Abridge Production Checklist

Overview

Production readiness checklist for deploying Abridge clinical AI in a healthcare organization. Clinical documentation systems are safety-critical — this checklist covers HIPAA compliance, EHR integration validation, provider onboarding, and rollback procedures.

Prerequisites

• A named clinical, security, privacy, EHR, and operations owner empowered to make the go/no-go decision.
• A BAA-covered production environment, approved change window, and a tested manual-documentation fallback.
• Completed sandbox validation using synthetic data, with no unresolved high-severity privacy, safety, or interoperability findings.

Instructions

Work through the pre-launch checklist with the responsible owner for each control, then run the readiness script in the target environment. Treat every fail result as a launch blocker. Record the decision, evidence locations, and rollback owner before enabling the integration; do not use warning-only results to override a failed security, EHR, or patient-safety control.

Pre-Launch Checklist

Legal & Compliance

• BAA signed — Business Associate Agreement executed with Abridge
• HIPAA risk assessment — Completed and documented
• Data flow diagram — PHI flow mapped: microphone → Abridge → EHR
• Breach notification plan — 60-day notification procedure documented
• Patient consent — State-specific recording consent requirements met
• Medical staff approval — Clinical AI usage approved by medical staff committee

Infrastructure

• TLS 1.3 — Enforced on all Abridge API connections
• Secrets management — Credentials in secret manager (not env files)
• Audit logging — All PHI access logged with 6-year retention
• Monitoring — Health checks, latency alerts, error rate dashboards
• Backup connectivity — Fallback for Abridge outages (manual documentation)

EHR Integration

• FHIR R4 endpoint — Verified DocumentReference POST works
• Epic SmartPhrases — Mapped to Abridge note templates
• Provider enrollment — All go-live providers registered in Abridge
• Specialty configuration — Licensed specialties configured per contract
• Note templates — SOAP/H&P/Progress templates validated with clinical leads

Validation Script

// src/prod/readiness-check.ts
interface ReadinessResult {
  check: string;
  status: 'pass' | 'fail' | 'warn';
  detail: string;
}

async function runReadinessChecks(): Promise<ReadinessResult[]> {
  const results: ReadinessResult[] = [];

  // 1. API connectivity
  try {
    const res = await fetch(`${process.env.ABRIDGE_BASE_URL}/health`, {
      headers: { 'Authorization': `Bearer ${process.env.ABRIDGE_CLIENT_SECRET}` },
    });
    results.push({ check: 'API Health', status: res.ok ? 'pass' : 'fail', detail: `HTTP ${res.status}` });
  } catch (err) {
    results.push({ check: 'API Health', status: 'fail', detail: (err as Error).message });
  }

  // 2. FHIR endpoint
  try {
    const res = await fetch(`${process.env.EPIC_FHIR_BASE_URL}/metadata`);
    results.push({ check: 'FHIR Server', status: res.ok ? 'pass' : 'fail', detail: `HTTP ${res.status}` });
  } catch (err) {
    results.push({ check: 'FHIR Server', status: 'fail', detail: (err as Error).message });
  }

  // 3. TLS version
  results.push({
    check: 'TLS Version',
    status: process.env.NODE_TLS_MIN_VERSION === 'TLSv1.3' ? 'pass' : 'warn',
    detail: `Min TLS: ${process.env.NODE_TLS_MIN_VERSION || 'not set'}`,
  });

  // 4. Secrets not in env file
  const envFiles = ['.env', '.env.local', '.env.production'];
  for (const f of envFiles) {
    try {
      const content = await import('fs').then(fs => fs.readFileSync(f, 'utf8'));
      if (content.includes('ABRIDGE_CLIENT_SECRET')) {
        results.push({ check: `Secrets in ${f}`, status: 'fail', detail: 'Credentials in file — use secret manager' });
      }
    } catch { /* file doesn't exist — good */ }
  }

  // 5. Audit logging
  results.push({
    check: 'Audit Logging',
    status: process.env.AUDIT_LOG_ENABLED === 'true' ? 'pass' : 'fail',
    detail: 'HIPAA requires audit trail for all PHI access',
  });

  return results;
}

// Run and display
runReadinessChecks().then(results => {
  console.log('\n=== Abridge Production Readiness ===\n');
  for (const r of results) {
    const icon = r.status === 'pass' ? 'PASS' : r.status === 'warn' ? 'WARN' : 'FAIL';
    console.log(`[${icon}] ${r.check}: ${r.detail}`);
  }
  const failures = results.filter(r => r.status === 'fail');
  console.log(`\n${failures.length === 0 ? 'READY FOR PRODUCTION' : `${failures.length} BLOCKING ISSUES`}`);
});

Rollback Plan

#!/bin/bash
# scripts/abridge-rollback.sh
# Rollback Abridge integration — revert to manual documentation

echo "=== Abridge Rollback Procedure ==="

# 1. Disable Abridge in EHR
echo "Step 1: Disable Abridge module in Epic App Orchard"
echo "  - Navigate to Epic > Admin > App Orchard > Abridge"
echo "  - Set status: DISABLED"

# 2. Notify providers
echo "Step 2: Send notification to enrolled providers"
echo "  - Subject: Abridge temporarily offline — use manual documentation"

# 3. Verify EHR still accepts manual notes
echo "Step 3: Verify manual note creation in Epic works"
curl -X POST "${EPIC_FHIR_BASE_URL}/DocumentReference" \
  -H "Authorization: Bearer $EPIC_TOKEN" \
  -H "Content-Type: application/fhir+json" \
  -d '{"resourceType":"DocumentReference","status":"current","content":[{"attachment":{"contentType":"text/plain","data":"'"$(echo 'Manual note test' | base64)"'"}}]}'

echo "=== Rollback Complete ==="

Post-Launch Monitoring

Metric	Target	Alert Threshold
Note generation latency	< 30s	> 60s
API error rate	< 1%	> 5%
Provider adoption	> 80% in 30 days	< 50%
Note acceptance rate	> 90%	< 70%
Patient summary delivery	< 5s	> 15s

Output

• Readiness check script with pass/fail results
• Rollback procedure documented and tested
• Post-launch monitoring thresholds configured
• Go/no-go decision evidence collected

Examples

During a scheduled production rehearsal, have each control owner complete the checklist against the BAA-covered target environment and run the readiness script using its managed identity. A clean result contains no fail entries, an authenticated FHIR metadata response, confirmed audit logging, and a named rollback operator. Capture the redacted results and change approval with the release record. If a control fails, declare a no-go, keep the integration disabled, and use the documented manual workflow until the owner corrects and re-verifies the failure.

Error Handling

Failure	Required response
Readiness check reports fail	Stop the launch and assign remediation to the control owner.
FHIR validation or authorization fails	Keep automated note delivery disabled and use the manual fallback.
Monitoring cannot prove audit coverage	Treat the deployment as non-compliant and do not enable PHI processing.
Rollback drill is incomplete	Schedule and pass the drill before the next go-live decision.

Resources

• Abridge Platform
• HIPAA Security Rule Checklist
• Epic Go-Live Best Practices

Next Steps

For version upgrades, see abridge-upgrade-migration.