WUEM Sim Intel

WUEM Sim Intel is a simulation improvement and Latent Safety Threat (LST) management system developed for the Washington University School of Medicine, Department of Emergency Medicine.

The platform helps simulation teams turn high-fidelity clinical scenarios into usable safety work: structured post-session reports, reliable LST identification, follow-up tracking, searchable institutional learning, and documentation that can be shared with educators, safety leaders, and operational stakeholders.

Current release: v3.9.0 — provider-flexible AI report drafting, case-summary context, a redesigned clinical workspace, persistent dark mode, and a hardened Cloudflare deployment path.

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🏛️ Project Overview

WUEM Sim Intel is specialized for clinical simulation programs that need more than a written debrief summary. It supports a Just Culture approach by helping teams document what happened, identify system vulnerabilities, assign follow-up, and preserve lessons learned across repeated simulations.

The system is designed around the practical workflow of a simulation program:

• Capture what occurred during a session.
• Generate a polished post-session report.
• Identify and classify LSTs.
• Track mitigation status and institutional follow-up.
• Search across prior sessions, scenarios, and safety findings.
• Export clean documents with supporting photos and media.

Key Capabilities

• 🏥 LST Identification & Management: Centralized tracking for Latent Safety Threats with categories, severity, status, mitigation notes, and institutional audit history.
• 📋 Simulation Report Generation: Converts session notes into professional reports grounded in simulation education, safety improvement, and Just Culture principles.
• ✅ Follow-Up Workflow Support: Keeps safety findings visible after the session so unresolved threats can be reviewed, escalated, and closed.
• 🔍 Institutional Learning Search: Search across prior scenarios, reports, and safety findings to recognize repeated patterns and recurring operational risks.
• 📸 Session Media Documentation: Attach simulation photos and high-resolution media, then include them in exported reports as polished photo collages.
• 🤖 Provider-Flexible Clinical Assistant: Uses OpenAI or Gemini for report drafting and LST extraction, with retrieval over prior simulation evidence to support faster synthesis.
• 🧾 Case-Aware Drafting: Includes concise case-file summaries in the report prompt so generated drafts reflect the selected scenarios without overwhelming the model context.
• 🌗 Accessible Clinical Workspace: A responsive clinical-editorial interface with shared, persistent light and dark themes across the simulation suite.

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🏗️ System Architecture

Built on a Cloudflare-native stack for reliability, fast access, and secure clinical education workflows:

• Frontend: React (Vite + TypeScript + Tailwind) deployed to Cloudflare Pages at https://intel.wuemsim.org.
• Backend API: Cloudflare Workers (Hono) running at the edge. The public workers.dev route is disabled, and the Pages Function proxy calls the Worker through the WASHU_SIM_INTEL_API service binding.
• Decision Support:
  • Library Q&A: Retrieval-augmented answers over the local simulation knowledge base.
  • Report Drafting: Provider-agnostic asynchronous streaming via the OpenAI Responses API or Google Gemini.
  • Semantic Indexing: Cloudflare Vectorize with Workers AI for retrieval across scenarios, reports, and LST records.
• Data Primitives:
  • Relational SQL: Cloudflare D1 (washu_sim_db)
  • Object Storage: Cloudflare R2 (washu-sim-intel-storage-2026)
  • Metadata Cache: Cloudflare KV (RATELIMIT_V2)
  • Vector Index: Cloudflare Vectorize (sim_search)

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🛠️ Getting Started

Prerequisites

• Node.js: v20 or higher.
• Cloudflare Account: With access to D1, R2, Vectorize, Workers AI, KV, Pages, and Workers.
• Secrets:
  • OPENAI_API_KEY: Preferred provider for report generation, library Q&A, and LST extraction.
  • GEMINI_API_KEY: Optional fallback provider.
  • TURNSTILE_SECRET_KEY: For spam protection on generation endpoints.
  • ADMIN_TOKEN: For protected clinical data and administrative API access.

Local Development

1. Clone the repository:

   git clone https://github.com/salthepal/WashUSimIntelligence.git
   cd WashUSimIntelligence

2. Frontend Setup:

   npm install
   npm run dev

3. Backend Setup (Wrangler):

   cd worker
   npm install
   npx wrangler dev

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🚀 Deployment

The system uses GitHub Actions for continuous delivery:

• Frontend: Automatically deployed via Cloudflare Pages and served at https://intel.wuemsim.org.
• Backend: Update resource IDs in worker/wrangler.toml and run npm run deploy in the worker/ directory.
• Proxying: Production /api/* traffic flows through the Pages Function service binding WASHU_SIM_INTEL_API. Use an explicit BACKEND_URL only for local or break-glass testing.
• Access: Cloudflare Access protects intel.wuemsim.org, washusimintelligence.pages.dev, and Pages preview hostnames for wustl.edu users plus the configured admin email.

See DEPLOYMENT.md for resource bindings, secrets, migrations, and deployment checks.

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📦 Releases

Release notes and version history are available in GitHub Releases and CHANGELOG.md.

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🔒 Security & Governance

• Just Culture: Reports prioritize growth and systemic fixes over individual blame.
• Data Residency: Current production placement is Cloudflare D1 in ENAM and R2 in WNAM. Treat that as approved only for non-PHI simulation safety data; migrate to newly created jurisdiction-pinned resources before accepting stricter residency requirements.
• Administrative Access: Clinical data reads and writes require X-Admin-Token.
• Spam Protection: Upload and generation endpoints are protected by Cloudflare Turnstile.
• Security Headers: Browser protections are served from public/_headers.
• Clinical Data Handling: Avoid entering patient identifiers or protected health information unless your Cloudflare deployment has been approved for that use.

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📜 License

This project is licensed under the GNU General Public License v3.0 (GPLv3). See LICENSE.md for full details.

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© 2026 Washington University School of Medicine. Emergency Medicine Simulation.