💊 Sprint 5.1 · M11 Chronic Care Plans · 5 - 25 Jul 2027 · v1.2
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Sprint 5.1 · M11 Chronic Care Plans

60% of clinic encounters relate to chronic disease — but every encounter is treated as one-shot. M11 ships long-term care plans for DM, HTN, and asthma. Adherence tracking, seasonal reminders, disease-specific dashboards, M10 wearables integration. The chronic patient gets a structured care arc, not just episodic visits.

1. 🎯 Sprint Summary

Sprint5.1 (M11 CARE · Chronic Care Plans)
Duration5 - 25 Jul 2027 (3 weeks · 15 working days)
ModuleM11 CARE — net-new module · long-term care arcs
Goal3 disease care plans (DM · HTN · asthma) · adherence tracking · seasonal reminders · disease-specific dashboards · M10 wearables integration · 40%+ chronic patients enrolled by end of phase
Capacity5 FTE (2 BE + 1 FE + 1 prompt + 1 DevOps) + 0.5 Founder + 1.0 Doc Zam (heavy clinical pathways)
Velocity target85 SP
Demo date25 Jul 2027 · sprint demo + 5.2 prep

2. 🩺 Disease Coverage (v1.2 launch)

DM · Diabetes Mellitus — Type 2 (most common). Care plan: HbA1c targets · medication regimen · CGM/glucometer integration (M10) · diet logging · quarterly review · annual fundus screening reminder.
HTN · Hypertension — Care plan: BP targets · home BP tracking (M10) · medication adherence · DASH diet · monthly review (early) → quarterly review (stable) · ECG annual.
Asthma — Care plan: control level (well/partly/poorly) · trigger log · peak flow tracking · medication adherence · seasonal reminders · MART/SMART regimen support · annual review.
Out of scope for 5.1 (defer to v1.3+): CKD · HF · COPD · IHD · stroke recovery · paeds asthma deep · gestational diabetes. Add disease-by-disease as adoption grows.

3. 🚦 Pre-Sprint Gate Checklist

  • v1.1 phase closeout sign-off · 10 tenants stable
  • MOH-CPG references for DM · HTN · asthma indexed in pgvector
  • Care plan template structure approved by Doc Zam (4 sections: Targets · Medications · Lifestyle · Review schedule)
  • M10 wearables integration map verified (CGM → DM, BP cuff → HTN, peak flow → asthma)
  • Adherence-scoring algorithm reviewed by external endocrinologist + respirologist consultants
  • Patient-facing care plan copy templates drafted (BM/EN)
  • Seasonal/festive reminder calendar prepared (Ramadan diet adjustment · CNY · Deepavali)

4. 🧩 Module Scope

  • Care Plan Schema: care_plans · care_plan_targets · care_plan_medications · care_plan_reviews · disease-specific extension tables
  • Care Plan Builder (Doctor): Doctor enrolls patient · disease-specific template auto-suggests · doctor adjusts targets/regimen · sign-off
  • Patient Care Plan View: Patient PA shows enrolled care plan · today's targets · medication schedule · upcoming review
  • Adherence Scoring: Per-medication adherence (taken/missed) · vital target hit rate · review attendance · weekly score
  • Seasonal Reminders: Ramadan diet adjustment for DM · festive sugar warnings · haze peak flow alerts for asthma
  • Disease Dashboards (Doctor): Filament page · all chronic patients · sortable by adherence · overdue reviews flagged
  • M10 Wearables Integration: CGM data feeds DM care plan · BP feeds HTN · peak flow feeds asthma · auto-target-tracking
  • Pre-Consult Briefing (M2 extension): Care plan summary surfaces in pre-consult briefing for chronic patients
  • Care Plan Review Workflow: Quarterly auto-trigger · doctor reviews · adjusts care plan · signs new arc

5. 📅 Day-by-Day Plan (15 days)

D1Mon 5 Jul · Schema + DM Template
Migrations · DM care plan template structure · Doc Zam sign-off on DM template.
D2Tue 6 Jul · DM Care Plan Builder UI
Doctor enrolls patient · template auto-suggest · target adjust · sign-off flow.
D3Wed 7 Jul · Patient DM Care Plan View
Patient PA · enrolled view · today's targets · medication schedule · review countdown.
D4Thu 8 Jul · DM-CGM Integration
CGM glucose feed (M10) → DM care plan target tracking · weekly summary auto-gen.
D5Fri 9 Jul · Mid-Demo + HTN Template
DM live demo to Doc Zam · HTN template kicks off · BP cuff data integration plan.
D6Mon 12 Jul · HTN Care Plan + BP Integration
HTN template · BP cuff (M10) feeds target tracking · DASH diet flags.
D7Tue 13 Jul · Asthma Template + Peak Flow
Asthma template · control-level scoring · peak flow tracking · trigger log.
D8Wed 14 Jul · Adherence Scoring
Adherence algorithm · medication taken/missed · weekly score · trend graph.
D9Thu 15 Jul · Seasonal Reminders
Ramadan diet adjustment · CNY · Deepavali · haze peak-flow alerts · WhatsApp notif.
D10Fri 16 Jul · Mid-Demo Round 2
3 diseases live · 5 mock chronic patients walked through · Doc Zam validation.
D11Mon 19 Jul · Disease Dashboards (Doctor)
Filament page · all chronic patients · adherence sort · overdue review flag · per-disease tabs.
D12Tue 20 Jul · Pre-Consult Briefing Extension
M2 briefing surfaces care plan summary · last 4 vitals · adherence trend · upcoming review.
D13Wed 21 Jul · Quarterly Review Workflow
Auto-trigger 90 days · doctor reviews · adjusts plan · signs new arc · audit logged.
D14Thu 22 Jul · Hardening + Production Test
Doc Zam tenant flips on · 5 real chronic patients enrolled · monitor 24h.
D15Fri 23 Jul · Demo Prep + Polish
Demo deck · 3-disease narrative · 40%-target pathway.
+Mon 25 Jul · Sprint Demo + Retro
9am demo · 11am retro · 2pm 5.2 (BCN/Tamil) prep.

6. 📦 Deliverables

FRItemSP
FR-11.1Care plan schema + 4-section template5
FR-11.2DM care plan template + builder8
FR-11.3Patient care plan view (M1 extension)5
FR-11.4DM-CGM integration (M10)5
FR-11.5HTN care plan + BP integration8
FR-11.6Asthma care plan + peak flow8
FR-11.7Adherence scoring algorithm5
FR-11.8Seasonal/festive reminder engine5
FR-11.9Disease dashboards (Filament)8
FR-11.10Pre-consult briefing extension (M2)3
FR-11.11Quarterly review workflow5
FR-11.12Production rollout · monitoring5
FR-11.13External clinical advisor sign-off (endo + resp)5
FR-11.14Patient education content (BM/EN, 3 diseases)5
FR-11.15Pen-test light + audit log extension5
TOTAL85 SP

7. 👥 Team Capacity

RoleAllocationFocus
Eng Lead / BE1.0 FTECare plan schema + adherence engine + reviews
BE Dev 21.0 FTEDisease templates + M10 integration + reminders
FE Dev1.0 FTECare plan UI + dashboards
Prompt Eng1.0 FTECare plan reasoning · adherence narrative · patient education
DevOps0.5 FTECron + WhatsApp reminder infra
Founder0.5 FTEEndocrinologist + respirologist consultant procurement
Doc Zam1.0 FTE (heavy)3 disease pathway sign-off · sample patient enrolment review
External consultants0.5 FTE (split)Endo + resp sign-off · 5 days each
QA0.5 FTECare plan flows + reminder timing + adherence

8. 🔔 Sprint Ceremonies

  • Mon 5 Jul 9am — Sprint Planning (90 min)
  • Daily 9am — Standup (15 min · Doc Zam joins Tue/Thu)
  • Fri 9 Jul + Fri 16 Jul 4pm — Mid-sprint demos (45 min each)
  • Tue 13 Jul + Wed 21 Jul — External consultant reviews (90 min each · endo + resp)
  • Mon 25 Jul 9am — Sprint Demo (60 min)
  • Mon 25 Jul 11am — Sprint Retro (60 min)

9. 🩺 Doc Zam Sign-off Items

  • DM care plan template clinically valid · 10 sample enrolments reviewed
  • HTN care plan target ranges + medication regimens correct
  • Asthma control-level scoring + step-up/step-down logic correct
  • Adherence scoring clinically meaningful · doesn't misclassify
  • Seasonal reminders culturally appropriate (Ramadan diet · festive sugar)
  • Endocrinologist consultant sign-off (DM)
  • Respirologist consultant sign-off (Asthma)
  • Patient education content (BM/EN) clinically accurate
  • Final demo (25 Jul) — written sign-off

10. 🎬 Demo Agenda — 25 Jul 9am (60 min)

TimeSegment
0-5Recap · M11 narrative · 60% of visits chronic insight
5-15Live DM enrolment · CGM data integration · adherence trend
15-25Live HTN care plan · BP cuff data · monthly review
25-35Live asthma · peak flow · seasonal reminder example
35-45Disease dashboard (doctor view) · adherence ranked
45-55Pre-consult briefing extension · quarterly review trigger
55-60Doc Zam + consultants sign-off · 5.2 prep

11. 🛡️ Contingency

RiskTriggerResponse
External consultant delayEndo/resp unavailableBackup consultants identified · ship with Doc Zam sign-off · external sign-off post-launch
Adherence scoring misfiresFP rate > 15%Tighter calibration · clinician override visible · iterate post-launch
M10 wearables data gapPatient doesn't syncManual entry fallback · "missing data" surfaces in adherence
Care plan adoption slow< 20% by end Phase 5Doctor incentive · patient education campaign · simplify enrolment
Cultural advisor input lateFestive content driftGeneric seasonal reminder ship · culture-specific iterate