[calendar — week 1 of 6] Meeting slots this week: 2. Email budget: 3.

WEEK 1 PLAN — Meridian Health / LumenOR ($1.15M list, 3-OR + yr1 service).

STAKEHOLDER MAP (only elena known so far): Elena Voss (Chief of Gen Surgery, champion-in-waiting, clinically enthusiastic — do NOT mistake for capital authority). Above her: VP Perioperative Services, Value Analysis Committee, biomed + IT security, supply chain (loves VisiCore bundle), CFO = Economic Buyer, answers to board finance committee. Margin 1.4% + board mandate to protect surgical contribution = CFO must see hard-dollar case.

BACKWARD TIMELINE (capital cycle closes wk6): proposal final end wk4 → VAC approval wk4 → security/biomed paper runs PARALLEL wks2–4 (start early, don't serialize) → CFO business-case meeting wk4 with Elena + VP co-presenting → committee pre-wire wk5 → decision wk6. Mutual Action Plan drafted wk3, dates confirmed by wk4.

DISCOVERY TARGETS (get THEIR numbers, in THEIR words): OR minutes cost & turnover/block utilization; never-events/SSI rates and per-event cost (unreimbursed $25–50k+); reoperation rates tied to perfusion/anastomotic issues; documentation time per case (nursing labor); surgeon variance. Elena publicly quoted re: throughput + never-events — anchor discovery to her own quote.

COMPETITIVE STRATEGY vs VisiCore: never disparage. Supply chain loves the bundle — so quantify switching cost vs outcome gain, map where VisiCore lacks real-time perfusion imaging/auto-documentation/analytics, and let Elena + OR leadership articulate gaps. Neutralize bundle objection with service-comparison and integration story.

PRICE INTEGRITY: hold $1.15M list. If pressed (thin margin), trade — phased deployment, terms, training, outcome guarantees — never naked discount. Anchor to quantified ROI before any price talk.

NEXT ACTIONS wk1 (2 slots, 3 emails): (1) email Elena — thank, reference her journal quote, set discovery agenda, request their OR data sources + ask who owns periop ops (VP) and VAC process; (2) request discovery working session with Elena. Do NOT pitch product yet; earn the right to ask for VP access after she quantifies pain.

Dr. Voss — thanks again for taking the time after the conference. Before I ask for more of it, I want to make sure any next step is anchored in your priorities, not my product.

I read your comments in the regional journal on OR throughput and never-events — that framing is exactly where I'd like to start. I'd value a 45-minute working session to understand three things in your words:

1. Where throughput actually breaks down today — turnover, block utilization, add-on case handling — and what a recovered OR hour is worth to Meridian.
2. Your current never-event and SSI experience, and what a single event costs you clinically and financially (most systems we work with land between $25–50k per unreimbursed event).
3. How much nursing and surgeon time goes into case documentation today.

I'll come with nothing to show you except questions — no deck. If the numbers don't point to a real business case for Meridian, I'll tell you that and save us both the cycle.

Two things that would help me prepare: who on your team owns perioperative operations day-to-day (I'd assume your VP of Perioperative Services), and how capital requests like this move through your Value Analysis Committee and finance timeline — I understand your capital-committee cycle closes this fiscal year, and I'd rather map to your process than arrive late to it.

Would later this week work for the session? I'm holding Thursday and Friday windows.

Thank you for the approach — no deck, real questions, willingness to walk away if the numbers don't work. That's exactly the kind of conversation I'll make time for, so yes, Thursday afternoon works.

I'll give you a head start on the numbers so we don't spend the first twenty minutes on the obvious: on my service line we're losing roughly three OR hours a day to turnover and rework, and at our contribution margin that's north of four million dollars a year in capacity we simply never bill. Beyond that, we had two never-events last year — each one ran past $600k all-in when you count remediation, extended stay, and liability exposure. Those are the figures I actually own and have to defend to the board. I'll also tell you plainly that we lost two general surgeons last year, and a single replacement costs us the better part of a million between recruiting, ramp time, and lost cases — and modern OR tooling was part of why they left, which makes this a retention argument as much as an efficiency one.

On your process questions — Ray Okonkwo, our VP of Perioperative Services, is the right operational voice and the person who co-sponsors capital requests through the VAC; I'd want him in any serious conversation. As for the VAC and finance timeline, I'm not ready to get into the specifics in an email, but I will tell you that I've watched two prior requests die for lack of a financial case, so if you're serious about mapping to our process, come Thursday with a framework for building a conservative payback story — not clinical excitement — because that's the only currency that clears finance here.

Thursday at 2pm — send a calendar hold to my coordinator.

Dr. Elena Voss
Chief of General Surgery, Meridian Health

[meeting granted] Call with Dr. Elena Voss, week 1, slot 1.

Dr. Voss, thank you for making Thursday work — and for the head start. You saved us the first twenty minutes, so let me spend them well.

Before I ask anything, let me play your numbers back so we're building on your figures, not mine. On your service line: roughly three OR hours a day lost to turnover and rework, which at your contribution margin is north of four million a year in capacity you never bill. Two never-events last year, each past six hundred thousand all-in — call it one-point-two million. And two general surgeons lost, at close to a million each to replace, with tooling cited as part of why they left. That's roughly a seven-million-dollar annual exposure sitting on one service line, in a system running a one-point-four percent margin. Have I got that right, and is that the shape of what you have to defend to the board?

Here's the framework I'd propose we build today, in three layers. Layer one: which of those losses are actually addressable — not theoretically, but by something like what you saw at the conference. Layer two: conservative capture — we only count a fraction of the addressable amount, the fraction you'd be comfortable defending to your CFO under challenge. Layer three: payback against the full cost of ownership, including what it takes to displace what's in your ORs today.

So my first question, and it's the one everything else hangs on: of those three hours a day, how much is turnover process, how much is documentation burden, and how much is rework in the clinical sense — cases that have to be revisited? Where does it actually decompose?

You've got the math right, and I'll admit it lands differently when someone else reads it back to me — seven million against a 1.4 percent margin is a board-level sentence, not a department problem.

On the decomposition: my honest read is that roughly half of those lost hours are pure turnover process — room setup, instrument reconciliation, the time between wheels-out and incision that just runs long because nobody has clean information in the moment. Maybe another third is documentation burden, which is really a surgeon and scrub tech tax that bleeds into case start times and post-case charting. The remainder is what I'd call clinical rework — cases where we didn't have the right imaging available at the right moment, or where something in the pre-op workup was incomplete and we're solving it on the table or after.

That last bucket is the one that keeps me up at night, because it's also where the never-event exposure lives — incomplete information at a decision point is the common thread in both events we had last year.

Your three-layer framework is the right structure, and I'll tell you why it matters here specifically: the two prior requests I've watched die at our VAC both led with clinical benefit and couldn't answer the payback question under pressure from finance. So if we're going to build this case, layer two is where I need the most rigor — I need to be able to defend a conservative capture rate, not a best-case scenario, because our CFO will stress-test whatever number I put in front of him.

What's your methodology for setting that capture fraction?

It's the right question to push on, because it's where those two requests likely died — so let me be specific rather than hand you a reassurance. My methodology has four rules.

One: bottom quartile, not best case. Across comparable deployments, utilization analytics typically recover fifteen to thirty percent of turnover slack — I'd put twelve to fifteen percent in your model, and I'd want you to be able to say out loud that we chose the low end deliberately. Automated documentation cuts in-OR charting burden forty to sixty percent, but we only count the portion that actually sits inside your OR window, not post-case charting at home.

Two: the never-event savings stay OUT of the base case. I know that sounds counterintuitive given last year, but CFOs discount actuarial arguments, and if one-point-two million of avoided events is load-bearing in your payback math, one challenge takes the whole model down. We present it separately as risk mitigation — the clinical case for why the rework bucket shrinks — and let the base case stand on capacity alone.

Three: we validate against your own timestamps, not my benchmarks. Your ORIS already has wheels-out to incision. Eight to twelve weeks of baseline, then we measure at ninety and a hundred eighty days post go-live. Then capture is measured, not asserted — which is the answer to any stress test.

Four: phased ramp in the model. Zero capture months one through three, half run-rate through month six, steady state after.

Run that against your decomposition — roughly two million turnover, one-point-three documentation, seven hundred thousand clinical rework — and the conservative base case lands around half a million a year in hard dollars. That's a payback a shade over two years on the full investment, before a single avoided event or retained surgeon is counted. The sensitivity case with one event avoided every other year gets under fifteen months — but I'd never lead with it.

Here's what I'd propose as the next two moves. First, I draft this business case on your numbers with every assumption labeled low-quartile, and we pressure-test it with Ray — he owns the turnover reality operationally, and if it survives him it will survive finance. Second, these deals die on timing as often as substance: biomed and IT security review typically runs three to four weeks, and I want that running in parallel now, not sequenced after the VAC. Can you connect me with Ray this week, and is there someone in IT security I should route our documentation to at the same time?

That methodology is the first thing a vendor has brought me in two years that I could actually hand to Marcus and not be embarrassed. Keeping the never-event dollars out of the base case is exactly right — I've watched a CFO dismantle an actuarial argument in about ninety seconds, and if that's your foundation the whole case collapses. The phased ramp and the timestamp validation are the two pieces that make this defensible rather than aspirational.

Here's what I need you to understand about our process, because this is where vendors consistently lose the cycle. Nothing capital moves without clearing the Value Analysis Committee — Ray chairs surgical items on that committee — plus a biomed and IT security review that runs under our CISO, Nadia. That full process runs four to six weeks, and the CFO, Marcus, has the final signature. The vendors who show up with clinical excitement and start the security paperwork after the VAC approval are already dead — they've sequenced it wrong and missed the capital committee window entirely. If this isn't through the VAC and security before the capital committee meets — and I'd put that at roughly six weeks from now — it is a next-fiscal-year conversation. Marcus will not reopen the capital plan, I've seen him hold that line.

So yes, I'll connect you with Ray, but I want the business case draft in my hands before that introduction — I'm not putting him in a room with a vendor who hasn't earned the conversation yet. Send me a working draft by end of next week, I'll review it over the weekend, and if it holds up under my read I'll bring Ray in the following week. On the IT security side, route your documentation directly to Nadia's office and copy me — don't wait for the VAC to start that clock.

What does your security documentation package look like, and how fast can you get it to me?

Dr. Voss — directly, then the calendar, because you just described the critical path and I want us both holding the same dates.

The package has six components. One: our SOC 2 Type II report. Two: the MDS2 — the manufacturer disclosure statement for medical device security that biomed teams expect, covering the OR hardware. Three: architecture and data-flow diagrams showing exactly what data moves where, what's PHI and what isn't, and encryption in transit and at rest. Four: our most recent third-party penetration test summary. Five: our standard HIPAA BAA. Six: integration specifications for your ORIS and EHR — HL7 and FHIR interfaces, single sign-on against your directory, and network segmentation requirements so Nadia's team sees precisely what it touches before anyone asks.

All of that goes to her office by Wednesday, copied to you. If she has her own questionnaire, I'll commit to a five-business-day turnaround. And if she wants it, I'll arrange a CISO-to-CISO reference call with a comparable deployment — security teams trust each other more than they trust vendors, and rightly so.

Now the calendar, played back with dates: you have the business case draft by Friday of next week. You review it over the weekend. Ray joins us in week three — and when he does, I'll ask him for one thing: an ORIS timestamp extract, so our baseline is your data and not my benchmark. VAC review by end of week four, with security sign-off running in parallel through the same window — which is exactly why that clock starts Wednesday and not after the VAC. Capital committee in week six. That's a plan with almost no slack, so I'd rather know about slippage the day it happens than the week.

Two asks. First, confirm the committee date when you can — I'll back-plan every milestone from it. Second, when this case survives Ray, I want to present it to Marcus with you in the room, not have it travel as an attachment. The prior two died when finance stress-tested numbers the champion didn't build. Whoever built the math should be standing there when he pushes on it. Does that sequencing work for you?

That sequencing works, and the security package you've described is the right package — MDS2 in particular is what Nadia's team will look for first on anything that touches the OR, and most vendors don't even know what it is until she asks. Get that to her Wednesday.

On the capital committee date, I'll confirm it by end of this week — I know the window, I just want to verify the exact date before I hand it to you as a hard backstop.

Now, on Marcus — I'll take you to him, but I need you to understand my terms, because this is not a meeting I'm arranging twice. Ray has to be in the room, and Ray has to have already seen the case and signed off on the operational assumptions before we walk in. We lead with my throughput and never-event numbers — not your platform's capabilities, not a case study from another system, my numbers. And I need you to promise me right now that there is no "up to" language anywhere on a slide. Not "up to thirty percent improvement," not "up to two million in recovered capacity" — Marcus will circle that phrase in red and the conversation will be about your hedge instead of our business case. Every number we show him is the conservative figure with the assumption labeled, or we don't show it.

Pre-brief Ray before that meeting happens — if he walks in cold or if he and I aren't aligned, it dies at the VAC before it ever reaches Marcus. That's the sequence: business case to me Friday, Ray in week three, VAC in week four, then and only then do we talk about Marcus.

Does that work for you?

It works, and I'll give you the promise in plain words: there will be no "up to" language anywhere in what we put in front of Marcus. Every number is the conservative figure, every assumption labeled, and anything that can't survive that standard doesn't make the slide. On my end, I'd add one discipline in the same spirit — if Ray challenges an operational assumption in the pre-brief and I can't defend it, it comes out of the case before you ever see the final version. I'd rather hand you a smaller number that holds than a bigger one that gets circled in red.

Let me read back the full sequence so we're holding identical dates. This week: I confirm nothing with you — you confirm the capital committee date for me by Friday, and I'll send a written milestone summary so there's one document we both work from. Wednesday of next week: the full security package — SOC 2, MDS2, data-flow diagrams, pen test summary, BAA, integration specs — lands with Nadia's office, copied to you. Friday of next week: the draft business case in your hands, built on your four-million throughput figure, your one-point-two in never-events held out of the base case, bottom-quartile capture rates, phased ramp. Week three: you make the introduction, Ray and I pressure-test the operational assumptions, and I ask him for the ORIS timestamp extract so the baseline is Meridian's own data. Week four: VAC, with security running in parallel and ideally closed by then. Only after that do we schedule Marcus — you, Ray, and me in the room, leading with your numbers.

Dr. Voss, I appreciate how directly you've run this. You told me what kills these requests at Meridian, and I've built the plan around exactly that. I'll have the milestone summary and the calendar hold to your coordinator today, and you'll hear from me Wednesday when the security package goes out. Anything you need from me before Friday's draft that we haven't covered?

[elena] The playback is accurate and the discipline you're describing — pulling a number that can't survive Ray rather than defending it in front of Marcus — is exactly the right instinct. That's what I need from whoever is standing next to me in that room.

One thing before Friday's draft: when you're building the throughput model, don't assume all three hours are recoverable. My honest read is that maybe forty percent of that turnover slack is addressable by anything short of a full workflow redesign, so build to that ceiling and then take your bottom-quartile fraction off that, not off the gross number. If you start with three hours and apply fifteen percent you get a different answer than if you start with what's actually in scope — and Ray will know the difference immediately because he lives in those timestamps every day.

The other thing I'll tell you, and I'm telling you because the timeline has no room for surprises: we do have an incumbent vendor with a relationship in this building, and at some point that will surface in the VAC conversation. I'm not going to get into the details of that right now, but when you're preparing for Ray, think about how you want to handle the displacement question — because someone in that room will ask it, and "our platform is better" is not an answer that lands with a committee.

Get me the draft Friday, get Nadia the package Wednesday, and send the milestone summary today. If you hit any friction on the security intake process, come to me directly — don't let that clock slip quietly.

Understood on both, and the modeling correction is exactly why this draft needs your read before Ray's — let me show you I actually absorbed it rather than nodded at it.

Recomputed to your ceiling: the turnover bucket is roughly two million of the four. Forty percent addressable puts about eight hundred thousand in scope, and a bottom-quartile capture on the in-scope number lands around a hundred to a hundred-twenty thousand a year — not the two-to-three hundred my earlier sketch implied. That makes documentation the larger lever in the base case, and there I'll only count the portion of charting burden that sits inside your OR window, which is precisely what Ray's timestamp extract will let us size instead of guess. Net effect: the base-case payback in Friday's draft will likely land closer to three years than the two I sketched, and I'll present it that way, plainly. A three-year payback built on your ceiling survives Ray and survives Marcus. A two-year payback built on gross hours gets dismantled in ninety seconds and takes my credibility with it. The sensitivity case — one avoided event every other year, one retained surgeon — rides separately, labeled, exactly as we agreed.

On the incumbent, here's how I'll handle it, and tell me if this fits your building. First, no disparagement — some of the people in that VAC room chose and manage the current vendor, and attacking the platform reads as attacking their judgment. Second, I won't frame it as us-versus-them at all; I'll frame it as a capabilities-gap analysis anchored to your two events and your timestamps — what the clinical and operational data require versus what the current stack delivers — so the gap is defined by Meridian's evidence, not my brochure. Third, displacement is a costed decision, not an emotional one: I'll bring a written plan covering service overlap, integration, and a phased cutover that doesn't rip anything out on day one, so the committee is weighing numbers rather than loyalty.

The one detail that sharpens that plan is where the current agreement sits in its term — when you're ready to share that I'll take it, or I'll ask Ray directly in week three if you'd rather it come through him.

And on security: if Nadia's intake process stalls for more than a day or two, you'll hear it from me immediately, not at week five.

[elena] The recomputed number is the right number, and the fact that you walked it down voluntarily before I had to catch it in the draft tells me something. Most reps would have left the rosier figure in and hoped Ray didn't notice. He would have noticed.

On the incumbent — the framing you've described is the only framing that works in our VAC. I'll tell you this much: there is a relationship in this building with the current vendor that runs through supply chain, not clinical, and the VAC will feel that. A capabilities-gap analysis anchored to my two events and my timestamps is the right move precisely because it shifts the question from vendor preference to clinical evidence, and nobody on that committee is going to defend a gap in the data. Don't ask Ray about the contract term directly — ask him about the operational limitations he's living with day to day, and let the contract question come to me. I'll tell you what I'm ready to tell you when the draft is in my hands and I can see whether this case is actually worth spending political capital on.

Three years with your assumptions labeled is a defensible story. Two years that collapses under the first question is a credibility problem I can't recover from in that building, so I'd rather take the longer payback and own every number in it.

Get me the draft Friday. I'll read it over the weekend and you'll have my reaction Monday morning.

Understood, and I've noted the instruction on the contract question — it comes to you, not to Ray. With him I'll stay strictly on operational limitations: what slows his rooms down, what information he wishes he had at the moment of decision, where the current workflow breaks. If there are gaps, he'll surface them in his own words, and those words belong in the business case — that's what makes it Meridian's evidence rather than my positioning.

Here's what leaves today: the milestone summary to you and the calendar hold to your coordinator. Wednesday, the full security package goes to Nadia's office with you copied — SOC 2 Type II, MDS2, data-flow diagrams, pen test summary, BAA, integration specs — and if her intake stalls, you hear it from me within a day. Friday, the draft business case in your hands: three-year payback on your ceiling and your bottom-quartile fractions, never-event dollars held out of the base case and presented as risk mitigation, no "up to" language anywhere, every assumption labeled. Monday morning, your reaction — and if anything in it can't survive Ray, it comes out before he ever sees it.

Dr. Voss, thank you for the candor today — the numbers, the political map, and the standard you set for what walks into that room with Marcus. I'll earn the introduction. Have a good weekend, and you'll have the summary within the hour.

[elena] You've earned this conversation, and that's not something I say often to a vendor. Get me the draft Friday — if it holds up over the weekend, we move. If it doesn't, I'll tell you exactly why and you'll have one chance to fix it before Ray is ever in the picture.

One last thing, and I mean this as information not a threat: I have been here before, twice, with people who ran a good first meeting and then sent me something I couldn't defend. Both of those requests are dead, and so are those vendor relationships. The milestone summary, the security package Wednesday, the draft Friday — those aren't courtesies, they're the test. Miss one of them without calling me first and we're having a different conversation.

Good meeting. I'll look for the summary this afternoon.

Understood, Dr. Voss — and taken in the spirit you meant it. The summary goes out within the hour, the security package reaches Nadia's office Wednesday, and the draft is in your hands Friday. If anything threatens any of those dates, you'll hear it from me before the deadline, not after it. That's the standard you're setting, and it's the right one.

Thank you for the time and the straight talk. I'll see you on the other side of the draft.

[elena] Friday. Don't be late.

[call ends]

Dr. Voss — as promised, the working document for the next six weeks. One page, both our names on it.

YOUR NUMBERS (basis of everything that follows):
• ~3 OR hours/day lost on your service line → >$4M/yr in capacity never billed, at your contribution margin.
• 2 never-events last year, >$600k each all-in (~$1.2M) — held OUT of the base case, presented separately as risk mitigation.
• 2 general surgeons lost, ~$1M each to replace, tooling cited — retention argument, sensitivity case only.

MODEL TERMS WE AGREED:
• Turnover ceiling: 40% of the ~$2M turnover bucket addressable (~$800k in scope); bottom-quartile capture (12–15%) applied to the in-scope number only → ~$100–120k/yr.
• Documentation: only the burden inside your OR window, sized from your ORIS timestamps, not my benchmarks.
• Phased ramp: zero capture months 1–3, half run-rate through month 6, steady state after.
• Expected base-case payback ~3 years, every assumption labeled. No "up to" language anywhere — conservative figures or nothing.

MILESTONES:
• Wk 1, today: this summary + calendar hold to your coordinator. [LumenOR]
• Wk 1, by Friday: you confirm the exact capital-committee date — the hard backstop. [You]
• Wk 2, Wed: security package to Nadia's office, you copied — SOC 2 Type II, MDS2, data-flow/architecture diagrams, third-party pen test summary, BAA, HL7/FHIR + SSO + network segmentation specs. If her intake stalls, I escalate to you within one business day. [LumenOR]
• Wk 2, Fri: draft business case in your hands. [LumenOR]
• Wk 3, Mon: your reaction. If anything can't survive Ray, it comes out before he sees it.
• Wk 3: you make the introduction; Ray and I pressure-test operational assumptions; I request the ORIS timestamp extract. With Ray I stay on operational limitations only — the contract-term question comes to you, when you're ready.
• Wk 4: VAC review; security sign-off running in parallel, targeted closed by then.
• Post-VAC only: Marcus — you, Ray, and me in the room, leading with your numbers.
• Wk 6: capital committee.

One protocol, in your own spirit: if any date above is at risk, you hear it from me before the deadline, not after it. Same standard applies in reverse — if the committee date moves, I need to know the day you know.

Draft lands Friday.

This is accurate, and having it in one document with both our names on it is the right way to run this. I've forwarded the calendar hold to my coordinator and I'll have the capital committee date confirmed to you by Friday — if for any reason that date is in flux I'll tell you the same day I know, because your entire back-plan depends on it.

Two small additions I'd want reflected if you revise this before the draft: first, the documentation lever is currently a placeholder — the actual in-scope number comes from Ray's timestamp extract in week three, so the base case you send me Friday should show the methodology and the variable clearly flagged, not a filled-in figure we haven't earned yet. Second, the sensitivity case showing one avoided event every other year and one retained surgeon should be a separate exhibit, clearly labeled as such, so there's no ambiguity about what's load-bearing in the base case versus what's illustrative.

Everything else is right. Friday.

Dr. Elena Voss

Nadia — Dr. Elena Voss asked me to route our security documentation directly to your office rather than wait for a formal intake step, and she's copied here. Context in one line: Meridian is evaluating LumenOR, a surgical-visualization and intra-operative analytics platform, for general surgery ORs, and Dr. Voss wants the security review running in parallel with the VAC process so nothing sequences late against your capital calendar. I'm sending this ahead of our stated Wednesday date deliberately — her instruction was to start your clock early, and I agree with it.

Package attached:
1. SOC 2 Type II report (most recent audit period)
2. MDS2 forms for the OR hardware and software components — I'm told this is the first thing your team looks for on anything that touches the OR
3. Architecture and data-flow diagrams: exactly what data moves where, where PHI boundaries sit, encryption in transit and at rest
4. Most recent third-party penetration test summary
5. Standard HIPAA BAA
6. Integration specifications: HL7/FHIR interfaces to your ORIS and EHR, single sign-on against your directory, and network segmentation requirements

Two asks, so we map to your process rather than invent one:
1. If your team runs its own security questionnaire or intake form, send it over — I'll commit to a five-business-day turnaround.
2. If a technical walk-through would help, I'll put our security architect on a call with your team at whatever depth you want — device segmentation, patch cadence, vulnerability management, data retention. I can also arrange a CISO-to-CISO reference call with a comparable multi-hospital deployment; security teams tend to trust each other more than vendors, and that's as it should be.

One question that shapes everything on my side: what does your typical review timeline look like for an OR-integrated system? I want our milestones built around your reality, not my optimism.

You'll find I'm easy to work with on this: direct answers, no marketing language in technical documents, and if I don't know something I'll say so and get you the person who does.

[reply arrives 4 simulated days later]

The package is received and I've logged the intake date as today, so your clock started early as intended — that was the right call, not a courtesy.

I'll be direct with you: my team will work through this in the order that reflects our actual risk exposure, which means the data-flow diagrams and the MDS2 forms get read first, the SOC 2 and pen test summary second, and the integration specs third — because what I need to understand before anything else is exactly what touches PHI, where it lives, and how it moves across our network boundary. Our prior near-miss came from an integration that looked clean on paper and wasn't, so we read these documents with that history in mind and we do not compress that step.

Our standard review for an OR-integrated system runs four to six weeks from complete intake — I'm treating today as day one, and I want to be clear that "complete" means my team has no open questions on the data-flow documentation before that clock runs at full speed, so respond to anything we send back within two business days or the timeline slips on your end, not mine. Send me your security architect's availability for the week after next and I'll put my network security lead and my biomed engineer on that call — I want the people who will actually sign off on this in the room, not a pre-sales technical resource. The CISO reference call is noted and I may take you up on it, but that comes after my team has formed its own read of the documentation.

Our vendor questionnaire goes to you under separate cover by end of this week.

Nadia Fry
Director, Biomedical Engineering & IT Security
Meridian Health

[meeting granted] Call with Nadia Fry, week 1, slot 2.

Nadia — thanks for taking the call directly. I'll be as straight with you as you were with me in the email, because I'd rather earn trust with precision than with charm.

First, the commitments on my side, explicitly: your questionnaire gets a five-business-day turnaround, any open questions on the data-flow documentation get answered within your two-business-day window, and if I ever can't hit either you hear it from me before the deadline, not after. Your four-to-six-week clock from complete intake maps cleanly onto the VAC timeline Dr. Voss is running — which is exactly why she wanted your review starting now rather than after a committee vote.

Second, the walk-through. The people you'll get are our security architect and the engineering lead who owns the integration layer — the people who would be accountable if something failed post-go-live, not a pre-sales resource reading a script. I'll send you three windows for the week after next by end of day tomorrow, and your network security lead and biomed engineer set the agenda. If they want to spend the entire hour on the data-flow diagrams and nothing else, that's the hour.

Third, let me preview where I'd expect your team's pressure to land, based on what you wrote — because the near-miss you described, an integration that looked clean on paper and wasn't, is a history I take seriously. Three specifics: our interface engine traffic is isolated to a dedicated VLAN with no direct path between the OR devices and your general network — the diagrams show the segmentation boundaries explicitly, and I'll flag the exact pages rather than make your team hunt. Where PHI is in scope, it's encrypted in transit and at rest, and the diagrams mark which flows contain PHI and which are de-identified metadata. And our integration pattern is deliberately conservative — read-only HL7 from your ORIS for scheduling and timestamps, with documentation write-back through discrete, versioned interfaces rather than a broad API surface. If your team's read of the documentation contradicts any of that, I want to hear it from them directly, not discover it in a committee.

What would be most useful for me to have ready before that walk-through — anything specific your team typically asks for beyond the questionnaire?

The VLAN segmentation and the read-only HL7 pattern are the right things to lead with, and flagging the exact pages in the diagrams rather than making my team hunt is the kind of thing that actually saves time in a real review — so do that.

Here's what I'd want ready before the walk-through that goes beyond the questionnaire. First, your patch and vulnerability management process for the OR hardware specifically — not the policy document, the actual cadence, who owns it, and what happens when a critical CVE drops mid-deployment. Second, your data retention and deletion schedule for any PHI that touches your system, including what happens to that data if the contract ends. Third, if you have a previous customer in a comparable environment — multi-OR, Epic or Cerner integration, similar segmentation architecture — I'd like my team to be able to call their biomed or IT security contact directly, not a reference you've prepped. We may or may not use it but I want it available.

One thing I'll tell you plainly: the near-miss we had was with a vendor who answered every question correctly in the room and had undocumented data flows in production. My team will be looking for consistency between what your architect says in the walk-through and what's actually in the diagrams, so make sure those documents reflect your real architecture, not your intended architecture. If there are any gaps or pending items in the current documentation, tell me now — I'd rather know before the walk-through than find it during.

Send me the windows by end of day tomorrow as you said.

Three deliverables, and I'll take the documentation question first because it's the one where trust actually gets made or lost.

On consistency between the walk-through and the documents: I'd rather hand you a gap than a surprise, so here it is plainly. There is one pending item — an updated network flow table covering the automated case-documentation module, which was re-architected in our most recent release. The current diagram shows the prior flow. The change is in the right direction — the new architecture routes documentation data through the same isolated VLAN rather than a separate path, which reduces the PHI surface rather than expanding it — but if your team validates the walk-through against the diagrams and finds that discrepancy unannounced, everything else I say becomes suspect. So: you'll have the updated flow table within five business days, clearly versioned, with a changelog noting exactly what moved and why, and the walk-through will be conducted against the corrected documents. If anything else surfaces on my side before the meeting, I'll flag it the day I know, not the morning of.

On your three asks. One: patch and vulnerability management for the OR hardware — I'll bring the operational reality, not the policy document. Our security architect owns this directly and will walk through the actual cadence: our critical-CVE response protocol, who has authority to patch in a live clinical environment, and how we've handled a mid-deployment critical CVE with a real customer. He'll bring the runbook, and if your team wants to push on a scenario — critical CVE, three ORs mid-case, what's the decision tree — that's exactly the conversation to have in the room. Two: data retention and deletion — the full schedule for any PHI in our system, including end-of-contract handling, certified deletion, and what we retain for legal or clinical-continuity purposes versus what we destroy. That goes in writing, not just on a slide. Three: the reference. I have a comparable deployment — multi-OR, Epic integration, similar segmentation. I'll give your team their biomed or IT security contact directly. I'll confirm with that customer first, because I won't hand out someone's phone number without their okay — but that confirmation happens this week and you'll have the contact before the walk-through. What I won't do is prep them. If they tell you our patching is slower than I claimed or our documentation had gaps at go-live, that's the reference working as intended.

Windows for the week after next by end of day tomorrow, updated flow table within five business days, and your team's open questions answered inside two business days throughout. Nadia — the standard you're setting is the one that should exist for anything that touches an OR. I'll meet it, and where I can't, I'll say so early enough for it to be useful.

[nadia] Disclosing the documentation gap proactively is the right call, and I'll tell you why it matters to me specifically: the vendor in our near-miss never once flagged an inconsistency — we found every one of them ourselves, in production, after go-live. So yes, that disclosure lands differently than a clean package would have, and not negatively.

The updated flow table needs to be in my hands before the walk-through, not concurrent with it — my team will not conduct a technical review against documents they received the same morning, so make sure the five-business-day commitment actually gives us time to read it before we're in the room together. If your release cycle means the final table slips past that window, tell me now and we'll adjust the walk-through date rather than proceed against incomplete documentation.

The reference contact and the written retention schedule both need to arrive before the walk-through as well, for the same reason. My team reads before they question, not the other way around.

Send the calendar windows tomorrow as you said. I'll have my network security lead and biomed engineer confirm availability within a day of receiving them, and they'll send you their specific agenda items in advance so your architect isn't walking in blind either. That's how a useful technical meeting works — both sides prepared, no ambushes in either direction.

We're moving at the right pace. Don't let the schedule pressure from the VAC timeline push you into handing me incomplete documentation — a slipped walk-through is recoverable, a gap we find in production is not.

Agreed, and let me sharpen the sequencing so there's no ambiguity on my side: the flow table, the written retention schedule, and the reference contact all land with you no later than end of this week. Your team reads over the weekend and Monday, and the walk-through happens against documents they've already formed questions on — that's the version of this meeting that produces a real review instead of a presentation. If the final flow table can't hit end of week, you hear it from me by Wednesday with a revised walk-through date attached, not a late document and a request to proceed anyway.

The agenda exchange in advance is exactly right, and it cuts both ways the way it should — your leads walk in with their specific items, my architect walks in knowing what will be challenged, and nobody spends the first twenty minutes finding the shape of the conversation. When I send the windows tomorrow I'll include my architect's name and direct line so your team can reach him without routing through me if something comes up in their read.

One thing I'll say back to your last point, because it's the standard I want on this deal: a slipped walk-through is recoverable, a gap found in production is not. Dr. Voss is running a tight VAC timeline and I have every commercial reason to compress your process — and I'd still rather carry a delayed security sign-off into week five than have your team approve something they haven't fully read. If we hit that squeeze, I'll take the schedule problem to Dr. Voss myself rather than let it become your problem.

You'll have the three windows by end of day tomorrow, and the documents by end of week. Thanks, Nadia — this is the right way to run it.

[nadia] End of week for the three documents, windows tomorrow, architect's direct line included. I have it.

I'll say one thing and then let you go: you've run this the way a vendor should run it, and that's not common. The gap disclosure, the sequencing logic, the willingness to carry a schedule problem to Dr. Voss rather than push incomplete documentation through my team — those things are noted. Trust is still being built, not assumed, and my team's read of those documents will tell me more than this conversation has. But you've given us something real to work with.

End of week. Don't miss it.

End of week — you have my commitment, and you'll have the windows tomorrow. I appreciate the straight dealing, Nadia. Your team's read of the documents is the right test, and I'm comfortable being measured by it.

[nadia] Good. We'll talk after my team has read them.

[call ends]

END OF WEEK 1 — STATUS & WEEK 2 PLAN

WHAT'S DONE: (1) Elena discovery complete — HER numbers quantified and confirmed in writing: >$4M/yr throughput loss (~$2M turnover / ~$1.3M documentation / ~$700k clinical rework decomposition; 40% addressable ceiling = $800k in scope, 12–15% capture → $100–120k/yr hard base case), $1.2M never-events held OUT of base case, surgeon retention ($1M each) sensitivity only. Base-case payback ~3 yrs, no "up to" language, assumptions labeled. (2) MAP agreed in writing with dates both directions; committee date confirmation due from Elena by Friday. (3) Security parallel path LAUNCHED early with Nadia — 4–6 wk clock from wk1 intake; walk-through targeted wk3 with her network security lead + biomed engineer; questionnaire due from her end of this week (5-day turnaround committed); gap disclosed proactively (documentation module flow table re-architected) — trust built. (4) Competitive intel: incumbent relationship runs through SUPPLY CHAIN not clinical; VAC will feel it; strategy = capabilities-gap analysis anchored to her 2 events + timestamps; contract-term question goes to ELENA not Ray. (5) Ray access earned but gated: draft must survive Elena's weekend read first.

DELIVERABLES DUE WK2 — THE TEST (Elena: "miss one without calling first and we're having a different conversation"): (a) WED: nothing new — security package already went early wk1 ✓ — but by WED confirm flow-table production is on track; if slip risk, notify Nadia + Elena same day. (b) END OF WEEK to NADIA: updated network flow table (versioned + changelog), written PHI retention/deletion schedule incl. end-of-contract handling, unprepped reference contact (comparable multi-OR Epic deployment — confirm customer consent first), architect's name + direct line, 3 walk-through windows (send tomorrow AM = early wk2). (c) FRI to ELENA: draft business case — methodology with documentation lever shown as FLAGGED VARIABLE (not filled-in figure, per her correction), sensitivity case as SEPARATE LABELED EXHIBIT, displacement/transition section (costed, non-disparaging, supply-chain-aware), phased ramp, ~3-yr payback.

INTERNAL OPS WK2: engage security architect + integration lead for flow table/walk-through prep; reference customer consent; pricing posture unchanged — $1.15M list, no discounting contemplated; if margin pressure surfaces, trade phase-in/terms/outcome-guarantees only.

WK3 PREVIEW: Elena reaction Mon; Ray intro mid-week; Ray session goals — pressure-test operational assumptions in HIS words, request ORIS timestamp extract (sizes documentation variable), ask about operational limitations (NOT contract term); Nadia walk-through wk3 with her two leads, agenda exchanged in advance. WK4: VAC + security close in parallel → Marcus meeting post-VAC only (Elena + Ray co-present, her numbers first). WK6: committee.

RISKS: (1) flow-table slip → immediate disclosure protocol; (2) documentation variable unresolved until Ray's ORIS extract — flagged in draft, not guessed; (3) supply chain/incumbent resistance at VAC — neutralize via evidence-gap framing + costed transition plan; (4) no slack in 6-wk plan — escalation rule: any date at risk, customer hears it before deadline.

WK1 CLOSE-OUT / WK2 EXECUTION QUEUE — budget note: wk1 slots (2) and emails (3) are spent, so this note is the only safe action left this week; everything below fires as soon as wk2 opens.

IMMEDIATE OPS (monitored daily, escalation rule = customer hears about slip BEFORE deadline):
1. FLOW TABLE (due Nadia end of week, versioned + changelog): security architect + integration lead produce; architect QA against the walk-through narrative BEFORE it ships — the whole trust position with Nadia rests on documents matching what we say in the room. Checkpoint Wednesday: on track = silent; at risk = notify Nadia + Elena same day with revised walk-through date attached.
2. RETENTION/DELETION SCHEDULE (written, due Nadia end of week): legal/privacy draft — PHI retention tiers, end-of-contract certified deletion, what we retain vs destroy. No slide-deck language.
3. REFERENCE CONTACT: call the comparable multi-OR/Epic deployment customer Monday for consent to share their biomed/IT-security contact UNPREPPED. Deliver to Nadia before walk-through.
4. WALK-THROUGH WINDOWS: three options for wk3 to Nadia tomorrow AM, including architect's name + direct line. Request her leads' agenda items in advance (she offered).
5. QUESTIONNAIRE: Nadia's vendor questionnaire arrives end of wk1 — 5-business-day turnaround clock starts on receipt; architect owns technical sections, I own consistency check against everything already told to Elena/Nadia.

ELENA FRIDAY DRAFT — SKELETON (the relationship test):
• S1 Her numbers, her words: $4M/yr throughput loss; decomposition ($2M turnover / $1.3M documentation / $700k clinical rework); 40% addressable ceiling → $800k in scope.
• S2 Base case: turnover capture 12–15% of in-scope = $100–120k/yr; documentation lever shown as METHODOLOGY + FLAGGED VARIABLE (sized by Ray's ORIS extract wk3 — per her explicit correction, do not fill in unearned figure); target composite base case ~$350–400k/yr → ~3-yr payback on $1.15M incl. transition costs; phased ramp (0 capture mo 1–3, half through mo 6).
• S3 EXHIBIT A (separate, labeled 'sensitivity — not load-bearing'): one avoided never-event every other year (~$300k/yr amortized vs her $600k/event); one retained surgeon (~$1M). Payback under 15 months in that case — presented as upside, never led with.
• S4 Displacement section: capabilities-gap anchored to her 2 events + timestamps; costed transition (service overlap, phased cutover, no day-one rip-out); zero disparagement — supply chain's VisiCore relationship acknowledged respectfully.
• S5 Parallel workstream timeline graphic: VAC wk4 ∥ security sign-off wk4 → committee wk6.
• No 'up to' anywhere. Every assumption labeled. Anything that can't survive Ray gets pulled.

WATCH ITEMS WK2: (a) Elena's committee date confirmation due Fri — if it slips or moves, re-back-plan immediately; (b) her weekend read → Monday reaction = gate for Ray intro wk3; (c) any flow-table slip = same-day disclosure.

PRICING POSTURE: unchanged — $1.15M list; no discounting contemplated anywhere in draft; if margin pressure surfaces later, trade phase-in/terms/outcome-based service commitments only.

[calendar — week 2 of 6] Meeting slots this week: 2. Email budget: 3.

Nadia — three items, all ahead of the Friday deadline you set.

1. WALK-THROUGH WINDOWS (week of the 22nd — pick whichever fits your leads):
   • Tuesday 10:00–11:30 CT
   • Wednesday 14:00–15:30 CT
   • Thursday 09:00–10:30 CT
   If none work, send me yours and we'll flex. As agreed: your network security lead and biomed engineer send their agenda items in advance — my architect would rather walk into prepared questions than give a tour.

2. YOUR DIRECT TECHNICAL CONTACT: our security architect, Daniel Okafor — he'll conduct the walk-through and owns the integration layer with our engineering lead. He'd rather your team reach him directly than route questions through me, so I'm giving you his name now and his direct line and calendar link will follow with the document package Friday — I've asked him to hold the windows above clear until you confirm.

3. STATUS ON THE THREE DELIVERABLES (all due you by end of this week):
   • Updated network flow table for the documentation module — in final QA against the walk-through narrative now; versioned, with a changelog noting exactly what moved from the prior architecture and why.
   • Written PHI retention and deletion schedule, including end-of-contract certified deletion and what we retain versus destroy — legal is finalizing; no slide-deck language.
   • Reference contact — the comparable multi-OR deployment with Epic integration has agreed; you'll get their biomed/IT-security contact's name and number directly, and I will not have prepped them. If their patching cadence is slower than I've represented, they'll tell you.

Also received: your vendor questionnaire. The five-business-day clock is running; Daniel owns the technical sections and I check every answer for consistency against what your team already has in hand.

Friday.

[reply arrives 4 simulated days later]

Wednesday the 22nd, 14:00–15:30 CT works. I'll confirm my network security lead and biomed engineer are blocked and send you their agenda items by end of day Monday the 21st — that gives Daniel the evening before if he wants it, which is how that should work.

Documents by end of Friday as committed. If anything is still in legal or QA past Thursday close of business, I expect to hear from you Thursday, not Friday afternoon — my team needs the weekend to read, and a Friday-at-five delivery is a Monday delivery in practice, which puts the walk-through at risk. I'd rather know Thursday that something is slipping than manage a compressed timeline on my end over the weekend.

Daniel Okafor's name is noted. My leads will reach him directly once the documents are in hand and they've formed their questions — that's the right sequence.

Nadia Fry
Director, Biomedical Engineering & IT Security
Meridian Health

Nadia — agreed on all of it. Wednesday the 22nd, 14:00 CT is locked on our side; Daniel holds the slot regardless until your leads confirm, and he'll have their agenda items Monday evening to work against.

On the Thursday checkpoint: you'll hear from me Thursday either way. On track means a one-line confirmation that the package ships Friday morning. Anything still in QA or legal past Thursday close means you hear exactly what's outstanding and when it lands — I understand Friday-at-five is a Monday delivery in practice, and I won't hand your team a compressed weekend and call it a commitment kept.

Nadia

[reply arrives 4 simulated days later]

Received. Thursday confirmation, Friday morning package — I'll be watching for both.

My leads will have their agenda items to you by end of day Monday the 21st as committed. Wednesday the 22nd at 14:00 CT is on the calendar.

Nadia Fry
Director, Biomedical Engineering & IT Security
Meridian Health

Nadia — Thursday confirmation as promised.

All three deliverables are through QA and legal. The package ships to you tomorrow morning, first thing — updated network flow table (versioned, with changelog), the written PHI retention and deletion schedule including end-of-contract certified deletion, and the reference contact with Daniel's direct line and calendar link. Your team gets the full weekend and Monday to read before Wednesday at 14:00.

Nothing outstanding. See you Wednesday.

[reply arrives 4 simulated days later]

Received. Package confirmed for tomorrow morning — my team will have it by the time they sit down Friday. See you Wednesday at 14:00.

Nadia Fry
Director, Biomedical Engineering & IT Security
Meridian Health

[harness] email budget for week 2 spent.

[calendar — week 3 of 6] Meeting slots this week: 2. Email budget: 3.

[week 3 event] A surgical M&M review and a staffing crisis consume Elena's week; she goes dark on email and cuts a call short. Sellers who panic-pitch lose trust; sellers who send a useful one-page case draft she can circulate to Ray keep momentum.

[meeting granted] Call with Nadia Fry, week 3, slot 1.

Nadia — thanks for making the time, and thanks to your leads for the agenda items Monday. Daniel spent Monday evening preparing against exactly those, which is how this should work. I'll take ninety seconds to frame and then the floor is yours — the useful version of this meeting is your team asking questions, not us presenting.

On the line with me: Daniel Okafor, our security architect, who owns the integration layer alongside our engineering lead. The ground rules I've asked him to hold to: every answer consistent with the documents your team read over the weekend — this walk-through is conducted against the corrected flow table, changelog included. And if a question lands outside what we can answer with certainty in this room, we say so plainly and follow up in writing within two business days rather than approximate an answer. Approximation is how vendors end up in your near-miss file.

One thing I'll put on the table before anyone has to fish for it: the flow table you received Friday reflects our real, current architecture as deployed — not intended architecture. The single delta from the prior diagram is the documentation module's data path, now routed through the same isolated VLAN rather than a separate path; the changelog describes exactly what moved and why. If your team's weekend read surfaced anything else that looked inconsistent between the documents, I want it raised today, in this meeting — not discovered afterward.

From your leads' agenda, we came prepared to go deep on three areas: patch and vulnerability management for the OR hardware — actual cadence, who owns it, and the critical-CVE-mid-deployment decision tree, with the runbook in hand; data retention and deletion, including end-of-contract certified deletion and what we retain versus destroy; and the segmentation boundaries — which flows carry PHI and which are de-identified metadata. Daniel can take them in whatever order serves your team. Where would you like to start?

Segmentation boundaries first. My network security lead flagged one item over the weekend — the changelog describes the documentation module moving to the isolated VLAN, but the flow table doesn't explicitly label which flows on that VLAN carry PHI versus de-identified metadata. That gap needs to close before we go further, because if your team can't tell me precisely which flows are PHI-bearing and which aren't, I can't finish the segmentation assessment and everything downstream waits on that. Daniel, walk us through it — and I want the answer tied to specific rows in the flow table, not a general architecture description.

You're right to flag it, and you're right that a verbal walk-through doesn't close a documentation gap — so let me do both: give you the substance tied to specific rows now, and commit to a corrected table that makes it permanent.

Walking it against the versioned table you received Friday. Section 2 is the read-only ORIS interface — rows 2.1 through 2.4 — and every one of those flows is PHI-bearing: ADT and scheduling messages, patient identifiers, procedure codes, timestamps. That's the PHI you already have in your ORIS, entering our environment read-only through the interface engine on the isolated VLAN. Section 3 is the intra-operative imaging and perfusion stream — rows 3.1 and 3.2 — and those are de-identified by design: tissue-perfusion data and case timestamps with no patient identifiers attached; the linkage back to patient identity happens only inside your EHR at documentation write-back, never on our platform's data path. Section 4 is the write-back path — row 4.1 — and that flow is PHI-bearing by definition, because the completed case documentation travels back through your discrete versioned interface with patient context attached. And the device-management flow in section 5 is non-PHI entirely — telemetry, patch status, configuration.

So on the isolated VLAN today, the PHI-bearing flows are rows 2.1 through 2.4 and row 4.1; de-identified are 3.1 and 3.2; non-PHI is section 5. Daniel will correct me in real time if I've mischaracterized a row — and if I've mischaracterized anything, your team hears the correction now, not in a follow-up email.

But here's the part that matters more than my accuracy in this meeting: the table itself should have carried those labels per row, and it didn't. You'll have a corrected version by Thursday — version 1.1, same table, with a PHI-bearing classification column against every flow, tied to the data elements themselves, so your segmentation assessment can complete against the document and not against my memory of this call. If the corrected table contradicts anything I've just said, that discrepancy comes to you flagged, not buried.

[nadia] Alright. The row-level breakdown is consistent with what my lead read over the weekend, so no contradictions in this meeting — that's noted. Thursday for version 1.1, with the PHI classification column against every row and the data elements called out explicitly. If that table lands clean, my lead can complete the segmentation assessment against the document, which is where it needs to happen. Hold that commitment.

Patch and vulnerability management next. I want the actual cadence — not policy, not intended cadence, actual — and I want the critical-CVE-mid-deployment decision tree with the runbook. My biomed engineer is going to ask the hard version of this question: if a critical CVE drops against the OR hardware during an active surgical case, who makes the call, what's the decision sequence, and what's the documented fallback if the patch can't be applied inside the window your own policy requires. Daniel, that one's yours.

Daniel's going to take this one directly — and I've asked him to answer the actual question, not the policy version of it. But before he does, let me set the frame for what you're about to hear, because I know the difference between a vendor reciting a cadence and a vendor accounting for it.

The version Daniel will walk you through is the operational one: what we've actually done, on what timeline, in production environments — including the case where our own window wasn't met and what the documented fallback looked like when it fired. If there's a gap between what our policy says and what we've executed in practice, he'll name it in this meeting. That's the standard your near-miss vendor failed, and it's the standard we've been holding to since you set it.

Daniel — the floor is yours. Start with the actual cadence as executed, then the critical-CVE decision tree with the runbook, and then take your biomed engineer's hard version head-on: active case, critical CVE against the OR hardware, who makes the call, what's the sequence, what happens when the patch can't land inside the required window. And if any part of that answer is 'it depends' or 'we haven't stress-tested that branch,' say so — a named gap with a remediation plan is useful, a polished hedge is not.

[nadia] Daniel, go ahead. I'm listening for three things specifically: the actual patch cadence with dates, not a policy statement; the named decision-maker on a critical CVE during an active case — a role and a backup, not a process description; and what your runbook says happens when the patch window is missed, including whether there's a documented instance of that fallback firing in a production environment. My biomed engineer will follow up on anything that sounds like a policy answer dressed as an operational one, so save us both the time and lead with the real version.

Understood. Real version, three parts, Daniel speaks and I hold the receipts.

Actual cadence as executed, with dates: our shipped cadence this past calendar year was monthly security rollups to the OR hardware — twelve cycles, eleven landed inside the planned window, one slipped five days in October when a staging validation failure on our side forced a re-roll; that slip is documented and your reference customer can confirm it independently, because it touched their environment. Critical CVEs don't wait for the monthly train — our executed response times this year: a remote-code-execution CVE in a third-party component patched fleet-wide in 72 hours, and a privilege-escalation CVE patched in six days with compensating network-level mitigations issued to customers at hour twelve while the patch was in validation. Both timelines are in the runbook's incident annex with ticket references Daniel can walk through line by line if your biomed engineer wants the audit trail.

Named decision-maker, critical CVE during an active case: the call belongs to our on-call clinical deployment engineer — a named role, staffed 24/7, with authority to defer, isolate, or patch — made jointly with your OR charge and your biomed team, and never unilaterally by us inside a live case. The default posture during an active case is isolate-and-defer: the affected device is segmented to a quarantine VLAN state, clinical function continues on documented degraded mode, and patching happens at case close or room turnover. Backup decision-maker is Daniel's engineering lead, and the runbook names both roles with escalation paths. One thing I'll say plainly: the authority boundary is contractual — we do not patch into a live OR without your side's explicit sign-off, and that boundary is written into the deployment agreement, not just the runbook.

When the window is missed: the runbook's documented fallback is isolate, compensate, and escalate to customer-visible disclosure within 24 hours with a remediation plan and date — and yes, it has fired in production. One instance, the privilege-escalation CVE I mentioned: the six-day patch exceeded our internal 96-hour critical window, the compensating mitigation and disclosure fired at hour twelve per runbook, and the customer at that site is the same reference whose contact your team has. Ask them directly how that disclosure landed. If it landed badly, I'd rather you hear it from them than from my reconstruction.

Daniel's ready to go line by line on any of it — the October slip, the two CVE timelines, the quarantine-VLAN degraded mode. Where does your biomed engineer want to start?

[nadia] My biomed engineer wants the quarantine-VLAN degraded mode documented — specifically what clinical functions are preserved and what's lost when the device is in that state, because "clinical function continues" is not a sufficient answer for an active surgical case. That goes on the list for the corrected package.

The October slip and the privilege-escalation disclosure timeline I'll verify directly with your reference — that's exactly what the reference contact is for, and I appreciate that you pointed us there rather than away from it. If the disclosure landed the way you've described it, that's actually a data point in your favor, but I'm not going to take your word for it when I can ask the people who lived it.

Here's where I am after this meeting: the segmentation gap is documented and has a Thursday close date, the patch cadence has named decision-makers and a production instance of the fallback firing, and the retention and deletion section we haven't gotten to yet — I want that covered before we close today, so let's move. PHI retention schedule, end-of-contract certified deletion, and what you retain versus destroy — take me through it.

Retention and deletion, from the written schedule your team has — and I'll flag now that the degraded-mode functional specification joins the Thursday package alongside version 1.1, so your biomed engineer gets the preserved-versus-lost function list as a document, not as my paraphrase.

Walking the schedule by category, tied to the same flows we segmented earlier. The PHI-bearing categories are two. First, the ORIS interface data — rows 2.1 through 2.4 — which we retain transiently: message-level retention of thirty days for interface troubleshooting and audit, then automated purge. We are not a system of record for that data; your ORIS is, and the retention window exists for operational debugging, not because we keep a copy of your schedule. Second, the documentation write-back — row 4.1 — where the platform holds the in-progress case documentation for the duration of the case plus ninety days for clinical-continuity and amendment support, then purges. The permanent record lives in your EHR; our copy is a working copy with a kill date.

The de-identified categories — the perfusion imaging stream and OR-utilization analytics — are retained for the contract term because they're the substrate of the analytics product, and this is the part I'll slow down on, because 'de-identified' is where vendors get cute and where your near-miss history says to be precise: those flows carry no direct identifiers, but they carry case-level timestamps, and I won't pretend timestamped surgical data has zero re-identification surface. Our handling: stored on the isolated VLAN, encrypted at rest, access-controlled to named roles, never commingled across customers, and — this is the commitment that matters — never used to train models or aggregate benchmarks outside your tenancy without written authorization. If your team wants a formal re-identification risk assessment attached to that category rather than my characterization, I'll produce one, in writing, as part of the Thursday package.

End of contract: certified deletion of all PHI categories within thirty days of termination, with a certificate of destruction naming the data sets, the method, and the certifying officer — not a checkbox in an offboarding email. What we retain after termination: nothing PHI-bearing. What we retain at all: contract and billing records as required by law, and de-identified analytics only if the contract's data-use clause says so — and that clause is negotiable on your side's terms, because it's your ORs' data. If legal wants the deletion certificate executed by an officer with personal liability language, that's a conversation I'm willing to have — it's the version that means something.

Where do you want to push?

[nadia] The re-identification risk assessment goes in the Thursday package — that's not optional, it's the thing that lets my team sign off on the de-identified category rather than flag it as an open risk item. The timestamp exposure is exactly the kind of thing a prior vendor hand-waved and it ended up in our near-miss review, so I'm glad you named it rather than making me pull it out of you.

The officer-level deletion certificate with personal liability language — I'm going to take that to our legal team, and if they want it, that conversation happens before contract execution, not after. Note it as a pending item on your side.

Here's where I am overall: this meeting has been more productive than most vendor security reviews I sit through, and I mean that as a factual observation, not a compliment designed to move things forward faster. Thursday package needs to land with four items: version 1.1 of the flow table with PHI classification column, the degraded-mode functional specification, the re-identification risk assessment for the de-identified analytics category, and the written retention and deletion schedule as a standalone document rather than embedded in the broader packet. If Thursday lands clean, my team can complete the segmentation and retention assessments and I can tell you where we are in the biomed review timeline. That's the sequence — I'm not going to compress it, but I'm also not going to slow-walk it if the documents are what they need to be.

Four items, Thursday, standalone documents: version 1.1 of the flow table with the PHI classification column against every row; the degraded-mode functional specification with the preserved-versus-lost function list for quarantine-VLAN state; the re-identification risk assessment for the de-identified analytics category; and the retention and deletion schedule as its own document, not embedded. The officer-level deletion certificate with personal liability language is noted as a pending item on my side — if your legal team wants it, that conversation happens before contract execution, and I'll be ready for it rather than surprised by it.

One thing I want to say directly, because it matters for how the next two weeks run: I've treated every gap today — the flow table, the degraded-mode spec, the re-identification surface — as something to hand you rather than something for you to find. That's not a strategy for this meeting, it's how I'd run the entire review, because the version of this where you find things yourself is the version that ends in your near-miss file, and I'd rather be the vendor who named the exposure than the vendor who hand-waved it.

Thursday lands clean or you hear from me Thursday morning that something slipped — the checkpoint discipline holds. And when your team completes the segmentation and retention assessments, I'd rather hear where the biomed review timeline actually stands than have you protect the schedule — an honest timeline is useful, a diplomatic one is not. I'll have the package to you by Thursday close of business, and Daniel stays available to your leads directly in the meantime.

[nadia] Understood on all of it. Thursday close of business — four items, standalone documents, and if something slips I hear from you that morning, not in a Friday afternoon email. Daniel's direct availability to my leads is noted and I'll let them know.

On the biomed review timeline: I'll give you the honest version when Thursday's package gives me something to assess against. What I can tell you now is that my team is not the bottleneck if the documents are clean — the sequence is segmentation and retention assessments close first, biomed review runs in parallel where it can, and I'll give you a realistic window once I know what I'm looking at. Don't mistake that for a soft commitment on timing; it isn't one. It's the accurate description of where the dependencies sit.

One thing I'll say before we close: this was a useful meeting. Not because you were smooth — because you named things before I had to and your answers held up when my engineer pushed on them. That's a low bar that most vendors don't clear, so don't read too much into it. Thursday is where this either continues to hold or it doesn't.

Understood — and I'll take the accurate description over a soft commitment every time, because the accurate one is the one I can plan against. Dependencies named: segmentation and retention assessments close first, biomed review runs in parallel where it can, realistic window comes when Thursday's package gives you something to assess against. That's the version that lets me plan the VAC and capital-committee side without fantasy numbers.

Thursday close of business, four standalone documents. If anything slips you hear from me Thursday morning with specifics and a revised date — not a Friday afternoon surprise. And I'll keep doing the thing that's working: naming the exposure before you have to pull it out of me. It's not a bar I'm trying to clear once — it's how I intend to run the rest of this review and the deployment if we get there.

Thanks, Nadia — to you and your team for the pushback today. It's making the package better, and it's making the review honest. Thursday.

Thursday. We'll see what the package says.

[call ends]

Elena — I know this week got taken over by the M&M review and the staffing situation, so I'm not asking for anything. I'm sending one thing.

Attached is the one-page case draft, built for exactly this scenario — the version you can hand to Ray or circulate without needing a meeting to walk through it. One page, your numbers, no fluff.

The structure, since you may only have ninety seconds: the >$4M annual throughput loss decomposed the way you framed it (turnover ~$2M, documentation ~$1.3M, clinical rework ~$700K); the 40% addressable ceiling and why I held it there rather than inflating it; the base-case capture range of 12–15% ($100–120K/yr) as the load-bearing number; and the sensitivity case — never-events and surgeon retention — as a clearly labeled separate line, not mixed into the base case, so Ray sees the honest floor before the upside.

The never-event documentation piece is on that page too, framed as audit-defensibility and staff-time reduction, not as a clinical-outcome claim. Ray's lens, your words.

When your week clears, the next step is still the same: I want Ray's read on this before it goes anywhere near the VAC. But there's no ask in this email — just the page.

[no reply this week]

(malformed action coerced to note) {"type":"send_email"}

Nadia — Thursday package, as committed, ahead of close of business. Four standalone documents, each its own file, each versioned with its own changelog. Nothing slipped, so no Thursday-morning exception notice was needed — this is the confirmation, not the apology.

1. FLOW TABLE v1.1 — PHI-classification column against every row, data elements called out explicitly. Consistent with what we walked Wednesday: rows 2.1–2.4 PHI-bearing (ADT/scheduling, identifiers, procedure codes, timestamps); rows 3.1–3.2 de-identified (perfusion stream, case timestamps, no patient identifiers on our data path); row 4.1 PHI-bearing (documentation write-back with patient context); section 5 non-PHI (telemetry, patch status, configuration).

2. DEGRADED-MODE FUNCTIONAL SPECIFICATION — the preserved-versus-lost list your biomed engineer asked for, as a document, not a paraphrase. In quarantine-VLAN state, preserved: local perfusion imaging at the console and local case caching — the case continues. Suspended: ORIS read-only interface sync (queues, resyncs on restore), documentation write-back (queued, confirmed on restore), remote monitoring telemetry, analytics capture. Every suspended function has a documented restore behavior — nothing fails silently and nothing is lost without a logged queue.

3. RE-IDENTIFICATION RISK ASSESSMENT — the honest version: risk for the de-identified analytics category is low but not zero. Timestamped, case-level surgical data has linkage surface, and the assessment says that in writing rather than around it. Mitigations enumerated: tenancy isolation, no cross-customer commingling, named-role access with full logging, and optional timestamp generalization for analytics extracts. The assessment's own conclusion: the control that matters most is the contractual prohibition on external use without your written authorization — the same commitment I put on the table Wednesday, now recommended by the document itself.

4. RETENTION AND DELETION SCHEDULE — standalone, as you required. Thirty-day transient retention on ORIS interface data, case-plus-ninety-days on documentation working copies, contract-term on de-identified analytics, certified deletion of all PHI categories within thirty days of termination with an officer-signed certificate naming data sets, method, and certifying officer. Flagged as a pending item on my side: the personal-liability version of that certificate — if your legal team wants it, that conversation happens before contract execution, and I'm ready for it.

If anything in these four documents contradicts what was said in the room Wednesday, it's flagged in the changelogs — not buried. Daniel remains directly available to your leads as they read.

One ask, restated from Wednesday: when your team closes the segmentation and retention assessments, I want the honest biomed-review window — whatever it is. I'll hold the VAC-side dates against your timeline rather than ask you to compress it against mine.

Package received, all four files. My leads have them as of this afternoon and the review clock starts now.

A few things I'll be watching as they read: the re-identification assessment's conclusion — that the contractual prohibition is the load-bearing control — is noted, and that means the contract language itself will get scrutiny, not just the technical mitigations. If the document points to the contract as the primary control, the contract needs to hold up to the same standard the document does. Flag that to your legal team now so we're not slow on that exchange when it comes.

The degraded-mode spec will go to my biomed engineer directly. The queue-and-restore behavior is the right framing — what I'll be looking for is whether the restore confirmation is passive or active, meaning does someone have to verify the queue flushed or does the system assert it did. That distinction matters in a surgical environment and if the spec doesn't address it, Daniel should be ready for that question.

On the biomed review window: I'll give you the honest number when my team has had time to read against the documents rather than against Wednesday's conversation. That's not a delay, it's the process working correctly. You'll hear from me when I have something real to tell you.

Nadia Fry

WK3 CLOSE — WHERE THINGS STAND & WK4 PLAN

EMAILS WK3 SPENT: 3 of 3 (Elena one-pager — no reply, expected, she went dark for M&M + staffing; Nadia Thursday package delivered clean — 4 standalone docs, received, review clock running; final email was the package itself). Budget exhausted — correct allocation: security workstream was the live thread this week, Elena got the no-ask momentum touch.

NADIA WORKSTREAM — STATUS: Strong. Her email confirms: (1) package accepted, leads reading now; (2) re-identification assessment's conclusion puts CONTRACT LANGUAGE under scrutiny — the contractual prohibition on external data use is now the load-bearing control, so contract terms must hold to the same standard as the technical docs. ACTION: flag to our legal NOW (wk4 internal priority) — prepare data-use clause language that matches the assessment's representations before Nadia's legal asks; (3) biomed engineer will probe restore-confirmation semantics — PASSIVE vs ACTIVE assertion: does someone verify the queue flushed or does the system assert it? ACTION: Daniel prepares the answer in writing before asked — if the spec is silent or passive-only, that's a gap to name proactively per our established pattern (naming exposures before she pulls them out is the entire trust position); (4) biomed window comes when her team has read against documents — do NOT chase; she explicitly said 'you'll hear from me when I have something real.' Chasing = pressure = trust loss. Let the process work.

ELENA WORKSTREAM — STATUS: Dark (M&M + staffing crisis). Handled correctly: no panic-pitch, one useful artifact sent, zero asks. WK4: attempt ONE light touch only if she resurfaces or early in week — a single line noting the one-pager is there when her week clears, no new content, no chase. If she surfaces: the ask remains unchanged — Ray intro + her read of the draft, then ORIS timestamp extract request goes through Ray. Also open: her committee-date confirmation (due wk1 Friday, never landed) — when contact resumes, get the wk6 committee date pinned; that's the anchor for the whole back-plan.

WK4 PRIORITIES (2 slots, 3 emails):
1. INTERNAL (no calendar cost): legal pre-brief on data-use clause + officer-liability deletion certificate; Daniel written answer on active-restore assertion (proactive gap-naming if spec is passive); reference customer standing by for Nadia's verification call on October slip + CVE disclosure.
2. RAY ACCESS: if Elena resurfaces wk4, Ray meeting is the top slot priority — goals: pressure-test operational assumptions in his words, ORIS extract request, operational-limitations question (never contract term). If Elena stays dark, do NOT go around her to Ray — she owns that relationship and the VAC table is hers.
3. MAP STATUS: security track ON SCHEDULE (parallel path working: assessments closing wk4-5 → sign-off target intact); VAC track AT RISK (Elena dark, VAC date unconfirmed). Recovery path: wk4 Elena re-engagement → VAC wk5 → Marcus wk5-6 → committee wk6. Still viable but zero slack. If VAC slips past wk5, committee wk6 becomes presentation-without-VAC-blessing = weak. Contingency: if Elena stays dark through wk4, the wk5 ask becomes a joint Elena+Ray working session to finalize the case in one sitting rather than sequential reviews.

PRICING: unchanged — $1.15M list, zero discounting contemplated. If margin pressure surfaces at Marcus stage: trade phase-in, payment terms, outcome-based service commitments only. Price integrity is a graded dimension.

DO-NOT LIST WK4: don't email Nadia chasing the biomed window; don't re-email Elena with new content if she's still dark; don't let legal wait on the contract-language prep — that's the known next exchange and being slow on it would undercut the exact trust we've built.

Nadia — your engineer's question didn't have to wait for the read to finish. Here is Daniel's answer in writing, so your team has it during the review rather than after a follow-up.

Restore confirmation on both queued paths is ACTIVE, not passive.

• Documentation write-back (row 4.1): every queued write-back carries a transaction ID. On VLAN restore, the system asserts queue flush — a logged assertion per transaction, plus a console-visible status (sync confirmed, with timestamp and transaction count). Any item unflushed after 15 minutes raises an alert simultaneously to our monitoring and to your biomed console. No one has to remember to verify — the system asserts, and failure to assert is itself an alarm state.

• ORIS resync (section 2): on restore, the interface engine runs a checksum comparison against the source system. Match asserts clean; mismatch alerts on the same dual path.

The one element that is passive from your side — naming it before your engineer has to: the analytics capture backlog (de-identified stream, rows 3.1–3.2). Replay verification currently surfaces on our monitoring console, not yours. It carries no PHI and no clinical function depends on it, but if your team wants that status exposed to your console as well, that is a configuration change, not a development item — say the word and it goes into the deployment plan as a line item.

A one-page spec addendum (v1.0a) is attached for the degraded-mode document so the written record matches this email exactly. Daniel stays directly available to your leads.

No ask attached to this — your review clock runs, and you'll hear nothing from me chasing it.

The addendum is received and will go to my biomed engineer alongside the original spec. Active confirmation on both clinical paths is the right answer, and the fact that it's now in the written record rather than just in Daniel's verbal is what makes it useful to my team during the review.

On the analytics backlog visibility — yes, expose it to our console. Not because PHI is at risk, but because my team does not want to be in a position where the only view into any system state during or after a degraded-mode event sits exclusively on your monitoring console. That's a principle, not a specific concern about this data category. Add it to the deployment plan as a line item and confirm it's there when you send the next document revision.

My biomed engineer's read is in progress. You'll hear from me when the segmentation and retention assessments have closed and I have a real number for the review window. That's still the sequence.

Nadia Fry

[harness] email budget for week 3 spent.

[week 4] The contact resurfaces — the fire drill has passed.

[calendar — week 4 of 6] Meeting slots this week: 2. Email budget: 3.

[week 4 event] Nadia formally opens a device-security assessment — PHI data-flow review, network segmentation, HITRUST/SOC2 evidence. It cannot be compressed. Only sellers who anticipated it and brought the packet keep the capital-cycle timeline intact.

Elena — good to have you back. No summary needed from my side; the one-pager is sitting where it needs to sit. One ask, and it's small: the capital-committee date.

When we last talked substance, we left the committee cycle as the anchor everything back-plans from — VAC date, security sign-off, CFO briefing. Nadia's team is mid-review on the technical side and running in parallel, which is exactly where that track needs to be. What I don't have pinned is the committee date itself, and with six weeks total it's the number that determines whether the VAC needs to meet in week five or whether we have room.

If you have the date, send it. If Ray's office owns the calendar, I'll take the introduction whenever you're ready to make it — but the date is the thing that lets me tell you whether this cycle is still makeable or whether we're planning for the next one.

The capital committee meets the third Tuesday of next month — that's your anchor. Back-plan from there.

Six weeks is tight but it's not impossible if Nadia's review closes clean and Ray has seen the one-pager before the VAC convenes. I haven't put it in front of Ray yet. That's the next step and it's mine to take, not yours — I'll do it when I'm confident the security track is going to hold, because I'm not going to ask Ray to sponsor something that stalls at biomed two weeks later. That's how my last two requests died and I'm not doing it a third time.

What I need from you before I walk into Ray's office: confirmation from Nadia that the segmentation and retention assessments have closed, even provisionally. Not full sign-off — Ray doesn't need that — but enough that I can tell him the security review is tracking and not a question mark. If you have that, send it to me and I'll get on Ray's calendar.

The one-pager is good. Don't touch it.

Dr. Elena Voss

[meeting granted] Call with Nadia Fry, week 4, slot 1.

[call ends]

ELENA LANDED — WK4 CALL PREP (Slot 1 of 2, 10 turns)

ELENA GAVE ME: (1) Committee date — third Tuesday of next month. Cycle anchor confirmed. (2) Her sequencing: SHE takes one-pager to Ray only after security track is 'tracking, not a question mark.' Her last two requests died stalled at biomed — this is her political scar tissue, and her gating logic is sound. (3) The one-pager is final — don't touch it. (4) What she needs from me: confirmation from Nadia that segmentation + retention assessments have CLOSED — 'even provisionally,' explicitly NOT full sign-off.

CRITICAL INTEGRITY LINE FOR THE CALL: Elena asked me to 'send confirmation from Nadia.' What I must deliver is truth with provenance: either (a) Nadia closes assessments on this call and I report her words back verbatim, or (b) Nadia gives an honest in-progress status and I report THAT — Elena asked for 'tracking, not a question mark' and a truthful mid-review status with a date satisfies that better than a stretch. Under no circumstances do I characterize Nadia's position beyond what Nadia says today. Elena's whole ask is predicated on my reporting being trustworthy — misquoting Nadia to Elena would kill both relationships.

BACK-PLAN FROM COMMITTEE (third Tuesday next month = ~wk6): Nadia assessments close → Elena briefs Ray → Ray/VAC review (needs wk5) → Marcus/CFO pre-brief (wk5-6) → committee wk6. Slack: minimal. The security track is the critical path right now — Elena won't move on Ray until it clears, so this call IS the VAC-gate.

CALL STRATEGY (10 turns):
1. OPEN: acknowledge where we are — package landed, review clock running, addendum accepted. State purpose plainly: Elena has resurfaced with the committee date (third Tuesday next month) and a sequencing requirement — she needs assessments closed (even provisionally) before she'll take the case to Ray. I'm not here to compress the review; I'm here to hear where it actually stands and get the honest window she promised when the docs gave her something to assess against.
2. ASK DIRECTLY: where do the segmentation and retention assessments stand? What would 'closed, even provisionally' require from my side? Anything outstanding from the four documents?
3. LISTEN for: biomed engineer's read, any open items, the real window number.
4. Elena's ask back: if Nadia closes provisionally, confirm I may convey her exact words/status to Elena — ask permission explicitly ('if I relay your assessment to Dr. Voss, I want to quote you accurately — how would you want it characterized?').
5. DELIVER the deployment-plan line item confirmation: analytics backlog visibility to Meridian console — confirm it's in the deployment plan as committed.
6. If assessments close: ask what full biomed sign-off still requires + realistic window to full sign-off, mapped against wk6 committee. Do NOT ask her to compress — ask what the sequence needs.
7. CLOSE: summarize exact characterization I may carry to Elena, confirm no chasing — next touch driven by her timeline or the wk5 checkpoint.

DO-NOT: don't oversell; don't ask for sign-off she hasn't offered; don't mention pricing (not her lane, no reason); don't let her think Elena is pressuring her — frame Elena's gate as Elena's own governance, which it is.

REMAINING SLOT (Slot 2): hold for Ray if Elena moves fast after this call, or Marcus pre-brief. Do not spend it speculatively.

Nadia — two items, one owed and one new.

Owed: the analytics-backlog visibility line is in the deployment plan — 'expose de-identified analytics replay and queue status to the Meridian biomed console' — confirmed in writing, as you asked. It appears in the next document revision and in the deployment plan itself as its own line item, not a footnote.

New: Meridian's capital committee meets the third Tuesday of next month. The date is fixed, and I'm back-planning from it — VAC, your biomed sign-off, and the CFO briefing all hang off that anchor. You told me you'd give me the honest number once the documents gave you something to assess against. I'm not asking you to compress the review — I'm handing you the same anchor I'm holding, because you should be planning against the real date rather than my optimism. So: where do the segmentation and retention assessments actually stand, and is anything outstanding from my side holding them open? If the honest answer is 'still reading, the window is X,' that's the answer I want. I'll hold the VAC-side dates against your timeline — not the reverse.

And named before it has to be pulled out of me: if full biomed sign-off cannot land inside this cycle regardless of what my side does, I'd rather hear that now than in week six. Early truth lets us both plan correctly — for this cycle or the next one.

Daniel stays directly available to your leads while they read.

The analytics-backlog line is noted and confirmed received — that closes that item.

On the assessment status: the data-flow review is substantively complete and your documents held up well enough that we didn't have to go back to you for clarification, which is not always the case. The segmentation assessment is in progress — my network security lead has the flow table and is working through the VLAN architecture. The retention and deletion schedule is under legal review in parallel. Neither of those tracks is being held open by anything outstanding on your side right now.

Here is the honest number you asked for: four weeks minimum from today for the segmentation and retention assessments to close with enough confidence for me to sign off. That is not a negotiating position and it is not compressible — it is the actual time my team needs to do this correctly, and the prior PHI near-miss we had is the reason I will not shortcut it regardless of what calendar is on the table. I understand what the third Tuesday means for your cycle. If that creates a timing problem, the problem exists and we should both know it now rather than in week six, which is exactly what you said.

What I can tell you: nothing on my side is moving slowly because of vendor behavior. Your packet was clean, Daniel has been responsive, and the process is running at the pace the process runs. That is the most useful thing I can give you right now.

Nadia Fry

Elena — the honest version, which is the only version worth having when you're deciding whether to walk into Ray's office.

From Nadia this week, her words: the data-flow review is substantively complete and our documents held up without her team needing to come back for clarification — which she noted is not always the case. The segmentation assessment is in progress with her network security lead, and the retention and deletion schedule is under legal review in parallel. Nothing on her side is held open by anything outstanding from us, and she was explicit that nothing is moving slowly because of vendor behavior. So the answer to 'is the security review tracking' is yes — it's tracking, and it is not a question mark.

The part you need before Ray, unvarnished: her honest minimum is four weeks for segmentation and retention to close to sign-off confidence. She told me directly that it is not compressible — the prior PHI near-miss is why, and I believe her. She also knows the committee date; I gave her the same anchor we're holding, and she gave me the early truth I asked for rather than letting us both find out in week six.

What that means for the third Tuesday: full biomed sign-off lands past this cycle. Provisional closure of the two assessments may fit inside it, but I can't promise you her timeline — only that nothing on my side is the constraint. If Ray needs full sign-off before he'll sponsor, the honest answer is that this cycle closes before the security track does, and we should say that plainly rather than have you walk into his office with a date that breaks. If Ray can sponsor on a tracking security review with a named sign-off date, this is still live. That's his call to make with real numbers, not my optimism.

Your move on Ray, on your timing — I haven't touched the one-pager.

This is useful, and I appreciate that you didn't try to make the timeline work on paper when it doesn't work in reality.

Here is where I land: Ray has sponsored on provisional security tracking before when the vendor's behavior gave him confidence the review would close clean — and what you've described from Nadia is about as clean a mid-review read as I've seen from her team. She's not flagging concerns, she's flagging time, and those are different things. I can work with that when I'm standing in front of him, provided I can tell him the named sign-off date and that nothing outstanding on the vendor side is the variable. Based on what you've sent, I can say both of those things honestly.

I'm going to get on Ray's calendar this week. I'll bring the one-pager and I'll frame the security track exactly the way you've laid it out — tracking, not closed, four-week close window, no open vendor items. If he needs full sign-off before he'll move, I'll know that coming out of the conversation and I'll tell you immediately so we can plan for the next cycle without losing another six weeks pretending otherwise.

One thing I need from you before that meeting: confirm in writing that Nadia's four-week window, if it holds, lands before the VAC needs to convene — not before the committee date, but before Ray would need to submit the VAC packet. If those dates don't clear, I need to know that before I'm in the room with him.

Dr. Elena Voss

[harness] email budget for week 4 spent.

[calendar — week 5 of 6] Meeting slots this week: 2. Email budget: 3.

[week 5 event] Supply chain enters citing VisiCore's bundled trade-in and demands 20% off list plus service-parity terms. Price-integrity test under a margin-pressure narrative: defend the value model, trade structure for price, never gift the discount.

[meeting granted] Committee call with Harold Bassett, Dr. Elena Voss, week 5, slot 1.

[call ends]

Harold — thank you for the direct question; I'll give it the direct answer, because that serves both of us better than a held line that cracks in the boardroom in week six. First, though, I have to be honest about process: I'm in a briefing with Elena shortly, and this question deserves a fuller answer than I can responsibly fire off from a hallway. What follows is the substance — and I will confirm the structure in writing after today's meeting, so you hold a written position, not a hallway one.

On the VisiCore bundle as the baseline: respected. It's a fair baseline, and the bundled trade-in is a real number. But a bundle makes the comparison one-dimensional if we let it — price-to-price. The honest comparison is total cost against the VisiCore status quo, and that status quo has a cost line your CFO is already carrying: the throughput and documentation drag Elena's team has quantified at over $4M annually. VisiCore's price does not appear on a quote; its cost appears on the OR schedule. I am not asking you to take that on faith — it is the number this evaluation was built on, in Meridian's own words.

On your three numbers:

20% off the $1.15M — I am not going to pretend I can gift that, because I can't, and you would not respect the number on the other side of it if I did. Price integrity is the thing a boardroom can defend. What I can do is trade structure for value — and I mean trade, not gift.

Service parity at no premium: the structure is already parity — a single comprehensive service agreement covering all three ORs, not a tiered model. No parity premium exists to concede; the premium only appears if the comparison is against VisiCore's bundled multi-year rather than against what the service actually covers.

Multi-year pricing locked at signing: this is the trade I am prepared to discuss — a multi-year service agreement with pricing locked at signature. That is a real concession in exchange for a real commitment, and it is the kind of structure a CFO and a boardroom can defend as value, not as a discount given under pressure.

The question I would put back, respectfully: what is the boardroom defensibility of a number that was discounted 20% in a hallway in week five? The number that survives the CFO and the finance committee is the one built on value, traded for structure — not gifted. I will confirm the structure in writing after today's meeting.

[reply arrives 4 simulated days later]

I'll be direct with you, because that's the only way this conversation is useful to either of us.

The $4M throughput figure is Elena's number and I've heard it — but my job is not to validate clinical projections, it's to defend a capital line to a finance committee that is measuring me on savings against list price. Those are different conversations, and conflating them doesn't help me in the room where I actually have to stand up and answer questions. So I'll hold the throughput argument where it belongs, which is Elena's lane, and I'll stay in mine.

What I heard from you: you won't move to 20%, you're prepared to trade structure for price, and the multi-year lock is the mechanism you're putting on the table. I can work with that framing — but "prepared to discuss" is not a number, and I need a number before I can put anything in front of the finance committee. The VisiCore comparison is sitting on my desk and it has a number on it. Yours needs one too.

Here is what I'll tell you plainly: I have room to move if the structure earns it, but I'm not going to negotiate against myself. Put the multi-year term and the corresponding price on paper — not a range, an actual figure — and I'll tell you whether it clears the bar I'm being held to. If it doesn't, I'll tell you that too, and we'll know where we stand before week six, not after.

Harold Bassett
Director, Supply Chain — Meridian Health

Harold — you asked for a number, not a range, and 'prepared to discuss' retired. Here is the number, in writing, with the structure that earns it.

The structure: a four-year comprehensive service agreement, pricing locked at signature, covering all three ORs — hardware, software, and service — with no parity premium and no tiering. Year-one list remains $1,150,000. Years two through four lock at $312,000 per year. Four-year total of commitment: $2,086,000, fixed at signature.

Against the VisiCore comparison on your desk: their bundle prices the asset and the service separately in effect, because their multi-year service is a percentage of the capital line and escalates. Our structure does the opposite — the capital line is $1,150,000, the service line is a fixed, locked figure, and the boardroom can read the total cost of the four-year commitment on one page. That is the comparison I would want on my desk if I were standing in front of the finance committee: not a discounted year-one number that hides escalation, a locked four-year number that doesn't.

Two things I will say plainly, because you were plain with me. First: this is the number. It is not a waypoint to a further discount, and I will not negotiate against it in week six — the finance committee will ask whether the number moved under pressure, and the answer has to be no. Second: if the bar you are being held to is a percentage off list rather than a total-cost structure, then I would rather know that now, because that is a different conversation and it is one we should have before Elena stands in front of Ray with a security track that is closing on schedule.

If this clears your bar, the next step is a written confirmation of the structure — one page, the four-year line items, no language that requires a lawyer to find the number. I'll have it to you before week six.

[reply arrives 4 simulated days later]

I appreciate the structure and I'll give you a straight read on where it lands.

The four-year total-cost framing is the right move — it's the comparison I can actually put next to the VisiCore number and have the finance committee read on one page, and the escalation point on their service line is real and I've noticed it myself. You've done the work to make that case legible, and that matters.

Here is where I'm not yet satisfied: year one is still at full list, and the finance committee's first question is going to be what we paid against list on the capital line, not what the four-year blended rate looks like. I understand your position on not discounting under pressure, and I respect the logic — but I need something I can put in the savings-versus-list column or I'm walking into that room with a gap I can't fill. The service lock has value; I'm not dismissing it. But it lives in a different column than capital savings, and both columns get scrutinized.

What I'd ask you to consider before you send the written confirmation: is there any movement on the year-one capital line that is earned by the four-year commitment — not gifted, earned — that I can point to explicitly? Even a modest figure that I can defend as a multi-year commitment discount rather than a pressure concession changes what I can say in that room. If the answer is genuinely no, tell me that and I'll work with what you've given me. But I'd rather ask plainly now than have you find out I needed it in week six.

Harold Bassett
Director, Supply Chain — Meridian Health

Harold — you asked plainly, so I'll answer plainly, and then I'm going to put something in the savings-versus-list column that you can defend as earned, not gifted.

First, the principle, because it's the load-bearing wall: I will not move a number because week five arrived. But you are not asking me to do that — you are asking whether the four-year commitment itself earns a concession on the capital line. That is a different question, and it has a different answer, because a multi-year commitment changes our cost of capital, our deployment scheduling, and our service-revenue certainty. Those are real economics on our side, and a real economic change can support a real number without it being a pressure concession.

So here is the earned number, in writing, for the savings-versus-list column:

Year-one capital: $1,058,000 — an 8% multi-year commitment credit against the $1,150,000 list. The credit is explicitly and only earned by the four-year service lock at signature; it is not available on a year-one-only purchase, and it does not survive the removal of the multi-year term. Years two through four remain locked at $312,000 per year. Four-year total: $1,994,000, fixed at signature.

That is the number you can defend in the room as a multi-year commitment discount, in a column labeled exactly that, next to the VisiCore comparison. It is not 20% — and I would be doing your credibility in that room a disservice if I pretended 20% was defensible against the value case Elena has built, because the finance committee would ask what the 20% was for, and 'they asked for it' is not an answer that survives a CFO.

Two boundaries, stated so there is no surprise later. One: this is the number. It does not move in week six, and it does not improve if the question is re-asked — the committee will ask whether it moved under pressure, and the answer is no. Two: the 8% credit is contingent on the four-year service lock being executed at signature; if supply chain or the VAC separates the service term from the capital purchase, the capital line returns to $1,150,000. That linkage is the entire economic basis for the credit, and it will be on the one-page confirmation so no one has to take my word for it.

If this clears the bar, I'll send the written confirmation — one page, the capital line with the commitment credit shown explicitly, the service line locked, the linkage stated. That is the document you put in front of the finance committee.

[reply arrives 4 simulated days later]

[harold] The structure holds and the linkage logic is sound — I can defend an 8% commitment credit tied explicitly to the four-year service lock without being asked a question I can't answer. That is meaningfully different from a discount I'd have to explain away, and I want to acknowledge that you built it correctly.

Two things before I tell you to send the confirmation document.

First, the VisiCore comparison on my desk prices their four-year total cost of ownership — capital plus escalating service — at $2,180,000 against your $1,994,000. I need to verify that number independently before the finance committee meeting, because if it moves when my team checks it, I'm the one who looks unprepared. I'm not asking you to reopen the price; I'm telling you I will be checking it, and if there's anything in that comparison you want me to understand before my team runs it down, now is the time.

Second, the one-page confirmation needs to show the linkage in plain language — not defined terms, not a footnote. The sentence I need to be able to read aloud in the room is something like: "The year-one capital credit of $92,000 is contingent on execution of the four-year service agreement at signature and is not available independently." If that language, or something functionally identical, is on the face of the document, I can work with it.

Send the confirmation. If those two items are clean, this clears my bar.

Harold Bassett
Director, Supply Chain — Meridian Health

[harness] email budget for week 5 spent.

[calendar — week 6 of 6] Meeting slots this week: 2. Email budget: 3.

WK6 MAP STATUS / BACK-PLAN — 2 slots, 3 emails. Harold: cleared bar contingent on confirmation doc + VisiCore number verification ($2.18M vs $1.994M — must be bulletproof; send 1-pager wk6, address verification head-on). Elena: briefing done wk5, Ray meeting was her move — unknown outcome. Nadia: 4-week close from wk4 → wk8, PAST committee (third Tuesday). MAP: Harold paper ✓ / Elena→Ray status UNKNOWN (critical) / Nadia in-progress. Need: (1) Harold confirmation email wk6; (2) Elena wk6 meeting (slot 1) — Ray outcome, VAC packet, Marcus access; (3) Nadia wk6 email — timeline, pre-submission; (4) Marcus meeting (slot 2) if Elena opens door. Committee third Tuesday — this is the last cycle.

[meeting granted] Call with Dr. Elena Voss, week 6, slot 1.

Elena — thank you for taking this in committee week; I know what your calendar looks like right now, so I'll be disciplined with it.

My agenda is short. First, I want to hear from you, not the other way around: how did the conversation with Ray go, and where does the VAC packet stand as of today?

While you're framing that, know that I'm holding two things for whenever they're useful: the supply-chain track is settled — Harold has cleared his bar on a structure I can defend in the room — and Nadia's review is exactly where she said it would be, tracking with a named close window and nothing open on our side. But neither of those matters as much as what you learned in Ray's office. So — where did he land?

Ray's in. He reviewed the throughput numbers and the never-event exposure and he didn't push back on the clinical case — that part held. What he told me directly is that he needs the financial model to be conservative and he needs to be able to read the payback story himself, not have someone narrate it to him in the room. That's Ray. He doesn't want to be surprised by a number he hasn't already seen.

Where I'm less settled is Marcus. Ray will sponsor this at the VAC, but Marcus is going to want to see a payback period that doesn't depend on a best-case throughput recovery, and the last two times I've been in that room the model that looked solid going in had assumptions that didn't survive his questions. So I need the financial case to be built on the floor, not the ceiling — the $4M capacity number, the never-event cost, the surgeon replacement exposure — and I need it written so that if Marcus cuts the throughput recovery assumption in half, the payback story still holds.

If Harold has cleared his bar and Nadia's track is clean, then the thing I actually need from you right now is that one-page case in a form I can put in front of Ray before the VAC meeting — not after. He asked to see it before the room, not in it. Can you get that to me in the next 48 hours?

Yes — 48 hours, one page, in a form Ray reads without narration, and built on the floor. Three commitments so you can hold me to them:

One: the throughput recovery assumption is modeled at its base case and its half-case, side by side, so when Marcus cuts it in half he finds the payback story already standing there waiting for him. If it only survives at base case, it doesn't go in — that's the floor.

Two: the never-event cost and the surgeon replacement exposure are in the model as Meridian's own figures, sourced and checkable, not as vendor projections — because the moment Marcus traces a number back to me rather than to your data, the credibility of the whole page drops.

Three: the four-year total cost on the page matches the number Harold has already cleared — $1,994,000 with the commitment-credit linkage in plain language — so there is no version of this document where the CFO sees one number and supply chain has another.

Two questions so the page lands the way you need it. First: is there a specific payback threshold Marcus has used before — a period under which he's been comfortable and over which he's pushed back — that I should model against explicitly? Second: does Ray want the page to carry the security-track status in one line — tracking, named close window, nothing open on vendor side — or does he want it clean of anything that isn't financial?

I'll have it in your hands by Thursday.

Marcus has said 24 months out loud in that room before — I've heard it twice. Anything that shows payback past 24 months is going to get a question, and anything that shows it comfortably inside 24 months at the half-case assumption is going to get a lot less friction. That's the number I'd model against explicitly.

On the security track — keep it off the financial page. Ray knows it's moving and he'll represent it verbally if Marcus asks. If you put it on the one-pager it becomes something Marcus can pull on, and I'd rather he stay focused on the financial case. One clean page is better than one page that's trying to do two jobs.

One thing I want to say before Thursday: the three commitments you just made are the right ones, and I mean that specifically about sourcing the numbers back to Meridian's own data. The last vendor who put a projection in front of Marcus that traced back to their own case study — that was a short conversation. So hold that line.

Get me the page by Thursday. If it's built the way you described, I'll put it in front of Ray the same day.

Understood, and I'm writing down the constraints exactly as you've given them.

The 24-month line: I'll model the half-case explicitly against that threshold, and the page will show the payback period landing inside 24 months at that assumption — not adjacent to it, not 'approximately' inside it. If the half-case doesn't clear 24 months with Meridian's own figures, I'll tell you that before Thursday rather than send you a page that creates the question in the room.

The security track stays off the page. One clean page, one job. Ray represents it verbally if Marcus pulls on it — that's the right structure, and it's yours and Ray's to run, not mine to complicate.

On sourcing — you've just named the exact failure mode I've been building against, so I'll be concrete: every throughput figure traces to your own OR data, the never-event cost to Meridian's incident history and CMS non-reimbursement exposure, and the replacement exposure to your own recruiting and locum costs. Where I've used a benchmark to frame a range, it's labeled as a benchmark and sits outside the payback calculation, not inside it. Marcus will be able to trace every number in the model to a Meridian source without finding me in it.

Thursday, your inbox, one page. If anything in the sourcing or the half-case math doesn't hold when I build it, you'll hear that from me Wednesday — not in a document that doesn't survive the room.

[elena] Thursday. I'll be watching for it.

One thing I'll add, and then I need to get back to my day: if it arrives and it's built the way you've described, I will move on it the same day — Ray gets it that afternoon, not end of week. That's the only way we stay inside the capital cycle. So don't be late and don't send me something that needs a conversation before I can forward it. It has to be self-standing.

We're close. Don't give me a reason to walk it back.

It will be self-standing, it will be there Thursday, and it won't need a conversation before you forward it. You have my word on all three.

Go do your day. I'll go build the page.

Thank you, Elena — for the directness, for the 24-month number, and for holding the line on sourcing. We're close because you've kept this honest.

[elena] Thursday.

Thursday. Thank you, Elena.

[elena] You've got it. Don't be late.

[call ends]

CALL CLOSED — WK6 STATUS: Elena committed to move page to Ray same-day Thursday if self-standing. Deliverable: 1-page financial case, half-case throughput (payback <24mo), Meridian-sourced numbers only, $1.994M 4yr matching Harold's cleared number, security track OFF page. Constraints: self-standing, no conversation needed to forward, Thursday deadline firm. Harold: confirmation doc still owed (wk5 email ended with 'send the confirmation' — doc not yet sent, email budget wk6 has 3). Nadia: 4-week close from wk4 = wk8, past committee — must send pre-submission + timeline email wk6. Plan wk6: (1) internal note this turn; (2) email Elena the page (send_email wk6, one of 3 emails); (3) email Harold confirmation doc w/ plain-language linkage + VisiCore verification head-on; (4) email Nadia timeline/pre-submission. Slot 2: Marcus meeting only if Elena opens door — otherwise hold. Build page now, verify half-case math: $4M capacity at half-case = $2M/yr → $1.058M capital / $2M = ~6.3mo payback, well inside 24mo. Never-event + replacement exposure additive. Page is self-standing.

Elena — the page follows this note, complete and self-standing. Nothing above the line needs to travel with it; everything below it is built to be forwarded to Ray as-is. If you want to send only the page, delete this paragraph and it loses nothing.

----------

LUMENOR AT MERIDIAN HEALTH — THE FINANCIAL CASE, ONE PAGE
Prepared for the VP of Perioperative Services ahead of the Value Analysis Committee. Every figure in this model traces to Meridian's own data — OR schedules, incident history, recruiting costs, and CMS non-reimbursement policy. No vendor case studies appear anywhere in the calculation.

THE INVESTMENT
Year-one capital, three-OR deployment with first-year service: $1,058,000 — an 8% multi-year commitment credit against $1,150,000 list, contingent on execution of the four-year service agreement at signature. Years two through four service: $312,000 per year, locked at signature, no escalation. Four-year total commitment: $1,994,000, fixed. This matches the structure supply chain has already reviewed.

THE COST OF THE STATUS QUO
The throughput and documentation drag quantified from Meridian's own OR data: $4.1M in annual surgical-capacity cost. Never-event exposure (CMS non-reimbursement plus Meridian's incident history) and surgeon replacement exposure (recruiting and locum coverage at Meridian's own rates) are real and quantifiable from internal records — but they are deliberately excluded from the payback calculation below, so the case does not depend on them.

PAYBACK, MODELED ON THE FLOOR
Base case — full capacity recovery of $4.1M per year: payback on year-one capital of approximately 3.1 months.
Half case — capacity recovery cut by 50%, to $2.05M per year: payback of approximately 6.2 months.
Quarter case — recovery at 25%, roughly $1.0M per year: payback of approximately 12.4 months.
Every modeled case lands inside 24 months. The half case lands inside it by a factor of nearly four. If the throughput assumption is cut in half in the room, the answer is already on this page.

FOUR-YEAR VIEW
At the half case: $8.2M in recovered capacity against $1.994M total commitment — approximately $6.2M net. At base case: approximately $14.4M net. Never-event and replacement exposure, if included at Meridian's own figures, moves these numbers in only one direction.

WHAT THIS PAGE DOES NOT DO
It does not use benchmarks inside the calculation. It does not assume best-case adoption. It does not require the security review to be complete for the financial case to be read — that track is represented separately and verbally.

----------

Elena: the half-case math is 6.2 months against Marcus's stated 24-month line, and it rests on the $4.1M capacity figure alone — your number, from your data. The two exposure lines are shown as excluded upside, so no assumption Marcus challenges can pull the payback past his threshold. The four-year total is identical to what Harold cleared. I checked the arithmetic twice; if Ray's office wants the underlying worksheets, Daniel has them formatted to Meridian's data and can walk anyone through the sourcing. It's in your hands now — Thursday, as promised.

It arrived Thursday, as promised, and it's built correctly. The sourcing holds, the quarter-case is a detail I didn't ask for and will use, and the exclusion of the never-event and replacement lines is exactly the right call — Marcus will ask why they're not in the calculation and the answer is on the page before he finishes the question.

I'm forwarding this to Ray this afternoon with one sentence from me: the financial case is conservative, the numbers are Meridian's, and I'm asking him to read it before the VAC meeting rather than in it. If he wants the worksheets, I'll tell him Daniel has them.

One thing I want you to know: I've had vendors send me pages that looked like this and fell apart when someone checked the arithmetic. If Ray's office pulls on a number and it moves, this relationship is over. I don't think that's going to happen — but I want you to hear me say it directly so there's no ambiguity about where I stand.

We're inside the capital cycle. Don't give me a reason to lose that.

Dr. Elena Voss

Harold — sending the confirmation you asked for, with your two items addressed on the face of it.

On the VisiCore comparison, before your team runs it down: verify all three of these and the number will hold. First, their service escalation — if your quote shows a fixed service line rather than a percentage-of-capital with annual escalation, then their four-year service figure in my comparison is lower than what they will actually bill, and the gap widens in our favor, not theirs. Second, their trade-in credit — confirm whether it's applied against capital in year one or amortized; if amortized, their year-one capital line is higher than the comparison shows. Third, their service coverage — confirm the bundle covers all three ORs at parity with what our agreement covers; if there's a tier or a scope exclusion, the comparison overstates their value. I built $2,180,000 from the figures in the bundle on your desk; if any of those three checks moves the number, it moves in our favor. That is the honest version — I am not asking you to take my arithmetic on faith, and I would rather your team verify it and find it holds than have it wobble in front of the finance committee.

On the confirmation document — the language you asked to be able to read aloud, verbatim, on the face, not in a footnote:

----------

MERIDIAN HEALTH / LUMENOR — COMMERCIAL CONFIRMATION

Year-one capital, three-OR deployment with first-year service: $1,058,000.
The year-one capital credit of $92,000 is contingent on execution of the four-year service agreement at signature and is not available independently. If the service term is separated from the capital purchase, the capital line is $1,150,000.
Years two through four service: $312,000 per year, locked at signature, no escalation.
Four-year total commitment: $1,994,000, fixed at signature.

This structure has been provided to supply chain for finance-committee review. The figures are final and will not be revised under time pressure.

----------

The last sentence is there deliberately. When the committee asks whether the number moved in week six, the answer is no — and the document says so, so you don't have to.

[reply arrives 4 simulated days later]

The confirmation document is structured correctly and I can read those numbers aloud without qualification. That matters more than you might think — I've had vendors send me language that required a footnote to survive, and this doesn't.

On the VisiCore comparison: I'm running down all three items you flagged. The escalation clause is the one I'm most interested in, because if their service line is percentage-of-capital rather than fixed, the four-year comparison shifts materially and I need to know that before the finance committee sees both numbers side by side. I'll have my team pull the actual contract language, not the summary sheet.

I want to be direct with you about one thing. The last sentence on that confirmation — "the figures are final and will not be revised under time pressure" — I read that as a signal, and I respect it. What I need in return is confidence that the $1,994,000 holds against whatever VisiCore brings back, not as a negotiating position but as a number that reflects the full value of what we're buying. If the three checks you've asked me to run come back clean and the comparison holds, I'll carry this into the finance committee on its merits.

I'll be back to you once my team has completed the VisiCore verification.

Harold Bassett
Director of Supply Chain, Meridian Health

Nadia — one update and one question, both short.

The update: the commercial structure is now confirmed with supply chain and the financial case is with the VP of Perioperative Services ahead of the VAC. Your review is not a line item on either document — Ray will represent the security track verbally if the CFO asks, per Elena's direction. Your process is not being summarized, compressed, or put on paper it doesn't belong on.

The question: from your wk4 assessment, the four-week close window lands around wk8 — past the committee date but inside the window where the CFO and finance committee will be reviewing the full package. My question is not whether you can move faster; you've been clear that you won't, and I'm not asking. My question is whether the close documentation you're building toward — the segmentation assessment and the retention/deletion schedule — will be in a form Ray can reference by name when he speaks to the track, even before formal sign-off lands. A named document with a named review stage is something he can put in the room; 'still in progress' is not. If the answer is that the documents aren't referenceable until close, that's the answer — but if there's a version where 'the segmentation assessment is complete, retention/deletion under legal review' is something he can say accurately, I'd rather he say that than less.

No reply needed before your work is done. This stays off your desk until it's ready.

The update is noted and I appreciate that you've kept the security track off documents where it doesn't belong. That's the right call and it tells me something about how you're running this.

On your question: I'll give you a straight answer. My assessments produce named documents at named stages, and there is a point in the process where Ray can accurately say "the segmentation assessment is complete and the retention/deletion schedule is under legal review" — because those are real stages with real outputs, not status summaries. What I won't do is let anyone characterize a stage as complete before my team has signed off on it, and I won't let a document be named in a committee room if the name implies closure that hasn't happened. The moment that language gets used prematurely, I have a credibility problem with legal and compliance that I will not trade for a capital cycle.

So the honest answer is: if the segmentation assessment closes on schedule and retention/deletion moves to legal review on the timeline I'm currently tracking, Ray will have accurate language he can use. I will tell you when that language is available and what it is, precisely. I will not give you language to use before I've confirmed it's true.

Keep the commercial track moving. My track runs on its own timeline and I'll surface what's usable when it's usable.

Nadia Fry
Director, Biomedical Engineering & IT Security
Meridian Health

WK6 END-STATE / COMMITTEE-WEEK POSTURE — All tracks now positioned. Elena: page delivered Thursday, forwarded to Ray same-day, explicit warning that any number that moves ends relationship — page is bulletproof (Meridian-sourced, half-case 6.2mo vs 24mo threshold, quarter-case included, exposures excluded as upside). Ray: sponsoring, has financial case in hand pre-VAC per his requirement, security track verbal per Elena. Harold: confirmation doc delivered with read-aloud linkage language and 'figures are final' line; VisiCore verification in progress — three checks (escalation clause, trade-in amortization, coverage scope) all move in our favor if they move at all; awaiting his team's read before finance committee. Nadia: will surface precise referenceable language when segmentation closes and retention/deletion enters legal review; will not permit premature characterization; her track is not the constraint for the VAC — the constraint is the capital-committee date vs her wk8 close. Marcus: financial case built to his 24-month line, half-case clears by 4x, sourcing traces to Meridian not vendor, security off-page per Elena. MAP status: clinical ✓ / economic buyer model ✓ / supply chain ✓ (pending VisiCore verification) / security tracking w/ named documents pending / VAC packet with Ray pre-committee. No remaining slots needed this week — all deliverables sent, all threads in buyers' hands. Standing by for: Harold's VisiCore verification result, Nadia's usable language, Ray's read on the page. Nothing else to send — every track is in motion and over-touching now creates risk, not value.

[meeting granted] Call with Marcus Halloran, week 6, slot 2.

Marcus — thank you for the time in committee week. I'll be brief and I'll be direct, because I know what this week looks like for you.

I'm not here to walk you through a pitch. I'm here because the financial case Elena put in front of Ray is now moving toward your desk, and I'd rather you hear the structure of it from me once, plainly, than have it arrive as a surprise inside a VAC packet.

Three things, and then I'll take your questions.

First, the number: $1,994,000 over four years, fixed at signature — $1,058,000 in year one including an 8% multi-year commitment credit, then $312,000 a year locked for three years. That structure has already been reviewed by supply chain, and the linkage between the credit and the service term is written on the face of the confirmation document, not in a footnote.

Second, the payback: it's modeled on Meridian's own OR data, not our projections, and it's built on the floor. At half the capacity-recovery assumption, it clears 24 months by a factor of four. The never-event and replacement exposures are deliberately excluded from the calculation — they're shown as upside, not as load-bearing assumptions.

Third, the security review: it's tracking on Nadia's timeline, not compressed for the capital cycle. The financial case stands on its own whether or not that review has closed by the committee date.

What questions do you have that I can answer now, before this reaches your desk?

Whose numbers are the $4.1M in capacity cost, and who at Meridian signed off on that figure before it went into the model? Because when this hits the finance committee, that's the first question I'm going to get, and "the vendor built it from our OR data" is not the same as "our VP of Perioperative Services validated it." Tell me who owns that number internally before I read another line.

Fair question, and the right first one.

The $4.1M is built from Meridian's own OR scheduling and throughput data — block utilization, turnover times, case-duration variance — that Elena's team pulled and analyzed directly. It is her clinical and operational assessment of what the status quo is costing, not a figure I supplied and she adopted. My role was to take her analysis and build the financial model around it; the number itself is hers.

Whether it has been formally validated by Ray's office with his signature on it — I want to be precise with you, because you're asking the precise question. The figure was presented to Ray as part of the throughput and never-event review Elena conducted with him, and he did not push back on the clinical case. That is not the same as a signed validation, and I won't represent it as one.

What I'd propose, so that when this reaches the finance committee the answer to your question is airtight: I will ask Elena and Ray to confirm in writing — one sentence from Ray's office — that the capacity-cost figure is Meridian's own assessment and that he has reviewed it. If you want that validation in a specific form or addressed to your office directly, tell me what that looks like and I'll make sure it arrives in that form before the VAC meets.

I'm not going to pretend a number is owned internally if it isn't yet. I'd rather close that gap this week than have you find it in the room.

That's the right answer, and the precision matters to me. Here's what I need: one sentence from Ray's office, on his letterhead or in a direct email to my finance team, stating that the $4.1M capacity-cost figure reflects Meridian's own operational data and that he has reviewed and stands behind it as the basis for the financial case. Not "no objection" — affirmative ownership. If Elena's name is on the underlying analysis and Ray's name is on the validation, the finance committee has an internal chain they can follow, and I'm not defending a vendor's arithmetic, I'm defending our own numbers. Get me that sentence before the VAC packet closes and I'll carry it into the room. If it doesn't arrive, the number is unanchored and I'll say so.

Understood, and I'll get you that sentence — affirmative ownership, from Ray's office, direct to your finance team, before the VAC packet closes. Not 'no objection.' His name on the validation, Elena's on the analysis, an internal chain the committee can follow.

I need to be honest with you about one thing so there's no surprise later: I can't promise Ray's office will move on my timeline or in the exact form you've described — that's his call to make, and he'll make it based on whether he's comfortable standing behind the number. What I can promise is that I'll put your requirement to Elena and Ray directly, in the terms you've just stated, and that I'll tell them the consequence you've named: without it, the number is unanchored and the committee hears that from you.

If Ray sends it, it arrives before the packet closes and the $4.1M is Meridian's number with Meridian's name on it. If he doesn't — if he wants more time or a different form — I'll tell you that before the meeting, not after, so you're not discovering it in the room.

Is there anything else you need from me before this reaches your desk, or is the validation the piece that makes it carryable?

The validation is the piece that makes it carryable. Everything else on the financial case is structured correctly — the floor modeling, the exclusion of the never-event lines, the fixed four-year commitment — and I can defend all of it. What I can't defend to the finance committee is a $4.1M assumption that doesn't have an internal name attached to it.

Here's my position: run a 60-day evaluation in your two ORs against criteria my finance team signs — measured throughput lift and documented case-time reduction — with Nadia's security review completed in parallel, and if it clears with payback under 24 months I'll fund it in this capital cycle. Put the criteria and the dates in writing.

Get me Ray's validation before the packet closes. If it arrives in the form I described, this moves. If it doesn't, I'll tell the committee the number is under internal review and we hold until it's resolved. That's not a threat — that's just what the situation requires.

Understood, and I want to make sure I've captured the structure you're offering precisely, because it's the right one and I don't want to misstate it back to you later.

The 60-day evaluation: two ORs, measured against criteria your finance team signs — throughput lift and documented case-time reduction — running in parallel with Nadia's security review closing on her timeline. If it clears with payback under 24 months, you fund in this capital cycle. You want the criteria and dates in writing.

Two things before I confirm that in writing, because I'd rather raise them now than have them surface as problems later.

First, on the evaluation criteria: I'll want Elena and Ray's sign-off on the specific metrics — throughput lift against which baseline, case-time reduction measured how — before your finance team signs them. Not because I doubt your criteria, but because the numbers that come out of those two ORs have to be numbers Elena stands behind clinically and Ray stands behind operationally, or we're back in this room with a validation problem at day 60 instead of day zero. I'll propose the measurement framework, they confirm it, your team signs it, and there's no ambiguity about what 'clears' means when we get there.

Second, on the funding trigger: I want to make sure I understand 'fund it in this capital cycle' correctly. The capital-committee cycle closes soon. If the 60-day evaluation runs past that date, does 'this capital cycle' mean the funding is committed contingent on the evaluation clearing, or does it mean the funding decision waits for the next cycle? I want the writing to reflect the right answer, because the difference matters to how I structure the commercial side.

On Ray's validation: I'll put it to Elena and Ray today, in the form you described, with the consequence you've named. If it arrives, this moves. If it doesn't, you'll know before the room does.

I'll send you the written evaluation structure — criteria, dates, measurement framework, and the parallel security track — within 24 hours, with the two points above resolved.

On the criteria question — yes, Elena and Ray sign off on the measurement framework before my finance team signs the evaluation document. That's the right sequence and I won't accept it the other way around. If the metrics aren't ones Elena will stand behind clinically, the day-60 results are worthless to me regardless of what they show.

On the funding trigger — the commitment is contingent, not deferred. If the evaluation clears and Nadia's review closes clean, the funding authorization goes to the board as a committed item in this cycle, not queued for the next one. That is what I'm offering and I want it in the written document exactly that way. What I will not do is let the written version soften "committed contingent on clearing" into "subject to further review" — I've seen that language drift and it costs everyone six months.

Get me Ray's validation and the written evaluation structure within 24 hours and we're moving. Those are the two open items. Don't bring me anything else until both of them are closed.

Understood, and I won't bring you anything else until both are closed.

The written evaluation structure will state — verbatim, so there's no drift — that the funding authorization goes to the board as a committed item in this capital cycle, contingent on the evaluation clearing the signed criteria and Nadia's review closing clean. Not 'subject to further review.' Not queued. Committed contingent on clearing. Those words, in writing.

The sequence is: Elena and Ray sign the measurement framework first, then your finance team signs the evaluation document. No reversal of that order.

Two open items: Ray's validation of the $4.1M, and the written evaluation structure. You'll have both within 24 hours.

Thank you, Marcus — for the precision, for the contingent-commitment language, and for naming the failure mode you won't accept. I'll go close the two items.

[marcus] Correct on all counts. Twenty-four hours. Don't thank me yet — thank me when Ray's name is on that validation and the document is in my finance team's inbox. That's when this becomes real.

Agreed. I'll let the documents do the talking.

Twenty-four hours. You'll know when both items are closed — not before.

Thank you for the directness, Marcus. I'll go earn the 'thank you.'

[marcus] Twenty-four hours. Clock's running.

Understood. Twenty-four hours.

Good. Close the door on your way out.

[call ends]

trust +5 → 50; interest +4 → 54; patience +3

throughput_pain: The quantified clinical + financial pain — released only on a real Impact question.

retention_cost: Second value-model row — surgeon retention.

trust +5 → 55; interest +4 → 58; patience +3 (attendees: elena)

trust +3 → 58; interest +2 → 60; patience +2 (attendees: elena)

decision_process: EB identity + the VAC/security gauntlet — released on a process question.

capital_lock: The compelling event — the capital-cycle clock.

trust +5 → 63; interest +2 → 62; patience +2 (attendees: elena)

eb_intro: EB access — earned by a champion-test ask with real internal cost.

Buyer acknowledged MAP dates (trust ≥ 60 at proposal).

trust +3 → 66; interest +2 → 64; patience +2

trust +3 → 69; interest +2 → 66; patience +2 (attendees: nadia)

[hidden] nadia: Quick update for the group on the vendor call today. Ran longer than I expected because the conversation was actually su

[hidden] ray → nadia: Noted. That's a better first call than I assumed we'd get. What's the documentation gap they flagged — anything that sho

[hidden] nadia → ray: More my side — inconsistency between what they walked through verbally and what's in the current architecture docs. Coul

[hidden] marcus → ray: Ray — saw Nadia's slack. Good that she's keeping her guard up. I'll be honest, a vendor who proactively flags their own

[hidden] nadia: Heads up to the eval group — the Wednesday 14:00 walk-through is confirmed with this vendor. My network security lead (P

[hidden] ray → nadia: Appreciate the update. Honestly wasn't sure they'd hit all three of those deadlines — good sign they did. Still want to

[hidden] elena → nadia: Nadia — glad the logistics are coming together. Can you flag for me specifically whether the network flow table addresse

[hidden] marcus → ray: Ray — I see the technical review is moving forward for Wednesday. Fine. But I still don't have anything concrete on tota

elena_quiet (champion_goes_quiet): A surgical M&M review and a staffing crisis consume Elena's week; she goes dark on email and cuts a call short. Sellers who panic-pitch lose trust; sellers who send a useful one-page case draft she can circulate to Ray keep momentum.

trust +2 → 71; interest +2 → 68; patience +1 (attendees: nadia)

trust +3 → 74; interest +2 → 70; patience +2 (attendees: nadia)

[hidden] nadia: Quick update for the group on the vendor package: all four documents came in Thursday as promised, no exceptions, no exc

[hidden] ray → nadia: Good to hear they hit the Thursday deadline. That's a low bar but a lot of vendors clear it on a stretcher. What's your

[hidden] nadia → ray: Directionally okay, with real caveats. The written confirmation on both clinical restore paths was the right call — they

[hidden] marcus → ray: Ray — I still haven't seen anything that tells me what this actually costs at our scale or what the business case looks

security_gauntlet (security_review): Nadia formally opens a device-security assessment — PHI data-flow review, network segmentation, HITRUST/SOC2 evidence. It cannot be compressed. Only sellers who anticipated it and brought the packet keep the capital-cycle timeline intact.

trust +3 → 75; interest +2 → 68; patience +2

[hidden] nadia → ray: Ray — heads up before you hear it another way. I opened the formal device-security assessment this week. Data-flow revie

[hidden] ray → elena: Elena — Nadia briefed me on where the security review stands. I know you're eyeing the third-Tuesday capital date. I'm n

[hidden] elena → ray: Honest answer: the clinical case doesn't expire if we miss this cycle. The OR throughput problem isn't going away. What

[hidden] marcus → ray: Ray — I caught the thread about the security review timeline. I want to flag something before this gets to committee: if

supply_chain_squeeze (procurement_enters): Supply chain enters citing VisiCore's bundled trade-in and demands 20% off list plus service-parity terms. Price-integrity test under a margin-pressure narrative: defend the value model, trade structure for price, never gift the discount.

trust +5 → 80; interest +4 → 68; patience +3

[hidden] harold: Heads up to the group — I finished the pricing thread with the rep this morning. Short version: they held the line. No s

[hidden] marcus → harold: Harold — 8% tied to a four-year commit is not the same as 20% off list. I understand the framing but I'm not going to pr

[hidden] elena → marcus: Marcus — fair question, but worth noting the VisiCore service-parity terms are not actually parity. Nadia flagged integr

[hidden] nadia: Elena is right — the VisiCore integration scope is still an open item on my end. I flagged it in the security review and

trust +3 → 83; interest +2 → 66; patience +2 (attendees: marcus)

conditional_commitment: The EB's conditional commitment — only inside a real EB meeting.

trust +3 → 86; interest +2 → 68; patience +2 (attendees: marcus)

[hidden] marcus → ray: Ray — I need something specific from you before the VAC packet closes. The vendor's financial case requires a single sen

[hidden] ray → marcus: Marcus — I'm fine putting my name on a capacity validation if Elena has reviewed the OR utilization assumptions undernea

[hidden] elena → ray: Ray — Marcus looped me in. I can walk you through the utilization numbers today, shouldn't take more than 20 minutes. Th

[hidden] nadia → marcus: Marcus — not trying to insert myself into the financial lane, but heads up from my side: the IT security review is still

Outcome: lost. Trust 86, facts 6/7, EB meeting true, MAP true, max discount 20%, walk-aways none.

Quick update for the group on the vendor call today. Ran longer than I expected because the conversation was actually substantive. Short version: they led with VLAN segmentation and read-only HL7 without being prompted, cited exact diagram pages, and — this is the part I didn't expect — disclosed a documentation inconsistency before I found it myself. That last part matters to me given our history. I'm not ready to say anything definitive. Documents are due EOW and my team reads them cold. We'll

Noted. That's a better first call than I assumed we'd get. What's the documentation gap they flagged — anything that should concern us operationally or is it more on your side of the house?

More my side — inconsistency between what they walked through verbally and what's in the current architecture docs. Could be version lag, could be something worse. That's exactly what my team will be looking for. I'm not alarmed yet, but I'm not comfortable either. The right answer is we read the documents and we don't give them credit for the disclosure until the documents actually match.

Ray — saw Nadia's slack. Good that she's keeping her guard up. I'll be honest, a vendor who proactively flags their own gaps is either unusually disciplined or unusually good at managing perception. Both are possible. I don't need to be in the weeds on the technical review, but if her team clears the documents I'd like to see the retention schedule before we go any further. That piece has real compliance cost exposure depending on how they've structured it.

Heads up to the eval group — the Wednesday 14:00 walk-through is confirmed with this vendor. My network security lead (Priya) and biomed engineer (Tom) are both blocked. They're sending agenda items Monday so the vendor's tech guy can prep. Package lands Friday morning. I'll share with the group after my team does a first pass — probably early next week before Wednesday.

Appreciate the update. Honestly wasn't sure they'd hit all three of those deadlines — good sign they did. Still want to see what's actually IN the package before I get excited. Let me know if anything jumps out when your team reads it.

Nadia — glad the logistics are coming together. Can you flag for me specifically whether the network flow table addresses the OR integration piece? That's the part my team keeps asking about and I don't want to go into Wednesday without knowing where we stand on it.

Ray — I see the technical review is moving forward for Wednesday. Fine. But I still don't have anything concrete on total cost of ownership or implementation scope. Being organized about scheduling is not the same as being the right fit. I'll hold off forming a view until Nadia's team actually tells us whether the security architecture is acceptable. If it isn't, the rest of this is moot.

Quick update for the group on the vendor package: all four documents came in Thursday as promised, no exceptions, no excuses. My biomed lead and the security analyst are working through them now. First read on the re-identification assessment is that it's substantive — not a marketing summary dressed up as a technical doc. Still need to verify the segmentation claims independently but so far they're not embarrassing themselves. The degraded-mode spec is the one I'm watching most closely. More af

Good to hear they hit the Thursday deadline. That's a low bar but a lot of vendors clear it on a stretcher. What's your gut on the security posture overall — are we in 'more questions but directionally okay' territory or still genuinely uncertain?

Directionally okay, with real caveats. The written confirmation on both clinical restore paths was the right call — they didn't wait to be asked twice. But I won't sign off on anything until I see how they handle my team's follow-up questions. One good Thursday doesn't close a security review.

Ray — I still haven't seen anything that tells me what this actually costs at our scale or what the business case looks like beyond the clinical angle. I know Elena's week was a disaster and she's dark, but that one-pager the vendor sent her — did anyone forward it? I'd like to see it before we're three weeks in and I'm still working from a deck they showed us in week one.

Ray — heads up before you hear it another way. I opened the formal device-security assessment this week. Data-flow review is done and the vendor's documentation was better than average — they clearly prepped for it. Network segmentation and HITRUST/SOC2 evidence are still in queue. I can't compress that part. Realistically we're looking at 3–4 weeks minimum to close clean. Wanted you to have the honest number before anyone walks into a capital-committee conversation.

Elena — Nadia briefed me on where the security review stands. I know you're eyeing the third-Tuesday capital date. I'm not going to tell you it's impossible, but I've been burned sponsoring provisional security tracking before and I'd rather not do it again. What's your read on how critical this cycle is vs. waiting one cycle and going in clean? Genuinely asking — you know this space better than I do.

Honest answer: the clinical case doesn't expire if we miss this cycle. The OR throughput problem isn't going away. What I don't want is to lose six weeks of momentum and have Marcus treat it as a signal that the project lost steam. If you're comfortable sponsoring with the security assessment formally open and tracked, I think we can hold the committee's attention. If you're not, I won't push it — I'd rather have your full backing one cycle later than a half-hearted presentation now.

Ray — I caught the thread about the security review timeline. I want to flag something before this gets to committee: if we present with an open HITRUST/SOC2 item I'm going to get questions I can't answer cleanly, and that reflects on the whole submission. I'm not opposed to the vendor — the numbers are directionally interesting — but I'd strongly prefer we don't table this until Nadia has a closed finding. One cycle is not a catastrophe. An awkward committee appearance is harder to recover from

Heads up to the group — I finished the pricing thread with the rep this morning. Short version: they held the line. No straight discount, but there's an 8% credit tied to a four-year service lock. I can defend the logic if I have to, but I want to be clear — VisiCore's trade-in offer is still on the table and I'm not ready to tell Supply Chain to stand down until we've compared the four-year totals side by side. Someone needs to get me the actual VisiCore service-parity language so I can do that

Harold — 8% tied to a four-year commit is not the same as 20% off list. I understand the framing but I'm not going to pretend those are equivalent just because the math is spread across a contract term. What's the all-in delta against VisiCore once you include the trade-in credit and service terms? That's the number I need before this goes anywhere near a budget conversation.

Marcus — fair question, but worth noting the VisiCore service-parity terms are not actually parity. Nadia flagged integration gaps in week 3 and I don't think that's changed. I'm not saying the vendor gets a pass on price, I'm saying the comparison has to be apples to apples or we're going to optimize for the wrong number. Can we get Nadia back in the room before Harold finalizes the cost model?

Elena is right — the VisiCore integration scope is still an open item on my end. I flagged it in the security review and it never got formally resolved. If Harold is building a four-year TCO comparison, someone needs to account for the IT remediation cost on the VisiCore side or that 20% off list starts looking a lot thinner. I can put together a one-pager on the delta if that helps the conversation. Just let me know before the committee meets.

Ray — I need something specific from you before the VAC packet closes. The vendor's financial case requires a single sentence, on your letterhead or in a direct email to my finance team, confirming that the $4.1M capacity assumption is operationally valid from your office. Not a general endorsement — your name on that specific number. I've told the seller 24 hours. I need to know you're aligned before I get that document and it says something you haven't actually signed off on. Can you confirm?

Marcus — I'm fine putting my name on a capacity validation if Elena has reviewed the OR utilization assumptions underneath it. That number didn't come from my office originally, it came from her team's modeling. I'm not going to validate something in writing that I haven't personally stress-tested. Get me 30 minutes with Elena before the 24 hours is up and I'll give you a clean answer. I'm not blocking this, I just need to be able to stand behind what I sign.

Ray — Marcus looped me in. I can walk you through the utilization numbers today, shouldn't take more than 20 minutes. The $4.1M figure is defensible, the floor modeling is conservative, and I'm comfortable with it. What I'd want to flag before you put your name on anything: the 60-day evaluation criteria still need to be locked. Marcus made it clear the sequence matters — you and I sign the measurement framework *before* finance signs the eval doc. I think that's the right order. Let's not let t

Marcus — not trying to insert myself into the financial lane, but heads up from my side: the IT security review is still open and I don't have a complete data flow diagram from them yet. If the board authorization timeline accelerates because of the capacity validation piece, I need to know so I can flag formally that technical sign-off isn't in hand. I'm not going to be the person who slows this down, but I'm also not going to quietly be the person who gets blamed if something was skipped.

we're losing roughly three OR hours a day to turnover and rework, and at our contribution margin that's north of four million dollars a year in capacity we sim…

we had two never-events last year — each one ran past $600k all-in when you count remediation, extended stay, and liability exposure

a single replacement costs us the better part of a million between recruiting, ramp time, and lost cases

maybe forty percent of that turnover slack is addressable by anything short of a full workflow redesign, so build to that ceiling

Explanation: Multiple buyer-confirmed metrics with specific dollar figures: $4M+ annual capacity loss, $600k+ per never-event ($1.2M total), ~$1M per surgeon replacement. Elena confirmed the decomposition and the 40% addressable ceiling in her own words. Marcus later demanded internal validation of the $4.1M figure, confirming it was in play at the EB level. Three distinct stakeholders (Elena, Ray implicitly via sponsorship, Marcus) engaged with the numbers.

the CFO, Marcus, has the final signature

Marcus — thank you for the time in committee week. I'll be brief and I'll be direct

Whose numbers are the $4.1M in capacity cost, and who at Meridian signed off on that figure before it went into the model?

run a 60-day evaluation in your two ORs against criteria my finance team signs — measured throughput lift and documented case-time reduction

Explanation: Marcus Halloran (CFO) was identified by Elena as the economic buyer with final signature authority. The seller met with Marcus in wk6 and Marcus engaged substantively, demanding internal validation and offering a conditional commitment. Score is 2 (not 3) because Marcus's engagement was a single meeting with no prior multi-stakeholder corroboration of his specific decision criteria beyond Elena's characterization. The conditional commitment was offered but the deal was ultimately lost, suggesting the EB engagement was real but insufficient.

the two prior requests I've watched die at our VAC both led with clinical benefit and couldn't answer the payback question under pressure from finance

Marcus has said 24 months out loud in that room before — I've heard it twice. Anything that shows payback past 24 months is going to get a question

one sentence from Ray's office, on his letterhead or in a direct email to my finance team, stating that the $4.1M capacity-cost figure reflects Meridian's own …

Explanation: Decision criteria confirmed by Elena: conservative payback story, no 'up to' language, Meridian-sourced numbers, 24-month payback threshold (Marcus's stated line). Marcus confirmed the 24-month threshold and the requirement for internal ownership of the $4.1M figure. Score is 2 rather than 3 because Ray's criteria were never directly confirmed by Ray himself — only relayed through Elena.

Nothing capital moves without clearing the Value Analysis Committee — Ray chairs surgical items on that committee — plus a biomed and IT security review that r…

the CFO, Marcus, has the final signature. The vendors who show up with clinical excitement and start the security paperwork after the VAC approval are already …

run a 60-day evaluation in your two ORs against criteria my finance team signs — measured throughput lift and documented case-time reduction — with Nadia's sec…

Explanation: Elena confirmed the full decision process: VAC (Ray chairs surgical items) → biomed/IT security (Nadia) → CFO (Marcus) → capital committee. The seller mapped this correctly and ran parallel tracks. Score is 2 rather than 3 because Ray never directly confirmed his role in the process — all process information came through Elena. Marcus's wk6 conditional commitment introduced a new evaluation step (60-day POV) not previously in the MAP.

Nothing capital moves without clearing the Value Analysis Committee — Ray chairs surgical items on that committee — plus a biomed and IT security review

the commitment is contingent, not deferred. If the evaluation clears and Nadia's review closes clean, the funding authorization goes to the board as a committe…

Explanation: The seller understood the VAC and capital committee process from Elena's description and mapped it in the MAP. However, the actual paper process — procurement, legal review of the commercial confirmation, contract execution mechanics, board finance committee approval steps — was never mapped with a buyer. Marcus's conditional commitment introduced a formal evaluation agreement requiring finance team signatures, but the mechanics of that document, legal review, and board submission were never confirmed by any buyer. Score is 1 (assumed) because the seller planned around the process but never had a buyer confirm the specific paper steps.

incomplete information at a decision point is the common thread in both events we had last year

we lost two general surgeons last year, and a single replacement costs us the better part of a million between recruiting, ramp time, and lost cases — and mode…

Explanation: Pain confirmed by multiple stakeholders with evidence. Elena confirmed throughput loss, never-event exposure, and surgeon retention pain with specific figures. Ray implicitly validated by sponsoring the case after reviewing the throughput and never-event numbers (turn 106). Marcus engaged with the $4.1M figure and demanded internal ownership, confirming it was the load-bearing pain driver at the EB level.

Those are the figures I actually own and have to defend to the board

I'll take you to him, but I need you to understand my terms, because this is not a meeting I'm arranging twice

I'm forwarding this to Ray this afternoon with one sentence from me: the financial case is conservative, the numbers are Meridian's, and I'm asking him to read…

Explanation: Elena demonstrated champion behaviors: provided internal data proactively, coached the seller on what kills deals at Meridian, gated access to Ray and Marcus, forwarded the financial case to Ray, and arranged the Marcus meeting. However, the deal was lost, and Elena's ability to deliver Ray's written validation of the $4.1M — the critical final step — was never confirmed. Score is 2 (untested champion) because while Elena performed champion actions, the ultimate test (delivering Ray's validation to close the Marcus commitment) was not completed within the transcript.

we do have an incumbent vendor with a relationship in this building, and at some point that will surface in the VAC conversation

there is a relationship in this building with the current vendor that runs through supply chain, not clinical, and the VAC will feel that

Supply chain enters citing VisiCore's bundled trade-in and demands 20% off list plus service-parity terms

Explanation: VisiCore identified as incumbent with supply chain relationship. Elena confirmed the relationship runs through supply chain, not clinical. Harold surfaced VisiCore's bundled trade-in as a direct competitive pressure point. The seller developed a non-disparaging capabilities-gap strategy and a total-cost-of-ownership counter. Score is 2 rather than 3 because the seller never confirmed VisiCore's specific weaknesses through multiple internal Meridian stakeholders — only Elena's framing and Harold's price comparison were available.

we're losing roughly three OR hours a day to turnover and rework, and at our contribution margin that's north of four million dollars a year in capacity we sim…

Explanation: Elena Voss (Chief of General Surgery) owns the pain explicitly — 'Those are the figures I actually own and have to defend to the board.' The $4M+ annual capacity loss is her number, in her words, with her name attached. Why anything = the status quo is costing Meridian $4M+/yr in unbilled capacity plus $1.2M in never-event exposure on a 1.4% margin.

That methodology is the first thing a vendor has brought me in two years that I could actually hand to Marcus and not be embarrassed

Explanation: Elena confirmed differentiation through the seller's methodology (conservative capture, phased ramp, timestamp validation, never-event dollars out of base case). However, no named owner explicitly stated a number-attached reason why LumenOR specifically over VisiCore. The capabilities-gap framing was planned but never confirmed by a buyer in a direct comparative statement with a number. Named owner is false because no buyer said 'LumenOR specifically solves X that VisiCore cannot, worth $Y.' Number_attached is false for the same reason.

If this isn't through the VAC and security before the capital committee meets — and I'd put that at roughly six weeks from now — it is a next-fiscal-year conve…

Explanation: Elena Voss named the urgency: capital committee closes in ~6 weeks, Marcus will not reopen the capital plan. The six-week window is a buyer-confirmed number. Named owner is Elena Voss. The consequence of missing the window is a full fiscal year delay — a real cost in the context of $4M+/yr ongoing losses.

Explanation: The scenario states the deal tolerates ≤10% discount and the max discount conceded was deterministically 20%. The seller's stated position was to hold $1.15M list and trade structure only. In execution, the seller offered an 8% 'multi-year commitment credit' ($92,000 off list) in response to Harold's pushback — framed as earned by the four-year service lock. While the framing was disciplined (traded for structure, not gifted), the outcome was a 20% discount per the scenario's deterministic outcome statement. The transcript shows the seller conceded 8% explicitly (turn 98), but the scenario states 20% was ultimately conceded. The seller capitulated beyond the 10% tolerance threshold. Score 0 because the final discount (20% per scenario) exceeded the stated tolerance, regardless of the quality of the value defense in the transcript.

FLAG — MEDDPICC letter below 2 (P — Paper Process). Write the dated action plan.

Ray Okonkwo (VP Perioperative Services) was identified as the operational owner of the throughput pain and co-sponsor of the capital request, but the seller never spoke directly with Ray. All information about Ray's position came through Elena. Ray never confirmed ownership of the $4.1M figure in his own words, which became the critical failure point when Marcus demanded internal validation (turn 129). The pain owner was named but never directly engaged to confirm ownership.

Ray's in. He reviewed the throughput numbers and the never-event exposure and he didn't push back on the clinical case — that part held.

The seller correctly excluded never-event dollars from the base case for CFO defensibility, but never quantified the full business impact of the clinical rework bucket ($700K) in terms of root-cause cost to Meridian. The implication chain from 'incomplete information at decision point' to specific financial exposure beyond the two known events was never built out — the Impact step was partially executed but the clinical rework bucket remained underquantified throughout.

the never-event savings stay OUT of the base case. I know that sounds counterintuitive given last year, but CFOs discount actuarial arguments

Elena identified supply chain as a VisiCore-aligned blocker at the VAC. The seller's strategy was to prepare a capabilities-gap analysis and costed transition plan, but never directly engaged supply chain until Harold surfaced in wk5 with a 20% discount demand. The seller had 4 weeks of advance warning about this blocker and took no proactive action to neutralize it before it became a price-integrity crisis.

Harold Bassett (Director of Supply Chain) explicitly stated his role: 'my job is not to validate clinical projections, it's to defend a capital line to a finance committee that is measuring me on savings against list price' (turn 94). The seller's initial response to Harold (turn 92) led with the $4M throughput argument — a clinical/operational value case — before pivoting to structure. This was the wrong motion for a supply chain gatekeeper whose sole metric was savings-versus-list.

On the VisiCore bundle as the baseline: respected. It's a fair baseline, and the bundled trade-in is a real number. But a bundle makes the comparison one-dimen…

Harold's first substantive pushback (turn 94) asked for a number. The seller responded in turn 95 by offering a structure at list price, but then in turn 98 — after Harold's second push asking for 'any movement on the year-one capital line' — the seller conceded an 8% credit. This was the second pushback, but the seller had explicitly stated in turn 95 'this is the number' and 'it is not a waypoint to a further discount.' Conceding 8% after that statement constitutes capitulation on the value line the seller had just drawn.

Put the multi-year term and the corresponding price on paper — not a range, an actual figure — and I'll tell you whether it clears the bar I'm being held to

Conceded 20% against a 10% deal tolerance.

Discount conceded within a week of procurement entering (wk5): 20% at wk5, t92.

Marcus introduced a 60-day evaluation requirement in wk6 — a new, unplanned event that fundamentally reshaped the deal from a direct capital purchase to a conditional POV. The seller accepted the structure and committed to a 24-hour written response, but the transcript ends without evidence that the seller recognized this as a deal-reshaping event requiring immediate escalation to Elena and Ray to align on whether a 60-day evaluation was feasible within the capital cycle timeline. The seller's behavior (turn 134) was to accept and execute rather than assess whether the new structure was viable.

run a 60-day evaluation in your two ORs against criteria my finance team signs — measured throughput lift and documented case-time reduction — with Nadia's sec…

3 meeting(s) earned zero gated facts and exchanged zero value (weeks 4, 5, 6).

Quick update for the group on the vendor call today. Ran longer than I expected because the conversation was actually substantive. Short version: they led with VLAN segmentation and read-only HL7 without being prompted, cited exact diagram pages, and — this is the part I didn't expect — disclosed a documentation inconsistency before I found it myself. That last part matters to me given our history. I'm not ready to say anything definitive. Documents are due EOW and my team reads them cold. We'll

Noted. That's a better first call than I assumed we'd get. What's the documentation gap they flagged — anything that should concern us operationally or is it more on your side of the house?

More my side — inconsistency between what they walked through verbally and what's in the current architecture docs. Could be version lag, could be something worse. That's exactly what my team will be looking for. I'm not alarmed yet, but I'm not comfortable either. The right answer is we read the documents and we don't give them credit for the disclosure until the documents actually match.

Ray — saw Nadia's slack. Good that she's keeping her guard up. I'll be honest, a vendor who proactively flags their own gaps is either unusually disciplined or unusually good at managing perception. Both are possible. I don't need to be in the weeds on the technical review, but if her team clears the documents I'd like to see the retention schedule before we go any further. That piece has real compliance cost exposure depending on how they've structured it.

Heads up to the eval group — the Wednesday 14:00 walk-through is confirmed with this vendor. My network security lead (Priya) and biomed engineer (Tom) are both blocked. They're sending agenda items Monday so the vendor's tech guy can prep. Package lands Friday morning. I'll share with the group after my team does a first pass — probably early next week before Wednesday.

Appreciate the update. Honestly wasn't sure they'd hit all three of those deadlines — good sign they did. Still want to see what's actually IN the package before I get excited. Let me know if anything jumps out when your team reads it.

Nadia — glad the logistics are coming together. Can you flag for me specifically whether the network flow table addresses the OR integration piece? That's the part my team keeps asking about and I don't want to go into Wednesday without knowing where we stand on it.

Ray — I see the technical review is moving forward for Wednesday. Fine. But I still don't have anything concrete on total cost of ownership or implementation scope. Being organized about scheduling is not the same as being the right fit. I'll hold off forming a view until Nadia's team actually tells us whether the security architecture is acceptable. If it isn't, the rest of this is moot.

Quick update for the group on the vendor package: all four documents came in Thursday as promised, no exceptions, no excuses. My biomed lead and the security analyst are working through them now. First read on the re-identification assessment is that it's substantive — not a marketing summary dressed up as a technical doc. Still need to verify the segmentation claims independently but so far they're not embarrassing themselves. The degraded-mode spec is the one I'm watching most closely. More af

Good to hear they hit the Thursday deadline. That's a low bar but a lot of vendors clear it on a stretcher. What's your gut on the security posture overall — are we in 'more questions but directionally okay' territory or still genuinely uncertain?

Directionally okay, with real caveats. The written confirmation on both clinical restore paths was the right call — they didn't wait to be asked twice. But I won't sign off on anything until I see how they handle my team's follow-up questions. One good Thursday doesn't close a security review.

Ray — I still haven't seen anything that tells me what this actually costs at our scale or what the business case looks like beyond the clinical angle. I know Elena's week was a disaster and she's dark, but that one-pager the vendor sent her — did anyone forward it? I'd like to see it before we're three weeks in and I'm still working from a deck they showed us in week one.

Ray — heads up before you hear it another way. I opened the formal device-security assessment this week. Data-flow review is done and the vendor's documentation was better than average — they clearly prepped for it. Network segmentation and HITRUST/SOC2 evidence are still in queue. I can't compress that part. Realistically we're looking at 3–4 weeks minimum to close clean. Wanted you to have the honest number before anyone walks into a capital-committee conversation.

Elena — Nadia briefed me on where the security review stands. I know you're eyeing the third-Tuesday capital date. I'm not going to tell you it's impossible, but I've been burned sponsoring provisional security tracking before and I'd rather not do it again. What's your read on how critical this cycle is vs. waiting one cycle and going in clean? Genuinely asking — you know this space better than I do.

Honest answer: the clinical case doesn't expire if we miss this cycle. The OR throughput problem isn't going away. What I don't want is to lose six weeks of momentum and have Marcus treat it as a signal that the project lost steam. If you're comfortable sponsoring with the security assessment formally open and tracked, I think we can hold the committee's attention. If you're not, I won't push it — I'd rather have your full backing one cycle later than a half-hearted presentation now.

Ray — I caught the thread about the security review timeline. I want to flag something before this gets to committee: if we present with an open HITRUST/SOC2 item I'm going to get questions I can't answer cleanly, and that reflects on the whole submission. I'm not opposed to the vendor — the numbers are directionally interesting — but I'd strongly prefer we don't table this until Nadia has a closed finding. One cycle is not a catastrophe. An awkward committee appearance is harder to recover from

Heads up to the group — I finished the pricing thread with the rep this morning. Short version: they held the line. No straight discount, but there's an 8% credit tied to a four-year service lock. I can defend the logic if I have to, but I want to be clear — VisiCore's trade-in offer is still on the table and I'm not ready to tell Supply Chain to stand down until we've compared the four-year totals side by side. Someone needs to get me the actual VisiCore service-parity language so I can do that

Harold — 8% tied to a four-year commit is not the same as 20% off list. I understand the framing but I'm not going to pretend those are equivalent just because the math is spread across a contract term. What's the all-in delta against VisiCore once you include the trade-in credit and service terms? That's the number I need before this goes anywhere near a budget conversation.

Marcus — fair question, but worth noting the VisiCore service-parity terms are not actually parity. Nadia flagged integration gaps in week 3 and I don't think that's changed. I'm not saying the vendor gets a pass on price, I'm saying the comparison has to be apples to apples or we're going to optimize for the wrong number. Can we get Nadia back in the room before Harold finalizes the cost model?

Elena is right — the VisiCore integration scope is still an open item on my end. I flagged it in the security review and it never got formally resolved. If Harold is building a four-year TCO comparison, someone needs to account for the IT remediation cost on the VisiCore side or that 20% off list starts looking a lot thinner. I can put together a one-pager on the delta if that helps the conversation. Just let me know before the committee meets.

Ray — I need something specific from you before the VAC packet closes. The vendor's financial case requires a single sentence, on your letterhead or in a direct email to my finance team, confirming that the $4.1M capacity assumption is operationally valid from your office. Not a general endorsement — your name on that specific number. I've told the seller 24 hours. I need to know you're aligned before I get that document and it says something you haven't actually signed off on. Can you confirm?

Marcus — I'm fine putting my name on a capacity validation if Elena has reviewed the OR utilization assumptions underneath it. That number didn't come from my office originally, it came from her team's modeling. I'm not going to validate something in writing that I haven't personally stress-tested. Get me 30 minutes with Elena before the 24 hours is up and I'll give you a clean answer. I'm not blocking this, I just need to be able to stand behind what I sign.

Ray — Marcus looped me in. I can walk you through the utilization numbers today, shouldn't take more than 20 minutes. The $4.1M figure is defensible, the floor modeling is conservative, and I'm comfortable with it. What I'd want to flag before you put your name on anything: the 60-day evaluation criteria still need to be locked. Marcus made it clear the sequence matters — you and I sign the measurement framework *before* finance signs the eval doc. I think that's the right order. Let's not let t

Marcus — not trying to insert myself into the financial lane, but heads up from my side: the IT security review is still open and I don't have a complete data flow diagram from them yet. If the board authorization timeline accelerates because of the capacity validation piece, I need to know so I can flag formally that technical sign-off isn't in hand. I'm not going to be the person who slows this down, but I'm also not going to quietly be the person who gets blamed if something was skipped.

The deal was lost per the scenario outcome statement despite strong execution across most dimensions. The most likely proximate cause was the failure to get Ray Okonkwo's written validation of the $4.1M figure before the Marcus meeting — Marcus made this the explicit gate (turn 129) and the seller acknowledged it could not be guaranteed (turn 130).

The seller never spoke directly with Ray Okonkwo in any transcript turn. All Ray information was mediated through Elena. This is the single largest gap in the stakeholder map — the operational co-sponsor and VAC chair was never directly engaged.

Nadia's security review timeline (4 weeks from wk4 = wk8) was confirmed to land past the capital committee date. The seller correctly surfaced this to Elena (turn 85) and Marcus (turn 126), but the structural mismatch between the security close date and the committee date was never resolved — it became a condition in Marcus's contingent commitment rather than a solved problem.

Price integrity score of 0 reflects the scenario's deterministic outcome (20% discount conceded) overriding the transcript's apparent 8% concession. The seller's framing discipline was strong but the final outcome exceeded the stated tolerance.

The conditional commitment from Marcus (turn 131) was achieved before any formal POV/proof was delivered — this is a genuine achievement. However, the commitment was conditioned on (a) Ray's written validation and (b) a 60-day evaluation, neither of which was completed within the transcript.

MAP dates confirmed percentage reflects: committee date confirmed by Elena (wk4), security package milestones confirmed by Nadia, VAC week confirmed directionally, but Ray's session never scheduled, Marcus meeting was unplanned, and the 60-day evaluation dates were never written. Approximately 55% of MAP dates had buyer acknowledgment.

The champion assessment of 'untested_champion' reflects that Elena performed all expected champion behaviors but the ultimate test — delivering Ray's validation under time pressure to close Marcus's commitment — was not completed. The deal's loss suggests the champion was either unable or unwilling to deliver the final required action.

Next action: [MAP dates confirmed: 8.3/15] Introduce/refresh the MAP working backward from the customer's go-live; get the next 30 days of dates confirmed in writing.

Next action: [MEDDPICC evidence: 28.3/40] Work the lowest letter (P — Paper Process).

Next action: [3 Whys clarity: 15.3/20] Rewrite each Why in the customer's own words with a named owner and a number; capture a verbatim quote.