How do you run an agent-drafted clinical note through Epic, Oracle Health, or Notable without losing the named clinician signature?
You keep the chart in the EHR. You move the draft, the agent identity, the clinician review, and the timestamp into Dock. The note only writes back to Epic, Oracle Health, or Notable after a human clinician signs the Dock row. The agent never holds the pen. The clinician does. Dock holds the record of who held it, when, and why.
The architecture
Epic, Oracle Health, and Notable stay the system of record for the patient chart. Dock is the system of record for what the agent interpreted from the encounter audio, the prior notes, and the problem list. Each Dock row carries a pointer back to the source chart (epic_encounter_id, oracle_encounter_id, or notable_visit_id), the agent identity that drafted the note, the clinician who reviewed it, the decision, and the timestamp. When the agent needs current medication or allergy state, it re-fetches via a fresh FHIR read. It does not cache and reason from stale data.
This separation matters because the EHR audit log treats every entry as a clinician action. Without Dock, an agent draft either gets attributed to the clinician (false authorship) or gets stripped of its provenance (lost reasoning). The Dock row carries the provenance the chart cannot.
The Dock surface: clinical_note_drafts table
| draft_id | epic_encounter_id | agent_id | draft_summary | reviewing_clinician | status | signed_at |
|---|---|---|---|---|---|---|
| cnd_8821 | EPC-44910 | scribe-agent-v3 | 62F follow-up, HTN stable on lisinopril 10mg, A1c 7.1 trending down, continue current regimen | dr.okafor@clinic | signed_and_posted | 2026-05-30T14:22Z |
| cnd_8822 | ORC-77204 | scribe-agent-v3 | 48M new c/o R-sided chest pain x 3d, pleuritic, no SOB, EKG WNL, plan CXR and trop | dr.lin@clinic | edits_requested | null |
| cnd_8823 | NTB-V-3301 | scribe-agent-v3 | 7yo well-child, immunizations UTD, growth 50th %ile, no parental concerns | dr.patel@clinic | signed_and_posted | 2026-05-30T15:04Z |
The workflow
- The scribe agent listens to the visit, pulls the prior problem list via FHIR, drafts a SOAP note, and writes a row to
clinical_note_draftswith statusawaiting_review. - The reviewing clinician opens the Dock row, reads the draft against the chart, and either edits and signs or rejects with a reason.
- On sign, Dock posts the finalized note to the EHR under the clinician's credentials via the appropriate API and flips status to
signed_and_posted. - The row persists. The agent identity, the clinician identity, the edit diff, and the timestamp are now permanent and queryable.
This is a two-key handshake: the agent drafts, the clinician signs, and the EHR write only fires when both keys turn.
Why it matters
CMS requires that services provided or ordered be authenticated by the author, and the medical record must clearly identify who performed the service (CMS MLN Signature Requirements). An agent-drafted note posted under a clinician's name with no separate provenance record fails that test on the spirit if not the letter. The Dock row is the provenance record.
AHIMA's clinical documentation integrity guidance emphasizes documentation that is "clear, concise, consistent, and accurate" and treats authorship as a first-class concern (AHIMA Clinical Documentation Integrity). Dock makes the authorship layered and explicit: the agent authored the draft, the clinician authored the signed note, and both are recorded.
The compliance team gets a single queryable surface for every agent-touched note. The clinician gets a faster draft without surrendering signature authority. The patient gets a chart entry signed by a human.
Talk to us about clinical documentation workflows on Dock.
FAQ
Q: Does the agent ever write directly to the EHR? A: No. The agent writes only to Dock. The EHR write happens after a named clinician signs the Dock row, and the write is performed under that clinician's credentials. See agent audit and compliance.
Q: What happens if the clinician edits the draft before signing? A: The edit diff persists on the Dock row. The original agent draft, the clinician's edits, and the final signed text are all queryable. This is the agent identity record working as intended.
Q: How do you handle agent version changes mid-workflow? A: The agent identity field captures the exact version that drafted the row. When the scribe agent is upgraded, prior rows still attribute to the prior version. See agent identity lifecycle.
Q: Does this work for amendments and addenda? A: Yes. Amendments follow the same pattern: a new Dock row points to the original chart entry, the agent drafts the amendment, and the clinician signs. The audit trail extends rather than overwrites. See Dock for compliance.
