Kareplexityv0.1 demoOpen workspace
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Agent invocation · 5/9/2026, 7:54:27 AM

Show me documentation gaps for Evelyn Strickland.

Latency

30.9s

Tools

5

Tokens

97,594

Model

claude-opus-4-7

Final response

Documentation Gaps — Evelyn Strickland

Resident: Evelyn Strickland, age 89, ltc_insurance, active Primary Dx: S72.002A — Displaced fracture of left femoral neck (s/p left THA) Current HIPPS: BBADD (PT: B, OT: B, SLP: A, Nursing: D, NTA: D) Risk Severity: High

HIPPS Optimization Gaps (2)

These are documentation items already supported by notes in the record, but not yet captured in MDS coding — so they aren't translating into HIPPS components.

1. Depression not flagged on MDS (Nursing component)

  • Field: pdpmDepression is currently false, despite MDS C0500 = 13 (which already meets the PDPM depression threshold).
  • Evidence already in the record:
    • MD note 2/3: "...depressed mood, tearfulness, and decreased appetite since admission. Will continue to monitor mood."
    • MSW note 1/31: "Observed tearfulness during interview... Will monitor for depressive symptoms..."
  • Action: Complete a PHQ-9 (D0150) or staff assessment (D0500) and reconcile with C0500=13 at next MDS. This typically lifts the Nursing component (currently D) — material PDPM rate impact.

2. Pressure injury / wound not flagged in NTA

  • Field: ntaUlcersExceptStage4 and ntaOpenWoundsLesions both false.
  • Evidence already in the record:
    • RN note 2/10: "Coccygeal pressure injury... 1.8 × 1.5 cm, non-blanchable erythema... Stage 1 pressure injury. Resident repositioned Q2H... pressure-redistributing mattress overlay in place."
  • Action: Capture the appropriate NTA wound flag. Each NTA point matters — this could move the NTA component above D.

Survey-Risk Gaps (F-Tag exposure)

From the pending high-severity recommendation on her chart:

  1. Unwitnessed fall on 2/8 — incident report shows resident found on floor, bed alarm re-activated, care plan updated. ✅ Post-fall actions documented, but no PHQ-9 score was completed despite mood symptoms (F-tag F697/F758 exposure).
  2. Depressed mood across MD + MSW notes with C0500 = 13 but no PHQ-9 (D0150) on file — same gap drives both the F-tag and HIPPS issues above.
  3. Stage 1 coccygeal pressure injury — clinically being managed (Q2H repositioning, overlay mattress), but no formal wound care plan is referenced in the notes (F-tag F686 exposure).

Recommended Next Step

Route Evelyn Strickland to the IDT review queue for a PHQ-9 completion (D0150) and an NTA reconciliation at her next MDS window, and have nursing attach the existing repositioning/overlay interventions to a formal Stage 1 pressure injury care plan. Closing the PHQ-9 alone resolves both the largest F-tag exposure and the Nursing-component HIPPS gap.

Tool chain

  1. 01Query residents
    306ms
    input
    {
  "limit": 5
}
    result preview
    {"facilityId":"2ff057db-734f-4d27-824f-d4cbc864cac8","appliedFilters":{"payer":null,"ptLetterMax":null,"diagnosisPrefix":null,"admittedAfter":null,"riskLevel":null,"limit":5},"matchCount":5,"residents":[{"id":"1e608feb-9811-47e1-96f9-8e66cb94aa55","firstName":"Sylvia","lastName":"Beaumont","primaryPayer":"medicare","currentStatus":"active","admissionDate":"2026-03-14","age":85,"hippsCode":"KKKEC","ptComponent":"K","mdsDate":"2026-03-19","primaryIcd10":"I69.30","primaryDiagnosis":"Sequelae of cerebral infarction with unspecified late effects, driving SNF stay for rehabilitation","riskSeverity":"critical","riskSummary":"Resident had an unwitnessed fall with bed alarm found inactive, plus documented post-stroke depression symptoms and dysphagia findings without confirmed PHQ-9 scoring or MBSS…[truncated 2570 chars]
  2. 02Semantic note searcherror
    1238ms
    input
    {
  "limit": 3,
  "query": "Evelyn Strickland"
}
    result preview
    ERROR: Failed query: 
      SELECT
        n.id,
        n.resident_id AS "residentId",
        r.first_name AS "firstName",
        r.last_name AS "lastName",
        n.note_date AS "noteDate",
        n.author_role AS "authorRole",
        n.note_type AS "noteType",
        SUBSTRING(n.content FROM 1 FOR 500) AS "content",
        1 - (n.embedding <=> $1::vector) AS "similarity"
      FROM clinical_notes n
      INNER JOIN residents r ON r.id = n.resident_id
      WHERE (::uuid IS NULL OR r.facility_id = ::uuid)
        AND (::uuid IS NULL OR n.resident_id = ::uuid)
      ORDER BY n.embedding <=> $2::vector
      LIMIT $3
    
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  3. 03Query residents
    158ms
    input
    {
  "limit": 100
}
    result preview
    {"facilityId":"2ff057db-734f-4d27-824f-d4cbc864cac8","appliedFilters":{"payer":null,"ptLetterMax":null,"diagnosisPrefix":null,"admittedAfter":null,"riskLevel":null,"limit":100},"matchCount":50,"residents":[{"id":"1e608feb-9811-47e1-96f9-8e66cb94aa55","firstName":"Sylvia","lastName":"Beaumont","primaryPayer":"medicare","currentStatus":"active","admissionDate":"2026-03-14","age":85,"hippsCode":"KKKEC","ptComponent":"K","mdsDate":"2026-03-19","primaryIcd10":"I69.30","primaryDiagnosis":"Sequelae of cerebral infarction with unspecified late effects, driving SNF stay for rehabilitation","riskSeverity":"critical","riskSummary":"Resident had an unwitnessed fall with bed alarm found inactive, plus documented post-stroke depression symptoms and dysphagia findings without confirmed PHQ-9 scoring or M…[truncated 31258 chars]
  4. 04Get resident detail
    493ms
    input
    {
  "resident_id": "21e38564-49f8-4546-81e6-a4bf3d468875"
}
    result preview
    {"id":"21e38564-49f8-4546-81e6-a4bf3d468875","name":"Evelyn Strickland","age":89,"sex":"female","primaryPayer":"ltc_insurance","currentStatus":"active","admissionDate":"2026-01-30","dischargeDate":null,"diagnoses":[{"icd10Code":"S72.002A","description":"Fracture of left femoral neck, displaced, initial encounter for closed fracture","isPrimary":true,"onsetDate":"2026-01-28","resolvedDate":null},{"icd10Code":"F03.90","description":"Unspecified dementia without behavioral disturbance","isPrimary":false,"onsetDate":"2023-05-02","resolvedDate":null},{"icd10Code":"I50.9","description":"Heart failure, unspecified","isPrimary":false,"onsetDate":"2021-07-10","resolvedDate":null},{"icd10Code":"N18.30","description":"Chronic kidney disease, stage 3, unspecified","isPrimary":false,"onsetDate":"2019-0…[truncated 8615 chars]
  5. 05Analyze HIPPS optimization
    290ms
    input
    {
  "resident_id": "21e38564-49f8-4546-81e6-a4bf3d468875"
}
    result preview
    {"residentId":"21e38564-49f8-4546-81e6-a4bf3d468875","name":"Evelyn Strickland","currentHipps":"BBADD","components":{"pt":"B","ot":"B","slp":"A","nursing":"D","nta":"D"},"gapCount":2,"gaps":[{"type":"depression_unflagged","field":"pdpmDepression","evidence":["[MD] ... noted by staff and social work to have depressed mood, tearfulness, and decreased appetite since admission. Will continue to mon...","[MSW] ...ness during interview. Will monitor for depressive symptoms and coordinate with interdisciplinary team. Medicare Part A insurance ..."],"suggestion":"Notes describe depressive symptoms but pdpmDepression is false. Score a PHQ-9 (D0150) or staff assessment (D0500) at next MDS to capture for nursing classification."},{"type":"wound_care_unflagged","field":"ntaUlcersExceptStage4 / ntaOpen…[truncated 584 chars]

Audit ID

d2fd342f-2f92-4503-84a7-0d24edf66551

Session

demo-session