Command Center + Copilot
A reviewable morning round
Run three simulated calls, follow progress, hear a text-and-voice morning brief, ask the queue, and inspect the read-only tool trace behind each answer.
Published resources · Toolkit V3.4.1 · App v1.10.1
Heart failure care where there's no cardiologist.
HEARTLAND connects a published implementation framework, a versioned toolkit and an open-source companion App for rural and resource-limited settings. Explore the workflow with fictional cases; clinical judgment stays with people.
Public demonstration only. Do not enter real patient, personal, or health information. Privacy-minimized interaction metadata may be recorded. No clinical or regulatory authorization is implied.
The implementation gap
From a recommendation to an accountable workflow.
The framework addresses practical questions for rural teams: how to organize follow-up, accommodate access barriers, identify missing information and make the next responsible person explicit.
The article explains the framework; the toolkit contains implementation material; the App offers interactive educational and controlled-evaluation workflows. These are complementary resources, not proof of clinical effectiveness.
Read the HEARTLAND technical report ↗Protocol architecture
Eight modules, one workflow.
Explore eight educational topics and their companion tools. The article, toolkit and software are distinct resources; public access does not authorize clinical activation.
Module 01
Risk Stratification
Bring access barriers and social context into a structured discussion of heart failure follow-up.
Jump to detail ↓
Module 02
GDMT Optimization
Organize medication review, access barriers and the information needed for clinician-led decisions.
Jump to detail ↓
Module 03
Telephone-Based Titration
Make room for telephone and paper workflows when digital access is limited.
Jump to detail ↓
Module 04
Discharge Transitions
Connect education, medication reconciliation and follow-up responsibility across a transition.
Jump to detail ↓
Module 05
Remote Monitoring
Show how measurements, missing data, review capacity and follow-up fit together.
Jump to detail ↓
Module 06
Comorbidity Management
Keep coexisting conditions visible during heart failure review.
Jump to detail ↓
Module 07
Primary Care Coordination
Make the next owner, unresolved question and handoff visible.
Jump to detail ↓
Module 08
Implementation Guidance
Plan around local staffing, infrastructure and governance before any real-world activation.
Jump to detail ↓
Published release · v1.10.1
Follow the evidence. Keep people in charge.
Explore population replay, simulated outreach, English/Spanish check-ins, Copilot, Patient 360, pathways, coordination and assisted SBAR. AI handles bounded language; registered rules set simulated routing; people own clinical judgment.
Synthetic walkthrough · No clinical care
One answer, five visible handoffs.
Open a step to inspect this fixed fictional example. This explanation runs no AI, saves no patient record and makes no contact. The dated implementation states below are separate from this illustration.
01 CollectionStart with the answer, its source and its time.
Fictional check-in, demo day 1 at 09:00: “I did not record my weight today.” The example contains no measured weight.
02 RecordSeparate the original answer from structured fields.
AI may structure language, but an unprovided weight stays unknown. Selected input and generated-text screens apply on supported paths.
03 SignalExpose a required-input gap for review.
Registered rules and documented monitoring-gap policies set simulated routing. The language model does not assign the disposition.
04 Human reviewCheck the evidence before choosing an action.
Example owner: demo reviewer. Source, unknown fields and routing reason are reviewed together; AI wording is only a proposal.
05 Documented outcomeKeep the next owner and unresolved work visible.
Illustrated outcome: clarification remains pending. No real contact, delivery or clinical benefit is demonstrated.
Choose the scale, then inspect a case.
Replay 500, 2,500 or 5,000 synthetic check-ins across five fictional clinic days. Counts describe a simulation, not observed clinical performance or staffing savings.
The Evidence Flow and Decision Receipt expose source, extraction, unknowns, routing reason and the next human action.
- Synthetic input
- Fictional values only
- AI language
- Converses, extracts, drafts, narrates
- Registered rules
- Rules and gap policies set simulated routing
- Optional voice
- Microphone off until visitor opt-in
- Human review
- Verifies evidence and authorizes the next action
The archived App baseline describes nine capabilities, grouped below by five surfaces. This is not a guarantee that every mode is currently enabled; see the recording-specific audio release and implementation states below.
Outreach + Daily Loop
Displayed exceptions keep their source context
Source transcript, structured extraction, unknowns, rule ID, owner, and fictional outcome stay together. Compare proposed Situation and Background wording with accept, reject, and undo; Assessment and Recommendation remain provider-owned.
Patient 360 + Pathways + Coordination
One case, end to end
Review a 60-second brief, source freshness, trends, safety data, protocol context, ownership, deadline, and the next handoff in the fictional workflow.
Patient Today + Impact
Bilingual check-ins with visible limits
Try English or Spanish by tap, text, or optional voice. Missing answers route to review; Impact reports tour behavior, not clinical efficacy.
Protocol Guide + Public Tools
Ask and explain without changing the result
Ask a bounded assistant about published protocol content with references, or request a plain-language explanation of a deterministic tool result. The AI layer does not recalculate the score or threshold.
Selected emergency phrases and identifier patterns are screened; supported generated-text paths check selected prescriptive wording. Missing required answers remain visible. These bounded safeguards are not a guarantee that all unsafe input is detected. AI capacity limits and fallbacks apply.
Explore the published synthetic sandbox →Operational clarification
Same clinical goal. Explicit human responsibility.
Pharmacy at any tier
Community, ambulatory or remote pharmacists may participate when available. Define reconciliation, teaching, access, monitoring and recommendation roles without assuming prescribing authority.
Recognize, assess, authorize
Trained observers raise concerns; qualified professionals assess them within scope. A title, certificate or software permission alone does not authorize medication changes or disposition.
Referral with context
Distinguish planned consultation, urgent assessment and advanced-HF/inpatient evaluation. Retain ownership until an accepted transfer; a request is not completed care.
Prepare and rehearse
Four preparation steps, printable worksheets and 12 synthetic scenarios make coverage, communication and recovery gaps visible. Material prepared is not training delivered or clinical readiness.
Resource tier changes delivery support, not clinically indicated care. No patient pilot, institutional adoption or clinical outcome is demonstrated.
Deep dive
The protocol, module by module.
These summaries explain scope and questions for review. Links open educational tools, not treatment orders. Review the full versioned sources and current institutional guidance.
Module 01
Risk Stratification
Educational overview
Bring access barriers and social context into a structured discussion of heart failure follow-up.
- Proposed HEARTLAND score
- An educational heuristic incorporating clinical and rural-access variables. It is not a validated prognosis or a substitute for established instruments.
- Context before interpretation
- Review the inputs, missing information and source dates alongside the clinical situation.
- Research boundary
- Explore the calculator with fictional values. Prospective validation remains a research objective.
Module 02
GDMT Optimization
Educational overview
Organize medication review, access barriers and the information needed for clinician-led decisions.
- Medication context
- Explore the guideline-directed medical therapy (GDMT) pathway and its source references.
- Access planning
- The Generic Bridge material discusses affordability and assistance pathways. Actual price, coverage, availability and eligibility require verification.
- Individual review
- Medication selection and changes require qualified review of the full clinical record, current guidance and institutional policy.
Module 03
Telephone-Based Titration
Educational overview
Make room for telephone and paper workflows when digital access is limited.
- Digital and analog routes
- Compare communication channels, documentation needs, escalation ownership and contingency plans.
- Clinician-led follow-up
- Review the checklist as educational material. Contact cadence and medication decisions require an approved local plan.
- Hózhó trial context
- The trial studied clinician-led telephone medication optimization with home blood pressure monitoring in Navajo Nation.
Module 04
Discharge Transitions
Educational overview
Connect education, medication reconciliation and follow-up responsibility across a transition.
- Education and teach-back
- Review understanding, accessible materials and the means to seek help. Resource tiers do not remove the need for essential safety education.
- Medication access
- Identify reconciliation, supply and affordability issues for the responsible clinical team.
- Follow-up ownership
- Make the planned contact, responsible person, unresolved questions and escalation route explicit.
Module 05
Remote Monitoring
Educational overview
Show how measurements, missing data, review capacity and follow-up fit together.
- Source and recency
- Distinguish when a measurement was collected from when it was entered or reviewed.
- Review responsibility
- A displayed alert does not prove delivery or review. Emergency procedures and staffing must be defined locally.
- Operational feasibility
- Equipment, connectivity, workload and reimbursement need setting-specific assessment; this site promises no billing eligibility or revenue.
Module 06
Comorbidity Management
Educational overview
Keep coexisting conditions visible during heart failure review.
- Connected clinical context
- Explore material covering rhythm disorders, kidney disease, diabetes and other coexisting conditions.
- Questions for review
- Identify missing assessments and questions to bring to the responsible clinician.
- Individualized decisions
- Screening, testing and treatment depend on the full record and current clinical guidance, not a promotional-page cutoff.
Module 07
Primary Care Coordination
Educational overview
Make the next owner, unresolved question and handoff visible.
- Structured handoff
- Situation, Background, Assessment and Recommendation (SBAR) provide a shared documentation structure.
- Assisted drafting
- In the synthetic sandbox, compare AI-proposed Situation and Background wording before accepting it. Assessment and Recommendation remain provider-owned.
- Accountable follow-up
- Explore assignment, deadlines and next steps in fictional cases; real referrals and delivery require a governed operational workflow.
Module 08
Implementation Guidance
Educational overview
Plan around local staffing, infrastructure and governance before any real-world activation.
- Resource tiers
- Compare paper-first, mixed digital/analog and regional coordination settings without treating a tier as clinical authorization.
- Readiness
- Define ownership, essential education, downtime procedures, review capacity and escalation coverage.
- Evaluation
- Start with synthetic rehearsal. Any study or clinical activation requires its own approved plan and applicable institutional permissions.
Scale
Three tiers for three realities.
Illustrative planning contexts, not staffing prescriptions or validated service levels. Essential safety education and accountable review apply across tiers; no tier is automatically authorized for clinical use.
Tier 1
Critical Access Hospital
Paper-first or low-connectivity planning
- Foundation
- Identify the clinical lead, essential education and follow-up owner.
- Synthetic rehearsal
- Walk through a fictional case using a paper diary and telephone workflow.
- Before activation
- Confirm coverage, documentation and escalation before any real-world use.
Question to verify
Can the team identify who owns each unresolved item?
Tier 2
FQHC / Community Hospital
Mixed digital and analog planning
- Foundation
- Map review capacity, access needs and the digital/analog handoff.
- Synthetic rehearsal
- Test missing answers, unavailable staff and downtime with fictional cases.
- Before activation
- Verify approved clinical content, security and communication arrangements.
Question to verify
Does every handoff retain its source and next owner?
Tier 3
Regional HF Center
Regional coordination planning
- Foundation
- Define responsibilities across the hub and participating sites.
- Synthetic rehearsal
- Rehearse cross-site escalation, access boundaries and reconciliation.
- Before activation
- Confirm institutional approvals, validation and an evaluation plan.
Question to verify
Can the network trace a case without assuming a contact was completed?
Readiness, not a launch schedule
Rehearse before considering real-world use.
A suggested preparation sequence, not a treatment timetable or authorization to enroll patients. Progress depends on evidence and responsible approval, not elapsed days.
01 · Read and reconcile
Compare the article, versioned toolkit and software documentation; record unresolved clinical questions.
Suggested owner: Clinical lead
02 · Assign responsibility
Name review, follow-up, escalation and downtime owners; check realistic coverage.
Suggested owner: Local leadership and clinical team
03 · Rehearse with fictional cases
Practice missing answers, draft rejection, handoffs and failure recovery without real patient data.
Suggested owner: Trained evaluation team
04 · Review activation gates
Resolve clinical, institutional, privacy, security and study requirements before deciding whether to progress.
Suggested owner: Accountable institutional reviewers
The ecosystem
A connected, open research ecosystem.
Each resource has its own scope, version and readiness conditions. Explore the relevant documentation before considering adoption.
App
Clinical Implementation App
Educational companion with synthetic workflows, calculators, bounded AI and human review.
app.heartlandprotocol.org →
Archived release v1.10.1 · DOI 10.5281/zenodo.23076550
Scoring
Risk Engine
Ten weighted criteria, 0–18 points. Source archive v1.0.2; the calculator still uses npm v1.0.0. Zod is required. Proposed framework pending validation.
scoring.heartlandprotocol.org →
Archived release v1.0.2 · DOI 10.5281/zenodo.23050660
Guide
Pocket Guide
Offline-first bedside reference with GDMT tables and red-flag cards.
guide.heartlandprotocol.org →
Archived release v0.2.2 · DOI 10.5281/zenodo.23076500
Atlas
Rural Cardiology Desert Atlas
County-level map of cardiology access gaps across the United States.
atlas.heartlandprotocol.org →
Archived release v0.2.0 · DOI 10.5281/zenodo.21323595
REDCap
REDCap Template
Pre-built REDCap instruments for the HEARTLAND registry.
redcap.heartlandprotocol.org →
Archived release v1.0.2 · DOI 10.5281/zenodo.22132635
Synthetic
Synthetic Cohort
Python generator for synthetic heart failure cohorts with rural variables.
synthetic.heartlandprotocol.org →
Archived release v0.3.1 · DOI 10.5281/zenodo.23051476
FHIR
FHIR IG
HL7 FHIR Implementation Guide for HEARTLAND interoperability.
fhir.heartlandprotocol.org →
Archived release v0.3.0 · DOI 10.5281/zenodo.23050675
Published records
One ecosystem. Distinct evidence.
The peer-reviewed HEARTLAND technical report describes the framework. The toolkit and App have separate versioned archives. Publication, software testing and clinical validation are not interchangeable.
Clinical trials informing the framework did not evaluate the HEARTLAND App or its AI. Three companion systematic reviews address their own research questions.
HEARTLAND article
Cureus · peer-reviewed technical report
Article DOI 10.7759/cureus.104817 · PMID 41948265. Not a clinical validation trial.
Toolkit V3.4.1
Zenodo · versioned implementation material
Version DOI 10.5281/zenodo.23076249. Separate from the journal article and software.
App v1.10.1
Zenodo · published software baseline
Version DOI 10.5281/zenodo.23076550. Immutable source archive; deployed status is verified separately.
OSF project
Project materials and collaboration
Check each file and its date; a project page is not itself a new validation study.
GLP-1 RA · Systematic Review
Cureus · PMID 42292722
Meta-analysis across the heart failure spectrum.
Remote Monitoring · Systematic Review
Cureus · PMID 42164012
Meta-analysis with trial sequential analysis.
SGLT2 · Systematic Review
Cureus · separate research publication
Systematic review of early SGLT2 inhibitor initiation in acute heart failure.
Software Heritage
Historical site-source snapshot
Immutable earlier snapshot of this site repository, not the current local changes.
Cite the resource you used.
Use the article DOI for the journal report, the Toolkit V3.4.1 DOI for its archived files, or the App v1.10.1 DOI for that software baseline. The companion cards identify the separately archived Pocket Guide v0.2.2, Scoring v1.0.2, Synthetic v0.3.1 and FHIR v0.3.0 source releases. Toolkit V3.4.1, App v1.10.1 and Pocket Guide v0.2.2 have separate published archives; a software archive is not evidence of clinical validation or a production deployment.
Next step by role
Where do you come in?
Primary Care Provider
MD, DO, NP, or PA caring for heart failure patients in a rural or underserved setting.
- Read
- The protocol (60 min) + Module 2 (GDMT) quick-reference.
- Do
- Review the pathway and its sources with your clinical team; use fictional cases for evaluation.
Health-System Admin
Hospital leadership, nurse informatics, or implementation science lead.
- Read
- Module 8 (Implementation) + the Tier Selector quiz.
- Do
- Map staffing, training, privacy and review responsibilities before planning an evaluation.
Researcher
Epidemiologist, implementation scientist, biostatistician, or trainee.
- Read
- The full protocol in Zenodo + the REDCap instrument template.
- Do
- Propose a validation study. The risk score awaits prospective cohort data.
Author
Vicky Muller Ferreira, MD
Independent clinical researcher. Sole author and architect of the HEARTLAND Protocol. Dedicated to extending evidence-based heart failure care to underserved rural communities across the United States.
Read
The versioned eight-module implementation toolkit. The peer-reviewed article is a separate publication.
Access on Zenodo→Explore
Run a fictional clinic day end to end. Inspect the displayed source, registered rule, draft, handoff, and human checkpoint.
Open the synthetic sandbox→Cite
Cite the specific article, toolkit or software version actually used. Their records are not interchangeable.
View publication records→