Attached means both sides said yes.
A clinic accepting someone leaves the attachment pending. It counts only when the patient confirms too, so your attachment numbers match what people experience.
For Canadian provinces and health authorities
Manage primary care attachment in one registry.
Astam brings patient waitlists, practitioner panels and clinic capacity into one registry. Staff can see the reasons behind each match and confirm attachments with both the clinic and patient.
Built by Two Rivers Digital on Microsoft Dynamics 365. Explore a working demonstration with fictional data.
How Astam works
Register
A person joins the registry.
Confirm capacity
Clinics report how many new patients they can accept.
Review matches
Staff review potential matches and the reasons behind each ranking.
Confirm attachment
The attachment counts once both the clinic and patient confirm.
Five rules the registry keeps
These five rules help keep attachment records accurate, protect each person's original registration date and make matching decisions easier to review. Astam enforces each rule.
Nobody loses their place.
The original registration date is locked. If someone declines an offer, or a removal is reversed, they go back on the list with the date they first registered.
Every match shows its reasons.
For each opening, Astam ranks the people who could take it and says why: priority, time waited against the target, distance and stated preferences. It also lists who was left out, and the reason.
Duplicates become cases, not deletions.
When someone appears on two clinics' panels, Astam opens a conflict case and asks the patient. Their choice decides it. The other attachment ends with a reason and stays in the history. A pediatrician beside a family doctor is not a conflict.
Clinic capacity expires.
Clinics confirm how many new patients they can take this month. Capacity older than 14 days is marked stale and drops off the public map, so the list of clinics taking patients stays true.
Astam in action
The staff workspace
Registry navigators and program managers work in Dynamics 365, with live counts on every screen.
For the people waiting
Patients register on a phone in plain language, for themselves, their child or someone in their care. A newborn can be registered before they have a health number. People who prefer the phone can register through the provincial health line instead.
The public clinic list shows only clinics that confirmed room in the last 14 days, with the date they confirmed. People can check their status, confirm an attachment and tell the registry they still need a provider.
How it runs
- Staff work in Microsoft Dynamics 365, on Dataverse in a Canadian Azure region.
- Staff sign in with Microsoft Entra ID, the account they already use.
- The patient site runs on Microsoft Power Pages and works on a phone.
- The data model follows HL7 FHIR (CA Core+), and FHIR is the contract for integration.
- Messages to patients are recorded with each record, ready for the province's own channels.
Where Astam stands
- Astam currently runs in a demonstration environment using fictional data. Imports from clinic electronic medical record systems are not yet built and will be scoped with each province or health authority.
- Astam holds no real patient data and has not been clinically validated.
- Registry rules: 77 automated tests of Astam's registry rules passed in the demonstration environment on October 29, 2026.
- Accessibility: an automated axe-core scan against WCAG 2.2 AA rules found no violations on 10 staff screens and 6 patient site pages, at desktop and phone widths, on October 28 and 29, 2026.
- Test records are kept and available on request.
Updated
Questions buyers ask
What is Astam?
Astam is a primary care access and attachment solution for Canadian provinces and health authorities, built by Two Rivers Digital on Microsoft Dynamics 365. It combines a patient attachment registry for people waiting for a family doctor or nurse practitioner with a practitioner panel registry, and counts an attachment only when both the clinic and the patient confirm it.
What is a primary care attachment registry?
It is the provincial list of people who need a family doctor or nurse practitioner, matched against the clinics and practitioners with room to take them. A good registry also keeps a practitioner panel registry, so the province knows who is already attached and how many unattached patients are left. Read the guide.
What are the alternatives to Astam?
Clinic networks use platforms such as Ocean Care Networks, Novari eRequest or Caredove, and several provinces built their own registries. Compare the options.
Who is Astam for?
Provincial health ministries, health authorities and the agencies that run attachment programs: registry navigators, program managers, clinic staff who confirm capacity, and the people waiting.
What happens when one patient is on two panels?
Astam opens a conflict case, asks the patient which provider they see, and records their choice. Nothing is deleted. How Astam handles attachment conflicts.
What does the name mean?
âstam is Plains Cree for “come here!”. ASTAM also stands for Attachment Service for Triage And Matching.
See it with your own rules.
Tell the Two Rivers Digital team about your program and what you’d like to explore.
Contact Two Rivers Digital