Who this document is for
This runbook is for the person who has been given the institutional workspace key and responsibility for monitoring the ATLAS Command Center. You may be a clinical informatics coordinator, a research operations manager, a pharmacy director, or a department head. You do not need to be technical — this document covers everything operationally without assuming technical background.
1. Command Center Overview
The ATLAS Population Health Command Center is the institutional view of all medication adherence activity across your sites. It is accessible to the holder of the institutional workspace key (format: INST-[ABBREV]-XXXX-2026).
What you see in the Command Center
| Section | What it shows | Update frequency |
|---|
| Pulse Bar (top) | Live totals: all assessments across all sites, countries, global average | Real-time |
| MMAS-8 Panel | Aggregate MMAS-8 data for your institution: total submissions, mean score, INA/UNA/Mixed/High breakdown | Real-time |
| PEACS Panel | Aggregate PEACS data: total assessments, mean PE, zone distribution (Optimal/Good/Moderate/Poor) | Real-time |
| Site Benchmarking | Score distribution comparison across your sites and against global ATLAS average | On load |
| Sentinel Feed (right) | Active alerts requiring clinical attention — sorted by urgency | Real-time |
| Longitudinal Trajectories | Score trends over time for patients with multiple assessments | On load |
| Drug · Condition Stratification | Mean adherence score by drug class and medical condition across your population | On load |
| Active Patients table | All individual patient records across all sites with search and filter | Real-time |
| MTM Audit Log | CMS-formatted encounter documentation with CPT codes across all sites | Real-time |
The institutional key vs site keys
Your institutional key sees everything — all sites, all patients. Each site coordinator has their own key that sees only their site's data. This hierarchy is enforced at the database level — site coordinators cannot access other sites' data even if they have the institutional key prefix.
2. Daily Monitoring Routine
This routine should take 10–15 minutes and covers the most important operational checks. It should be completed at the start of each working day during active data collection periods.
Step 1 — Check Sentinel feed for overnight alerts
Open ATLAS, log in with institutional key. Look at the Sentinel feed on the right side of the dashboard. Any red (Urgent) alerts require same-day response. See Sentinel Triage Protocol below.
Step 2 — Review submission volume
Check the submission counter against expected daily volume from each site. If a site shows no submissions for 3+ consecutive days during an active collection period, contact that site coordinator. Log the gap in your operations journal.
Step 3 — Review aggregate score trends
The mean score should remain broadly stable across days unless a new patient population is being enrolled. A sudden drop may indicate a new high-risk cohort being added or a data quality issue. Review new submissions from that day if you see an unexpected shift.
Step 4 — Check INA proportion
If the INA (Intentional Non-Adherence) count increases materially week-over-week, this is a clinically significant trend. Bring it to the attention of the clinical lead. INA patients require motivational intervention — reminders and pill organisers will not address this pattern.
Step 5 — Log completion and any actions
Record in your operations journal: date, submission count, Sentinel alerts actioned, any anomalies noted. This log is important for quality audits and JC documentation.
3. Sentinel Alert Triage Protocol
Sentinel alerts are generated automatically when ATLAS detects adherence patterns that warrant clinical attention. Your role is to ensure alerts are seen, assigned, and actioned within the required timeframes.
Triage categories
| Alert type | Trigger | Response required | By whom | Timeframe |
|---|
| Urgent · Red |
MMAS-8 score < 4, INA pattern, ZOE clinical flag, or rapid screen < 2/3 |
Site coordinator contacts patient. Documents intervention attempted. |
Site coordinator (primary), clinical lead (if uncontactable) |
Within 7 days |
| Moderate · Amber |
MMAS-8 score 4–6, follow-up due, medium adherence |
Schedule follow-up assessment. No immediate clinical action required. |
Site coordinator |
Within 14 days |
| Routine · Green |
Follow-up reminder for high-adherence patient (30-day cycle) |
Schedule next assessment. Document in patient record. |
Site coordinator or admin |
Within 30 days |
| ZOE Requested |
Pharmacist flagged patient for full ZOE assessment from Daily Intake |
Ensure full MMAS-8 + ZOE assessment is completed at next patient contact |
Site coordinator |
Next patient contact |
Triage procedure
Identify the alert patient. The Sentinel card shows Patient ID, score, pattern, condition, and whether a ZOE session was used. Click the card to expand full details including ZOE transcript excerpt if available.
Assign to site coordinator. Contact the coordinator at the submitting site (shown in the alert card as workspace). Forward the Patient ID and alert details via your normal clinical communication channel.
Document in ATLAS. Click "Mark Reviewed" on the alert card. In the notes field, enter: date actioned, assigned to whom, and planned intervention. This creates an audit trail.
Follow up. If the coordinator has not actioned an Urgent alert within 3 days, escalate to the clinical lead. Log the escalation in your operations journal.
Export the sentinel log monthly. Use the "Export Sentinel Log" button at the bottom of the sentinel feed. File in your quality documentation. This export covers all alerts including reviewed ones.
Patient safety note
ATLAS Sentinel alerts are clinical triage tools, not emergency response systems. If a patient expresses immediate distress, harm to self or others, or a medical emergency during a ZOE assessment, normal clinical emergency protocols apply — call emergency services or activate your institution's rapid response process. ATLAS does not have direct patient contact capability.
4. Reading the Population Health Dashboards
Site Benchmarking panel
The benchmarking panel compares score distributions across your sites against each other and against the global ATLAS average. A site whose distribution skews significantly lower than others may be collecting data from a genuinely higher-risk population, or may have a data collection issue (assessments being completed by proxy rather than patients themselves). Investigate outliers before drawing clinical conclusions.
Drug · Condition Stratification
This panel shows mean adherence score by drug class (antihypertensives, diabetes medications, statins, etc.) and medical condition. Use this to identify which therapeutic areas have the lowest adherence in your institution's population — this informs where to direct pharmacist counseling resources and where to prioritise ZOE-assisted intake.
PEACS population view
The PEACS panel in institutional view shows the distribution of patients across the four PE zones (Optimal, Good, Moderate, Poor). A high proportion in the Poor zone warrants a STRATA review — social determinants barriers are likely the primary driver and require systemic intervention beyond clinical counseling.
Longitudinal Trajectories
This panel requires patients to have completed 2 or more assessments under the same Patient ID. It shows whether individual patients are improving, stable, or deteriorating over time. Use it to evaluate the effectiveness of interventions — if a cohort received a pharmacist intervention and reassessed 30 days later, this panel shows whether adherence scores improved.
5. Adding and Managing Sites
Adding a new site
Email info@adherence.cc with: new site name, coordinator name and email, approximate patient volume, and your institutional key prefix.
Adherence Inc. provisions a Researcher-tier key linked to your institutional key. The coordinator receives their key, Letter of Permission, and a welcome email with login instructions within 24 business hours.
Coordinate with the new coordinator to complete onboarding: confirm they can log into ATLAS, submit a test assessment, and see their data in their dashboard. Verify the test record appears in your institutional view under their site key.
Request deletion of test records (email info@adherence.cc). Add the new site to your operations documentation.
Suspending a site
If a site coordinator leaves, is unavailable, or a site closes: email info@adherence.cc requesting that the site's workspace key be suspended. The existing data remains accessible to you via the institutional key. The suspended coordinator can no longer log in or submit data.
Changing a site coordinator
Email info@adherence.cc with the current site key and the new coordinator's name and email. We will update the key profile and send new credentials to the incoming coordinator. The data and Patient IDs remain unchanged.
6. Bulk Data Upload Procedure
The PI and Institution tiers support bulk upload via an XLSM template. This allows you to import data collected on paper, in REDCap, or from other electronic systems into ATLAS in a single operation.
When to use bulk upload
- Retrospective data entry — converting legacy paper CRF data to digital
- Site migration — moving data from an existing system into ATLAS
- High-volume entry by a research coordinator who collected data offline
Bulk upload procedure
Download the XLSM template. In ATLAS, find the bulk upload button (key icon in the dashboard nav) → Download Template. The template has one row per patient with columns matching ATLAS data fields.
Complete the template. Each row is one patient assessment. Required fields: Q1–Q8 scores (0 or 1 for Q1–Q7, numeric 0–1 for Q8), Patient ID (recommended), timestamp (date of assessment). Optional: country, city, condition, drug name.
Validate before upload. The template includes a validation tab — review it for red cells indicating errors before uploading. Common errors: out-of-range Q8 scores, missing Q scores, invalid date format.
Upload the file. Click the bulk upload button → select your completed XLSM file. ATLAS processes each row, displays a progress bar, and shows results (uploaded / errors / skipped) when complete.
Review the results. Check the error report for any rows that were not uploaded and why. Export a fresh CSV after upload to verify all records are present and scored correctly.
Bulk upload is irreversible without support
Records uploaded via bulk upload are tagged with your workspace key and the upload timestamp. If a batch was uploaded with errors, contact info@adherence.cc with your workspace key prefix, the upload date, and the Patient IDs of affected records.
7. Export and Reporting Procedures
Monthly reporting package
Recommended monthly export procedure for institutions with active population health programs:
- Export MMAS CSV (all sites) → file in data repository dated folder
- Export PEACS CSV → same folder
- Export Sentinel Log CSV → file separately for quality/JC documentation
- Export MTM Audit PDF → submit to billing department for reimbursement processing
- Generate Session Certificate → file in regulatory binder
IRB progress report data
For annual or interim IRB progress reports, the MMAS CSV provides all required data elements. The Site Benchmarking panel can be screenshotted as a visual summary. The Session Certificate provides a timestamped count of total submissions for the reporting period.
Quality improvement reporting
For JC (Joint Commission) or equivalent quality documentation, the Sentinel Log export provides evidence of adherence screening activity, alert identification, and clinical follow-up. The MTM Audit Log provides documentation of pharmacist consultation encounters with CPT codes for reimbursement audit.
8. Access Management
Key security policy
- The institutional key should be held by no more than 3 named individuals
- Do not email the full institutional key — share the prefix only in email and provide the last segment verbally or via secure message
- When a key-holder leaves your organisation, email info@adherence.cc immediately to revoke their access and issue a new key
- Do not store the institutional key in shared documents or ticketing systems
Onboarding a new Command Center administrator
Provide the new administrator with this runbook and the institutional key (via secure channel).
Walk them through a dashboard review session — show them the Sentinel feed, site breakdowns, and export workflow.
Have them complete the daily monitoring routine independently on day 2 and compare observations with you.
Email info@adherence.cc to add their name to the institutional account contact list for support communications.
Offboarding
When a Command Center administrator leaves: immediately email info@adherence.cc requesting key rotation. Provide the name and email of the replacement. New key is issued within 24 business hours. Old key is revoked simultaneously.
9. Escalation and Incident Procedures
Platform outage
If ATLAS is unavailable
1. Check atlas.adherence.cc — if the page loads but login fails, try clearing browser cache. 2. Try a different browser. 3. If unavailable across all devices and browsers, email info@adherence.cc with subject line "Platform unavailability — [your institution name]". 4. Activate paper backup CRF procedure for sites with active collection. 5. Document downtime period in operations journal. Data collected on paper during downtime can be bulk uploaded when platform is restored.
If data appears in wrong cohort
If records appear in your institutional dashboard that do not belong to your institution (wrong workspace key used by a site), email info@adherence.cc immediately. Do not attempt to export or use this data. Include your institutional key prefix and the approximate timestamp of the records in question.
If a workspace key is compromised
If you believe a site key has been shared unauthorised or used by someone outside your organisation, email info@adherence.cc requesting immediate revocation. A new key will be issued within 2 business hours. Log as a security incident per your institution's information security policy.
Escalation contacts
| Issue type | First contact | Response time |
|---|
| Platform technical issue | info@adherence.cc — subject: "Platform issue [institution]" | 24 hours |
| Data access / security concern | info@adherence.cc — subject: "Security [institution]" | 2 business hours |
| Key provisioning / rotation | info@adherence.cc — subject: "Key request [institution]" | 24 business hours |
| Billing / subscription | info@adherence.cc — subject: "Billing [institution]" | 48 business hours |
| IRB / compliance documentation | info@adherence.cc — subject: "Compliance docs [institution]" | 48 business hours |
Include in all support emails
Your institutional key prefix (first 8 characters only — never the full key), your institution name, and the approximate time of the incident. This allows the support team to identify your account immediately without requiring the full key.
10. Platform Maintenance and Updates
ATLAS is a continuously deployed platform — updates are released without downtime. The changelog and release notes are available at docs.adherence.cc. Key updates that affect operations will be communicated to institutional contacts via email.
What updates may affect you operationally
- New MMAS-8 translation available — Site coordinators can immediately use new languages without any configuration change
- New PEACS feature — New dashboard panels appear automatically; existing data is not affected
- Export format changes — Notified by email 14 days in advance; existing exports are not affected
- Firebase rules changes — Transparent to users; may affect data access patterns
Annual review checklist
- Review all site coordinator access — remove departures, add new coordinators
- Export full year's data to institutional repository
- Review Sentinel alert response rates — calculate % actioned within timeframe
- Update this runbook if operational procedures have changed
- Re-sign PI SOP if study is ongoing
- Verify Letter of Permission certificate is still active at keys.adherence.cc/verify
- Review MTM audit completeness for billing reconciliation