---
name: aireadylife-health-op-monthly-sync
type: op
cadence: monthly
description: >
  Full health data sync on the 1st of each month. Pulls new wearable exports (Oura
  Ring or Apple Health), downloads visit notes and lab results from the configured
  patient portal (MyChart), refreshes the medication list, updates the deductible
  and HSA balance from the insurance log, and organizes all new files in vault. Then
  triggers the Health Review Brief. Triggers: "health monthly sync", "sync health
  data", "refresh health vault", "run my health sync".
---

# aireadylife-health-monthly-sync

**Cadence:** Monthly (1st of month)
**Produces:** Fully refreshed health vault; then triggers `aireadylife-health-review-brief`

## What It Does

The monthly sync is the master operation that keeps the health vault current across all sub-domains. It runs in four sequential phases — wearable, portal, medications, and insurance — then hands off to the review brief for synthesis.

**Phase 1: Wearable Sync.** Calls `aireadylife-health-sync-wearable-data` to ingest any new Oura Ring or Apple Health export files from the configured sync folder. Reports records added, coverage dates, and any gaps.

**Phase 2: Patient Portal Sync.** Using the configured patient portal (MyChart/Epic or equivalent), downloads any new lab results, visit notes (after-visit summaries), upcoming appointment confirmations, and active medication list from the portal. New lab PDFs are placed in `vault/health/00_current/` with standard naming (YYYY-MM-DD_lab_[panel-type].pdf). New visit notes go to `vault/health/00_current/`. If new lab results are found, `aireadylife-health-lab-review` is triggered automatically. This step requires the portal to be configured and accessible — if the session has expired, the user is prompted to re-authenticate.

**Phase 3: Medication List Refresh.** Cross-references the portal's current medication list against the vault's `vault/health/00_current/medications.md`. Flags any discrepancies (medication listed in vault but not on portal active list; medication on portal but not in vault). Does not automatically update the vault list — presents the diff and asks the user to confirm before writing changes.

**Phase 4: Insurance and HSA Update.** Prompts user to confirm current deductible balance and HSA balance if the values haven't been updated within the past 30 days. Updates `vault/health/00_current/deductible-tracker.md` and `vault/health/00_current/hsa-balance.md` with the confirmed values and the date of update.

After all four phases complete, the sync triggers `aireadylife-health-review-brief` to produce the monthly wellness brief from the freshly synchronized vault.

## Configuration

Set in `vault/health/config.md`:
- `wearable_type` — oura | apple_health | both
- `portal_type` — mychart | other
- `portal_url` — your specific portal URL (e.g., https://mychart.yourhospital.org)
- `portal_username` — login username for the portal

## Calls

- **Flows:** `aireadylife-health-sync-wearable-data`
- **Ops triggered:** `aireadylife-health-lab-review` (if new labs found), `aireadylife-health-review-brief` (on completion)
- **Tasks:** `aireadylife-health-update-open-loops`

## Apps

- `oura-ring` or `apple-health` — wearable data export
- `mychart` — patient portal download (headless=False required)

## Vault Output

- `vault/health/00_current/` — updated wearable log
- `vault/health/00_current/` — new lab result files
- `vault/health/00_current/` — new visit notes
- `vault/health/00_current/medications.md` — refreshed after user confirms diff
- `vault/health/00_current/deductible-tracker.md` — updated balance
- `vault/health/00_current/hsa-balance.md` — updated balance
- `vault/health/02_briefs/YYYY-MM-health-brief.md` — monthly review brief (produced by triggered op)

## Vault Paths

- Reads from: `~/Documents/aireadylife/vault/health/00_current/` — active records and current state
- Reads from: `~/Documents/aireadylife/vault/health/01_prior/` — prior period records for trend comparison
- Reads from: `~/Documents/aireadylife/vault/health/02_briefs/` — prior briefs for period-over-period context