See Fireline Care Transitions. The way your team will use it on a Tuesday morning.
Six screens, in the order a clinician actually opens them. No marketing mock-ups, no abstract icons - this is the real product.
The morning worklist, risk-sorted
Every patient in their 30-day post-discharge window, ranked by readmission risk and days remaining. No second login, no inbox triage.
One chart, one timeline
Discharge summary, ADT signals, SDOH needs, caregiver contact, and the open TCM tasks, all stacked against a single timeline.
- ☑ 24-hr outreach
- ☐ 7-day face-to-face
- ☐ 30-day check
Loop the family in, without a portal
Magic-link conversations with the named caregiver. Two-way SMS, language preference respected, every message audit-logged.
Codes surface when criteria are met
99495, 99496, 99490 readiness checked against contact, face-to-face, and time thresholds. Drop straight to the biller as a clean claim.
Closed-loop, not a fax to nowhere
Unite Us and local CBO referrals tracked to acceptance, service delivery, and outcome, with an honest 'not reached' state when that's the truth.
Per-org isolation, real RLS
Your clinic's panel only, row-level security scoped to your organization. Consent capture, soft-delete, and a full audit trail on every PHI read.
See it on your own panel.
We'll stand up a pilot tenant for your clinic, walk the team through these screens with your patients, and have you live in under three weeks.
Request a pilot