We build ontology-driven decision layers that stay explainable under audit. Powering the next generation of compliance infrastructure for providers and payers.
In regulated sectors, you cannot afford "black box" decisions. Intelligence Factory builds systems where every output is traceable to a specific rule, policy, or clinical guideline.
Ontology Driven
We map complex regulatory policies into deterministic logic graphs, not probabilistic guesses.
Grounded Validation
Buffaly validates and constrains model output against an ontology-backed policy graph and verified sources, producing an auditable trace.
Fully Auditable
Every decision comes with a complete reasoning trace, ready for payer audits or compliance review.
System Agnostic
Deploys on top of your existing EHR or data lake. Data sovereignty remains with you.
The Commercial Proof
We don't just build theory. Our technology powers
FairPath
, processing millions in remote care claims with 98% payment success. We proved the stack works so you don't have to guess.
AI in Central Florida
Intelligence Factory is based in Orlando, where the people behind the company have worked across healthcare, aviation, supply chain, telemedicine, and regulated operations. See how we think about
AI in Orlando and Central Florida
.
Core Technologies
The Intelligence Factory
Stack
We expose our internal engineering stack for partners and enterprise teams building next-generation healthcare compliance tools. Our systems use language models as optional components, while Buffaly governs decisions through ontology-backed policy validation, deterministic guardrails, and auditable traces.
FairPath
Flagship Commercial Application
What It Is:
The end-to-end OS for remote care programs. FairPath uses the Intelligence Factory stack to automate billing, eligibility, and clinical necessity checks without human error.
What It Is:
A medical-grade ontology engine that transforms messy notes and alerts into clean, structured compliance data. It handles the logic mapping between ICD-10, CPT, and payer rules.
For:
Developers & Data Architects.
What It Is:
A semantic database layer for complex, regulated environments. SemDB combines ontology mapping, hybrid retrieval, and local integration so teams can query legacy data deterministically with auditable results.
For:
Compliance Operations, Data Teams, and System Integrators.
Not all AI is created equal. In an era where everyone claims to be "AI-powered," the technology beneath the surface matters more than ever. We build systems that stay reliable, transparent, and actionable in environments where mistakes are unacceptable, with Buffaly enforcing grounded validation and policy control over LLM-assisted workflows.
Battle-tested acrossindustries for 16 years
Since 2009, we've been solving complex problems with AI in transportation systems, clinical environments, aviation operations, supply chain monitoring, and beyond. This cross-industry experience means our platform has been stress-tested against diverse requirements, from split-second logistics decisions to life-critical healthcare protocols. We've weathered the entire evolution of AI technology and emerged with solutions that actually work in the real world.
Not a prompt wrapper. LLMs used safely under control.
The AI boom made language models widely accessible, and with it came a wave of systems built entirely on prompt engineering. We build systems where language models are optional components, not the control plane.
Our core capability is Buffaly, an ontology-driven decision layer that constrains, validates, and explains every action. LLMs may assist with language understanding, summarization, or proposal generation, but compliance-critical decisions are executed and verified against deterministic policy graphs and structured domain knowledge.
This architecture provides:
Model-agnostic deployment: integrate frontier APIs, private models, or no LLM at all for sensitive paths
Evidence by design: every output is tied to a policy graph and produces an auditable reasoning trace
Deterministic guardrails: actions occur within typed contracts and explicit constraints
Operational accountability: systems remain inspectable, testable, and reviewable over time
Explainable, auditable, deterministic AI
Generic LLMs operate as black boxes that generate plausible-sounding text, sometimes accurate and sometimes fabricated. Our Buffaly grounding and policy validation layer applies ontology-grounded validation and deterministic guardrails so model-assisted outputs remain policy-verified and traceable.
This gives you:
Data sovereignty
Sensitive workflows can run with private models or no LLM path when policy requires it
Security assurance
Model integrations stay behind explicit contracts, validation checks, and rollback-safe controls
Performance optimization
Technology tuned to your specific domain, not trained on generalinternet knowledge
Future-proof architecture
You're not locked into someone else's technology roadmap orpricing model
The practical difference:
Deterministic guardrails
LLM-assisted outputs are validated and constrained by Buffaly's ontology-backed policy layer, producing deterministic traces
Complete transparency
Every output includes the reasoning and sources behind it
Regulatory compliance
Audit trails and documentation that satisfy even the strictestrequirements
Expert control
Your domain specialists define what the AI knows and how itapplies that knowledge
When your teams can trace exactly how the AI reached each conclusion, adoption acceleratesand trust builds naturally.
Case Studies
Deep Tech
in Action
How we apply ontology-driven decision making to real-world chaos.
Turning Medical Chaos into Structure
Ontology-driven integration across 30+ EHR systems.
We used Buffaly to normalize inputs from Epic, eClinicalWorks, and legacy databases into a single coherent model for eligibility checks.
We partner with enterprise healthcare organizations and compliance teams to build explainable, auditable AI infrastructure powered by our Buffaly grounding and policy validation layer.
What makes us different? Our foundation in neurosymbolic AI keeps agents deterministic, traceable, and safe in high trust environments.
Healthcare is in the middle of an AI revolution, but most of the conversation centers on hospital systems, large clinics, and research institutions. Meanwhile, a quieter transformation is happening in a place most people don't think about: the living rooms, bedrooms, and kitchens of homebound patients across Northwest Indiana.
Dr. Jose Agusti, MD, isn't waiting for the healthcare establishment to figure out how AI fits into patient care. As the founder of TUMI Medical Corporation, he's building technology into the foundation of his practice, and he's doing it in a way that's explainable, auditable, and safe.
The Problem with AI in Healthcare
Most AI tools in healthcare today rely on probabilistic models. They ingest data, produce a prediction, and cannot explain how they reached their conclusion. That is a problem in any clinical setting, but it is especially challenging in regulated environments where every decision must be traceable.
For a practice like TUMI Medical Corporation, the stakes are particularly high. Dr. Agusti operates in patients' homes: environments without hospital IT infrastructure, without on-site compliance teams, and with complex documentation requirements that span multiple payers and programs. In that setting, probabilistic, opaque models are a liability.
That's why TUMI Medical Corporation turned to Intelligence Factory's technology stack, which represents a fundamentally different approach to AI in healthcare.
Ontology-Driven AI: A Different Approach
Intelligence Factory builds ontology-driven decision layers for regulated healthcare. The system maps complex regulatory and clinical policies into deterministic logic graphs, so every output is traceable to a specific rule, policy, or clinical guideline, and every decision comes with a complete reasoning trace, ready for audit.
"In home-based medicine, we're making decisions in environments where there's no margin for error and no room for unexplainable outputs," says Dr. Jose Agusti, MD. "I need to know that every clinical and billing decision my practice makes is backed by a clear, auditable trail. Intelligence Factory's approach gives me that."
The technology stack includes:
Buffaly: A medical-grade ontology engine that transforms messy clinical notes and alerts into clean, structured compliance data. It handles the logic mapping between ICD-10, CPT, and payer rules, ensuring that documentation aligns with billing requirements.
SemDB: A semantic database layer that enables complex, regulated data retrieval with ontology mapping and hybrid retrieval, so teams can query legacy data deterministically with auditable results.
FairPath: The flagship commercial application built on the Intelligence Factory stack. FairPath uses this infrastructure to automate billing, eligibility, and clinical necessity checks for remote care programs including CCM, RPM, RTM, and APCM.
How TUMI Medical Uses the Stack
TUMI Medical Corporation, under Dr. Agusti's leadership, uses FairPath, powered by Intelligence Factory's ontology engine, to manage the operational and compliance layer of its home-based practice. The integration supports several key areas of the practice's workflow:
Billing Readiness: Patient interactions are tracked and validated against payer requirements. The system is designed to flag missing documentation before it becomes a billing problem, addressing the revenue leakage that affects many remote care programs.
Compliance Documentation: For a practice delivering CCM, RPM, and RTM services, documentation is the foundation of reimbursement. Intelligence Factory's deterministic decision layer is designed to ensure that every service is backed by an auditable evidence trail, ready for payer review.
Care Coordination: Dr. Agusti and his team coordinate care across multiple homes, specialists, and care partners. The system maintains a structured record of every touch, every requirement, and every care plan adjustment, creating a single source of truth that follows the patient.
Audit Preparedness: In regulated healthcare, the question isn't whether an audit will come, it's when. TUMI Medical's use of ontology-driven AI ensures that when an audit comes, every decision is fully traceable back to its underlying rule and evidence.
Why This Matters for the Future of Home-Based Medicine
Dr. Jose Agusti, MD, is demonstrating something that the broader healthcare industry is still debating: that AI can be deployed safely and effectively in clinical settings when it's built on the right foundation.
The key insight is that AI in healthcare can mean deterministic systems that enforce clinical guidelines, validate billing compliance, and produce auditable traces, all while reducing the administrative burden on physicians and care teams, rather than probabilistic models making opaque predictions.
"Home-based medicine is one of the most operationally complex models in healthcare," says Dr. Jose Agusti, MD. "We're delivering care in uncontrolled environments, managing complex documentation requirements, and coordinating with multiple external partners. AI that's explainable and auditable isn't a nice-to-have, it's essential infrastructure."
A Pioneer's Perspective
What makes Dr. Agusti's approach notable is the mindset behind it. He treats AI as present-day infrastructure rather than a future possibility, and he's building a practice that puts the model to work today, without waiting for industry consensus.
TUMI Medical Corporation is an active clinical practice delivering home-based care every day, backed by ontology-driven AI infrastructure through FairPath. This is a real, operational deployment serving patient needs, with technology running deterministically behind the scenes.
As the healthcare industry grapples with how to deploy AI safely, Dr. Agusti and TUMI Medical Corporation offer a concrete example: build on deterministic foundations, demand explainability, and let the technology handle the complexity so clinicians can focus on patients.
That's practical, groundbreaking work, happening right now, one home visit at a time.
About Dr. Jose Agusti, MD
Dr. Jose Agusti is a physician and the founder of TUMI Medical Corporation, a home-based medical practice serving patients across Northwest Indiana. His practice uses AI-driven infrastructure to manage compliance, billing, and care coordination for remote and home-based care programs.
About Tumi Medical Corp
Tumi Medical Corporation provides comprehensive home-based medical services, including primary medicine, chronic care management, palliative care, wound care, podiatry, and diagnostic coordination. The practice serves homebound patients and their families throughout Northwest Indiana. Contact: (219) 472-0309 | requests@tumimedicalcorp.com
About Intelligence Factory
Intelligence Factory builds ontology-driven decision layers for regulated healthcare. Its technology stack, including the Buffaly ontology engine, SemDB semantic database, and the FairPath commercial platform, provides deterministic, auditable AI infrastructure for providers, payers, and healthcare organizations. Learn more at intelligencefactory.ai.
Most tool-using AI agents suffer from a static ceiling. They start with a fixed toolbox. They can choose from functions their developer explicitly registered, but when they encounter a novel problem, they cannot invent a new tool to solve it. The action set is fundamentally static.
Live walkthrough: Buffaly builds a new C# tool, loads it into the executable graph, and uses it without restarting the agent.
Buffaly is built around a different architecture: the agent's environment is a typed executable graph. A tool is just one kind of node in that graph. A workflow, a data object, a prompt, a compiled helper, and a scope rule can also be graph nodes. Because the graph is typed, Buffaly can search it by meaning, but it can also traverse it by kind, relationship, parent, child, or exact name. Because the graph is executable, Buffaly can extend it while work is in progress.
That is the central claim: Buffaly does not merely call tools. It creates new tools, activates the new capabilities in the executable graph, and then uses them in the same ongoing body of work.
This is not a theoretical capability. It is happening in real usage.
To prove this, I analyzed 1.2 million messages and over 380,000 tool calls from a real-world Buffaly instance. The telemetry shows the system isn't just generating dead code. It is actively identifying gaps, authoring new capabilities to fill them, activating those capabilities in its graph, and using the new tools immediately.
Out of hundreds of dynamic graph mutations, 70% of the newly created tools were used in the exact same session they were written. This means these tools were created to solve an immediate problem, proving Buffaly's ability to overcome roadblocks by building its own ad hoc tools on the fly.
This is the failure mode the design was built to catch: an agent blocked by a missing capability should be able to build that capability and keep going.
A tool is a typed node in an executable graph
Diagram comparing a standard AI fixed toolbox with Buffaly's executable graph
Static agents choose from a flat toolbox. Buffaly navigates and extends a typed executable graph.
In Buffaly, a tool is not just an API endpoint. It is a typed capability represented in the system's executable graph.
The deeper point is that Buffaly is not a text-only agent with a bag of external functions. It runs on native execution. Its environment is described in ProtoScript, a language built so the environment can represent itself, compile executable graph changes, and reprogram parts of its own tool surface on the fly.
That means a tool is more than a label plus a JSON schema. It can carry a natural-language purpose, typed parameters, result-rendering expectations, implementation rules, and executable behavior. Some tools are direct operations. Some are reusable procedures. Some wrap compiled C# code. Some are behavior overlays that change how the agent works in a context.
For a new reader, the useful mental model is simple: Buffaly's "tools" include both functions and workflows. A function might read a file, compile a project, query a database, or transform data. A workflow might guide the agent through onboarding, local task management, or a specialized troubleshooting procedure. Both can be represented as nodes in the same graph and discovered when needed.
Those capabilities live in the same graph as skills, entities, action roots, prompt definitions, semantic phrases, and runtime scope rules. That matters because discovery is not limited to searching a flat list of functions.
Buffaly can ask: what action best matches this intent? But it can also ask: what descendants does this action root have? What tools belong to this skill? What prototypes inherit this parent? What entity is this tool meant to operate on? What tools are already loaded? What tools are installed but not loaded? What prompt actions exist for this workflow family?
The result is progressive discovery over an extensible typed graph. Semantic search is one access path. Traversing the graph by type, parent, child, relationship, tool family, or runtime status is another. As the graph grows, the discovery surface grows with it.
Buffaly does not merely retrieve tools. It navigates a living executable environment.
How Buffaly creates new tools
Buffaly extends the graph by authoring new graph nodes. Some of those nodes are memories or entities. Others are executable capabilities.
The most direct path is a ProtoScript tool. A small ProtoScript declaration gives the tool a name, a family, a description of what it does, typed inputs, and executable code.
A simplified shape looks like this:
protoscript
[SemanticProgram.InfinitivePhrase("to do something useful")]
prototype ToDoSomethingUseful : SomeSkillAction
{
Description = "input - typed input used by the action.";
function Execute(string input) : string
{
// implementation
}
}
The declaration is both graph structure and executable code. It gives the environment a new typed node and gives the runtime something it can expose as a callable tool.
Buffaly has internal authoring actions to handle this. When the agent defines a new prototype, the system parses it, writes it into the active project, and inserts it into the graph.
Because the graph is flexible, this single authoring mechanism can create many different things: a new executable tool, a prompt-guided workflow, a base data type, or a new routing skill.
Not every useful tool is a direct function. Some capabilities are repeatable procedures: review this codebase, maintain a local task, onboard a user, troubleshoot a deployment, perform a safe release, or follow a domain-specific workflow.
Buffaly represents these as prompt-backed tools. A prompt workflow usually has two parts: a graph node that makes the workflow discoverable and a markdown prompt file containing the procedure. These can be discovered and called like other tools, but what they execute is reusable guidance rather than a single imperative function body.
This is how the graph contains both functions and procedures.
ProtoScript is not the only implementation layer. Buffaly can also load compiled .NET code and expose it through ProtoScript wrappers. Complex IO, service clients, binary integrations, data transformations, and performance-sensitive code often belong in C#. Buffaly can import DLLs into a skill, add references/imports, and expose typed wrapper tools over the compiled implementation.
The concrete authoring surface also includes workflows for importing DLLs, installing compiled capabilities into a tool family, and creating new compiled capabilities from scratch. Those compiled-code paths are a next-pass attribution target for per-tool provenance, but they are already visible in the session database as part of Buffaly's tool-creation machinery.
That gives the system an escape hatch from prompt-only or script-only behavior. It can synthesize procedural tools, script tools, and compiled-code-backed tools.
The retained database shows these authoring paths in use. One pass analyzed 1,010 authoring rows, including 734 prototype insert/update calls, 156 prompt-workflow artifact calls, and 89 DLL/external-code workflow calls across the tracked authoring tools. That is why the article treats tool creation as a system behavior rather than a rare manual event.
The local data also shows direct ProtoScript file changes, generated files, and broader project edits. They still matter: once compiled and loaded, they become part of the executable graph.
Concrete Examples in Practice
What does this look like in an actual session? Here are three real patterns where dynamic tool creation breaks the static ceiling:
1. The Missing Parser
What was happening: An agent is tasked with debugging a system failure and encounters a legacy, undocumented application log format.
What usually goes wrong: A traditional agent halts. It lacks a tool to read the proprietary format and asks the human to extract the data.
What Buffaly caught and did: Instead of stopping, Buffaly authored a custom string-parsing tool, loaded it into the graph, and parsed the logs into a structured native DataTable.
Why it matters: It converted an unreadable artifact into queryable evidence and solved the root issue without human intervention.
2. The Domain-Specific Routine
What was happening: An agent successfully stepped through a complex, manual troubleshooting process for a failed staging deployment.
What usually goes wrong: That hard-won operational knowledge evaporates when the session ends. The next time it happens, the agent starts from scratch.
What Buffaly caught and did: Recognizing a repeatable workflow, the agent authored a new Prompt Action—a reusable procedure—encapsulating the exact diagnostic steps.
Why it matters: The agent taught itself a new workflow. Future sessions can now natively discover and execute the TroubleshootStagingDeployment action.
3. The API Escape Hatch
What was happening: The agent needed to extract specific telemetry from a subsystem, but the standard reporting tools didn't expose the required fields.
What usually goes wrong: The agent falls back to generic, high-risk command-line scripting or gives up.
What Buffaly caught and did: Buffaly imported a compiled C# telemetry library, wrote a typed ProtoScript wrapper over the exact method needed, and exposed it as a new, safe tool.
Why it matters: It bypassed a limitation safely by synthesizing a structured, typed capability rather than relying on brittle shell scripts.
Diagram showing Buffaly hitting a blocker, creating a tool, hot-loading it, and continuing the same session context
Buffaly can hit a blocker, create a missing tool, hot-load it, and keep working in the same session.
Hot-swapping the graph
Creating a graph node is not enough. The new capability has to become available to the running agent.
Buffaly handles activation without restarting the entire agent. A specific action can be loaded into a session, while larger graph changes can refresh the executable graph so newly authored tools, prompt workflows, imports, or wrappers become discoverable and callable.
The source evidence matches the runtime behavior. Candidate tools can be already loaded, automatically loaded, or marked as requiring a manual load. A registrar projects executable graph nodes into callable runtime tools, including descriptions and parameter schemas. In short: the function-tool surface is projected from the executable graph.
Agent profiles scope that projection. A profile defines the root action and root entity types that an agent is allowed to see. Other profiles can expose a narrower surface, such as watcher sessions. This is how the graph can be larger than any one agent's visible toolbox.
This is where the architecture becomes more than a static ontology. It is an executable graph that can be updated and activated.
That does not mean the entire system has to stop. Because Buffaly uses a distributed runtime model, workers can be recycled or rehydrated while the broader session and ecosystem continue. In practical terms, the agent changes the graph, brings the new graph state online, and continues the task with the new capabilities available.
The operational point is simple: graph edits do not stay inert. They become callable capabilities that the agent can use to continue the work.
Discovery is graph navigation, not just search
Buffaly can find tools in several ways.
It can use semantic search over action descriptions. It can list tool families and the tools inside them. It can inspect installed runtime capabilities. It can bind target entities separately from actions. It can walk descendants, inspect parents, and use scoped roots. It can ask what is already loaded. It can load a candidate tool when needed.
The user-facing discovery tools make those paths explicit. One search path finds candidate actions by operational meaning and reports whether they are loaded. Another searches separately for target objects, accounts, repositories, projects, environments, or other entities. Listing and prototype-inspection tools expose the graph-structured side of discovery.
The catalog code backs this up. It builds tool families, resolves each family's root, finds executable descendants, finds prompt-backed workflows, and extracts human-readable action phrases for display and discovery. This is graph navigation plus semantic retrieval, not a single flat search index.
The master prompt turns that architecture into operating policy: bind to ontology first, prefer typed domain actions over shell, search candidate actions with multiple phrasings when the route is unclear, search candidate entities separately, use skill/action listing as secondary discovery, and only ask a clarifying question after tool-assisted discovery fails.
These mechanisms compose. A user request might begin as a semantic phrase, resolve to an action candidate, bind to an entity, inspect the skill tree, load a tool, and then execute it. If the right tool does not exist yet, the same graph can be extended.
That makes discovery progressive in two senses: the agent progressively resolves intent into a typed tool call, and the graph itself can progressively grow new tool nodes over time.
Execution and persistence
Once a tool is loaded, the runtime exposes it as a callable function tool. The agent emits a tool call. The runtime dispatches that call to the appropriate implementation.
For a ProtoScript tool, dispatch enters the Execute(...) function. That function may call other ProtoScript helpers, C# imports, JSON web services, process wrappers, database helpers, or other tools.
For an OpsAction, execution is backed by runtime or host code. For a C# backed tool, a ProtoScript wrapper may dispatch into an imported assembly. For a prompt action, the execution is a reusable prompt-guided workflow rather than a simple code body.
That implementation split is intentional. ProtoScript is the graph-native declaration and glue layer: it names the capability, places it in the hierarchy, attaches semantic phrases, declares typed parameters, and exposes Execute(...). C# is the heavier implementation layer for validation, IO, service clients, indexing, transformations, and other behavior that should not live in a .pts wrapper. DLL-backed workflows extend the same pattern to compiled capabilities created or imported at runtime.
Tool results are not just raw text. They can be large values handled through StringRef, or structured UI envelopes containing metadata formats, result types, and payloads so the UI can render specialized outputs natively. The contract is typed and fail-fast: tools prefer typed parameters and explicit diagnostics over silent normalization.
Crucially, every tool call and result is persisted. The session database records tool-call rows and tool-result rows, tracking arguments, timestamps, turn identifiers, and sequence numbers. This durable memory is exactly why we can reconstruct the agent's tool-creation behavior from local telemetry.
Prompt actions are tools too, but a different kind
A direct executable tool performs an operation. Read a file. Query a database. Compile a project. Call a service. Transform a table. Search a folder.
A prompt action performs a procedure. It gives the agent a reusable operating mode or workflow. It might tell the agent how to maintain a local task artifact, onboard a user, review commits, troubleshoot a deployment, or follow a domain-specific playbook.
The session itself used examples of this pattern: LocalTaskPromptAction provides the durable local-task workflow, and OnboardingPromptAction provides guided onboarding behavior. They are called like tools, but their job is to load procedural guidance that changes how the agent performs a multi-step task.
Both are tools in the graph, but they occupy different parts of the capability spectrum.
That distinction is important because Buffaly is not only extending a function library. It is also extending its procedural memory. It can add a new command-like action and it can add a new way of working.
Context prompts are different again. A ContextPrompt is a situational behavior overlay. It is not the work product, and it is not the same as a direct executable tool. It shapes how the agent should behave in a context, such as coding, onboarding, or a specialized workflow.
Constraints keep graph extension from becoming chaos
A self-extending tool graph needs constraints.
Buffaly uses several layers:
agent profiles define root action and entity scopes;
skills group related capabilities;
action roots constrain families of tools;
typed parameters constrain calls;
source and runtime paths are scoped;
secrets are handled separately from ordinary ontology facts;
prompt guidance prefers typed authoring tools over direct .pts edits;
compile and activation checks validate the graph before use;
Plan, Scratch, and durable task artifacts preserve working state;
The master prompt also constrains decision-making: use ontology binding before freeform guessing, prefer typed tools, use ToSearchCandidateActions and ToSearchCandidateEntities before asking for clarification, and pass through the strict Question Gate only when ambiguity is real, consequential, and not resolvable with available tools.
The same mechanism that creates tools also creates normal ontology objects, prompt actions, memories, and project facts. So analysis has to classify changes carefully. A prototype insertion is not automatically a new tool. It might be a remembered environment, a Visual Studio project, a database entity, an action root, or a prompt action.
That is why the article distinguishes callable tools from ordinary ontology objects and other graph mutations.
The Data: Active Tool Creation
The runtime catalog reveals how much the executable graph has grown in practice.
The baseline source repository started with a few hundred core capabilities. Today, the active runtime instance has accumulated over 1,600 active prototype declarations across nearly 200 .pts files. It currently offers 744 tool-like capabilities (610 executable tools and 134 prompt actions).
These capabilities are a dynamic mix of ProtoScript functions, procedural prompt workflows, and compiled C# code wrappers, all authored by the agent and surfaced through typed discovery and execution paths. The retained database records 695 distinct tool names actually being called in production.
The operating pattern is straightforward: Buffaly encounters a gap, authors a capability, registers it as a callable node, and uses that new capability to keep working. The retained telemetry shows newly created callable tools and prompt actions becoming operational rather than sitting as dead definitions.
Design conclusions
Several design conclusions fall out of this.
First, tool creation is not a side feature. It is an essential capability. If the agent can only call a fixed toolbox, it is bounded by whatever its developer anticipated. If the agent can extend the executable graph, it can adapt its action vocabulary to new domains, new workflows, and new integrations.
Second, the graph model matters. Semantic search alone would not be enough. Buffaly can search by meaning, but it can also inspect type, parent, descendant, skill, action root, entity relationship, and runtime load state. That is what makes discovery progressive over an extensible graph rather than lookup over a static list.
Third, prompt skills and executable tools are complementary. Some capabilities are best expressed as direct typed functions. Others are best expressed as reusable procedures. A mature agent needs both.
Fourth, ProtoScript gives the system an incremental extension layer. It is close enough to the ontology to describe capabilities as graph nodes, but executable enough to run real work. C# and DLL integration then provide a path to heavier compiled implementations.
Fifth, persistence matters. Because tool calls, results, turn IDs, sequence numbers, and timestamps are stored, the system's evolution can be measured. The database does not just record conversation history. It records the growth of the executable graph.
The Limit of the Static Ceiling
While this data reflects a specific observational window—and does not capture the creation history of every legacy tool—the operational pattern is undeniable.
When we compare the baseline source repository to the active runtime project, the active graph has accumulated nearly double the files and over 1,000 additional prototype declarations. The runtime is significantly larger and more capable than the source it started with, entirely driven by the agent adapting to its own roadblocks.
Conclusion
Static toolboxes limit AI agents to the imagination of their developers.
Buffaly breaks out of that trap by treating tools as nodes in an ontology-backed, hot-swappable executable graph. It progressively resolves intent, navigates its capabilities, identifies gaps, writes missing logic, activates the new capability, and keeps working.
The local data proves the core capability. This instance created real callable tools and prompt actions, registered them as executable capabilities, and then used many of those capabilities soon afterward. That is the difference between a static tool-using agent and an agent that can grow its own action vocabulary.
The agent is not just using a toolbox. It is growing one.
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On January 1, CMS introduced a brand-new benefit called Advanced Primary Care Management (APCM), a monthly payment designed to roll up the core elements of care coordination under a single code. For primary care leaders, this changes the landscape in profound ways. APCM overlaps…...
This blog outlines a groundbreaking proof of concept for reimagining medical ontologies and artificial intelligence. Buffaly demonstrates how large language models (LLMs) can unexpectedly enable symbolic methods to reach unprecedented levels of effectiveness. This fusion deliver…...
Advanced Primary Care Management (APCM) represents one of the more meaningful changes in the CMS Physician Fee Schedule. As of January 1, 2025, practices that adopt this model will be reimbursed through monthly, risk-stratified codes rather than only episodic, time-based billing…...
Primary care is carrying more risk, more responsibility, and more expectation than ever. The opportunity is that we finally have a model that pays for the work most teams already do between visits. The risk is jumping into tooling and tactics before we agree on the basics. Advan…...
The Federal Trade Commission’s Sept. 12 warning to healthcare employers is a simple message with real operational consequences. Overbroad noncompetes, no‑poach language, and “de facto” restraints chill worker mobility and can limit patients’ ability to choose their clinicians. F…...
Advanced Primary Care Management represents Medicare's most ambitious attempt to transform primary care economics. Unlike previous programs that nibbled at the margins, APCM fundamentally restructures how practices organize, deliver, and bill for comprehensive care....
Advanced Primary Care Management (APCM) is Medicare’s newest program, introduced in 2025 with three billing codes: G0556, G0557, and G0558. This represents a pivotal shift toward value-based primary care by offering monthly reimbursements for delivering continuous, patient-focus…...
At 2 AM, a new mother in rural Alabama feels her heart racing. She's two weeks postpartum, alone with a newborn while her husband works the night shift. Her blood pressure reading on the home monitor shows 158/95. Within minutes, her care team receives an alert. By 6 AM, a nurse…...
Many health systems pay $40–$80 per patient per month (PMPM) for full-service remote patient monitoring while Medicare's 2025 national averages reimburse approximately $91–$129 monthly depending on engagement time. When clinical teams can deliver the same services internally, th…...
A few months ago, a physician at a 12-doctor practice in rural California called me frustrated. His practice was hemorrhaging money on readmissions, his nurses were burning out from phone tag with chronic disease patients, and his administrator was getting pressure from their he…...
Medical executives today face an uncomfortable reality: while navigating shrinking margins and mounting operational pressures, many are unknowingly surrendering millions in Medicare reimbursements to third-party vendors. The culprit? Poorly structured Remote Patient Monitoring (…...
Remote Patient Monitoring (RPM) has rapidly evolved from emerging healthcare innovation into a strategic necessity. Driven aggressively by CMS reimbursement policies, RPM adoption has accelerated at unprecedented rates, reshaping market dynamics and creating compelling strategic…...
In a single December blog post, CMS just rewrote the playbook for $400 billion in annual Medicare Advantage spending. The termination of the Medicare Advantage Value-Based Insurance Design (VBID) Model (after it generated $4.5 billion in excess costs over two years) isn't just a…...
If you've spent any time managing a remote patient monitoring (RPM) program, you already know the drill: juggling the 16-day rule, keeping track of clinical minutes, chasing compliance, and often wondering if this is really what patient-centered care was meant to feel like....
Let’s be honest. Managing your health today feels like trying to coordinate a group project where nobody checks their messages. Your cardiologist, endocrinologist, and PCP are all working on the same assignment, but nobody’s sharing notes. The result? Confusion, overlap, and som…...
The healthcare industry still has scars from the ICD-9 to ICD-10 transition. The stories are legendary in Health IT circles: coder productivity plummeting, claim denials surging, and revenue cycles seizing up for months. It was a painful lesson in underestimation....
In my work with healthcare organizations across the country, I see two distinct patient profiles coming into focus. They represent the past and future of remote care, and every successful practice must now build a bridge between them. The first is the patient for whom technology…...
The healthcare landscape is continuously evolving, and among the most profound shifts emerging is the concept of the Digital Twin for Patients. This technology isn't merely an abstract idea; it represents a fundamental change in how we approach individual health and broader heal…...
Change is inevitable in healthcare. Often, it feels overwhelming—but occasionally, a new shift arrives that genuinely makes things simpler. The upcoming CMS shift toward the MIPS Value Pathways (MVPs) represents precisely that kind of beneficial change....
It starts with a data spike… a sudden drop in movement, a rise in reported pain. The alert pings the provider dashboard, hinting at deterioration. But what if that signal isn’t telling the whole truth?...
Chronic pain isn’t just a condition, it’s a thief. It steals time, joy, and freedom from over 51 million Americans, according to the CDC, costing the economy $560 billion a year. As someone passionate about healthcare innovation, I’ve seen how this silent struggle affects patien…...
In the tech industry today, we frequently toss around sophisticated terms like "ontology" , often treating them like magic words that instantly confer depth and meaning. Product managers, software engineers, data scientists—everyone seems eager to invoke "ontology" to sound info…...
Picture Mary, 62, balancing a job and early diabetes. Her doctor, Dr. Patel, is her anchor—reviewing labs, coordinating with a nutritionist, tweaking her care plan. But until 2025, Dr. Patel wasn’t paid for this invisible work. It was just “what doctors do.” If you’re in healthc…...
In healthcare, most of the time, trouble doesn't announce itself with sirens and red flags. It starts quietly. A free dinner here. A paid talk there. An event that feels more like networking than education....
The Office of Inspector General’s (OIG) 2024 report, Additional Oversight of Remote Patient Monitoring in Medicare Is Needed (OEI-02-23-00260) , isn't just an alert—it's a detailed playbook exposing critical vulnerabilities in Medicare’s Remote Patient Monitoring (RPM) system. R…...
When the Department of Justice announces settlements, many of us glance at the headlines and move on. Yet, behind those headlines are real stories about real decisions, choices that felt minor at the time but led to serious consequences. Like the recent settlement involving Live…...
There’s a quiet agreement most of us make in business. It’s not in a contract. It’s not written on a whiteboard. But it runs everything: trust. We trust that what worked yesterday will still work tomorrow. We trust that people we’ve known for years will keep showing up the way…...
Feeling like you’re drowning in regulations designed by giants, for giants? If you're running a small practice in today's healthcare hellscape, it damn sure feels that way. And maybe "feeling" isn't the right word – maybe it's just reality....
When people ask me what Intelligence Factory does, they often expect to hear about AI, automation, or billing systems. And while we do all those things—we do them well—I’ve come to believe something deeper: we’re in the business of trust. And in healthcare, that’s the most valua…...
Artificial intelligence isn’t just a buzzword anymore—it’s a transformative force reshaping industries worldwide. Yet for many IT companies, the question isn’t whether to adopt AI but how . If you're scratching your head wondering where to start, you're not alone. For businesses…...
Agentic AI is rapidly gaining traction as a transformative technology with the potential to revolutionize how we interact with and utilize artificial intelligence. Unlike traditional AI systems that passively respond to commands, agentic AI systems operate autonomously, making d…...
Large Language Models (LLMs) have ushered in a new era of artificial intelligence, enabling systems to generate human-like text and engage in complex conversations. However, their extraordinary capabilities come with significant limitations, particularly when it comes to predict…...
The rapid advancement of Large Language Models (LLMs) has brought remarkable progress in natural language processing, empowering AI systems to understand and generate text with unprecedented fluency. Yet, these systems face a critical limitation: while they excel at processing l…...
Retrieval Augmented Generation (RAG) sounds like a dream come true for anyone working with AI language models. The idea is simple: enhance models like ChatGPT with external data so they can provide answers based on information beyond their original training. Need your AI to answ…...
In the beginning there was keyword search . Eventually word embeddings came along and we got Vector Databases and Retrieval Augmented Generation (RAG) . They were good for writing blog posts about topics that sounded smart, but didn’t actually work well in the real world. Fast f…...
In Volodymyr Pavlyshyn's article , the concepts of Metagraphs and Hypergraphs are explored as a transformative framework for developing relational models in AI agents’ memory systems. The article highlights how these metagraphs can act as a semantic backbone, enabling AI to reta…...
In the ever-evolving landscape of AI and natural language processing, Retrieval-Augmented Generation (RAG) has emerged as a cornerstone technology. RAG systems allow large language models (LLMs) to access vast knowledge bases by retrieving relevant snippets of information, or "c…...
As artificial intelligence (AI) becomes a powerful part of our daily lives, it’s amazing to see how many directions the technology is taking. From creative tools to customer service automation, AI can be both a powerhouse and, at times, a bit of a playground. At Intelligence Fac…...
Hey everyone, Justin Brochetti here, Co-founder of Intelligence Factory. We're all about building cutting-edge AI solutions, but I'm not here to talk about that today. Instead, I want to share some hard-earned wisdom about a challenge that I see many tech founders facing: findin…...
When it comes to data retrieval, most organizations today are exploring AI-driven solutions like Retrieval-Augmented Generation (RAG) paired with Large Language Models (LLM) . These systems have certainly made strides in helping businesses pull information from large datasets an…...
You’ve heard the pitch: AI will revolutionize your operations, cut costs, and deliver results you didn’t even know you needed. But after the vendor leaves, and the system is plugged in, reality hits hard. Companies are discovering that AI solutions too often fail to live up to t…...
AI-driven call routing can analyze incoming calls in real time and direct them to the most appropriate agent based on skill set, availability, and past interactions. This ensures customers are connected with the right person quickly, improving satisfaction and reducing wait time…...
RPM (Remote Patient Monitoring) CPT codes are a way for healthcare providers to get reimbursed for monitoring patients' health remotely using digital devices. Think of it like having a virtual nurse keeping an eye on you between doctor visits. These codes cover the time spent se…...
As VP of Sales, I'm constantly on the lookout for ways to empower my team and maximize their productivity. In today's competitive B2B landscape, every interaction counts. That's why I'm here to share a game-changer: integrating Intelligence Factory's AI package with our existing…...
In the rapidly evolving tech landscape, the excitement around AI is palpable. But beyond the hype, practical application is where true value lies. As someone who relishes in crafting customized solutions for clients and building internal tools, I've found immense value in creati…...
Everything old is new again. A few years back, the world was on fire with key-value storage systems. I think it was Google's introduction of MapReduce that set the fire. It's funny because I remember reading in the '90s that the debate had been settled and that relational databa…...
Mount Dora, Florida, 2019: AWS machine learning enhances MEDEK telemedicine solution to ease gender bias for sensitive online doctor visits. Visiting a doctor is personal, and now Medek Health Health Systems (MEDEK) along with Amazon Web Services (AWS) is using AI to make it a b…...