories by ejection fraction: 40% or lower; 41% to 49%; 50% or higher; improved (earlier 40% or lower, now above 40%, a rise of at least 10 points). Acuity is a clinical judgement: indicators are shown, nothing is concluded.","span":[244,288],"note_mentions":true,"lab_ids":[],"direction":"UNSUPPORTED","definition":"front_hf_ef_type@1.0","reviewed":false,"evidence":[{"text":"Ejection fraction 48% · echocardiogram 2026-10-13 (transthoracic, biplane)","quote":"Left ventricular ejection fraction 48% by biplane method.","by":"Dr. Leopold Nairn (cardiology)","item":"ECHO-P33-2"},{"text":"Ejection fraction 30% · echocardiogram 2025-05-21 (transthoracic, biplane)","quote":"Left ventricular ejection fraction 30% by biplane method.","by":"Dr. Leopold Nairn (cardiology)","item":"ECHO-P33-1"}],"acuity":[],"options":[{"key":"reduced","kind":"wording","requires":"latest ejection fraction 40% or lower","shows":"latest 48% on 2026-10-13","status":"not_met","status_label":"not met","wording":"Heart failure with reduced ejection fraction (HFrEF)"},{"key":"mildly_reduced","kind":"wording","requires":"latest ejection fraction 41% to 49%","shows":"latest 48% on 2026-10-13","status":"met","status_label":"met","wording":"Heart failure with mildly reduced ejection fraction (HFmrEF)"},{"key":"preserved","kind":"wording","requires":"latest ejection fraction 50% or higher","shows":"latest 48% on 2026-10-13","status":"not_met","status_label":"not met","wording":"Heart failure with preserved ejection fraction (HFpEF)"},{"key":"improved","kind":"wording","requires":"an earlier ejection fraction of 40% or lower, the latest above 40%, and a rise of at least 10 points","shows":"earlier 30% on 2025-05-21, latest 48% on 2026-10-13 (change +18 points)","status":"met","status_label":"met","wording":"Heart failure with improved ejection fraction (HFimpEF)"},{"key":"other","kind":"fixed","wording":"Other (I will write it)"},{"key":"unable","kind":"fixed","wording":"Clinically unable to determine"},{"key":"not_supported","kind":"fixed","wording":"Not clinically supported (I will revise the note myself)"}],"chosen":null}],"dismissed":0}}