Air-gapped ambient clinical documentation service capturing audio streams via secure WebSockets, redacting protected health information (PHI) locally, and structuring FHIR-compliant payloads for Epic and Cerner EHR integration.
Why traditional off-the-shelf software or agency workflows were unviable for this deployment.
A clinical provider network faced severe physician burnout, with clinicians spending up to 3.5 hours per shift manually transcribing consultation audio into unstructured EHR records. This created severe documentation backlogs, elevated billing cycle lag, and increased cognitive fatigue across hospital departments.
Clinical health systems operate under strict regulatory enforcement (HIPAA, HITECH) where any unvetted third-party cloud LLM API introduces severe legal compliance liability. At the same time, manual physician documentation was consuming 3.5 hours per shift, causing systemic clinician fatigue and documentation bottlenecks.
CmdFlow architected an air-gapped ambient clinical documentation service that captures audio streams via secure WebSockets, redacts protected health information (PHI) locally using private edge models, and routes structured FHIR-compliant payloads to Epic and Cerner EHR instances.
Local PII/PHI sanitization filter guaranteeing zero sensitive patient metadata exits the hospital perimeter.
Deterministic FHIR HL7 schema validation preventing malformed clinical notes from reaching production records.
Sub-30 second clinical summary generation following patient discharge.
Clinician-patient dialogue streamed via TLS 1.3 WebSockets directly from the exam room.
Rule-based and NER models mask patient names, dates, and medical record numbers in-memory.
Private LLM extracts subjective, objective, assessment, and plan (SOAP) sections.
Structured clinical payload validated and dispatched to EHR instances via REST APIs.
How CmdFlow built, validated, and shipped this production software.
Built with Next.js 16 and a high-performance Python FastAPI service communicating over bidirectional binary WebSockets. Whisper models run on private GPU instances with strict token streaming. PostgreSQL with pgvector provides semantic retrieval for ICD-10 and CPT medical coding validation.
All components, schemas, and pipelines delivered with full client IP ownership and zero proprietary vendor lock-in.
Moving beyond generic chatbots, we engineer deterministic agentic systems that execute mission-critical business processes with strict validation, auditability, and data security.
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