OPEN FRAMEWORK · FREE TO USE

DIPA

Describe. Interpret. Predict. Act.

A complete note does not merely state what the patient has. It explains what is happening, why it is happening, what may happen next, and what the care team is doing about it. DIPA makes those four things explicit while they can still change the outcome.

Read the framework The one rule
No license or fee
Inpatient and ambulatory
Vendor-neutral
Matthew Ayinde, MBA, BSN, RN
Emergency nurse · Clinical documentation integrity · AI workflow and prompt architecture
Progress note, hospital day 1DIPA form
Describe
Fever, productive cough, worsening dyspnea. T 39.1, HR 118, RR 28, BP 88/54, SpO₂ 86% RA. RLL infiltrate. WBC 18.4, lactate 3.8, creatinine 2.0 from baseline 0.9.
Interpret
Sepsis due to community-acquired RLL pneumonia with hypotension and lactic acidosis. Acute hypoxic respiratory failure. AKI likely secondary to sepsis-associated hypotension.
Predict
At risk for progression to septic shock and worsening hypoxemia if hemodynamics, oxygen requirement, lactate, and mental status do not improve with resuscitation and antibiotics.
Act
Fluid resuscitation, cultures, ceftriaxone and azithromycin, O₂ to keep SpO₂ above 92%, serial lactate. Escalate to ICU for MAP < 65 > 30 min lactate rising O₂ > 6 L/min or new confusion.
Every anticipated risk is paired with the criteria that answer it.
The framework

Four questions, in order

DIPA is an overlay on SOAP, APSO, and assessment-and-plan documentation, not a replacement. It asks for the reasoning clinicians already perform but rarely write down.

D
Describe
What is happening with the patient now?
Findings, objective data, treatment response, and change from this patient's own baseline.
I
Interpret
What does it mean clinically, and why is it happening?
Diagnosis, etiology, acuity, severity, and the relationships among conditions.
P
Predict
What is the expected course, and what would tell us it is not going well?
Trajectory, deterioration signals, monitoring needs, and escalation criteria stated as observable conditions.
A
Act
What are we doing, monitoring, and escalating?
Treatment, reassessment interval, escalation plan, coordination, and disposition requirements.
The one rule that matters
A prediction without a corresponding action is not DIPA documentation.

Anticipated risk must be paired with the monitoring, reassessment, and escalation plan that answers it. They are one move, not two.

This rule exists for clinical reasons and for medico-legal ones. Documented risk with no documented response is the strongest version of a failure-to-rescue narrative. Documented risk paired with monitoring parameters and escalation criteria is contemporaneous evidence that the clinician recognized the risk and planned for it, which is the record that defends clinical care.

Predict without Act is an unanswered warning. Act without Predict is a plan without a reason.

Scope

What DIPA is, and is not

The framework is defined as much by its exclusions as by its elements. These are stated plainly so that implementations and products can be held to them.

DIPA is
  • A clinical reasoning and communication framework
  • An overlay complementing SOAP, APSO, assessment and plan, and progress notes
  • A structure making findings, interpretation, anticipated course, and action explicit
  • A standard AI-generated documentation can be measured against
  • A means of tracking execution of a clinician-authored plan
  • A prospective model for recognizing risk during the episode of care
DIPA is not
  • A coding checklist or an E/M leveling tool
  • A replacement for clinician judgment
  • An automated diagnosis engine
  • A deterioration detection or patient risk scoring system
  • A query factory or documentation generator
  • A mechanism to encourage unsupported diagnoses or reimbursement-driven documentation
Two settings

Same reasoning, different failure

The four elements hold everywhere. What changes between the hospital and the clinic is what goes wrong, and therefore what has to be kept track of.

Inpatient
Deterioration without escalation

The patient is in front of you. The failure is a documented risk that materialized while nobody was watching, the escalation criterion was written, the condition occurred, and nothing happened.

The mechanism: escalation criteria written as observable conditions with thresholds, so the team and the record both know what would change the plan.
Ambulatory
The open loop

The patient goes home. The failure is a pending result nobody reviewed, an incidental finding nobody followed up, a referral never completed, or a patient told to return who never did.

The mechanism: return precautions written as observable conditions, plus explicit ownership of every loop the encounter leaves open.
Read the framework

Six documents

Working drafts, published for review and comment. Corrections and critiques are welcome, including from people who think the framework is wrong.

Core · v3.0
Framework concept brief
The four elements, the two levers of Predict, the paired-statement rule, medico-legal considerations, and required design principles for supporting technology.
 Companion · v1.0
Ambulatory companion
Office, outpatient, urgent care, and emergency settings. Return precautions as escalation criteria, diagnostic safety nets, and closing the open loop.
 Implementation · v3.0
Clinical pilot charter
Phased pilot design with cohort selection, governance structure, gating criteria, and a measurement plan built around balancing measures.
 Procurement · v3.0
Vendor capability and RFI guide
Evaluation questions, demonstration scenarios, disqualifying criteria, and a scoring model weighted toward clinician authorship rather than financial return.
 One page
Clinician one-pager
A single printable page for clinicians: the four elements, the pairing rule, a worked note, and what DIPA is not. Designed to be handed out.
 Illustrated
Framework, illustrated edition
The full framework with diagrams: the DIPA sequence, the two levers of Predict, the trigger lifecycle, and the two-layer data architecture.
MA
Matthew Ayinde, MBA, BSN, RN
Emergency nurse · Clinical documentation integrity · AI workflow and prompt architecture

DIPA came out of a simple observation made at the bedside and then again in the chart: clinicians reason carefully about where a patient is heading, and almost none of that reasoning reaches the record. The framework asks for the four things a complete clinical story needs, and insists that anticipated risk never appear without the plan that answers it. It is published openly so it can be tested, criticized, and improved by the people who have to use it.

Use it. Adapt it. Publish what you find.

DIPA is published openly because a framework is only worth anything if people use it. There is no license, no fee, and no product you have to buy to implement it.

Attribution is requested for derivative or published work. The name and mark DIPA: Describe. Interpret. Predict. Act. are retained by the author.

Comments, corrections, and collaboration: dipa@reveiqai.com

  • Implement it in your own templates and smart phrases without asking
  • Adapt it for your specialty and share what you changed
  • Evaluate vendors against the design principles, whoever built them
  • Publish your results: including studies that find no effect
  • Tell us where the framework breaks down in practice
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Scope and limitations. These are working drafts published for professional education and discussion. They do not constitute legal, regulatory, or clinical advice, and they do not substitute for your organization's own counsel on medico-legal, privilege, or regulatory questions. Organizations implementing any part of this framework should obtain review from risk management, compliance, and clinical leadership. No PHI is collected or processed by this site.