Meridian

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Meridian is a living document, not a static policy. This page describes how provider feedback flows from the point of care into reviewed, agreed-upon updates. The system works at whatever tier of infrastructure is currently available — starting functional today and evolving toward a continuously improving clinical intelligence platform.

Active Tier: Tier 1 — Email-Based Feedback
Tier 1
Email-Based Feedback
Active
How it works

Each item in Meridian has a speech bubble icon. Tapping it opens a pre-addressed email with the module name and item pre-filled in the subject line. You add your comment and send. Emails route to a dedicated Meridian Feedback folder via Outlook rule. An administrator reviews the folder periodically and consolidates feedback manually.

What you need to do

Write your comment. Hit send. That's it.

What happens next

The module owner reviews submissions on a defined cadence (target: monthly). Accepted changes are incorporated into the next version of the relevant module. You will see a version number update in the footer of each module.

Limitations
  • No aggregated view for reviewers without manual work
  • Submitter has no visibility into whether feedback was received
  • No threading or discussion between reviewers
  • Suitable for low-volume feedback during early prototype phase
Tier 2
Power Automate + Shared Repository
Available
Requires

Power Automate access (typically included in M365 license). Low IT lift — may be self-service.

How it works

Speech bubble emails continue as in Tier 1, but a Power Automate flow monitors the Meridian Feedback inbox and automatically parses each submission. Module name and item are extracted from the subject line. A structured row is appended to a shared Excel file or SharePoint List with columns for: timestamp, submitter, module, item reference, and comment body. A notification is posted to a designated Teams channel so the review team sees submissions in real time.

What administrators see

A shared spreadsheet or SharePoint List, filterable by module, date, and review status. Designated reviewers have read access at all times. No manual aggregation required.

Upgrade path from Tier 1

One Power Automate flow connecting Outlook to SharePoint. Estimated setup time with IT support: half a day.

Limitations
  • Feedback still arrives as unstructured email text
  • No in-app confirmation to submitter
  • Review and discussion still happen outside the system
  • Version control is manual
Tier 3
Microsoft Forms + SharePoint + Planner
Planned
Requires

IT involvement. Standard M365 stack. Recommended architecture for enterprise deployment.

How it works

Speech bubble opens a Microsoft Form (not an email) with structured fields: module name (pre-filled), item reference (pre-filled), comment type (factual correction / clinical disagreement / suggested addition / other), comment text, and optional submitter name. Submission triggers a Power Automate flow that creates a SharePoint List item, creates a Planner task in the Meridian Feedback plan, and posts a Teams notification.

What reviewers see

A Planner kanban board with one column per module. Each piece of feedback is a card that moves across columns: Submitted, Under Review, Accepted, Incorporated, Deferred. Reviewers can comment on cards, assign them, set due dates, and track resolution without leaving Teams.

What happens to accepted changes

A Power Automate flow generates a Word document from all Accepted items in the SharePoint List, structured by module with item-level comments. This document is the update spec passed to the development workflow. Version history is maintained in SharePoint.

Upgrade path from Tier 2

Replace mailto links with Microsoft Forms links. Add Planner integration to existing Power Automate flow. Estimated additional setup time: half a day.

Limitations
  • Requires login for form submission (M365 account)
  • Planner visibility limited to licensed users
  • Still a periodic review cycle, not continuous
Tier 4
Continuous Intelligence Platform
Reach Objective
Long-term vision

Requires development investment and IT partnership. This tier represents the full platform vision for Meridian.

A — Continuous Provider Feedback Loop

Speech bubbles write directly to a structured database. Submissions are timestamped, tagged to content versions, and visible to submitters with status indicators. High-frequency feedback on a specific item surfaces automatically as a priority signal. Review cycles shift from periodic to rolling.

B — Meridian Chatbot

A conversational interface grounded exclusively in Meridian content plus a curated clinical corpus. Answers questions about institutional approach — not general medical questions. Cites specific modules and items. Explicitly declares when a question falls outside scope.

C — Curated External Knowledge Links

Each module item carries optional reference links maintained by the module owner: guidelines (KDIGO, CDC, APA), key evidence (SPRINT, CDC 2022), tools (CKD-EPI calculator, MME calculator), and patient resources. Links are versioned and reviewed before each module version publishes.

D — Chatbot Web Retrieval

For questions at the edge of the curated corpus, the chatbot fetches current information from pre-approved external sources — society guidelines, FDA drug safety communications, CDC clinical guidance — combining institutional policy with the latest external evidence. Never fetches from unapproved sources.

E — Version Control and Audit Trail

Every content change tracked with author, date, source feedback, reviewer approval, and prior version preserved. Providers see when any item was last reviewed and what changed. Transforms Meridian into an auditable clinical governance artifact.

F — Analytics Layer

Aggregate, de-identified data on module access, feedback volume, FAQ usage, and chatbot queries. Answers which clinical areas have provider uncertainty, which items generate disagreement, and whether Meridian is used at point of care or only during onboarding.

Governance Principles — All Tiers
Content Ownership
Each clinical module has a named owner responsible for review cadence and accuracy. Module owner is the first reviewer of all feedback for that domain. Medical director approval required for any change that modifies a clinical threshold or escalation criterion.
Feedback Destination
Feedback that arrives without a response is worse than no feedback mechanism at all. Every submission receives at minimum an automated acknowledgment. Substantive responses to accepted or deferred items are provided on the module review cadence.
Version Discipline
Footer version numbers are updated with every content change. Major changes (new module, revised clinical threshold) increment the first digit. Minor changes (clarified language, added FAQ) increment the second. Providers can always see what version they are reading.
Stability Before Expansion
New modules are not added until existing modules have completed at least one full feedback cycle. A framework that grows faster than it can be reviewed loses credibility.