Acute, scribe, and outpatient aren't three products. They're one loop — something arrives, intelligence enriches it, a clinician decides, the work files, the follow-through is tracked — run at eight different timescales. Synapse 3.0 is that loop given one surface: a time spine every role reads at their own zoom.
Rationale pins explain the design decisions. What's-real maps every element to EXISTS / EXTEND / NEW against today's products.
A concept exploration uniting the acute time-rail, the scribe platform, and the outpatient tool set. Fictional data throughout.
THE ARGUMENT
One loop, eight timescales 1
Role
Timescale
Unit of work
Verbs
Acute neurologist
Minutes (LKW-anchored)
The consult
activate, order, document, sign
Neuro hospitalist
A 12-hour shift
The rounding list
round, reconcile, handoff
EEG reader
Study queue (SLA hours)
The study
read, report, link, sign
Clinic neurologist
A clinic day
The encounter
prep, see, sign, route
Triage nurse
Continuous (contact age)
The inbound contact
triage, schedule, escalate, close the loop
Medical assistant
Real-time flow
The rooming step
room, capture, complete, flag
Practice manager
Day / week
The exception
rebalance, staff, intervene
Patient
Episodic → years
Their own story
share, confirm, follow
N1 — Eight rows, one architecture. What changes between roles is zoom, unit of work, and verbs — not the system. This table is the whole pitch; everything below is it, rendered. Rows can share one human: acute + rounds + reads is a single rostered day.
N15 — Roles are rostered per day. Acute + rounds + reads is a legal combination; reads stack onto either side; inpatient and clinic never share a daytime — the schedule doesn't fit. The role-stack chip shows which hats this login wears today; switching lenses never re-authenticates.
N5 — Per-engine autonomy — Draft → Queue → File+audit. The dial makes governance visible instead of burying it in settings. The deterministic safety gate deliberately has no dial.
ACUTE ZOOM · LKW 09:58 · minute scale 7
22:56remaining in 4.5h windowdoor-to-needle if treated now: 40 min · target < 60
09:58 LKWwitnessed onset
10:22 ED arrivalMercy General
10:34 CT headno hemorrhage · ASPECTS 9
10:41 Labs drawnglucose pending
10:47 Consult — youNIHSS 11
10:52 ✦ CT read draftqueued for over-read
11:10 CTA resultexpected
11:25 Decision pointcriteria review
N7 — This zoom level IS the parked Synapse 3.0 time-rail — LKW anchor, offsets, derived door-to-needle. The parked exploration didn't die; it turned out to be the seed of the whole information architecture. (its clock header + gates + detail cards became Rail → Band → Card, platform-wide)
N2 — 'The clock is the organizing principle, not the modality' — written about stroke codes, promoted to the platform spine. Every lens is a zoom preset on one plane; past files left, work approaches from the right.
▲ STROKE CODE+15 min
Walter Simmons · 71M
Criteria review blocked by 2 items — glucose, anticoag hx
✦ DRAFT+10 min
CT over-read
✦ radiology draft awaiting your co-sign
⏱ NEXTin 8 min
CTA result expected
auto-lands on this rail when resulted
3
N3 — Temporal position under-orders priority, so the region around now renders as a ranked attention band — the worklist absorbed into the timeline's geometry. Rail answers when; the band answers what needs you.
Walter Simmons
71M · MRN F-204871 (fictional) · Mercy General ED
HTNAFib — hx unclearapixaban Rx 2024? ✦ found in outside recordNIHSS 11 @ 10:47BP 168/94
THROMBOLYSIS CRITERIA — DISPLAY ONLY
Within treatment window — LKW +64 min
Disabling deficit documented — NIHSS 11
CT: no hemorrhage · ASPECTS 9
Serum glucose — pending BLOCKS REVIEW
Anticoagulant use — unconfirmed (✦ apixaban Rx flagged from outside record — verify with family) BLOCKS REVIEW
Platelets — resulted 10:59, within range
Criteria checklist · decision support only · not an eligibility determination · ruleset v0 — ownership TBD
6
N6 — Criteria, never verdicts — carried verbatim from the parked doc. Missing data is a first-class state: the gate renders what blocks review, not a recommendation. The unanswered question from that doc stands: who owns this ruleset, with a version and a review cadence?
N4 — AI outputs land as events — the historian interview, the drafted note, the CT read arrive on the rail like lab results. No chat box as the primary metaphor: the engines work ambiently and their finished work lands in time, reviewed at the now-line. This is the prompting-direction departure from 2.0.
NEXT VISIT11:15
Evelyn Park · 34F
New migraine consult — ✦ prep brief ready, 3 flags
✦ NOTE READYsince 09:24
James Whitfield · 58M
Scribe note awaiting your review — 96% complete
● FOLLOW-UP08:30
Carlos Delgado · 45M
No-show — reschedule task with MA, GBS f/u overdue
✦ LINKED
Whitfield amb-EEG
report signed by Dr. Vega 08:20 — attached to today's med-check
Evelyn Park
34F · new consult · self-referred
migraine w/ aura — pt reportedfamily hx — mothersleep disruption ✦no prior imaging on fileoutside records requested — Epic ✦
✦ PREP BRIEF — HISTORIAN INTERVIEW 08:40 · 12 MIN
Eight months of recurrent unilateral throbbing headache, 1–2 per week, with visual scintillations preceding onset by ~20 minutes. Photophobia and nausea during episodes; resolution with sleep.
Triggers reported: sleep disruption (new shift schedule), skipped meals. No thunderclap onset, no focal weakness, no fever. ✦ flagged for you: aura description atypical on one episode — worth characterizing.
OTC use escalating — pt counts 12 analgesic days last month ✦.
EXISTS · historianEXTEND · historian → prep wiring
✦ plan library — migraine, new consult (487-plan set)
96% · 1 pending item: seizure frequency — say or type to resolve
HPI
Exam
Assessment dictated, not inferred
Plan from library · edited
Interval history: no events since last visit per patient and spouse. Medication adherence confirmed…
OURS → EPIC · FINAL
files to our archive · paste finalizes in Epic
✦ scribe — File+audit
8
N8 — The Epic-hybrid rule from the triage MVP, generalized: every artifact wears its single owner. OURS is authored here; EPIC · FINAL means the paste filed it; Epic-only artifacts (orders, results, patient messages) never pretend to live here.
no bowel/bladder involvement reported — gateway checked negation
hx lumbar stenosis — correlates with distribution
Thanks for writing, Ms. Alvarez. We'd like to see you within the next 2–3 days rather than wait…
Thu 9:20 · PatelThu 15:40 · Rivera
EPIC
message returns via Epic
✦ triage — Queue (drafts never auto-send)
gateway: deterministic — no dial
Dorothy Kling
66F · phone callback 10:41
recurrent BPPV 2024lives alone
RN DECISION RECORD
Engine returned: undetermined — human-first hold (dizziness cluster, low confidence).
RN assessment on callback: symptoms positional, resolving, no red flags — same-day visit appropriate rather than ED.
DISPOSED · same-day 14:30 — Dr. Chen✦ engine deferred
10
N10 — Human-first holds survive 3.0: the engine deferred, the nurse decided, and the record says exactly that. AI proposes, clinician disposes — the same contract in every lens, at every autonomy setting.
N11 — AI-readiness per visit — historian done? prep built? — is the MA's actual question about every upcoming patient. Straight from the Feb role-based design's flow board, re-expressed on the shared rail: same events, flow-state rendering.
ROOM NEXT11:10
Evelyn Park · Chen
✦ prep ready · vitals + headache diary intake
⏱ TURNOVER
Room 3 by 11:05
turnover before Park's rooming — Whitfield out at 10:58
3 providers on site2 virtual MAs9 rooms · 8 staffed
92%
ON-TIME STARTS
— steady
2
TRIAGE OPEN
oldest 7 min
3.1h
EEG READ P50
▲ STAT SLA at risk
3.8m
NOTE LAG · MEDIAN
▼ 0.6 · ✦ scribe
Site
On-time
Open triage
Riverview
92% —
2
Lakewood
93% —
0
10:47 — coverage: Dr. Vega pulled to acute (rounds 3/9 remain · STAT read due 11:20)
10:19 — triage: ED disposition locked (Barnes) ✓ closed
08:31 — first note filed 5 min post-visit ✦
12
N12 — Aggregates are the same events, summed — the manager lens runs on the identical stream, so there is no separate reporting product to keep honest. Note-lag comes straight from the scribe's noteReadyAt; the coverage suggestion is Draft-autonomy: it proposes, a human rebalances.
metrics: OURS
✦ ops digest — Draft
EXISTS · PM dashboard design (Feb 2026, approved)EXTEND · noteReadyAt + triage SLA as live metricsNEW · same-stream aggregation (no reporting silo)
EVELYN'S PHONE · 10:58 AM
Your visit today
✦ You told your story — 8:40 AM, 12 minutes. Dr. Chen has it. sleep patternaura detailsmedication days3 things flagged for today's conversation
Your visit is on time — 11:15 with Dr. Chen.
confirmed 10:45
After your visit: your plan, in plain words.
We'll likely start a daily preventive — details after you and Dr. Chen decide.
14
N14 — The historian's other end. The patient tells the story once and watches it get used — the loop's 'arrives' step seen from outside. Whether this lives inside Synapse or ships as a companion with the same primitives is an open question below.
THE PROOF
Seven lenses, one day 9
Acute
The parked time-rail returns as a zoom level: LKW clock fused to the now-line, criteria gates that render missing data, never verdicts. Fastest loop, same primitives.
Rounds
The census is a worklist with a now-line: seen recedes left, the code pauses the list mid-round, and the ✦ discharge draft queues for review. Same rail, twelve-hour zoom.
EEG Read
Studies age toward SLA like triage contacts; the report is sentence-built with deterministic CPT — the real Report Builder — and a signed read links itself to the chart, the rounds list, and this afternoon's clinic visit.
Clinic MD
A day is a rail: filed mornings left, ✦ prep and drafts landing as events, the band holding what actually needs the physician. The scribe files; the paste finalizes.
Triage RN
Contacts age along the rail toward SLA, the engine drafts in Queue autonomy, and human-first holds close as RN decisions with the record saying so.
MA Flow
Three provider lanes, one now-line: rooming states, readiness dots, and the acute ripple applied — the Feb flow board living on the shared spine.
Manager
The same stream, summed: coverage events, SLA, note lag. Suggestions arrive at Draft autonomy; a human rebalances.
N9 — Same 10:47 consult — one person, three hats. The code is the work in Acute, pauses the census in Rounds, and puts a STAT read's SLA at risk in EEG Read, where the Manager sees a reassignment suggestion — while Clinic and Triage correctly never feel it. Multi-role days are rostered reality (acute + rounds + reads mix; inpatient and clinic never share a daytime); the lens switcher isn't a demo trick, it's the product.
Walter Simmons71M · MRN F-204871 (fictional) · chart · years-zoom16
N16 — Every patient is a rail too: the chart drawer is the years-zoom from the thesis table, opened from any patient or any study event. Priors are events left of every now. Ownership stays honest — our notes are OURS; Epic-owned results appear as paste-mirrored snapshots in clinic; acute imaging rides the consult, where Synapse 2.0's PACS panel already exists. Imaging is still read in the dark — the viewer is Daylight's one dark room.
2019 · OUTSIDE RECORDHypertension — dx, treated
2024 · OUTSIDE RECORDApixaban Rx — ✦ flagged from outside record · verify with family
TODAY 10:34 · MERCY GENERALCT head — non-contrast · no hemorrhage · ASPECTS 9
TODAY 08:20Amb-EEG — signed ✦ Dr. Vega · linked to this visit
TODAY 09:00Visit — med check · scribe note in your queue
Clinic priors are paste-mirrored snapshots — Epic stays the source for Epic-owned artifacts; our notes live here natively.
Amb-EEG report — signed 08:20 · Dr. R. Vega
Background: well-organized for age. No electrographic seizures captured across the 48-hour recording. Interictal findings unchanged from the 2025 study.
✦ sentence-builtlinked: chart · rounds · this visit
CPT computed deterministically on sign — the Report Builder's coding engine, rules not a model.
report: OURS
THE LANGUAGE
Daylight — a full departure 13
Synapse 2.0 is a command-center console: near-black tonal steps, 9–11px density, one expert user, no shadows. Daylight leaves it entirely — warm paper, real elevation, an editorial serif for human names, and color reduced to a strict grammar.
paper#f6f3ee
card#fdfbf7
well#efeae2
line#e3ddd2
ink#1f2430
ink-2#555e6e
ink-3#8b93a1
action#1e40af
ember#c2410c
AI#9333ea
ok#047857
warn#a16207
critical#be123c
INK — structure and action.
EMBER — time. The now-line, the countdown, never a data dot.
VIOLET — AI provenance. If ✦ touched it, it's violet. (The one piece of 2.0 kept on purpose.)
RED/AMBER/GREEN — clinical state, always with a label, never color alone.
Walter Simmonspatients get the serif — people, not data
This is the body sans — 14.5px, humane, easy at a glance.everything that isn't a name or a time is sans
2:56time is mono, tabular, ember
Mark palette validated all-pairs (OKLab CVD simulation): navy/violet/rose/green pass; warm hues are restricted to structure and labeled chips by rule — red-green pairs carry shape + label redundancy (crit = double ring, AI = ✦ ring, filed = ✓).
What changed, and why
Synapse 2.0
Daylight / 3.0
why
near-black tonal stack, no shadows
warm paper + real elevation
only the now and the top-ranked card cast a shadow — elevation is meaning, not decoration
9–13px dense type, uncontrolled scale
13px floor, 5-step scale
time-pressured reading punishes microtype; density moves to progressive disclosure
fixed 260 / 380 / 520px rails
zoom presets on one plane
layout adapts to role, not to one hand-fit desktop
queue tabs (Acute · Rounding · EEG · Outpatient)
role lenses on one stream
the switch is who you are, not which list you watch
emoji as icons
12-glyph inline SVG set
themeable, consistent, prints
blue #3b82f6 everywhere
navy #1e40af, used sparingly
action stands out only because almost nothing else is blue
purple = AI (✦)
KEPT — violet, re-lit for daylight
the equity worth keeping: everyone already reads violet as 'AI touched this'
20%-tint badges
kept as chips — always labeled
the badge DNA survives; color-alone semantics don't
chat/copilot as AI metaphor
AI work lands as events in time
ambient engines, reviewed at the now-line — the dial governs how far they run
N13 — The 2.0 audit drove every row: 9–11px type, fixed 260/380/520px rails, emoji icons, a single-role data model. Daylight inverts each deliberately. One survivor by choice: violet still means 'AI touched this.'
THE PATH
How we get there
Today's products are the lenses' ancestors
The acute console (Synapse 2.0), the desktop scribe, the OPS triage engine, the historian, the plan library, the EEG Report Builder (eeg.neuroplans.app) — each already runs one arc of the loop. Nothing here requires a new capability; it requires the same capabilities on one spine.
The Feb role-based dashboards are the first lenses
The approved MA flow board and practice-manager views ship as OPS pages first. When they land, they are Daylight lenses in waiting — same events, same primitives. The triage-nurse MVP (Epic-hybrid, paste as the bridge) is the triage lens's v1, and its boundary rule generalizes platform-wide.
The boundary stays honest
Epic remains record + contact for outpatient; Sevaro remains tracking + intelligence. 3.0 does not assume integration — it renders ownership on every artifact and gets better, not different, if deeper integration ever arrives.
Frame-stage discipline: this page is concept fuel for the unified-app architecture doc cycling through the Wednesday deep-dives. Per the portfolio card — nothing else should couple to this direction yet.
UNRESOLVED
Open questions for the Lab
Autonomy defaults — every engine has a stop: Draft (writes a draft you have to open), Queue (finished work waits in your band for sign-off), File+audit (files itself, logged, always reviewable). Today’s scribe effectively runs File+audit; triage runs Queue. Which stop does each engine launch at — and can a practice raise its own dial, or is raising autonomy a governance action?
Gate rulesets — who maintains the thrombolysis criteria content over time? (Steve 7/21: the physician owns the criteria decision; the tool supports it. Open sub-question is maintenance: who signs a ruleset update when guidelines change, on what review cadence — the parked doc’s stale-checklist warning.)
How much AI in the exam is too much? (Steve 7/21: today’s scribe pattern is the seed — it listens to the exam and fills NIHSS plus recommended scales, and the physician manually selects to add them. Getting this workflow right matters; never-auto-score stands.)
The patient lens — the phone view in this concept (✦ historian interview status, visit updates, the plan in plain words). Does that ship inside Synapse or as a companion patient app on the same data? In today’s terms: where does the historian’s patient-facing side live?
Migration for today's 2.0 acute users. (Steve 7/21: not a worry yet — eventually a big bang; lay it out and build it first. Aspirational, and it runs through product.)
Manager visibility into individual clinician metrics. (Steve 7/21: physicians should see their own data — quality reviews included; the fine line is what gets surfaced to managers.)
Role rostering — where do legal same-day combinations live (acute + rounds + reads: yes; either + reads: yes; inpatient + clinic in daytime: never), and does the surface enforce them or just display them?