Agent Outputs

{
  "differentials": [
    {
      "diagnosis": "Acute Myocardial Infarction",
      "likelihood": "most likely",
      "reasoning": "Classic presentation with crushing chest pain radiating to arm",
      "confidence": "high",
      "supporting_evidence": ["Typical cardiac symptoms", "CV risk factors"]
    }
  ],
  "risk_scores": {
    "HEART Score": "6 — High risk"
  },
  "soap_draft": "S: 45yo M with HTN, DM2 presents with chest pain...\nO: BP 160/95, HR 110...",
  "reasoning_trace": "1. Patient presents with classic cardiac chest pain\n2. Risk factors include HTN, DM2, male, age 45\n3. HEART Score = 6 (high risk)\n4. Differential: STEMI vs NSTEMI vs unstable angina",
  "confidence": "high"
}

{
  "evidence": [
    {
      "title": "HEART score for the assessment of patients with chest pain in the emergency department",
      "authors": "Backus BE, et al.",
      "journal": "Neth Heart J",
      "year": "2013",
      "pmid": "23415484",
      "snippet": "The HEART score is a simple and effective tool to risk-stratify patients with chest pain...",
      "relevance": "high"
    }
  ],
  "summary": "Strong evidence supports use of HEART Score for risk stratification in chest pain. AHA/ACC guidelines recommend immediate ECG and troponin for suspected ACS.",
  "contradictions": [],
  "confidence": "high"
}

{
  "flags": [
    {
      "category": "drug-drug",
      "severity": "moderate",
      "description": "Aspirin may increase risk of hypoglycemia when combined with Metformin",
      "mechanism": "Aspirin enhances insulin secretion and glucose uptake",
      "recommendation": "Monitor blood glucose closely if initiating aspirin therapy",
      "drugs_involved": ["Aspirin", "Metformin"]
    },
    {
      "category": "drug-disease",
      "severity": "major",
      "description": "Beta-blockers may mask hypoglycemia symptoms in diabetic patients",
      "mechanism": "Beta-blockade suppresses tachycardia and tremor associated with hypoglycemia",
      "recommendation": "Educate patient on non-adrenergic hypoglycemia symptoms (sweating, confusion)",
      "drugs_involved": ["Metoprolol"]
    }
  ],
  "medication_review": "Current medications (Metformin, Lisinopril) are appropriate for HTN and DM2. Aspirin therapy recommended for ACS. Monitor for drug interactions with proposed treatment plan.",
  "dosing_alerts": [
    "Metformin: Check renal function before contrast imaging (risk of lactic acidosis)"
  ],
  "population_warnings": []
}

{
  "ehr_contradictions": [],
  "evidence_gaps": [
    "ECG not yet available - critical for STEMI diagnosis",
    "Troponin pending - needed to confirm myocardial injury"
  ],
  "safety_misses": [
    "Clinical Agent did not initially consider aortic dissection - important given hypertension"
  ],
  "overall_assessment": "Strong consensus on ACS as primary diagnosis. Appropriate risk stratification with HEART Score. Safety agent correctly identified drug interactions. Recommend proceeding with SOAP synthesis while flagging need for ECG and troponin.",
  "consensus_reached": true,
  "dissent_log": [
    "Clinical Agent initially prioritized GERD in differential - overruled by evidence supporting cardiac etiology"
  ]
}

{
  "round_number": 1,
  "clinical_outputs": [
    {
      "differentials": [...],
      "risk_scores": {...},
      "soap_draft": "...",
      "reasoning_trace": "...",
      "confidence": "high"
    }
  ],
  "literature_outputs": [
    {
      "evidence": [...],
      "summary": "...",
      "contradictions": [],
      "confidence": "high"
    }
  ],
  "safety_outputs": [
    {
      "flags": [...],
      "medication_review": "...",
      "dosing_alerts": [...],
      "population_warnings": []
    }
  ],
  "critic_outputs": [
    {
      "ehr_contradictions": [],
      "evidence_gaps": [...],
      "safety_misses": [...],
      "overall_assessment": "...",
      "consensus_reached": true,
      "dissent_log": [...]
    }
  ],
  "final_consensus": true,
  "flagged_for_human": false
}

{
  "drug_interactions": [
    {
      "drug_a": "Aspirin",
      "drug_b": "Lisinopril",
      "severity": "moderate",
      "description": "NSAIDs may reduce antihypertensive effect of ACE inhibitors",
      "mechanism": "Inhibition of prostaglandin synthesis",
      "recommendation": "Monitor blood pressure closely"
    }
  ],
  "contraindications": [],
  "dosing_alerts": [
    {
      "drug": "Metformin",
      "alert_type": "renal",
      "description": "Adjust dose for eGFR 30-45 mL/min, avoid if <30",
      "recommendation": "Check serum creatinine and eGFR before continuing"
    }
  ],
  "population_flags": [],
  "summary": "Moderate drug interaction between Aspirin and Lisinopril. Monitor BP. Metformin requires renal function check."
}