SMART on FHIR Integration Specification — NomosLogic Dendrite

1. Overview

NomosLogic Dendrite is an EMR-native clinical decision support (CDS) utility that provides real-time multi-omic fusion. By correlating a patient's high-fidelity genomic data with live clinical biomarkers directly from the EHR, Dendrite eliminates the 14-day industry diagnostic lag and delivers Calculated Truth in under 130 seconds.

Dendrite operates as an umbrella platform comprising three core modules:

COVENANT — Genome Resolution Engine

COVENANT is the sovereign genome resolution layer. It ingests raw GVCF/WGS data at GQ30 fidelity (99.9% accuracy), resolves every variant against the Hardy Bridge index of 496,805 distinct RSIDs and 1,257,095 active clinical rules, and produces deterministic classification in under 130 seconds. COVENANT enforces Three-Outcome Safety Logic: POSITIVE_MATCH, NEGATIVE_CONFIRMED, and NO_CALL — eliminating false negatives by distinguishing true negatives from insufficient coverage.

TRINITY — Multi-Omic Fusion Engine

TRINITY correlates resolved genomic findings from COVENANT with live clinical biomarkers (labs, vital signs) ingested from the EHR via FHIR R4 resources. It performs real-time phenotype-genotype reconciliation, identifying diagnostic gaps, pharmacogenomic conflicts, and multi-system risk cascades that no single data source can reveal in isolation.

PROTEUS — Evolutionary Discovery & Simulation Engine

PROTEUS calculates vulnerability coefficients and effective barrier heights using ancestry-aware population frequencies against a de-identified patient Blueprint. It simulates biological stressors — drugs, pathogens, environmental triggers — to predict therapeutic response and adverse event probability. All simulation operates on de-identified data; population-level variables are never persisted to patient identity.

2. Intended Use & Clinical Utility

Dendrite is engineered for high-acuity clinical environments, including the NICU, PICU, Oncology, and Cardiology.

The NICU Miracle

Immediate resolution of neonatal metabolic crises (e.g., HPA-1a/ITGB3) via multi-omic handshakes between COVENANT variant resolution and TRINITY biomarker fusion.

Pharmacogenomic Safety

Identification of “Never Event” variants (e.g., DPYD, MT-RNR1) to prevent lethal adverse drug reactions before the first dose is ordered. PROTEUS simulates drug-gene interactions against the patient's resolved genome to quantify risk in real time.

Resource Totality

Access to a logic refinery of 16.2 million clinical assets, including 1,257,095 active deterministic clinical rules anchored to verified PubMed IDs (PMIDs) and 496,805 distinct Hardy Bridge variant mappings.

3. Technical & Integration Specifications

3.1 Platform Architecture

	Genome Resolution	Multi-Omic Fusion	Simulation & Discovery
Input	GVCF/WGS (GQ30)	FHIR Observations + COVENANT output	De-identified Blueprint
Output	Classified Variants	Fused Diagnostic Report	Risk Coefficients
Speed	< 130 seconds	Real-time (streaming)	On-demand

3.2 FHIR R4 Data Flow

The application utilizes OAuth2 (PKCE) to securely ingest the following FHIR resources:

Resource	Purpose	Module
Patient	Demographics and identity anchoring	All modules
Observation	Live laboratory values and metabolic signals	TRINITY
MolecularSequence	Genomic data payloads (VCF/GVCF references)	COVENANT
[Reserved]	Future modality expansion (pending regulatory clearance)	—
DiagnosticReport	Historical clinical findings for gap analysis	TRINITY
MedicationRequest	Active prescriptions for PGx conflict detection	PROTEUS

3.3 Genomic Ingestion Standard (GVCF/WGS)

For institutional deployments, COVENANT supports high-fidelity GVCF (Genomic Variant Call Format) ingestion standardized at GQ30 (99.9% accuracy).

Reference Call Integrity: Unlike standard VCFs, GVCF ingestion includes Non-Variant blocks, allowing the engine to distinguish between a True Negative and Insufficient Coverage.
Three-Outcome Safety Logic:

POSITIVE_MATCHVariant detected with high confidence.

NEGATIVE_CONFIRMEDReference allele confirmed with high coverage (DP ≥ 20x).

NO_CALLInsufficient data; flags region for manual review to prevent false negatives.

3.4 Computational Engine

Fusion is executed within the Titan-STORM Kernel, a database-native execution layer that treats biological rules as executable code rather than static text. This architecture ensures a 10,000x speed advantage over legacy manual interpretation.

4. Security & Sovereign Privacy

NomosLogic utilizes a Zero-Knowledge Architecture designed to exceed HIPAA and GDPR standards.

Sovereign Hashing: All Protected Health Information (PHI) is salted and hashed via HMAC-SHA256 at the source. Patient identity is anchored to an opaque, institutional Sovereign Hash — never to raw PII.

Data Residency: No PII is stored within the NomosLogic refinery. Only biological truth is anchored to the Sovereign Hash identifier.

Encryption: All data in transit is secured via TLS 1.3. Data at rest utilizes AES-256-GCM with FIPS 140-2 validated encryption and HSM key management.

Internal Air-Gap: NomosLogic employees have zero visibility into raw patient data. Any exception requires a time-bound, institution-authorized Break the Glass protocol with full audit trail.

5. Deployment & Configuration

NomosLogic Dendrite is a plug-and-play utility requiring zero custom site-level integration projects.

Direct EHR Launch: Available in the Epic Hyperspace and Oracle Health Millennium sidebars via standard SMART on FHIR launch context.

One-Click Enablement: Authorized administrators activate the utility via standard Client ID / Secret exchange and OAuth2 (PKCE) registration.

Module Configuration: COVENANT, TRINITY, and PROTEUS can be enabled independently or as a unified platform based on institutional licensing and clinical workflow requirements.

6. Clinical Asset Summary

Total Clinical Assets	16.2 Million
Active Deterministic Clinical Rules	1,257,095
Distinct Hardy Bridge Variant Mappings (RSIDs)	496,805
Verified PubMed Citation Anchors	Comprehensive

7. Support & Clinical Validity

For technical support, EHR integration assistance, or to request authorized access to the Clinical Rule Validation Audit, please contact:

Emailsupport@nomoslogic.com

Webnomoslogic.com/support

NomosLogic Dendrite