clinic-protocol-decision-support

name

clinic-protocol-decision-support

description

Produce a single strict-JSON answer for a protocol-bound clinical decision-support task against the synthetic Harborview / GDPEVO clinic runtime. Use whenever a prompt names a target case id like CASE-XXX-NNN, points to a runtime at <TASK_ENV_BASE_URL> with GET /api/... endpoints, and requires output conforming to input/payloads/answer_template.json. Covers adult respiratory / CAP assessment, pediatric head injury triage, potassium repletion, observation-window / protocol-gate retrieval, and care-management routing — and generalizes to unseen case types that follow the same shape.

Clinic protocol decision-support (GDPEVO synthetic clinic)

What these tasks look like

Every task in this family shares one shape:

1. A prompt.txt names exactly one target case id (e.g. CASE-RESP-102) and tells you to review it in a runtime environment at <TASK_ENV_BASE_URL>.
2. input/payloads/answer_template.json is a strict contract: required top-level keys, enum-constrained values, types, null rules, numeric precision, and ordering rules. This file — not your medical judgment about wording — defines every allowed value. Read it first and last.
3. A separate environment_access.md lists the base URL, credentials (usually none), and the exact allowed endpoints for this run.

Your deliverable is exactly one JSON object that satisfies the template. No markdown, no code fences, no prose outside the object, no extra top-level keys.

Operating procedure

Do these in order for any task:

1. Extract identifiers from the prompt. Note the target case_id. Determine task_id: if the template pins it (expected_constant / required_value, e.g. "train_004"), use that exact string; otherwise use the task's own directory / run name. Never invent an unrelated id.

2. Read the template as a schema. List every required key, every enum's allowed values, every *_or_null field, every precision rule, and every ordering / ordering_rule. Build your answer to hit those keys and only those keys. Enum fields must contain a value from the allowed list verbatim — if your clinical reading has no matching enum, you have misread the case, not found a gap in the template.

3. Read environment_access.md for this run. Take the base URL and endpoint list from it — do not hardcode a host. Credentials are typically none.

4. Pull the case bundle — the one call that matters. GET <base>/api/cases/{case_id} returns a fully joined record for that case: case, patient, findings (key/value/source_id), observations, medications, allergies, problems, imaging, care_registry, sdoh. This bundle is the authoritative, case-scoped evidence. Prefer it over the global list endpoints. Read patient.patient_id here — that is the patient_id for your answer.

5. Fetch the governing protocol. Map case.case_type → protocol_id and GET <base>/api/protocols/{protocol_id}. The protocol body holds the thresholds, controlled codes, status rules, and routing logic you must apply. Use the live protocol values; treat references/protocol-logic.md only as a fast orientation guide. Case-type → protocol mapping and endpoint details are in references/endpoints.md and references/protocol-logic.md.

6. Select evidence and filter distractors (see "Distractor discipline" below).

7. Apply the protocol to the filtered evidence to fill each template field. When a field is genuine clinical judgment within the enum set, choose the value the protocol thresholds support and cite the driving observation in evidence_ids.

8. Run the safety checks (below), then emit one JSON object and stop.

Distractor discipline (this is where tasks are won or lost)

The runtime is seeded with decoys. Filter every piece of evidence against the target:

• Wrong patient. A row may carry the target case_id yet a different patient_id (e.g. a potassium result stamped with another patient's id). Keep only rows whose patient_id equals the target patient from the bundle.
• Wrong code. "Serum potassium" is a specific controlled code (K); a whole-blood potassium (6298-4) or a sodium (NA) is not the target code even though it looks similar. Match the protocol's controlled_codes exactly.
• Wrong status. Only status = "final" observations satisfy protocol gates. Exclude preliminary, entered-in-error, canceled. (Protocols state this explicitly.)
• Wrong time window. When a task defines a window, treat from as inclusive and to as exclusive (a March-2026 window is 2026-03-01T00:00:00Z ≤ t < 2026-04-01T00:00:00Z). Drop observations outside it.
• Distractor cases/patients. Ids like CASE-D30xx and PAT-D20xx and any "generated distractor feed" source are never your target. The global lists (/api/observations, /api/medications, …) are dominated by these; if you use a list endpoint, filter it hard (?patient_id=&code=&status=) and cross-check against the bundle.
• POST /api/query is unusable here. It demands a clinic token that a credentials: none run does not have (returns invalid or missing clinic token). Do everything with the GET endpoints.

When a task asks you to report both matched and excluded observation ids, the excluded list is the relevant near-misses you filtered out (wrong date/code/status/patient) — not every unrelated row in the database. Sort exactly as the template's ordering says (typically effective_time ascending, then observation_id ascending). When picking a single "latest" value, choose the latest qualifying final effective_time.

Evidence ids

Populate evidence_ids (or source_provenance) with the stable identifiers you actually relied on: observation_ids, imaging_ids, the source_id from findings, the protocol id, and the case id. Follow any stated ordering (e.g. "case id first," or "descending relevance"). Do not pad with ids you did not use.

Output-contract rules

• Emit only the required top-level keys. Extra keys are at best ignored, at worst a failure; omit them.
• Use enum values verbatim. Booleans are real booleans, not strings.
• Honor numeric precision exactly: "one decimal place" → 3.5 (not 3.50 or 3); integer fields → integers; keep units out of numeric fields unless the field is a string like blood_pressure: "152/88".
• Use null only where the field type permits it (*_or_null, ["integer","null"], nullable objects). Never send null for a plain required field, and never invent a placeholder string where null is meant.
• Timestamps: ISO-8601 UTC with trailing Z when the field asks for it.
• Empty is a valid answer: use [] for a list when the protocol yields no items, not a fabricated entry.

Safety checks (do not fabricate reassuring findings)

Several templates carry safety_checks booleans and forbid unsupported claims. The recurring rule: never assert a normal/negative finding you did not observe.

• Do not claim a "normal CXR" or "clear lungs" when imaging shows consolidation; set the corresponding no_normal_cxr_claim / no_clear_lungs_claim to true only because your answer genuinely avoids that claim.
• Do not claim absent loss-of-consciousness / vomiting / photophobia unless the record supports absence; the no_false_* booleans assert your answer did not fabricate them.
• Allergy-aware medication selection: read active allergies from the bundle and avoid every implicated class. If penicillin and sulfonamide allergies are active, do not recommend a beta-lactam or sulfa drug; pick an enum-allowed alternative the patient tolerates, and list the avoided classes in avoid_allergens. Set no_penicillin_or_sulfa true only when your plan truly avoids them.
• When the protocol's urgent/ED-escalation thresholds are not met, do not escalate; when they are met, defer definitive treatment as the protocol directs (e.g. defer antibiotic choice to the ED) rather than improvising.
• Do not mutate the environment or "place orders" — these are read-only assessments.

Final self-check before returning

• task_id, case_id, patient_id match the prompt/template (pinned constants used where required).
• Every required key present; no extra top-level keys; all enums from the allowed set.
• Evidence filtered by patient + code + status + window; distractors excluded.
• Numeric precision, null rules, and list ordering obey the template.
• evidence_ids cite only ids you used; ordering rule followed.
• Safety booleans reflect an answer that makes no unsupported normal/negative claim, and any medication plan is allergy-aware.
• Output is a single JSON object — no markdown, comments, or surrounding text.