SNF Referral AI Platform — Architecture Flowchart

1

📥 Document Ingestion & OCR

300+ page referral packets → clean structured text · <3 min per packet

📝 Marker

PDF → Markdown with 96% accuracy. Tables, multi-column, headers preserved. LLM-enhanced mode.

PRIMARY OCR · GPL-3.0

🔍 Surya

Transformer-based OCR. 97% similarity vs Google Cloud Vision. 90+ languages, 0.62s/page.

SCANNED DOCS · GPL-3.0

✍️ TrOCR

Microsoft's handwriting recognition. 94.6% accuracy on medical handwritten forms.

HANDWRITING · MIT

👁️ Qwen2.5-VL

Vision-language model. Reads complex pages visually — tables, charts, mixed content. 7B params.

COMPLEX DOCS · Apache 2.0

📐 Docling

IBM layout analysis. Document structure understanding, reading order, section detection.

LAYOUT · MIT

🔧 OpenCV

Preprocessing: deskew, denoise, contrast enhance, upscale to 300 DPI. +5-10% accuracy on faxes.

PREPROCESSING · Apache 2.0

2

🧬 Clinical NLP & Entity Extraction

Raw text → structured medical entities (diagnoses, meds, insurance, demographics)

🏥 scispaCy

Allen AI clinical NLP. Medical NER: diagnoses, medications, procedures, anatomy. Battle-tested.

CORE NLP · Apache 2.0

🧠 BioBERT

Fine-tuned on n2c2/i2b2 datasets. ICD-10 code extraction, clinical relation detection.

NER MODEL · Apache 2.0

💊 MedXN

Mayo Clinic medication extractor. Drug names → RxNorm normalized codes. Interaction checking.

MEDICATIONS · Open Source

🔒 Presidio

Microsoft PHI de-identification. 94% recall on patient names. HIPAA compliance layer.

DE-ID · MIT

🏗️ FHIR Resources

Map entities to FHIR Patient, Condition, MedicationStatement, Coverage. Interoperable output.

STANDARDS · Open Source

3

🧠 Intelligence Engine — Fine-Tuned LLM

Clinical reasoning, facility matching, financial analysis · Custom-trained on healthcare data

⚡ Qwen 2.5 (32B)

Base model fine-tuned with QLoRA on MIMIC-III/IV clinical data. Top clinical reasoning scores.

BASE MODEL · Apache 2.0

🔧 LLaMA-Factory

Fine-tuning framework. QLoRA r=64, 72% MedQA accuracy. Trains 32B model on single A100 in ~12hrs.

FINE-TUNING · Apache 2.0

📋 SGLang / Outlines

Guaranteed valid JSON extraction. FHIR-compatible schemas with per-field confidence scores.

STRUCTURED OUTPUT · Apache 2.0

📊 RAGAS + DeepEval

Evaluate faithfulness, relevancy, hallucination rate. Custom clinical accuracy metrics.

EVALUATION · Apache 2.0

3½

🕸️ Hybrid Knowledge Layer NEW

Temporal knowledge graph + vector search — relational reasoning meets semantic retrieval

👤

Patient

has_dx

🩺

Diagnosis

requires

🕸️

Graphiti
Temporal KG

covers

💳

Payer

accepts

🏠

Facility

🕸️

Graphiti (Zep)

Temporal Knowledge Graph
Entity relationships that evolve over time. Bitemporal tracking (event time + ingestion time). Multi-hop reasoning: Patient → Diagnosis → Equipment → Facility capability.

Queries: "What are this patient's current active medications?" · "Has this payer denied this diagnosis combo before?" · "Which facilities accepted similar acuity last month?"

Neo4j / FalkorDB · Apache 2.0

+

🗄️

Weaviate

Vector Semantic Search
Document-level retrieval with embeddings. Facility criteria docs, clinical guidelines, drug databases, ICD-10 codebook. Multi-tenant per facility.

Queries: "What are Facility X's admission criteria for wound care patients?" · "What does Medicare say about 3-day stay waivers?" · "Drug interactions for this medication list?"

On-prem K8s, HIPAA-ready · BSD-3

⏱️ Bitemporal Tracking

Every fact has valid_from/valid_to timestamps. Know what was true WHEN. Medications discontinued, diagnoses resolved, payer rules changed — all tracked.

TEMPORAL · Graphiti

🔗 Multi-Hop Reasoning

Patient → Diagnosis → requires Equipment → Facility has/doesn't have. Traverse entity chains for complex admission logic.

GRAPH TRAVERSAL · Neo4j

📚 LlamaIndex + LangChain

Hybrid RAG orchestration. Routes queries to graph (relational) or vector (semantic) based on question type.

RAG FRAMEWORK · MIT/Apache

📈 Institutional Memory

Graph accumulates cross-referral patterns over time. Readmission predictors, payer behavior, facility performance — emerges automatically.

PATTERN DISCOVERY · Graphiti

4

🤖 Multi-Agent Decision System (LangGraph)

Specialized agents query both graph & vector knowledge to produce recommendations

🔀

Triage Agent

Classify urgency & route

Vector: guidelines

→

🩺

Clinical Agent

Risk assessment & care needs

Graph: patient history

→

💰

Financial Agent

PDPM, insurance, med costs

Graph: payer patterns

→

✅

Criteria Agent

Facility match via RAG

Both: criteria + capabilities

→

📝

Explanation Agent

Reasoning + page citations

Graph: provenance trail

5

📤 Decision Output & Integrations

Structured recommendations pushed to EHRs, dashboards, and clinical review queues

⚖️ Admit / Consider / Deny

Transparent recommendation with confidence score, reasoning chain, and source page citations from the referral packet.

PRIMARY OUTPUT

📊 Clinical Summary

Single-page patient overview: diagnoses, medications, risks, care needs, financial projections.

SUMMARY

🔌 EHR Push

PointClickCare + MatrixCare integration. FHIR R4 resources. Bidirectional sync.

INTEGRATION

👨‍⚕️ Human Review Queue

Low-confidence items routed to clinicians. Override feedback loops back into model + graph.

HUMAN-IN-THE-LOOP

⚙️

🏭 Production Infrastructure

HIPAA-compliant, scalable, monitored — 240+ packets/day on a single GPU

🚀 vLLM

Model serving. 24x throughput vs alternatives. AWQ quantization. OpenAI-compatible API.

SERVING · Apache 2.0

☁️ HealthStack

Open-source IaC for AWS. HIPAA Terraform modules: VPC, encryption, audit logging, BAA-ready.

INFRASTRUCTURE · OSS

📈 MLflow + W&B

Experiment tracking, model registry, A/B testing. W&B has HIPAA BAA for enterprise.

MLOPS · Apache/Comm

🖥️ NVIDIA L4 GPU

24GB VRAM, $1.50/hr on AWS. Single GPU handles full pipeline. Scale to multi-GPU as needed.

COMPUTE · $800/mo

🌐 FastAPI

Async API layer. OAuth2/OIDC auth. Webhook callbacks. Rate limiting via Celery + Redis.

API · MIT

📊 Grafana + Prometheus

Observability: latency, accuracy drift, error rates, GPU utilization, model performance.

MONITORING · OSS

AI-Powered SNF ReferralManagement Platform

Graphiti (Zep)

Weaviate

AI-Powered SNF Referral
Management Platform