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⚕Healthcare · D4 · Regional Medical CenterAnonymized — Real Engagement✓ Go-Live Achieved

D4 — Monthly Governance Report

Generated monthly post go-live — PDIO Deliverable 4 of 4 (recurring). Covers receipt chain metrics, governance rule performance, LLM-as-a-Judge accuracy, sample sealed receipts, and the operator improvement register. Report period: May 2026.

📄 D4 Deliverable — Monthly Governance Report · Engagement ENG-001 · PDIO Phase 4 of 4 (Recurring)

Receipt Chain Metrics — May 2026

1,247
Receipts Generated
Month of report
100%
Chain Integrity
No breaks detected
100%
Seal Verification
SHA-256 validated
312ms
Avg Receipt Latency
P95: 440ms
47
Escalations Triggered
Confidence < 0.70
3.8%
Auto-Escalation Rate
Within SLA: 100%

Governance Rule Performance

GOV-001

Chemotherapy Dosing

SLA: 100%
Triggers
23
Passed
19
Blocked
4
Avg Confidence
0.88
Avg Window
2.1 min

4 DPYD variants caught — 2 poor metabolizers (orders blocked), 2 intermediate (doses reduced)

GOV-002

Immunocompromised Environment

SLA: 97%
Triggers
67
Passed
61
Blocked
6
Avg Confidence
0.82
Avg Window
18.4 min

2 SLA misses during overnight surge — process improvement queued

GOV-003

Treatment Eligibility

SLA: 100%
Triggers
31
Passed
27
Blocked
4
Avg Confidence
0.86
Avg Window
21.7 hrs

4 VUS findings flagged — all routed to tumor board for adjudication

GOV-004

Wildfire Smoke Response

SLA: 100%
Triggers
8
Passed
8
Blocked
0
Avg Confidence
0.91
Avg Window
7.2 min

2 AQI spikes, 1 NASA FIRMS alert — HVAC activated in all cases

GOV-005

Hereditary Screening

SLA: 100%
Triggers
14
Passed
12
Blocked
2
Avg Confidence
0.84
Avg Window
31.6 hrs

2 VUS-only findings blocked — appropriately not actionable under NCCN

LLM-as-a-Judge Monthly Performance

Recommendations evaluated
143
Threshold: ≥ 15/month
Judge pass rate
94.4%
Threshold: ≥ 90%
Correctly blocked (true positive)
16
Threshold: Documented per block
False positive rate
5.6%
Threshold: ≤ 10%
False negative rate
0%
Threshold: Must be 0% — GO-LIVE GATE

Sample Sealed Governance Receipts

ATLAS GOVERNANCE RECEIPT — GR-20260501-RMCTR-0047✓ SEALED
DECISION ID:GR-20260501-RMCTR-0047TIMESTAMP:2026-05-01T09:23:14ZFACILITY:Regional Medical Center — Oncology Unit 4TRIGGER:GOV-001: Chemotherapy Dosing GovernanceRISK SCORE:LPRM: 0.87 (patient-level)CONFIDENCE:0.93JUDGE RESULT:PASSED — DPYD *2A/*2A confirmed, standard-dose 5-FU order presentRECOMMENDATION:BLOCK ORDER — Poor metabolizer confirmed. Require 50% dose reduction before proceeding. CPIC Grade A recommendation.AUTHORITY:AUTH-001: Pharmacogenomics SpecialistHUMAN ACTION:Dose reduced to 50%. Attending oncologist notified. Pharmacist co-signed.RATIONALE:DPYD *2A/*2A allele confirmed — CPIC poor metabolizer classification. Standard dose is contraindicated.SHA-256 SEAL:SHA-256:7f3a9b2c4d1e8f6a3b9c2d4e1f8a6b3c9d2e4f1a8b6c3d9e2f4a1b8c6d3e9f2aPATENT REF:TPP96862STATUS:SEALED
ATLAS GOVERNANCE RECEIPT — GR-20260508-RMCTR-0112✓ SEALED
DECISION ID:GR-20260508-RMCTR-0112TIMESTAMP:2026-05-08T02:47:31ZFACILITY:Regional Medical Center — Bone Marrow Transplant UnitTRIGGER:GOV-002: Immunocompromised Patient EnvironmentRISK SCORE:LPRM: 0.91 (ANC=280) + ERI: 0.74 (pressure 0.7 Pa)CONFIDENCE:0.88JUDGE RESULT:PASSED — ANC confirmed <500, pressure confirmed below thresholdRECOMMENDATION:Initiate emergency HEPA protocol. Restrict visitor access. Notify nursing charge and infection preventionist immediately.AUTHORITY:AUTH-003: Infection PreventionistHUMAN ACTION:HEPA protocol activated 02:51. Visitor restriction posted. Room pressure remediated by 03:22.RATIONALE:ANC 280 (severe neutropenia) + clean room pressure 0.7 Pa (below 1.0 Pa threshold). Dual trigger confirmed.SHA-256 SEAL:SHA-256:4c8f2b1a9d3e7f2c4b8a1d9e3f7c2b4a8d1e9f3c7b2a4d8e1f9c3b7a2d4e8f1cPATENT REF:TPP96862STATUS:SEALED

Operator Improvement Register

P1

GOV-002 overnight SLA misses (2 events)

ETA: 2026-06-01

Add automated charge nurse paging for 2 AM–6 AM window. Deploy in Sprint 47.

P2

Confidence calibration — GOV-003 borderline VUS cases

ETA: 2026-06-15

Retrain judge prompt with 15 additional VUS adjudication examples from tumor board records.

P3

Phase 2 sensor deployment

ETA: 2026-07-01

CO₂ and VOC sensors in oncology unit — adds 40% reserved ERI weight.

Ongoing Operation — D4 Cadence

This D4 report is generated monthly for the life of the ATLAS deployment. Receipt chain integrity is verified on every report. Governance rule performance is reviewed quarterly with the client's compliance team. The operator improvement register is maintained continuously. All receipts are available for regulatory audit on demand with retrieval latency < 200ms.

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Anonymized · Real Engagement · CROMTEC.AI · Patent TPP96862

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