Quality reporting fails in the gap between calculation and attestation. The agent computes a numerator from Epic encounters, a denominator from Vizient cohorts, and an exclusion from an AHRQ measure spec. The hospital then needs a person to sign that the number is right. Dock is where that signing happens, with the agent identity, the source pointer, and the reviewer recorded on one row.
Epic remains the clinical system of record. Vizient holds the comparative cohort. AHRQ publishes the measure logic. Dock is the system of record for what the agent INTERPRETED from those sources: the assembled numerator, the chosen exclusions, the human attestation. Each row carries epic_encounter_id, vizient_cohort_id, or ahrq_measure_id, the agent identity that built the row, the reviewer, and the attestation timestamp. The agent re-fetches charts via fresh API reads when current state is needed for resubmission.
The measure attestation table
| measure_id | period | numerator | denominator | excluded | source_ids | built_by | reviewed_by | attested_at |
|---|---|---|---|---|---|---|---|---|
| AHRQ PSI-90 | 2026 Q1 | 47 | 12,418 | 312 | epic_enc:48211..., ahrq:psi90.v2026 | agent:quality-rollup | dr.okafor | 2026-04-22 14:08 |
| CMS HAI-CDI | 2026 Q1 | 18 | 9,884 | 41 | epic_enc:51002..., vizient:coh_q1 | agent:quality-rollup | dr.lin | 2026-04-22 15:31 |
| CMS READM-30 | 2026 Q1 | 612 | 7,209 | 188 | epic_enc:44900..., ahrq:readm.spec | agent:quality-rollup | dr.okafor | 2026-04-23 09:14 |
Three rows. Every count is traceable back to a specific Epic encounter set, a specific measure spec version, and the named human who attested. No spreadsheet.
The workflow
The quality-rollup agent runs the AHRQ PSI-90 spec against the quarter's Epic discharge file. It writes the row to Dock with the encounter list and spec version pinned. The quality lead opens the row, spot-checks five encounters via the Epic deep link, and approves. Approval signs the row with the reviewer's identity. The CMS packet is generated from approved rows only, with a consent gate before submission to QualityNet. Late chart corrections write a new row; the prior row is preserved as historical attestation.
Why this matters
CMS requires attestation that the data submitted is accurate. Attestation without per-measure attribution is a signature on a black box. Dock makes the box transparent: the reviewer signs a specific numerator built by a specific agent from a specific encounter list against a specific spec version.
Vizient benchmarking and AHRQ comparison only work when your numerator logic is defensible. When a peer hospital questions a rate, the Dock row shows the exclusions applied and the spec version used. The conversation moves from "trust our number" to "here is the encounter list."
When the rollup agent is replaced or upgraded, attestations made by the prior agent identity stay intact. Quality reporting does not regress when tooling changes. See agent identity for why the agent's signature has to persist across versions, and agent audit and compliance for the audit posture this creates.
Get started
Map measures to Dock rows, point the rollup agent at Epic and Vizient, put your quality lead in the approval seat, and route attestations through Dock for compliance. Dock for healthcare operations covers the full cluster.
FAQ
Where does the actual CMS submission happen? On QualityNet, not in Dock. Dock holds the attested rows; the submission step reads the approved rows and posts the formatted file. See CMS Hospital Inpatient Quality Reporting for submission requirements.
What if Epic data changes after attestation?
The agent writes a new row with a new attested_at and a pointer to the corrected encounter set. The prior row is retained for audit, which is the pattern documented in agent audit and compliance.
How does Dock handle AHRQ Quality Indicators specifically? The AHRQ spec version is pinned per row. When AHRQ updates a QI module, the agent runs the new spec on the next period and writes new rows. Old rows still reference the old spec.
Is this enough for The Joint Commission and CMS audit? Per-row attribution, source pointers, and reviewer signature are the evidence auditors want. Dock for compliance covers the framework mapping in detail.
