Closure ledger design
Who this page is for: the practice manager responsible for proving the administrative loop closed - and who would rather see UNKNOWN than a false CLOSED.
Current release posture: this page documents an evaluated design exploration. The standalone closure-ledger route is not included in the licensed connected console. Current Practice analytics exposes bounded aggregate closure and timing from tenant-owned events; it does not expose the specimen-level workflow described below.
Most of Refera is about what arrives. The design-only closure model watches what leaves. For every billed specimen, the ledger expects a result, a review and a notification, and resolves each one to a single state, provable from the practice’s own records. It runs quietly in the private test fixture; it is an evaluated assurance design, not a current connected route.
The three states
Section titled “The three states”| State | Meaning |
|---|---|
| CLOSED | Result on file, review evidenced, notification recorded. |
| OPEN | Something is still outstanding. It stays on the list until it is not. |
| UNKNOWN | The records do not prove closure either way. Shown for staff review - never assumed closed. |
Deliberately biased to UNKNOWN
Section titled “Deliberately biased to UNKNOWN”When the evidence is incomplete, the ledger says so rather than assuming the loop was closed. UNKNOWN is an answer, and it routes to a person. A ledger that guessed “probably fine” would be worse than no ledger at all - the whole value is that CLOSED is provable.
Where the evidence comes from
Section titled “Where the evidence comes from”The ledger reads only the practice’s own records - either a billing report the practice exports itself, or the pathology results that already arrive on Refera’s inbound stream. It needs no live EMR integration for evidence review. Capture, surfacing, drafting and growth need no billing data at all.
The framing that never changes
Section titled “The framing that never changes”This is administrative process-state tracking: whether the loop closed - never what a result means. Refera tracks referral admin only. It does not triage patients.
Related
Section titled “Related”- Chain of custody - the sealing underneath every state change.
- What Refera does not do - UNKNOWN as an answer, in context.
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Refera tracks referral admin only. It does not triage patients.
Examples are fictional and contain no patient information. Practice staff approve every external action. Refera never auto-sends or independently contacts patients.
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