Between the rooms, nobody is watching. A patient leaves the ICU, then the ward, then the hospital, and every hand-off drops something. Standing Watch is AI MedAgent stretched across the whole stay and the first 30 days at home: the same reasoning layer in every room, a mediator on every finding so it reaches a person and gets an answer, and an encrypted bridge to the person's own phone, where the consumer app, Ami, takes over. The hospital runs the watch through day 30 inside its own security boundary. After that, it is the person's own.
| Step | What happens |
|---|---|
| 1. Acquire | Pump (IHE PCD-01), monitor, orders, labs and allergies (HL7 FHIR); at home, the Health app list, wearables and the hospital's discharge packet. |
| 2. Normalize | The Rosetta layer. Whatever the EHR, whatever the pump, one meaning comes out: RxNorm for drugs, LOINC for labs, the ISO/IEEE 11073 nomenclature for devices, the UMLS over all of it. The same job IHE's Rosetta Terminology Mapping does for pumps, done for the whole encounter. |
| 3. Reason | A large language model, continuous, over the local feeds and the public data marts. Proposes act, hold or escalate, inside bounds the clinicians set, and says why and what it could not check. |
| 4. Connect to a human | The mediator carries every finding to a named role and keeps it there until someone answers. In the hospital, the nurse and the pharmacist decide. At home, the person reads one sentence and may send one question. |
| Field | Carried in (HL7 FHIR R4) | Demonstrated |
|---|---|---|
| The finding and its evidence | DetectedIssue: code, severity, detail, evidence | Yes |
| Who hears it, and who is next | Task.owner (PractitionerRole); CommunicationRequest.recipient; the chain in Task.input | Yes |
| Criticality, and why | Task.priority (routine, urgent, stat); the reason in Task.input; from the CDS Hooks card indicator when the live reasoning writes it | Yes |
| Reminder and escalation timers | Task.restriction.period.end; minutes in Task.input | Yes, on a simulated clock |
| Respond, defer, reject, or nothing | Task.status: completed, on-hold, rejected; Task.statusReason; Task.note | Yes |
| The trail | AuditEvent, one per step; downloadable as a FHIR Bundle | Yes |
| Device-originated alerts | IHE Alert Communication Management, PCD-04 to PCD-07 | Mapped, not yet wired |
| Delivery channel | CDS Hooks card first; secure chat where an API exists | Named, not yet wired |
| Demonstration | Address | What is real |
|---|---|---|
| Reasoning Demo | aimedagent.net/reasoning | Live reasoning on a synthetic critically ill patient, with the federal evidence it read |
| ICU watch board | aimedagent.net/watch-icu.html | The mediator on five synthetic beds; any bed's chart can be sent to the live reasoning |
| One patient, five rooms | aimedagent.net/watch-journey.html | The mediator and one audit trail across the continuum; scenario findings |
| The bridge | aimedagent.net/watch-bridge.html | Real SMART Health Link construction and AES-256-GCM encryption in the browser; Ami side simulated |
| Ami | iPhone, take one | Built and running on the developer's own phone; not yet distributed |
AI MedAgent is covered by multiple pending U.S. patent applications, in which AI reasoning over a patient's local data together with public data marts is the central claim. Standing Watch is a research demonstration on synthetic patients, built and funded by one person. It is not a medical device, is not FDA cleared, and is not for clinical use. A hospital that ran the watch for real would set its own recipients, timers and escalation chains, run it inside its own security boundary, and validate it before anyone relied on it.
Working with me. I work with device makers, health systems and health IT companies one at a time: licensing the method, a pilot partner for the first real watch, or advisory work.