Product
The infrastructure layer for real-world coordination
Trellis turns referrals, providers, and outcomes into a system that continuously improves — without changing how teams work.
Not another platform. The layer that makes every platform smarter.
What Trellis actually does
Observes
Ingests referral activity, CBO capacity, acceptance rates, and outcome data from every connected system in the network.
Learns
Converts raw referral signal into match quality scores, network performance patterns, and predictive capacity indicators.
Improves
Every referral outcome feeds back into match rankings. The system gets smarter with every closed loop, without manual intervention.
Built on open standards
Credible architecture, not proprietary lock-in. Trellis uses the same standards adopted by EHRs, 211 systems, and health information exchanges nationally.
| Standard | Version | Trellis Role |
|---|---|---|
| OpenReferral HSDS | 3.0 | Canonical import/export format. HSDS-compatible, not HSDS-native. The directory interchange standard used by 211 systems nationally. |
| FHIR R4 / US Core | 4.0.1 | EHR integration surface. HealthcareService, ServiceRequest, Task, Patient, Condition, Observation. SMART on FHIR and CDS Hooks. |
| 360X | 1.0 | Closed-loop referral transaction protocol. Send, accept/reject, status update, complete/return. Bidirectional outcome signal. |
| SDOH Clinical Care IG | HL7 ballot | SDOH screening result ingestion. AHC HRSN, PRAPARE, Hunger Vital Sign. Gravity Project Z-code mappings. |
| IHE PIXm / PDQm | ITI-83/84 | Patient identity cross-referencing. Probabilistic patient matching across EHR and CBO records. |
| AIRS Taxonomy | 2024 ed. | Canonical human services classification vocabulary used by 211 systems. Mapped to internal Trellis taxonomy at ingest. |
HSDS is a directory data standard — excellent at bulk publishing and interoperability for resource listings. It is not designed for transactional coordination. FHIR and 360X own the transactional layer. HSDS owns the resource catalog layer.
Four capabilities. One intelligence stack.
Network Intelligence
Live capacity, acceptance rates, and outcome signals from every connected network
Performance visibility across providers and CBOs — which ones close loops
Signal aggregation that improves with every participating system
Directory Governance
HSDS canonical store with staged diff import and admin review
Freshness scoring and stale listing detection — data that ages out automatically
Taxonomy governance with AIRS classification and crosswalk mapping
Referral Orchestration
AI matching engine: POST /v1/match returns ranked shortlist of 3-5 best-fit services
Eligibility pre-checks, match rationale, and capacity status per result
360X closed-loop lifecycle: send, accept, status, complete
Continuous Optimization
Every referral outcome becomes signal that reshapes future rankings
Network effect: more connected systems means better matching for everyone
No manual tuning — the system improves from usage
Without Trellis vs. With Trellis
Without Trellis
Directories go stale within weeks of being published
Referrals disappear after handoff — no outcome visibility
Search returns everything in a ZIP code — no ranking by fit
Care workers leave their system to search a separate tool
CBOs overwhelmed by bad-fit referrals from disconnected systems
Network performance is invisible — no one knows what works
With Trellis
Listings enriched continuously by live network signal and CBO self-report
Every referral tracked through 360X closed-loop protocol
Ranked shortlist: best-fit services for this person, this need, right now
Intelligence embedded in-workflow via SMART on FHIR and REST API
CBOs receive better-fit referrals and build visible performance records
Network performance becomes observable, measurable, improvable
Six independently deployable layers
Each layer ships value on its own. Together they form a complete referral intelligence stack — independently deployable infrastructure, not an all-or-nothing platform.
CCH portals, EHR SMART apps, MCP dashboards, 211 outcome feed, HIE connections, patient-facing apps
FHIR R4 HealthcareService, HSDS export/import, REST + GraphQL, webhook events, 360X send/receive
AI matching engine, network signal aggregation, enrichment engine, freshness scoring, stale listing detection
HSDS canonical store, crosswalk/ID registry, taxonomy governance, MPI/patient identity, multi-tenant isolation
HSDS import (staged diff), CLR signal ingestion, CBO self-report, FHIR bulk export, eligibility feed (270/271)
211 SD / 211 LA / HSDS feeds, connected referral networks, EHRs via SMART on FHIR, CBO portal/email bridge, DHCS eligibility file
How Trellis fits into your existing systems
Trellis doesn't replace your EHR, case management platform, CLR, or 211 system. It sits beneath all of them as a shared intelligence layer — improving what every connected system can do without changing how teams work.
One API call from any connected system. Ranked results returned in milliseconds. The care worker never leaves their screen.
Trellis meets each calling system where it is
Every integration pattern — from SMART on FHIR inside an EHR to a flat-file pipeline for systems with no API surface.
| Caller type | Method | Sends | Receives |
|---|---|---|---|
| EHR system | SMART on FHIR / CDS Hooks | FHIR Patient + SDOH Conditions | Ranked matches surfaced inline |
| Case management | REST / GraphQL | Client profile: SDOH flags, demographics, enrollment | Ranked shortlist with eligibility pre-check |
| CLR platform | REST + 360X outcomes | Client SDOH at initiation; outcome events after referral | Ranked shortlist; enriched matching from signal |
| CHW portal | Authenticated REST (OAuth 2.0) | Manual context: need toggles, location, language | Ranked shortlist with full detail + refer payload |
| 211 data partner | HSDS bulk import / delta | HSDS ZIP package (org, location, service CSVs) | Staged diff report; anonymized outcome feed |
| Public / patient app | Public read API (rate-limited) | ZIP, service category, language | Published listings; no network signals |
For systems without APIs: Trellis provides an HL7 v2 adapter for MLLP systems and a flat-file/SFTP pipeline for systems with no integration surface. For CBOs without technical infrastructure: the email/SMS bridge delivers referrals as structured emails with a one-click response form.
Multi-speed connectivity
Real-world networks include organizations at every level of technical readiness. Trellis meets each one where it is — not where it should be.
Tier 1
Full API / FHIR
For large CBOs with technical infrastructure. Direct FHIR/REST integration, full bidirectional data flow.
Tier 2
Hosted portal
For mid-size organizations. Web portal for listing management, referral receipt, and status updates. No developer required.
Tier 3
Email/SMS bridge
For small CBOs and volunteer-run organizations. Referrals delivered as structured emails with a one-click response form. No login, no account, no portal.
Compliance is designed in, not bolted on
Serious infrastructure for serious environments. Every layer built with enterprise-grade security and regulatory requirements from day one.
HIPAA
PHI flows only in the referral and patient identity layers. BAAs required from all CBO partners receiving PHI. AES-256 at rest; TLS 1.3 minimum in transit.
42 CFR Part 2
SUD referrals carry a part2_flag enforcing re-disclosure restrictions. Part 2-flagged referrals excluded from all aggregate reporting and signal feeds.
State confidentiality laws
State-level requirements (e.g. California CMIA) impose stricter rules than HIPAA baseline. Trellis applies state-specific access controls at the service taxonomy level.
Multi-tenant isolation + audit log
Every object scoped to a tenant with row-level security. No cross-tenant data accessible via any API tier. Non-deletable append-only audit log for program oversight.
Why this matters now
Healthcare and community systems are being asked to coordinate across organizations that were never designed to work together.
The problem is not effort. It is infrastructure.
Trellis provides the missing layer.
Ships value before the full stack is complete
A phased build designed so each milestone delivers usable capability to real deployments. No all-or-nothing dependency.
HSDS canonical store + 211 ingest pipeline
Sprints 1-2Live, 211-sourced directory with diff-report admin review. HSDS export API available to partners.
Enrichment engine + CBO connector tiers
Sprints 3-4Freshness scoring, stale listing detection, CBO self-report portal, email/SMS bridge for small CBOs.
AI matching engine + authenticated API
Sprints 5-6POST /v1/match live. CHWs get ranked shortlists in one API call. First workflow integration deployed.
Network intelligence layer + 360X
Sprints 7-8CLR signal flowing into match rankings. CBO performance visible on listings. Outcome data to 211 partners.
ECM/CS compliance workflows
Sprints 9-10Authorization state management, encounter pre-population, Medicaid eligibility integration, program reporting.
Multi-region federation + HIE integration
Sprints 11+Multi-tenant regional deployment, FHIR HealthcareService HIE export, TEFCA QHIN connection.
The Phase 3 milestone — a working POST /v1/match endpoint with real SDOH-to-resource matching and a live CHW integration — is the proof point that matters most. Everything before it is foundation. Everything after it is scale.
You don't need another platform. You need this layer.