Shareable with Neha. Exam tab, Imaging/results with longitudinal labs, and the scale drill-down you asked for. Plus the real scale-catalog state, which is not what any existing doc says.
1. "MoCA is already in production, live compliance question." I said this three times and pushed it as urgent. You: "there's nothing actually shipped, just to be clear. This is all in data testing, just drafts." That kills the urgency entirely. MoCA licensing is a normal pre-launch item, not a fire. I manufactured a clock that doesn't exist.
2. "ALSFRS-R and MG-ADL aren't built — add them." They're both already in
sevaro-scribe-companion on main, added in commit 55a76aa.
And they're already classified 'history', with the reasoning spelled out —
"patient-reported symptom-burden questionnaire". Someone applied your rule and reached
your answer before either of us discussed it.
3. The "18 shared / 7 / 10" ledger I quoted is stale, and so is the
byte-identity claim in SCALE_CATALOG.md. Both were true on 2026-07-06 and aren't now.
The pattern: all three came from reading one repo and
generalising. I checked origin/main in every repo this time rather than
whatever branch happened to be checked out — the working copies are all sitting on stale feature
branches, which is what fooled me.
Read from origin/main in each repo, just now. Companion has quietly
become the superset.
scales-enhanced.jsonscale-definitions.tsscale-definitions.tsSCALE_CATALOG.md says SEE and companion are byte-identical, and a CI job guards
each file's hash. They differ by 604 lines and 7 scales on main today. Each
repo's hash guard is working perfectly — it stops silent drift within a file. Neither
guard compares the two repos to each other, so they've drifted apart loudly, in
commits, and no check noticed.
| Set | n | Scales | Action |
|---|---|---|---|
| All three | 20 | The shared core — PHQ-9, GAD-7, MIDAS, HIT-6, MoCA, ESS, NIHSS, ABCD2, Mini-Cog, H&Y, EDSS, CHA₂DS₂-VASc, HAS-BLED, GCS, mRS, Barthel, Hunt-Hess, FOUR, ICH, STOP-BANG | ALIGNED (ids/counts still differ) |
| Companion only | 7 | alsfrs_r, mg_adl, wfns, house_brackmann, hughes_gbs, cam_icu, rass |
Port to SEE. Purely additive |
| Code, not np2 | 11 | dhi, dn4, isi, odi, ndi, modified_ashworth, updrs_motor, ecog, race, stess, four_at |
Backfill into np2. These are the outpatient ones |
| np2 only | 8 | fisher, modified_fisher, mmse, mrc_sum_score, mgfa, schwab_england, ranchos_los_amigos, gbs_disability |
Per-scale call — see below |
| SEE only | 0 | — | NOTHING TO DO |
Hughes GBS and gbs_disability are the same scale. Companion
calls it Hughes, np2 calls it GBS Disability. It looks like a gap on both sides and isn't —
it's a rename. That's one of eight "np2-only" scales evaporating on inspection, which is a fair
warning about the other seven.
MMSE is on the np2-only list — so dropping it is a one-repo edit, not three. Easiest item in this whole document.
Reconciliation isn't one job, it's three. SEE←companion is mechanical (additive, zero conflicts). np2←code is a backfill of 11. code←np2 needs your per-scale calls — and I'd argue most of them are no: Fisher, modified Fisher, Rancho, Schwab-England and WFNS are SAH/ICU scales that don't belong in an outpatient picker. That's not divergence to fix; it's np2 carrying inpatient scales the outpatient product shouldn't show.
You asked which one you have. It's labelled UPDRS Part III but it is
the MDS-UPDRS. Three independent tells: it cites "Goetz CG, et al.
Movement Disorder Society-sponsored revision of the UPDRS. Movement Disorders. 2008" —
that's the MDS revision paper; its items are numbered 3.1 Speech, which is MDS
numbering, not the original's; and it models 33 items, the MDS Part III count.
So the licensed one is in the catalog wearing the unlicensed one's name. Nobody did anything
wrong — UPDRS-III is what everyone calls it colloquially. But it means "we'll use
whichever one you think we have" resolves to the one that needs MDS permission.
Either get permission, or rebuild it as the original UPDRS Part III, or drop Parkinson's motor
scoring. Given nothing's shipped, this is a cheap fix now and an expensive one later.
You: "Should we give a baseline? We build a nice generic one that would be helpful for just telemedicine, recognizing the limitations… It would give them one, but they can edit it to make it their own voice."
An empty template is a blank page, and a blank page is why "author your normal exam" has never happened. Shipping one means the feature works on day one for a physician who never opens settings, and editing-to-taste is a much smaller ask than composing from nothing.
Your "recognizing the limitations" is the part I'd emphasise most. A Sevaro default that silently asserts reflexes would be documenting an exam nobody can do over video — and you already said it: "reflexes on video are like worthless." Dr. Peeyoosh agreed: "I never got them right, ever." So the default omits reflexes, fundoscopy, and fine sensory by construction. The default template is a clinical-safety artifact, not a convenience. It's the one place you can make the honest thing the easy thing — and if someone wants reflexes, they add them deliberately, which is exactly the right friction.
Of the 38 in companion, most are acute. The exam tab should show the exam-classified, outpatient-relevant ones — eight, not thirty-eight:
| Exam scale | For | Note |
|---|---|---|
| NIHSS | Stroke follow-up | FREE |
| MoCA | Cognitive | MA administers · training |
| Mini-Cog | Cognitive screen | FREE |
| EDSS | MS | FREE |
| UPDRS-III | Parkinson's | MDS-UPDRS 🔒 |
| Hoehn & Yahr | Parkinson's staging | FREE |
| DN4 | Neuropathic pain | FREE |
| Modified Ashworth | Spasticity | FREE |
| House-Brackmann | Facial palsy — Bell's | IN COMPANION |
| MRC-SS, MGFA | Neuromuscular | np2 → backfill |
GCS, Hunt-Hess, FOUR, ICH, RACE, STESS, 4AT, CAM-ICU, RASS, WFNS stay out. They're inpatient and ICU scales. They can live in the catalog and never appear in an outpatient picker — which is an argument for one catalog with a surface filter, rather than separate catalogs per app.
You said you'd never heard of it. That's the answer: it's a cervical-dystonia severity scale used by movement-disorder specialists running Botox clinics. If it's not in your vocabulary it's not in your workflow, and my research over-indexed on completeness rather than on what Sevaro's neurologists actually do. Dropping it. Same instinct applies to anything else on my earlier list you don't recognise — that's a signal about the list, not about you.
| Lab | 11/17/24 | 05/02/25 | 11/08/25 | 01/16/26 | |
|---|---|---|---|---|---|
JCV antibody index index |
0.31 | 0.42 | 0.88 | 1.62 | ↑ |
Vitamin D, 25-OH ng/mL |
18 | 24 | 31 | 41 | ↗ |
ALT U/L |
22 | 26 | 24 | 21 | → |
WBC K/µL |
6.2 | 5.8 | — | 6.0 | → |
You: "Sometimes I may want to see their individual components. Can I dig even deeper? So if I click on the score of 32 for the Midas… I want to see each of those components and trend those."
Yes. The score is a link; components trend underneath it. Same pattern the labs table already uses — a row per thing, values across time.
The total says "MIDAS improved 32 → 14, treatment working." The components say something the total can't: work and household impact both fell, and social/leisure never moved. That patient is functioning at work and still not going out — which is a different conversation, and possibly a different intervention.
That's the argument for depth-2. The total is the quality metric you sell to a health system; the components are the clinical signal you use in the room. Different consumers, same data, and only one of them is served by the number alone.
I'd stop at two levels. Below the component is an individual answer at one visit, which is just the form you already filled in — no third level.
You: "If people search for them, say why we're not using them… if the clinician wants it, they could maybe say, can we subscribe to this one? That way people are looking for it a lot, we're keeping track of that… That's probably more than we're going to have in the MVP."
You're right it's post-MVP. But note what the "Request anyway" button actually is: your quorum process, turned into data. Instead of debating in a meeting whether a scale is worth licensing, you'd know that eleven physicians asked for MMSE this quarter and nobody asked for SDMT. That converts a recurring argument into a number.
The screen is post-MVP. The counter isn't — log the searches from day one. It costs almost nothing and it's the only way the data exists when you eventually want it. You cannot backfill a year of demand signal.
| Decision | Detail | Status |
|---|---|---|
| Master catalog | OPSAmplehtml is the demo — ignore it. neuro-plans-v2 + SEE + companion reconcile to one. Companion is today's superset (38). | STEVE |
| Exam vs history rule | Does producing the number require a physical maneuver at this encounter? Examiner → exam. Patient reports → history. | RATIFIED |
| mRS → history | And Barthel. Both interview-derived. Currently 'exam' in code. Melanie's ask. | RATIFIED |
| Drop MMSE | Licensed + redundant vs MoCA/Mini-Cog. np2-only, so a one-repo edit. | AGREED |
| Keep MoCA | MA administers. Free for clinical use with training — build the education path. | AGREED |
| Drop HIT-6, keep MIDAS | Commercially owned; MIDAS covers headache disability free. Open: confirm no payer mandates HIT-6 for Botox PA — Prachi's question. | 1 OPEN |
| UPDRS-III is MDS-UPDRS | Mislabelled. Needs MDS permission, or rebuild as original UPDRS, or drop. | NEEDS CALL |
| No shared critical flags | Pins are per-user bookmarks. Unpin/repin freely. AI summary may surface critical items instead. | DECIDED |
| Ship a default exam | Sevaro tele-neuro normal, editable to voice. Omits reflexes/fundoscopy/fine sensory by construction. | DECIDED |
| No settings area | "Save as my default" in place on the exam. Settings earns its way in later. | DECIDED |
| Scale drill-down | Score → components, each trended. Two levels, no third. | DECIDED |
| Drop TWSTRS | Withdrawn — outside Sevaro's workflow. | WITHDRAWN |
| Vitals / fever chips | Never discussed in 3 hours. Still open. | OPEN |