The system holds. The human decides.
On a gray-zone case, Decionis can deliberately restrain — hold the action pending review rather than block it outright. The verdict is a recommendation with authority context, never a clinical determination.
Healthcare · Execution governance
Execution authority for regulated healthcare decisions.
Healthcare regulators understand five things: approvals, authority, audit trails, compliance, and explainability. The challenge in an AI-assisted workflow is not generating the recommendation — it is ensuring only authorized actions execute, and that every decision can be explained later. Decionis is the control plane that sits between the recommendation and the action, and leaves a signed Decision Dossier behind it.
Built on the same decision layer already governing 16,000+ approval gates in production — now scoped for the workflows a health system actually has to defend in an audit.
The challenge isn't the recommendation. It's the authority to act on it.
Healthcare organizations increasingly route consequential actions through AI-assisted and automated workflows:
AI-assisted triagePatient routingClaims processingPrior authorizationReferral managementDischarge workflowsProcurement approvals
Only authorized actions execute
A recommendation is not authority. Decionis verifies that the right approval level is present before the referral, the authorization, or the purchase commits.
Every decision explains itself later
When a reviewer, a CMS auditor, or a plaintiff's attorney asks “who approved this and on what basis,” the answer is a signed chain of custody that existed at the moment of the decision — not a reconstructed log.
Human judgment / system logic
Where the system decides, and where the clinician does.
The hard part of governing a live clinical workflow is the boundary between human judgment and system logic — and proving it held. Decionis is designed to be pressure-tested on exactly that line.
Authority is verified, not assumed.
A Hold or denial that requires a licensed clinician cannot be finalized until that clinician submits a confirmation event. The dossier records the human confirmation, not just the system verdict.
Disagreement is captured, not erased.
When a clinician overrides a Hold, the original dossier stays intact and the exception attaches as an Override Dossier with the reviewer's rationale. Repeated overrides surface as Policy Drift for governance to act on.
Workflows to govern
Decionis deliberately stays out of diagnosis — a hard regulatory path. It starts where the decision is about authority and spend, not clinical judgment, and moves toward the clinical edge only where it can govern the loop without touching the medical call.
Use case 1
Referral & escalation governance
A workflow or model recommends a referral. Decionis evaluates risk score, specialist criteria, and network status against your protocol and returns proceed, hold, or escalate before the referral action commits — with the reasoning signed into a dossier.
Patient request → recommendation → Decionis → proceed / hold / escalate → referral action → Decision Dossier
Use case 2
Prior authorization workflow
Replace manual review, email approvals, and inconsistent decisions with policy evaluation, authority verification, and escalation routing. Every determination carries the policy version that governed it and a licensed-clinician confirmation event where the law requires one.
Auth request → policy evaluation → authority verification → escalation routing → Decision Dossier
Use case 3 — recommended first workflow
Procurement governance
Govern spend thresholds, approval authority, and supplier exceptions for equipment, pharmaceuticals, and services. Zero PHI, zero EHR dependency, zero clinical risk — the safest place to prove the control plane and generate the first evidence pack.
Requisition → threshold & authority check → escalate to CMO/CFO → signed Decision Dossier
Next on the roadmap
Critical-result closed-loop governance
Was a flagged critical or abnormal result routed to the required authority inside the policy time window, acknowledged (NPI + timestamp), and escalated up the coverage chain if the window breached? Decionis governs the integrity of the notify→acknowledge→escalate loop — never the meaning of the value.
Critical result flagged → SLA clock + routing tier → Decionis → proceed / hold / escalate / restrain → acknowledged or escalated → Decision Dossier
Read the deep diveA shadow-mode-first rollout, scoped to 12 weeks
Nothing is enforced before the evidence supports it. Shadow mode is the most important stage: the control plane observes a live workflow and produces dossiers without blocking anything, so trust is earned before authority is granted.
1Weeks 1–2
Discovery
Map the workflow, its approval paths, compliance requirements and escalation paths into a Decision Map.
2Weeks 3–4
Policy encoding
Turn your policy manuals, SOPs and approval matrices into Decision Graphs, rule by rule, with your governance lead.
3Weeks 5–8
Shadow mode
Nothing is blocked. Nothing changes. Decionis observes what would proceed, what would escalate, and where policy drifts — producing a Decision Dossier for every observed decision.
4Weeks 9–12
Controlled enforcement
Enable proceed, hold, and escalate on one workflow — not the whole organization. A kill switch returns any workflow to shadow mode instantly.
What the signed dossier proves to a regulator
An approval log records that someone clicked approve. A Decision Dossier records the authority behind it — designed as a legal instrument, cryptographically chained so it is tamper-evident, and verifiable without an account.
Who held the authority
The role, credential, and — where required — the licensed-clinician confirmation behind the action.
Which policy version applied
The exact encoded policy and rule digest that governed the decision, attached at the moment it was made.
Why it proceeded, held, or escalated
Reason codes, the signals evaluated, and the escalation trail — recoverable without reconstructing logs.
Operational targets: 100% Decision Dossier coverage, sub-second evaluation, and a policy version attached to every decision.
Compliance targets: 100% traceability and retained escalation evidence — the fields a HIPAA audit control expects.
What Decionis is not
The category discipline is the point. Decionis governs process authority, not clinical judgment.
- It does not diagnose.
- It does not determine medical necessity.
- It does not replace physician judgment.
- It does not generate the clinical recommendation — it governs the authority to act on one.
Shadow-mode rollout
Pressure-test validation, governance, and the human–system boundary on a live workflow.
Pressure-test where the system decides and where the clinician decides, on your own workflows. Start with procurement: zero PHI, zero EHR dependency, and a signed evidence pack in eight weeks of shadow mode.