KleranOS // Knowledge · Outcomes · Sovereignty

The operating system for clinical code.

KleranOS begins with one premise: the physicians who build software and the engineers who understand medicine are converging on the same destination. Clinical workflows at maximal temporal and financial efficiency. Accuracy of care that keeps improving. And patient data that never passes to a third party. What that convergence builds, this collective holds in the open.

Read the ManifestoBrowse the Feed
Founding cohort open3 invariant suites, runnable in-browser24 deterministic tests6 exemplar dossiers
The Kernel

Peer-reviewed clinical primitives. Dosing guards, interaction matrices, FHIR linters. Copy the code, run the test.

Patches & Commits

Vendor defects, documented and fixed in public. EMR quirks, billing traps, integration scars.

System Calls

Bedside bottlenecks posted by clinicians. Engineers answer with working tools, not slide decks.

Showing 6 of 6 threads
PolicyPOLICY // 42 U.S.C. § 1395w-3aDr. Hannah Cross, MD, JDHealth Law Strategist & DPC Clinician
1 MIN READ

Undoing the HITECH Act liability traps: How open clinical state machines legally protect physician autonomy

Legacy hospital systems weaponize CMS billing regulations to force physicians into employment contracts. We drafted an open legal and technical framework showing that direct-care contracts combined with deterministic clinical safety logs satisfy state medical board standards without submitting a single ICD-10 claim to a commercial payer.

STATUTORY PROOF // MEDICARE BENEFICIARY DEFENSE VERIFIED PRIMARY RECORD
Citation: Social Security Act § 1802 [42 U.S.C. § 1395a]
“Any physician or practitioner may enter into a private contract with a beneficiary for healthcare services without filing claims with the Secretary, protecting practice sovereignty.”
18comments
ClinicalCOGNITIVE // AMBIENT INVARIANT PROTOCOLDr. Priya Sharma, MD & David ChenPediatric Intensivist & Systems Integrator
1 MIN READ

Architecture Teardown: Real-time ambient clinical encounter to structured FHIR with pediatric dose guardrail

We hooked local Whisper STT into a Claude Code agent running on a clinician laptop. It listens to a doctor-patient conversation, creates the visit summary, extracts the medication order, checks the child weight in our local SQLite table, and prints the verified script, all in under two seconds.

CLINICAL BENCHMARK // AMBIENT PIPELINE VERIFIED PRIMARY RECORD
Citation: KŌS Invariant Verification Protocol #089-A
“All ambient transcription pipelines must route through a deterministic parameter barrier before executing prescription dispatch or diagnostic order generation.”
27comments
ArchitecturalSECURITY // 45 C.F.R. § 164.514Tariq Al-MansoorSecurity & Cryptographic Systems Researcher
1 MIN READ

Hospital IT tried to veto our local-first agent: How we air-gapped DuckDB & zero-knowledge patient storage on bare metal

Enterprise health system IT departments use HIPAA as a weapon to force proprietary vendor lock-in. We showed them that running an embedded local DuckDB instance with AES-256-GCM client-side encryption and zero outbound network telemetry is mathematically more compliant than their cloud Epic instance.

REGULATORY COMPLIANCE // HIPAA SECURITY RULE VERIFIED PRIMARY RECORD
Citation: 45 C.F.R. § 164.312(a)(2)(iv) & § 164.514(b)
“Client-side hardware encryption with zero-knowledge key isolation renders data mathematically unintelligible to intermediaries, fulfilling Safe Harbor without cloud vendor BAA exposure.”
19comments
PolicyPOLICY // 42 U.S.C. § 256b & CMS E&MDr. Julian Hayes, MDDirect Primary Care Pioneer & Python Builder
1 MIN READ

Bypassing the clearinghouse cartel: Building a local-first Direct Primary Care (DPC) billing state machine

We walked away from insurance billing 4 years ago. Legacy EMRs force you to document for billing levels (E&M 99213 vs 99214). In DPC, your billing is simply a monthly membership state machine. We built an autonomous billing agent in 200 lines of Python that eliminated $40k/yr in billing service fees.

STATUTORY RECEIPT // 42 U.S.C. § 300gg-91 VERIFIED PRIMARY RECORD
Citation: Direct Primary Care Exemption to ACA Mandates, 42 U.S.C. § 300gg-91(a)(1)
“Direct primary care medical home fee arrangements are explicitly recognized outside commercial health plan requirements, preempting third-party insurance billing codes.”
22comments
ClinicalCLINICAL // AAP AMB-DOSING PROTOCOLElena RostovaPrincipal Systems Architect (ex-Epic Integrations)
1 MIN READ

Deterministic vs. Probabilistic: Where do you draw the absolute line on letting an agent execute a tool call in your clinical pipeline?

A lot of teams are letting LLMs decide tool arguments directly (e.g. calling create_prescription with whatever milligram dose the model hallucinates). That is malpractice waiting to happen. Here is our hard boundary: agents propose intents, pure deterministic code evaluates safety invariants.

CLINICAL GUIDELINE // AAP DRUG SAFETY VERIFIED PRIMARY RECORD
Citation: American Academy of Pediatrics (AAP) Clinical Practice Guideline (2024)
“Amoxicillin dosing for acute otitis media in pediatric populations SHALL NOT exceed 90 mg/kg/day divided into two doses. Any higher administration constitutes a critical safety hazard.”
31comments
ArchitecturalARCHITECTURAL // HL7 FHIR R4 § 2.1Dr. Marcus Vance, MDEmergency Medicine & Python Builder
1 MIN READ

How are you structuring system prompts in Claude Code / Cursor to force strict FHIR R4 JSON rather than conversational markdown?

We spent three weeks battling LLM hallucinations where Claude would return markdown wrappers around FHIR Bundles or drop required fields like meta.lastUpdated and subject.reference. Here is the exact two-tier prompt architecture that reached 99.4% schema compliance.

STATUTORY SPEC // HL7 FHIR R4 SCHEMA VERIFIED PRIMARY RECORD
Citation: HL7 FHIR Release 4 (v4.0.1) Specification § 2.1.0
“Bundle.entry.resource of type transaction SHALL satisfy invariant bdl-3: every entry must have a fullUrl or resource, and Condition resources require verified SNOMED-CT clinical coding.”
14comments