Healthcare Ops

You are in AUTONOMOUS MODE. Do NOT ask questions. Review the entire codebase from a healthcare operations perspective, identifying bottlenecks and optimization opportunities.

TARGET: $ARGUMENTS

If no arguments provided, review the entire project in the current working directory for operational efficiency. If a specific area is named (e.g., "scheduling", "patient flow", "integrations"), focus there but still note cross-cutting issues.

============================================================ PHASE 0: SYSTEM AND OPERATIONS CONTEXT

Characterize the system from an operations standpoint:

1. Detect the tech stack and architecture.
2. Identify the operational domain:
   • Inpatient (hospital) vs outpatient (clinic) vs both
   • Single facility vs multi-facility
   • Specialty-specific or general
3. Map operational modules in the codebase:
   • Scheduling / appointments
   • Registration / check-in
   • Clinical workflow / order entry
   • Billing / revenue cycle
   • Reporting / analytics
   • Staff management / credentialing
   • Inventory / supply chain
   • Communication / messaging
4. Identify integration points with external systems:
   • EHR systems (Epic, Cerner, Meditech, etc.)
   • Lab information systems (LIS)
   • Pharmacy systems
   • Radiology (PACS/RIS)
   • Billing / claims clearinghouses
   • State registries (immunization, disease reporting)

============================================================ PHASE 1: SCHEDULING AND RESOURCE ALLOCATION

Review scheduling implementation for operational efficiency:

APPOINTMENT SCHEDULING:

• Check appointment data model: does it capture provider, location, type, duration, status, patient, reason, recurring flag?
• Verify scheduling constraints: provider availability, room availability, equipment availability, patient preferences.
• Check for overbooking support (configurable overbooking rules by provider/type).
• Verify wait-list management implementation.
• Check for no-show tracking and predictive no-show modeling.
• Verify cancellation and rescheduling workflows.

RESOURCE ALLOCATION:

• Check for room/bed assignment logic.
• Verify equipment scheduling (shared resources across providers/departments).
• Check for provider template management (recurring availability patterns).
• Verify block scheduling support (surgical blocks, procedure rooms).
• Check for resource conflict detection and resolution.

CAPACITY PLANNING:

• Check for capacity utilization tracking.
• Verify appointment type duration analytics (actual vs scheduled).
• Check for demand forecasting features (seasonal patterns, growth).
• Verify bottleneck identification capabilities.

OPTIMIZATION OPPORTUNITIES:

• Flag scheduling logic that is purely FIFO without optimization.
• Check for batch scheduling capabilities (multiple related appointments).
• Verify support for multi-resource scheduling (provider + room + equipment).
• Check for travel time consideration in multi-location practices.

============================================================ PHASE 2: CLINICAL WORKFLOW EFFICIENCY

Review clinical workflows for documentation burden and throughput:

ORDER ENTRY:

• Check order entry workflow step count (fewer clicks = less provider burden).
• Verify order set / favorites support (frequently used order bundles).
• Check for smart defaults based on diagnosis or encounter type.
• Verify order validation at entry (not just submission).
• Check for verbal/telephone order workflows with cosign requirements.

DOCUMENTATION WORKFLOW:

• Measure documentation template complexity (fields, required entries).
• Check for auto-population from previous encounters.
• Verify copy-forward functionality with review requirements.
• Check for structured documentation vs free-text balance.
• Verify speech-to-text or ambient listening integration points.
• Flag documentation workflows with more than 10 required clicks.

CLINICAL DECISION SUPPORT:

• Check for alerts and reminders implementation.
• Verify alert fatigue mitigation (severity tiers, suppression rules, snooze).
• Check for evidence-based order recommendations.
• Verify drug interaction and allergy alert implementation.
• Check for care gap identification (preventive care, chronic disease management).

REFERRAL MANAGEMENT:

• Check for referral workflow completeness (create, send, track, close loop).
• Verify referral status tracking.
• Check for closed-loop referral communication.
• Verify authorization tracking tied to referrals.

TASK MANAGEMENT:

• Check for clinical task queues (inbox, results review, message responses).
• Verify task assignment and routing logic.
• Check for task priority and escalation rules.
• Verify task completion tracking and SLA monitoring.

============================================================ PHASE 3: INTEGRATION ARCHITECTURE

Review integration points for reliability and completeness:

EHR INTEGRATION:

• Check for HL7v2 / FHIR interface implementations.
• Verify ADT message handling (admit, discharge, transfer notifications).
• Check for bidirectional data sync vs one-way feeds.
• Verify error handling and retry logic on integration failures.
• Check for message queue / dead letter queue implementation.
• Flag any polling-based integrations that should be event-driven.

LAB SYSTEM INTEGRATION:

• Check for order-to-result workflow across systems.
• Verify specimen tracking integration.
• Check for auto-result filing with review workflows.
• Verify reference range handling across lab vendors.

PHARMACY INTEGRATION:

• Check for e-prescribing (NCPDP SCRIPT) implementation.
• Verify medication dispensing system integration.
• Check for formulary checking at point of prescribing.
• Verify controlled substance workflows (EPCS compliance).

BILLING INTEGRATION:

• Check for charge capture completeness (all billable events generate charges).
• Verify coding assistance integration (encoder, CAC).
• Check for claims submission workflow (EDI 837).
• Verify remittance processing (EDI 835) automation.
• Check for real-time eligibility verification (EDI 270/271).

EXTERNAL REPORTING:

• Check for state immunization registry reporting.
• Verify syndromic surveillance reporting.
• Check for quality measure reporting (CMS, HEDIS, MIPS).
• Verify public health reporting capabilities.

INTEGRATION RELIABILITY:

• Check for circuit breaker patterns on external calls.
• Verify timeout configuration on integration endpoints.
• Check for message retry with exponential backoff.
• Verify integration monitoring and alerting.
• Check for data reconciliation mechanisms.

============================================================ PHASE 4: PATIENT FLOW OPTIMIZATION

Review patient flow management:

REGISTRATION AND CHECK-IN:

• Check for pre-registration capabilities (online, kiosk).
• Verify insurance eligibility verification at check-in.
• Check for patient identity verification workflow.
• Verify consent capture at registration.
• Flag manual data entry that could be automated.

ADMISSION / DISCHARGE / TRANSFER:

• Check ADT workflow completeness and status tracking.
• Verify bed management and bed board functionality.
• Check for discharge planning workflows (discharge criteria, pending items).
• Verify patient flow visibility (real-time census, wait times).
• Check for transfer coordination between units/facilities.

WAIT TIME MANAGEMENT:

• Check for patient wait time tracking.
• Verify queue management and prioritization.
• Check for patient notification capabilities (text when ready).
• Verify wait time analytics and reporting.

THROUGHPUT METRICS:

• Check for door-to-provider time tracking.
• Verify length-of-stay calculation and monitoring.
• Check for turnaround time tracking on key processes (lab, radiology).
• Verify throughput dashboards and real-time status boards.

============================================================ PHASE 5: REPORTING AND ANALYTICS

Review reporting capabilities:

OPERATIONAL DASHBOARDS:

• Check for real-time operational dashboards (census, wait times, bed status).
• Verify provider productivity reporting.
• Check for financial performance dashboards.
• Verify patient satisfaction tracking integration.

QUALITY METRICS:

• Check for CMS quality measure calculation.
• Verify HEDIS measure support (if health plan related).
• Check for MIPS / APM quality reporting.
• Verify clinical quality dashboard implementation.

REGULATORY REPORTING:

• Check for meaningful use / promoting interoperability measure tracking.
• Verify state reporting requirements implementation.
• Check for Joint Commission / accreditation reporting support.

DATA EXPORT AND ANALYTICS:

• Check for data warehouse / analytics database feeds.
• Verify ETL pipeline implementation for reporting.
• Check for ad-hoc reporting capabilities.
• Verify role-based report access controls.

============================================================ PHASE 6: STAFF MANAGEMENT

Review staff-related functionality:

CREDENTIALING:

• Check for provider credentialing status tracking.
• Verify license expiration alerting.
• Check for privilege delineation management.
• Verify CME / continuing education tracking.

SCHEDULING AND WORKLOAD:

• Check for staff shift scheduling.
• Verify workload balancing algorithms.
• Check for overtime tracking and alerting.
• Verify on-call schedule management.
• Check for float pool / resource pool management.

COMMUNICATION:

• Check for secure messaging between staff.
• Verify handoff/sign-out communication tools.
• Check for team-based care coordination features.
• Verify critical result notification workflows.

============================================================ SELF-HEALING VALIDATION (max 2 iterations)

After producing the review, validate completeness and consistency:

1. Verify all required output sections are present and non-empty.
2. Verify every finding references a specific file or code location.
3. Verify recommendations are actionable (not vague).
4. Verify severity ratings are justified by evidence.

IF VALIDATION FAILS:

• Identify which sections are incomplete or lack specificity
• Re-analyze the deficient areas
• Repeat up to 2 iterations

============================================================ OUTPUT

Healthcare Operations Review

Project: [name] Stack: [detected technologies] Operational Domain: [inpatient/outpatient/both] | [single/multi-facility] Date: [date]

Operations Module Coverage

Integration Health

Bottleneck Analysis

Workflow Efficiency Findings

Optimization Roadmap

[Ordered by operational impact and implementation effort]

1. [Quick win] -- [description], effort: S, impact: High
2. [Major improvement] -- [description], effort: M, impact: High
3. ...

============================================================ NEXT STEPS

After reviewing the findings:

• "Run /healthcare-api to build missing integration endpoints."
• "Run /clinical-data-review to verify clinical data models support identified workflows."
• "Run /medical-billing to deep-dive on revenue cycle optimization."
• "Run /healthcare-compliance to ensure operational changes maintain regulatory compliance."
• "Run /patient-engagement to evaluate patient-facing features supporting operational goals."
• "Run /perf to benchmark integration and query performance on bottleneck areas."

============================================================ SELF-EVOLUTION TELEMETRY

After producing output, record execution metadata for the /evolve pipeline.

Check if a project memory directory exists:

• Look for the project path in ~/.claude/projects/
• If found, append to skill-telemetry.md in that memory directory

Entry format:

### /healthcare-ops — {{YYYY-MM-DD}}
- Outcome: {{SUCCESS | PARTIAL | FAILED}}
- Self-healed: {{yes — what was healed | no}}
- Iterations used: {{N}} / {{N max}}
- Bottleneck: {{phase that struggled or "none"}}
- Suggestion: {{one-line improvement idea for /evolve, or "none"}}

Only log if the memory directory exists. Skip silently if not found. Keep entries concise — /evolve will parse these for skill improvement signals.

============================================================ DO NOT

• Do NOT modify any code -- this is a review skill, not a build skill.
• Do NOT evaluate clinical correctness of medical logic -- focus on operational efficiency.
• Do NOT assume single-facility operations unless the code confirms it.
• Do NOT skip integration review -- integration failures are the top operational pain point.
• Do NOT ignore staff-facing UX -- provider burden directly impacts operational throughput.
• Do NOT recommend operational changes without grounding them in actual code/architecture evidence.
• Do NOT provide specific clinical practice recommendations -- stay in the software operations lane.
• Do NOT install external tools -- analyze codebase and configuration directly.