09 · The visit clock
Put every effort on one timeline and the coverage gap is visible
One clock, anchored on the visit. Private band: the whole arc, continuous. Public band: frozen slices.
Amber notes: the blind spot at each layer.
Usage analytics — observed liveproduct analytics + app DB
Post-usage — reconciledEHR evidence + reconciliation, batch
−7d
−5d
−3d
−1d
VISIT
+1d
+3d
+7d
+14d
+30d
Private — product telemetry · continuous
1Delivery
generated → publishedapp DB — the tracker never sees it
no consumer analogue: the product pushes — generation can stop for one clinic while usage charts still look alive
2Exposure
queue → viewed pre-visit or at the visittracker views ∪ app-DB opens
"delivered" isn't reach — one deployment's accept rate went 12%→44% when the denominator became viewed
3Engagement
the session itselfopen time · chat turns · patients touched
DAU measures the clinic schedule — normalize per appointment-provider-day
4Action
accept / rejectapp DB, deduplicated · some land days later
the decisive click is where the SDK isn't — and vendor staff use the same UI: know whose click it was
5Trust
thumbs → rejection comments in reviewtraces + feedback + reviewer notes
stars say nothing — the rejection comment ("note doesn't exist — hallucination?") is the clinician's bug report
6Outcome
EHR evidence lands → reconciled to what the AI saidchart review + LLM attribution + manual citations
conversion happens in someone else's system weeks later — it doesn't exist unless deliberately captured
Public — benchmarks on the same clock · frozena curated vignette stands in for the patient
Knowledge · safety
the answer at the CDS momentUSMLE · safety evals · HealthBench
a synthetic vignette hands the model perfect exposure — layers 1–2 assumed away
Task benchmarks
documentation & admin tasksMedHELM slices — the visit plus a day
graded on output quality, never on adoption — layer 4 invisible
Outcome studies
RCTs — rare, years from question to answerthe only public instrument reaching layer 6
gold standard, wrong cadence: one verdict per multi-year study vs a funnel that updates daily
Uncovered
no public benchmark sees this side of the visitsupply, delivery, exposure on real patients
and the workload denominator — time saved per appointment-day — is measured nowhere public