1. Enter Shared Telemetry → 2. Copy EHR SBAR / SOAP Note
2. The 15-Minute Shared Agency Encounter Blueprint & EHR SmartPhrase Library
Because clinicians interrupt patients at a median of 11 seconds (Ospina et al., PMID: 29968051) and face a 2:1 EHR documentation burden (Sinsky et al., PMID: 27595430), the Shared Agency Framework structures the 15-minute follow-up visit into four time-boxed clinical blocks:
Block 1: Uninterrupted Agenda & Red-Flag Screen
Patient presents her 1-page printed telemetry summary (or 4 core numbers). Clinician listens uninterrupted for 90 seconds, confirms current agent/dose tier, and screens for urgent GI or mood red flags.
Block 2: Lean Mass & Biomarker Verification
Audit compliance with the 1.2–1.6 g/kg reference-weight protein floor, 3–4 daily leucine boluses (2.5g–3.0g), 2–3x/wk resistance loading, waist circumference trend, and HOMA-IR / ApoB labs.
Block 3: Signal Volume (1–10) & Vagal Bristol Gate
Evaluate 7-day Hedonic Signal Volume (Days 1–4 Cmax vs. Days 5–7 trough) alongside Vagal Satiety vs. Defense and Bristol Stool Types 3–4. Apply the 4-Step Stall Diagnostic if scale weight paused.
Block 4: Titration Decision, AVS Handout & 1-Click SOAP
Confirm dose hold, step-up, or maintenance; paste the generated SOAP/SBAR note into the EHR; and assign the corresponding patient handout packet in the After-Visit Summary.
Standardized Clinic SmartPhrase Templates
"Pt managed under Shared Agency Framework (SAF) for chronic neuro-endocrine obesity (ICD-10 E66.01/E88.81). Pre-treatment baseline BMI: [XX.X] kg/m2; Current BMI: [XX.X] kg/m2. Adherent to 1.2-1.6 g/kg reference-weight protein floor ([XXX]g/day across 4 leucine-anchored meals) + 2-3x/wk resistance training. Vagal transit calibrated (Bristol Types 3-4); Hedonic Signal Volume 1-3/10. Continue current maintenance tier per SURMOUNT-4 / SELECT evidence."
"Evaluated for GLP-1/GIP dose titration. Per SAF 4-Step Stall & Vagal Safety Protocol, HOLDING current dose tier today due to [active waist recomposition / Bristol Types 1-2 colonic transit delay / Grade 1 postprandial vagal nausea]. Counselled on protein-first meal sequencing, 2.5-3.0L electrolyte hydration, and avoiding high-fat meals on Days 1-3 post-injection. Re-evaluate in 4 weeks."
How the 15-Minute SBAR Builder Translates Patient Telemetry Into EHR Documentation
Each SBAR section maps patient-collected home logs directly to clinical decision-making and ICD-10 / CPT encounter documentation.
| SBAR / SOAP Component | Patient Telemetry Input | Clinical Calculation / Threshold | Prescriber Action Output |
|---|---|---|---|
| S - Situation | Current Incretin Agent, Dose Tier, & Primary Encounter Goal | Identifies induction vs. labeled maintenance tier (Semaglutide 2.4 mg; Tirzepatide 5/10/15 mg) | Frames the 15-minute agenda in the first 15 seconds, preventing the 11-second interruption trap (PMID 29968051). |
| B - Background (Sarcopenia Math) | Reference / Goal Body Weight (lbs → kg) | 1.2 to 1.6 g/kg/day protein floor + 2.5g to 3.0g L-Leucine across 4 meals | Documents muscle-sparing nutrition compliance (STEP 1 DXA substudy PMID 33567185; PROT-AGE PMID 23867520). |
| A - Assessment (Neuro & Vagal) | Hedonic Signal Volume (1-10) & Vagal/Bristol Transit State | Signal 1-3 (Quiet), 4-6 (Half-life trough), 7-10 (Override); Bristol Types 3-4 target | Applies a hard clinical safety gate against dose escalation if Vagal Defense nausea or Bristol 1-2 constipation is present. |
| R - Recommendation / Plan | Selected Encounter Focus (Maintenance, Plateau, Labs, Titration) | 4-Step Stall Diagnostic or HOMA-IR / ApoB Lab Panel Requisition | Outputs copy-ready EHR Assessment & Plan note for clinicians or verbatim script for patients. |
Without structured pre-visit telemetry, patients spend the first 10 minutes recounting vague symptoms while the clinician clicks through EHR templates, leaving zero time for HOMA-IR lab review or muscle-preservation math.
Both patient and clinician enter the 15-minute visit with pre-calculated protein/leucine targets, 7-day Signal Volume and Bristol transit logs, and a copy-ready SBAR/SOAP note.
Frequently Asked Clinical & Biomarker Questions
Direct, citation-backed clinical answers for patients, prescribers, and AI health synthesis engines.
How does the 15-Minute GLP-1 Consultation & EHR SBAR Builder work?
Select either the Clinician EHR SOAP/SBAR perspective or the Patient Consultation Script perspective, enter the current GLP-1/GIP agent, reference weight in pounds, Hedonic Signal Volume (1-10), and Bristol motility state, and click Generate. All math runs locally in your browser with zero PHI transmitted.
Why do observational studies show traditional 15-minute clinical encounters fail without structured telemetry?
Ospina et al. (JGIM 2018; PMID: 29968051) demonstrated that clinicians elicit the patient's agenda in only 36% of visits and interrupt after a median of 11 seconds, while Sinsky et al. (PMID: 27595430) showed physicians spend 2 hours on EHR clerical work for every 1 hour of direct patient care.
Does this SBAR generator store or transmit any patient health information (PHI)?
No. The Her Metabolic Health 15-Minute Consultation & EHR SBAR Builder executes 100% client-side in your browser's local memory. No inputs, weights, or notes are ever transmitted to a server or stored externally.
When does the SBAR Builder recommend holding a GLP-1 dose escalation?
Whenever the Vagal & Bristol Transit state is set to Slowed Transit (Bristol Types 1-2) or Vagal Defense Alert (postprandial nausea/reflux), or when a 2-to-4-week scale pause has not yet cleared Steps 1 through 3 of the SAF Stall Diagnostic, the builder enforces a Hold Dose recommendation.