The Medical Chronology, Built From the EHR
A source-linked timeline assembled directly from structured records — that auto-flags entries changed after the fact.
The case
A 54-year-old presents to the ED on Sept 2 with pleuritic chest pain, shortness of breath, a heart rate of 112 and an O₂ sat of 93%. She is diagnosed with musculoskeletal chest pain, given ibuprofen, and discharged. Four days later she returns by ambulance with syncope — a saddle pulmonary embolism. The printed chart looks routine. The metadata does not.
The chronology the tool produces
| When | Category | Entry |
|---|---|---|
| 2025-09-02 14:10 | Encounter | Emergency — Pleuritic chest pain, shortness of breath |
| 2025-09-02 14:25 | Observation | Heart rate: 112 bpm |
| 2025-09-02 14:25 | Observation | Oxygen saturation: 93 % |
| 2025-09-02 14:26 | Observation | Respiratory rate: 22 breaths/min |
| 2025-09-02 16:40 | Diagnosis | Musculoskeletal chest pain (active) ⚠ entered/changed 20 days later (2025-09-22) |
| 2025-09-02 16:45 | Medication | Ibuprofen 600 mg PO PRN |
| 2025-09-02 16:50 | Document | ED discharge instructions — return if worse |
| — 4 days — | ||
| 2025-09-06 08:05 | Encounter | Emergency — Syncope, severe dyspnea |
| 2025-09-06 08:40 | Observation | Troponin I: 0.41 ng/mL |
| 2025-09-06 08:42 | Observation | D-dimer: 4200 ng/mL FEU |
| 2025-09-06 09:30 | Procedure | CT pulmonary angiography |
| 2025-09-06 10:05 | Diagnostic Report | CT angiogram, chest — Saddle pulmonary embolism with right heart strain. |
| 2025-09-06 10:10 | Diagnosis | Acute pulmonary embolism (saddle) (active) |
| 2025-09-06 10:15 | Medication | Heparin IV infusion |
| 2025-09-22 11:00 | Authorship | Provenance — Recorded by Dr. A. Resident — Amended |
What the metadata caught
The "musculoskeletal chest pain" diagnosis is dated Sept 2 — the day of the first visit. But its system last-modified timestamp is Sept 22: twenty days later, and over two weeks after the patient came back with a saddle PE. The Provenance record names who touched it last.
On the printed chart, that diagnosis looks contemporaneous. The tool flags the gap automatically — pointing you exactly where to aim an audit-trail discovery request.
Two lanes, by design
Structured EHR access (FHIR) carries authorship and last-modified metadata — enough to flag a suspicious entry. It does not carry the deep forensic audit trail (chart-open durations, access logs, full edit history); that exists only behind discovery. The product uses both:
2 · Discovery lane (live tool)
The flag tells you where to look. The audit-trail discovery request gets the forensic proof — who entered or changed each note, the exact timestamps, who accessed the chart.
Want this on a real case?
The consent-connect chronology is in active development and we're piloting it with a small number of plaintiff firms. See it on a sample, or put it on one of your cases.
Request a pilot Try the audit-trail toolSynthetic demonstration for attorneys — not legal or medical advice, and not a real patient record. A last-modified timestamp later than the clinical date is a signal to investigate, not proof of wrongdoing (it can reflect a legitimate addendum or a data migration). Confirm timing and authorship through the audit trail and discovery in your venue.