Care Team Experience
Care coordinators, care managers, and nurse navigators get shared visibility across specialists — with role + consent-scoped routing.
Team composition
| Role | Typical responsibility |
|---|---|
attending_physician | Primary decision-maker |
specialist | Consult within specialty |
care_coordinator | Cross-team logistics, referral tracking |
nurse | Clinical support, patient communication |
case_manager | Long-term continuity, insurance + social |
Per-patient care team
Every patient has a care-team assignment with delegation types:
team— whole-team visibility (default)specialist— single-specialist scoped
Team members share the patient chart under standing consent. Leaving the team revokes that scope immediately.
Key workflows
Referral coordination
Task routing + follow-up
- Discharge → coordinator creates follow-up task (e.g., "48h post-discharge call")
- Task assigned by role, not person (auto-route to on-call nurse)
- Overdue tasks surface on dashboard + push notification
- Every task has an audit trail of assignments + completions
Care-plan annotations
Care plans are collaborative — team members annotate per section:
- Goals
- Interventions
- Medications
- Lifestyle
- Follow-ups
- Patient education
Every annotation is attributed + timestamped. Patients can see the plan and ask questions via secure messaging.
Cross-patient operations (bounded)
Coordinators often look across patients ("all my diabetics with HbA1c > 9"). We support this with:
- Admin role with
@Roles('admin')for cross-patient queries - Care-coordinator role with scope-bounded aggregate views
- Aggregate queries that never return raw PHI — only counts + binned distributions
- Every cross-patient query audited with
scope=aggregateflag
Share visibility with family
When a patient grants family_read to a family member, the care team sees that relationship:
- Care-team messages CC'd family members appropriately
- Family has consent-scoped read access to the timeline
- Revocable by patient at any time
- Age-of-majority graduation respected
Shared dashboard
/dashboard/care-team surfaces:
- Team roster + assigned patients
- Shared task queue (sortable by due date + urgency)
- Referral pipeline
- Recent activity across the team
- Escalations + break-glass incidents
All views are consent-scoped: if a team member wasn't on the care team for a given patient at the time of a past action, they don't see that history.
Operational rigor
- Every action audit-chained (view, write, referral-transition, consent-change)
- Hash-chain verification hourly (Phase 2) — Sev 0 alert on mismatch
- Consent revocation → immediate denial of next request (no cache)
- Break-glass invocation → HIGH-severity audit + async care-manager notification + patient alert