{"patient_id":"P42","encounter_id":"KE-P42","note_id":"KN-P42-1","signed":false,"ignored_instructions":[],"origin":"clinician","origin_label":"Clinician-typed","origin_note":"as declared by the source system","needs_look":0,"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-00050","replay_hash":"a105aae252a094bdc71de152fefe846d3bad8f88b2cf1fe3c033f0606b1b6cd5","measurement_replay_hash":"4d0999ab7642a8b5e165d3587a7f48e5e9fc1f549441afa6f217e030f6ac2c19","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-00050","encounter_id":"KE-P42","note_id":"KN-P42-1","config":"library_default_set@1.1","engine":"library-engine 1.1","replay_hash":"57eb3fd6901743eb56b103a8ffc7a8065c43c398f8f612798b658ab0da188cd8","measurement_replay_hash":"59523e0f0a9c2764b58bc67468b864663779d2f08dfeac86b92882bc9196dcdb","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 180 days apart are 60 or above (filtering rate 74.5 on 2026-05-15 and 74.5 on 2026-11-11) 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-0098","L-0099"]}],"front":{"run_id":"FRUN-00050","cards":[{"family":"heart_failure","topic":"Heart pumping fraction (ejection fraction, EF)","status":"not_assessable","label":"Not assessable: your judgement","sentence":"The note says “Heart failure”; the latest echocardiogram report gives a range (35–45% on 2026-09-12) that spans categories, so the type cannot be checked.","quote":"Heart failure","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":[142,155],"note_mentions":true,"lab_ids":[],"direction":"NOT_ASSESSABLE","definition":"front_hf_ef_type@1.0","reviewed":false,"evidence":[{"text":"Ejection fraction 35–45% · echocardiogram 2026-09-12 (transthoracic, limited views, report text only)","quote":"Left ventricular ejection fraction visually estimated at 35-45%.","by":"Dr. Ines Varga (cardiology)","item":"ECHO-P42-1","read_label":"read from the report text by the AI reader · quote verified · rule reader agrees"}],"acuity":[{"text":"Acuity words in the note","quote":"chronic","item":null}],"options":[{"key":"reduced","kind":"wording","requires":"latest ejection fraction 40% or lower","shows":"latest 35–45% on 2026-09-12: a range that spans categories","status":"not_assessable","status_label":"not assessable","wording":"Heart failure with reduced ejection fraction (HFrEF)"},{"key":"mildly_reduced","kind":"wording","requires":"latest ejection fraction 41% to 49%","shows":"latest 35–45% on 2026-09-12: a range that spans categories","status":"not_assessable","status_label":"not assessable","wording":"Heart failure with mildly reduced ejection fraction (HFmrEF)"},{"key":"preserved","kind":"wording","requires":"latest ejection fraction 50% or higher","shows":"latest 35–45% on 2026-09-12: a range that spans categories","status":"not_assessable","status_label":"not assessable","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":"only one measurement on file (35–45% on 2026-09-12)","status":"not_assessable","status_label":"not assessable","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}}