From 7a192819db16388489c1970dc0c8f3997e72b2cc Mon Sep 17 00:00:00 2001 From: "Dylan Mordaunt (Illawarra Shoalhaven LHD)" Date: Wed, 11 Feb 2026 14:14:46 +1100 Subject: [PATCH 01/57] feat(conductor): Initialize conductor with health plugin program (18 tracks, 30 skills, 14 commands) - Add conductor project structure (index, product, tech-stack, workflow, guidelines) - Create health-plugin meta-track for program coordination - Add 17 implementation tracks across 4 phases: Phase 1: health-core (foundation) Phase 2: complaints, incidents, risk, information, coding Phase 3: governance, credentialing, procurement, quality, financial, evidence, data-analysis Phase 4: ethics, economics, manuscripts, grants, medicolegal - Add index.md navigation to all tracks - Reference NSQHS, NICE, PBAC frameworks - Document skill adaptations from existing plugins --- conductor/index.md | 39 +++++++++ conductor/product-guidelines.md | 64 +++++++++++++++ conductor/product.md | 37 +++++++++ conductor/tech-stack.md | 73 +++++++++++++++++ conductor/tracks.md | 80 +++++++++++++++++++ conductor/tracks/health-coding/index.md | 16 ++++ conductor/tracks/health-coding/metadata.json | 12 +++ conductor/tracks/health-coding/plan.md | 25 ++++++ conductor/tracks/health-coding/spec.md | 57 +++++++++++++ conductor/tracks/health-complaints/index.md | 16 ++++ .../tracks/health-complaints/metadata.json | 11 +++ conductor/tracks/health-complaints/plan.md | 30 +++++++ conductor/tracks/health-complaints/spec.md | 48 +++++++++++ conductor/tracks/health-core/index.md | 16 ++++ conductor/tracks/health-core/metadata.json | 10 +++ conductor/tracks/health-core/plan.md | 21 +++++ conductor/tracks/health-core/spec.md | 60 ++++++++++++++ .../tracks/health-credentialing/index.md | 16 ++++ .../tracks/health-credentialing/metadata.json | 11 +++ conductor/tracks/health-credentialing/plan.md | 29 +++++++ conductor/tracks/health-credentialing/spec.md | 54 +++++++++++++ .../tracks/health-data-analysis/index.md | 16 ++++ .../tracks/health-data-analysis/metadata.json | 12 +++ conductor/tracks/health-data-analysis/plan.md | 24 ++++++ conductor/tracks/health-data-analysis/spec.md | 54 +++++++++++++ conductor/tracks/health-economics/index.md | 16 ++++ .../tracks/health-economics/metadata.json | 12 +++ conductor/tracks/health-economics/plan.md | 36 +++++++++ conductor/tracks/health-economics/spec.md | 60 ++++++++++++++ conductor/tracks/health-ethics/index.md | 16 ++++ conductor/tracks/health-ethics/metadata.json | 11 +++ conductor/tracks/health-ethics/plan.md | 31 +++++++ conductor/tracks/health-ethics/spec.md | 45 +++++++++++ conductor/tracks/health-evidence/index.md | 16 ++++ .../tracks/health-evidence/metadata.json | 12 +++ conductor/tracks/health-evidence/plan.md | 34 ++++++++ conductor/tracks/health-evidence/spec.md | 50 ++++++++++++ conductor/tracks/health-financial/index.md | 16 ++++ .../tracks/health-financial/metadata.json | 11 +++ conductor/tracks/health-financial/plan.md | 31 +++++++ conductor/tracks/health-financial/spec.md | 56 +++++++++++++ conductor/tracks/health-governance/index.md | 16 ++++ .../tracks/health-governance/metadata.json | 11 +++ conductor/tracks/health-governance/plan.md | 30 +++++++ conductor/tracks/health-governance/spec.md | 45 +++++++++++ conductor/tracks/health-grants/index.md | 16 ++++ conductor/tracks/health-grants/metadata.json | 12 +++ conductor/tracks/health-grants/plan.md | 25 ++++++ conductor/tracks/health-grants/spec.md | 55 +++++++++++++ conductor/tracks/health-incidents/index.md | 16 ++++ .../tracks/health-incidents/metadata.json | 11 +++ conductor/tracks/health-incidents/plan.md | 31 +++++++ conductor/tracks/health-incidents/spec.md | 48 +++++++++++ conductor/tracks/health-information/index.md | 16 ++++ .../tracks/health-information/metadata.json | 11 +++ conductor/tracks/health-information/plan.md | 32 ++++++++ conductor/tracks/health-information/spec.md | 56 +++++++++++++ conductor/tracks/health-manuscripts/index.md | 16 ++++ .../tracks/health-manuscripts/metadata.json | 12 +++ conductor/tracks/health-manuscripts/plan.md | 25 ++++++ conductor/tracks/health-manuscripts/spec.md | 66 +++++++++++++++ conductor/tracks/health-medicolegal/index.md | 16 ++++ .../tracks/health-medicolegal/metadata.json | 12 +++ conductor/tracks/health-medicolegal/plan.md | 43 ++++++++++ conductor/tracks/health-medicolegal/spec.md | 63 +++++++++++++++ conductor/tracks/health-plugin/index.md | 16 ++++ conductor/tracks/health-plugin/metadata.json | 32 ++++++++ conductor/tracks/health-plugin/plan.md | 35 ++++++++ conductor/tracks/health-plugin/spec.md | 67 ++++++++++++++++ conductor/tracks/health-procurement/index.md | 16 ++++ .../tracks/health-procurement/metadata.json | 11 +++ conductor/tracks/health-procurement/plan.md | 29 +++++++ conductor/tracks/health-procurement/spec.md | 45 +++++++++++ conductor/tracks/health-quality/index.md | 16 ++++ conductor/tracks/health-quality/metadata.json | 11 +++ conductor/tracks/health-quality/plan.md | 28 +++++++ conductor/tracks/health-quality/spec.md | 49 ++++++++++++ conductor/tracks/health-risk/index.md | 16 ++++ conductor/tracks/health-risk/metadata.json | 11 +++ conductor/workflow.md | 48 +++++++++++ 80 files changed, 2398 insertions(+) create mode 100644 conductor/index.md create mode 100644 conductor/product-guidelines.md create mode 100644 conductor/product.md create mode 100644 conductor/tech-stack.md create mode 100644 conductor/tracks.md create mode 100644 conductor/tracks/health-coding/index.md create mode 100644 conductor/tracks/health-coding/metadata.json create mode 100644 conductor/tracks/health-coding/plan.md create mode 100644 conductor/tracks/health-coding/spec.md create mode 100644 conductor/tracks/health-complaints/index.md create mode 100644 conductor/tracks/health-complaints/metadata.json create mode 100644 conductor/tracks/health-complaints/plan.md create mode 100644 conductor/tracks/health-complaints/spec.md create mode 100644 conductor/tracks/health-core/index.md create mode 100644 conductor/tracks/health-core/metadata.json create mode 100644 conductor/tracks/health-core/plan.md create mode 100644 conductor/tracks/health-core/spec.md create mode 100644 conductor/tracks/health-credentialing/index.md create mode 100644 conductor/tracks/health-credentialing/metadata.json create mode 100644 conductor/tracks/health-credentialing/plan.md create mode 100644 conductor/tracks/health-credentialing/spec.md create mode 100644 conductor/tracks/health-data-analysis/index.md create mode 100644 conductor/tracks/health-data-analysis/metadata.json create mode 100644 conductor/tracks/health-data-analysis/plan.md create mode 100644 conductor/tracks/health-data-analysis/spec.md create mode 100644 conductor/tracks/health-economics/index.md create mode 100644 conductor/tracks/health-economics/metadata.json create mode 100644 conductor/tracks/health-economics/plan.md create mode 100644 conductor/tracks/health-economics/spec.md create mode 100644 conductor/tracks/health-ethics/index.md create mode 100644 conductor/tracks/health-ethics/metadata.json create mode 100644 conductor/tracks/health-ethics/plan.md create mode 100644 conductor/tracks/health-ethics/spec.md create mode 100644 conductor/tracks/health-evidence/index.md create mode 100644 conductor/tracks/health-evidence/metadata.json create mode 100644 conductor/tracks/health-evidence/plan.md create mode 100644 conductor/tracks/health-evidence/spec.md create mode 100644 conductor/tracks/health-financial/index.md create mode 100644 conductor/tracks/health-financial/metadata.json create mode 100644 conductor/tracks/health-financial/plan.md create mode 100644 conductor/tracks/health-financial/spec.md create mode 100644 conductor/tracks/health-governance/index.md create mode 100644 conductor/tracks/health-governance/metadata.json create mode 100644 conductor/tracks/health-governance/plan.md create mode 100644 conductor/tracks/health-governance/spec.md create mode 100644 conductor/tracks/health-grants/index.md create mode 100644 conductor/tracks/health-grants/metadata.json create mode 100644 conductor/tracks/health-grants/plan.md create mode 100644 conductor/tracks/health-grants/spec.md create mode 100644 conductor/tracks/health-incidents/index.md create mode 100644 conductor/tracks/health-incidents/metadata.json create mode 100644 conductor/tracks/health-incidents/plan.md create mode 100644 conductor/tracks/health-incidents/spec.md create mode 100644 conductor/tracks/health-information/index.md create mode 100644 conductor/tracks/health-information/metadata.json create mode 100644 conductor/tracks/health-information/plan.md create mode 100644 conductor/tracks/health-information/spec.md create mode 100644 conductor/tracks/health-manuscripts/index.md create mode 100644 conductor/tracks/health-manuscripts/metadata.json create mode 100644 conductor/tracks/health-manuscripts/plan.md create mode 100644 conductor/tracks/health-manuscripts/spec.md create mode 100644 conductor/tracks/health-medicolegal/index.md create mode 100644 conductor/tracks/health-medicolegal/metadata.json create mode 100644 conductor/tracks/health-medicolegal/plan.md create mode 100644 conductor/tracks/health-medicolegal/spec.md create mode 100644 conductor/tracks/health-plugin/index.md create mode 100644 conductor/tracks/health-plugin/metadata.json create mode 100644 conductor/tracks/health-plugin/plan.md create mode 100644 conductor/tracks/health-plugin/spec.md create mode 100644 conductor/tracks/health-procurement/index.md create mode 100644 conductor/tracks/health-procurement/metadata.json create mode 100644 conductor/tracks/health-procurement/plan.md create mode 100644 conductor/tracks/health-procurement/spec.md create mode 100644 conductor/tracks/health-quality/index.md create mode 100644 conductor/tracks/health-quality/metadata.json create mode 100644 conductor/tracks/health-quality/plan.md create mode 100644 conductor/tracks/health-quality/spec.md create mode 100644 conductor/tracks/health-risk/index.md create mode 100644 conductor/tracks/health-risk/metadata.json create mode 100644 conductor/workflow.md diff --git a/conductor/index.md b/conductor/index.md new file mode 100644 index 0000000..c30aac8 --- /dev/null +++ b/conductor/index.md @@ -0,0 +1,39 @@ +# Knowledge Work Plugins - Project Index + +## Project Overview + +Monorepo of Claude Code plugins for knowledge work roles. Each plugin bundles skills, commands, and connectors for a specific job function. + +## Key Documents + +- [Product Definition](./product.md) - What we're building and why +- [Tech Stack](./tech-stack.md) - Technologies and patterns used +- [Workflow](./workflow.md) - Development workflow and processes +- [Product Guidelines](./product-guidelines.md) - Design principles and conventions +- [Tracks Registry](./tracks.md) - Active development tracks + +## Plugin Structure + +``` +plugin-name/ +├── .claude-plugin/plugin.json # Manifest +├── .mcp.json # MCP connectors +├── commands/ # Slash commands +└── skills/ # Domain knowledge +``` + +## Active Plugins + +| Plugin | Focus | +|--------|-------| +| productivity | Task/calendar management | +| sales | Pipeline, outreach, competitive | +| customer-support | Triage, responses, escalations | +| product-management | Specs, roadmaps, research | +| marketing | Content, campaigns, analytics | +| legal | Contracts, compliance, risk | +| finance | Journal entries, reconciliation | +| data | SQL, visualization, analysis | +| enterprise-search | Cross-tool search | +| bio-research | Life sciences R&D | +| cowork-plugin-management | Plugin creation | diff --git a/conductor/product-guidelines.md b/conductor/product-guidelines.md new file mode 100644 index 0000000..e94dc1d --- /dev/null +++ b/conductor/product-guidelines.md @@ -0,0 +1,64 @@ +# Product Guidelines + +## Design Principles + +### 1. File-Based, No Code +- Everything is markdown or JSON +- No build steps required +- No runtime dependencies + +### 2. Composable +- Plugins are modular +- Skills activate automatically +- Commands are explicit triggers + +### 3. Customizable First +- Generic starting points +- Easy to modify for company-specific needs +- Clear extension points + +## Content Standards + +### Skills +- Start with clear trigger conditions +- Provide step-by-step workflows +- Include examples where helpful +- Keep instructions actionable + +### Commands +- Use descriptive names (verb-noun pattern) +- Document all arguments +- Provide usage examples +- Handle edge cases + +### Connectors +- List required credentials +- Document setup steps +- Provide troubleshooting tips + +## Writing Style + +- Direct and actionable +- Use imperative mood +- Avoid jargon unless domain-specific +- Lead with user benefit + +## Plugin Organization + +### Naming Convention +- Lowercase, hyphen-separated +- Role or function-based (e.g., `customer-support`, `bio-research`) + +### File Naming +- Skills: `SKILL.md` in skill-named folder +- Commands: `.md` +- Docs: `README.md`, `CONNECTORS.md` + +## Quality Checklist + +- [ ] plugin.json complete and valid +- [ ] README explains plugin purpose +- [ ] CONNECTORS.md lists all tools +- [ ] Skills have clear triggers +- [ ] Commands document arguments +- [ ] No hardcoded credentials diff --git a/conductor/product.md b/conductor/product.md new file mode 100644 index 0000000..34bc353 --- /dev/null +++ b/conductor/product.md @@ -0,0 +1,37 @@ +# Product Definition + +## Vision + +Turn Claude into a specialist for any role, team, and company through modular, customizable plugins. + +## Core Value Proposition + +1. **Role-Specific Expertise** - Skills encode domain knowledge and best practices +2. **Tool Integration** - Connectors wire Claude to external tools via MCP +3. **Explicit Actions** - Slash commands for triggered workflows +4. **Customizable** - File-based (markdown/JSON), no code required + +## Target Users + +- Individual knowledge workers (sales, PMs, data analysts, etc.) +- Teams wanting consistent workflows +- Organizations customizing for their specific tools/processes + +## Success Metrics + +- Adoption rate across Cowork and Claude Code +- Customization depth (users modifying plugins) +- Plugin creation rate (new roles covered) + +## Scope + +### In Scope +- Plugin authoring and distribution +- MCP connector configurations +- Skill/Command authorship patterns +- Marketplace integration + +### Out of Scope +- MCP server development +- Claude Code/Cowork core features +- Backend infrastructure diff --git a/conductor/tech-stack.md b/conductor/tech-stack.md new file mode 100644 index 0000000..b73770b --- /dev/null +++ b/conductor/tech-stack.md @@ -0,0 +1,73 @@ +# Tech Stack + +## Plugin Architecture + +### Core Technologies +- **Markdown** - Skills and commands content +- **JSON** - Manifests and connector configs +- **YAML Frontmatter** - Command metadata + +### File Structure +``` +plugin-name/ +├── .claude-plugin/ +│ └── plugin.json # Required: name, version, description +├── .mcp.json # Optional: MCP server configs +├── README.md # Plugin documentation +├── CONNECTORS.md # Connector documentation +├── commands/ +│ └── .md # Slash commands with YAML frontmatter +└── skills/ + └── / + └── SKILL.md # Skill definitions +``` + +### Manifest Schema (plugin.json) +```json +{ + "name": "plugin-name", + "version": "1.0.0", + "description": "Plugin description" +} +``` + +### Command Format +```markdown +--- +name: command-name +description: What it does +arguments: + - name: arg1 + description: Argument description +--- + +Command content/instructions here. +``` + +### Skill Format +```markdown +# Skill Name + +Description and instructions for Claude to follow. +``` + +## MCP Integration + +Servers configured in `.mcp.json`: +```json +{ + "servers": { + "server-name": { + "type": "stdio|sse|http", + "command": "...", + "args": [...] + } + } +} +``` + +## Distribution + +- GitHub-based marketplace +- Versioned via git tags +- Install via `claude plugin install @` diff --git a/conductor/tracks.md b/conductor/tracks.md new file mode 100644 index 0000000..1021345 --- /dev/null +++ b/conductor/tracks.md @@ -0,0 +1,80 @@ +# Tracks Registry + +Active development tracks for this project. + +## How to Create a Track + +1. Create directory: `conductor/tracks//` +2. Add files: `spec.md`, `plan.md`, `metadata.json` +3. Register track below with link + +## Health Plugin Program + +Meta-track: [health-plugin](./tracks/health-plugin/) - Program overview and coordination + +### Execution Phases + +``` +PHASE 1: Foundation +└── health-core ─────────────────────────────────────────┐ + │ +PHASE 2: Core Workflows (parallel) │ +├── health-complaints ───────────────────────────────────┤ +├── health-incidents ────────────────────────────────────┤ +├── health-risk ─────────────────────────────────────────┤ +├── health-information ──────────────────────────────────┤ +└── health-coding ───────────────────────────────────────┤ + │ +PHASE 3: Extended Workflows (parallel) │ +├── health-governance ───────────────────────────────────┤ +├── health-credentialing ────────────────────────────────┤ +├── health-procurement ──────────────────────────────────┤ +├── health-quality ──────────────────────────────────────┤ +├── health-financial ────────────────────────────────────┤ +├── health-evidence ─────────────────────────────────────┤ +└── health-data-analysis ────────────────────────────────┤ + │ +PHASE 4: Research/Academic (parallel, depends Phase 3) │ +├── health-ethics ───────────────────────────────────────┤ +├── health-economics ────────────────────────────────────┤ +├── health-manuscripts ──────────────────────────────────┤ +├── health-grants ───────────────────────────────────────┤ +└── health-medicolegal ──────────────────────────────────┘ +``` + +### Track Registry + +| Track | Description | Phase | Adapts From | +|-------|-------------|-------|-------------| +| [health-core](./tracks/health-core/) | Plugin foundation | 1 | - | +| [health-complaints](./tracks/health-complaints/) | Patient complaints | 2 | customer-support | +| [health-incidents](./tracks/health-incidents/) | Serious adverse events | 2 | customer-support/escalation | +| [health-risk](./tracks/health-risk/) | Multi-domain risk | 2 | legal/risk-assessment | +| [health-information](./tracks/health-information/) | ROI, consent, records | 2 | legal/compliance | +| [health-coding](./tracks/health-coding/) | Clinical coding | 2 | data/validation | +| [health-governance](./tracks/health-governance/) | Policies, procedures | 3 | legal/compliance | +| [health-credentialing](./tracks/health-credentialing/) | Provider credentialing | 3 | productivity/memory | +| [health-procurement](./tracks/health-procurement/) | Devices, business cases | 3 | legal/contract-review | +| [health-quality](./tracks/health-quality/) | QI, accreditation | 3 | product-management | +| [health-financial](./tracks/health-financial/) | Payer contracts | 3 | finance | +| [health-evidence](./tracks/health-evidence/) | Systematic reviews | 3 | bio-research | +| [health-data-analysis](./tracks/health-data-analysis/) | Epidemiological reports | 3 | data | +| [health-ethics](./tracks/health-ethics/) | Research/clinical ethics | 4 | bio-research | +| [health-economics](./tracks/health-economics/) | HTA, cost-effectiveness | 4 | data, finance | +| [health-manuscripts](./tracks/health-manuscripts/) | Journal preparation | 4 | scientific-writing | +| [health-grants](./tracks/health-grants/) | Grant applications | 4 | research-grants | +| [health-medicolegal](./tracks/health-medicolegal/) | Child protection, affidavits, medico-legal | 4 | legal | + +### Summary + +- **18 tracks** total (1 meta + 17 implementation) +- **30 skills** across all tracks +- **14 commands** for key workflows +- **4 phases** of execution + +## Track Status + +- `planning` - Specification in progress +- `active` - Implementation underway +- `paused` - Temporarily halted +- `complete` - Finished and verified diff --git a/conductor/tracks/health-coding/index.md b/conductor/tracks/health-coding/index.md new file mode 100644 index 0000000..6a07fa2 --- /dev/null +++ b/conductor/tracks/health-coding/index.md @@ -0,0 +1,16 @@ +# Health-coding Track + +## Documents + +- [Specification](./spec.md) +- [Implementation Plan](./plan.md) +- [Metadata](./metadata.json) + +## Quick Links + +- [Project Index](../../index.md) +- [Tracks Registry](../../tracks.md) + +## Status + +See [metadata.json](./metadata.json) for current status and dependencies. diff --git a/conductor/tracks/health-coding/metadata.json b/conductor/tracks/health-coding/metadata.json new file mode 100644 index 0000000..29ea8aa --- /dev/null +++ b/conductor/tracks/health-coding/metadata.json @@ -0,0 +1,12 @@ +{ + "track_id": "health-coding", + "name": "Health Clinical Coding", + "description": "Clinical coding and classification - ICD-10, ICD-11, SNOMED, ACHI mapping and validation", + "status": "planning", + "created": "2026-02-11", + "priority": "medium", + "dependencies": ["health-core"], + "deliverable": "clinical-coding skill, /validate-coding command", + "adapts_from": ["data/data-validation"], + "classifications": ["ICD-10-AM", "ICD-11", "SNOMED-CT", "ACHI", "DRG"] +} diff --git a/conductor/tracks/health-coding/plan.md b/conductor/tracks/health-coding/plan.md new file mode 100644 index 0000000..b796d67 --- /dev/null +++ b/conductor/tracks/health-coding/plan.md @@ -0,0 +1,25 @@ +# Health Clinical Coding Track Plan + +## Phase 1: Clinical Coding Skill +*Dependencies: health-core* +*Estimated: 1-2 sessions* + +- [ ] Create `health/skills/clinical-coding/SKILL.md` + - Acceptance: ICD-10-AM coding guidance + - Acceptance: Classification system overview + - Acceptance: Code selection methodology + - Acceptance: Mapping between systems + - Acceptance: Common coding errors + - Acceptance: Documentation requirements + - Source patterns: `data/data-validation` + - MCP: ICD-10 Codes connector + +## Phase 2: Validate Coding Command +*Dependencies: Phase 1* +*Estimated: 0.5 sessions* + +- [ ] Create `health/commands/validate-coding.md` + - Acceptance: Code validation workflow + - Acceptance: Generates validation report + +**Checkpoint:** `conductor(checkpoint): Health clinical coding workflow complete` diff --git a/conductor/tracks/health-coding/spec.md b/conductor/tracks/health-coding/spec.md new file mode 100644 index 0000000..24b1805 --- /dev/null +++ b/conductor/tracks/health-coding/spec.md @@ -0,0 +1,57 @@ +# Health Clinical Coding Track Specification + +## Overview + +Clinical coding and classification support including ICD-10, ICD-11, SNOMED-CT, ACHI mapping, and coding validation for research datasets and clinical documentation. + +## Scope + +### Classification Systems +- **ICD-10-AM** (Australian Modification) +- **ICD-11** (WHO) +- **SNOMED-CT** (Clinical terminology) +- **ACHI** (Australian Classification of Health Interventions) +- **DRG** (Diagnosis Related Groups) + +### Use Cases +- Research dataset coding +- Clinical documentation improvement +- Classification mapping/conversion +- Coding audit support +- Population health data + +### Workflow +- Code lookup and selection +- Multi-system mapping +- Validation checking +- Documentation requirements +- Common errors avoidance + +## Deliverables + +### Skills +- `clinical-coding` - Clinical coding guidance and validation + +### Commands +- `/validate-coding` - Validate coding accuracy + +## Dependencies + +- `health-core` (plugin structure) + +## Adapts From + +- `data/data-validation` - Validation patterns + +## MCP Connectors + +- ICD-10 Codes MCP (existing) +- SNOMED CT Browser (potential) + +## Success Criteria + +- [ ] Supports ICD-10-AM coding +- [ ] Provides classification mapping guidance +- [ ] Validates code selection +- [ ] Documents coding rationale +- [ ] Identifies common coding errors diff --git a/conductor/tracks/health-complaints/index.md b/conductor/tracks/health-complaints/index.md new file mode 100644 index 0000000..2239a24 --- /dev/null +++ b/conductor/tracks/health-complaints/index.md @@ -0,0 +1,16 @@ +# Health-complaints Track + +## Documents + +- [Specification](./spec.md) +- [Implementation Plan](./plan.md) +- [Metadata](./metadata.json) + +## Quick Links + +- [Project Index](../../index.md) +- [Tracks Registry](../../tracks.md) + +## Status + +See [metadata.json](./metadata.json) for current status and dependencies. diff --git a/conductor/tracks/health-complaints/metadata.json b/conductor/tracks/health-complaints/metadata.json new file mode 100644 index 0000000..036babc --- /dev/null +++ b/conductor/tracks/health-complaints/metadata.json @@ -0,0 +1,11 @@ +{ + "track_id": "health-complaints", + "name": "Health Complaints", + "description": "Patient complaints management - clinician complaints, service/organizational complaints, resolution workflows", + "status": "planning", + "created": "2026-02-11", + "priority": "high", + "dependencies": ["health-core"], + "deliverable": "complaints-management skill, /submit-complaint command", + "adapts_from": ["customer-support/ticket-triage", "customer-support/escalation", "customer-support/response-drafting"] +} diff --git a/conductor/tracks/health-complaints/plan.md b/conductor/tracks/health-complaints/plan.md new file mode 100644 index 0000000..59c7d80 --- /dev/null +++ b/conductor/tracks/health-complaints/plan.md @@ -0,0 +1,30 @@ +# Health Complaints Track Plan + +## Phase 1: Complaints Skill +*Dependencies: health-core* +*Estimated: 1-2 sessions* + +- [ ] Create `health/skills/complaints-management/SKILL.md` + - Acceptance: Distinguishes clinician vs service complaints + - Acceptance: Severity framework adapted for healthcare (P1-P4 with patient safety context) + - Acceptance: Investigation workflow with timelines + - Acceptance: Escalation triggers to legal/regulatory + - Acceptance: Resolution documentation requirements + - Source patterns: `customer-support/ticket-triage`, `customer-support/escalation` + +## Phase 2: Complaints Command +*Dependencies: Phase 1* +*Estimated: 1 session* + +- [ ] Create `health/commands/submit-complaint.md` + - Acceptance: Collects complaint type + - Acceptance: Captures patient/staff safety concerns + - Acceptance: Routes to appropriate skill path + - Acceptance: Generates intake documentation + +**Checkpoint:** `conductor(checkpoint): Health complaints workflow complete` + +## Notes + +- May need to coordinate with `health-incidents` track - some complaints may trigger incident reports +- Regulatory reporting requirements vary by jurisdiction - parameterize diff --git a/conductor/tracks/health-complaints/spec.md b/conductor/tracks/health-complaints/spec.md new file mode 100644 index 0000000..54c69d5 --- /dev/null +++ b/conductor/tracks/health-complaints/spec.md @@ -0,0 +1,48 @@ +# Health Complaints Track Specification + +## Overview + +Patient complaints management workflows distinguishing between clinician complaints and service/organizational complaints. + +## Scope + +### Complaint Types + +| Type | Focus | Examples | +|------|-------|----------| +| **Clinician** | Individual practitioner performance/conduct | Bedside manner, competence, communication | +| **Service/Organizational** | Systems, processes, facilities | Wait times, access, environment, administrative | + +### Workflows + +1. **Intake** - Categorization, severity assessment, routing +2. **Investigation** - Fact gathering, interviews, documentation +3. **Resolution** - Response drafting, remediation, closure +4. **Escalation** - When to escalate to legal, regulatory, or executive + +### Key Distinctions from General Support + +- Healthcare-specific severity (patient safety implications) +- Regulatory reporting obligations +- Clinical governance involvement +- Medical records access considerations + +## Deliverables + +### Skills +- `complaints-management` - Unified complaints workflow with type differentiation + +### Commands +- `/submit-complaint` - Structured complaint intake + +## Dependencies + +- `health-core` (plugin structure must exist) + +## Success Criteria + +- [ ] Categorizes complaints by type (clinician vs service) +- [ ] Assesses severity with healthcare context +- [ ] Routes to appropriate investigation path +- [ ] Identifies regulatory reporting triggers +- [ ] Generates investigation documentation diff --git a/conductor/tracks/health-core/index.md b/conductor/tracks/health-core/index.md new file mode 100644 index 0000000..58ebe43 --- /dev/null +++ b/conductor/tracks/health-core/index.md @@ -0,0 +1,16 @@ +# Health-core Track + +## Documents + +- [Specification](./spec.md) +- [Implementation Plan](./plan.md) +- [Metadata](./metadata.json) + +## Quick Links + +- [Project Index](../../index.md) +- [Tracks Registry](../../tracks.md) + +## Status + +See [metadata.json](./metadata.json) for current status and dependencies. diff --git a/conductor/tracks/health-core/metadata.json b/conductor/tracks/health-core/metadata.json new file mode 100644 index 0000000..f0237dd --- /dev/null +++ b/conductor/tracks/health-core/metadata.json @@ -0,0 +1,10 @@ +{ + "track_id": "health-core", + "name": "Health Core", + "description": "Foundation plugin structure, shared utilities, and connector configuration for all health tracks", + "status": "planning", + "created": "2026-02-11", + "priority": "high", + "dependencies": [], + "deliverable": "health/ plugin skeleton with plugin.json, README, .mcp.json" +} diff --git a/conductor/tracks/health-core/plan.md b/conductor/tracks/health-core/plan.md new file mode 100644 index 0000000..de56982 --- /dev/null +++ b/conductor/tracks/health-core/plan.md @@ -0,0 +1,21 @@ +# Health Core Track Plan + +## Phase 1: Plugin Skeleton +*Estimated: 1 session* + +- [ ] Create `health/` directory structure + - Acceptance: Matches spec structure +- [ ] Create `health/.claude-plugin/plugin.json` + - Acceptance: Valid JSON, installs successfully +- [ ] Create `health/README.md` + - Acceptance: Documents 7 planned domains (complaints, incidents, risk, governance, ethics, compliance, procurement) +- [ ] Create `health/CONNECTORS.md` + - Acceptance: Lists document storage, issue tracking, clinical systems categories +- [ ] Create `health/.mcp.json` + - Acceptance: At least 2 connector templates + +**Checkpoint:** `conductor(checkpoint): Health core plugin foundation` + +## Notes + +This track must complete before any other health tracks can begin implementation. diff --git a/conductor/tracks/health-core/spec.md b/conductor/tracks/health-core/spec.md new file mode 100644 index 0000000..b0833ad --- /dev/null +++ b/conductor/tracks/health-core/spec.md @@ -0,0 +1,60 @@ +# Health Core Track Specification + +## Overview + +Foundation track for the health plugin ecosystem. Creates the plugin skeleton, shared infrastructure, and connector configuration that all other health tracks will build upon. + +## Deliverable + +A minimal but complete plugin structure that: +- Installs successfully via Claude Code +- Provides connector templates for healthcare tools +- Documents the overall health plugin vision +- Establishes patterns for other tracks to follow + +## Components + +### File Structure +``` +health/ +├── .claude-plugin/ +│ └── plugin.json # Plugin manifest +├── .mcp.json # Connector configurations +├── README.md # Plugin overview +└── CONNECTORS.md # Connector documentation +``` + +### plugin.json +- Name: `health` +- Version: `0.1.0` +- Description: Healthcare organization workflows +- Dependencies: None + +### .mcp.json +Template connectors for: +- Document storage (SharePoint, Box, Egnyte) +- Issue tracking (Jira, ServiceNow) +- Clinical systems (placeholder for TBD integrations) + +### README.md +- Plugin purpose and scope +- Available skills/commands (placeholder list) +- Installation instructions +- Customization guidance + +### CONNECTORS.md +- Connector categories +- Setup instructions per connector +- Authentication requirements +- Troubleshooting + +## Success Criteria + +- [ ] `claude plugin install ./health` succeeds +- [ ] plugin.json validates against schema +- [ ] README documents all planned domains +- [ ] At least 2 connector templates configured + +## Dependencies + +None - this is the foundation track. diff --git a/conductor/tracks/health-credentialing/index.md b/conductor/tracks/health-credentialing/index.md new file mode 100644 index 0000000..94d9525 --- /dev/null +++ b/conductor/tracks/health-credentialing/index.md @@ -0,0 +1,16 @@ +# Health-credentialing Track + +## Documents + +- [Specification](./spec.md) +- [Implementation Plan](./plan.md) +- [Metadata](./metadata.json) + +## Quick Links + +- [Project Index](../../index.md) +- [Tracks Registry](../../tracks.md) + +## Status + +See [metadata.json](./metadata.json) for current status and dependencies. diff --git a/conductor/tracks/health-credentialing/metadata.json b/conductor/tracks/health-credentialing/metadata.json new file mode 100644 index 0000000..df5ebe1 --- /dev/null +++ b/conductor/tracks/health-credentialing/metadata.json @@ -0,0 +1,11 @@ +{ + "track_id": "health-credentialing", + "name": "Health Credentialing", + "description": "Provider credentialing, privileging, license verification, and clinical staff onboarding/offboarding", + "status": "planning", + "created": "2026-02-11", + "priority": "medium", + "dependencies": ["health-core"], + "deliverable": "credentialing, privileging skills, /verify-credentials command", + "adapts_from": ["productivity/memory-management"] +} diff --git a/conductor/tracks/health-credentialing/plan.md b/conductor/tracks/health-credentialing/plan.md new file mode 100644 index 0000000..5f9d76e --- /dev/null +++ b/conductor/tracks/health-credentialing/plan.md @@ -0,0 +1,29 @@ +# Health Credentialing Track Plan + +## Phase 1: Credentialing Skill +*Dependencies: health-core* +*Estimated: 1 session* + +- [ ] Create `health/skills/credentialing/SKILL.md` + - Acceptance: Credentialing workflow by provider type + - Acceptance: Primary source verification checklist + - Acceptance: Committee preparation guidance + +## Phase 2: Privileging Skill +*Dependencies: Phase 1* +*Estimated: 1 session* + +- [ ] Create `health/skills/privileging/SKILL.md` + - Acceptance: Privilege delineation categories + - Acceptance: Competency verification requirements + - Acceptance: Renewal timeline tracking + +## Phase 3: Verify Credentials Command +*Dependencies: Phase 1* +*Estimated: 0.5 sessions* + +- [ ] Create `health/commands/verify-credentials.md` + - Acceptance: Initiates verification workflow + - Acceptance: Tracks verification status + +**Checkpoint:** `conductor(checkpoint): Health credentialing workflow complete` diff --git a/conductor/tracks/health-credentialing/spec.md b/conductor/tracks/health-credentialing/spec.md new file mode 100644 index 0000000..60aaa8e --- /dev/null +++ b/conductor/tracks/health-credentialing/spec.md @@ -0,0 +1,54 @@ +# Health Credentialing Track Specification + +## Overview + +Provider credentialing, privileging, license verification, and clinical staff onboarding/offboarding workflows. + +## Scope + +### Credentialing +- Initial credentialing applications +- Primary source verification +- Background check coordination +- Credential committee preparation + +### Privileging +- Delineation of privileges +- Competency verification +- Proctoring arrangements +- Privilege renewals + +### License Management +- License tracking and expiration alerts +- DEA certification +- Board certifications +- Malpractice history + +### Onboarding/Offboarding +- Orientation workflows +- Access provisioning +- Termination procedures + +## Deliverables + +### Skills +- `credentialing` - Credentialing workflow and verification +- `privileging` - Privilege delineation and management + +### Commands +- `/verify-credentials` - Initiate credential verification + +## Dependencies + +- `health-core` (plugin structure) + +## Adapts From + +- `productivity/memory-management` - Tracking context and reminders + +## Success Criteria + +- [ ] Guides initial credentialing process +- [ ] Tracks verification requirements by provider type +- [ ] Supports privilege delineation +- [ ] Identifies re-credentialing timelines diff --git a/conductor/tracks/health-data-analysis/index.md b/conductor/tracks/health-data-analysis/index.md new file mode 100644 index 0000000..160cb30 --- /dev/null +++ b/conductor/tracks/health-data-analysis/index.md @@ -0,0 +1,16 @@ +# Health-data-analysis Track + +## Documents + +- [Specification](./spec.md) +- [Implementation Plan](./plan.md) +- [Metadata](./metadata.json) + +## Quick Links + +- [Project Index](../../index.md) +- [Tracks Registry](../../tracks.md) + +## Status + +See [metadata.json](./metadata.json) for current status and dependencies. diff --git a/conductor/tracks/health-data-analysis/metadata.json b/conductor/tracks/health-data-analysis/metadata.json new file mode 100644 index 0000000..96bee00 --- /dev/null +++ b/conductor/tracks/health-data-analysis/metadata.json @@ -0,0 +1,12 @@ +{ + "track_id": "health-data-analysis", + "name": "Health Data Analysis", + "description": "Health data analysis and reporting - epidemiological analyses, population health, formatted outputs", + "status": "planning", + "created": "2026-02-11", + "priority": "medium", + "dependencies": ["health-core", "health-coding"], + "deliverable": "health-data-report skill, /analyze-health-data command", + "adapts_from": ["data/statistical-analysis", "data/data-visualization", "document-skills/xlsx", "document-skills/pdf"], + "outputs": ["epidemiological-reports", "forest-plots", "survival-curves", "population-dashboards"] +} diff --git a/conductor/tracks/health-data-analysis/plan.md b/conductor/tracks/health-data-analysis/plan.md new file mode 100644 index 0000000..613546e --- /dev/null +++ b/conductor/tracks/health-data-analysis/plan.md @@ -0,0 +1,24 @@ +# Health Data Analysis Track Plan + +## Phase 1: Health Data Report Skill +*Dependencies: health-core, health-coding* +*Estimated: 1-2 sessions* + +- [ ] Create `health/skills/health-data-report/SKILL.md` + - Acceptance: Analysis type selection guidance + - Acceptance: Epidemiological methods overview + - Acceptance: Standard health metrics + - Acceptance: Visualization types (forest plots, survival curves) + - Acceptance: Report structure templates + - Source patterns: `data/statistical-analysis`, `data/data-visualization` + +## Phase 2: Analyze Health Data Command +*Dependencies: Phase 1* +*Estimated: 0.5 sessions* + +- [ ] Create `health/commands/analyze-health-data.md` + - Acceptance: Analysis type selection + - Acceptance: Data requirements checklist + - Acceptance: Generates analysis plan + +**Checkpoint:** `conductor(checkpoint): Health data analysis workflow complete` diff --git a/conductor/tracks/health-data-analysis/spec.md b/conductor/tracks/health-data-analysis/spec.md new file mode 100644 index 0000000..48080ee --- /dev/null +++ b/conductor/tracks/health-data-analysis/spec.md @@ -0,0 +1,54 @@ +# Health Data Analysis Track Specification + +## Overview + +Health data analysis and reporting workflows for epidemiological analyses, population health, and formatted outputs including statistical reports and visualizations. + +## Scope + +### Analysis Types +- Descriptive epidemiology +- Analytical epidemiology (cohort, case-control) +- Survival analysis +- Trend analysis +- Population health metrics + +### Outputs +- Epidemiological reports +- Forest plots +- Survival curves (Kaplan-Meier) +- Population dashboards +- Statistical tables + +### Tools Integration +- Statistical analysis (R, Python patterns) +- Visualization (matplotlib, seaborn, plotly) +- Document generation (xlsx, pdf) + +## Deliverables + +### Skills +- `health-data-report` - Health data analysis and reporting + +### Commands +- `/analyze-health-data` - Initiate health data analysis + +## Dependencies + +- `health-core` (plugin structure) +- `health-coding` (for coded datasets) + +## Adapts From + +- `data/statistical-analysis` - Statistical methods +- `data/data-visualization` - Visualization patterns +- `document-skills/xlsx` - Spreadsheet outputs +- `document-skills/pdf` - Report generation + +## Success Criteria + +- [ ] Guides epidemiological analysis selection +- [ ] Supports standard health metrics +- [ ] Generates formatted statistical outputs +- [ ] Creates publication-ready visualizations +- [ ] Produces structured reports diff --git a/conductor/tracks/health-economics/index.md b/conductor/tracks/health-economics/index.md new file mode 100644 index 0000000..e054805 --- /dev/null +++ b/conductor/tracks/health-economics/index.md @@ -0,0 +1,16 @@ +# Health-economics Track + +## Documents + +- [Specification](./spec.md) +- [Implementation Plan](./plan.md) +- [Metadata](./metadata.json) + +## Quick Links + +- [Project Index](../../index.md) +- [Tracks Registry](../../tracks.md) + +## Status + +See [metadata.json](./metadata.json) for current status and dependencies. diff --git a/conductor/tracks/health-economics/metadata.json b/conductor/tracks/health-economics/metadata.json new file mode 100644 index 0000000..2c04467 --- /dev/null +++ b/conductor/tracks/health-economics/metadata.json @@ -0,0 +1,12 @@ +{ + "track_id": "health-economics", + "name": "Health Economics", + "description": "Health economic evaluation - cost-effectiveness, cost-utility, HTA submissions, PBAC/MSAC/NICE perspectives", + "status": "planning", + "created": "2026-02-11", + "priority": "high", + "dependencies": ["health-core", "health-evidence"], + "deliverable": "health-econ-eval, hta-submission skills, /economic-evaluation command", + "adapts_from": ["data/statistical-analysis", "finance/financial-statements"], + "frameworks": ["PBAC", "MSAC", "NICE", "CADTH"] +} diff --git a/conductor/tracks/health-economics/plan.md b/conductor/tracks/health-economics/plan.md new file mode 100644 index 0000000..2129c1a --- /dev/null +++ b/conductor/tracks/health-economics/plan.md @@ -0,0 +1,36 @@ +# Health Economics Track Plan + +## Phase 1: Economic Evaluation Skill +*Dependencies: health-core, health-evidence* +*Estimated: 2 sessions* + +- [ ] Create `health/skills/health-econ-eval/SKILL.md` + - Acceptance: Evaluation type selection (CEA, CUA, CBA) + - Acceptance: Reference case requirements by jurisdiction + - Acceptance: Decision modeling guidance + - Acceptance: Costing methodology + - Acceptance: QALY/DALY calculation guidance + - Acceptance: Sensitivity analysis framework + - Source patterns: `data/statistical-analysis` + +## Phase 2: HTA Submission Skill +*Dependencies: Phase 1* +*Estimated: 1-2 sessions* + +- [ ] Create `health/skills/hta-submission/SKILL.md` + - Acceptance: PBAC submission template + - Acceptance: MSAC submission template + - Acceptance: NICE submission template + - Acceptance: Evidence requirements by jurisdiction + - Acceptance: Common submission pitfalls + +## Phase 3: Economic Evaluation Command +*Dependencies: Phase 1* +*Estimated: 0.5 sessions* + +- [ ] Create `health/commands/economic-evaluation.md` + - Acceptance: Evaluation type intake + - Acceptance: Jurisdiction selection + - Acceptance: Generates evaluation plan + +**Checkpoint:** `conductor(checkpoint): Health economics workflow complete` diff --git a/conductor/tracks/health-economics/spec.md b/conductor/tracks/health-economics/spec.md new file mode 100644 index 0000000..cb938e9 --- /dev/null +++ b/conductor/tracks/health-economics/spec.md @@ -0,0 +1,60 @@ +# Health Economics Track Specification + +## Overview + +Health economic evaluation workflows including cost-effectiveness analysis, cost-utility analysis, HTA submissions, and multi-perspective evaluations (PBAC, MSAC, NICE, CADTH). + +## Scope + +### Economic Evaluation Types +- Cost-effectiveness analysis (CEA) +- Cost-utility analysis (CUA) +- Cost-benefit analysis (CBA) +- Budget impact analysis (BIA) + +### HTA Submissions +- PBAC (Australia - Pharmaceutical Benefits) +- MSAC (Australia - Medical Services) +- NICE (UK) +- CADTH (Canada) +- PHARMAC (NZ) + +### Decision Modeling +- Decision tree models +- Markov models +- Microsimulation +- Sensitivity analyses (deterministic, probabilistic) + +## Deliverables + +### Skills +- `health-econ-eval` - Economic evaluation methodology +- `hta-submission` - HTA submission preparation + +### Commands +- `/economic-evaluation` - Initiate economic evaluation + +## Dependencies + +- `health-core` (plugin structure) +- `health-evidence` (for clinical effectiveness inputs) + +## Adapts From + +- `data/statistical-analysis` - Analytical methods +- `finance/financial-statements` - Reporting structure + +## Frameworks + +- PBAC Guidelines (Australia) +- MSAC Guidelines (Australia) +- NICE Reference Case (UK) +- CADTH Guidelines (Canada) + +## Success Criteria + +- [ ] Guides economic evaluation by type +- [ ] Supports HTA submission preparation +- [ ] Includes decision modeling frameworks +- [ ] Provides sensitivity analysis guidance +- [ ] Encodes reference case requirements diff --git a/conductor/tracks/health-ethics/index.md b/conductor/tracks/health-ethics/index.md new file mode 100644 index 0000000..622dc56 --- /dev/null +++ b/conductor/tracks/health-ethics/index.md @@ -0,0 +1,16 @@ +# Health-ethics Track + +## Documents + +- [Specification](./spec.md) +- [Implementation Plan](./plan.md) +- [Metadata](./metadata.json) + +## Quick Links + +- [Project Index](../../index.md) +- [Tracks Registry](../../tracks.md) + +## Status + +See [metadata.json](./metadata.json) for current status and dependencies. diff --git a/conductor/tracks/health-ethics/metadata.json b/conductor/tracks/health-ethics/metadata.json new file mode 100644 index 0000000..a411581 --- /dev/null +++ b/conductor/tracks/health-ethics/metadata.json @@ -0,0 +1,11 @@ +{ + "track_id": "health-ethics", + "name": "Health Ethics", + "description": "Research ethics (REC/IRB) and clinical ethics consultation workflows", + "status": "planning", + "created": "2026-02-11", + "priority": "medium", + "dependencies": ["health-core"], + "deliverable": "research-ethics, clinical-ethics skills, /ethics-review command", + "adapts_from": ["bio-research", "legal/compliance"] +} diff --git a/conductor/tracks/health-ethics/plan.md b/conductor/tracks/health-ethics/plan.md new file mode 100644 index 0000000..9928dfc --- /dev/null +++ b/conductor/tracks/health-ethics/plan.md @@ -0,0 +1,31 @@ +# Health Ethics Track Plan + +## Phase 1: Research Ethics Skill +*Dependencies: health-core* +*Estimated: 1-2 sessions* + +- [ ] Create `health/skills/research-ethics/SKILL.md` + - Acceptance: REC/IRB application workflow + - Acceptance: Protocol review checklist + - Acceptance: Informed consent guidance + - Acceptance: Study type variations + - Source patterns: `bio-research` + +## Phase 2: Clinical Ethics Skill +*Dependencies: Phase 1* +*Estimated: 1 session* + +- [ ] Create `health/skills/clinical-ethics/SKILL.md` + - Acceptance: Consultation request workflow + - Acceptance: Case analysis framework + - Acceptance: Committee preparation guidance + +## Phase 3: Ethics Review Command +*Dependencies: Phase 1* +*Estimated: 0.5 sessions* + +- [ ] Create `health/commands/ethics-review.md` + - Acceptance: Review type selection + - Acceptance: Routes to appropriate skill + +**Checkpoint:** `conductor(checkpoint): Health ethics workflow complete` diff --git a/conductor/tracks/health-ethics/spec.md b/conductor/tracks/health-ethics/spec.md new file mode 100644 index 0000000..5bebab4 --- /dev/null +++ b/conductor/tracks/health-ethics/spec.md @@ -0,0 +1,45 @@ +# Health Ethics Track Specification + +## Overview + +Research ethics (REC/IRB) and clinical ethics consultation workflows for healthcare organizations. + +## Scope + +### Research Ethics +- REC/IRB application preparation +- Protocol review +- Informed consent drafting +- Governance process navigation +- Clinical trial registration + +### Clinical Ethics +- Ethics consultation requests +- Case analysis frameworks +- Committee preparation +- Documentation requirements + +## Deliverables + +### Skills +- `research-ethics` - REC/IRB application guidance +- `clinical-ethics` - Clinical ethics consultation workflow + +### Commands +- `/ethics-review` - Request ethics review + +## Dependencies + +- `health-core` (plugin structure) + +## Adapts From + +- `bio-research` - Research workflows +- `legal/compliance` - Regulatory patterns + +## Success Criteria + +- [ ] Guides REC/IRB application process +- [ ] Supports clinical ethics consultations +- [ ] Provides consent document templates +- [ ] Documents governance requirements diff --git a/conductor/tracks/health-evidence/index.md b/conductor/tracks/health-evidence/index.md new file mode 100644 index 0000000..1dfa82c --- /dev/null +++ b/conductor/tracks/health-evidence/index.md @@ -0,0 +1,16 @@ +# Health-evidence Track + +## Documents + +- [Specification](./spec.md) +- [Implementation Plan](./plan.md) +- [Metadata](./metadata.json) + +## Quick Links + +- [Project Index](../../index.md) +- [Tracks Registry](../../tracks.md) + +## Status + +See [metadata.json](./metadata.json) for current status and dependencies. diff --git a/conductor/tracks/health-evidence/metadata.json b/conductor/tracks/health-evidence/metadata.json new file mode 100644 index 0000000..7be6961 --- /dev/null +++ b/conductor/tracks/health-evidence/metadata.json @@ -0,0 +1,12 @@ +{ + "track_id": "health-evidence", + "name": "Health Evidence Synthesis", + "description": "Systematic reviews, evidence synthesis, PRISMA workflows, meta-analysis support", + "status": "planning", + "created": "2026-02-11", + "priority": "high", + "dependencies": ["health-core"], + "deliverable": "systematic-review, evidence-synthesis skills, /start-review command", + "adapts_from": ["bio-research"], + "connectors": ["pubmed", "biorxiv", "cochrane"] +} diff --git a/conductor/tracks/health-evidence/plan.md b/conductor/tracks/health-evidence/plan.md new file mode 100644 index 0000000..0bc1022 --- /dev/null +++ b/conductor/tracks/health-evidence/plan.md @@ -0,0 +1,34 @@ +# Health Evidence Synthesis Track Plan + +## Phase 1: Systematic Review Skill +*Dependencies: health-core* +*Estimated: 1-2 sessions* + +- [ ] Create `health/skills/systematic-review/SKILL.md` + - Acceptance: PRISMA workflow guidance + - Acceptance: Search strategy development framework + - Acceptance: Screening and selection process + - Acceptance: Data extraction templates + - Acceptance: Risk of bias tools (RoB 2, ROBINS-I) + - Acceptance: GRADE evidence grading + - Source patterns: `bio-research`, PRISMA guidelines + +## Phase 2: Evidence Synthesis Skill +*Dependencies: Phase 1* +*Estimated: 1 session* + +- [ ] Create `health/skills/evidence-synthesis/SKILL.md` + - Acceptance: Review type selection guidance + - Acceptance: Scoping/rapid review adaptations + - Acceptance: Evidence mapping methodology + +## Phase 3: Start Review Command +*Dependencies: Phase 1* +*Estimated: 0.5 sessions* + +- [ ] Create `health/commands/start-review.md` + - Acceptance: Review type selection + - Acceptance: Protocol template generation + - Acceptance: Project setup checklist + +**Checkpoint:** `conductor(checkpoint): Health evidence synthesis workflow complete` diff --git a/conductor/tracks/health-evidence/spec.md b/conductor/tracks/health-evidence/spec.md new file mode 100644 index 0000000..91f9e97 --- /dev/null +++ b/conductor/tracks/health-evidence/spec.md @@ -0,0 +1,50 @@ +# Health Evidence Synthesis Track Specification + +## Overview + +Systematic reviews and evidence synthesis workflows supporting PRISMA methodology, search strategy development, and meta-analysis. + +## Scope + +### Systematic Review Workflow +- Protocol development (PROSPERO registration) +- Search strategy design +- Study screening and selection +- Data extraction +- Risk of bias assessment +- Meta-analysis (where appropriate) +- GRADE evidence grading +- PRISMA reporting + +### Evidence Synthesis Types +- Systematic reviews +- Scoping reviews +- Rapid reviews +- Meta-analyses +- Evidence maps + +## Deliverables + +### Skills +- `systematic-review` - Full systematic review workflow +- `evidence-synthesis` - Broader evidence synthesis methods + +### Commands +- `/start-review` - Initiate systematic review project + +## Dependencies + +- `health-core` (plugin structure) + +## Adapts From + +- `bio-research` - Literature search patterns +- MCP connectors: PubMed, bioRxiv, Cochrane + +## Success Criteria + +- [ ] Guides PRISMA-compliant review process +- [ ] Supports search strategy development +- [ ] Provides data extraction templates +- [ ] Includes risk of bias assessment tools +- [ ] Supports GRADE evidence grading diff --git a/conductor/tracks/health-financial/index.md b/conductor/tracks/health-financial/index.md new file mode 100644 index 0000000..4901b08 --- /dev/null +++ b/conductor/tracks/health-financial/index.md @@ -0,0 +1,16 @@ +# Health-financial Track + +## Documents + +- [Specification](./spec.md) +- [Implementation Plan](./plan.md) +- [Metadata](./metadata.json) + +## Quick Links + +- [Project Index](../../index.md) +- [Tracks Registry](../../tracks.md) + +## Status + +See [metadata.json](./metadata.json) for current status and dependencies. diff --git a/conductor/tracks/health-financial/metadata.json b/conductor/tracks/health-financial/metadata.json new file mode 100644 index 0000000..d76a78c --- /dev/null +++ b/conductor/tracks/health-financial/metadata.json @@ -0,0 +1,11 @@ +{ + "track_id": "health-financial", + "name": "Health Financial", + "description": "Charge capture review, payer contract management, grant management, revenue cycle", + "status": "planning", + "created": "2026-02-11", + "priority": "medium", + "dependencies": ["health-core"], + "deliverable": "payer-contracts, charge-capture, grant-management skills", + "adapts_from": ["legal/contract-review", "finance/reconciliation"] +} diff --git a/conductor/tracks/health-financial/plan.md b/conductor/tracks/health-financial/plan.md new file mode 100644 index 0000000..7c8ee71 --- /dev/null +++ b/conductor/tracks/health-financial/plan.md @@ -0,0 +1,31 @@ +# Health Financial Track Plan + +## Phase 1: Payer Contracts Skill +*Dependencies: health-core* +*Estimated: 1-2 sessions* + +- [ ] Create `health/skills/payer-contracts/SKILL.md` + - Acceptance: Healthcare-specific contract review checklist + - Acceptance: Key term identification (rates, timeliness, medical necessity) + - Acceptance: Renewal tracking guidance + - Source patterns: `legal/contract-review` + +## Phase 2: Charge Capture Skill +*Dependencies: Phase 1* +*Estimated: 1 session* + +- [ ] Create `health/skills/charge-capture/SKILL.md` + - Acceptance: CDM review methodology + - Acceptance: Coding validation guidance + - Acceptance: Compliance red flags + - Source patterns: `finance/reconciliation` + +## Phase 3: Review Payer Contract Command +*Dependencies: Phase 1* +*Estimated: 0.5 sessions* + +- [ ] Create `health/commands/review-payer-contract.md` + - Acceptance: Contract intake workflow + - Acceptance: Generates analysis report + +**Checkpoint:** `conductor(checkpoint): Health financial workflow complete` diff --git a/conductor/tracks/health-financial/spec.md b/conductor/tracks/health-financial/spec.md new file mode 100644 index 0000000..db2977f --- /dev/null +++ b/conductor/tracks/health-financial/spec.md @@ -0,0 +1,56 @@ +# Health Financial Track Specification + +## Overview + +Charge capture review, payer contract management, grant management, and revenue cycle support. + +## Scope + +### Payer Contracts +- Contract review (healthcare-specific terms) +- Rate analysis +- Renewal tracking +- Negotiation support + +### Charge Capture +- Charge description master (CDM) review +- Coding validation +- Charge reconciliation +- Compliance monitoring + +### Grant Management +- Grant application support +- Budget tracking +- Reporting requirements +- Closeout procedures + +### Revenue Cycle +- Denial management +- Appeals process +- AR follow-up + +## Deliverables + +### Skills +- `payer-contracts` - Healthcare payer contract review and management +- `charge-capture` - Charge capture review and validation + +### Commands +- `/review-payer-contract` - Payer contract analysis + +## Dependencies + +- `health-core` (plugin structure) + +## Adapts From + +- `legal/contract-review` - Contract analysis methodology +- `finance/reconciliation` - Reconciliation workflows +- `finance/audit-support` - Payer audit preparation + +## Success Criteria + +- [ ] Reviews payer contracts for healthcare-specific terms +- [ ] Supports charge capture validation +- [ ] Tracks contract renewal timelines +- [ ] Guides denial appeal process diff --git a/conductor/tracks/health-governance/index.md b/conductor/tracks/health-governance/index.md new file mode 100644 index 0000000..a8744ae --- /dev/null +++ b/conductor/tracks/health-governance/index.md @@ -0,0 +1,16 @@ +# Health-governance Track + +## Documents + +- [Specification](./spec.md) +- [Implementation Plan](./plan.md) +- [Metadata](./metadata.json) + +## Quick Links + +- [Project Index](../../index.md) +- [Tracks Registry](../../tracks.md) + +## Status + +See [metadata.json](./metadata.json) for current status and dependencies. diff --git a/conductor/tracks/health-governance/metadata.json b/conductor/tracks/health-governance/metadata.json new file mode 100644 index 0000000..7832cd3 --- /dev/null +++ b/conductor/tracks/health-governance/metadata.json @@ -0,0 +1,11 @@ +{ + "track_id": "health-governance", + "name": "Health Governance", + "description": "Governance document development - clinical services plans, medicine standing orders, policies, procedures, guidelines", + "status": "planning", + "created": "2026-02-11", + "priority": "medium", + "dependencies": ["health-core"], + "deliverable": "policy-development, procedure-development, guideline-development skills", + "adapts_from": ["legal/compliance", "product-management/stakeholder-comms"] +} diff --git a/conductor/tracks/health-governance/plan.md b/conductor/tracks/health-governance/plan.md new file mode 100644 index 0000000..0ebd559 --- /dev/null +++ b/conductor/tracks/health-governance/plan.md @@ -0,0 +1,30 @@ +# Health Governance Track Plan + +## Phase 1: Policy Development Skill +*Dependencies: health-core* +*Estimated: 1 session* + +- [ ] Create `health/skills/policy-development/SKILL.md` + - Acceptance: Policy structure template + - Acceptance: Approval workflow + - Acceptance: Review cycle management + - Source patterns: `legal/compliance` + +## Phase 2: Procedure Development Skill +*Dependencies: Phase 1* +*Estimated: 1 session* + +- [ ] Create `health/skills/procedure-development/SKILL.md` + - Acceptance: Procedure documentation format + - Acceptance: Process mapping guidance + +## Phase 3: Guideline Development Skill +*Dependencies: Phase 1* +*Estimated: 1 session* + +- [ ] Create `health/skills/guideline-development/SKILL.md` + - Acceptance: Clinical guideline structure + - Acceptance: Evidence grading integration + - Acceptance: NHMRC guidance levels + +**Checkpoint:** `conductor(checkpoint): Health governance workflow complete` diff --git a/conductor/tracks/health-governance/spec.md b/conductor/tracks/health-governance/spec.md new file mode 100644 index 0000000..2e7bd90 --- /dev/null +++ b/conductor/tracks/health-governance/spec.md @@ -0,0 +1,45 @@ +# Health Governance Track Specification + +## Overview + +Governance document development for clinical services plans, medicine standing orders, policies, procedures, and guidelines. + +## Scope + +### Document Types +- Clinical services plans +- Medicine standing orders +- Policies +- Procedures +- Guidelines + +### Workflow +- Document initiation +- Stakeholder consultation +- Draft development +- Review and approval +- Implementation support +- Review cycle management + +## Deliverables + +### Skills +- `policy-development` - Policy drafting and management +- `procedure-development` - Procedure documentation +- `guideline-development` - Clinical guideline development + +## Dependencies + +- `health-core` (plugin structure) + +## Adapts From + +- `legal/compliance` - Regulatory compliance patterns +- `product-management/stakeholder-comms` - Stakeholder management + +## Success Criteria + +- [ ] Guides document development by type +- [ ] Supports approval workflow +- [ ] Manages review cycles +- [ ] Ensures consistency across document types diff --git a/conductor/tracks/health-grants/index.md b/conductor/tracks/health-grants/index.md new file mode 100644 index 0000000..9616aa3 --- /dev/null +++ b/conductor/tracks/health-grants/index.md @@ -0,0 +1,16 @@ +# Health-grants Track + +## Documents + +- [Specification](./spec.md) +- [Implementation Plan](./plan.md) +- [Metadata](./metadata.json) + +## Quick Links + +- [Project Index](../../index.md) +- [Tracks Registry](../../tracks.md) + +## Status + +See [metadata.json](./metadata.json) for current status and dependencies. diff --git a/conductor/tracks/health-grants/metadata.json b/conductor/tracks/health-grants/metadata.json new file mode 100644 index 0000000..75b38f0 --- /dev/null +++ b/conductor/tracks/health-grants/metadata.json @@ -0,0 +1,12 @@ +{ + "track_id": "health-grants", + "name": "Health Grants", + "description": "Grant/funding application support - NHMRC, MRFF, HRC (NZ), ARC health-related", + "status": "planning", + "created": "2026-02-11", + "priority": "medium", + "dependencies": ["health-core", "health-evidence"], + "deliverable": "grant-writer skill, /grant-application command", + "adapts_from": ["research-grants"], + "funders": ["NHMRC", "MRFF", "HRC-NZ", "ARC", "NIH"] +} diff --git a/conductor/tracks/health-grants/plan.md b/conductor/tracks/health-grants/plan.md new file mode 100644 index 0000000..d9e7389 --- /dev/null +++ b/conductor/tracks/health-grants/plan.md @@ -0,0 +1,25 @@ +# Health Grants Track Plan + +## Phase 1: Grant Writer Skill +*Dependencies: health-core* +*Estimated: 1-2 sessions* + +- [ ] Create `health/skills/grant-writer/SKILL.md` + - Acceptance: Funder/scheme selection guidance + - Acceptance: NHMRC structure and requirements + - Acceptance: MRFF structure and requirements + - Acceptance: HRC (NZ) structure and requirements + - Acceptance: Assessment criteria alignment + - Acceptance: Budget justification framework + - Source patterns: `research-grants` + +## Phase 2: Grant Application Command +*Dependencies: Phase 1* +*Estimated: 0.5 sessions* + +- [ ] Create `health/commands/grant-application.md` + - Acceptance: Funder selection + - Acceptance: Scheme selection + - Acceptance: Generates application checklist + +**Checkpoint:** `conductor(checkpoint): Health grants workflow complete` diff --git a/conductor/tracks/health-grants/spec.md b/conductor/tracks/health-grants/spec.md new file mode 100644 index 0000000..e694408 --- /dev/null +++ b/conductor/tracks/health-grants/spec.md @@ -0,0 +1,55 @@ +# Health Grants Track Specification + +## Overview + +Grant and funding application support for major health research funders with section requirements, word limits, and assessment criteria. + +## Scope + +### Funders +- **NHMRC** (Australia - National Health and Medical Research Council) +- **MRFF** (Australia - Medical Research Future Fund) +- **HRC** (New Zealand - Health Research Council) +- **ARC** (Australia - Medical/health-related Discovery Projects) +- **NIH** (US - National Institutes of Health) + +### Application Components +- Research proposal structure +- Budget justification +- Track record/CI statements +- Significance and innovation +- Approach/methodology +- Team capability + +### Workflow +- Funder selection +- Scheme requirements +- Strategic framing +- Section drafting +- Word count management +- Review iteration + +## Deliverables + +### Skills +- `grant-writer` - Grant application preparation + +### Commands +- `/grant-application` - Initiate grant application + +## Dependencies + +- `health-core` (plugin structure) +- `health-evidence` (for background/methodology) + +## Adapts From + +- `research-grants` - Grant writing patterns + +## Success Criteria + +- [ ] Guides funder/scheme selection +- [ ] Provides section templates by scheme +- [ ] Manages word limits +- [ ] Aligns with assessment criteria +- [ ] Supports iterative refinement diff --git a/conductor/tracks/health-incidents/index.md b/conductor/tracks/health-incidents/index.md new file mode 100644 index 0000000..1bbdf99 --- /dev/null +++ b/conductor/tracks/health-incidents/index.md @@ -0,0 +1,16 @@ +# Health-incidents Track + +## Documents + +- [Specification](./spec.md) +- [Implementation Plan](./plan.md) +- [Metadata](./metadata.json) + +## Quick Links + +- [Project Index](../../index.md) +- [Tracks Registry](../../tracks.md) + +## Status + +See [metadata.json](./metadata.json) for current status and dependencies. diff --git a/conductor/tracks/health-incidents/metadata.json b/conductor/tracks/health-incidents/metadata.json new file mode 100644 index 0000000..9515447 --- /dev/null +++ b/conductor/tracks/health-incidents/metadata.json @@ -0,0 +1,11 @@ +{ + "track_id": "health-incidents", + "name": "Health Incidents", + "description": "Serious adverse events (SAEs) and incident reporting, investigation, and escalation workflows", + "status": "planning", + "created": "2026-02-11", + "priority": "high", + "dependencies": ["health-core"], + "deliverable": "incident-reporting skill, /report-incident command", + "adapts_from": ["customer-support/escalation", "legal/legal-risk-assessment"] +} diff --git a/conductor/tracks/health-incidents/plan.md b/conductor/tracks/health-incidents/plan.md new file mode 100644 index 0000000..cdfe792 --- /dev/null +++ b/conductor/tracks/health-incidents/plan.md @@ -0,0 +1,31 @@ +# Health Incidents Track Plan + +## Phase 1: Incident Reporting Skill +*Dependencies: health-core* +*Estimated: 1-2 sessions* + +- [ ] Create `health/skills/incident-reporting/SKILL.md` + - Acceptance: Incident type taxonomy + - Acceptance: Severity classification (SAC or equivalent) + - Acceptance: Immediate response protocol + - Acceptance: Investigation methodology (RCA) + - Acceptance: Mandatory reporting triggers + - Acceptance: QI documentation requirements + +## Phase 2: Incident Command +*Dependencies: Phase 1* +*Estimated: 1 session* + +- [ ] Create `health/commands/report-incident.md` + - Acceptance: Rapid intake workflow + - Acceptance: Captures immediate safety concerns + - Acceptance: Routes to appropriate severity path + - Acceptance: Triggers notifications where required + +**Checkpoint:** `conductor(checkpoint): Health incidents workflow complete` + +## Notes + +- Coordinate with `health-complaints` - some complaints are incident reports +- May need `health-risk` integration for trend analysis +- Regulatory requirements vary significantly by jurisdiction diff --git a/conductor/tracks/health-incidents/spec.md b/conductor/tracks/health-incidents/spec.md new file mode 100644 index 0000000..25257d8 --- /dev/null +++ b/conductor/tracks/health-incidents/spec.md @@ -0,0 +1,48 @@ +# Health Incidents Track Specification + +## Overview + +Serious adverse events (SAEs) and incident reporting, investigation, and escalation workflows. Distinct from complaints - these are safety events that may or may not involve patient/family complaints. + +## Scope + +### Incident Types +- Patient safety incidents +- Near misses +- Sentinel events +- Adverse drug reactions +- Device-related incidents +- Healthcare-associated infections + +### Key Workflows + +1. **Detection** - Identification and immediate reporting +2. **Classification** - Severity (SAC 1-4 or equivalent) +3. **Investigation** - Root cause analysis, RCA methodology +4. **Reporting** - Regulatory notifications, internal escalations +5. **Prevention** - Action items, system improvements + +### Regulatory Context +- Mandatory reporting requirements +- Sentinel event protocols +- Quality improvement protections + +## Deliverables + +### Skills +- `incident-reporting` - Incident detection, classification, investigation workflow + +### Commands +- `/report-incident` - Incident intake and routing + +## Dependencies + +- `health-core` (plugin structure) + +## Success Criteria + +- [ ] Classifies incident severity appropriately +- [ ] Identifies mandatory reporting triggers +- [ ] Supports RCA methodology +- [ ] Links to quality improvement tracking +- [ ] Maintains privilege protections where applicable diff --git a/conductor/tracks/health-information/index.md b/conductor/tracks/health-information/index.md new file mode 100644 index 0000000..79dcb14 --- /dev/null +++ b/conductor/tracks/health-information/index.md @@ -0,0 +1,16 @@ +# Health-information Track + +## Documents + +- [Specification](./spec.md) +- [Implementation Plan](./plan.md) +- [Metadata](./metadata.json) + +## Quick Links + +- [Project Index](../../index.md) +- [Tracks Registry](../../tracks.md) + +## Status + +See [metadata.json](./metadata.json) for current status and dependencies. diff --git a/conductor/tracks/health-information/metadata.json b/conductor/tracks/health-information/metadata.json new file mode 100644 index 0000000..d8d8a73 --- /dev/null +++ b/conductor/tracks/health-information/metadata.json @@ -0,0 +1,11 @@ +{ + "track_id": "health-information", + "name": "Health Information Management", + "description": "Release of information (ROI), consent management, medical records retention, privacy", + "status": "planning", + "created": "2026-02-11", + "priority": "medium", + "dependencies": ["health-core"], + "deliverable": "release-of-information, consent-management skills, /process-roi command", + "adapts_from": ["legal/compliance", "customer-support/response-drafting"] +} diff --git a/conductor/tracks/health-information/plan.md b/conductor/tracks/health-information/plan.md new file mode 100644 index 0000000..aab2e0e --- /dev/null +++ b/conductor/tracks/health-information/plan.md @@ -0,0 +1,32 @@ +# Health Information Management Track Plan + +## Phase 1: Release of Information Skill +*Dependencies: health-core* +*Estimated: 1-2 sessions* + +- [ ] Create `health/skills/release-of-information/SKILL.md` + - Acceptance: Authorization validation checklist + - Acceptance: Request types and processing timelines + - Acceptance: Minimum necessary guidance + - Acceptance: Accounting of disclosures requirements + - Source patterns: `legal/compliance`, `customer-support/response-drafting` + +## Phase 2: Consent Management Skill +*Dependencies: Phase 1* +*Estimated: 1 session* + +- [ ] Create `health/skills/consent-management/SKILL.md` + - Acceptance: Consent type taxonomy + - Acceptance: Documentation requirements + - Acceptance: Capacity assessment guidance + +## Phase 3: Process ROI Command +*Dependencies: Phase 1* +*Estimated: 0.5 sessions* + +- [ ] Create `health/commands/process-roi.md` + - Acceptance: ROI request intake + - Acceptance: Validation workflow + - Acceptance: Processing checklist + +**Checkpoint:** `conductor(checkpoint): Health information management workflow complete` diff --git a/conductor/tracks/health-information/spec.md b/conductor/tracks/health-information/spec.md new file mode 100644 index 0000000..c0d0e7f --- /dev/null +++ b/conductor/tracks/health-information/spec.md @@ -0,0 +1,56 @@ +# Health Information Management Track Specification + +## Overview + +Release of information (ROI), consent management, medical records retention, and privacy compliance. + +## Scope + +### Release of Information (ROI) +- Authorization validation +- Request processing workflow +- Minimum necessary standard +- Accounting of disclosures + +### Consent Management +- Treatment consent +- Research consent +- Advance directives +- Proxy/representative documentation + +### Records Management +- Retention schedules +- Destruction protocols +- Legal hold management +- Format requirements + +### Privacy +- Breach assessment +- Patient rights requests +- Notice of privacy practices + +## Deliverables + +### Skills +- `release-of-information` - ROI processing workflow +- `consent-management` - Consent types and documentation + +### Commands +- `/process-roi` - Process release of information request + +## Dependencies + +- `health-core` (plugin structure) +- `health-compliance` (for regulatory requirements) + +## Adapts From + +- `legal/compliance` - Privacy regulations +- `customer-support/response-drafting` - Patient communications + +## Success Criteria + +- [ ] Validates authorization requirements +- [ ] Guides ROI processing with minimum necessary +- [ ] Tracks consent documentation +- [ ] Applies retention schedules correctly diff --git a/conductor/tracks/health-manuscripts/index.md b/conductor/tracks/health-manuscripts/index.md new file mode 100644 index 0000000..1658680 --- /dev/null +++ b/conductor/tracks/health-manuscripts/index.md @@ -0,0 +1,16 @@ +# Health-manuscripts Track + +## Documents + +- [Specification](./spec.md) +- [Implementation Plan](./plan.md) +- [Metadata](./metadata.json) + +## Quick Links + +- [Project Index](../../index.md) +- [Tracks Registry](../../tracks.md) + +## Status + +See [metadata.json](./metadata.json) for current status and dependencies. diff --git a/conductor/tracks/health-manuscripts/metadata.json b/conductor/tracks/health-manuscripts/metadata.json new file mode 100644 index 0000000..bfde85d --- /dev/null +++ b/conductor/tracks/health-manuscripts/metadata.json @@ -0,0 +1,12 @@ +{ + "track_id": "health-manuscripts", + "name": "Health Manuscripts", + "description": "Journal manuscript preparation with formatting requirements, CONSORT/STROBE/CHEERS compliance", + "status": "planning", + "created": "2026-02-11", + "priority": "medium", + "dependencies": ["health-core", "health-evidence"], + "deliverable": "manuscript-prep skill, /prepare-manuscript command", + "adapts_from": ["scientific-writing"], + "checklists": ["CONSORT", "STROBE", "CHEERS", "PRISMA", "ARRIVE"] +} diff --git a/conductor/tracks/health-manuscripts/plan.md b/conductor/tracks/health-manuscripts/plan.md new file mode 100644 index 0000000..914a079 --- /dev/null +++ b/conductor/tracks/health-manuscripts/plan.md @@ -0,0 +1,25 @@ +# Health Manuscripts Track Plan + +## Phase 1: Manuscript Preparation Skill +*Dependencies: health-core* +*Estimated: 1-2 sessions* + +- [ ] Create `health/skills/manuscript-prep/SKILL.md` + - Acceptance: Journal selection guidance + - Acceptance: Study type to checklist mapping + - Acceptance: Structure templates by article type + - Acceptance: Reporting guideline compliance checking + - Acceptance: Figure/table preparation guidance + - Acceptance: Reference formatting + - Source patterns: `scientific-writing`, `venue-templates` + +## Phase 2: Prepare Manuscript Command +*Dependencies: Phase 1* +*Estimated: 0.5 sessions* + +- [ ] Create `health/commands/prepare-manuscript.md` + - Acceptance: Study type selection + - Acceptance: Target journal input + - Acceptance: Generates manuscript checklist + +**Checkpoint:** `conductor(checkpoint): Health manuscripts workflow complete` diff --git a/conductor/tracks/health-manuscripts/spec.md b/conductor/tracks/health-manuscripts/spec.md new file mode 100644 index 0000000..78db8a3 --- /dev/null +++ b/conductor/tracks/health-manuscripts/spec.md @@ -0,0 +1,66 @@ +# Health Manuscripts Track Specification + +## Overview + +Journal manuscript preparation with target journal formatting requirements, reporting guideline compliance (CONSORT, STROBE, CHEERS), and submission readiness checking. + +## Scope + +### Manuscript Types +- Clinical trials (CONSORT) +- Observational studies (STROBE) +- Economic evaluations (CHEERS) +- Systematic reviews (PRISMA) +- Quality improvement (SQUIRE) +- Case reports (CARE) + +### Workflow +- Target journal selection +- Structure and formatting +- Reporting guideline compliance +- Figure/table preparation +- Reference formatting +- Cover letter drafting + +### High-Impact Targets +- BMJ +- Lancet +- JAMA +- NEJM +- Speciality journals + +## Deliverables + +### Skills +- `manuscript-prep` - Manuscript preparation workflow + +### Commands +- `/prepare-manuscript` - Initiate manuscript preparation + +## Dependencies + +- `health-core` (plugin structure) +- `health-evidence` (for systematic review manuscripts) + +## Adapts From + +- `scientific-writing` - Writing methodology +- `venue-templates` - Journal formatting + +## Reporting Checklists + +- CONSORT (randomized trials) +- STROBE (observational studies) +- CHEERS (economic evaluations) +- PRISMA (systematic reviews) +- ARRIVE (animal studies) +- CARE (case reports) +- SQUIRE (quality improvement) + +## Success Criteria + +- [ ] Guides journal selection +- [ ] Applies reporting guidelines by study type +- [ ] Formats for target journal requirements +- [ ] Checks submission readiness +- [ ] Generates cover letter diff --git a/conductor/tracks/health-medicolegal/index.md b/conductor/tracks/health-medicolegal/index.md new file mode 100644 index 0000000..6036d0c --- /dev/null +++ b/conductor/tracks/health-medicolegal/index.md @@ -0,0 +1,16 @@ +# Health-medicolegal Track + +## Documents + +- [Specification](./spec.md) +- [Implementation Plan](./plan.md) +- [Metadata](./metadata.json) + +## Quick Links + +- [Project Index](../../index.md) +- [Tracks Registry](../../tracks.md) + +## Status + +See [metadata.json](./metadata.json) for current status and dependencies. diff --git a/conductor/tracks/health-medicolegal/metadata.json b/conductor/tracks/health-medicolegal/metadata.json new file mode 100644 index 0000000..0473fb2 --- /dev/null +++ b/conductor/tracks/health-medicolegal/metadata.json @@ -0,0 +1,12 @@ +{ + "track_id": "health-medicolegal", + "name": "Health Medicolegal", + "description": "Medicolegal documentation - child protection reports, affidavits, medico-legal reports, coroner's reports, workers compensation", + "status": "planning", + "created": "2026-02-11", + "priority": "medium", + "dependencies": ["health-core"], + "deliverable": "medicolegal-reports, child-protection, affidavit-drafting skills, /prepare-report command", + "adapts_from": ["legal/canned-responses", "legal/contract-review"], + "document_types": ["child-protection", "affidavit", "medicolegal-report", "coroner-report", "workers-comp", "capacity-assessment"] +} diff --git a/conductor/tracks/health-medicolegal/plan.md b/conductor/tracks/health-medicolegal/plan.md new file mode 100644 index 0000000..894427c --- /dev/null +++ b/conductor/tracks/health-medicolegal/plan.md @@ -0,0 +1,43 @@ +# Health Medicolegal Track Plan + +## Phase 1: Medicolegal Reports Skill +*Dependencies: health-core* +*Estimated: 1-2 sessions* + +- [ ] Create `health/skills/medicolegal-reports/SKILL.md` + - Acceptance: Document type taxonomy + - Acceptance: General structure requirements + - Acceptance: Legal admissibility guidance + - Acceptance: Confidentiality considerations + - Source patterns: `legal/contract-review` + +## Phase 2: Child Protection Skill +*Dependencies: Phase 1* +*Estimated: 1 session* + +- [ ] Create `health/skills/child-protection/SKILL.md` + - Acceptance: Mandatory reporting triggers + - Acceptance: Report structure template + - Acceptance: Risk assessment documentation + - Acceptance: Jurisdiction variations + +## Phase 3: Affidavit Drafting Skill +*Dependencies: Phase 1* +*Estimated: 1 session* + +- [ ] Create `health/skills/affidavit-drafting/SKILL.md` + - Acceptance: Affidavit structure + - Acceptance: Swearing requirements + - Acceptance: Court formatting + - Acceptance: Common pitfalls + +## Phase 4: Prepare Report Command +*Dependencies: Phases 1-3* +*Estimated: 0.5 sessions* + +- [ ] Create `health/commands/prepare-report.md` + - Acceptance: Document type selection + - Acceptance: Jurisdiction selection + - Acceptance: Generates appropriate template + +**Checkpoint:** `conductor(checkpoint): Health medicolegal workflow complete` diff --git a/conductor/tracks/health-medicolegal/spec.md b/conductor/tracks/health-medicolegal/spec.md new file mode 100644 index 0000000..5e4ed9b --- /dev/null +++ b/conductor/tracks/health-medicolegal/spec.md @@ -0,0 +1,63 @@ +# Health Medicolegal Track Specification + +## Overview + +Medicolegal documentation workflows supporting child protection reporting, court documentation, expert witness statements, and statutory reporting obligations. + +## Scope + +### Document Types + +| Type | Description | Regulatory Context | +|------|-------------|-------------------| +| **Child protection reports** | Mandatory reporting, risk assessments | State/territory child protection legislation | +| **Affidavits** | Court documentation, sworn statements | Court rules, evidence law | +| **Medico-legal reports** | Independent medical examinations, personal injury | Civil procedure rules | +| **Coroner's reports** | Reportable deaths, death certificates | Coroner's Act | +| **Workers compensation** | Work capacity, impairment assessments | Workers compensation legislation | +| **Capacity assessments** | Decision-making capacity, guardianship | Guardianship legislation | + +### Workflow Elements + +- Document structure requirements +- Legal admissibility considerations +- Confidentiality and privilege +- Mandatory reporting triggers +- Court formatting requirements +- Service and filing procedures + +## Deliverables + +### Skills +- `medicolegal-reports` - General medico-legal report structure +- `child-protection` - Child protection reporting workflow +- `affidavit-drafting` - Affidavit preparation and formatting + +### Commands +- `/prepare-report` - Initiate medicolegal document + +## Dependencies + +- `health-core` (plugin structure) + +## Adapts From + +- `legal/canned-responses` - Template patterns +- `legal/contract-review` - Document review methodology + +## Jurisdiction Considerations + +Medicolegal requirements vary significantly by jurisdiction: +- Australian states/territories +- New Zealand +- Different court jurisdictions (Federal, State, Family) + +Skills should parameterize by jurisdiction where requirements differ. + +## Success Criteria + +- [ ] Guides child protection report preparation +- [ ] Supports affidavit drafting with proper formatting +- [ ] Identifies mandatory reporting triggers +- [ ] Documents legal requirements by type +- [ ] Maintains appropriate tone and structure diff --git a/conductor/tracks/health-plugin/index.md b/conductor/tracks/health-plugin/index.md new file mode 100644 index 0000000..b18be39 --- /dev/null +++ b/conductor/tracks/health-plugin/index.md @@ -0,0 +1,16 @@ +# Health-plugin Track + +## Documents + +- [Specification](./spec.md) +- [Implementation Plan](./plan.md) +- [Metadata](./metadata.json) + +## Quick Links + +- [Project Index](../../index.md) +- [Tracks Registry](../../tracks.md) + +## Status + +See [metadata.json](./metadata.json) for current status and dependencies. diff --git a/conductor/tracks/health-plugin/metadata.json b/conductor/tracks/health-plugin/metadata.json new file mode 100644 index 0000000..c21e082 --- /dev/null +++ b/conductor/tracks/health-plugin/metadata.json @@ -0,0 +1,32 @@ +{ + "track_id": "health-plugin", + "name": "Health Plugin Program", + "description": "Meta-track coordinating 17 health implementation tracks", + "status": "planning", + "created": "2026-02-11", + "priority": "high", + "type": "meta", + "tracks": [ + "health-core", + "health-complaints", + "health-incidents", + "health-risk", + "health-information", + "health-coding", + "health-governance", + "health-credentialing", + "health-procurement", + "health-quality", + "health-financial", + "health-evidence", + "health-data-analysis", + "health-ethics", + "health-economics", + "health-manuscripts", + "health-grants", + "health-medicolegal" + ], + "total_skills": 30, + "total_commands": 14, + "phases": 4 +} diff --git a/conductor/tracks/health-plugin/plan.md b/conductor/tracks/health-plugin/plan.md new file mode 100644 index 0000000..2827821 --- /dev/null +++ b/conductor/tracks/health-plugin/plan.md @@ -0,0 +1,35 @@ +# Health Plugin Program Plan + +## Role + +This is a meta-track coordinating 11 implementation tracks. No direct implementation work - that's delegated to individual tracks. + +## Coordination Tasks + +### Setup +- [x] Define program scope and track structure +- [x] Create track registry with dependencies +- [ ] Receive and analyze user templates (pending link) + +### During Implementation +- [ ] Monitor track progress +- [ ] Resolve cross-track dependencies +- [ ] Ensure consistent patterns across skills +- [ ] Coordinate documentation updates + +### Integration +- [ ] Verify all tracks installed correctly +- [ ] Test cross-skill references +- [ ] Final README consolidation +- [ ] Marketplace preparation + +## Dependencies + +All implementation tracks depend on `health-core` completion. + +## Checkpoints + +- `conductor(checkpoint): Health program Phase 1 complete` - After health-core +- `conductor(checkpoint): Health program Phase 2 complete` - After core workflows +- `conductor(checkpoint): Health program Phase 3 complete` - After extended workflows +- `conductor(checkpoint): Health plugin ready for release` - Final integration diff --git a/conductor/tracks/health-plugin/spec.md b/conductor/tracks/health-plugin/spec.md new file mode 100644 index 0000000..57d7e1b --- /dev/null +++ b/conductor/tracks/health-plugin/spec.md @@ -0,0 +1,67 @@ +# Health Plugin Program + +## Overview + +A comprehensive healthcare plugin ecosystem comprising 17 tracks delivering 27 skills and 13 commands for healthcare organizations. + +## Program Goals + +1. **Operational Excellence** - Complaints, incidents, risk, credentialing +2. **Governance & Compliance** - Policies, procedures, quality, ethics +3. **Research & Academic** - Evidence synthesis, economics, manuscripts, grants +4. **Financial & Data** - Payer contracts, coding, analysis + +## Track Summary + +### Phase 1: Foundation +| Track | Skills | Commands | +|-------|--------|----------| +| health-core | - | - | + +### Phase 2: Core Workflows +| Track | Skills | Commands | Adapts From | +|-------|--------|----------|-------------| +| health-complaints | complaints-management | /submit-complaint | customer-support/ticket-triage | +| health-incidents | incident-reporting | /report-incident | customer-support/escalation | +| health-risk | clinical-risk, worker-risk, enterprise-risk | /assess-risk | legal/legal-risk-assessment | +| health-information | release-of-information, consent-management | /process-roi | legal/compliance | +| health-coding | clinical-coding | /validate-coding | data/data-validation | + +### Phase 3: Extended Workflows +| Track | Skills | Commands | Adapts From | +|-------|--------|----------|-------------| +| health-governance | policy-development, procedure-development, guideline-development | - | legal/compliance | +| health-credentialing | credentialing, privileging | /verify-credentials | productivity/memory-management | +| health-procurement | device-procurement, business-case | /procurement-request, /business-case | legal/contract-review | +| health-quality | quality-improvement, accreditation-prep | /qi-project | product-management/roadmap-management | +| health-financial | payer-contracts, charge-capture | /review-payer-contract | legal/contract-review, finance | +| health-evidence | systematic-review, evidence-synthesis | /start-review | bio-research | +| health-data-analysis | health-data-report | /analyze-health-data | data | + +### Phase 4: Research/Academic +| Track | Skills | Commands | Adapts From | +|-------|--------|----------|-------------| +| health-ethics | research-ethics, clinical-ethics | /ethics-review | bio-research | +| health-economics | health-econ-eval, hta-submission | /economic-evaluation | data, finance | +| health-manuscripts | manuscript-prep | /prepare-manuscript | scientific-writing | +| health-grants | grant-writer | /grant-application | research-grants | + +## Total Deliverables + +- **27 Skills** across 16 implementation tracks +- **13 Commands** for key workflows +- **1 Plugin** installable as `health` + +## Coordination Points + +- All tracks share `health/` plugin directory +- Cross-references between related skills +- Shared connector configuration +- Unified README and CONNECTORS documentation + +## Next Steps + +1. Complete `health-core` track +2. Begin Phase 2 tracks in parallel +3. Analyze user-provided templates to refine workflows +4. Progress through Phase 3, then Phase 4 diff --git a/conductor/tracks/health-procurement/index.md b/conductor/tracks/health-procurement/index.md new file mode 100644 index 0000000..fc7b238 --- /dev/null +++ b/conductor/tracks/health-procurement/index.md @@ -0,0 +1,16 @@ +# Health-procurement Track + +## Documents + +- [Specification](./spec.md) +- [Implementation Plan](./plan.md) +- [Metadata](./metadata.json) + +## Quick Links + +- [Project Index](../../index.md) +- [Tracks Registry](../../tracks.md) + +## Status + +See [metadata.json](./metadata.json) for current status and dependencies. diff --git a/conductor/tracks/health-procurement/metadata.json b/conductor/tracks/health-procurement/metadata.json new file mode 100644 index 0000000..a67455f --- /dev/null +++ b/conductor/tracks/health-procurement/metadata.json @@ -0,0 +1,11 @@ +{ + "track_id": "health-procurement", + "name": "Health Procurement", + "description": "Medical device procurement, vendor assessment, and business case development", + "status": "planning", + "created": "2026-02-11", + "priority": "medium", + "dependencies": ["health-core"], + "deliverable": "device-procurement, business-case skills, /procurement-request, /business-case commands", + "adapts_from": ["legal/contract-review", "finance/audit-support"] +} diff --git a/conductor/tracks/health-procurement/plan.md b/conductor/tracks/health-procurement/plan.md new file mode 100644 index 0000000..95d32dd --- /dev/null +++ b/conductor/tracks/health-procurement/plan.md @@ -0,0 +1,29 @@ +# Health Procurement Track Plan + +## Phase 1: Device Procurement Skill +*Dependencies: health-core* +*Estimated: 1-2 sessions* + +- [ ] Create `health/skills/device-procurement/SKILL.md` + - Acceptance: Device evaluation criteria + - Acceptance: Regulatory compliance checklist + - Acceptance: Vendor assessment framework + - Source patterns: `legal/contract-review` + +## Phase 2: Business Case Skill +*Dependencies: Phase 1* +*Estimated: 1 session* + +- [ ] Create `health/skills/business-case/SKILL.md` + - Acceptance: Business case structure + - Acceptance: ROI calculation guidance + - Acceptance: Risk assessment section + +## Phase 3: Commands +*Dependencies: Phases 1, 2* +*Estimated: 0.5 sessions* + +- [ ] Create `health/commands/procurement-request.md` +- [ ] Create `health/commands/business-case.md` + +**Checkpoint:** `conductor(checkpoint): Health procurement workflow complete` diff --git a/conductor/tracks/health-procurement/spec.md b/conductor/tracks/health-procurement/spec.md new file mode 100644 index 0000000..c8ffb82 --- /dev/null +++ b/conductor/tracks/health-procurement/spec.md @@ -0,0 +1,45 @@ +# Health Procurement Track Specification + +## Overview + +Medical device procurement, vendor assessment, and business case development for healthcare organizations. + +## Scope + +### Device Procurement +- Medical device evaluation +- Regulatory compliance (FDA, TGA, CE marking) +- Vendor assessment +- Contract review (healthcare terms) + +### Business Cases +- Investment justification +- ROI calculation +- Risk assessment +- Stakeholder approval + +## Deliverables + +### Skills +- `device-procurement` - Device evaluation and procurement +- `business-case` - Business case development + +### Commands +- `/procurement-request` - Initiate procurement +- `/business-case` - Draft business case + +## Dependencies + +- `health-core` (plugin structure) + +## Adapts From + +- `legal/contract-review` - Contract analysis +- `finance/audit-support` - Financial review + +## Success Criteria + +- [ ] Guides device evaluation +- [ ] Supports vendor assessment +- [ ] Develops business cases +- [ ] Reviews healthcare-specific contract terms diff --git a/conductor/tracks/health-quality/index.md b/conductor/tracks/health-quality/index.md new file mode 100644 index 0000000..31633ef --- /dev/null +++ b/conductor/tracks/health-quality/index.md @@ -0,0 +1,16 @@ +# Health-quality Track + +## Documents + +- [Specification](./spec.md) +- [Implementation Plan](./plan.md) +- [Metadata](./metadata.json) + +## Quick Links + +- [Project Index](../../index.md) +- [Tracks Registry](../../tracks.md) + +## Status + +See [metadata.json](./metadata.json) for current status and dependencies. diff --git a/conductor/tracks/health-quality/metadata.json b/conductor/tracks/health-quality/metadata.json new file mode 100644 index 0000000..8f2a754 --- /dev/null +++ b/conductor/tracks/health-quality/metadata.json @@ -0,0 +1,11 @@ +{ + "track_id": "health-quality", + "name": "Health Quality & Performance", + "description": "Quality improvement projects, accreditation preparation, patient experience, outcomes tracking", + "status": "planning", + "created": "2026-02-11", + "priority": "medium", + "dependencies": ["health-core"], + "deliverable": "quality-improvement, accreditation-prep skills, /qi-project command", + "adapts_from": ["product-management/roadmap-management", "data/statistical-analysis"] +} diff --git a/conductor/tracks/health-quality/plan.md b/conductor/tracks/health-quality/plan.md new file mode 100644 index 0000000..a9767b4 --- /dev/null +++ b/conductor/tracks/health-quality/plan.md @@ -0,0 +1,28 @@ +# Health Quality & Performance Track Plan + +## Phase 1: Quality Improvement Skill +*Dependencies: health-core* +*Estimated: 1-2 sessions* + +- [ ] Create `health/skills/quality-improvement/SKILL.md` + - Acceptance: QI project framework + - Acceptance: PDSA cycle guidance + - Acceptance: Data collection planning + - Source patterns: `product-management/roadmap-management` + +## Phase 2: Accreditation Prep Skill +*Dependencies: Phase 1* +*Estimated: 1-2 sessions* + +- [ ] Create `health/skills/accreditation-prep/SKILL.md` + - Acceptance: Survey preparation checklist + - Acceptance: Tracer methodology + - Acceptance: Continuous readiness + +## Phase 3: QI Project Command +*Dependencies: Phase 1* +*Estimated: 0.5 sessions* + +- [ ] Create `health/commands/qi-project.md` + +**Checkpoint:** `conductor(checkpoint): Health quality workflow complete` diff --git a/conductor/tracks/health-quality/spec.md b/conductor/tracks/health-quality/spec.md new file mode 100644 index 0000000..f0044ac --- /dev/null +++ b/conductor/tracks/health-quality/spec.md @@ -0,0 +1,49 @@ +# Health Quality & Performance Track Specification + +## Overview + +Quality improvement projects, accreditation preparation, patient experience management, and outcomes tracking. + +## Scope + +### Quality Improvement +- QI project initiation +- PDSA cycle methodology +- Data collection planning +- Results analysis + +### Accreditation +- Joint Commission preparation +- State licensing surveys +- CMS conditions of participation +- Continuous readiness + +### Patient Experience +- HCAHPS tracking +- Service recovery +- Patient advisory integration + +## Deliverables + +### Skills +- `quality-improvement` - QI methodology +- `accreditation-prep` - Survey preparation + +### Commands +- `/qi-project` - Initiate QI project + +## Dependencies + +- `health-core` (plugin structure) + +## Adapts From + +- `product-management/roadmap-management` - Strategic planning +- `product-management/stakeholder-comms` - Reporting + +## Success Criteria + +- [ ] Guides QI project workflow +- [ ] Supports PDSA methodology +- [ ] Prepares for accreditation surveys +- [ ] Tracks quality metrics diff --git a/conductor/tracks/health-risk/index.md b/conductor/tracks/health-risk/index.md new file mode 100644 index 0000000..0ccdeda --- /dev/null +++ b/conductor/tracks/health-risk/index.md @@ -0,0 +1,16 @@ +# Health-risk Track + +## Documents + +- [Specification](./spec.md) +- [Implementation Plan](./plan.md) +- [Metadata](./metadata.json) + +## Quick Links + +- [Project Index](../../index.md) +- [Tracks Registry](../../tracks.md) + +## Status + +See [metadata.json](./metadata.json) for current status and dependencies. diff --git a/conductor/tracks/health-risk/metadata.json b/conductor/tracks/health-risk/metadata.json new file mode 100644 index 0000000..32f47bc --- /dev/null +++ b/conductor/tracks/health-risk/metadata.json @@ -0,0 +1,11 @@ +{ + "track_id": "health-risk", + "name": "Health Risk Assessment", + "description": "Multi-domain risk assessment - clinical risk, clinician/worker risk, enterprise risk, clinical services plan risk, medicine standing orders risk", + "status": "planning", + "created": "2026-02-11", + "priority": "high", + "dependencies": ["health-core"], + "deliverable": "clinical-risk, worker-risk, enterprise-risk skills, /assess-risk command", + "adapts_from": ["legal/legal-risk-assessment"] +} diff --git a/conductor/workflow.md b/conductor/workflow.md new file mode 100644 index 0000000..c3eb4aa --- /dev/null +++ b/conductor/workflow.md @@ -0,0 +1,48 @@ +# Development Workflow + +## Branch Strategy + +- `main` - Production-ready plugins +- Feature branches for new work + +## Development Process + +### 1. Plugin Development +1. Create/modify plugin files +2. Test locally with Claude Code +3. Update documentation +4. Submit PR + +### 2. Quality Checks +- Verify plugin.json schema +- Test all commands +- Validate skill instructions +- Check markdown formatting + +### 3. Review Process +- Peer review for content accuracy +- Verify connector configurations +- Test installation flow + +## Testing + +### Local Testing +```bash +claude plugin install ./path/to/plugin +``` + +### Command Testing +Run commands in Claude Code session to verify behavior. + +## Release + +1. Merge to main +2. Tag release version +3. Update marketplace + +## Contribution Guidelines + +- Fork repo +- Make changes +- Submit PR with description of changes +- Address review feedback From 524aca0a293f2490ea567e3700f3e3a7d77b2e12 Mon Sep 17 00:00:00 2001 From: "Dylan Mordaunt (Illawarra Shoalhaven LHD)" Date: Wed, 11 Feb 2026 14:28:06 +1100 Subject: [PATCH 02/57] feat(health): Create core plugin skeleton with foundation files - Create health/ directory structure with .claude-plugin/ - Add plugin.json manifest (v0.1.0, healthcare workflows) - Add README.md documenting 17 planned domains across 4 phases - Add CONNECTORS.md with SharePoint, Jira, FHIR connector guides - Add .mcp.json with 3 connector templates (disabled by default) --- conductor/tracks/health-core/plan.md | 2 +- health/.claude-plugin/plugin.json | 22 +++++ health/.mcp.json | 34 ++++++++ health/CONNECTORS.md | 117 +++++++++++++++++++++++++++ health/README.md | 66 +++++++++++++++ 5 files changed, 240 insertions(+), 1 deletion(-) create mode 100644 health/.claude-plugin/plugin.json create mode 100644 health/.mcp.json create mode 100644 health/CONNECTORS.md create mode 100644 health/README.md diff --git a/conductor/tracks/health-core/plan.md b/conductor/tracks/health-core/plan.md index de56982..78f255e 100644 --- a/conductor/tracks/health-core/plan.md +++ b/conductor/tracks/health-core/plan.md @@ -3,7 +3,7 @@ ## Phase 1: Plugin Skeleton *Estimated: 1 session* -- [ ] Create `health/` directory structure +- [~] Create `health/` directory structure - Acceptance: Matches spec structure - [ ] Create `health/.claude-plugin/plugin.json` - Acceptance: Valid JSON, installs successfully diff --git a/health/.claude-plugin/plugin.json b/health/.claude-plugin/plugin.json new file mode 100644 index 0000000..15e2be5 --- /dev/null +++ b/health/.claude-plugin/plugin.json @@ -0,0 +1,22 @@ +{ + "name": "health", + "version": "0.1.0", + "description": "Healthcare organization workflows for compliance, quality, and clinical operations", + "author": "Knowledge Work Plugins", + "license": "MIT", + "keywords": [ + "healthcare", + "compliance", + "quality", + "clinical", + "risk", + "governance" + ], + "repository": { + "type": "git", + "url": "https://github.com/anomaly/knowledge-work-plugins" + }, + "engines": { + "claude-code": ">=0.1.0" + } +} diff --git a/health/.mcp.json b/health/.mcp.json new file mode 100644 index 0000000..18827b4 --- /dev/null +++ b/health/.mcp.json @@ -0,0 +1,34 @@ +{ + "mcpServers": { + "sharepoint": { + "command": "npx", + "args": ["-y", "@modelcontextprotocol/server-sharepoint"], + "env": { + "SHAREPOINT_TENANT": "${SHAREPOINT_TENANT}", + "SHAREPOINT_CLIENT_ID": "${SHAREPOINT_CLIENT_ID}", + "SHAREPOINT_CLIENT_SECRET": "${SHAREPOINT_CLIENT_SECRET}" + }, + "disabled": true + }, + "jira": { + "command": "npx", + "args": ["-y", "@modelcontextprotocol/server-jira"], + "env": { + "JIRA_BASE_URL": "${JIRA_BASE_URL}", + "JIRA_EMAIL": "${JIRA_EMAIL}", + "JIRA_API_TOKEN": "${JIRA_API_TOKEN}" + }, + "disabled": true + }, + "fhir": { + "command": "npx", + "args": ["-y", "@modelcontextprotocol/server-fhir"], + "env": { + "FHIR_BASE_URL": "${FHIR_BASE_URL}", + "FHIR_CLIENT_ID": "${FHIR_CLIENT_ID}", + "FHIR_CLIENT_SECRET": "${FHIR_CLIENT_SECRET}" + }, + "disabled": true + } + } +} diff --git a/health/CONNECTORS.md b/health/CONNECTORS.md new file mode 100644 index 0000000..3eb6849 --- /dev/null +++ b/health/CONNECTORS.md @@ -0,0 +1,117 @@ +# Health Plugin Connectors + +This document describes the connector categories and setup instructions for the health plugin. + +## Connector Categories + +### Document Storage + +Healthcare organizations typically use enterprise document management systems: + +| Connector | Use Case | Authentication | +|-----------|----------|----------------| +| SharePoint | Microsoft 365 environments | OAuth 2.0 / Entra ID | +| Box | Cloud content management | OAuth 2.0 / JWT | +| Egnyte | Hybrid cloud storage | OAuth 2.0 / API Key | +| Google Drive | Google Workspace | OAuth 2.0 | + +### Issue Tracking + +For complaint management, incident tracking, and workflow automation: + +| Connector | Use Case | Authentication | +|-----------|----------|----------------| +| Jira | IT service management | API Token / OAuth | +| ServiceNow | Enterprise service management | OAuth 2.0 / Basic | +| Azure DevOps | Development tracking | PAT / OAuth | + +### Clinical Systems + +Integration points for clinical data (organization-specific): + +| Connector | Use Case | Authentication | +|-----------|----------|----------------| +| Epic FHIR | EHR data access | OAuth 2.0 / SMART | +| Cerner | EHR integration | OAuth 2.0 / API Key | +| Custom APIs | Organization systems | Varies | + +## Setup Instructions + +### 1. Document Storage (SharePoint Example) + +```json +{ + "mcpServers": { + "sharepoint": { + "command": "npx", + "args": ["-y", "@modelcontextprotocol/server-sharepoint"], + "env": { + "SHAREPOINT_TENANT": "your-tenant.sharepoint.com", + "SHAREPOINT_CLIENT_ID": "${SHAREPOINT_CLIENT_ID}", + "SHAREPOINT_CLIENT_SECRET": "${SHAREPOINT_CLIENT_SECRET}" + } + } + } +} +``` + +### 2. Issue Tracking (Jira Example) + +```json +{ + "mcpServers": { + "jira": { + "command": "npx", + "args": ["-y", "@modelcontextprotocol/server-jira"], + "env": { + "JIRA_BASE_URL": "https://your-org.atlassian.net", + "JIRA_EMAIL": "${JIRA_EMAIL}", + "JIRA_API_TOKEN": "${JIRA_API_TOKEN}" + } + } + } +} +``` + +### 3. Clinical Systems (FHIR Example) + +```json +{ + "mcpServers": { + "fhir": { + "command": "npx", + "args": ["-y", "@modelcontextprotocol/server-fhir"], + "env": { + "FHIR_BASE_URL": "https://fhir.your-org.com/r4", + "FHIR_CLIENT_ID": "${FHIR_CLIENT_ID}", + "FHIR_CLIENT_SECRET": "${FHIR_CLIENT_SECRET}" + } + } + } +} +``` + +## Authentication Best Practices + +1. **Never commit credentials** - Use environment variables +2. **Use service accounts** - Dedicated accounts for automation +3. **Rotate credentials** - Regular key rotation schedule +4. **Least privilege** - Grant minimum required permissions +5. **Audit access** - Enable logging for compliance + +## Troubleshooting + +### Common Issues + +| Issue | Solution | +|-------|----------| +| Authentication failed | Verify credentials and token expiration | +| Permission denied | Check OAuth scopes and API permissions | +| Connection timeout | Verify network access and firewall rules | +| Rate limiting | Implement backoff and retry logic | + +### Getting Help + +1. Check connector documentation +2. Review MCP server logs +3. Contact your IT security team for access issues diff --git a/health/README.md b/health/README.md new file mode 100644 index 0000000..994cb50 --- /dev/null +++ b/health/README.md @@ -0,0 +1,66 @@ +# Health Plugin + +Healthcare organization workflows for compliance, quality, and clinical operations. + +## Overview + +This plugin provides specialized skills and commands for healthcare professionals working in: + +- **Complaints Management** - Patient complaint handling and resolution +- **Incident Reporting** - Serious adverse event documentation and investigation +- **Risk Management** - Multi-domain risk assessment and mitigation +- **Information Governance** - ROI, consent management, records handling +- **Clinical Coding** - Medical coding validation and auditing +- **Governance** - Policy and procedure management +- **Credentialing** - Provider credential verification +- **Procurement** - Medical device evaluation and business cases +- **Quality Improvement** - QI projects and accreditation support +- **Financial Operations** - Payer contract analysis +- **Evidence Review** - Systematic reviews and evidence synthesis +- **Data Analysis** - Epidemiological reporting +- **Ethics** - Research and clinical ethics consultation +- **Health Economics** - HTA and cost-effectiveness analysis +- **Manuscript Preparation** - Journal article formatting +- **Grants** - Research grant applications +- **Medicolegal** - Child protection, affidavits, medico-legal reports + +## Installation + +```bash +claude plugin install ./health +``` + +## Available Skills + +Skills are organized by domain and will be added by individual track implementations: + +| Domain | Skills | Status | +|--------|--------|--------| +| complaints | complaint-analysis, response-drafting | Planned | +| incidents | root-cause-analysis, cap-writing | Planned | +| risk | risk-assessment, mitigation-planning | Planned | +| governance | policy-review, procedure-writing | Planned | +| ethics | ethics-consultation, irb-preparation | Planned | +| compliance | audit-preparation, gap-analysis | Planned | +| procurement | device-evaluation, business-case | Planned | + +## Configuration + +### Connectors + +See [CONNECTORS.md](./CONNECTORS.md) for connector setup instructions. + +### Customization + +1. Copy `.mcp.json.template` to `.mcp.json` +2. Configure your organization's connectors +3. Adjust skill parameters in your Claude Code settings + +## Dependencies + +- Claude Code >= 0.1.0 +- Appropriate MCP connectors for your organization's tools + +## License + +MIT From 90a209777a5e698a15d83ab8d252855042998782 Mon Sep 17 00:00:00 2001 From: "Dylan Mordaunt (Illawarra Shoalhaven LHD)" Date: Wed, 11 Feb 2026 14:28:51 +1100 Subject: [PATCH 03/57] conductor(plan): Mark Phase 1 complete for health-core track --- conductor/tracks/health-core/plan.md | 12 ++++++------ 1 file changed, 6 insertions(+), 6 deletions(-) diff --git a/conductor/tracks/health-core/plan.md b/conductor/tracks/health-core/plan.md index 78f255e..bfdee29 100644 --- a/conductor/tracks/health-core/plan.md +++ b/conductor/tracks/health-core/plan.md @@ -1,17 +1,17 @@ # Health Core Track Plan -## Phase 1: Plugin Skeleton +## Phase 1: Plugin Skeleton [checkpoint: 524aca0] *Estimated: 1 session* -- [~] Create `health/` directory structure +- [x] Create `health/` directory structure (524aca0) - Acceptance: Matches spec structure -- [ ] Create `health/.claude-plugin/plugin.json` +- [x] Create `health/.claude-plugin/plugin.json` (524aca0) - Acceptance: Valid JSON, installs successfully -- [ ] Create `health/README.md` +- [x] Create `health/README.md` (524aca0) - Acceptance: Documents 7 planned domains (complaints, incidents, risk, governance, ethics, compliance, procurement) -- [ ] Create `health/CONNECTORS.md` +- [x] Create `health/CONNECTORS.md` (524aca0) - Acceptance: Lists document storage, issue tracking, clinical systems categories -- [ ] Create `health/.mcp.json` +- [x] Create `health/.mcp.json` (524aca0) - Acceptance: At least 2 connector templates **Checkpoint:** `conductor(checkpoint): Health core plugin foundation` From ea709a9440151965186727cf27cbf331c53493d1 Mon Sep 17 00:00:00 2001 From: "Dylan Mordaunt (Illawarra Shoalhaven LHD)" Date: Wed, 11 Feb 2026 14:28:59 +1100 Subject: [PATCH 04/57] conductor(checkpoint): Checkpoint end of Phase 1 - Plugin Skeleton From ebe0303eceee77c8a63bf19939a847ace942b103 Mon Sep 17 00:00:00 2001 From: "Dylan Mordaunt (Illawarra Shoalhaven LHD)" Date: Wed, 11 Feb 2026 14:29:48 +1100 Subject: [PATCH 05/57] conductor(plan): Mark health-core track as complete --- conductor/tracks/health-core/metadata.json | 3 ++- 1 file changed, 2 insertions(+), 1 deletion(-) diff --git a/conductor/tracks/health-core/metadata.json b/conductor/tracks/health-core/metadata.json index f0237dd..cd9e4ee 100644 --- a/conductor/tracks/health-core/metadata.json +++ b/conductor/tracks/health-core/metadata.json @@ -2,8 +2,9 @@ "track_id": "health-core", "name": "Health Core", "description": "Foundation plugin structure, shared utilities, and connector configuration for all health tracks", - "status": "planning", + "status": "complete", "created": "2026-02-11", + "completed": "2026-02-11", "priority": "high", "dependencies": [], "deliverable": "health/ plugin skeleton with plugin.json, README, .mcp.json" From 9ef52a9a4a4c87302a6db4f38d9a011b4ba4664d Mon Sep 17 00:00:00 2001 From: "Dylan Mordaunt (Illawarra Shoalhaven LHD)" Date: Wed, 11 Feb 2026 15:03:41 +1100 Subject: [PATCH 06/57] fix: Address PR review feedback - Update health-core plan acceptance criteria to match README scope - Update health-core spec to list actual connectors provided - Add health to Active Plugins table in index.md - Remove 'disabled' field from .mcp.json (not standard) - Change author to object format in plugin.json for consistency - Rewrite CONNECTORS.md to follow repo convention (~~category format) - Fix track counts in health-plugin spec (30 skills, 14 commands) - Add health-medicolegal to Phase 4 table - Update Adapts From references to match actual skill paths - Fix health-financial metadata to match spec deliverables - Remove .mcp.json.template reference from README (file doesn't exist) --- conductor/index.md | 1 + conductor/tracks.md | 12 +- conductor/tracks/health-core/plan.md | 2 +- conductor/tracks/health-core/spec.md | 6 +- .../tracks/health-financial/metadata.json | 2 +- conductor/tracks/health-plugin/plan.md | 2 +- conductor/tracks/health-plugin/spec.md | 11 +- health/.claude-plugin/plugin.json | 4 +- health/.mcp.json | 3 - health/CONNECTORS.md | 122 ++---------------- health/README.md | 4 +- 11 files changed, 33 insertions(+), 136 deletions(-) diff --git a/conductor/index.md b/conductor/index.md index c30aac8..9f46f7d 100644 --- a/conductor/index.md +++ b/conductor/index.md @@ -37,3 +37,4 @@ plugin-name/ | enterprise-search | Cross-tool search | | bio-research | Life sciences R&D | | cowork-plugin-management | Plugin creation | +| health | Healthcare organization workflows | diff --git a/conductor/tracks.md b/conductor/tracks.md index 1021345..e017ddc 100644 --- a/conductor/tracks.md +++ b/conductor/tracks.md @@ -47,13 +47,13 @@ PHASE 4: Research/Academic (parallel, depends Phase 3) │ | Track | Description | Phase | Adapts From | |-------|-------------|-------|-------------| | [health-core](./tracks/health-core/) | Plugin foundation | 1 | - | -| [health-complaints](./tracks/health-complaints/) | Patient complaints | 2 | customer-support | +| [health-complaints](./tracks/health-complaints/) | Patient complaints | 2 | customer-support/ticket-triage | | [health-incidents](./tracks/health-incidents/) | Serious adverse events | 2 | customer-support/escalation | -| [health-risk](./tracks/health-risk/) | Multi-domain risk | 2 | legal/risk-assessment | +| [health-risk](./tracks/health-risk/) | Multi-domain risk | 2 | legal/legal-risk-assessment | | [health-information](./tracks/health-information/) | ROI, consent, records | 2 | legal/compliance | -| [health-coding](./tracks/health-coding/) | Clinical coding | 2 | data/validation | +| [health-coding](./tracks/health-coding/) | Clinical coding | 2 | data/data-validation | | [health-governance](./tracks/health-governance/) | Policies, procedures | 3 | legal/compliance | -| [health-credentialing](./tracks/health-credentialing/) | Provider credentialing | 3 | productivity/memory | +| [health-credentialing](./tracks/health-credentialing/) | Provider credentialing | 3 | productivity/memory-management | | [health-procurement](./tracks/health-procurement/) | Devices, business cases | 3 | legal/contract-review | | [health-quality](./tracks/health-quality/) | QI, accreditation | 3 | product-management | | [health-financial](./tracks/health-financial/) | Payer contracts | 3 | finance | @@ -61,8 +61,8 @@ PHASE 4: Research/Academic (parallel, depends Phase 3) │ | [health-data-analysis](./tracks/health-data-analysis/) | Epidemiological reports | 3 | data | | [health-ethics](./tracks/health-ethics/) | Research/clinical ethics | 4 | bio-research | | [health-economics](./tracks/health-economics/) | HTA, cost-effectiveness | 4 | data, finance | -| [health-manuscripts](./tracks/health-manuscripts/) | Journal preparation | 4 | scientific-writing | -| [health-grants](./tracks/health-grants/) | Grant applications | 4 | research-grants | +| [health-manuscripts](./tracks/health-manuscripts/) | Journal preparation | 4 | bio-research | +| [health-grants](./tracks/health-grants/) | Grant applications | 4 | bio-research | | [health-medicolegal](./tracks/health-medicolegal/) | Child protection, affidavits, medico-legal | 4 | legal | ### Summary diff --git a/conductor/tracks/health-core/plan.md b/conductor/tracks/health-core/plan.md index bfdee29..7243878 100644 --- a/conductor/tracks/health-core/plan.md +++ b/conductor/tracks/health-core/plan.md @@ -8,7 +8,7 @@ - [x] Create `health/.claude-plugin/plugin.json` (524aca0) - Acceptance: Valid JSON, installs successfully - [x] Create `health/README.md` (524aca0) - - Acceptance: Documents 7 planned domains (complaints, incidents, risk, governance, ethics, compliance, procurement) + - Acceptance: Documents the planned health domains (complaints, incidents, risk, governance, ethics, compliance, procurement) - [x] Create `health/CONNECTORS.md` (524aca0) - Acceptance: Lists document storage, issue tracking, clinical systems categories - [x] Create `health/.mcp.json` (524aca0) diff --git a/conductor/tracks/health-core/spec.md b/conductor/tracks/health-core/spec.md index b0833ad..6e6a661 100644 --- a/conductor/tracks/health-core/spec.md +++ b/conductor/tracks/health-core/spec.md @@ -32,9 +32,9 @@ health/ ### .mcp.json Template connectors for: -- Document storage (SharePoint, Box, Egnyte) -- Issue tracking (Jira, ServiceNow) -- Clinical systems (placeholder for TBD integrations) +- Document storage (SharePoint) +- Issue tracking (Jira) +- Clinical systems (FHIR) ### README.md - Plugin purpose and scope diff --git a/conductor/tracks/health-financial/metadata.json b/conductor/tracks/health-financial/metadata.json index d76a78c..bae893a 100644 --- a/conductor/tracks/health-financial/metadata.json +++ b/conductor/tracks/health-financial/metadata.json @@ -6,6 +6,6 @@ "created": "2026-02-11", "priority": "medium", "dependencies": ["health-core"], - "deliverable": "payer-contracts, charge-capture, grant-management skills", + "deliverable": "payer-contracts, charge-capture skills", "adapts_from": ["legal/contract-review", "finance/reconciliation"] } diff --git a/conductor/tracks/health-plugin/plan.md b/conductor/tracks/health-plugin/plan.md index 2827821..6325286 100644 --- a/conductor/tracks/health-plugin/plan.md +++ b/conductor/tracks/health-plugin/plan.md @@ -2,7 +2,7 @@ ## Role -This is a meta-track coordinating 11 implementation tracks. No direct implementation work - that's delegated to individual tracks. +This is a meta-track coordinating 17 implementation tracks. No direct implementation work - that's delegated to individual tracks. ## Coordination Tasks diff --git a/conductor/tracks/health-plugin/spec.md b/conductor/tracks/health-plugin/spec.md index 57d7e1b..a51cca5 100644 --- a/conductor/tracks/health-plugin/spec.md +++ b/conductor/tracks/health-plugin/spec.md @@ -2,7 +2,7 @@ ## Overview -A comprehensive healthcare plugin ecosystem comprising 17 tracks delivering 27 skills and 13 commands for healthcare organizations. +A comprehensive healthcare plugin ecosystem comprising 17 tracks delivering 30 skills and 14 commands for healthcare organizations. ## Program Goals @@ -43,13 +43,14 @@ A comprehensive healthcare plugin ecosystem comprising 17 tracks delivering 27 s |-------|--------|----------|-------------| | health-ethics | research-ethics, clinical-ethics | /ethics-review | bio-research | | health-economics | health-econ-eval, hta-submission | /economic-evaluation | data, finance | -| health-manuscripts | manuscript-prep | /prepare-manuscript | scientific-writing | -| health-grants | grant-writer | /grant-application | research-grants | +| health-manuscripts | manuscript-prep | /prepare-manuscript | bio-research | +| health-grants | grant-writer | /grant-application | bio-research | +| health-medicolegal | child-protection, affidavits, medicolegal-reports | /medicolegal-report | legal | ## Total Deliverables -- **27 Skills** across 16 implementation tracks -- **13 Commands** for key workflows +- **30 Skills** across 17 implementation tracks +- **14 Commands** for key workflows - **1 Plugin** installable as `health` ## Coordination Points diff --git a/health/.claude-plugin/plugin.json b/health/.claude-plugin/plugin.json index 15e2be5..7a57da0 100644 --- a/health/.claude-plugin/plugin.json +++ b/health/.claude-plugin/plugin.json @@ -2,7 +2,9 @@ "name": "health", "version": "0.1.0", "description": "Healthcare organization workflows for compliance, quality, and clinical operations", - "author": "Knowledge Work Plugins", + "author": { + "name": "Anthropic" + }, "license": "MIT", "keywords": [ "healthcare", diff --git a/health/.mcp.json b/health/.mcp.json index 18827b4..61d4841 100644 --- a/health/.mcp.json +++ b/health/.mcp.json @@ -8,7 +8,6 @@ "SHAREPOINT_CLIENT_ID": "${SHAREPOINT_CLIENT_ID}", "SHAREPOINT_CLIENT_SECRET": "${SHAREPOINT_CLIENT_SECRET}" }, - "disabled": true }, "jira": { "command": "npx", @@ -18,7 +17,6 @@ "JIRA_EMAIL": "${JIRA_EMAIL}", "JIRA_API_TOKEN": "${JIRA_API_TOKEN}" }, - "disabled": true }, "fhir": { "command": "npx", @@ -28,7 +26,6 @@ "FHIR_CLIENT_ID": "${FHIR_CLIENT_ID}", "FHIR_CLIENT_SECRET": "${FHIR_CLIENT_SECRET}" }, - "disabled": true } } } diff --git a/health/CONNECTORS.md b/health/CONNECTORS.md index 3eb6849..5149cf8 100644 --- a/health/CONNECTORS.md +++ b/health/CONNECTORS.md @@ -1,117 +1,15 @@ -# Health Plugin Connectors +# Connectors -This document describes the connector categories and setup instructions for the health plugin. +## How tool references work -## Connector Categories +Plugin files use `~~category` as a placeholder for whatever tool the user connects in that category. For example, `~~cloud storage` might mean SharePoint, Box, or any other storage provider with an MCP server. -### Document Storage +Plugins are **tool-agnostic** — they describe workflows in terms of categories rather than specific products. The `.mcp.json` pre-configures specific MCP servers, but any MCP server in that category works. -Healthcare organizations typically use enterprise document management systems: +## Connectors for this plugin -| Connector | Use Case | Authentication | -|-----------|----------|----------------| -| SharePoint | Microsoft 365 environments | OAuth 2.0 / Entra ID | -| Box | Cloud content management | OAuth 2.0 / JWT | -| Egnyte | Hybrid cloud storage | OAuth 2.0 / API Key | -| Google Drive | Google Workspace | OAuth 2.0 | - -### Issue Tracking - -For complaint management, incident tracking, and workflow automation: - -| Connector | Use Case | Authentication | -|-----------|----------|----------------| -| Jira | IT service management | API Token / OAuth | -| ServiceNow | Enterprise service management | OAuth 2.0 / Basic | -| Azure DevOps | Development tracking | PAT / OAuth | - -### Clinical Systems - -Integration points for clinical data (organization-specific): - -| Connector | Use Case | Authentication | -|-----------|----------|----------------| -| Epic FHIR | EHR data access | OAuth 2.0 / SMART | -| Cerner | EHR integration | OAuth 2.0 / API Key | -| Custom APIs | Organization systems | Varies | - -## Setup Instructions - -### 1. Document Storage (SharePoint Example) - -```json -{ - "mcpServers": { - "sharepoint": { - "command": "npx", - "args": ["-y", "@modelcontextprotocol/server-sharepoint"], - "env": { - "SHAREPOINT_TENANT": "your-tenant.sharepoint.com", - "SHAREPOINT_CLIENT_ID": "${SHAREPOINT_CLIENT_ID}", - "SHAREPOINT_CLIENT_SECRET": "${SHAREPOINT_CLIENT_SECRET}" - } - } - } -} -``` - -### 2. Issue Tracking (Jira Example) - -```json -{ - "mcpServers": { - "jira": { - "command": "npx", - "args": ["-y", "@modelcontextprotocol/server-jira"], - "env": { - "JIRA_BASE_URL": "https://your-org.atlassian.net", - "JIRA_EMAIL": "${JIRA_EMAIL}", - "JIRA_API_TOKEN": "${JIRA_API_TOKEN}" - } - } - } -} -``` - -### 3. Clinical Systems (FHIR Example) - -```json -{ - "mcpServers": { - "fhir": { - "command": "npx", - "args": ["-y", "@modelcontextprotocol/server-fhir"], - "env": { - "FHIR_BASE_URL": "https://fhir.your-org.com/r4", - "FHIR_CLIENT_ID": "${FHIR_CLIENT_ID}", - "FHIR_CLIENT_SECRET": "${FHIR_CLIENT_SECRET}" - } - } - } -} -``` - -## Authentication Best Practices - -1. **Never commit credentials** - Use environment variables -2. **Use service accounts** - Dedicated accounts for automation -3. **Rotate credentials** - Regular key rotation schedule -4. **Least privilege** - Grant minimum required permissions -5. **Audit access** - Enable logging for compliance - -## Troubleshooting - -### Common Issues - -| Issue | Solution | -|-------|----------| -| Authentication failed | Verify credentials and token expiration | -| Permission denied | Check OAuth scopes and API permissions | -| Connection timeout | Verify network access and firewall rules | -| Rate limiting | Implement backoff and retry logic | - -### Getting Help - -1. Check connector documentation -2. Review MCP server logs -3. Contact your IT security team for access issues +| Category | Placeholder | Included servers | Other options | +|----------|-------------|-----------------|---------------| +| Cloud storage | `~~cloud storage` | SharePoint | Box, Egnyte, Google Drive, Dropbox | +| Project tracker | `~~project tracker` | Jira | ServiceNow, Azure DevOps, Linear, Asana | +| Clinical systems | `~~clinical systems` | FHIR | Epic, Cerner, Custom APIs | diff --git a/health/README.md b/health/README.md index 994cb50..70fa77b 100644 --- a/health/README.md +++ b/health/README.md @@ -52,9 +52,7 @@ See [CONNECTORS.md](./CONNECTORS.md) for connector setup instructions. ### Customization -1. Copy `.mcp.json.template` to `.mcp.json` -2. Configure your organization's connectors -3. Adjust skill parameters in your Claude Code settings +Configure your organization's connectors in the `.mcp.json` file. Enable the connectors you need and set the appropriate environment variables. ## Dependencies From 8fc30b5ee8681a04b26ce5b19eb99a24d7e52528 Mon Sep 17 00:00:00 2001 From: "Dylan Mordaunt (Illawarra Shoalhaven LHD)" Date: Wed, 11 Feb 2026 15:10:26 +1100 Subject: [PATCH 07/57] fix: Address remaining PR review feedback - Remove non-existent health-compliance dependency from health-information spec - Fix tech-stack.md MCP example to use mcpServers (not servers) --- conductor/tech-stack.md | 2 +- conductor/tracks/health-information/spec.md | 1 - 2 files changed, 1 insertion(+), 2 deletions(-) diff --git a/conductor/tech-stack.md b/conductor/tech-stack.md index b73770b..81a2c4a 100644 --- a/conductor/tech-stack.md +++ b/conductor/tech-stack.md @@ -56,7 +56,7 @@ Description and instructions for Claude to follow. Servers configured in `.mcp.json`: ```json { - "servers": { + "mcpServers": { "server-name": { "type": "stdio|sse|http", "command": "...", diff --git a/conductor/tracks/health-information/spec.md b/conductor/tracks/health-information/spec.md index c0d0e7f..1272e48 100644 --- a/conductor/tracks/health-information/spec.md +++ b/conductor/tracks/health-information/spec.md @@ -41,7 +41,6 @@ Release of information (ROI), consent management, medical records retention, and ## Dependencies - `health-core` (plugin structure) -- `health-compliance` (for regulatory requirements) ## Adapts From From 6edddafcb3855f776450d582120ac52ca0239836 Mon Sep 17 00:00:00 2001 From: Dylan Mordaunt <15080672+edithatogo@users.noreply.github.com> Date: Wed, 11 Feb 2026 15:12:51 +1100 Subject: [PATCH 08/57] Update conductor/index.md Co-authored-by: Copilot <175728472+Copilot@users.noreply.github.com> --- conductor/index.md | 1 + 1 file changed, 1 insertion(+) diff --git a/conductor/index.md b/conductor/index.md index 9f46f7d..29fce1c 100644 --- a/conductor/index.md +++ b/conductor/index.md @@ -36,5 +36,6 @@ plugin-name/ | data | SQL, visualization, analysis | | enterprise-search | Cross-tool search | | bio-research | Life sciences R&D | +| health | Health checks & diagnostics | | cowork-plugin-management | Plugin creation | | health | Healthcare organization workflows | From 91fc243059f3a461f6a0618df71e495c9e4c36e2 Mon Sep 17 00:00:00 2001 From: "Dylan Mordaunt (Illawarra Shoalhaven LHD)" Date: Wed, 11 Feb 2026 15:40:11 +1100 Subject: [PATCH 09/57] feat(conductor): Add skill-quality track for systematic skill improvements - Add spec.md with 14 improvement areas and quality standards - Add plan.md with 4 phases covering 50+ skills - Define standard skill structure with 8 required sections - Include plugin-specific improvement recommendations - Add quality gates and success metrics --- conductor/tracks.md | 8 +- conductor/tracks/skill-quality/index.md | 49 +++ conductor/tracks/skill-quality/metadata.json | 12 + conductor/tracks/skill-quality/plan.md | 141 +++++++++ conductor/tracks/skill-quality/spec.md | 309 +++++++++++++++++++ 5 files changed, 518 insertions(+), 1 deletion(-) create mode 100644 conductor/tracks/skill-quality/index.md create mode 100644 conductor/tracks/skill-quality/metadata.json create mode 100644 conductor/tracks/skill-quality/plan.md create mode 100644 conductor/tracks/skill-quality/spec.md diff --git a/conductor/tracks.md b/conductor/tracks.md index e017ddc..c93e773 100644 --- a/conductor/tracks.md +++ b/conductor/tracks.md @@ -67,7 +67,7 @@ PHASE 4: Research/Academic (parallel, depends Phase 3) │ ### Summary -- **18 tracks** total (1 meta + 17 implementation) +- **19 tracks** total (1 meta + 18 implementation) - **30 skills** across all tracks - **14 commands** for key workflows - **4 phases** of execution @@ -78,3 +78,9 @@ PHASE 4: Research/Academic (parallel, depends Phase 3) │ - `active` - Implementation underway - `paused` - Temporarily halted - `complete` - Finished and verified + +## Infrastructure Tracks + +| Track | Description | Status | +|-------|-------------|--------| +| [skill-quality](./tracks/skill-quality/) | Improve 50+ existing skills across all plugins | planning | diff --git a/conductor/tracks/skill-quality/index.md b/conductor/tracks/skill-quality/index.md new file mode 100644 index 0000000..2e220aa --- /dev/null +++ b/conductor/tracks/skill-quality/index.md @@ -0,0 +1,49 @@ +# Skill Quality Improvement Track + +Systematic improvements to existing skills across all plugins. + +## Quick Links + +- [Specification](./spec.md) - Problems, standards, and improvement details +- [Plan](./plan.md) - Phased implementation timeline +- [Metadata](./metadata.json) - Track status and priorities + +## Overview + +This track improves 50+ existing skills by: + +1. **Standardizing structure** - Consistent sections across all skills +2. **Adding missing sections** - Triggers, anti-patterns, success criteria +3. **Improving depth** - Minimum 150 lines, practical examples +4. **Enabling discovery** - Cross-references between related skills + +## Key Deliverables + +| Phase | Focus | Skills | +|-------|-------|--------| +| 1 | Standards & Templates | Infrastructure | +| 2 | High-Impact Skills | 10 priority skills | +| 3 | Complete Coverage | 40+ remaining skills | +| 4 | Documentation & Tooling | CI/CD, relationship graph | + +## Standards Summary + +### Required Sections +- When to Use This Skill +- Detailed Guidance (150+ lines) +- Common Mistakes (3+ entries) +- Tool Requirements +- Success Indicators (3+ criteria) +- Related Skills (2+ references) + +### Quality Gates +- All required sections present +- No placeholder content +- Cross-references bidirectional +- Practical examples included + +## Status + +**Current:** Planning +**Priority:** Medium +**Dependencies:** None diff --git a/conductor/tracks/skill-quality/metadata.json b/conductor/tracks/skill-quality/metadata.json new file mode 100644 index 0000000..0cd8fb2 --- /dev/null +++ b/conductor/tracks/skill-quality/metadata.json @@ -0,0 +1,12 @@ +{ + "track_id": "skill-quality", + "name": "Skill Quality Improvement", + "description": "Systematic improvements to existing skills across all plugins: standardization, depth, cross-references, and quality gates", + "status": "planning", + "created": "2026-02-11", + "priority": "medium", + "dependencies": [], + "deliverable": "Updated skill files with consistent structure, triggers, anti-patterns, and quality standards", + "phases": 3, + "total_skills_affected": 50 +} diff --git a/conductor/tracks/skill-quality/plan.md b/conductor/tracks/skill-quality/plan.md new file mode 100644 index 0000000..ef4b30b --- /dev/null +++ b/conductor/tracks/skill-quality/plan.md @@ -0,0 +1,141 @@ +# Skill Quality Improvement Track Plan + +## Phase 1: Standards & Infrastructure +*Estimated: 1 session* + +- [ ] Create standardized skill template + - Acceptance: Template includes all 14 required sections +- [ ] Write skill style guide + - Acceptance: Covers voice, tone, formatting, terminology +- [ ] Create quality checklist for reviewers + - Acceptance: Checklist covers all quality gates +- [ ] Build automated validation script + - Acceptance: Script checks for required sections, minimum length, cross-references +- [ ] Document improvement process + - Acceptance: Clear instructions for updating existing skills + +**Checkpoint:** `conductor(checkpoint): Skill quality standards established` + +## Phase 2: High-Impact Skills +*Estimated: 3 sessions* + +### Cross-Plugin Foundation Skills +- [ ] Update `data/data-validation` (234 lines) + - Add: Tool requirements, Success indicators, Related skills + - Acceptance: Meets all quality gates +- [ ] Update `customer-support/ticket-triage` (184 lines) + - Add: Quick reference, Common mistakes, Troubleshooting + - Acceptance: Meets all quality gates +- [ ] Update `legal/compliance` (214 lines) + - Add: Quick reference, Success indicators, Related skills + - Acceptance: Meets all quality gates + +### High-Usage Skills (Priority) +- [ ] Update `productivity/task-management` (90 lines → 150+) + - Add: Prioritization matrix, Eisenhower framework, Common mistakes + - Acceptance: Minimum 150 lines, all sections present +- [ ] Update `productivity/memory-management` (322 lines) + - Add: Success indicators, Related skills, Troubleshooting + - Acceptance: Meets all quality gates +- [ ] Update `data/sql-queries` (427 lines) + - Add: Performance tips, Quick reference, Related skills + - Acceptance: Meets all quality gates +- [ ] Update `customer-support/response-drafting` (302 lines) + - Add: Tone calibration, Success indicators, Related skills + - Acceptance: Meets all quality gates + +### Plugin-Specific Priority Skills +- [ ] Update `finance/reconciliation` (174 lines) + - Add: Common discrepancy patterns, Troubleshooting, Related skills + - Acceptance: Meets all quality gates +- [ ] Update `sales/create-an-asset` (867 lines) + - Add: Quick start path, Success indicators, Related skills + - Acceptance: Has quick-start section for simple cases +- [ ] Update `marketing/content-creation` (156 lines → 200+) + - Add: Brand voice checklist, Examples gallery, Related skills + - Acceptance: Minimum 200 lines, examples included +- [ ] Update `bio-research/scvi-tools` (155 lines → 200+) + - Add: Computational requirements, Quick reference, Troubleshooting + - Acceptance: Minimum 200 lines, all sections present + +**Checkpoint:** `conductor(checkpoint): High-impact skills updated` + +## Phase 3: Complete Coverage +*Estimated: 4 sessions* + +### Productivity Plugin +- [ ] Update remaining productivity skills (2 skills) + - Acceptance: All skills meet quality gates + +### Data Plugin +- [ ] Update remaining data skills (5 skills) + - Acceptance: All skills meet quality gates + +### Customer Support Plugin +- [ ] Update remaining customer-support skills (2 skills) + - Acceptance: All skills meet quality gates + +### Legal Plugin +- [ ] Update remaining legal skills (4 skills) + - Acceptance: All skills meet quality gates + +### Finance Plugin +- [ ] Update remaining finance skills (5 skills) + - Acceptance: All skills meet quality gates + +### Sales Plugin +- [ ] Update remaining sales skills (4 skills) + - Acceptance: All skills meet quality gates + +### Marketing Plugin +- [ ] Update remaining marketing skills (2 skills) + - Acceptance: All skills meet quality gates + +### Bio-Research Plugin +- [ ] Update remaining bio-research skills (4 skills) + - Acceptance: All skills meet quality gates + +### Enterprise Search Plugin +- [ ] Update all enterprise-search skills (3 skills) + - Acceptance: All skills meet quality gates + +### Cowork Plugin Management +- [ ] Update all cowork-plugin-management skills (2 skills) + - Acceptance: All skills meet quality gates + +**Checkpoint:** `conductor(checkpoint): All skills updated to quality standard` + +## Phase 4: Documentation & Tooling +*Estimated: 1 session* + +- [ ] Create skill relationship graph + - Acceptance: Visual diagram showing skill connections +- [ ] Build skill composition documentation + - Acceptance: Documents common workflows using multiple skills +- [ ] Create contributor guide for skill quality + - Acceptance: Guide explains standards and review process +- [ ] Set up CI validation for skill files + - Acceptance: Automated checks run on PRs + +**Checkpoint:** `conductor(checkpoint): Skill quality tooling complete` + +## Notes + +### Execution Strategy +- Work plugin-by-plugin to maintain consistency +- Run validation script after each skill update +- Review related skills together to ensure cross-references are bidirectional +- Prioritize skills with < 150 lines first + +### Avoiding Scope Creep +- Only add sections specified in this plan +- Do not add new functionality to skills +- Do not change existing behavior +- Focus on structure, not content changes + +### Quality Verification +After each skill update: +1. Run automated validation script +2. Check all quality gates pass +3. Verify cross-references resolve correctly +4. Confirm no placeholder content remains diff --git a/conductor/tracks/skill-quality/spec.md b/conductor/tracks/skill-quality/spec.md new file mode 100644 index 0000000..a24cf30 --- /dev/null +++ b/conductor/tracks/skill-quality/spec.md @@ -0,0 +1,309 @@ +# Skill Quality Improvement Track Specification + +## Overview + +Systematically improve existing skills across all plugins to ensure consistency, depth, and practical utility. This track establishes quality standards and implements them across the 50+ existing skills. + +## Problems Identified + +### 1. Inconsistent Structure +- Some skills have explicit "Triggers" sections, others don't +- Varying levels of detail (90 lines to 867 lines) +- No standard section ordering + +### 2. Missing Key Sections +- No "Anti-Patterns" / "Common Mistakes" in most skills +- No "Related Skills" cross-references +- No "Success Criteria" or quality gates +- No tool integration hints + +### 3. Depth Imbalance +- Short skills (< 120 lines) lack sufficient guidance +- Very long skills need quick-start options +- Technical skills missing practical examples + +### 4. Discoverability +- Skills operate in isolation +- No cross-plugin references +- Hard to find related capabilities + +## Proposed Standards + +### Standard Skill Structure + +```markdown +--- +name: skill-name +description: One-line description. Use when [trigger condition 1], [trigger condition 2]. +--- + +# Skill Name + +Brief introduction (1-2 sentences). + +## When to Use This Skill + +Invoke when: +- User mentions X +- User asks about Y +- Context indicates Z + +## Quick Reference + +[For simple cases - condensed guidance in 5-10 bullet points] + +## Detailed Guidance + +[Main content - organized with clear headers] + +### Step-by-Step Process + +1. ... +2. ... + +## Common Mistakes + +| Mistake | Why It's Wrong | Instead | +|---------|----------------|---------| +| ... | ... | ... | + +## Tool Requirements + +- `~~category` - Purpose +- `~~category` - Purpose + +## Success Indicators + +You've applied this skill well when: +- [ ] Criterion 1 +- [ ] Criterion 2 + +## Related Skills + +- `~~plugin/skill-name` - Brief description of relationship +- `~~plugin/skill-name` - Brief description of relationship +``` + +### Section Guidelines + +| Section | Required | Min Lines | Purpose | +|---------|----------|-----------|---------| +| Frontmatter | ✓ | 3 | Name, description with triggers | +| When to Use | ✓ | 5 | Explicit invocation conditions | +| Quick Reference | For complex skills | 10 | Fast path for simple cases | +| Detailed Guidance | ✓ | 50+ | Main instructional content | +| Common Mistakes | ✓ | 10 | Anti-patterns and corrections | +| Tool Requirements | ✓ | 5 | MCP connector dependencies | +| Success Indicators | ✓ | 5 | Quality gate checklist | +| Related Skills | ✓ | 3 | Cross-references | + +### Quality Gates + +Before any skill is considered complete: + +- [ ] Minimum 150 lines total +- [ ] All required sections present +- [ ] At least 3 "Common Mistakes" documented +- [ ] At least 2 "Related Skills" referenced +- [ ] At least 3 "Success Indicators" defined +- [ ] Frontmatter description includes trigger conditions +- [ ] Practical examples included (not just theory) +- [ ] No placeholder content (e.g., "TODO", "TBD") + +## Additional Improvements + +### 5. Accessibility & Internationalization +- Use plain language (avoid jargon without definition) +- Consider non-native English speakers +- Define acronyms on first use +- Use consistent terminology across skills + +### 6. Versioning & Changelog +Add to each skill: +```markdown +## Version History + +| Version | Date | Changes | +|---------|------|---------| +| 1.1.0 | 2026-02-11 | Added anti-patterns section | +``` + +### 7. Example Gallery +For visual/creative skills, include: +```markdown +## Examples + +### Example 1: [Scenario Name] +**Context:** ... +**Input:** ... +**Output:** ... +**Why it works:** ... +``` + +### 8. Error Handling Guidance +```markdown +## Troubleshooting + +| Error | Cause | Solution | +|-------|-------|----------| +| ... | ... | ... | +``` + +### 9. Performance Considerations +For skills involving large data or complex operations: +```markdown +## Performance Tips + +- For datasets > 10K rows, use X approach +- Cache Y for repeated operations +- Avoid Z pattern with large files +``` + +### 10. Security & Privacy Notes +For skills handling sensitive data: +```markdown +## Security Considerations + +- Never log PII +- Sanitize inputs before processing +- Use environment variables for credentials +- Data retention: delete after X days +``` + +### 11. Skill Composition +Enable skills to build on each other: +```markdown +## Workflow Integration + +This skill is often used as part of: + +1. **[Workflow Name]** + - Start with: `~~plugin/skill-a` + - Then: `~~plugin/skill-b` (this skill) + - End with: `~~plugin/skill-c` +``` + +### 12. Confidence Levels +Help users know when to trust the output: +```markdown +## Confidence Indicators + +| Scenario | Confidence | Action | +|----------|------------|--------| +| Standard inputs | High | Use directly | +| Edge case X | Medium | Review before sharing | +| Novel situation | Low | Flag for human review | +``` + +### 13. Input/Output Contracts +```markdown +## Expected Inputs + +| Input | Type | Required | Description | +|-------|------|----------|-------------| +| data | file | ✓ | CSV, JSON, or Excel | +| config | object | | Override defaults | + +## Outputs + +| Output | Type | Description | +|--------|------|-------------| +| report | markdown | Analysis summary | +| data | file | Cleaned dataset | +``` + +### 14. Testing & Validation +Add skill self-tests where applicable: +```markdown +## Self-Validation + +Before delivering output, verify: +1. [Specific check 1] +2. [Specific check 2] + +If validation fails: [Recovery steps] +``` + +## Plugin-Specific Improvements + +### Productivity Plugin +- `task-management`: Add prioritization matrix, Eisenhower framework +- `memory-management`: Add memory decay curves, retention strategies + +### Data Plugin +- `sql-queries`: Add query performance optimization section +- `data-validation`: Add statistical significance checks +- All skills: Add sample datasets for practice + +### Customer Support Plugin +- `ticket-triage`: Add sentiment analysis indicators +- `response-drafting`: Add tone calibration for different cultures +- `escalation`: Add executive communication templates + +### Legal Plugin +- `compliance`: Add jurisdiction-specific quick reference +- `contract-review`: Add red flag checklist by contract type +- All skills: Add regulatory update monitoring guidance + +### Finance Plugin +- `reconciliation`: Add common discrepancy patterns +- `audit-support`: Add audit trail documentation standards +- All skills: Add SOX compliance considerations + +### Sales Plugin +- `create-an-asset`: Add quick-start path for simple assets +- `competitive-intelligence`: Add source credibility assessment +- All skills: Add CRM integration patterns + +### Marketing Plugin +- `content-creation`: Add brand voice consistency checklist +- `campaign-planning`: Add channel-specific considerations +- All skills: Add A/B testing guidance + +### Bio-Research Plugin +- All skills: Add reproducibility checklist +- All skills: Add data provenance tracking +- `scvi-tools`: Add computational requirements section + +### Enterprise Search Plugin +- `search-strategy`: Add query expansion techniques +- `knowledge-synthesis`: Add source quality assessment + +## Deliverables + +### Phase 1: Standards & Templates +- Skill template with all required sections +- Style guide for consistent voice/tone +- Quality checklist for reviewers +- Automated validation script + +### Phase 2: High-Impact Skills +- Update top 20 most-used skills to new standard +- Focus on cross-plugin skills first +- Add comprehensive cross-references + +### Phase 3: Complete Coverage +- Update remaining 30+ skills +- Create skill composition documentation +- Build skill relationship graph + +## Success Metrics + +| Metric | Current | Target | +|--------|---------|--------| +| Skills with "When to Use" section | ~30% | 100% | +| Skills with "Common Mistakes" | ~15% | 100% | +| Skills with "Related Skills" | ~5% | 100% | +| Average skill length | ~200 lines | 200-400 lines | +| Cross-skill references | ~10 total | 150+ total | +| Skills < 150 lines | 15 | 0 | + +## Dependencies + +None - this track improves existing content without blocking other work. + +## Risks + +- **Scope creep**: Limit to documented improvements, avoid feature additions +- **Breaking changes**: Preserve existing skill behavior, only add sections +- **Inconsistency**: Use templates and automated checks to enforce standards From 2458e83485806937307c3fe547cb67b357615c03 Mon Sep 17 00:00:00 2001 From: "Dylan Mordaunt (Illawarra Shoalhaven LHD)" Date: Wed, 11 Feb 2026 15:58:19 +1100 Subject: [PATCH 10/57] refactor(skill-quality): Focus on health plugin skills only - Rename to health-skill-quality in metadata - Rewrite spec.md with healthcare-specific requirements: - Regulatory context (HIPAA, HITECH) - Clinical accuracy standards - Privacy & PHI considerations - Healthcare workflow integration - Rewrite plan.md to support health track implementations - Update to 12 required sections, 11 quality gates - Add domain-specific improvements for all health tracks - Minimum 200 lines per health skill (vs 150 general) --- conductor/tracks.md | 14 +++++++++----- 1 file changed, 9 insertions(+), 5 deletions(-) diff --git a/conductor/tracks.md b/conductor/tracks.md index c93e773..2a04bd3 100644 --- a/conductor/tracks.md +++ b/conductor/tracks.md @@ -32,12 +32,14 @@ PHASE 3: Extended Workflows (parallel) │ ├── health-quality ──────────────────────────────────────┤ ├── health-financial ────────────────────────────────────┤ ├── health-evidence ─────────────────────────────────────┤ -└── health-data-analysis ────────────────────────────────┤ +├── health-data-analysis ────────────────────────────────┤ +└── health-public-health ────────────────────────────────┤ │ PHASE 4: Research/Academic (parallel, depends Phase 3) │ ├── health-ethics ───────────────────────────────────────┤ ├── health-economics ────────────────────────────────────┤ ├── health-manuscripts ──────────────────────────────────┤ +├── health-doc-coauthoring ──────────────────────────────┤ ├── health-grants ───────────────────────────────────────┤ └── health-medicolegal ──────────────────────────────────┘ ``` @@ -59,17 +61,19 @@ PHASE 4: Research/Academic (parallel, depends Phase 3) │ | [health-financial](./tracks/health-financial/) | Payer contracts | 3 | finance | | [health-evidence](./tracks/health-evidence/) | Systematic reviews | 3 | bio-research | | [health-data-analysis](./tracks/health-data-analysis/) | Epidemiological reports | 3 | data | +| [health-public-health](./tracks/health-public-health/) | Notifiable disease reporting and surveillance | 3 | legal/compliance | | [health-ethics](./tracks/health-ethics/) | Research/clinical ethics | 4 | bio-research | | [health-economics](./tracks/health-economics/) | HTA, cost-effectiveness | 4 | data, finance | | [health-manuscripts](./tracks/health-manuscripts/) | Journal preparation | 4 | bio-research | +| [health-doc-coauthoring](./tracks/health-doc-coauthoring/) | Three-stage collaborative clinical document development | 4 | document-skills/docx | | [health-grants](./tracks/health-grants/) | Grant applications | 4 | bio-research | | [health-medicolegal](./tracks/health-medicolegal/) | Child protection, affidavits, medico-legal | 4 | legal | ### Summary -- **19 tracks** total (1 meta + 18 implementation) -- **30 skills** across all tracks -- **14 commands** for key workflows +- **21 tracks** total (1 meta + 20 implementation) +- **33 skills** across all tracks +- **16 commands** for key workflows - **4 phases** of execution ## Track Status @@ -83,4 +87,4 @@ PHASE 4: Research/Academic (parallel, depends Phase 3) │ | Track | Description | Status | |-------|-------------|--------| -| [skill-quality](./tracks/skill-quality/) | Improve 50+ existing skills across all plugins | planning | +| [health-skill-quality](./tracks/skill-quality/) | Quality standards for health plugin skills (30 skills) | planning | From 89d929b2876738f245550e4ad2f88ff467fc40d2 Mon Sep 17 00:00:00 2001 From: "Dylan Mordaunt (Illawarra Shoalhaven LHD)" Date: Wed, 11 Feb 2026 16:04:40 +1100 Subject: [PATCH 11/57] refactor(skill-quality): Focus on health plugin skills only - Rename to health-skill-quality in metadata - Rewrite spec.md with healthcare-specific requirements: - Regulatory context (HIPAA, HITECH) - Clinical accuracy standards - Privacy & PHI considerations - Healthcare workflow integration - Rewrite plan.md to support health track implementations - Update to 12 required sections, 11 quality gates - Add domain-specific improvements for all health tracks - Minimum 200 lines per health skill (vs 150 general) --- conductor/tracks/skill-quality/index.md | 58 ++- conductor/tracks/skill-quality/metadata.json | 14 +- conductor/tracks/skill-quality/plan.md | 227 +++++----- conductor/tracks/skill-quality/spec.md | 433 ++++++++----------- 4 files changed, 330 insertions(+), 402 deletions(-) diff --git a/conductor/tracks/skill-quality/index.md b/conductor/tracks/skill-quality/index.md index 2e220aa..8337112 100644 --- a/conductor/tracks/skill-quality/index.md +++ b/conductor/tracks/skill-quality/index.md @@ -1,49 +1,59 @@ -# Skill Quality Improvement Track +# Health Skill Quality Track -Systematic improvements to existing skills across all plugins. +Quality standards and templates for health plugin skills. ## Quick Links -- [Specification](./spec.md) - Problems, standards, and improvement details -- [Plan](./plan.md) - Phased implementation timeline +- [Specification](./spec.md) - Healthcare-specific standards and requirements +- [Plan](./plan.md) - Template creation and skill support phases - [Metadata](./metadata.json) - Track status and priorities ## Overview -This track improves 50+ existing skills by: +This track establishes quality standards specifically for the 30 planned health plugin skills, ensuring: -1. **Standardizing structure** - Consistent sections across all skills -2. **Adding missing sections** - Triggers, anti-patterns, success criteria -3. **Improving depth** - Minimum 150 lines, practical examples -4. **Enabling discovery** - Cross-references between related skills +1. **Regulatory compliance** - HIPAA, state laws, accreditation standards +2. **Clinical accuracy** - Appropriate disclaimers and escalation criteria +3. **Privacy protection** - PHI handling, de-identification, retention +4. **Workflow integration** - EHR considerations, documentation standards ## Key Deliverables -| Phase | Focus | Skills | +| Phase | Focus | Output | |-------|-------|--------| -| 1 | Standards & Templates | Infrastructure | -| 2 | High-Impact Skills | 10 priority skills | -| 3 | Complete Coverage | 40+ remaining skills | -| 4 | Documentation & Tooling | CI/CD, relationship graph | +| 1 | Standards & Templates | Health skill template, style guide, quality checklist | +| 2 | Skill Support | Templates for all 30 health skills across 17 tracks | -## Standards Summary +## Health Skill Requirements -### Required Sections +### Required Sections (12) - When to Use This Skill -- Detailed Guidance (150+ lines) -- Common Mistakes (3+ entries) +- Regulatory Context +- Quick Reference (for complex skills) +- Detailed Guidance +- Documentation Requirements +- Common Mistakes +- When to Escalate +- Privacy Considerations - Tool Requirements -- Success Indicators (3+ criteria) -- Related Skills (2+ references) +- Success Indicators +- Related Skills -### Quality Gates +### Quality Gates (11) +- Minimum 200 lines total - All required sections present +- HIPAA relevance documented +- Healthcare disclaimers included +- Privacy considerations complete +- Escalation criteria defined +- 3+ Common Mistakes +- 2+ Related Skills +- 3+ Success Indicators +- Documentation requirements clear - No placeholder content -- Cross-references bidirectional -- Practical examples included ## Status **Current:** Planning **Priority:** Medium -**Dependencies:** None +**Dependencies:** health-core diff --git a/conductor/tracks/skill-quality/metadata.json b/conductor/tracks/skill-quality/metadata.json index 0cd8fb2..77dc573 100644 --- a/conductor/tracks/skill-quality/metadata.json +++ b/conductor/tracks/skill-quality/metadata.json @@ -1,12 +1,12 @@ { - "track_id": "skill-quality", - "name": "Skill Quality Improvement", - "description": "Systematic improvements to existing skills across all plugins: standardization, depth, cross-references, and quality gates", + "track_id": "health-skill-quality", + "name": "Health Skill Quality", + "description": "Quality standards and templates for health plugin skills: healthcare-specific structure, regulatory compliance, and cross-references", "status": "planning", "created": "2026-02-11", "priority": "medium", - "dependencies": [], - "deliverable": "Updated skill files with consistent structure, triggers, anti-patterns, and quality standards", - "phases": 3, - "total_skills_affected": 50 + "dependencies": ["health-core"], + "deliverable": "Health skill template and quality standards for all 30 planned health skills", + "phases": 2, + "total_skills": 30 } diff --git a/conductor/tracks/skill-quality/plan.md b/conductor/tracks/skill-quality/plan.md index ef4b30b..7f3abd1 100644 --- a/conductor/tracks/skill-quality/plan.md +++ b/conductor/tracks/skill-quality/plan.md @@ -1,141 +1,110 @@ -# Skill Quality Improvement Track Plan +# Health Skill Quality Track Plan -## Phase 1: Standards & Infrastructure +## Phase 1: Standards & Templates *Estimated: 1 session* -- [ ] Create standardized skill template - - Acceptance: Template includes all 14 required sections -- [ ] Write skill style guide - - Acceptance: Covers voice, tone, formatting, terminology -- [ ] Create quality checklist for reviewers - - Acceptance: Checklist covers all quality gates -- [ ] Build automated validation script - - Acceptance: Script checks for required sections, minimum length, cross-references -- [ ] Document improvement process - - Acceptance: Clear instructions for updating existing skills - -**Checkpoint:** `conductor(checkpoint): Skill quality standards established` - -## Phase 2: High-Impact Skills -*Estimated: 3 sessions* - -### Cross-Plugin Foundation Skills -- [ ] Update `data/data-validation` (234 lines) - - Add: Tool requirements, Success indicators, Related skills - - Acceptance: Meets all quality gates -- [ ] Update `customer-support/ticket-triage` (184 lines) - - Add: Quick reference, Common mistakes, Troubleshooting - - Acceptance: Meets all quality gates -- [ ] Update `legal/compliance` (214 lines) - - Add: Quick reference, Success indicators, Related skills - - Acceptance: Meets all quality gates - -### High-Usage Skills (Priority) -- [ ] Update `productivity/task-management` (90 lines → 150+) - - Add: Prioritization matrix, Eisenhower framework, Common mistakes - - Acceptance: Minimum 150 lines, all sections present -- [ ] Update `productivity/memory-management` (322 lines) - - Add: Success indicators, Related skills, Troubleshooting - - Acceptance: Meets all quality gates -- [ ] Update `data/sql-queries` (427 lines) - - Add: Performance tips, Quick reference, Related skills - - Acceptance: Meets all quality gates -- [ ] Update `customer-support/response-drafting` (302 lines) - - Add: Tone calibration, Success indicators, Related skills - - Acceptance: Meets all quality gates - -### Plugin-Specific Priority Skills -- [ ] Update `finance/reconciliation` (174 lines) - - Add: Common discrepancy patterns, Troubleshooting, Related skills - - Acceptance: Meets all quality gates -- [ ] Update `sales/create-an-asset` (867 lines) - - Add: Quick start path, Success indicators, Related skills - - Acceptance: Has quick-start section for simple cases -- [ ] Update `marketing/content-creation` (156 lines → 200+) - - Add: Brand voice checklist, Examples gallery, Related skills - - Acceptance: Minimum 200 lines, examples included -- [ ] Update `bio-research/scvi-tools` (155 lines → 200+) - - Add: Computational requirements, Quick reference, Troubleshooting - - Acceptance: Minimum 200 lines, all sections present - -**Checkpoint:** `conductor(checkpoint): High-impact skills updated` - -## Phase 3: Complete Coverage -*Estimated: 4 sessions* - -### Productivity Plugin -- [ ] Update remaining productivity skills (2 skills) - - Acceptance: All skills meet quality gates - -### Data Plugin -- [ ] Update remaining data skills (5 skills) - - Acceptance: All skills meet quality gates - -### Customer Support Plugin -- [ ] Update remaining customer-support skills (2 skills) - - Acceptance: All skills meet quality gates - -### Legal Plugin -- [ ] Update remaining legal skills (4 skills) - - Acceptance: All skills meet quality gates - -### Finance Plugin -- [ ] Update remaining finance skills (5 skills) - - Acceptance: All skills meet quality gates - -### Sales Plugin -- [ ] Update remaining sales skills (4 skills) - - Acceptance: All skills meet quality gates - -### Marketing Plugin -- [ ] Update remaining marketing skills (2 skills) - - Acceptance: All skills meet quality gates - -### Bio-Research Plugin -- [ ] Update remaining bio-research skills (4 skills) - - Acceptance: All skills meet quality gates - -### Enterprise Search Plugin -- [ ] Update all enterprise-search skills (3 skills) - - Acceptance: All skills meet quality gates - -### Cowork Plugin Management -- [ ] Update all cowork-plugin-management skills (2 skills) - - Acceptance: All skills meet quality gates - -**Checkpoint:** `conductor(checkpoint): All skills updated to quality standard` - -## Phase 4: Documentation & Tooling -*Estimated: 1 session* +- [ ] Create health skill template + - Acceptance: Template includes all 12 required sections with healthcare examples +- [ ] Write health skill style guide + - Acceptance: Covers voice, tone, healthcare terminology, disclaimer standards +- [ ] Create health skill quality checklist + - Acceptance: Checklist covers all 11 quality gates specific to health skills +- [ ] Build health skill validation script + - Acceptance: Script checks for required sections, disclaimers, privacy sections +- [ ] Document health skill creation process + - Acceptance: Clear instructions for health track implementers + +**Checkpoint:** `conductor(checkpoint): Health skill quality standards established` + +## Phase 2: Skill Development Support +*Ongoing - supports all health track implementations* + +### Complaints Skills (health-complaints track) +- [ ] Provide template for complaint-analysis skill +- [ ] Provide template for response-drafting skill + +### Incident Skills (health-incidents track) +- [ ] Provide template for root-cause-analysis skill +- [ ] Provide template for cap-writing skill + +### Risk Skills (health-risk track) +- [ ] Provide template for clinical-risk skill +- [ ] Provide template for worker-risk skill +- [ ] Provide template for enterprise-risk skill + +### Information Governance Skills (health-information track) +- [ ] Provide template for release-of-information skill +- [ ] Provide template for consent-management skill + +### Coding Skills (health-coding track) +- [ ] Provide template for clinical-coding skill + +### Governance Skills (health-governance track) +- [ ] Provide template for policy-development skill +- [ ] Provide template for procedure-development skill +- [ ] Provide template for guideline-development skill + +### Credentialing Skills (health-credentialing track) +- [ ] Provide template for credentialing skill +- [ ] Provide template for privileging skill + +### Procurement Skills (health-procurement track) +- [ ] Provide template for device-procurement skill +- [ ] Provide template for business-case skill + +### Quality Skills (health-quality track) +- [ ] Provide template for quality-improvement skill +- [ ] Provide template for accreditation-prep skill + +### Financial Skills (health-financial track) +- [ ] Provide template for payer-contracts skill +- [ ] Provide template for charge-capture skill + +### Evidence Skills (health-evidence track) +- [ ] Provide template for systematic-review skill +- [ ] Provide template for evidence-synthesis skill + +### Data Analysis Skills (health-data-analysis track) +- [ ] Provide template for health-data-report skill + +### Ethics Skills (health-ethics track) +- [ ] Provide template for research-ethics skill +- [ ] Provide template for clinical-ethics skill + +### Economics Skills (health-economics track) +- [ ] Provide template for health-econ-eval skill +- [ ] Provide template for hta-submission skill + +### Manuscript Skills (health-manuscripts track) +- [ ] Provide template for manuscript-prep skill + +### Grants Skills (health-grants track) +- [ ] Provide template for grant-writer skill -- [ ] Create skill relationship graph - - Acceptance: Visual diagram showing skill connections -- [ ] Build skill composition documentation - - Acceptance: Documents common workflows using multiple skills -- [ ] Create contributor guide for skill quality - - Acceptance: Guide explains standards and review process -- [ ] Set up CI validation for skill files - - Acceptance: Automated checks run on PRs +### Medicolegal Skills (health-medicolegal track) +- [ ] Provide template for child-protection skill +- [ ] Provide template for affidavits skill +- [ ] Provide template for medicolegal-reports skill -**Checkpoint:** `conductor(checkpoint): Skill quality tooling complete` +**Checkpoint:** `conductor(checkpoint): All health skill templates provided` ## Notes ### Execution Strategy -- Work plugin-by-plugin to maintain consistency -- Run validation script after each skill update -- Review related skills together to ensure cross-references are bidirectional -- Prioritize skills with < 150 lines first +- Provide templates proactively as each health track begins implementation +- Quality review skills as they are created, not retroactively +- Ensure cross-references between related health skills +- Validate regulatory context for each domain -### Avoiding Scope Creep -- Only add sections specified in this plan -- Do not add new functionality to skills -- Do not change existing behavior -- Focus on structure, not content changes +### Template Distribution +- Store templates in health/skills/.templates/ directory +- Reference in each health tracks spec.md +- Update templates based on track implementer feedback ### Quality Verification -After each skill update: -1. Run automated validation script -2. Check all quality gates pass -3. Verify cross-references resolve correctly -4. Confirm no placeholder content remains +For each completed health skill: +1. Run validation script for required sections +2. Verify regulatory context is appropriate for domain +3. Check privacy considerations are complete +4. Confirm escalation criteria are realistic +5. Validate cross-references to related health skills diff --git a/conductor/tracks/skill-quality/spec.md b/conductor/tracks/skill-quality/spec.md index a24cf30..02235a6 100644 --- a/conductor/tracks/skill-quality/spec.md +++ b/conductor/tracks/skill-quality/spec.md @@ -1,39 +1,38 @@ -# Skill Quality Improvement Track Specification +# Health Skill Quality Specification ## Overview -Systematically improve existing skills across all plugins to ensure consistency, depth, and practical utility. This track establishes quality standards and implements them across the 50+ existing skills. +Establish quality standards and templates specifically for health plugin skills. These standards ensure consistency across all 30 planned health skills, with healthcare-specific considerations for compliance, privacy, and clinical accuracy. -## Problems Identified +## Health-Specific Quality Requirements -### 1. Inconsistent Structure -- Some skills have explicit "Triggers" sections, others don't -- Varying levels of detail (90 lines to 867 lines) -- No standard section ordering +### 1. Regulatory & Compliance Context +Every health skill must include: +- **Applicable regulations** (HIPAA, HITECH, state privacy laws, etc.) +- **Compliance checkpoints** specific to the workflow +- **Documentation requirements** for audit trails -### 2. Missing Key Sections -- No "Anti-Patterns" / "Common Mistakes" in most skills -- No "Related Skills" cross-references -- No "Success Criteria" or quality gates -- No tool integration hints +### 2. Clinical Accuracy Standards +- **Disclaimer placement** - "This skill assists with clinical workflows but does not provide clinical advice" +- **Validation requirements** - When outputs require clinical review +- **Escalation criteria** - When to involve subject matter experts -### 3. Depth Imbalance -- Short skills (< 120 lines) lack sufficient guidance -- Very long skills need quick-start options -- Technical skills missing practical examples +### 3. Privacy & Security +- **PHI handling** - Identifiable data considerations +- **Data minimization** - Using minimum necessary information +- **Retention guidance** - How long to retain generated documents +- **De-identification** - When and how to de-identify data -### 4. Discoverability -- Skills operate in isolation -- No cross-plugin references -- Hard to find related capabilities +### 4. Healthcare Workflow Integration +- **EHR/EMR considerations** - How skill integrates with clinical systems +- **Documentation standards** - Formatting for medical records +- **Communication protocols** - Appropriate channels for different content types -## Proposed Standards - -### Standard Skill Structure +## Standard Health Skill Structure ```markdown --- -name: skill-name +name: health-skill-name description: One-line description. Use when [trigger condition 1], [trigger condition 2]. --- @@ -41,269 +40,219 @@ description: One-line description. Use when [trigger condition 1], [trigger cond Brief introduction (1-2 sentences). +**Important**: [Appropriate disclaimer for healthcare context] + ## When to Use This Skill Invoke when: -- User mentions X -- User asks about Y -- Context indicates Z +- User mentions [specific healthcare scenario] +- User asks about [specific workflow] +- Context indicates [specific need] + +## Regulatory Context + +| Regulation | Relevance | Key Requirements | +|------------|-----------|------------------| +| HIPAA | [How it applies] | [Specific requirements] | +| [Other] | [How it applies] | [Specific requirements] | ## Quick Reference -[For simple cases - condensed guidance in 5-10 bullet points] +[Condensed guidance for simple/common cases - 5-10 bullet points] ## Detailed Guidance -[Main content - organized with clear headers] +[Main content organized with clear headers] ### Step-by-Step Process 1. ... 2. ... +## Documentation Requirements + +- [ ] Required documentation element 1 +- [ ] Required documentation element 2 +- [ ] Audit trail requirements + ## Common Mistakes | Mistake | Why It's Wrong | Instead | |---------|----------------|---------| | ... | ... | ... | +## When to Escalate + +Escalate to [appropriate party] when: +- [Escalation criterion 1] +- [Escalation criterion 2] + +## Privacy Considerations + +- **PHI involved**: [Yes/No/Conditional] +- **Data minimization**: [Guidance] +- **Retention**: [How long to keep outputs] + ## Tool Requirements -- `~~category` - Purpose -- `~~category` - Purpose +- \`~~cloud storage\` - For document storage +- \`~~project tracker\` - For workflow tracking +- \`~~clinical systems\` - For EHR integration (if applicable) ## Success Indicators You've applied this skill well when: -- [ ] Criterion 1 -- [ ] Criterion 2 +- [ ] All required documentation is complete +- [ ] Compliance checkpoints verified +- [ ] Output meets documentation standards ## Related Skills -- `~~plugin/skill-name` - Brief description of relationship -- `~~plugin/skill-name` - Brief description of relationship +- \`~~health/related-skill\` - Brief description of relationship +- \`~~health/related-skill\` - Brief description of relationship ``` -### Section Guidelines +## Section Guidelines for Health Skills -| Section | Required | Min Lines | Purpose | -|---------|----------|-----------|---------| -| Frontmatter | ✓ | 3 | Name, description with triggers | -| When to Use | ✓ | 5 | Explicit invocation conditions | -| Quick Reference | For complex skills | 10 | Fast path for simple cases | -| Detailed Guidance | ✓ | 50+ | Main instructional content | -| Common Mistakes | ✓ | 10 | Anti-patterns and corrections | -| Tool Requirements | ✓ | 5 | MCP connector dependencies | -| Success Indicators | ✓ | 5 | Quality gate checklist | -| Related Skills | ✓ | 3 | Cross-references | +| Section | Required | Min Lines | Healthcare-Specific Purpose | +|---------|----------|-----------|----------------------------| +| Frontmatter | Yes | 3 | Name, description with clinical triggers | +| When to Use | Yes | 5 | Explicit clinical/operational scenarios | +| Regulatory Context | Yes | 10 | HIPAA, state laws, accreditation standards | +| Quick Reference | Complex skills | 10 | Fast path for routine cases | +| Detailed Guidance | Yes | 50+ | Step-by-step clinical/operational procedures | +| Documentation Requirements | Yes | 10 | Required elements for medical records | +| Common Mistakes | Yes | 10 | Healthcare-specific anti-patterns | +| When to Escalate | Yes | 5 | Criteria for involving SMEs/leadership | +| Privacy Considerations | Yes | 10 | PHI handling, de-identification, retention | +| Tool Requirements | Yes | 5 | MCP connector dependencies | +| Success Indicators | Yes | 5 | Compliance and quality gates | +| Related Skills | Yes | 3 | Cross-references within health plugin | -### Quality Gates +## Quality Gates for Health Skills -Before any skill is considered complete: +Before any health skill is considered complete: -- [ ] Minimum 150 lines total +- [ ] Minimum 200 lines total (health skills require more detail) - [ ] All required sections present +- [ ] Regulatory context includes at least HIPAA relevance - [ ] At least 3 "Common Mistakes" documented -- [ ] At least 2 "Related Skills" referenced +- [ ] At least 2 "Related Skills" referenced (within health plugin preferred) - [ ] At least 3 "Success Indicators" defined -- [ ] Frontmatter description includes trigger conditions -- [ ] Practical examples included (not just theory) +- [ ] Privacy considerations section complete +- [ ] When to Escalate section with clear criteria +- [ ] Appropriate healthcare disclaimers included - [ ] No placeholder content (e.g., "TODO", "TBD") - -## Additional Improvements - -### 5. Accessibility & Internationalization -- Use plain language (avoid jargon without definition) -- Consider non-native English speakers -- Define acronyms on first use -- Use consistent terminology across skills - -### 6. Versioning & Changelog -Add to each skill: -```markdown -## Version History - -| Version | Date | Changes | -|---------|------|---------| -| 1.1.0 | 2026-02-11 | Added anti-patterns section | -``` - -### 7. Example Gallery -For visual/creative skills, include: -```markdown -## Examples - -### Example 1: [Scenario Name] -**Context:** ... -**Input:** ... -**Output:** ... -**Why it works:** ... -``` - -### 8. Error Handling Guidance -```markdown -## Troubleshooting - -| Error | Cause | Solution | -|-------|-------|----------| -| ... | ... | ... | -``` - -### 9. Performance Considerations -For skills involving large data or complex operations: -```markdown -## Performance Tips - -- For datasets > 10K rows, use X approach -- Cache Y for repeated operations -- Avoid Z pattern with large files -``` - -### 10. Security & Privacy Notes -For skills handling sensitive data: -```markdown -## Security Considerations - -- Never log PII -- Sanitize inputs before processing -- Use environment variables for credentials -- Data retention: delete after X days -``` - -### 11. Skill Composition -Enable skills to build on each other: -```markdown -## Workflow Integration - -This skill is often used as part of: - -1. **[Workflow Name]** - - Start with: `~~plugin/skill-a` - - Then: `~~plugin/skill-b` (this skill) - - End with: `~~plugin/skill-c` -``` - -### 12. Confidence Levels -Help users know when to trust the output: -```markdown -## Confidence Indicators - -| Scenario | Confidence | Action | -|----------|------------|--------| -| Standard inputs | High | Use directly | -| Edge case X | Medium | Review before sharing | -| Novel situation | Low | Flag for human review | -``` - -### 13. Input/Output Contracts -```markdown -## Expected Inputs - -| Input | Type | Required | Description | -|-------|------|----------|-------------| -| data | file | ✓ | CSV, JSON, or Excel | -| config | object | | Override defaults | - -## Outputs - -| Output | Type | Description | -|--------|------|-------------| -| report | markdown | Analysis summary | -| data | file | Cleaned dataset | -``` - -### 14. Testing & Validation -Add skill self-tests where applicable: -```markdown -## Self-Validation - -Before delivering output, verify: -1. [Specific check 1] -2. [Specific check 2] - -If validation fails: [Recovery steps] -``` - -## Plugin-Specific Improvements - -### Productivity Plugin -- `task-management`: Add prioritization matrix, Eisenhower framework -- `memory-management`: Add memory decay curves, retention strategies - -### Data Plugin -- `sql-queries`: Add query performance optimization section -- `data-validation`: Add statistical significance checks -- All skills: Add sample datasets for practice - -### Customer Support Plugin -- `ticket-triage`: Add sentiment analysis indicators -- `response-drafting`: Add tone calibration for different cultures -- `escalation`: Add executive communication templates - -### Legal Plugin -- `compliance`: Add jurisdiction-specific quick reference -- `contract-review`: Add red flag checklist by contract type -- All skills: Add regulatory update monitoring guidance - -### Finance Plugin -- `reconciliation`: Add common discrepancy patterns -- `audit-support`: Add audit trail documentation standards -- All skills: Add SOX compliance considerations - -### Sales Plugin -- `create-an-asset`: Add quick-start path for simple assets -- `competitive-intelligence`: Add source credibility assessment -- All skills: Add CRM integration patterns - -### Marketing Plugin -- `content-creation`: Add brand voice consistency checklist -- `campaign-planning`: Add channel-specific considerations -- All skills: Add A/B testing guidance - -### Bio-Research Plugin -- All skills: Add reproducibility checklist -- All skills: Add data provenance tracking -- `scvi-tools`: Add computational requirements section - -### Enterprise Search Plugin -- `search-strategy`: Add query expansion techniques -- `knowledge-synthesis`: Add source quality assessment +- [ ] Documentation requirements align with medical record standards + +## Health Domain-Specific Improvements + +### Complaints Management Skills +- Patient satisfaction framework references +- Service recovery guidelines +- Regulatory reporting thresholds (state-specific) + +### Incident Reporting Skills +- Sentinel event criteria +- Root cause analysis methodology +- CAP (Corrective Action Plan) templates +- Joint Commission requirements + +### Risk Management Skills +- Risk matrix with healthcare-specific likelihood/severity +- Enterprise risk management framework +- Insurance/notification requirements + +### Information Governance Skills +- ROI (Release of Information) processing standards +- Consent requirements by jurisdiction +- Records retention schedules by document type + +### Clinical Coding Skills +- ICD-10/CPT validation rules +- Query physician guidelines +- Audit preparation checklists + +### Governance Skills +- Policy lifecycle management +- Approval workflow requirements +- Accreditation standard mapping + +### Credentialing Skills +- Primary source verification requirements +- FPPE/OPPE framework +- Expiration tracking requirements + +### Procurement Skills +- Value analysis committee process +- FDA clearance/approval verification +- Business case templates for capital equipment + +### Quality Improvement Skills +- PDSA cycle methodology +- Statistical process control basics +- Accreditation readiness checklists + +### Financial Skills +- Payer contract red flags +- Charge capture audit points +- Denial management workflows + +### Evidence Review Skills +- PRISMA guidelines +- GRADE methodology +- Literature search strategies + +### Data Analysis Skills +- Statistical methods for healthcare data +- Risk adjustment concepts +- Dashboard design principles + +### Ethics Skills +- IRB submission requirements +- Ethics committee consultation process +- Conflict of interest disclosure + +### Health Economics Skills +- HTA submission requirements +- Cost-effectiveness analysis methods +- Budget impact model structure + +### Manuscript Skills +- Journal selection criteria +- Authorship guidelines (ICMJE) +- Peer review response templates + +### Grants Skills +- Funder alignment assessment +- Budget justification templates +- Compliance requirements (federal vs. foundation) + +### Medicolegal Skills +- Child protection reporting requirements (jurisdiction-specific) +- Affidavit formatting standards +- Court testimony preparation ## Deliverables ### Phase 1: Standards & Templates -- Skill template with all required sections -- Style guide for consistent voice/tone -- Quality checklist for reviewers -- Automated validation script - -### Phase 2: High-Impact Skills -- Update top 20 most-used skills to new standard -- Focus on cross-plugin skills first -- Add comprehensive cross-references +- Health skill template with all required sections +- Healthcare style guide (voice, tone, terminology) +- Quality checklist specific to health skills +- Validation script for health skill standards -### Phase 3: Complete Coverage -- Update remaining 30+ skills -- Create skill composition documentation -- Build skill relationship graph +### Phase 2: Skill Development Support +- Apply standards as skills are created in health tracks +- Provide templates to track implementers +- Quality review of completed skills ## Success Metrics -| Metric | Current | Target | -|--------|---------|--------| -| Skills with "When to Use" section | ~30% | 100% | -| Skills with "Common Mistakes" | ~15% | 100% | -| Skills with "Related Skills" | ~5% | 100% | -| Average skill length | ~200 lines | 200-400 lines | -| Cross-skill references | ~10 total | 150+ total | -| Skills < 150 lines | 15 | 0 | - -## Dependencies - -None - this track improves existing content without blocking other work. - -## Risks - -- **Scope creep**: Limit to documented improvements, avoid feature additions -- **Breaking changes**: Preserve existing skill behavior, only add sections -- **Inconsistency**: Use templates and automated checks to enforce standards +| Metric | Target | +|--------|--------| +| Skills with "Regulatory Context" section | 100% | +| Skills with "When to Escalate" section | 100% | +| Skills with "Privacy Considerations" section | 100% | +| Average skill length | 200-400 lines | +| Cross-skill references within health | 2+ per skill | +| Skills with healthcare disclai From bf9416f083161ae01a1549cb8380f16f6f022fbb Mon Sep 17 00:00:00 2001 From: "Dylan Mordaunt (Illawarra Shoalhaven LHD)" Date: Thu, 12 Feb 2026 02:22:48 +1100 Subject: [PATCH 12/57] feat(health): established high-rigor skill standards and clinical safety guardrails - Created health-specific skill standards with 14-section architecture mandate - Established interoperability standards (FHIR, SNOMED-CT) and hybrid evidence management - Implemented AU/NZ-first jurisdictional strategy with US/EU-lite portability - Mandated Standard and Lite operating modes for all health skills - Propagated new quality gates and clinical guardrails across all 20 health implementation tracks --- conductor/tracks/health-coding/plan.md | 5 ++ conductor/tracks/health-complaints/plan.md | 5 ++ conductor/tracks/health-credentialing/plan.md | 3 + conductor/tracks/health-data-analysis/plan.md | 3 + .../tracks/health-doc-coauthoring/index.md | 16 ++++ .../health-doc-coauthoring/metadata.json | 14 +++ .../tracks/health-doc-coauthoring/plan.md | 33 +++++++ .../tracks/health-doc-coauthoring/spec.md | 75 ++++++++++++++++ conductor/tracks/health-economics/plan.md | 5 ++ conductor/tracks/health-ethics/plan.md | 5 ++ conductor/tracks/health-evidence/plan.md | 4 + conductor/tracks/health-financial/plan.md | 2 + conductor/tracks/health-governance/plan.md | 3 + conductor/tracks/health-grants/plan.md | 4 + conductor/tracks/health-incidents/plan.md | 5 ++ conductor/tracks/health-information/plan.md | 4 + conductor/tracks/health-manuscripts/plan.md | 4 + conductor/tracks/health-medicolegal/plan.md | 5 ++ .../interoperability-standards.md | 53 +++++++++++ .../health-plugin/jurisdiction-au-nz.md | 25 ++++++ .../health-plugin/jurisdiction-us-eu-lite.md | 19 ++++ conductor/tracks/health-plugin/plan.md | 5 +- .../tracks/health-plugin/skill-standards.md | 88 +++++++++++++++++++ conductor/tracks/health-procurement/plan.md | 2 + .../tracks/health-public-health/index.md | 16 ++++ .../tracks/health-public-health/metadata.json | 13 +++ conductor/tracks/health-public-health/plan.md | 44 ++++++++++ conductor/tracks/health-public-health/spec.md | 63 +++++++++++++ conductor/tracks/health-quality/plan.md | 2 + conductor/tracks/health-risk/index.md | 4 +- conductor/tracks/health-risk/metadata.json | 4 +- conductor/tracks/health-risk/plan.md | 38 ++++++++ conductor/tracks/health-risk/spec.md | 57 ++++++++++++ 33 files changed, 625 insertions(+), 3 deletions(-) create mode 100644 conductor/tracks/health-doc-coauthoring/index.md create mode 100644 conductor/tracks/health-doc-coauthoring/metadata.json create mode 100644 conductor/tracks/health-doc-coauthoring/plan.md create mode 100644 conductor/tracks/health-doc-coauthoring/spec.md create mode 100644 conductor/tracks/health-plugin/interoperability-standards.md create mode 100644 conductor/tracks/health-plugin/jurisdiction-au-nz.md create mode 100644 conductor/tracks/health-plugin/jurisdiction-us-eu-lite.md create mode 100644 conductor/tracks/health-plugin/skill-standards.md create mode 100644 conductor/tracks/health-public-health/index.md create mode 100644 conductor/tracks/health-public-health/metadata.json create mode 100644 conductor/tracks/health-public-health/plan.md create mode 100644 conductor/tracks/health-public-health/spec.md create mode 100644 conductor/tracks/health-risk/plan.md create mode 100644 conductor/tracks/health-risk/spec.md diff --git a/conductor/tracks/health-coding/plan.md b/conductor/tracks/health-coding/plan.md index b796d67..e15bb9b 100644 --- a/conductor/tracks/health-coding/plan.md +++ b/conductor/tracks/health-coding/plan.md @@ -5,6 +5,11 @@ *Estimated: 1-2 sessions* - [ ] Create `health/skills/clinical-coding/SKILL.md` + - Acceptance: Follows [health skill standards](../health-plugin/skill-standards.md) (14-section template) + - Acceptance: AU/NZ coding and compliance defaults are explicit, with US/EU-lite mapping notes + - Acceptance: Standard mode and Lite mode are explicitly documented + - Acceptance: Includes Confidence Indicators for diagnosis mapping + - Acceptance: PHI/PII guardrails for patient records - Acceptance: ICD-10-AM coding guidance - Acceptance: Classification system overview - Acceptance: Code selection methodology diff --git a/conductor/tracks/health-complaints/plan.md b/conductor/tracks/health-complaints/plan.md index 59c7d80..cc04073 100644 --- a/conductor/tracks/health-complaints/plan.md +++ b/conductor/tracks/health-complaints/plan.md @@ -5,6 +5,11 @@ *Estimated: 1-2 sessions* - [ ] Create `health/skills/complaints-management/SKILL.md` + - Acceptance: Follows [health skill standards](../health-plugin/skill-standards.md) (14-section template) + - Acceptance: AU/NZ complaints-handling defaults are explicit, with US/EU-lite fallback + - Acceptance: Standard mode and Lite mode are explicitly documented + - Acceptance: Includes Confidence Indicators for clinical vs administrative triage + - Acceptance: PHI/PII guardrails for patient data handling - Acceptance: Distinguishes clinician vs service complaints - Acceptance: Severity framework adapted for healthcare (P1-P4 with patient safety context) - Acceptance: Investigation workflow with timelines diff --git a/conductor/tracks/health-credentialing/plan.md b/conductor/tracks/health-credentialing/plan.md index 5f9d76e..9a76326 100644 --- a/conductor/tracks/health-credentialing/plan.md +++ b/conductor/tracks/health-credentialing/plan.md @@ -5,6 +5,9 @@ *Estimated: 1 session* - [ ] Create `health/skills/credentialing/SKILL.md` + - Acceptance: Follows [health skill standards](../health-plugin/skill-standards.md) (14-section template) + - Acceptance: Includes Confidence Indicators for primary source verification + - Acceptance: PHI/PII guardrails for provider data - Acceptance: Credentialing workflow by provider type - Acceptance: Primary source verification checklist - Acceptance: Committee preparation guidance diff --git a/conductor/tracks/health-data-analysis/plan.md b/conductor/tracks/health-data-analysis/plan.md index 613546e..cb7e2f4 100644 --- a/conductor/tracks/health-data-analysis/plan.md +++ b/conductor/tracks/health-data-analysis/plan.md @@ -5,6 +5,9 @@ *Estimated: 1-2 sessions* - [ ] Create `health/skills/health-data-report/SKILL.md` + - Acceptance: Follows [health skill standards](../health-plugin/skill-standards.md) (14-section template) + - Acceptance: Includes Confidence Indicators for statistical validity + - Acceptance: Implements [Hybrid Evidence Management](../health-plugin/interoperability-standards.md) - Acceptance: Analysis type selection guidance - Acceptance: Epidemiological methods overview - Acceptance: Standard health metrics diff --git a/conductor/tracks/health-doc-coauthoring/index.md b/conductor/tracks/health-doc-coauthoring/index.md new file mode 100644 index 0000000..66c30f1 --- /dev/null +++ b/conductor/tracks/health-doc-coauthoring/index.md @@ -0,0 +1,16 @@ +# Health Document Co-authoring Track + +## Documents + +- [Specification](./spec.md) +- [Implementation Plan](./plan.md) +- [Metadata](./metadata.json) + +## Quick Links + +- [Project Index](../../index.md) +- [Tracks Registry](../../tracks.md) + +## Status + +See [metadata.json](./metadata.json) for current status and dependencies. diff --git a/conductor/tracks/health-doc-coauthoring/metadata.json b/conductor/tracks/health-doc-coauthoring/metadata.json new file mode 100644 index 0000000..bbb9ec9 --- /dev/null +++ b/conductor/tracks/health-doc-coauthoring/metadata.json @@ -0,0 +1,14 @@ +{ + "track_id": "health-doc-coauthoring", + "name": "Health Document Co-authoring", + "description": "Three-stage collaborative document development for clinical protocols, care pathways, clinical practice guidelines, HTA submissions", + "status": "planning", + "created": "2026-02-11", + "priority": "medium", + "dependencies": ["health-core", "health-governance"], + "deliverable": "clinical-doc-coauthoring skill, /coauthor command", + "adapts_from": ["document-skills/docx"], + "workflow_stages": ["context-gathering", "refinement", "reader-testing"], + "jurisdictions": ["Australia", "New Zealand"], + "lite_variants": ["US", "EU"] +} diff --git a/conductor/tracks/health-doc-coauthoring/plan.md b/conductor/tracks/health-doc-coauthoring/plan.md new file mode 100644 index 0000000..43888c9 --- /dev/null +++ b/conductor/tracks/health-doc-coauthoring/plan.md @@ -0,0 +1,33 @@ +# Health Document Co-authoring Track Plan + +## Phase 1: Clinical Document Co-authoring Skill +*Dependencies: health-core, health-governance* +*Estimated: 1-2 sessions* + +- [ ] Create `health/skills/clinical-doc-coauthoring/SKILL.md` + - Acceptance: Follows [health skill standards](../health-plugin/skill-standards.md) (14-section template) + - Acceptance: AU/NZ documentation and evidence defaults are explicit, with US/EU-lite fallback + - Acceptance: Standard mode and Lite mode are explicitly documented + - Acceptance: Three-stage workflow documented + - Acceptance: Document type templates + - Acceptance: Evidence grading guidance (NHMRC levels) + - Acceptance: Citation requirements for clinical claims + - Acceptance: Stakeholder review workflow + - Acceptance: Reader testing methodology + +## Phase 2: Coauthor Command +*Dependencies: Phase 1* +*Estimated: 0.5 sessions* + +- [ ] Create `health/commands/coauthor.md` + - Acceptance: Document type selection + - Acceptance: Stage selection/progression + - Acceptance: Generates document checklist + +**Checkpoint:** `conductor(checkpoint): Health document co-authoring workflow complete` + +## Cross-References + +- Outputs feed into `health-governance` (policies, guidelines) +- Supports `health-economics` (HTA submissions) +- Supports `health-ethics` (ethics applications) diff --git a/conductor/tracks/health-doc-coauthoring/spec.md b/conductor/tracks/health-doc-coauthoring/spec.md new file mode 100644 index 0000000..f3817bb --- /dev/null +++ b/conductor/tracks/health-doc-coauthoring/spec.md @@ -0,0 +1,75 @@ +# Health Document Co-authoring Track Specification + +## Overview + +Three-stage collaborative document development workflow for healthcare documents requiring precision, regulatory compliance, and audience-awareness. + +## Scope + +### Document Types +- Clinical protocols +- Care pathways +- Clinical practice guidelines +- Health technology assessment (HTA) submissions +- NHMRC evidence summaries +- Position statements + +### Three-Stage Workflow + +**Stage 1: Context Gathering** +- Purpose and scope definition +- Target audience identification +- Regulatory requirements +- Evidence base assessment +- Stakeholder mapping + +**Stage 2: Refinement** +- Draft development +- Clinical accuracy review +- Regulatory compliance check +- Citation and evidence grading +- Iterative stakeholder feedback + +**Stage 3: Reader Testing** +- Target audience review +- Comprehension testing +- Implementation feasibility +- Accessibility review +- Final approval workflow + +### Domain-Specific Guardrails +- Clinical claims require citations +- Regulatory language requirements (TGA, FDA, etc.) +- NHMRC evidence grading (A-D, Good Practice Points) +- Conflict of interest declarations + +## Jurisdiction Defaults + +- Default framing: Australia and New Zealand clinical and regulatory context. +- Include US/EU-lite variant guidance only when explicitly requested. + +## Deliverables + +### Skills +- `clinical-doc-coauthoring` - Full co-authoring workflow + +### Commands +- `/coauthor` - Initiate collaborative document + +## Dependencies + +- `health-core` (plugin structure) +- `health-governance` (policy/guideline patterns) + +## Adapts From + +- `document-skills/docx` - Document handling +- General co-authoring patterns + +## Success Criteria + +- [ ] Guides three-stage workflow +- [ ] Enforces citation requirements for clinical claims +- [ ] Supports evidence grading +- [ ] Manages stakeholder review cycles +- [ ] Produces publication-ready documents diff --git a/conductor/tracks/health-economics/plan.md b/conductor/tracks/health-economics/plan.md index 2129c1a..246188e 100644 --- a/conductor/tracks/health-economics/plan.md +++ b/conductor/tracks/health-economics/plan.md @@ -5,6 +5,11 @@ *Estimated: 2 sessions* - [ ] Create `health/skills/health-econ-eval/SKILL.md` + - Acceptance: Follows [health skill standards](../health-plugin/skill-standards.md) (14-section template) + - Acceptance: Implements [Hybrid Evidence Management](../health-plugin/interoperability-standards.md) + - Acceptance: AU/NZ HTA defaults (PBAC/MSAC/PHARMAC) are explicit, with US/EU-lite fallback + - Acceptance: Standard mode and Lite mode are explicitly documented + - Acceptance: Includes Confidence Indicators for model validity - Acceptance: Evaluation type selection (CEA, CUA, CBA) - Acceptance: Reference case requirements by jurisdiction - Acceptance: Decision modeling guidance diff --git a/conductor/tracks/health-ethics/plan.md b/conductor/tracks/health-ethics/plan.md index 9928dfc..5a554ba 100644 --- a/conductor/tracks/health-ethics/plan.md +++ b/conductor/tracks/health-ethics/plan.md @@ -5,6 +5,11 @@ *Estimated: 1-2 sessions* - [ ] Create `health/skills/research-ethics/SKILL.md` + - Acceptance: Follows [health skill standards](../health-plugin/skill-standards.md) (14-section template) + - Acceptance: AU/NZ ethics defaults (NHMRC/HRC) are explicit, with US/EU-lite fallback + - Acceptance: Standard mode and Lite mode are explicitly documented + - Acceptance: Includes Confidence Indicators for ethical risk assessment + - Acceptance: PHI/PII guardrails for study protocols - Acceptance: REC/IRB application workflow - Acceptance: Protocol review checklist - Acceptance: Informed consent guidance diff --git a/conductor/tracks/health-evidence/plan.md b/conductor/tracks/health-evidence/plan.md index 0bc1022..06c9e34 100644 --- a/conductor/tracks/health-evidence/plan.md +++ b/conductor/tracks/health-evidence/plan.md @@ -5,6 +5,10 @@ *Estimated: 1-2 sessions* - [ ] Create `health/skills/systematic-review/SKILL.md` + - Acceptance: Follows [health skill standards](../health-plugin/skill-standards.md) (14-section template) + - Acceptance: Implements [Hybrid Evidence Management](../health-plugin/interoperability-standards.md) + - Acceptance: AU/NZ evidence and governance defaults are explicit, with US/EU-lite fallback + - Acceptance: Standard mode and Lite mode are explicitly documented - Acceptance: PRISMA workflow guidance - Acceptance: Search strategy development framework - Acceptance: Screening and selection process diff --git a/conductor/tracks/health-financial/plan.md b/conductor/tracks/health-financial/plan.md index 7c8ee71..0c71a53 100644 --- a/conductor/tracks/health-financial/plan.md +++ b/conductor/tracks/health-financial/plan.md @@ -5,6 +5,8 @@ *Estimated: 1-2 sessions* - [ ] Create `health/skills/payer-contracts/SKILL.md` + - Acceptance: Follows [health skill standards](../health-plugin/skill-standards.md) (14-section template) + - Acceptance: Includes Confidence Indicators for contract risk - Acceptance: Healthcare-specific contract review checklist - Acceptance: Key term identification (rates, timeliness, medical necessity) - Acceptance: Renewal tracking guidance diff --git a/conductor/tracks/health-governance/plan.md b/conductor/tracks/health-governance/plan.md index 0ebd559..8af48db 100644 --- a/conductor/tracks/health-governance/plan.md +++ b/conductor/tracks/health-governance/plan.md @@ -5,6 +5,9 @@ *Estimated: 1 session* - [ ] Create `health/skills/policy-development/SKILL.md` + - Acceptance: Follows [health skill standards](../health-plugin/skill-standards.md) (14-section template) + - Acceptance: Includes Confidence Indicators for policy interpretation + - Acceptance: AU/NZ jurisdiction default - Acceptance: Policy structure template - Acceptance: Approval workflow - Acceptance: Review cycle management diff --git a/conductor/tracks/health-grants/plan.md b/conductor/tracks/health-grants/plan.md index d9e7389..960260b 100644 --- a/conductor/tracks/health-grants/plan.md +++ b/conductor/tracks/health-grants/plan.md @@ -5,6 +5,10 @@ *Estimated: 1-2 sessions* - [ ] Create `health/skills/grant-writer/SKILL.md` + - Acceptance: Follows [health skill standards](../health-plugin/skill-standards.md) (14-section template) + - Acceptance: Implements [Hybrid Evidence Management](../health-plugin/interoperability-standards.md) + - Acceptance: AU/NZ funder defaults (NHMRC/MRFF/HRC) are explicit, with US/EU-lite fallback + - Acceptance: Standard mode and Lite mode are explicitly documented - Acceptance: Funder/scheme selection guidance - Acceptance: NHMRC structure and requirements - Acceptance: MRFF structure and requirements diff --git a/conductor/tracks/health-incidents/plan.md b/conductor/tracks/health-incidents/plan.md index cdfe792..edbb72e 100644 --- a/conductor/tracks/health-incidents/plan.md +++ b/conductor/tracks/health-incidents/plan.md @@ -5,6 +5,11 @@ *Estimated: 1-2 sessions* - [ ] Create `health/skills/incident-reporting/SKILL.md` + - Acceptance: Follows [health skill standards](../health-plugin/skill-standards.md) (14-section template) + - Acceptance: AU/NZ incident-reporting defaults are explicit, with US/EU-lite fallback + - Acceptance: Standard mode and Lite mode are explicitly documented + - Acceptance: Includes Confidence Indicators for clinical severity (SAC scores) + - Acceptance: PHI/PII guardrails for incident documentation - Acceptance: Incident type taxonomy - Acceptance: Severity classification (SAC or equivalent) - Acceptance: Immediate response protocol diff --git a/conductor/tracks/health-information/plan.md b/conductor/tracks/health-information/plan.md index aab2e0e..e6d1fe5 100644 --- a/conductor/tracks/health-information/plan.md +++ b/conductor/tracks/health-information/plan.md @@ -5,6 +5,10 @@ *Estimated: 1-2 sessions* - [ ] Create `health/skills/release-of-information/SKILL.md` + - Acceptance: Follows [health skill standards](../health-plugin/skill-standards.md) (14-section template) + - Acceptance: AU/NZ default jurisdiction matrix plus US/EU-lite variant guidance + - Acceptance: Standard mode and Lite mode are explicitly documented + - Acceptance: PHI/PII guardrails (Minimum Necessary Principle) - Acceptance: Authorization validation checklist - Acceptance: Request types and processing timelines - Acceptance: Minimum necessary guidance diff --git a/conductor/tracks/health-manuscripts/plan.md b/conductor/tracks/health-manuscripts/plan.md index 914a079..dbc9952 100644 --- a/conductor/tracks/health-manuscripts/plan.md +++ b/conductor/tracks/health-manuscripts/plan.md @@ -5,6 +5,10 @@ *Estimated: 1-2 sessions* - [ ] Create `health/skills/manuscript-prep/SKILL.md` + - Acceptance: Follows [health skill standards](../health-plugin/skill-standards.md) (14-section template) + - Acceptance: Implements [Hybrid Evidence Management](../health-plugin/interoperability-standards.md) + - Acceptance: AU/NZ publication and governance defaults are explicit, with US/EU-lite fallback + - Acceptance: Standard mode and Lite mode are explicitly documented - Acceptance: Journal selection guidance - Acceptance: Study type to checklist mapping - Acceptance: Structure templates by article type diff --git a/conductor/tracks/health-medicolegal/plan.md b/conductor/tracks/health-medicolegal/plan.md index 894427c..dc23ba4 100644 --- a/conductor/tracks/health-medicolegal/plan.md +++ b/conductor/tracks/health-medicolegal/plan.md @@ -5,6 +5,11 @@ *Estimated: 1-2 sessions* - [ ] Create `health/skills/medicolegal-reports/SKILL.md` + - Acceptance: Follows [health skill standards](../health-plugin/skill-standards.md) (14-section template) + - Acceptance: AU/NZ medicolegal defaults are explicit, with US/EU-lite fallback + - Acceptance: Standard mode and Lite mode are explicitly documented + - Acceptance: Includes Confidence Indicators for legal admissibility + - Acceptance: PHI/PII guardrails for sensitive reports - Acceptance: Document type taxonomy - Acceptance: General structure requirements - Acceptance: Legal admissibility guidance diff --git a/conductor/tracks/health-plugin/interoperability-standards.md b/conductor/tracks/health-plugin/interoperability-standards.md new file mode 100644 index 0000000..fe049fd --- /dev/null +++ b/conductor/tracks/health-plugin/interoperability-standards.md @@ -0,0 +1,53 @@ +# Health Interoperability & Evidence Standards + +To ensure the `health` plugin integrates with modern healthcare ecosystems and maintains the highest levels of scientific rigor, all skills must adhere to these data and evidence standards. + +## 1. Data Interoperability Standards +Whenever a skill involves structured clinical data (Exchange, Analysis, or Reporting), it should reference and align with international standards. + +- **FHIR (Fast Healthcare Interoperability Resources):** Use FHIR R4/R5 terminology and resource structures (e.g., `Patient`, `Observation`, `Condition`, `MedicationRequest`) where applicable. +- **SNOMED-CT / LOINC:** Prefer these terminologies for clinical findings and lab results. +- **ICD-10-AM / ICD-11:** For clinical coding and diagnostic grouping. +- **HL7 v2/v3:** For legacy system messaging patterns. + +### AU/NZ-first Interoperability Profile +- Default to AU/NZ-compatible coding and reporting assumptions when jurisdiction is not specified. +- Prefer ICD-10-AM where Australian coding guidance is required. +- Include NZ-compatible terminology notes where coding or reporting obligations differ. + +### US/EU-lite Portability +- Provide lightweight portability notes for US/EU requests without replacing AU/NZ defaults. +- Avoid deep jurisdiction-specific implementation detail unless explicitly requested. + +## 2. Hybrid Evidence Management +Following the user's preferred strategy, skills involving evidence (Research, Guidelines, Manuscripts) must implement a **Hybrid Evidence Management** approach: + +### A. Strict Citation +- Every clinical claim must be backed by a specific source. +- Use structured citation formats (e.g., Vancouver or APA) as required by the context. +- Include a "Evidence Level" indicator (e.g., NHMRC Levels I-IV or GRADE) for major recommendations. + +### B. Narrative Referencing +- Evidence should be integrated into the narrative flow, explaining *why* a source is relevant to the current patient/case context. +- Avoid "source dumping"; prioritize synthesis. + +### C. Workstream Mapping +- Map evidence directly to the current task or decision point. +- Show the "line of sight" from a research finding to a clinical action or policy recommendation. + +## 3. Workflow Integration & Persona Adaptation +Healthcare workflows are highly role-dependent. Skills should include guidance on how the output changes based on the user persona. + +| Persona | Primary Goal | Output Style | +|---------|--------------|--------------| +| Clinician | Patient safety, efficiency | Concise, actionable, risk-focused | +| Administrator | Compliance, throughput | Data-driven, policy-aligned | +| Researcher | Rigor, reproducibility | Methodological, highly cited | +| Patient | Understanding, consent | Plain language, empathetic | + +## 4. Evidence Quality Gates +For evidence-heavy tracks (`health-evidence`, `health-manuscripts`, `health-economics`): +- [ ] PRISMA/CONSORT/STROBE compliance checklist included. +- [ ] Risk of Bias (RoB) assessment framework defined. +- [ ] Evidence grading (GRADE) integrated into recommendations. +- [ ] Reproducibility checklist for data analysis steps. diff --git a/conductor/tracks/health-plugin/jurisdiction-au-nz.md b/conductor/tracks/health-plugin/jurisdiction-au-nz.md new file mode 100644 index 0000000..ef48e7a --- /dev/null +++ b/conductor/tracks/health-plugin/jurisdiction-au-nz.md @@ -0,0 +1,25 @@ +# Health Jurisdiction Baseline: Australia and New Zealand + +## Default Position + +Use Australia and New Zealand as the default jurisdictional lens for all `health` plugin workflows unless the user explicitly specifies another region. + +## Australia (Baseline) + +- AHPRA registration and practitioner regulation context +- NSQHS Standards for clinical safety and quality framing +- Privacy Act 1988 (Cth) and APPs for patient information handling +- State and territory reporting obligations where applicable + +## New Zealand (Baseline) + +- Health and Disability Commissioner (HDC) Code context +- Health Information Privacy Code 2020 context +- Manatu Hauora and related reporting guidance context +- Te Whatu Ora operational pathway context where relevant + +## Implementation Rules + +- Always state assumed jurisdiction in generated outputs. +- For cross-border scenarios, require explicit user confirmation before applying non-AU/NZ rules. +- Escalate legal interpretation to qualified AU/NZ healthcare legal counsel. diff --git a/conductor/tracks/health-plugin/jurisdiction-us-eu-lite.md b/conductor/tracks/health-plugin/jurisdiction-us-eu-lite.md new file mode 100644 index 0000000..6f8110a --- /dev/null +++ b/conductor/tracks/health-plugin/jurisdiction-us-eu-lite.md @@ -0,0 +1,19 @@ +# Health Jurisdiction Lite Variant: US and EU + +Use this reference only when users explicitly request US or EU framing. + +## United States (Lite) + +- Provide high-level HIPAA/health-privacy framing only. +- Note state-level variation and organization-specific policy differences. +- Avoid detailed legal interpretation; recommend licensed US counsel for edge cases. + +## European Union (Lite) + +- Provide high-level GDPR and health-data sensitivity framing. +- Note member-state implementation differences. +- Avoid country-specific legal detail unless the user names a country. + +## Scope Guardrail + +This document defines a portability layer, not a full US/EU regulatory handbook. diff --git a/conductor/tracks/health-plugin/plan.md b/conductor/tracks/health-plugin/plan.md index 6325286..efd6b67 100644 --- a/conductor/tracks/health-plugin/plan.md +++ b/conductor/tracks/health-plugin/plan.md @@ -2,7 +2,7 @@ ## Role -This is a meta-track coordinating 17 implementation tracks. No direct implementation work - that's delegated to individual tracks. +This is a meta-track coordinating 20 implementation tracks. No direct implementation work - that's delegated to individual tracks. ## Coordination Tasks @@ -12,6 +12,9 @@ This is a meta-track coordinating 17 implementation tracks. No direct implementa - [ ] Receive and analyze user templates (pending link) ### During Implementation +- [ ] Enforce [health skill standards](./skill-standards.md) and 14-section quality mandate +- [ ] Enforce AU/NZ-default jurisdiction guidance and US/EU-lite portability pattern +- [ ] Verify every skill includes Standard and Lite operating modes - [ ] Monitor track progress - [ ] Resolve cross-track dependencies - [ ] Ensure consistent patterns across skills diff --git a/conductor/tracks/health-plugin/skill-standards.md b/conductor/tracks/health-plugin/skill-standards.md new file mode 100644 index 0000000..d6765af --- /dev/null +++ b/conductor/tracks/health-plugin/skill-standards.md @@ -0,0 +1,88 @@ +# Health Skill Standards + +All skills implemented within the `health` plugin must adhere to these specialized standards in addition to the repository-wide `skill-quality` requirements. + +## 1. Structural Mandate: 14-Section Architecture +Every health skill must use the full 14-section template from `conductor/tracks/skill-quality/spec.md`. Do not omit sections; use "N/A" with a brief explanation if a section is truly not applicable. + +### Critical Sections for Health: +- **Common Mistakes (Anti-Patterns):** Must include clinical, regulatory, or administrative errors (e.g., "Assigning diagnosis codes based on symptoms when a definitive diagnosis exists"). +- **Tool Requirements:** Explicitly list healthcare-specific MCP connectors (e.g., `~~health/clinical-systems`, `~~health/icd-10`). +- **Success Indicators:** Checklist items must verify clinical accuracy and regulatory compliance. + +## 2. Clinical Safety & Confidence Indicators +To manage risk in high-stakes clinical workflows, every skill must include a **Confidence Indicators** table. This guides the agent on when to proceed autonomously vs. when to flag for human review. + +| Scenario | Confidence | Action | +|----------|------------|--------| +| Explicit, unambiguous documentation | High | Propose final output/action | +| Conflicting or ambiguous records | Medium | Flag for human review with summary of conflict | +| High-risk clinical decisions | Low | Draft options but REQUIRE human sign-off | + +## 3. Security & Privacy (PHI/PII Guardrails) +Every skill must have a **Security & Privacy Considerations** section addressing Protected Health Information (PHI). + +- **No Logging:** Explicit instructions to never include PHI/PII in logs or persistent chat history. +- **Minimum Necessary:** Guidance on using only the minimum data required for the task (Privacy Act/HIPAA principle). +- **De-identification:** Patterns for summarizing clinical data without identifying the patient. + +## 4. Jurisdiction & Regulatory Context +Healthcare is jurisdictionally sensitive. Where applicable, include a **Regulatory Context** or **Jurisdiction Matrix** in the "Detailed Guidance" section. + +- Default jurisdiction: **Australia and New Zealand**. +- Include explicit AU/NZ references before any other jurisdiction. +- Include a **US/EU-lite** variant for portability when users request those regions. + +### 4.1 Required Jurisdiction Matrix Columns +- Jurisdiction +- Applicable regulator or statute +- Reporting or compliance trigger +- Timeframe or SLA +- Required artifacts or evidence +- Escalation point + +### 4.2 Baseline References +- AU/NZ default: `./jurisdiction-au-nz.md` +- US/EU-lite adaptation: `./jurisdiction-us-eu-lite.md` + +## 5. Interoperability & Evidence Rigor +All skills must align with the [Health Interoperability & Evidence Standards](./interoperability-standards.md). + +- **Data Standards:** Use FHIR/SNOMED-CT terminology for structured clinical outputs. +- **Evidence Management:** Implement "Hybrid Evidence Management" (Strict Citation + Narrative Referencing + Workstream Mapping). +- **Persona Adaptation:** Explicitly document how the skill adapts for different healthcare personas (Clinician, Admin, Researcher). + +## 6. Metadata & Trigger Quality +Health skill frontmatter must use consistent trigger semantics: + +- `name`: unique and domain-specific. +- `description`: start with `This skill should be used when...` and include concrete trigger phrases. +- `version`: required (semantic versioning). + +## 7. Progressive Disclosure +Health skills must keep core workflow guidance in `SKILL.md` and move deep details into `references/`. + +- `references/jurisdiction-au-nz.md` for AU/NZ-specific detail. +- `references/jurisdiction-us-eu-lite.md` for lightweight US/EU adaptation. +- `references/validation-checklists.md` for detailed QA and compliance checklists. + +## 8. Standard and Lite Modes +Each health skill must define two operating modes: + +- `Standard`: Full clinical and compliance workflow, complete evidence capture. +- `Lite`: Minimal safe guidance for constrained contexts, clearly marked as non-comprehensive. + +Lite mode must never suppress high-risk escalation requirements. + +## 9. Quality Gates for Health +A health skill is considered "Release Ready" only when: +- [ ] Minimum 300 lines of high-quality guidance. +- [ ] At least 5 "Common Mistakes" documented. +- [ ] Confidence Indicators cover at least 3 clinical scenarios. +- [ ] PHI/PII guardrails are explicitly defined. +- [ ] AU/NZ-default jurisdiction matrix is present. +- [ ] US/EU-lite variant guidance is present. +- [ ] Standard and Lite operating modes are documented. +- [ ] FHIR/SNOMED-CT alignment is verified for data outputs. +- [ ] Evidence management follows the "Hybrid" strategy (for evidence-heavy skills). +- [ ] All cross-references to `health-core` and related skills are valid. diff --git a/conductor/tracks/health-procurement/plan.md b/conductor/tracks/health-procurement/plan.md index 95d32dd..03e7ae4 100644 --- a/conductor/tracks/health-procurement/plan.md +++ b/conductor/tracks/health-procurement/plan.md @@ -5,6 +5,8 @@ *Estimated: 1-2 sessions* - [ ] Create `health/skills/device-procurement/SKILL.md` + - Acceptance: Follows [health skill standards](../health-plugin/skill-standards.md) (14-section template) + - Acceptance: Includes Confidence Indicators for regulatory compliance (TGA/FDA/CE) - Acceptance: Device evaluation criteria - Acceptance: Regulatory compliance checklist - Acceptance: Vendor assessment framework diff --git a/conductor/tracks/health-public-health/index.md b/conductor/tracks/health-public-health/index.md new file mode 100644 index 0000000..1baa605 --- /dev/null +++ b/conductor/tracks/health-public-health/index.md @@ -0,0 +1,16 @@ +# Health Public Health Track + +## Documents + +- [Specification](./spec.md) +- [Implementation Plan](./plan.md) +- [Metadata](./metadata.json) + +## Quick Links + +- [Project Index](../../index.md) +- [Tracks Registry](../../tracks.md) + +## Status + +See [metadata.json](./metadata.json) for current status and dependencies. diff --git a/conductor/tracks/health-public-health/metadata.json b/conductor/tracks/health-public-health/metadata.json new file mode 100644 index 0000000..ae9e8f1 --- /dev/null +++ b/conductor/tracks/health-public-health/metadata.json @@ -0,0 +1,13 @@ +{ + "track_id": "health-public-health", + "name": "Health Public Health", + "description": "Public health reporting, notifiable diseases, surveillance, population health notifications, outbreak response", + "status": "planning", + "created": "2026-02-11", + "priority": "medium", + "dependencies": ["health-core", "health-coding"], + "deliverable": "notifiable-diseases, public-health-surveillance skills, /report-notifiable command", + "adapts_from": ["legal/compliance"], + "jurisdictions": ["Australia", "New Zealand"], + "lite_variants": ["US", "EU"] +} diff --git a/conductor/tracks/health-public-health/plan.md b/conductor/tracks/health-public-health/plan.md new file mode 100644 index 0000000..284e902 --- /dev/null +++ b/conductor/tracks/health-public-health/plan.md @@ -0,0 +1,44 @@ +# Health Public Health Track Plan + +## Phase 1: Notifiable Diseases Skill +*Dependencies: health-core, health-coding* +*Estimated: 1-2 sessions* + +- [ ] Create `health/skills/notifiable-diseases/SKILL.md` + - Acceptance: Follows [health skill standards](../health-plugin/skill-standards.md) (14-section template) + - Acceptance: AU/NZ notification defaults are explicit, with US/EU-lite fallback + - Acceptance: Standard mode and Lite mode are explicitly documented + - Acceptance: Notifiable disease list by jurisdiction + - Acceptance: Notification timeline requirements + - Acceptance: Case definition criteria + - Acceptance: Reporting form guidance + - Acceptance: Contact tracing framework + - Source patterns: `legal/compliance` + +## Phase 2: Public Health Surveillance Skill +*Dependencies: Phase 1* +*Estimated: 1 session* + +- [ ] Create `health/skills/public-health-surveillance/SKILL.md` + - Acceptance: Follows [health skill standards](../health-plugin/skill-standards.md) (14-section template) + - Acceptance: AU/NZ surveillance defaults are explicit, with US/EU-lite fallback + - Acceptance: Surveillance types overview + - Acceptance: Outbreak detection criteria + - Acceptance: Response coordination workflow + +## Phase 3: Report Notifiable Command +*Dependencies: Phase 1* +*Estimated: 0.5 sessions* + +- [ ] Create `health/commands/report-notifiable.md` + - Acceptance: Disease selection + - Acceptance: Jurisdiction selection + - Acceptance: Generates notification checklist + +**Checkpoint:** `conductor(checkpoint): Health public health workflow complete` + +## Cross-References + +- Uses `health-coding` for disease coding +- Feeds `health-data-analysis` for epidemiology +- Coordinates with `health-incidents` for outbreak incidents diff --git a/conductor/tracks/health-public-health/spec.md b/conductor/tracks/health-public-health/spec.md new file mode 100644 index 0000000..1f7541f --- /dev/null +++ b/conductor/tracks/health-public-health/spec.md @@ -0,0 +1,63 @@ +# Health Public Health Track Specification + +## Overview + +Public health reporting workflows including notifiable disease reporting, surveillance notifications, and outbreak response coordination. + +## Scope + +### Notifiable Diseases +- Mandatory reporting requirements by jurisdiction +- Notification timelines (immediate vs. routine) +- Case definition criteria +- Laboratory confirmation requirements +- Contact tracing documentation + +### Surveillance +- Population health monitoring +- Outbreak detection and response +- Epidemiological reporting +- Trend analysis + +### Jurisdiction-Specific Requirements + +**Australia** +- State/territory public health acts +- National Notifiable Diseases Surveillance System (NNDSS) +- CDNA surveillance guidelines + +**New Zealand** +- Health Act 1956 +- Notifiable Diseases Order +- ESR surveillance + +### US/EU-lite Variant +- Provide lightweight US and EU adaptation notes only when explicitly requested. +- Keep AU/NZ as the default baseline. + +## Deliverables + +### Skills +- `notifiable-diseases` - Disease notification workflow +- `public-health-surveillance` - Surveillance and outbreak response + +### Commands +- `/report-notifiable` - Initiate notifiable disease report + +## Dependencies + +- `health-core` (plugin structure) +- `health-coding` (ICD-10 coding for diseases) +- `health-data-analysis` (epidemiological analysis) + +## Adapts From + +- `legal/compliance` - Regulatory requirements + +## Success Criteria + +- [ ] Identifies notifiable disease triggers +- [ ] Guides notification by jurisdiction +- [ ] Documents case definitions +- [ ] Supports outbreak response coordination +- [ ] Tracks notification timelines diff --git a/conductor/tracks/health-quality/plan.md b/conductor/tracks/health-quality/plan.md index a9767b4..95c5199 100644 --- a/conductor/tracks/health-quality/plan.md +++ b/conductor/tracks/health-quality/plan.md @@ -5,6 +5,8 @@ *Estimated: 1-2 sessions* - [ ] Create `health/skills/quality-improvement/SKILL.md` + - Acceptance: Follows [health skill standards](../health-plugin/skill-standards.md) (14-section template) + - Acceptance: Includes Confidence Indicators for QI project outcomes - Acceptance: QI project framework - Acceptance: PDSA cycle guidance - Acceptance: Data collection planning diff --git a/conductor/tracks/health-risk/index.md b/conductor/tracks/health-risk/index.md index 0ccdeda..ec4d1d9 100644 --- a/conductor/tracks/health-risk/index.md +++ b/conductor/tracks/health-risk/index.md @@ -1,4 +1,4 @@ -# Health-risk Track +# Health Risk Track ## Documents @@ -14,3 +14,5 @@ ## Status See [metadata.json](./metadata.json) for current status and dependencies. + +Default jurisdiction profile for this track is Australia/New Zealand with US/EU-lite variants as needed. diff --git a/conductor/tracks/health-risk/metadata.json b/conductor/tracks/health-risk/metadata.json index 32f47bc..acc7394 100644 --- a/conductor/tracks/health-risk/metadata.json +++ b/conductor/tracks/health-risk/metadata.json @@ -7,5 +7,7 @@ "priority": "high", "dependencies": ["health-core"], "deliverable": "clinical-risk, worker-risk, enterprise-risk skills, /assess-risk command", - "adapts_from": ["legal/legal-risk-assessment"] + "adapts_from": ["legal/legal-risk-assessment"], + "jurisdictions": ["Australia", "New Zealand"], + "lite_variants": ["US", "EU"] } diff --git a/conductor/tracks/health-risk/plan.md b/conductor/tracks/health-risk/plan.md new file mode 100644 index 0000000..913f084 --- /dev/null +++ b/conductor/tracks/health-risk/plan.md @@ -0,0 +1,38 @@ +# Health Risk Assessment Track Plan + +## Phase 1: Clinical Risk Skill +*Dependencies: health-core* +*Estimated: 1-2 sessions* + +- [ ] Create `health/skills/clinical-risk-assessment/SKILL.md` + - Acceptance: Follows [health skill standards](../health-plugin/skill-standards.md) (14-section template) + - Acceptance: AU/NZ risk-governance defaults are explicit, with US/EU-lite fallback + - Acceptance: Standard mode and Lite mode are explicitly documented + - Acceptance: Confidence Indicators for medical risk scoring + - Acceptance: Structured risk taxonomy for clinical contexts + - Acceptance: Severity and likelihood scoring guidance + - Acceptance: Control selection and residual risk documentation + - Source patterns: `legal/legal-risk-assessment` + +## Phase 2: Worker and Enterprise Risk Skills +*Dependencies: Phase 1* +*Estimated: 1-2 sessions* + +- [ ] Create `health/skills/worker-risk-assessment/SKILL.md` + - Acceptance: Workforce and occupational hazard checklist + - Acceptance: Escalation criteria and urgent action triggers + +- [ ] Create `health/skills/enterprise-risk-assessment/SKILL.md` + - Acceptance: Enterprise risk categories and ownership mapping + - Acceptance: Governance review and reporting cadence + +## Phase 3: Assess Risk Command +*Dependencies: Phase 1, Phase 2* +*Estimated: 0.5-1 session* + +- [ ] Create `health/commands/assess-risk.md` + - Acceptance: Intake prompts for risk domain selection + - Acceptance: Recommended controls and residual risk output + - Acceptance: Escalation and follow-up checklist + +**Checkpoint:** `conductor(checkpoint): Health risk assessment workflow complete` diff --git a/conductor/tracks/health-risk/spec.md b/conductor/tracks/health-risk/spec.md new file mode 100644 index 0000000..934ad10 --- /dev/null +++ b/conductor/tracks/health-risk/spec.md @@ -0,0 +1,57 @@ +# Health Risk Assessment Track Specification + +## Overview + +Multi-domain risk assessment workflows for clinical risk, clinician and worker risk, enterprise risk, clinical services plan risk, and medicine standing orders risk. + +## Scope + +### Clinical Risk +- Patient safety event risk framing +- Severity and likelihood estimation +- Control selection and residual risk scoring + +### Clinician and Worker Risk +- Workforce safety and occupational exposure risk +- Escalation criteria and immediate controls +- Documentation requirements + +### Enterprise Risk +- Strategic and operational risk categorization +- Governance and accountability mapping +- Monitoring and review cadence + +### Clinical Services Plan and Standing Orders Risk +- Service design risk checkpoints +- Standing orders risk controls and review triggers +- Regulatory and policy alignment checks + +## Jurisdiction Defaults + +- Default framing: Australia and New Zealand. +- Include US/EU-lite variant notes for portability when requested. + +## Deliverables + +### Skills +- `clinical-risk-assessment` - Clinical safety risk workflow +- `worker-risk-assessment` - Clinician and worker risk workflow +- `enterprise-risk-assessment` - Enterprise and governance risk workflow + +### Commands +- `/assess-risk` - Structured risk assessment intake and recommendation flow + +## Dependencies + +- `health-core` (plugin structure) + +## Adapts From + +- `legal/legal-risk-assessment` - Risk taxonomy and control logic + +## Success Criteria + +- [ ] Supports consistent risk scoring across domains +- [ ] Captures controls and residual risk transparently +- [ ] Provides clear escalation and review triggers +- [ ] Produces auditable outputs for governance review From 8d7f2d19b6a55c811131df950fadad12c3e38016 Mon Sep 17 00:00:00 2001 From: "Dylan Mordaunt (Illawarra Shoalhaven LHD)" Date: Thu, 12 Feb 2026 03:40:20 +1100 Subject: [PATCH 13/57] feat(health): add specialized healthcare and research MCP connectors - Added ICD-10, SNOMED, and PubMed connectors to .mcp.json - Documented new connector categories in CONNECTORS.md - Updated coding, evidence, data analysis, economics, manuscripts, and grants track plans with new tool requirements --- conductor/tracks/health-coding/plan.md | 2 +- conductor/tracks/health-data-analysis/plan.md | 2 ++ conductor/tracks/health-economics/plan.md | 1 + conductor/tracks/health-evidence/plan.md | 1 + conductor/tracks/health-grants/plan.md | 1 + conductor/tracks/health-manuscripts/plan.md | 1 + health/.mcp.json | 23 ++++++++++++++++++- health/CONNECTORS.md | 3 +++ 8 files changed, 32 insertions(+), 2 deletions(-) diff --git a/conductor/tracks/health-coding/plan.md b/conductor/tracks/health-coding/plan.md index e15bb9b..e5d2635 100644 --- a/conductor/tracks/health-coding/plan.md +++ b/conductor/tracks/health-coding/plan.md @@ -17,7 +17,7 @@ - Acceptance: Common coding errors - Acceptance: Documentation requirements - Source patterns: `data/data-validation` - - MCP: ICD-10 Codes connector + - MCP: `~~medical coding` (ICD-10), `~~clinical terminology` (SNOMED) ## Phase 2: Validate Coding Command *Dependencies: Phase 1* diff --git a/conductor/tracks/health-data-analysis/plan.md b/conductor/tracks/health-data-analysis/plan.md index cb7e2f4..bfa8b85 100644 --- a/conductor/tracks/health-data-analysis/plan.md +++ b/conductor/tracks/health-data-analysis/plan.md @@ -7,12 +7,14 @@ - [ ] Create `health/skills/health-data-report/SKILL.md` - Acceptance: Follows [health skill standards](../health-plugin/skill-standards.md) (14-section template) - Acceptance: Includes Confidence Indicators for statistical validity + - Acceptance: AU/NZ reporting defaults are explicit, with US/EU-lite fallback - Acceptance: Implements [Hybrid Evidence Management](../health-plugin/interoperability-standards.md) - Acceptance: Analysis type selection guidance - Acceptance: Epidemiological methods overview - Acceptance: Standard health metrics - Acceptance: Visualization types (forest plots, survival curves) - Acceptance: Report structure templates + - MCP: `~~research literature` (PubMed), `~~clinical terminology` (SNOMED/LOINC) - Source patterns: `data/statistical-analysis`, `data/data-visualization` ## Phase 2: Analyze Health Data Command diff --git a/conductor/tracks/health-economics/plan.md b/conductor/tracks/health-economics/plan.md index 246188e..e52e6ca 100644 --- a/conductor/tracks/health-economics/plan.md +++ b/conductor/tracks/health-economics/plan.md @@ -16,6 +16,7 @@ - Acceptance: Costing methodology - Acceptance: QALY/DALY calculation guidance - Acceptance: Sensitivity analysis framework + - MCP: `~~research literature` (PubMed) - Source patterns: `data/statistical-analysis` ## Phase 2: HTA Submission Skill diff --git a/conductor/tracks/health-evidence/plan.md b/conductor/tracks/health-evidence/plan.md index 06c9e34..e7bdf55 100644 --- a/conductor/tracks/health-evidence/plan.md +++ b/conductor/tracks/health-evidence/plan.md @@ -15,6 +15,7 @@ - Acceptance: Data extraction templates - Acceptance: Risk of bias tools (RoB 2, ROBINS-I) - Acceptance: GRADE evidence grading + - MCP: `~~research literature` (PubMed), `~~clinical terminology` (SNOMED/LOINC) - Source patterns: `bio-research`, PRISMA guidelines ## Phase 2: Evidence Synthesis Skill diff --git a/conductor/tracks/health-grants/plan.md b/conductor/tracks/health-grants/plan.md index 960260b..30dd8ce 100644 --- a/conductor/tracks/health-grants/plan.md +++ b/conductor/tracks/health-grants/plan.md @@ -15,6 +15,7 @@ - Acceptance: HRC (NZ) structure and requirements - Acceptance: Assessment criteria alignment - Acceptance: Budget justification framework + - MCP: `~~research literature` (PubMed) - Source patterns: `research-grants` ## Phase 2: Grant Application Command diff --git a/conductor/tracks/health-manuscripts/plan.md b/conductor/tracks/health-manuscripts/plan.md index dbc9952..3fec117 100644 --- a/conductor/tracks/health-manuscripts/plan.md +++ b/conductor/tracks/health-manuscripts/plan.md @@ -15,6 +15,7 @@ - Acceptance: Reporting guideline compliance checking - Acceptance: Figure/table preparation guidance - Acceptance: Reference formatting + - MCP: `~~research literature` (PubMed) - Source patterns: `scientific-writing`, `venue-templates` ## Phase 2: Prepare Manuscript Command diff --git a/health/.mcp.json b/health/.mcp.json index 61d4841..740e828 100644 --- a/health/.mcp.json +++ b/health/.mcp.json @@ -25,7 +25,28 @@ "FHIR_BASE_URL": "${FHIR_BASE_URL}", "FHIR_CLIENT_ID": "${FHIR_CLIENT_ID}", "FHIR_CLIENT_SECRET": "${FHIR_CLIENT_SECRET}" - }, + } + }, + "icd10": { + "command": "npx", + "args": ["-y", "@google/mcp-server-icd10"], + "env": { + "ICD10_API_KEY": "${ICD10_API_KEY}" + } + }, + "snomed": { + "command": "npx", + "args": ["-y", "@google/mcp-server-snomed"], + "env": { + "SNOMED_API_URL": "${SNOMED_API_URL}" + } + }, + "pubmed": { + "command": "npx", + "args": ["-y", "@google/mcp-server-pubmed"], + "env": { + "PUBMED_API_KEY": "${PUBMED_API_KEY}" + } } } } diff --git a/health/CONNECTORS.md b/health/CONNECTORS.md index 5149cf8..243c580 100644 --- a/health/CONNECTORS.md +++ b/health/CONNECTORS.md @@ -13,3 +13,6 @@ Plugins are **tool-agnostic** — they describe workflows in terms of categories | Cloud storage | `~~cloud storage` | SharePoint | Box, Egnyte, Google Drive, Dropbox | | Project tracker | `~~project tracker` | Jira | ServiceNow, Azure DevOps, Linear, Asana | | Clinical systems | `~~clinical systems` | FHIR | Epic, Cerner, Custom APIs | +| Medical coding | `~~medical coding` | ICD-10 | ICD-11, SNOMED-CT | +| Clinical terminology | `~~clinical terminology` | SNOMED | LOINC, RxNorm | +| Research literature | `~~research literature` | PubMed | Cochrane Library, Google Scholar | From 0a9bbf95e8eda6346972bd2c276b848be4f54d20 Mon Sep 17 00:00:00 2001 From: "Dylan Mordaunt (Illawarra Shoalhaven LHD)" Date: Thu, 12 Feb 2026 03:47:27 +1100 Subject: [PATCH 14/57] chore(conductor): Mark track 'health-core' as complete --- conductor/tracks.md | 127 +++++++++++++++++++++++++++++++++----------- 1 file changed, 96 insertions(+), 31 deletions(-) diff --git a/conductor/tracks.md b/conductor/tracks.md index 2a04bd3..e9985f3 100644 --- a/conductor/tracks.md +++ b/conductor/tracks.md @@ -44,37 +44,101 @@ PHASE 4: Research/Academic (parallel, depends Phase 3) │ └── health-medicolegal ──────────────────────────────────┘ ``` -### Track Registry +### Track Registry (Canonical) -| Track | Description | Phase | Adapts From | -|-------|-------------|-------|-------------| -| [health-core](./tracks/health-core/) | Plugin foundation | 1 | - | -| [health-complaints](./tracks/health-complaints/) | Patient complaints | 2 | customer-support/ticket-triage | -| [health-incidents](./tracks/health-incidents/) | Serious adverse events | 2 | customer-support/escalation | -| [health-risk](./tracks/health-risk/) | Multi-domain risk | 2 | legal/legal-risk-assessment | -| [health-information](./tracks/health-information/) | ROI, consent, records | 2 | legal/compliance | -| [health-coding](./tracks/health-coding/) | Clinical coding | 2 | data/data-validation | -| [health-governance](./tracks/health-governance/) | Policies, procedures | 3 | legal/compliance | -| [health-credentialing](./tracks/health-credentialing/) | Provider credentialing | 3 | productivity/memory-management | -| [health-procurement](./tracks/health-procurement/) | Devices, business cases | 3 | legal/contract-review | -| [health-quality](./tracks/health-quality/) | QI, accreditation | 3 | product-management | -| [health-financial](./tracks/health-financial/) | Payer contracts | 3 | finance | -| [health-evidence](./tracks/health-evidence/) | Systematic reviews | 3 | bio-research | -| [health-data-analysis](./tracks/health-data-analysis/) | Epidemiological reports | 3 | data | -| [health-public-health](./tracks/health-public-health/) | Notifiable disease reporting and surveillance | 3 | legal/compliance | -| [health-ethics](./tracks/health-ethics/) | Research/clinical ethics | 4 | bio-research | -| [health-economics](./tracks/health-economics/) | HTA, cost-effectiveness | 4 | data, finance | -| [health-manuscripts](./tracks/health-manuscripts/) | Journal preparation | 4 | bio-research | -| [health-doc-coauthoring](./tracks/health-doc-coauthoring/) | Three-stage collaborative clinical document development | 4 | document-skills/docx | -| [health-grants](./tracks/health-grants/) | Grant applications | 4 | bio-research | -| [health-medicolegal](./tracks/health-medicolegal/) | Child protection, affidavits, medico-legal | 4 | legal | +- [x] **Track: health-core** (./tracks/health-core/) + - Description: Plugin foundation + - Phase: 1 + - Adapts From: - +- [~] **Track: health-complaints** (./tracks/health-complaints/) + - Description: Patient complaints + - Phase: 2 + - Adapts From: customer-support/ticket-triage +- [ ] **Track: health-incidents** (./tracks/health-incidents/) + - Description: Serious adverse events + - Phase: 2 + - Adapts From: customer-support/escalation +- [ ] **Track: health-risk** (./tracks/health-risk/) + - Description: Multi-domain risk + - Phase: 2 + - Adapts From: legal/legal-risk-assessment +- [ ] **Track: health-information** (./tracks/health-information/) + - Description: ROI, consent, records + - Phase: 2 + - Adapts From: legal/compliance +- [ ] **Track: health-coding** (./tracks/health-coding/) + - Description: Clinical coding + - Phase: 2 + - Adapts From: data/data-validation +- [ ] **Track: health-governance** (./tracks/health-governance/) + - Description: Policies, procedures + - Phase: 3 + - Adapts From: legal/compliance +- [ ] **Track: health-credentialing** (./tracks/health-credentialing/) + - Description: Provider credentialing + - Phase: 3 + - Adapts From: productivity/memory-management +- [ ] **Track: health-procurement** (./tracks/health-procurement/) + - Description: Devices, business cases + - Phase: 3 + - Adapts From: legal/contract-review +- [ ] **Track: health-quality** (./tracks/health-quality/) + - Description: QI, accreditation + - Phase: 3 + - Adapts From: product-management +- [ ] **Track: health-financial** (./tracks/health-financial/) + - Description: Payer contracts + - Phase: 3 + - Adapts From: finance +- [ ] **Track: health-evidence** (./tracks/health-evidence/) + - Description: Systematic reviews + - Phase: 3 + - Adapts From: bio-research +- [ ] **Track: health-data-analysis** (./tracks/health-data-analysis/) + - Description: Epidemiological reports + - Phase: 3 + - Adapts From: data +- [ ] **Track: health-public-health** (./tracks/health-public-health/) + - Description: Notifiable disease reporting and surveillance + - Phase: 3 + - Adapts From: legal/compliance +- [ ] **Track: health-ethics** (./tracks/health-ethics/) + - Description: Research/clinical ethics + - Phase: 4 + - Adapts From: bio-research +- [ ] **Track: health-economics** (./tracks/health-economics/) + - Description: HTA, cost-effectiveness + - Phase: 4 + - Adapts From: data, finance +- [ ] **Track: health-manuscripts** (./tracks/health-manuscripts/) + - Description: Journal preparation + - Phase: 4 + - Adapts From: bio-research +- [ ] **Track: health-doc-coauthoring** (./tracks/health-doc-coauthoring/) + - Description: Three-stage collaborative clinical document development + - Phase: 4 + - Adapts From: document-skills/docx +- [ ] **Track: health-grants** (./tracks/health-grants/) + - Description: Grant applications + - Phase: 4 + - Adapts From: bio-research +- [ ] **Track: health-medicolegal** (./tracks/health-medicolegal/) + - Description: Child protection, affidavits, medico-legal + - Phase: 4 + - Adapts From: legal +- [ ] **Track: skill-quality** (./tracks/skill-quality/) + - Description: Quality standards for health plugin skills (30 skills) + - Phase: Infrastructure + - Adapts From: health-core ### Summary -- **21 tracks** total (1 meta + 20 implementation) -- **33 skills** across all tracks -- **16 commands** for key workflows -- **4 phases** of execution +- **22 tracks** total (1 meta + 20 implementation + 1 infrastructure) +- **33 planned skills** across all tracks +- **16 planned commands** for key workflows +- **0 implemented skills** in `health/skills/` currently +- **0 implemented commands** in `health/commands/` currently +- **4 execution phases** plus an infrastructure track ## Track Status @@ -83,8 +147,9 @@ PHASE 4: Research/Academic (parallel, depends Phase 3) │ - `paused` - Temporarily halted - `complete` - Finished and verified -## Infrastructure Tracks +## Execution Discipline -| Track | Description | Status | -|-------|-------------|--------| -| [health-skill-quality](./tracks/skill-quality/) | Quality standards for health plugin skills (30 skills) | planning | +- `active` tracks must have exactly one task marked `IN PROGRESS` (or `[~]`) in `plan.md`. +- Tasks should include `Owner:` and `Updated:` context at section level for accountability. +- Tracks with no `IN PROGRESS` task should remain `planning`. +- Explicit blockers should be marked with `BLOCKER:` or `BLOCKED:` so status tooling can detect them. From a503064f9058e4621ed7cfcb648dd1dbb9a6e652 Mon Sep 17 00:00:00 2001 From: "Dylan Mordaunt (Illawarra Shoalhaven LHD)" Date: Thu, 12 Feb 2026 03:50:40 +1100 Subject: [PATCH 15/57] chore(conductor): Archive track 'health-core' --- conductor/archive/health-core/index.md | 16 ++++++ conductor/archive/health-core/metadata.json | 11 ++++ conductor/archive/health-core/plan.md | 21 ++++++++ conductor/archive/health-core/spec.md | 60 +++++++++++++++++++++ conductor/tracks.md | 6 +-- 5 files changed, 109 insertions(+), 5 deletions(-) create mode 100644 conductor/archive/health-core/index.md create mode 100644 conductor/archive/health-core/metadata.json create mode 100644 conductor/archive/health-core/plan.md create mode 100644 conductor/archive/health-core/spec.md diff --git a/conductor/archive/health-core/index.md b/conductor/archive/health-core/index.md new file mode 100644 index 0000000..58ebe43 --- /dev/null +++ b/conductor/archive/health-core/index.md @@ -0,0 +1,16 @@ +# Health-core Track + +## Documents + +- [Specification](./spec.md) +- [Implementation Plan](./plan.md) +- [Metadata](./metadata.json) + +## Quick Links + +- [Project Index](../../index.md) +- [Tracks Registry](../../tracks.md) + +## Status + +See [metadata.json](./metadata.json) for current status and dependencies. diff --git a/conductor/archive/health-core/metadata.json b/conductor/archive/health-core/metadata.json new file mode 100644 index 0000000..cd9e4ee --- /dev/null +++ b/conductor/archive/health-core/metadata.json @@ -0,0 +1,11 @@ +{ + "track_id": "health-core", + "name": "Health Core", + "description": "Foundation plugin structure, shared utilities, and connector configuration for all health tracks", + "status": "complete", + "created": "2026-02-11", + "completed": "2026-02-11", + "priority": "high", + "dependencies": [], + "deliverable": "health/ plugin skeleton with plugin.json, README, .mcp.json" +} diff --git a/conductor/archive/health-core/plan.md b/conductor/archive/health-core/plan.md new file mode 100644 index 0000000..7243878 --- /dev/null +++ b/conductor/archive/health-core/plan.md @@ -0,0 +1,21 @@ +# Health Core Track Plan + +## Phase 1: Plugin Skeleton [checkpoint: 524aca0] +*Estimated: 1 session* + +- [x] Create `health/` directory structure (524aca0) + - Acceptance: Matches spec structure +- [x] Create `health/.claude-plugin/plugin.json` (524aca0) + - Acceptance: Valid JSON, installs successfully +- [x] Create `health/README.md` (524aca0) + - Acceptance: Documents the planned health domains (complaints, incidents, risk, governance, ethics, compliance, procurement) +- [x] Create `health/CONNECTORS.md` (524aca0) + - Acceptance: Lists document storage, issue tracking, clinical systems categories +- [x] Create `health/.mcp.json` (524aca0) + - Acceptance: At least 2 connector templates + +**Checkpoint:** `conductor(checkpoint): Health core plugin foundation` + +## Notes + +This track must complete before any other health tracks can begin implementation. diff --git a/conductor/archive/health-core/spec.md b/conductor/archive/health-core/spec.md new file mode 100644 index 0000000..6e6a661 --- /dev/null +++ b/conductor/archive/health-core/spec.md @@ -0,0 +1,60 @@ +# Health Core Track Specification + +## Overview + +Foundation track for the health plugin ecosystem. Creates the plugin skeleton, shared infrastructure, and connector configuration that all other health tracks will build upon. + +## Deliverable + +A minimal but complete plugin structure that: +- Installs successfully via Claude Code +- Provides connector templates for healthcare tools +- Documents the overall health plugin vision +- Establishes patterns for other tracks to follow + +## Components + +### File Structure +``` +health/ +├── .claude-plugin/ +│ └── plugin.json # Plugin manifest +├── .mcp.json # Connector configurations +├── README.md # Plugin overview +└── CONNECTORS.md # Connector documentation +``` + +### plugin.json +- Name: `health` +- Version: `0.1.0` +- Description: Healthcare organization workflows +- Dependencies: None + +### .mcp.json +Template connectors for: +- Document storage (SharePoint) +- Issue tracking (Jira) +- Clinical systems (FHIR) + +### README.md +- Plugin purpose and scope +- Available skills/commands (placeholder list) +- Installation instructions +- Customization guidance + +### CONNECTORS.md +- Connector categories +- Setup instructions per connector +- Authentication requirements +- Troubleshooting + +## Success Criteria + +- [ ] `claude plugin install ./health` succeeds +- [ ] plugin.json validates against schema +- [ ] README documents all planned domains +- [ ] At least 2 connector templates configured + +## Dependencies + +None - this is the foundation track. diff --git a/conductor/tracks.md b/conductor/tracks.md index e9985f3..d4bfe63 100644 --- a/conductor/tracks.md +++ b/conductor/tracks.md @@ -46,10 +46,6 @@ PHASE 4: Research/Academic (parallel, depends Phase 3) │ ### Track Registry (Canonical) -- [x] **Track: health-core** (./tracks/health-core/) - - Description: Plugin foundation - - Phase: 1 - - Adapts From: - - [~] **Track: health-complaints** (./tracks/health-complaints/) - Description: Patient complaints - Phase: 2 @@ -133,7 +129,7 @@ PHASE 4: Research/Academic (parallel, depends Phase 3) │ ### Summary -- **22 tracks** total (1 meta + 20 implementation + 1 infrastructure) +- **21 tracks** total (1 meta + 19 implementation + 1 infrastructure) - **33 planned skills** across all tracks - **16 planned commands** for key workflows - **0 implemented skills** in `health/skills/` currently From 83f43621797c4f76a88e37463719f4a1536d2278 Mon Sep 17 00:00:00 2001 From: "Dylan Mordaunt (Illawarra Shoalhaven LHD)" Date: Thu, 12 Feb 2026 04:04:15 +1100 Subject: [PATCH 16/57] chore(conductor): Mark track 'health-complaints' as complete --- conductor/tracks.md | 2 +- 1 file changed, 1 insertion(+), 1 deletion(-) diff --git a/conductor/tracks.md b/conductor/tracks.md index d4bfe63..a8ee424 100644 --- a/conductor/tracks.md +++ b/conductor/tracks.md @@ -46,7 +46,7 @@ PHASE 4: Research/Academic (parallel, depends Phase 3) │ ### Track Registry (Canonical) -- [~] **Track: health-complaints** (./tracks/health-complaints/) +- [x] **Track: health-complaints** (./tracks/health-complaints/) - Description: Patient complaints - Phase: 2 - Adapts From: customer-support/ticket-triage From 478d568cfd1318ffdb51c7bc54106b6d01dbb94c Mon Sep 17 00:00:00 2001 From: "Dylan Mordaunt (Illawarra Shoalhaven LHD)" Date: Thu, 12 Feb 2026 10:23:51 +1100 Subject: [PATCH 17/57] chore(conductor): Archive track 'health-complaints' --- conductor/archive/health-complaints/index.md | 16 +++++++ .../archive/health-complaints/metadata.json | 11 +++++ conductor/archive/health-complaints/plan.md | 35 ++++++++++++++ conductor/archive/health-complaints/spec.md | 48 +++++++++++++++++++ conductor/tracks.md | 6 +-- 5 files changed, 111 insertions(+), 5 deletions(-) create mode 100644 conductor/archive/health-complaints/index.md create mode 100644 conductor/archive/health-complaints/metadata.json create mode 100644 conductor/archive/health-complaints/plan.md create mode 100644 conductor/archive/health-complaints/spec.md diff --git a/conductor/archive/health-complaints/index.md b/conductor/archive/health-complaints/index.md new file mode 100644 index 0000000..2239a24 --- /dev/null +++ b/conductor/archive/health-complaints/index.md @@ -0,0 +1,16 @@ +# Health-complaints Track + +## Documents + +- [Specification](./spec.md) +- [Implementation Plan](./plan.md) +- [Metadata](./metadata.json) + +## Quick Links + +- [Project Index](../../index.md) +- [Tracks Registry](../../tracks.md) + +## Status + +See [metadata.json](./metadata.json) for current status and dependencies. diff --git a/conductor/archive/health-complaints/metadata.json b/conductor/archive/health-complaints/metadata.json new file mode 100644 index 0000000..036babc --- /dev/null +++ b/conductor/archive/health-complaints/metadata.json @@ -0,0 +1,11 @@ +{ + "track_id": "health-complaints", + "name": "Health Complaints", + "description": "Patient complaints management - clinician complaints, service/organizational complaints, resolution workflows", + "status": "planning", + "created": "2026-02-11", + "priority": "high", + "dependencies": ["health-core"], + "deliverable": "complaints-management skill, /submit-complaint command", + "adapts_from": ["customer-support/ticket-triage", "customer-support/escalation", "customer-support/response-drafting"] +} diff --git a/conductor/archive/health-complaints/plan.md b/conductor/archive/health-complaints/plan.md new file mode 100644 index 0000000..7eb5246 --- /dev/null +++ b/conductor/archive/health-complaints/plan.md @@ -0,0 +1,35 @@ +# Health Complaints Track Plan + +## Phase 1: Complaints Skill +*Dependencies: health-core* +*Estimated: 1-2 sessions* + +- [x] Create `health/skills/complaints-management/SKILL.md` (2026-02-12) + - Acceptance: Follows [health skill standards](../health-plugin/skill-standards.md) (14-section template) + - Acceptance: AU/NZ complaints-handling defaults are explicit, with US/EU-lite fallback + - Acceptance: Standard mode and Lite mode are explicitly documented + - Acceptance: Includes Confidence Indicators for clinical vs administrative triage + - Acceptance: PHI/PII guardrails for patient data handling + - Acceptance: Distinguishes clinician vs service complaints + - Acceptance: Severity framework adapted for healthcare (P1-P4 with patient safety context) + - Acceptance: Investigation workflow with timelines + - Acceptance: Escalation triggers to legal/regulatory + - Acceptance: Resolution documentation requirements + - Source patterns: `customer-support/ticket-triage`, `customer-support/escalation` + +## Phase 2: Complaints Command +*Dependencies: Phase 1* +*Estimated: 1 session* + +- [x] Create `health/commands/submit-complaint.md` (2026-02-12) + - Acceptance: Collects complaint type + - Acceptance: Captures patient/staff safety concerns + - Acceptance: Routes to appropriate skill path + - Acceptance: Generates intake documentation + +**Checkpoint:** `conductor(checkpoint): Health complaints workflow complete` + +## Notes + +- May need to coordinate with `health-incidents` track - some complaints may trigger incident reports +- Regulatory reporting requirements vary by jurisdiction - parameterize diff --git a/conductor/archive/health-complaints/spec.md b/conductor/archive/health-complaints/spec.md new file mode 100644 index 0000000..54c69d5 --- /dev/null +++ b/conductor/archive/health-complaints/spec.md @@ -0,0 +1,48 @@ +# Health Complaints Track Specification + +## Overview + +Patient complaints management workflows distinguishing between clinician complaints and service/organizational complaints. + +## Scope + +### Complaint Types + +| Type | Focus | Examples | +|------|-------|----------| +| **Clinician** | Individual practitioner performance/conduct | Bedside manner, competence, communication | +| **Service/Organizational** | Systems, processes, facilities | Wait times, access, environment, administrative | + +### Workflows + +1. **Intake** - Categorization, severity assessment, routing +2. **Investigation** - Fact gathering, interviews, documentation +3. **Resolution** - Response drafting, remediation, closure +4. **Escalation** - When to escalate to legal, regulatory, or executive + +### Key Distinctions from General Support + +- Healthcare-specific severity (patient safety implications) +- Regulatory reporting obligations +- Clinical governance involvement +- Medical records access considerations + +## Deliverables + +### Skills +- `complaints-management` - Unified complaints workflow with type differentiation + +### Commands +- `/submit-complaint` - Structured complaint intake + +## Dependencies + +- `health-core` (plugin structure must exist) + +## Success Criteria + +- [ ] Categorizes complaints by type (clinician vs service) +- [ ] Assesses severity with healthcare context +- [ ] Routes to appropriate investigation path +- [ ] Identifies regulatory reporting triggers +- [ ] Generates investigation documentation diff --git a/conductor/tracks.md b/conductor/tracks.md index a8ee424..46b5b30 100644 --- a/conductor/tracks.md +++ b/conductor/tracks.md @@ -46,10 +46,6 @@ PHASE 4: Research/Academic (parallel, depends Phase 3) │ ### Track Registry (Canonical) -- [x] **Track: health-complaints** (./tracks/health-complaints/) - - Description: Patient complaints - - Phase: 2 - - Adapts From: customer-support/ticket-triage - [ ] **Track: health-incidents** (./tracks/health-incidents/) - Description: Serious adverse events - Phase: 2 @@ -129,7 +125,7 @@ PHASE 4: Research/Academic (parallel, depends Phase 3) │ ### Summary -- **21 tracks** total (1 meta + 19 implementation + 1 infrastructure) +- **20 tracks** total (1 meta + 18 implementation + 1 infrastructure) - **33 planned skills** across all tracks - **16 planned commands** for key workflows - **0 implemented skills** in `health/skills/` currently From c6d8798b904c3c213b2971bf21d02c5c0dc432f3 Mon Sep 17 00:00:00 2001 From: "Dylan Mordaunt (Illawarra Shoalhaven LHD)" Date: Thu, 12 Feb 2026 15:46:13 +1100 Subject: [PATCH 18/57] chore(conductor): Archive track 'health-incidents - Serious adverse events' --- conductor/archive/health-incidents/index.md | 16 ++ .../archive/health-incidents/metadata.json | 11 ++ conductor/archive/health-incidents/plan.md | 36 ++++ conductor/archive/health-incidents/spec.md | 48 +++++ conductor/tracks.md | 186 ++++++++++-------- 5 files changed, 219 insertions(+), 78 deletions(-) create mode 100644 conductor/archive/health-incidents/index.md create mode 100644 conductor/archive/health-incidents/metadata.json create mode 100644 conductor/archive/health-incidents/plan.md create mode 100644 conductor/archive/health-incidents/spec.md diff --git a/conductor/archive/health-incidents/index.md b/conductor/archive/health-incidents/index.md new file mode 100644 index 0000000..1bbdf99 --- /dev/null +++ b/conductor/archive/health-incidents/index.md @@ -0,0 +1,16 @@ +# Health-incidents Track + +## Documents + +- [Specification](./spec.md) +- [Implementation Plan](./plan.md) +- [Metadata](./metadata.json) + +## Quick Links + +- [Project Index](../../index.md) +- [Tracks Registry](../../tracks.md) + +## Status + +See [metadata.json](./metadata.json) for current status and dependencies. diff --git a/conductor/archive/health-incidents/metadata.json b/conductor/archive/health-incidents/metadata.json new file mode 100644 index 0000000..e80179a --- /dev/null +++ b/conductor/archive/health-incidents/metadata.json @@ -0,0 +1,11 @@ +{ + "track_id": "health-incidents", + "name": "Health Incidents", + "description": "Serious adverse events (SAEs) and incident reporting, investigation, and escalation workflows", + "status": "complete", + "created": "2026-02-11", + "priority": "high", + "dependencies": ["health-core"], + "deliverable": "incident-reporting skill, /report-incident command", + "adapts_from": ["customer-support/escalation", "legal/legal-risk-assessment"] +} diff --git a/conductor/archive/health-incidents/plan.md b/conductor/archive/health-incidents/plan.md new file mode 100644 index 0000000..420fb03 --- /dev/null +++ b/conductor/archive/health-incidents/plan.md @@ -0,0 +1,36 @@ +# Health Incidents Track Plan + +## Phase 1: Incident Reporting Skill +*Dependencies: health-core* +*Estimated: 1-2 sessions* + +- [x] Create `health/skills/incident-reporting/SKILL.md` + - Acceptance: Follows [health skill standards](../health-plugin/skill-standards.md) (14-section template) + - Acceptance: AU/NZ incident-reporting defaults are explicit, with US/EU-lite fallback + - Acceptance: Standard mode and Lite mode are explicitly documented + - Acceptance: Includes Confidence Indicators for clinical severity (SAC scores) + - Acceptance: PHI/PII guardrails for incident documentation + - Acceptance: Incident type taxonomy + - Acceptance: Severity classification (SAC or equivalent) + - Acceptance: Immediate response protocol + - Acceptance: Investigation methodology (RCA) + - Acceptance: Mandatory reporting triggers + - Acceptance: QI documentation requirements + +## Phase 2: Incident Command +*Dependencies: Phase 1* +*Estimated: 1 session* + +- [x] Create `health/commands/report-incident.md` + - Acceptance: Rapid intake workflow + - Acceptance: Captures immediate safety concerns + - Acceptance: Routes to appropriate severity path + - Acceptance: Triggers notifications where required + +**Checkpoint:** `conductor(checkpoint): Health incidents workflow complete` + +## Notes + +- Coordinate with `health-complaints` - some complaints are incident reports +- May need `health-risk` integration for trend analysis +- Regulatory requirements vary significantly by jurisdiction diff --git a/conductor/archive/health-incidents/spec.md b/conductor/archive/health-incidents/spec.md new file mode 100644 index 0000000..25257d8 --- /dev/null +++ b/conductor/archive/health-incidents/spec.md @@ -0,0 +1,48 @@ +# Health Incidents Track Specification + +## Overview + +Serious adverse events (SAEs) and incident reporting, investigation, and escalation workflows. Distinct from complaints - these are safety events that may or may not involve patient/family complaints. + +## Scope + +### Incident Types +- Patient safety incidents +- Near misses +- Sentinel events +- Adverse drug reactions +- Device-related incidents +- Healthcare-associated infections + +### Key Workflows + +1. **Detection** - Identification and immediate reporting +2. **Classification** - Severity (SAC 1-4 or equivalent) +3. **Investigation** - Root cause analysis, RCA methodology +4. **Reporting** - Regulatory notifications, internal escalations +5. **Prevention** - Action items, system improvements + +### Regulatory Context +- Mandatory reporting requirements +- Sentinel event protocols +- Quality improvement protections + +## Deliverables + +### Skills +- `incident-reporting` - Incident detection, classification, investigation workflow + +### Commands +- `/report-incident` - Incident intake and routing + +## Dependencies + +- `health-core` (plugin structure) + +## Success Criteria + +- [ ] Classifies incident severity appropriately +- [ ] Identifies mandatory reporting triggers +- [ ] Supports RCA methodology +- [ ] Links to quality improvement tracking +- [ ] Maintains privilege protections where applicable diff --git a/conductor/tracks.md b/conductor/tracks.md index 46b5b30..b3c90da 100644 --- a/conductor/tracks.md +++ b/conductor/tracks.md @@ -46,90 +46,120 @@ PHASE 4: Research/Academic (parallel, depends Phase 3) │ ### Track Registry (Canonical) -- [ ] **Track: health-incidents** (./tracks/health-incidents/) - - Description: Serious adverse events - - Phase: 2 - - Adapts From: customer-support/escalation -- [ ] **Track: health-risk** (./tracks/health-risk/) - - Description: Multi-domain risk - - Phase: 2 - - Adapts From: legal/legal-risk-assessment -- [ ] **Track: health-information** (./tracks/health-information/) - - Description: ROI, consent, records - - Phase: 2 - - Adapts From: legal/compliance -- [ ] **Track: health-coding** (./tracks/health-coding/) - - Description: Clinical coding - - Phase: 2 - - Adapts From: data/data-validation -- [ ] **Track: health-governance** (./tracks/health-governance/) - - Description: Policies, procedures - - Phase: 3 - - Adapts From: legal/compliance -- [ ] **Track: health-credentialing** (./tracks/health-credentialing/) - - Description: Provider credentialing - - Phase: 3 - - Adapts From: productivity/memory-management -- [ ] **Track: health-procurement** (./tracks/health-procurement/) - - Description: Devices, business cases - - Phase: 3 - - Adapts From: legal/contract-review -- [ ] **Track: health-quality** (./tracks/health-quality/) - - Description: QI, accreditation - - Phase: 3 - - Adapts From: product-management -- [ ] **Track: health-financial** (./tracks/health-financial/) - - Description: Payer contracts - - Phase: 3 - - Adapts From: finance -- [ ] **Track: health-evidence** (./tracks/health-evidence/) - - Description: Systematic reviews - - Phase: 3 - - Adapts From: bio-research -- [ ] **Track: health-data-analysis** (./tracks/health-data-analysis/) - - Description: Epidemiological reports - - Phase: 3 - - Adapts From: data -- [ ] **Track: health-public-health** (./tracks/health-public-health/) - - Description: Notifiable disease reporting and surveillance - - Phase: 3 - - Adapts From: legal/compliance -- [ ] **Track: health-ethics** (./tracks/health-ethics/) - - Description: Research/clinical ethics - - Phase: 4 - - Adapts From: bio-research -- [ ] **Track: health-economics** (./tracks/health-economics/) - - Description: HTA, cost-effectiveness - - Phase: 4 - - Adapts From: data, finance -- [ ] **Track: health-manuscripts** (./tracks/health-manuscripts/) - - Description: Journal preparation - - Phase: 4 - - Adapts From: bio-research -- [ ] **Track: health-doc-coauthoring** (./tracks/health-doc-coauthoring/) - - Description: Three-stage collaborative clinical document development - - Phase: 4 - - Adapts From: document-skills/docx -- [ ] **Track: health-grants** (./tracks/health-grants/) - - Description: Grant applications - - Phase: 4 - - Adapts From: bio-research -- [ ] **Track: health-medicolegal** (./tracks/health-medicolegal/) - - Description: Child protection, affidavits, medico-legal - - Phase: 4 - - Adapts From: legal -- [ ] **Track: skill-quality** (./tracks/skill-quality/) - - Description: Quality standards for health plugin skills (30 skills) - - Phase: Infrastructure - - Adapts From: health-core +## [ ] Track: health-risk - Multi-domain risk +Folder: [./tracks/health-risk/](./tracks/health-risk/) +Phase: 2 +Adapts From: legal/legal-risk-assessment + +--- +## [ ] Track: health-information - ROI, consent, records +Folder: [./tracks/health-information/](./tracks/health-information/) +Phase: 2 +Adapts From: legal/compliance + +--- +## [ ] Track: health-coding - Clinical coding +Folder: [./tracks/health-coding/](./tracks/health-coding/) +Phase: 2 +Adapts From: data/data-validation + +--- +## [ ] Track: health-governance - Policies, procedures +Folder: [./tracks/health-governance/](./tracks/health-governance/) +Phase: 3 +Adapts From: legal/compliance + +--- +## [ ] Track: health-credentialing - Provider credentialing +Folder: [./tracks/health-credentialing/](./tracks/health-credentialing/) +Phase: 3 +Adapts From: productivity/memory-management + +--- +## [ ] Track: health-procurement - Devices, business cases +Folder: [./tracks/health-procurement/](./tracks/health-procurement/) +Phase: 3 +Adapts From: legal/contract-review + +--- +## [ ] Track: health-quality - QI, accreditation +Folder: [./tracks/health-quality/](./tracks/health-quality/) +Phase: 3 +Adapts From: product-management + +--- +## [ ] Track: health-financial - Payer contracts +Folder: [./tracks/health-financial/](./tracks/health-financial/) +Phase: 3 +Adapts From: finance + +--- +## [ ] Track: health-evidence - Systematic reviews +Folder: [./tracks/health-evidence/](./tracks/health-evidence/) +Phase: 3 +Adapts From: bio-research + +--- +## [ ] Track: health-data-analysis - Epidemiological reports +Folder: [./tracks/health-data-analysis/](./tracks/health-data-analysis/) +Phase: 3 +Adapts From: data + +--- +## [ ] Track: health-public-health - Notifiable disease reporting and surveillance +Folder: [./tracks/health-public-health/](./tracks/health-public-health/) +Phase: 3 +Adapts From: legal/compliance + +--- +## [ ] Track: health-ethics - Research/clinical ethics +Folder: [./tracks/health-ethics/](./tracks/health-ethics/) +Phase: 4 +Adapts From: bio-research + +--- +## [ ] Track: health-economics - HTA, cost-effectiveness +Folder: [./tracks/health-economics/](./tracks/health-economics/) +Phase: 4 +Adapts From: data, finance + +--- +## [ ] Track: health-manuscripts - Journal preparation +Folder: [./tracks/health-manuscripts/](./tracks/health-manuscripts/) +Phase: 4 +Adapts From: bio-research + +--- +## [ ] Track: health-doc-coauthoring - Three-stage collaborative clinical document development +Folder: [./tracks/health-doc-coauthoring/](./tracks/health-doc-coauthoring/) +Phase: 4 +Adapts From: document-skills/docx + +--- +## [ ] Track: health-grants - Grant applications +Folder: [./tracks/health-grants/](./tracks/health-grants/) +Phase: 4 +Adapts From: bio-research + +--- +## [ ] Track: health-medicolegal - Child protection, affidavits, medico-legal +Folder: [./tracks/health-medicolegal/](./tracks/health-medicolegal/) +Phase: 4 +Adapts From: legal + +--- +## [ ] Track: skill-quality - Quality standards for health plugin skills (30 skills) +Folder: [./tracks/skill-quality/](./tracks/skill-quality/) +Phase: Infrastructure +Adapts From: health-core ### Summary - **20 tracks** total (1 meta + 18 implementation + 1 infrastructure) - **33 planned skills** across all tracks - **16 planned commands** for key workflows -- **0 implemented skills** in `health/skills/` currently -- **0 implemented commands** in `health/commands/` currently +- **2 implemented skills** in `health/skills/` currently +- **2 implemented commands** in `health/commands/` currently - **4 execution phases** plus an infrastructure track ## Track Status From a5e68a581cf7b76bf18f862cb3dcd7a876819449 Mon Sep 17 00:00:00 2001 From: "Dylan Mordaunt (Illawarra Shoalhaven LHD)" Date: Thu, 12 Feb 2026 18:41:27 +1100 Subject: [PATCH 19/57] chore(conductor): Mark track 'health-risk - Multi-domain risk' as complete --- conductor/tracks.md | 2 +- conductor/tracks/health-incidents/index.md | 16 -- .../tracks/health-incidents/metadata.json | 11 - conductor/tracks/health-incidents/plan.md | 36 ---- conductor/tracks/health-incidents/spec.md | 48 ----- conductor/tracks/health-risk/plan.md | 8 +- health/commands/assess-risk.md | 83 ++++++++ .../enterprise-risk-assessment/SKILL.md | 169 ++++++++++++++++ health/skills/worker-risk-assessment/SKILL.md | 188 ++++++++++++++++++ 9 files changed, 445 insertions(+), 116 deletions(-) delete mode 100644 conductor/tracks/health-incidents/index.md delete mode 100644 conductor/tracks/health-incidents/metadata.json delete mode 100644 conductor/tracks/health-incidents/plan.md delete mode 100644 conductor/tracks/health-incidents/spec.md create mode 100644 health/commands/assess-risk.md create mode 100644 health/skills/enterprise-risk-assessment/SKILL.md create mode 100644 health/skills/worker-risk-assessment/SKILL.md diff --git a/conductor/tracks.md b/conductor/tracks.md index b3c90da..318044c 100644 --- a/conductor/tracks.md +++ b/conductor/tracks.md @@ -46,7 +46,7 @@ PHASE 4: Research/Academic (parallel, depends Phase 3) │ ### Track Registry (Canonical) -## [ ] Track: health-risk - Multi-domain risk +## [x] Track: health-risk - Multi-domain risk Folder: [./tracks/health-risk/](./tracks/health-risk/) Phase: 2 Adapts From: legal/legal-risk-assessment diff --git a/conductor/tracks/health-incidents/index.md b/conductor/tracks/health-incidents/index.md deleted file mode 100644 index 1bbdf99..0000000 --- a/conductor/tracks/health-incidents/index.md +++ /dev/null @@ -1,16 +0,0 @@ -# Health-incidents Track - -## Documents - -- [Specification](./spec.md) -- [Implementation Plan](./plan.md) -- [Metadata](./metadata.json) - -## Quick Links - -- [Project Index](../../index.md) -- [Tracks Registry](../../tracks.md) - -## Status - -See [metadata.json](./metadata.json) for current status and dependencies. diff --git a/conductor/tracks/health-incidents/metadata.json b/conductor/tracks/health-incidents/metadata.json deleted file mode 100644 index 9515447..0000000 --- a/conductor/tracks/health-incidents/metadata.json +++ /dev/null @@ -1,11 +0,0 @@ -{ - "track_id": "health-incidents", - "name": "Health Incidents", - "description": "Serious adverse events (SAEs) and incident reporting, investigation, and escalation workflows", - "status": "planning", - "created": "2026-02-11", - "priority": "high", - "dependencies": ["health-core"], - "deliverable": "incident-reporting skill, /report-incident command", - "adapts_from": ["customer-support/escalation", "legal/legal-risk-assessment"] -} diff --git a/conductor/tracks/health-incidents/plan.md b/conductor/tracks/health-incidents/plan.md deleted file mode 100644 index edbb72e..0000000 --- a/conductor/tracks/health-incidents/plan.md +++ /dev/null @@ -1,36 +0,0 @@ -# Health Incidents Track Plan - -## Phase 1: Incident Reporting Skill -*Dependencies: health-core* -*Estimated: 1-2 sessions* - -- [ ] Create `health/skills/incident-reporting/SKILL.md` - - Acceptance: Follows [health skill standards](../health-plugin/skill-standards.md) (14-section template) - - Acceptance: AU/NZ incident-reporting defaults are explicit, with US/EU-lite fallback - - Acceptance: Standard mode and Lite mode are explicitly documented - - Acceptance: Includes Confidence Indicators for clinical severity (SAC scores) - - Acceptance: PHI/PII guardrails for incident documentation - - Acceptance: Incident type taxonomy - - Acceptance: Severity classification (SAC or equivalent) - - Acceptance: Immediate response protocol - - Acceptance: Investigation methodology (RCA) - - Acceptance: Mandatory reporting triggers - - Acceptance: QI documentation requirements - -## Phase 2: Incident Command -*Dependencies: Phase 1* -*Estimated: 1 session* - -- [ ] Create `health/commands/report-incident.md` - - Acceptance: Rapid intake workflow - - Acceptance: Captures immediate safety concerns - - Acceptance: Routes to appropriate severity path - - Acceptance: Triggers notifications where required - -**Checkpoint:** `conductor(checkpoint): Health incidents workflow complete` - -## Notes - -- Coordinate with `health-complaints` - some complaints are incident reports -- May need `health-risk` integration for trend analysis -- Regulatory requirements vary significantly by jurisdiction diff --git a/conductor/tracks/health-incidents/spec.md b/conductor/tracks/health-incidents/spec.md deleted file mode 100644 index 25257d8..0000000 --- a/conductor/tracks/health-incidents/spec.md +++ /dev/null @@ -1,48 +0,0 @@ -# Health Incidents Track Specification - -## Overview - -Serious adverse events (SAEs) and incident reporting, investigation, and escalation workflows. Distinct from complaints - these are safety events that may or may not involve patient/family complaints. - -## Scope - -### Incident Types -- Patient safety incidents -- Near misses -- Sentinel events -- Adverse drug reactions -- Device-related incidents -- Healthcare-associated infections - -### Key Workflows - -1. **Detection** - Identification and immediate reporting -2. **Classification** - Severity (SAC 1-4 or equivalent) -3. **Investigation** - Root cause analysis, RCA methodology -4. **Reporting** - Regulatory notifications, internal escalations -5. **Prevention** - Action items, system improvements - -### Regulatory Context -- Mandatory reporting requirements -- Sentinel event protocols -- Quality improvement protections - -## Deliverables - -### Skills -- `incident-reporting` - Incident detection, classification, investigation workflow - -### Commands -- `/report-incident` - Incident intake and routing - -## Dependencies - -- `health-core` (plugin structure) - -## Success Criteria - -- [ ] Classifies incident severity appropriately -- [ ] Identifies mandatory reporting triggers -- [ ] Supports RCA methodology -- [ ] Links to quality improvement tracking -- [ ] Maintains privilege protections where applicable diff --git a/conductor/tracks/health-risk/plan.md b/conductor/tracks/health-risk/plan.md index 913f084..a4fcf9e 100644 --- a/conductor/tracks/health-risk/plan.md +++ b/conductor/tracks/health-risk/plan.md @@ -4,7 +4,7 @@ *Dependencies: health-core* *Estimated: 1-2 sessions* -- [ ] Create `health/skills/clinical-risk-assessment/SKILL.md` +- [x] Create `health/skills/clinical-risk-assessment/SKILL.md` - Acceptance: Follows [health skill standards](../health-plugin/skill-standards.md) (14-section template) - Acceptance: AU/NZ risk-governance defaults are explicit, with US/EU-lite fallback - Acceptance: Standard mode and Lite mode are explicitly documented @@ -18,11 +18,11 @@ *Dependencies: Phase 1* *Estimated: 1-2 sessions* -- [ ] Create `health/skills/worker-risk-assessment/SKILL.md` +- [x] Create `health/skills/worker-risk-assessment/SKILL.md` - Acceptance: Workforce and occupational hazard checklist - Acceptance: Escalation criteria and urgent action triggers -- [ ] Create `health/skills/enterprise-risk-assessment/SKILL.md` +- [x] Create `health/skills/enterprise-risk-assessment/SKILL.md` - Acceptance: Enterprise risk categories and ownership mapping - Acceptance: Governance review and reporting cadence @@ -30,7 +30,7 @@ *Dependencies: Phase 1, Phase 2* *Estimated: 0.5-1 session* -- [ ] Create `health/commands/assess-risk.md` +- [x] Create `health/commands/assess-risk.md` - Acceptance: Intake prompts for risk domain selection - Acceptance: Recommended controls and residual risk output - Acceptance: Escalation and follow-up checklist diff --git a/health/commands/assess-risk.md b/health/commands/assess-risk.md new file mode 100644 index 0000000..43379eb --- /dev/null +++ b/health/commands/assess-risk.md @@ -0,0 +1,83 @@ +--- +name: assess-risk +description: Structured risk assessment intake for clinical, worker, or enterprise domains with scoring, control recommendations, and governance routing. +arguments: + - name: risk_domain + description: "The primary domain for assessment: clinical, worker, or enterprise." + required: true + - name: summary + description: "Short description of the hazard or risk scenario. Avoid names or identifiers." + required: true + - name: initial_impact + description: "Preliminary impact/consequence score (1-5)." + required: true + - name: initial_likelihood + description: "Preliminary likelihood score (1-5)." + required: true + - name: jurisdiction + description: "Optional: au, nz, us, or eu. Defaults to au-nz if omitted." + required: false +--- + +# Assess Risk + +Use this command to initiate a formal risk assessment workflow, calculate scores, and identify required controls and governance paths. + +## 1. Domain Selection and Skill Activation + +Route to the appropriate skill based on `risk_domain`: +- If `clinical`: Use `~~health/clinical-risk-assessment` +- If `worker`: Use `~~health/worker-risk-assessment` +- If `enterprise`: Use `~~health/enterprise-risk-assessment` + +## 2. Risk Analysis + +For the selected domain: +1. Validate impact and likelihood rationales against the domain-specific scale. +2. Calculate the **Inherent Risk Score** (Impact x Likelihood). +3. Identify relevant existing controls. +4. Recommend additional controls following the appropriate hierarchy (e.g., Clinical adaptation or WHS Hierarchy). +5. Calculate the **Residual Risk Score**. + +## 3. Generate Structured Output + +Produce: + +### RISK ASSESSMENT SUMMARY +- **Risk ID**: [Generate unique ID] +- **Date**: {{current_timestamp}} +- **Domain**: {{risk_domain}} +- **Hazard Summary**: [Factual description] +- **Jurisdiction**: {{jurisdiction or "AU/NZ default"}} + +### SCORING & CLASSIFICATION +- **Inherent Risk**: {{initial_impact}} x {{initial_likelihood}} = [Inherent Score] ([LEVEL]) +- **Rationale**: [Brief explanation of why these scores were assigned] + +### RECOMMENDED CONTROLS +1. [Primary Control - Hierarchy Level] +2. [Secondary Control - Hierarchy Level] +3. [Administrative/Monitoring Control] + +### RESIDUAL RISK +- **Target Score**: [Residual Score] ([LEVEL]) +- **Acceptance Threshold**: [Within Appetite / Requires Escalation] + +### GOVERNANCE & ACCOUNTABILITY +- **Risk Owner**: [Recommended Role] +- **Governance Pathway**: [Local review / Governance Committee / Board] +- **Review Frequency**: [Daily/Weekly/Monthly/Quarterly/Annually] + +## 4. Execute Routing + +- Log risk entry in `~~project tracker`. +- For **ORANGE (High)** or **RED (Extreme)** risks: + - Notify domain Executive (CMO, HR Director, or CEO/CFO). + - Add to the next Governance Committee agenda. + - For Extreme risks, initiate the immediate executive briefing protocol. + +## 5. Output Guardrails + +- **De-identification**: Ensure the summary and rationale do not contain PHI or PII. +- **Provisional Status**: If likelihood or impact rationale is weak, mark the assessment as **Provisional** and request clinical/management review. +- **Precautionary Principle**: For high-consequence scenarios with low-confidence likelihood, default to the higher risk level for initial treatment. diff --git a/health/skills/enterprise-risk-assessment/SKILL.md b/health/skills/enterprise-risk-assessment/SKILL.md new file mode 100644 index 0000000..2f8ed89 --- /dev/null +++ b/health/skills/enterprise-risk-assessment/SKILL.md @@ -0,0 +1,169 @@ +--- +name: health/enterprise-risk-assessment +description: This skill should be used when assessing strategic, operational, financial, and reputational risks for a healthcare organization. Use when a user mentions enterprise risk management (ERM), strategic risk, clinical governance, financial sustainability, reputation risk, regulatory compliance, or board-level risk reporting. +version: 1.0.0 +--- + +# Enterprise Risk Assessment + +Structured guidance for identifying, scoring, treating, and monitoring risks that impact the strategic objectives, financial viability, and overall reputation of a healthcare organization. + +**Important**: This skill supports senior executive and board-level risk governance. It focuses on high-level organizational risks and should be used in conjunction with clinical and worker safety assessments. It does not replace professional financial, legal, or strategic consulting advice. + +## When to Use This Skill + +Invoke when: +- Conducting an annual or quarterly Enterprise Risk Management (ERM) review. +- Developing or updating the organization's Strategic Risk Register. +- Assessing risks associated with major capital projects, mergers, or service expansions. +- Evaluating the impact of significant regulatory or funding changes (e.g., new activity-based funding models). +- Addressing enterprise-level threats such as cyberattacks, large-scale clinical failures, or major workforce shortages. +- Preparing for board risk sub-committee meetings or executive leadership retreats. + +Do not use for individual patient safety events (use `~~health/clinical-risk-assessment`) or local occupational hazards (use `~~health/worker-risk-assessment`). + +## Operating Modes + +### Standard Mode +Full enterprise risk governance workflow: +- Alignment with ISO 31000 or COSO ERM frameworks. +- Detailed analysis across Strategic, Operational, Financial, Compliance, and Reputational domains. +- Assessment of risk appetite and tolerance levels. +- Documentation of executive ownership and board oversight. +- Integration with the organization's strategic planning and budgeting cycles. + +### Lite Mode +High-level risk scan or "Pre-mortem" for a specific initiative: +- Identification of top 5-10 strategic threats. +- Rapid scoring of impact and likelihood. +- Preliminary identification of mitigation strategies. +- Useful for project steering committees or early-stage strategy sessions. + +## Regulatory Context + +Default jurisdiction is Australia/New Zealand. Use US/EU-lite framing only when explicitly requested. + +| Jurisdiction | Framework/Statute | Compliance Trigger | Review Cadence | Required Artifacts | Escalation Point | +|---|---|---|---|---|---| +| Australia | ISO 31000, Corporations Act (for relevant entities), NSQHS Standards (Clinical Governance) | Annual review, significant adverse event, regulatory change | Quarterly for Board, Monthly for Exec | Enterprise Risk Register, Board Risk Report | Board Risk Committee, CEO | +| New Zealand | ISO 31000, Crown Entities Act 2004, Te Whatu Ora governance frameworks | Planning cycle, national health directive change | Quarterly | Strategic Risk Profile, Governance Statement | Board, Chief Executive | +| United States (lite) | COSO ERM Framework, Sarbanes-Oxley (if applicable), CMS regulations | Fiscal year start, major audit findings | Quarterly | ERM Dashboard, Compliance Report | Audit & Risk Committee, CFO | +| European Union (lite) | ISO 31000, country-specific health system governance codes | Strategy review, major public health event | Bi-annual or Quarterly | Risk Landscape Report | Supervisory Board, Director General | + +## Quick Reference + +1. **Scan the Horizon**: Identify external (political, economic, regulatory, technological) and internal (workforce, clinical, financial) threats. +2. **Categorize**: Assign risks to domains (Strategic, Operational, Financial, Compliance, Reputational). +3. **Assess Inherent Risk**: Score impact and likelihood on the organization's strategic objectives. +4. **Identify Controls**: Focus on governance structures, policies, audits, and financial hedges. +5. **Determine Residual Risk**: Evaluate if the risk sits within the organization's **Risk Appetite**. +6. **Assign Accountability**: Ensure an Executive Lead is responsible for each major risk. + +## Risk Assessment Framework + +### Enterprise Impact (Consequence) Scale + +| Level | Label | Strategic / Reputational | Financial | Clinical / Operational | +|---|---|---|---|---| +| 1 | **Minor** | Localized negative publicity; minor objective delay | <1% of budget; manageable locally | Negligible impact on service delivery | +| 2 | **Moderate** | Short-term media interest; minor regulator inquiry | 1-3% of budget; requires re-allocation | Brief service disruption in one department | +| 3 | **Serious** | Sustained media coverage; formal regulatory intervention | 3-5% of budget; affects capital plan | Significant service reduction; accreditation at risk | +| 4 | **Major** | Significant loss of public trust; major regulatory breach | 5-10% of budget; requires emergency funding | Systemic service failure; multiple site impacts | +| 5 | **Catastrophic** | Total loss of license/trust; organizational collapse | >10% of budget; insolvency risk | Permanent closure of core services; catastrophic harm | + +### Enterprise Likelihood Scale + +| Level | Label | Description | Probability | +|---|---|---|---| +| 1 | **Rare** | Only in exceptional circumstances; no industry precedent | <5% | +| 2 | **Unlikely** | Has occurred in other organizations but not locally | 5-25% | +| 3 | **Possible** | Might occur at some time; industry-wide trend | 25-50% | +| 4 | **Likely** | Will probably occur; clear local vulnerability | 50-75% | +| 5 | **Almost Certain** | Expected to occur; high frequency or systemic issue | >75% | + +## Enterprise Risk Domains + +| Domain | Focus | Key Indicators | +|---|---|---| +| **Strategic** | Ability to achieve long-term goals | Market share, clinical outcomes, innovation rate | +| **Operational** | Effectiveness of internal processes | Wait times, staffing ratios, system downtime | +| **Financial** | Sustainability and resource management | EBITDA, cash on hand, payer mix, insurance coverage | +| **Compliance** | Meeting legal and regulatory requirements | Audit findings, breach reports, credentialing status | +| **Reputational** | Public and stakeholder perception | Media sentiment, patient satisfaction, donor confidence | + +## Documentation Standards + +### Enterprise Risk Register Format + +| Field | Description | +|---|---| +| Risk Title | Concise name (e.g., "Workforce Shortage - Specialty Nursing") | +| Category | Strategic, Operational, etc. | +| Risk Owner | Executive Lead (e.g., Chief Nursing Officer) | +| Risk Description | The "Event -> Cause -> Impact" narrative | +| Inherent Risk | Impact x Likelihood | +| Controls | Governance, Policies, Audits, Systems | +| Residual Risk | After controls | +| Risk Appetite | Within / Outside / Close to | +| Action Plan | Specific strategic initiatives to mitigate | +| Last Review | Date and brief update on status | + +## Security & Privacy Considerations + +- **Commercial-in-Confidence**: Enterprise risk documents often contain sensitive financial or strategic data. Protect with restricted access. +- **Regulatory Privilege**: In some jurisdictions, certain risk reviews (e.g., Quality Assurance Committees) may have statutory protection from discovery. Ensure these are marked correctly. +- **De-identification**: While patient data is rarely in ERM reports, avoid using specific clinician or staff names where a role title suffices. + +## Confidence Indicators + +| Scenario | Confidence | Action | +|---|---|---| +| Clear financial or compliance risk with established metrics | High | Propose risk entry and mitigation plan based on standard templates | +| Emergent strategic shift with high uncertainty | Medium | Produce "Scenario Analysis" rather than a single score; highlight assumptions | +| Reputational risk based on anecdotal or early-stage social media sentiment | Low | Recommend sentiment monitoring; do not score until evidence of sustained impact | +| Risk involving complex legal or constitutional changes | Low | Flag as "Under Review"; require expert legal/governance opinion | + +## Common Mistakes (Anti-Patterns) + +| Mistake | Why It's Wrong | Instead | +|---|---|---| +| Setting "Risk Appetite" to zero for all risks | Stifles innovation and is realistically impossible in healthcare | Define clear, tiered appetite levels (e.g., "Averse" for safety, "Open" for innovation) | +| Confusing "Issues" with "Risks" | An issue is happening now; a risk is a future event | Manage issues in operations; track risks in the register | +| Using the ERM as a "Set and Forget" list | Risk profiles change rapidly; outdated registers provide false assurance | Integrate risk review into monthly executive meetings | +| Failing to link enterprise risks to clinical data | Organizational failure often starts with clinical deterioration | Ensure the ERM reflects high-level trends from clinical risk registers | +| Assigning enterprise risks to mid-level managers | If it's an enterprise risk, it needs an executive owner with budget authority | Assign ownership to C-suite or Executive Director level | + +## When to Escalate + +- **Risk Appetite Breach**: Any residual risk score that exceeds the board-approved appetite for that category. +- **New Emerging Threat**: Sudden external changes (e.g., global pandemic, sudden withdrawal of a major insurer). +- **Control Failure**: Identification that a major strategic control (e.g., clinical governance framework) is ineffective. +- **Media/Regulator Crisis**: Any event likely to cause sustained level 4-5 reputational impact. + +## Tool Requirements + +- `~~finance/financial-reports` for sustainability data. +- `~~legal/compliance-tracker` for regulatory status. +- `~~health/clinical-governance-dashboard` for high-level safety trends. +- `~~search` for industry benchmarking and competitor analysis. + +## Success Indicators + +- [ ] Risks are linked to specific strategic objectives. +- [ ] Executive ownership is clearly assigned. +- [ ] Scoring reflects organizational-wide impact (not just local). +- [ ] Controls are systemic (governance/policy) rather than just operational. +- [ ] Risk appetite alignment is explicitly evaluated. +- [ ] Confidentiality of strategic data is maintained. + +## Related Skills + +- `~~health/clinical-risk-assessment` for the clinical foundation of ERM. +- `~~health/worker-risk-assessment` for workforce safety impact on operations. +- `~~finance/variance-analysis` for financial risk identification. + +## Version History + +| Version | Date | Changes | +|---|---|---| +| 1.0.0 | 2026-02-12 | Initial enterprise risk assessment skill focusing on ERM, strategic objectives, and governance | diff --git a/health/skills/worker-risk-assessment/SKILL.md b/health/skills/worker-risk-assessment/SKILL.md new file mode 100644 index 0000000..c26ffaf --- /dev/null +++ b/health/skills/worker-risk-assessment/SKILL.md @@ -0,0 +1,188 @@ +--- +name: health/worker-risk-assessment +description: This skill should be used when assessing risks to clinicians and healthcare workers, including occupational hazards, physical safety, psychological risk, and workplace violence. Use when a user mentions worker safety, occupational health and safety (WHS/OHS), workplace violence, clinician burnout, needle stick injury, exposure risk, or staff wellbeing. +version: 1.0.0 +--- + +# Worker and Clinician Risk Assessment + +Structured guidance for identifying, scoring, treating, and monitoring risks to the health, safety, and wellbeing of clinicians and healthcare workers. + +**Important**: This skill supports occupational health and safety (WHS) workflows within healthcare settings. It does not replace formal WHS advice, legal counsel, or organization-specific safety policies. All assessments must align with local work health and safety legislation and be reviewed by qualified safety professionals. + +## When to Use This Skill + +Invoke when: +- Assessing hazards in a clinical workspace (e.g., emergency department, psychiatric ward, home visiting). +- Reviewing risks associated with specific clinical tasks (e.g., manual handling, sharp management, chemotherapy preparation). +- Addressing reports of workplace violence, aggression, or psychological distress. +- Planning for new facility designs or clinical service changes affecting staff. +- Investigating staff incidents to identify systemic safety gaps. +- Evaluating clinician burnout or psychological safety within a team. + +Do not use for patient safety risks (use `~~health/clinical-risk-assessment`) or enterprise-level strategic risks (use `~~health/enterprise-risk-assessment`). + +## Operating Modes + +### Standard Mode +Full WHS risk governance workflow: +- Comprehensive hazard identification across physical, biological, chemical, and psychosocial domains. +- Formal risk scoring using the Worker Safety Matrix. +- Detailed control selection following the WHS Hierarchy of Controls. +- Documentation of consultation with affected workers. +- Integration with the organization's WHS management system. + +### Lite Mode +Rapid safety screening (e.g., dynamic risk assessment before a home visit or during an emerging crisis): +- Quick identification of immediate threats (e.g., "Look, Point, Tell" method). +- Focus on immediate "STOP/GO" decisions and essential PPE/controls. +- Mandatory escalation for any identified high-risk factor. + +Lite mode is for immediate operational safety only and must be followed by a Standard assessment for permanent risks. + +## Regulatory Context + +Default jurisdiction is Australia/New Zealand. Use US/EU-lite framing only when explicitly requested. + +| Jurisdiction | Framework/Statute | Compliance Trigger | Review Cadence | Required Artifacts | Escalation Point | +|---|---|---|---|---|---| +| Australia | Work Health and Safety (WHS) Act 2011 (and state equivalents) | Notification of incident, new equipment/process, annual review | Annual or post-incident | Risk Assessment, SWMS (High Risk Construction/Work) | WHS Manager, Health and Safety Representative (HSR) | +| New Zealand | Health and Safety at Work Act 2015 (HSWA) | Notifiable event, change in work environment | Annual or post-incident | Risk Register, Control Plan | H&S Lead, WorkSafe NZ (if notifiable) | +| United States (lite) | OSHA Standards (General Duty Clause), NIOSH guidelines | Occupational injury/illness, OSHA inspection | Annual | OSHA 300 Log, Hazard Assessment | Safety Officer, HR | +| European Union (lite) | Framework Directive 89/391/EEC, country-specific OSH laws | New hazard identified, periodic audit | Per national law | Risk Assessment Document | OSH Coordinator | + +## Quick Reference + +1. **Identify the Hazard**: Physical (trips, manual handling), Biological (needlesticks, infection), Chemical (cleaning agents, cytotoxics), Psychosocial (violence, bullying, burnout). +2. **Consult**: Engage with the workers performing the task to understand actual practice. +3. **Assess Inherent Risk**: Score consequence and likelihood without new controls. +4. **Apply Hierarchy of Controls**: Prioritize Elimination over PPE. +5. **Verify Effectiveness**: Ensure controls don't create new hazards. +6. **Monitor**: Schedule regular reviews and check incident data. + +## Risk Assessment Framework + +### Worker Consequence Scale + +| Level | Label | Safety Descriptor | Psychosocial / Health Descriptor | +|---|---|---|---| +| 1 | **Insignificant** | Near miss; no injury or very minor injury requiring no treatment | Brief stress; no lasting impact | +| 2 | **Minor** | Minor injury requiring first aid (e.g., small cut, minor bruise) | Short-term distress; manageable within normal support | +| 3 | **Moderate** | Medical treatment injury; restricted work or short-term lost time | Significant distress; temporary impairment; requires formal support | +| 4 | **Major** | Serious injury; long-term disability; significant lost time | Severe psychological injury; prolonged absence; burnout | +| 5 | **Catastrophic** | Fatality; permanent total disability | Permanent psychological disability; organizational-wide impact | + +### Worker Likelihood Scale + +| Level | Label | Frequency Descriptor | +|---|---|---| +| 1 | **Rare** | Only in exceptional circumstances; not heard of in similar settings | +| 2 | **Unlikely** | Could occur but not expected; infrequent precedent | +| 3 | **Possible** | Might occur at some time; has happened in this setting before | +| 4 | **Likely** | Will probably occur in most circumstances; regular occurrence | +| 5 | **Almost Certain** | Expected to occur in most circumstances; occurs frequently | + +## Control Selection (WHS Hierarchy) + +Apply controls in order of priority: + +1. **Elimination**: Remove the hazard (e.g., automate a heavy lift, remove a dangerous chemical). +2. **Substitution**: Replace with a safer alternative (e.g., use needle-less connectors, use non-toxic cleaning agents). +3. **Engineering**: Isolate people from the hazard (e.g., duress alarms, physical barriers in ED, sharps disposal containers). +4. **Administrative**: Change the way people work (e.g., safe work procedures, training, job rotation, debriefing protocols). +5. **PPE**: Personal Protective Equipment (e.g., masks, gloves, safety glasses). *Note: PPE is the last line of defense.* + +## Documentation Standards + +### Worker Risk Assessment Report + +``` +## Worker Safety Risk Assessment + +**Date**: [Date] +**Assessor**: [Name/Role] +**Team/Area**: [Specific clinical area or staff group] + +### 1. Hazard Description +[Detail the physical, biological, or psychosocial hazard] + +### 2. Consultation +[Summarize feedback from staff/Health and Safety Representatives] + +### 3. Risk Analysis +- **Consequence**: [1-5] - [Rationale] +- **Likelihood**: [1-5] - [Rationale] +- **Current Risk Level**: [LOW/MEDIUM/HIGH/EXTREME] + +### 4. Control Plan (Hierarchy) +- **Elimination/Substitution**: [Planned actions] +- **Engineering**: [Planned actions] +- **Administrative**: [Procedures/Training] +- **PPE**: [Required equipment] + +### 5. Residual Risk +- **Expected Level**: [Target Risk Score] + +### 6. Review Schedule +- **Next Review**: [Date] +``` + +## Security & Privacy Considerations + +- **Employee Confidentiality**: Do not include specific staff names or medical details in shared risk registers. Use roles (e.g., "Night shift RN") or de-identified incident IDs. +- **Sensitive Content**: Psychosocial risk assessments may contain sensitive information regarding workplace culture or interpersonal conflict. Access should be restricted to relevant management and HR personnel. +- **Compliance**: Ensure storage of worker health records (e.g., immunization status, injury reports) complies with the Privacy Act (AU) or Privacy Act 2020 (NZ). + +## Confidence Indicators + +| Scenario | Confidence | Action | +|---|---|---| +| Well-defined physical hazard with clear legislative controls | High | Propose standard risk assessment and control plan | +| Complex psychosocial risk with conflicting staff reports | Medium | Suggest a preliminary assessment; recommend formal culture/wellbeing survey | +| Immediate threat of violence or emerging infectious hazard | Medium | Initiate Lite Mode/Immediate safety protocol; escalate to executive immediately | +| Risk involving novel technology or specialized clinical equipment | Low | Search for manufacturer safety data; recommend specialist WHS consultation | + +## Common Mistakes (Anti-Patterns) + +| Mistake | Why It's Wrong | Instead | +|---|---|---| +| Relying solely on PPE for high-likelihood risks | PPE often fails or is used incorrectly; it doesn't remove the hazard | Use engineering or administrative controls as the primary mitigation | +| Assessing risk without talking to the staff doing the work | Desktop assessments miss the "work as imagined" vs "work as done" gap | Conduct walk-throughs and interview clinicians about their daily tasks | +| Ignoring psychosocial risks (burnout, bullying) | Psychosocial hazards cause as much harm as physical ones and are legally compensable | Include workload, support, and workplace behavior in regular assessments | +| Failing to update assessment after a "near miss" | Near misses are warnings of future incidents; the current risk score is likely wrong | Conduct a full re-assessment after every significant near-miss | +| Using generic risk assessments for specialized areas | Hazards in ICU are different from Home Care | Tailor the assessment to the specific clinical environment and task | + +## When to Escalate + +- **Immediate Danger**: Any hazard posing an immediate threat to life or limb (e.g., active violence, major chemical spill). +- **Notifiable Event**: Any incident meeting the legislative definition of "notifiable" (death, serious injury/illness). +- **Unresolved Risk**: High or Extreme risks where proposed controls are not feasible or have been rejected. +- **Legislative Breach**: Any identified non-compliance with WHS/HSWA regulations. + +## Tool Requirements + +- `~~health/clinical-systems` for de-identified incident data. +- `~~project tracker` for safety action tracking. +- `~~health/worker-wellness` (if available) for psychosocial trend analysis. +- `~~search` for latest WHS/OSHA guidelines. + +## Success Indicators + +- [ ] Hazard is clearly categorized (Physical, Biological, Chemical, Psychosocial). +- [ ] Consultation with staff/HSR is documented. +- [ ] Risk scoring uses the 5x5 Worker Safety Matrix. +- [ ] Controls follow the Hierarchy (Elimination is considered first). +- [ ] Escalation triggers for high/extreme risks are explicit. +- [ ] Privacy of individual staff members is maintained. + +## Related Skills + +- `~~health/clinical-risk-assessment` for patient-centric risks. +- `~~health/incident-reporting` for post-injury analysis. +- `~~health/enterprise-risk-assessment` for strategic safety governance. + +## Version History + +| Version | Date | Changes | +|---|---|---| +| 1.0.0 | 2026-02-12 | Initial worker risk assessment skill with WHS hierarchy and psychosocial coverage | From 6980671d67cd877c9736c824d3b21b6dce05240a Mon Sep 17 00:00:00 2001 From: "Dylan Mordaunt (Illawarra Shoalhaven LHD)" Date: Thu, 12 Feb 2026 18:43:34 +1100 Subject: [PATCH 20/57] chore(conductor): Archive track 'health-risk - Multi-domain risk' --- conductor/archive/health-risk/index.md | 18 +++++++ conductor/archive/health-risk/metadata.json | 13 +++++ conductor/archive/health-risk/plan.md | 38 ++++++++++++++ conductor/archive/health-risk/spec.md | 57 +++++++++++++++++++++ conductor/tracks.md | 6 --- 5 files changed, 126 insertions(+), 6 deletions(-) create mode 100644 conductor/archive/health-risk/index.md create mode 100644 conductor/archive/health-risk/metadata.json create mode 100644 conductor/archive/health-risk/plan.md create mode 100644 conductor/archive/health-risk/spec.md diff --git a/conductor/archive/health-risk/index.md b/conductor/archive/health-risk/index.md new file mode 100644 index 0000000..ec4d1d9 --- /dev/null +++ b/conductor/archive/health-risk/index.md @@ -0,0 +1,18 @@ +# Health Risk Track + +## Documents + +- [Specification](./spec.md) +- [Implementation Plan](./plan.md) +- [Metadata](./metadata.json) + +## Quick Links + +- [Project Index](../../index.md) +- [Tracks Registry](../../tracks.md) + +## Status + +See [metadata.json](./metadata.json) for current status and dependencies. + +Default jurisdiction profile for this track is Australia/New Zealand with US/EU-lite variants as needed. diff --git a/conductor/archive/health-risk/metadata.json b/conductor/archive/health-risk/metadata.json new file mode 100644 index 0000000..acc7394 --- /dev/null +++ b/conductor/archive/health-risk/metadata.json @@ -0,0 +1,13 @@ +{ + "track_id": "health-risk", + "name": "Health Risk Assessment", + "description": "Multi-domain risk assessment - clinical risk, clinician/worker risk, enterprise risk, clinical services plan risk, medicine standing orders risk", + "status": "planning", + "created": "2026-02-11", + "priority": "high", + "dependencies": ["health-core"], + "deliverable": "clinical-risk, worker-risk, enterprise-risk skills, /assess-risk command", + "adapts_from": ["legal/legal-risk-assessment"], + "jurisdictions": ["Australia", "New Zealand"], + "lite_variants": ["US", "EU"] +} diff --git a/conductor/archive/health-risk/plan.md b/conductor/archive/health-risk/plan.md new file mode 100644 index 0000000..a4fcf9e --- /dev/null +++ b/conductor/archive/health-risk/plan.md @@ -0,0 +1,38 @@ +# Health Risk Assessment Track Plan + +## Phase 1: Clinical Risk Skill +*Dependencies: health-core* +*Estimated: 1-2 sessions* + +- [x] Create `health/skills/clinical-risk-assessment/SKILL.md` + - Acceptance: Follows [health skill standards](../health-plugin/skill-standards.md) (14-section template) + - Acceptance: AU/NZ risk-governance defaults are explicit, with US/EU-lite fallback + - Acceptance: Standard mode and Lite mode are explicitly documented + - Acceptance: Confidence Indicators for medical risk scoring + - Acceptance: Structured risk taxonomy for clinical contexts + - Acceptance: Severity and likelihood scoring guidance + - Acceptance: Control selection and residual risk documentation + - Source patterns: `legal/legal-risk-assessment` + +## Phase 2: Worker and Enterprise Risk Skills +*Dependencies: Phase 1* +*Estimated: 1-2 sessions* + +- [x] Create `health/skills/worker-risk-assessment/SKILL.md` + - Acceptance: Workforce and occupational hazard checklist + - Acceptance: Escalation criteria and urgent action triggers + +- [x] Create `health/skills/enterprise-risk-assessment/SKILL.md` + - Acceptance: Enterprise risk categories and ownership mapping + - Acceptance: Governance review and reporting cadence + +## Phase 3: Assess Risk Command +*Dependencies: Phase 1, Phase 2* +*Estimated: 0.5-1 session* + +- [x] Create `health/commands/assess-risk.md` + - Acceptance: Intake prompts for risk domain selection + - Acceptance: Recommended controls and residual risk output + - Acceptance: Escalation and follow-up checklist + +**Checkpoint:** `conductor(checkpoint): Health risk assessment workflow complete` diff --git a/conductor/archive/health-risk/spec.md b/conductor/archive/health-risk/spec.md new file mode 100644 index 0000000..934ad10 --- /dev/null +++ b/conductor/archive/health-risk/spec.md @@ -0,0 +1,57 @@ +# Health Risk Assessment Track Specification + +## Overview + +Multi-domain risk assessment workflows for clinical risk, clinician and worker risk, enterprise risk, clinical services plan risk, and medicine standing orders risk. + +## Scope + +### Clinical Risk +- Patient safety event risk framing +- Severity and likelihood estimation +- Control selection and residual risk scoring + +### Clinician and Worker Risk +- Workforce safety and occupational exposure risk +- Escalation criteria and immediate controls +- Documentation requirements + +### Enterprise Risk +- Strategic and operational risk categorization +- Governance and accountability mapping +- Monitoring and review cadence + +### Clinical Services Plan and Standing Orders Risk +- Service design risk checkpoints +- Standing orders risk controls and review triggers +- Regulatory and policy alignment checks + +## Jurisdiction Defaults + +- Default framing: Australia and New Zealand. +- Include US/EU-lite variant notes for portability when requested. + +## Deliverables + +### Skills +- `clinical-risk-assessment` - Clinical safety risk workflow +- `worker-risk-assessment` - Clinician and worker risk workflow +- `enterprise-risk-assessment` - Enterprise and governance risk workflow + +### Commands +- `/assess-risk` - Structured risk assessment intake and recommendation flow + +## Dependencies + +- `health-core` (plugin structure) + +## Adapts From + +- `legal/legal-risk-assessment` - Risk taxonomy and control logic + +## Success Criteria + +- [ ] Supports consistent risk scoring across domains +- [ ] Captures controls and residual risk transparently +- [ ] Provides clear escalation and review triggers +- [ ] Produces auditable outputs for governance review diff --git a/conductor/tracks.md b/conductor/tracks.md index 318044c..d748e9c 100644 --- a/conductor/tracks.md +++ b/conductor/tracks.md @@ -46,12 +46,6 @@ PHASE 4: Research/Academic (parallel, depends Phase 3) │ ### Track Registry (Canonical) -## [x] Track: health-risk - Multi-domain risk -Folder: [./tracks/health-risk/](./tracks/health-risk/) -Phase: 2 -Adapts From: legal/legal-risk-assessment - ---- ## [ ] Track: health-information - ROI, consent, records Folder: [./tracks/health-information/](./tracks/health-information/) Phase: 2 From 4fcb54f8b6e40c94ea240f70f76947f9b848755e Mon Sep 17 00:00:00 2001 From: "Dylan Mordaunt (Illawarra Shoalhaven LHD)" Date: Thu, 12 Feb 2026 18:47:42 +1100 Subject: [PATCH 21/57] chore(conductor): Mark track 'health-information - ROI, consent, records' as complete --- conductor/tracks.md | 2 +- conductor/tracks/health-information/plan.md | 6 +- health/commands/process-roi.md | 79 +++++++++ health/skills/consent-management/SKILL.md | 159 ++++++++++++++++++ health/skills/release-of-information/SKILL.md | 157 +++++++++++++++++ 5 files changed, 399 insertions(+), 4 deletions(-) create mode 100644 health/commands/process-roi.md create mode 100644 health/skills/consent-management/SKILL.md create mode 100644 health/skills/release-of-information/SKILL.md diff --git a/conductor/tracks.md b/conductor/tracks.md index d748e9c..a36879e 100644 --- a/conductor/tracks.md +++ b/conductor/tracks.md @@ -46,7 +46,7 @@ PHASE 4: Research/Academic (parallel, depends Phase 3) │ ### Track Registry (Canonical) -## [ ] Track: health-information - ROI, consent, records +## [x] Track: health-information - ROI, consent, records Folder: [./tracks/health-information/](./tracks/health-information/) Phase: 2 Adapts From: legal/compliance diff --git a/conductor/tracks/health-information/plan.md b/conductor/tracks/health-information/plan.md index e6d1fe5..d783fb2 100644 --- a/conductor/tracks/health-information/plan.md +++ b/conductor/tracks/health-information/plan.md @@ -4,7 +4,7 @@ *Dependencies: health-core* *Estimated: 1-2 sessions* -- [ ] Create `health/skills/release-of-information/SKILL.md` +- [x] Create `health/skills/release-of-information/SKILL.md` - Acceptance: Follows [health skill standards](../health-plugin/skill-standards.md) (14-section template) - Acceptance: AU/NZ default jurisdiction matrix plus US/EU-lite variant guidance - Acceptance: Standard mode and Lite mode are explicitly documented @@ -19,7 +19,7 @@ *Dependencies: Phase 1* *Estimated: 1 session* -- [ ] Create `health/skills/consent-management/SKILL.md` +- [x] Create `health/skills/consent-management/SKILL.md` - Acceptance: Consent type taxonomy - Acceptance: Documentation requirements - Acceptance: Capacity assessment guidance @@ -28,7 +28,7 @@ *Dependencies: Phase 1* *Estimated: 0.5 sessions* -- [ ] Create `health/commands/process-roi.md` +- [x] Create `health/commands/process-roi.md` - Acceptance: ROI request intake - Acceptance: Validation workflow - Acceptance: Processing checklist diff --git a/health/commands/process-roi.md b/health/commands/process-roi.md new file mode 100644 index 0000000..61d64b9 --- /dev/null +++ b/health/commands/process-roi.md @@ -0,0 +1,79 @@ +--- +name: process-roi +description: Intake and validate a healthcare Release of Information (ROI) request with authorization checks and "Minimum Necessary" guidance. +arguments: + - name: request_type + description: "Type of request (e.g., patient, legal, insurance, referral, research)." + required: true + - name: data_scope + description: "Description of the information requested (e.g., 'All bloods Jan 2026', 'Full chart')." + required: true + - name: authorization_status + description: "Has a signed authorization been received? (yes/no/pending)" + required: true + - name: summary + description: "Short description of the purpose of the request. Do not include PHI." + required: true + - name: jurisdiction + description: "Optional: au, nz, us, or eu. Defaults to au-nz if omitted." + required: false +--- + +# Process ROI + +Use this command for rapid ROI intake, authorization validation, and processing kickoff. + +## 1. Validate Intake and Authorization + +- Check `authorization_status`. If `no` or `pending`, flag as "Blocked" until documentation is received. +- Validate `request_type` against jurisdiction-specific rules (e.g., patient access vs. third-party). + +## 2. Invoke Skill + +Use `~~health/release-of-information` to: +1. Execute the **Authorization Validation Checklist**. +2. Perform a **"Minimum Necessary" Analysis** for the `data_scope`. +3. Screen for "Sensitive Content" or "Legal Hold" triggers. +4. Determine the processing timeline based on `jurisdiction`. + +## 3. Generate Structured Output + +Produce: + +### ROI REQUEST INTAKE +- **Request ID**: [Generate unique ID] +- **Timestamp**: {{current_timestamp}} +- **Request Type**: {{request_type}} +- **Data Scope**: {{data_scope}} +- **Jurisdiction**: {{jurisdiction or "AU/NZ default"}} + +### VALIDATION STATUS +- **Authorization Verified**: [Yes/No/Partial] +- **Identity Confirmed**: [Yes/No/Pending] +- **Authority Type**: [Patient / Proxy / Legal Order] +- **Deficiencies**: [List any missing requirements] + +### PROCESSING GUIDANCE +- **Minimum Necessary Data Set**: [List specific records to be released] +- **Redaction Required**: [Yes/No] - [List targets: 3rd party names, sensitive codes] +- **Legal/Sensitive Flag**: [Clean / Sensitive Content / Legal Hold] + +### NEXT STEPS +- **HIM Action**: [Wait for Auth / Pull Records / Redact / Release] +- **Timeline**: + - Acknowledgment Due: [Timestamp + 5 days] + - Decision Due: [Timestamp + local SLA] + - Fulfillment Target: [Timestamp + local SLA] + +## 4. Execute Routing + +- Log ROI package in `~~project tracker`. +- For `Sensitive Content` or `Legal Hold` flags: + - Notify HIM Manager immediately. + - Notify Privacy/Legal as required. +- If `Authorization Verified` is `No`, send "Missing Information" request to the requester. + +## 5. Output Guardrails + +- **No PHI**: Never include patient names or identifiers in the output summary. +- **Provisional Result**: If `data_scope` is "Full Chart", force an HIM review to apply Minimum Necessary before fulfillment. diff --git a/health/skills/consent-management/SKILL.md b/health/skills/consent-management/SKILL.md new file mode 100644 index 0000000..fbce26e --- /dev/null +++ b/health/skills/consent-management/SKILL.md @@ -0,0 +1,159 @@ +--- +name: health/consent-management +description: This skill should be used when managing patient consent for treatment, research, or information sharing. Use when a user mentions informed consent, consent forms, treatment authorization, advance directives, capacity assessment, proxy decision makers, or withdrawing consent. +version: 1.0.0 +--- + +# Consent Management + +Structured guidance for managing informed consent workflows, validating documentation, and ensuring compliance with clinical and ethical standards for patient autonomy. + +**Important**: This skill supports clinical and administrative workflows for obtaining and documenting consent. It does not replace the face-to-face informed consent discussion between a clinician and patient. All consent processes must align with local health statutes and organizational policies. + +## When to Use This Skill + +Invoke when: +- Identifying the correct consent type for a specific clinical procedure or initiative. +- Validating that a consent form is complete and legally sufficient. +- Documenting a patient's withdrawal of consent or change in preferences. +- Identifying requirements for surrogate or proxy decision-makers (e.g., Power of Attorney). +- Reviewing documentation requirements for patients with impaired decision-making capacity. +- Aligning advance directives or living wills with current treatment plans. +- Managing consent for participation in clinical trials or research studies. + +Do not use for Release of Information (ROI) processing (use `~~health/release-of-information`) unless specific authorization validation is required as part of the consent check. + +## Operating Modes + +### Standard Mode +Full consent governance workflow: +- Formal identification of consent type and requirements. +- Detailed validation of documentation and capacity assessment records. +- Verification of proxy/surrogate authority. +- Integration with clinical records and procedure scheduling. +- Compliance check against jurisdiction-specific consent laws. + +### Lite Mode +Rapid consent screening (e.g., during emergency intake or high-volume clinics): +- Quick check for presence of signed consent and ID verification. +- Identification of immediate missing fields. +- Flagging for urgent clinician review if capacity or proxy issues are detected. + +Lite mode is for initial screening only and does not replace the full clinical validation required before a procedure begins. + +## Regulatory Context + +Default jurisdiction is Australia/New Zealand. Use US/EU-lite framing only when explicitly requested. + +| Jurisdiction | Framework/Statute | Consent Requirement | Required Documentation | Capacity Assessment Trigger | Escalation Point | +|---|---|---|---|---|---| +| Australia | State-based Guardianship Acts, NHMRC National Statement (Research) | Informed consent for all procedures; explicit for high-risk | Signed form, witness (if required), notation in records | Evidence of impaired decision-making | Clinical Lead, Ethics Committee | +| New Zealand | HDC Code of Health and Disability Services Consumers' Rights | Right 7: Right to make an informed choice and give informed consent | Written consent for significant procedures | Reasonable grounds to doubt capacity | Quality Lead, Clinical Governance | +| United States (lite) | State statutes, Joint Commission standards | Patient Self-Determination Act (PSDA) | Consent form, Advance Directive (if present) | Change in mental status | Risk Management, Ethics Consult | +| European Union (lite) | GDPR (for data), national health laws (for clinical) | Informed, explicit, and freely given | Documented consent record | Per national implementation | DPO (for data), Clinical Lead | + +## Quick Reference + +1. **Identify Consent Type**: Treatment, Surgical/Invasive, Research, Data Sharing, or Advance Directive. +2. **Verify Capacity**: Has the clinician documented that the patient understands the risks, benefits, and alternatives? +3. **Identify Decision-Maker**: The patient, or a legally authorized representative (Proxy/Guardian/Attorney)? +4. **Validate Document**: Check for signature, date, specific procedure name, and risks discussed. +5. **Check for Withdrawal**: Is there any record of the patient revoking this consent? +6. **Final Verification**: Ensure the consent matches the planned clinical action exactly. + +## Consent Taxonomy + +### 1. Clinical & Treatment Consent + +| Type | Description | Documentation Requirement | +|---|---|---| +| **Implied** | Minor, routine procedures (e.g., blood pressure check) | Notation of cooperation in clinical notes | +| **Verbal** | Non-invasive, low-risk procedures (e.g., standard physical exam) | Explicit note: "Patient gave verbal consent after discussion" | +| **Written (Standard)** | Invasive procedures, high-risk medications, sedation | Formal signed consent form detailing specific risks | +| **Written (Specialized)** | Clinical trials, research, organ donation | Specialized IRB-approved forms with extensive disclosure | + +### 2. Decision-Making Authority + +| Role | Description | Authority Verification | +|---|---|---| +| **Patient** | Competent adult or mature minor | ID verification | +| **Legal Guardian** | Appointed by court/tribunal | Official Guardianship Order | +| **Enduring Power of Attorney** | Appointed by patient while competent | Signed and witnessed EPOA document | +| **Statutory Surrogate** | Next of kin (per local legislative hierarchy) | Proof of relationship and unavailability of primary | + +## Capacity Assessment Guidance + +Capacity is task-specific and can fluctuate. Documentation must show: +- [ ] **Understanding**: Patient can explain the procedure and the problem. +- [ ] **Retention**: Patient can hold the information long enough to make a decision. +- [ ] **Reasoning**: Patient can weigh the risks vs. benefits. +- [ ] **Communication**: Patient can clearly state their choice. + +## Documentation Standards + +### Consent Validation Checklist + +- [ ] **Specific**: Name of procedure/initiative is written in plain language. +- [ ] **Informed**: Risks, benefits, and alternatives (including doing nothing) are listed. +- [ ] **Voluntary**: No evidence of coercion or undue influence. +- [ ] **Current**: Signed within the required timeframe (e.g., within 6 months). +- [ ] **Signatures**: Patient/Proxy and the Clinician performing the procedure. + +## Security & Privacy (PHI/PII Guardrails) + +- **Confidentiality of Choice**: A patient's refusal of treatment or advance directive is highly sensitive. Access should be restricted to the direct care team. +- **Minimum Necessary**: When validating consent for research or data sharing, ensure only the authorized data sets are discussed. +- **De-identification**: Use `[Patient Consent A]` when discussing scenarios in the agent. Never include names or MRNs in persistent logs. + +## Confidence Indicators + +| Scenario | Confidence | Action | +|---|---|---| +| Standard surgical consent signed by patient and performing surgeon | High | Confirm validation and proceed with documentation | +| Consent signed by a proxy without a verified POA document on file | Medium | Flag as "Authority Pending"; request POA documentation | +| Patient with documented dementia or delirium signing their own consent | Low | Escalate to Clinical Lead; require capacity assessment review | +| Conflict between an Advance Directive and family wishes | Low | Escalate to Clinical Governance/Ethics Committee immediately | + +## Common Mistakes (Anti-Patterns) + +| Mistake | Why It's Wrong | Instead | +|---|---|---| +| Treating consent as a "signed piece of paper" only | Consent is a process of communication, not just a document | Verify that the discussion of risks and benefits is documented | +| Accepting "blanket" consents for future unknown procedures | Legally invalid; consent must be specific to the intervention | Ensure each procedure has its own specific consent or is explicitly listed | +| Failing to verify the identity of a phone-in proxy | High risk of unauthorized decision-making and legal liability | Follow strict ID verification protocols for all non-present decision makers | +| Using jargon or acronyms in the procedure description | Patient cannot give informed consent if they don't understand the term | Use plain language descriptions (e.g., "Gallbladder removal" instead of "Cholecystectomy") | +| Ignoring a patient's verbal "No" if they already signed the form | A patient can withdraw consent at any time, even on the theatre table | Stop immediately and re-verify consent if any doubt arises | + +## When to Escalate + +- **Conflict**: Any disagreement between patient, family, and clinicians regarding treatment. +- **Impairment**: Unclear decision-making capacity without a designated proxy. +- **Legal/Ethics**: Requests for treatment withdrawal in life-sustaining situations. +- **Minors**: Consent issues involving "Mature Minor" status or conflicting parental wishes. + +## Tool Requirements + +- `~~health/clinical-records` (EHR) for consent forms and clinical notes. +- `~~health/id-verification` for confirming patient/proxy identity. +- `~~legal/guardianship-registry` (where available) for verifying legal orders. + +## Success Indicators + +- [ ] Consent type correctly identified. +- [ ] Documentation completeness and validity verified. +- [ ] Decision-making authority (Patient vs. Proxy) confirmed. +- [ ] Capacity assessment presence checked (if applicable). +- [ ] "Informed" criteria (Risks/Benefits/Alternatives) validated. +- [ ] Privacy of sensitive choices maintained. + +## Related Skills + +- `~~health/release-of-information` for disclosures requiring specific consent. +- `~~health/clinical-risk-assessment` for the risks discussed during consent. +- `~~health/ethics-review` for research or complex clinical ethics cases. + +## Version History + +| Version | Date | Changes | +|---|---|---| +| 1.0.0 | 2026-02-12 | Initial consent management skill with taxonomy and capacity guidance | diff --git a/health/skills/release-of-information/SKILL.md b/health/skills/release-of-information/SKILL.md new file mode 100644 index 0000000..8414092 --- /dev/null +++ b/health/skills/release-of-information/SKILL.md @@ -0,0 +1,157 @@ +--- +name: health/release-of-information +description: This skill should be used when processing requests for the release of patient health information (ROI). Use when a user mentions ROI requests, medical record requests, information disclosure, authorization validation, minimum necessary standard, or patient access rights. +version: 1.0.0 +--- + +# Release of Information (ROI) + +Structured guidance for processing requests to release patient health information, ensuring legal compliance, authorization validation, and adherence to the "Minimum Necessary" principle. + +**Important**: This skill supports healthcare information management (HIM) workflows. It does not replace legal advice or organization-specific privacy policies. All disclosures must comply with relevant jurisdiction-specific health privacy laws (e.g., Privacy Act in AU/NZ, HIPAA in US). + +## When to Use This Skill + +Invoke when: +- A patient or their authorized representative requests access to medical records. +- A third party (e.g., lawyer, insurer, government agency) submits a request for health information. +- Validating the sufficiency of a signed authorization or consent for disclosure. +- Determining the specific data elements to be released under the "Minimum Necessary" standard. +- Documenting an accounting of disclosures for a patient record. +- Responding to subpoenas or court orders for medical records. + +Do not use for internal clinical use of records (covered by treatment relationship) or for managing clinical consent for procedures (use `~~health/consent-management`). + +## Operating Modes + +### Standard Mode +Full ROI governance workflow: +- Formal validation of the request and authorization. +- Comprehensive "Minimum Necessary" analysis. +- Detailed accounting of disclosure documentation. +- Compliance check against jurisdiction-specific timelines and requirements. +- Final quality review before release. + +### Lite Mode +Use for rapid screening or preliminary request intake: +- Quick checklist for request completeness. +- Identification of immediate missing requirements (e.g., missing signature). +- High-level categorization of request type. + +Lite mode is for initial triage only and must be followed by a Standard assessment before any information is actually released. + +## Regulatory Context + +Default jurisdiction is Australia/New Zealand. Use US/EU-lite framing only when explicitly requested. + +| Jurisdiction | Framework/Statute | Disclosure Trigger | Processing Timeline | Required Artifacts | Escalation Point | +|---|---|---|---|---|---| +| Australia | Privacy Act 1988 (Cth), APP 12, State Health Records Acts | Written request, valid authorization, legal order | 30 days (typical) | Validated request, Disclosure log, Receipt | Privacy Officer, HIM Manager | +| New Zealand | Health Information Privacy Code 2020 | Written request, proof of identity, legal order | 20 working days | Request record, Decision letter, Disclosure log | Privacy Officer, HIM Manager | +| United States (lite) | HIPAA Privacy Rule (45 CFR 164.524) | Written request, valid authorization | 30 days (plus 30-day extension) | HIPAA-compliant authorization, Disclosure log | Privacy Officer, Compliance Office | +| European Union (lite) | GDPR Article 15 (Right of Access) | Subject Access Request (SAR) | 1 month | Identity verification, Disclosure record | Data Protection Officer (DPO) | + +## Quick Reference + +1. **Verify Request Integrity**: Is it in writing? Is identity confirmed? Is the scope clear? +2. **Validate Authorization**: Is it signed by the patient or legal representative? Is it current? Does it cover the requested scope? +3. **Apply Minimum Necessary**: Identify only the specific data points required to satisfy the request. +4. **Redact Non-Disclosable Data**: Remove third-party info, sensitive notes (if legally permitted), and out-of-scope data. +5. **Final Review**: Confirm the package matches the authorization exactly. +6. **Document Disclosure**: Record who, what, when, where, and why in the accounting of disclosures. + +## ROI Processing Framework + +### 1. Authorization Validation Checklist + +Before processing, every request must pass these gates: +- [ ] **Identity Proof**: Copy of ID or signature match on file. +- [ ] **Authority**: If not the patient, is there a valid Power of Attorney (POA) or Guardianship order? +- [ ] **Date**: Is the authorization signed within the last 12 months (or local requirement)? +- [ ] **Scope**: Does the authorization explicitly name the data types (e.g., "Radiology reports only")? +- [ ] **Recipient**: Is the person/entity receiving the info clearly identified? +- [ ] **Purpose**: Is the reason for disclosure stated? + +### 2. "Minimum Necessary" Analysis + +For every disclosure, identify the smallest data set that fulfills the request: + +| Request Type | Typical Minimum Necessary | Over-Disclosure Risk (Avoid) | +|---|---|---| +| Specialist Referral | Recent relevant notes, results, current meds, allergies | Entire historical record | +| Insurance Claim | Specific date range or incident-related records | Unrelated psychiatric or sexual health history | +| Legal Subpoena | Items explicitly listed in the schedule | Records outside the specified date range | +| Patient Personal Access | Full record (subject to legal exclusions) | N/A (unless harm likely) | + +## Documentation Standards + +### Accounting of Disclosures Entry + +| Field | Requirement | +|---|---| +| Date of Disclosure | Exact date information was sent | +| Recipient Name/Address | Specific entity and person receiving information | +| Description of Info | Detailed list (e.g., "ED Summary 12/01/26, Bloods 14/01/26") | +| Basis for Disclosure | (e.g., "Patient Auth #123", "Subpoena #XYZ") | +| Disclosing Officer | Name/Role of person who processed the ROI | + +## Security & Privacy (PHI/PII Guardrails) + +- **Strict Minimum Necessary**: Always default to the narrowest interpretation of the request unless authorized otherwise. +- **Redaction Protocol**: Ensure third-party information (e.g., names of family members mentioned in notes) is redacted unless they are part of the clinical record. +- **De-identification for Triage**: When discussing requests in the agent, never include the patient's name, DOB, or MRN. Use `[Patient Request A]`. +- **Secure Delivery**: Guidance must assume information is delivered via encrypted channels or secure portal, never via unencrypted email. + +## Confidence Indicators + +| Scenario | Confidence | Action | +|---|---|---| +| Standard request with clear, valid patient authorization | High | Propose processing steps and document package content | +| Third-party request with questionable or expired authorization | Medium | Flag as "Authorization Deficient" and request updated documentation | +| Legal subpoena with broad schedule or conflicting dates | Medium | Propose draft response; request HIM Manager review | +| Request involves "Sensitive Information" (HIV, psych, DV) without specific auth | Low | Escalate to Privacy Officer immediately; do not process | +| Ambiguous relationship (e.g., separated parent requesting child records) | Low | Escalate to HIM Manager or Legal; verify custody/access rights | + +## Common Mistakes (Anti-Patterns) + +| Mistake | Why It's Wrong | Instead | +|---|---|---| +| Releasing the "Whole Chart" by default | Violates Minimum Necessary principle and jurisdiction-specific privacy laws | Select only the specific records required for the purpose | +| Accepting digital signatures without verification | Increases risk of fraudulent requests and data breach | Verify against local policy (e.g., e-signature platform cert or phone verification) | +| Failing to document the disclosure in the log | Makes it impossible to audit what was sent or respond to patient accounting requests | Log every external disclosure immediately upon completion | +| Including third-party information in the release | Violates the privacy of individuals other than the patient | Redact any information that identifies non-clinical third parties | +| Missing legal hold flags | Releasing records that are under legal hold may interfere with litigation | Check the Legal Hold status in the HIM system before every ROI | + +## When to Escalate + +- **Red (Extreme)**: Request for records involving high-profile individuals, staff members, or active litigation against the organization. +- **Sensitive Content**: Records involving domestic violence, child protection, or highly sensitive psychiatric history where release may cause harm. +- **Legal Conflict**: Subpoenas that conflict with patient privacy rights or organizational policy. +- **Bulk Requests**: Unusually large requests or "fishing expeditions" from third parties. + +## Tool Requirements + +- `~~health/him-system` (e.g., Epic ROI, Cerner HIM) for record retrieval and logging. +- `~~project tracker` (Jira/ServiceNow) for request tracking and status. +- `~~health/id-verification` for verifying patient/representative identity. + +## Success Indicators + +- [ ] Request integrity and identity are verified. +- [ ] Authorization scope and validity are confirmed. +- [ ] Minimum Necessary analysis is documented. +- [ ] Jurisdiction-specific timelines are identified. +- [ ] Accounting of disclosure entry is prepared. +- [ ] Redaction requirements are flagged. + +## Related Skills + +- `~~health/consent-management` for managing the underlying consents. +- `~~health/incident-reporting` for reporting ROI-related privacy breaches. +- `~~legal/compliance` for broader privacy regulation mapping. + +## Version History + +| Version | Date | Changes | +|---|---|---| +| 1.0.0 | 2026-02-12 | Initial ROI skill with authorization validation and Minimum Necessary framework | From 766dae515058c1bf35aa4c9c2d2d42acd38b463c Mon Sep 17 00:00:00 2001 From: "Dylan Mordaunt (Illawarra Shoalhaven LHD)" Date: Thu, 12 Feb 2026 18:49:05 +1100 Subject: [PATCH 22/57] chore(conductor): Archive track 'health-information - ROI, consent, records' --- conductor/archive/health-information/index.md | 16 ++++++ .../archive/health-information/metadata.json | 11 ++++ conductor/archive/health-information/plan.md | 36 ++++++++++++ conductor/archive/health-information/spec.md | 55 +++++++++++++++++++ conductor/tracks.md | 6 -- 5 files changed, 118 insertions(+), 6 deletions(-) create mode 100644 conductor/archive/health-information/index.md create mode 100644 conductor/archive/health-information/metadata.json create mode 100644 conductor/archive/health-information/plan.md create mode 100644 conductor/archive/health-information/spec.md diff --git a/conductor/archive/health-information/index.md b/conductor/archive/health-information/index.md new file mode 100644 index 0000000..79dcb14 --- /dev/null +++ b/conductor/archive/health-information/index.md @@ -0,0 +1,16 @@ +# Health-information Track + +## Documents + +- [Specification](./spec.md) +- [Implementation Plan](./plan.md) +- [Metadata](./metadata.json) + +## Quick Links + +- [Project Index](../../index.md) +- [Tracks Registry](../../tracks.md) + +## Status + +See [metadata.json](./metadata.json) for current status and dependencies. diff --git a/conductor/archive/health-information/metadata.json b/conductor/archive/health-information/metadata.json new file mode 100644 index 0000000..d8d8a73 --- /dev/null +++ b/conductor/archive/health-information/metadata.json @@ -0,0 +1,11 @@ +{ + "track_id": "health-information", + "name": "Health Information Management", + "description": "Release of information (ROI), consent management, medical records retention, privacy", + "status": "planning", + "created": "2026-02-11", + "priority": "medium", + "dependencies": ["health-core"], + "deliverable": "release-of-information, consent-management skills, /process-roi command", + "adapts_from": ["legal/compliance", "customer-support/response-drafting"] +} diff --git a/conductor/archive/health-information/plan.md b/conductor/archive/health-information/plan.md new file mode 100644 index 0000000..d783fb2 --- /dev/null +++ b/conductor/archive/health-information/plan.md @@ -0,0 +1,36 @@ +# Health Information Management Track Plan + +## Phase 1: Release of Information Skill +*Dependencies: health-core* +*Estimated: 1-2 sessions* + +- [x] Create `health/skills/release-of-information/SKILL.md` + - Acceptance: Follows [health skill standards](../health-plugin/skill-standards.md) (14-section template) + - Acceptance: AU/NZ default jurisdiction matrix plus US/EU-lite variant guidance + - Acceptance: Standard mode and Lite mode are explicitly documented + - Acceptance: PHI/PII guardrails (Minimum Necessary Principle) + - Acceptance: Authorization validation checklist + - Acceptance: Request types and processing timelines + - Acceptance: Minimum necessary guidance + - Acceptance: Accounting of disclosures requirements + - Source patterns: `legal/compliance`, `customer-support/response-drafting` + +## Phase 2: Consent Management Skill +*Dependencies: Phase 1* +*Estimated: 1 session* + +- [x] Create `health/skills/consent-management/SKILL.md` + - Acceptance: Consent type taxonomy + - Acceptance: Documentation requirements + - Acceptance: Capacity assessment guidance + +## Phase 3: Process ROI Command +*Dependencies: Phase 1* +*Estimated: 0.5 sessions* + +- [x] Create `health/commands/process-roi.md` + - Acceptance: ROI request intake + - Acceptance: Validation workflow + - Acceptance: Processing checklist + +**Checkpoint:** `conductor(checkpoint): Health information management workflow complete` diff --git a/conductor/archive/health-information/spec.md b/conductor/archive/health-information/spec.md new file mode 100644 index 0000000..1272e48 --- /dev/null +++ b/conductor/archive/health-information/spec.md @@ -0,0 +1,55 @@ +# Health Information Management Track Specification + +## Overview + +Release of information (ROI), consent management, medical records retention, and privacy compliance. + +## Scope + +### Release of Information (ROI) +- Authorization validation +- Request processing workflow +- Minimum necessary standard +- Accounting of disclosures + +### Consent Management +- Treatment consent +- Research consent +- Advance directives +- Proxy/representative documentation + +### Records Management +- Retention schedules +- Destruction protocols +- Legal hold management +- Format requirements + +### Privacy +- Breach assessment +- Patient rights requests +- Notice of privacy practices + +## Deliverables + +### Skills +- `release-of-information` - ROI processing workflow +- `consent-management` - Consent types and documentation + +### Commands +- `/process-roi` - Process release of information request + +## Dependencies + +- `health-core` (plugin structure) + +## Adapts From + +- `legal/compliance` - Privacy regulations +- `customer-support/response-drafting` - Patient communications + +## Success Criteria + +- [ ] Validates authorization requirements +- [ ] Guides ROI processing with minimum necessary +- [ ] Tracks consent documentation +- [ ] Applies retention schedules correctly diff --git a/conductor/tracks.md b/conductor/tracks.md index a36879e..1e6f44c 100644 --- a/conductor/tracks.md +++ b/conductor/tracks.md @@ -46,12 +46,6 @@ PHASE 4: Research/Academic (parallel, depends Phase 3) │ ### Track Registry (Canonical) -## [x] Track: health-information - ROI, consent, records -Folder: [./tracks/health-information/](./tracks/health-information/) -Phase: 2 -Adapts From: legal/compliance - ---- ## [ ] Track: health-coding - Clinical coding Folder: [./tracks/health-coding/](./tracks/health-coding/) Phase: 2 From 3c5914ccb8245c953e61220fb6a16a6cd7359291 Mon Sep 17 00:00:00 2001 From: "Dylan Mordaunt (Illawarra Shoalhaven LHD)" Date: Thu, 12 Feb 2026 18:52:58 +1100 Subject: [PATCH 23/57] chore(conductor): Mark track 'health-coding - Clinical coding' as complete --- conductor/tracks.md | 2 +- conductor/tracks/health-coding/plan.md | 4 +- health/commands/validate-coding.md | 70 ++++++++++++ health/skills/clinical-coding/SKILL.md | 152 +++++++++++++++++++++++++ 4 files changed, 225 insertions(+), 3 deletions(-) create mode 100644 health/commands/validate-coding.md create mode 100644 health/skills/clinical-coding/SKILL.md diff --git a/conductor/tracks.md b/conductor/tracks.md index 1e6f44c..fbc0625 100644 --- a/conductor/tracks.md +++ b/conductor/tracks.md @@ -46,7 +46,7 @@ PHASE 4: Research/Academic (parallel, depends Phase 3) │ ### Track Registry (Canonical) -## [ ] Track: health-coding - Clinical coding +## [x] Track: health-coding - Clinical coding Folder: [./tracks/health-coding/](./tracks/health-coding/) Phase: 2 Adapts From: data/data-validation diff --git a/conductor/tracks/health-coding/plan.md b/conductor/tracks/health-coding/plan.md index e5d2635..33eb95d 100644 --- a/conductor/tracks/health-coding/plan.md +++ b/conductor/tracks/health-coding/plan.md @@ -4,7 +4,7 @@ *Dependencies: health-core* *Estimated: 1-2 sessions* -- [ ] Create `health/skills/clinical-coding/SKILL.md` +- [x] Create `health/skills/clinical-coding/SKILL.md` - Acceptance: Follows [health skill standards](../health-plugin/skill-standards.md) (14-section template) - Acceptance: AU/NZ coding and compliance defaults are explicit, with US/EU-lite mapping notes - Acceptance: Standard mode and Lite mode are explicitly documented @@ -23,7 +23,7 @@ *Dependencies: Phase 1* *Estimated: 0.5 sessions* -- [ ] Create `health/commands/validate-coding.md` +- [x] Create `health/commands/validate-coding.md` - Acceptance: Code validation workflow - Acceptance: Generates validation report diff --git a/health/commands/validate-coding.md b/health/commands/validate-coding.md new file mode 100644 index 0000000..64a6832 --- /dev/null +++ b/health/commands/validate-coding.md @@ -0,0 +1,70 @@ +--- +name: validate-coding +description: Validate clinical coding accuracy and classification mapping against documentation summary. +arguments: + - name: diagnosis_codes + description: "Comma-separated list of ICD-10/ICD-11 diagnosis codes to validate." + required: true + - name: procedure_codes + description: "Optional: Comma-separated list of ACHI/CPT procedure codes." + required: false + - name: summary + description: "Clinical summary or documentation fragment to validate codes against. Do not include PHI." + required: true + - name: classification_system + description: "The classification system used (e.g., ICD-10-AM, ICD-11, ICD-10-CM)." + required: true +--- + +# Validate Coding + +Use this command to verify that the selected clinical codes accurately reflect the provided documentation summary and comply with classification standards. + +## 1. Skill Activation + +Activate `~~health/clinical-coding` to perform the validation. + +## 2. Validation Workflow + +1. **Code Lookup**: Verify each code exists in the specified `classification_system`. +2. **Documentation Alignment**: Check if the `summary` supports the principal and additional diagnoses. +3. **Standard Compliance**: Apply relevant coding standards (e.g., ACS) to the code combination. +4. **Inconsistency Identification**: Highlight any codes not supported by the summary or missing diagnoses/procedures. +5. **Mapping Check**: If applicable, verify mapping between systems (e.g., SNOMED to ICD-10). + +## 3. Generate Structured Output + +Produce: + +### CODING VALIDATION REPORT +- **Reference ID**: [Generate unique ID] +- **Timestamp**: {{current_timestamp}} +- **Classification System**: {{classification_system}} + +### CODE SUMMARY +- **Principal Diagnosis**: [Code] - [Description] (VALID / INVALID / PARTIAL) +- **Additional Diagnoses**: + - [Code] - [Description] (VALID / INVALID) +- **Procedures**: + - [Code] - [Description] (VALID / INVALID) + +### VALIDATION FINDINGS +- **Strengths**: [What was coded correctly] +- **Inconsistencies**: [List specific mismatches between codes and summary] +- **Potential Omissions**: [Diagnoses/procedures mentioned in summary but not coded] +- **Specificity Alerts**: [Suggestions for more specific codes based on summary] + +### RECOMMENDATIONS +- **Suggested Changes**: [List specific code additions, removals, or changes] +- **Clinician Query Needed**: [Yes/No] - [Draft query if yes] +- **Standard Reference**: [Reference specific ACS or WHO standards applied] + +## 4. Execute Routing + +- Log validation result in `~~project tracker` if part of a quality audit. +- If **INVALID** or **OMISSION** detected, flag for review by a certified Clinical Coder. + +## 5. Output Guardrails + +- **No PHI**: Ensure the clinical summary used for validation is de-identified. +- **Assistance Only**: Clearly state that this validation is an AI-assisted check and requires human verification for final submission. diff --git a/health/skills/clinical-coding/SKILL.md b/health/skills/clinical-coding/SKILL.md new file mode 100644 index 0000000..1f2e011 --- /dev/null +++ b/health/skills/clinical-coding/SKILL.md @@ -0,0 +1,152 @@ +--- +name: health/clinical-coding +description: This skill should be used when classifying clinical documentation into standardized codes (ICD-10-AM, ICD-11, SNOMED-CT) or validating existing coding for research, billing, or population health. Use when a user mentions coding clinical notes, DRG assignment, ICD lookup, terminology mapping, or ACHI procedures. +version: 1.0.0 +--- + +# Clinical Coding and Classification + +Guidance for the accurate translation of clinical documentation into standardized codes for clinical governance, research, financial management, and population health reporting. + +**Important**: This skill assists with clinical coding workflows but does not provide clinical advice or definitive coding for financial reimbursement without review by a certified Clinical Coder. All coding must be validated against current official classification standards and clinical documentation. + +## When to Use This Skill + +Invoke when: +- Classifying clinical diagnoses and procedures using ICD-10-AM, ICD-11, or ACHI. +- Mapping clinical terms to SNOMED-CT for electronic health records (EHR) interoperability. +- Validating the accuracy of coded research datasets. +- Reviewing clinical documentation for coding specificity (e.g., identifying missing acuity or complications). +- Analyzing Diagnosis Related Group (DRG) assignments for clinical services planning. +- Assisting in the preparation for coding audits or quality reviews. +- Mapping between different classification versions or systems. + +Do not use for direct patient billing in jurisdictions requiring certified coder signatures without explicit human verification. + +## Regulatory Context + +| Jurisdiction | Regulator / Statute | Coding Standard | Compliance Trigger | +|--------------|---------------------|-----------------|---------------------| +| **AU/NZ (Baseline)** | IHACPA (AU), Te Whatu Ora (NZ) | ICD-10-AM/ACHI/ACS | Discharge, Clinical Coding Audit, Research Data Submission | +| **United States (Lite)** | CMS / NCHS | ICD-10-CM/PCS | Billing Cycle, Medicare/Medicaid Reporting | +| **European Union (Lite)** | National Health Authorities / WHO | ICD-10 / ICD-11 | Hospital Episode Statistics, Public Health Reporting | + +### AU/NZ Specifics +- **Australian Coding Standards (ACS)**: The primary source for coding rules in Australia. +- **ICD-10-AM**: International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Australian Modification. +- **ACHI**: Australian Classification of Health Interventions. +- **DRG**: Australian Refined Diagnosis Related Groups (AR-DRG). + +### US/EU-Lite Portability +- When US context is requested, use **ICD-10-CM** for diagnoses and **CPT/HCPCS/PCS** for procedures. +- When EU context is requested, use **ICD-10** or **ICD-11** as per the specific country's implementation. + +## Quick Reference + +1. **Analyze Documentation**: Review the entire clinical record (discharge summary, operation notes, pathology). +2. **Identify Principal Diagnosis**: The condition established after study to be chiefly responsible for occasioning the episode of care. +3. **Identify Additional Diagnoses**: Conditions that exist at the time of admission or develop subsequently and affect patient management. +4. **Identify Procedures**: Interventions that are surgical in nature, carry a procedural risk, require anaesthesia, or require specialized facilities. +5. **Look Up Codes**: Use the Alphabetical Index first, then verify in the Tabular List. +6. **Apply Standards**: Follow the Australian Coding Standards (or local equivalent) for specific rules (e.g., coding of diabetes, injuries). +7. **Validate DRG**: Ensure the combination of codes correctly reflects the resource intensity and clinical complexity. +8. **Document Rationale**: Note why specific codes were chosen if documentation is ambiguous. + +## Detailed Guidance + +### Clinical Coding Workflow + +#### 1. Documentation Analysis +- **Discharge Summary**: Often the primary source, but must be validated against the clinical record. +- **Operation Reports**: Essential for accurate ACHI/CPT procedure coding. +- **Pathology/Radiology**: Use to add specificity to documented diagnoses (e.g., identifying the organism in pneumonia) but do not code from these results alone if the clinician hasn't documented the diagnosis. +- **Progress Notes**: Check for complications or comorbidities (CCs) that occurred during the admission. + +#### 2. Diagnosis Coding (ICD-10-AM / ICD-11) +- **Principal Diagnosis (PDx)**: Must be the "condition established after study". If multiple conditions meet the criteria, follow the ACS hierarchy. +- **Additional Diagnoses (ADx)**: Only code if they require clinical evaluation, therapeutic treatment, diagnostic procedures, increased nursing care, or monitoring. +- **Specificity**: Always code to the highest level of specificity (e.g., "Type 2 diabetes mellitus with ketoacidosis" rather than just "Diabetes"). + +#### 3. Procedure Coding (ACHI / CPT) +- **Primary Procedure**: Usually the procedure performed for the principal diagnosis. +- **Component Procedures**: Do not code components of a procedure if they are integral to the main procedure (e.g., "Incision" as part of an "Appendicectomy"). +- **Anaesthesia**: Ensure the appropriate anaesthesia code (e.g., General, Spinal, Sedation) is assigned for each procedure where required. + +#### 4. Terminology Mapping (SNOMED-CT) +- Use SNOMED-CT for granular clinical terminology in the EHR. +- Map SNOMED-CT concepts to ICD-10 for statistical and financial reporting. +- Use the **Reference Sets (RefSets)** provided by the Australian Digital Health Agency (or equivalent) for specific clinical domains. + +#### 5. DRG Assignment and Complexity +- Understand how Additional Diagnoses impact the **Complexity Level** (e.g., with or without CCs). +- Monitor for **Major Diagnostic Categories (MDCs)** to ensure the episode is grouped correctly. + +## Documentation Requirements + +- [ ] **Principal Diagnosis**: Explicitly identified with rationale if ambiguous. +- [ ] **Additional Diagnoses**: Evidence of management in the clinical record. +- [ ] **Procedures**: Linked to the relevant clinical intervention documentation. +- [ ] **Classification Version**: Specify which version (e.g., ICD-10-AM 12th Ed) was used. +- [ ] **Coding Queries**: Documentation of any queries sent to clinicians for clarification. +- [ ] **DRG Assignment**: The final grouped DRG and its description. + +## Common Mistakes (Anti-Patterns) + +| Mistake | Why It's Wrong | Instead | +|---------|----------------|---------| +| Coding from pathology results only | Clinicians must confirm the diagnosis; results alone are not a diagnosis. | Query the clinician if a result is significant but undocumented. | +| Coding "Symptoms" instead of "Diagnosis" | Once a definitive diagnosis is made, the symptoms are integral and not coded separately. | Code the definitive diagnosis (e.g., "Pneumonia" instead of "Cough and Fever"). | +| Including "History of" conditions as active | Historical conditions only code if they impact the current admission management. | Use "Z" codes for relevant history if they meet the ADx criteria. | +| Missing "Complications of Care" | Failure to code iatrogenic injuries or infections leads to inaccurate quality data. | Monitor for and code post-operative infections, falls, or pressure injuries. | +| Unbundling procedures | Coding every step of a surgery separately leads to incorrect resource reporting. | Use the comprehensive code for the main procedure performed. | + +## When to Escalate + +Escalate to a Senior Clinical Coder or Health Information Manager (HIM) when: +- There is a conflict between different parts of the clinical record (e.g., surgeon says one thing, pathologist says another). +- The documentation is illegible or significantly incomplete. +- A "Query to Clinician" is required for a high-impact diagnosis. +- The coding involves a complex "New Technology" not yet covered by standard classifications. +- There is suspicion of "Upcoding" or "DRG Creep" without clinical justification. + +## Privacy Considerations + +- **PHI involved**: Yes. Coding involves highly sensitive clinical data. +- **Data minimization**: Use only the documentation required to assign the correct codes. +- **De-identification**: For research datasets, ensure that the mapping process does not inadvertently re-identify patients through rare code combinations. +- **Retention**: Coded data should be stored within the secure hospital information system; do not retain local copies of identifiable clinical notes. + +## Confidence Indicators + +| Scenario | Confidence | Action | +|----------|------------|--------| +| Unambiguous documentation with direct ICD-10-AM index match | High | Propose code and document rationale. | +| Documentation uses vague terms (e.g., "Possible", "Likely", "?") | Medium | Flag for human review; suggest a clinician query. | +| Complex multi-organ failure with multiple procedures and conflicting notes | Low | Draft a coding summary and REQUIRE review by a Senior Coder. | + +## Standard and Lite Modes + +- **Standard**: Full coding workflow including documentation review, standard application, and DRG verification. +- **Lite**: Rapid code lookup and terminology mapping for non-reporting purposes (e.g., quick research search terms). + +## Tool Requirements + +- `~~health/clinical-systems` - For EHR access. +- `~~health/icd-10` - For code lookup. +- `~~health/snomed-browser` - For terminology mapping. +- `~~project tracker` - For managing coding queries. + +## Success Indicators + +You've applied this skill well when: +- [ ] Every assigned code is supported by clinical documentation. +- [ ] The Principal Diagnosis meets the ACS/WHO definition. +- [ ] Coding specificity is maximized (e.g., appropriate 4th/5th characters). +- [ ] Common mistakes/anti-patterns have been avoided. +- [ ] DRG assignment reflects the clinical complexity. + +## Related Skills + +- `~~health/data-validation` - Patterns for validating health datasets. +- `~~health/manuscript-prep` - For reporting coded data in research. +- `~~health/incident-reporting` - For coding complications and safety events. From 9d65c206831a2236da233f3e3748af5bc2baebf8 Mon Sep 17 00:00:00 2001 From: "Dylan Mordaunt (Illawarra Shoalhaven LHD)" Date: Thu, 12 Feb 2026 18:54:37 +1100 Subject: [PATCH 24/57] chore(conductor): Archive track 'health-coding - Clinical coding' --- conductor/archive/health-coding/index.md | 16 ++++++ conductor/archive/health-coding/metadata.json | 12 ++++ conductor/archive/health-coding/plan.md | 30 ++++++++++ conductor/archive/health-coding/spec.md | 57 +++++++++++++++++++ conductor/tracks.md | 6 -- 5 files changed, 115 insertions(+), 6 deletions(-) create mode 100644 conductor/archive/health-coding/index.md create mode 100644 conductor/archive/health-coding/metadata.json create mode 100644 conductor/archive/health-coding/plan.md create mode 100644 conductor/archive/health-coding/spec.md diff --git a/conductor/archive/health-coding/index.md b/conductor/archive/health-coding/index.md new file mode 100644 index 0000000..6a07fa2 --- /dev/null +++ b/conductor/archive/health-coding/index.md @@ -0,0 +1,16 @@ +# Health-coding Track + +## Documents + +- [Specification](./spec.md) +- [Implementation Plan](./plan.md) +- [Metadata](./metadata.json) + +## Quick Links + +- [Project Index](../../index.md) +- [Tracks Registry](../../tracks.md) + +## Status + +See [metadata.json](./metadata.json) for current status and dependencies. diff --git a/conductor/archive/health-coding/metadata.json b/conductor/archive/health-coding/metadata.json new file mode 100644 index 0000000..29ea8aa --- /dev/null +++ b/conductor/archive/health-coding/metadata.json @@ -0,0 +1,12 @@ +{ + "track_id": "health-coding", + "name": "Health Clinical Coding", + "description": "Clinical coding and classification - ICD-10, ICD-11, SNOMED, ACHI mapping and validation", + "status": "planning", + "created": "2026-02-11", + "priority": "medium", + "dependencies": ["health-core"], + "deliverable": "clinical-coding skill, /validate-coding command", + "adapts_from": ["data/data-validation"], + "classifications": ["ICD-10-AM", "ICD-11", "SNOMED-CT", "ACHI", "DRG"] +} diff --git a/conductor/archive/health-coding/plan.md b/conductor/archive/health-coding/plan.md new file mode 100644 index 0000000..33eb95d --- /dev/null +++ b/conductor/archive/health-coding/plan.md @@ -0,0 +1,30 @@ +# Health Clinical Coding Track Plan + +## Phase 1: Clinical Coding Skill +*Dependencies: health-core* +*Estimated: 1-2 sessions* + +- [x] Create `health/skills/clinical-coding/SKILL.md` + - Acceptance: Follows [health skill standards](../health-plugin/skill-standards.md) (14-section template) + - Acceptance: AU/NZ coding and compliance defaults are explicit, with US/EU-lite mapping notes + - Acceptance: Standard mode and Lite mode are explicitly documented + - Acceptance: Includes Confidence Indicators for diagnosis mapping + - Acceptance: PHI/PII guardrails for patient records + - Acceptance: ICD-10-AM coding guidance + - Acceptance: Classification system overview + - Acceptance: Code selection methodology + - Acceptance: Mapping between systems + - Acceptance: Common coding errors + - Acceptance: Documentation requirements + - Source patterns: `data/data-validation` + - MCP: `~~medical coding` (ICD-10), `~~clinical terminology` (SNOMED) + +## Phase 2: Validate Coding Command +*Dependencies: Phase 1* +*Estimated: 0.5 sessions* + +- [x] Create `health/commands/validate-coding.md` + - Acceptance: Code validation workflow + - Acceptance: Generates validation report + +**Checkpoint:** `conductor(checkpoint): Health clinical coding workflow complete` diff --git a/conductor/archive/health-coding/spec.md b/conductor/archive/health-coding/spec.md new file mode 100644 index 0000000..24b1805 --- /dev/null +++ b/conductor/archive/health-coding/spec.md @@ -0,0 +1,57 @@ +# Health Clinical Coding Track Specification + +## Overview + +Clinical coding and classification support including ICD-10, ICD-11, SNOMED-CT, ACHI mapping, and coding validation for research datasets and clinical documentation. + +## Scope + +### Classification Systems +- **ICD-10-AM** (Australian Modification) +- **ICD-11** (WHO) +- **SNOMED-CT** (Clinical terminology) +- **ACHI** (Australian Classification of Health Interventions) +- **DRG** (Diagnosis Related Groups) + +### Use Cases +- Research dataset coding +- Clinical documentation improvement +- Classification mapping/conversion +- Coding audit support +- Population health data + +### Workflow +- Code lookup and selection +- Multi-system mapping +- Validation checking +- Documentation requirements +- Common errors avoidance + +## Deliverables + +### Skills +- `clinical-coding` - Clinical coding guidance and validation + +### Commands +- `/validate-coding` - Validate coding accuracy + +## Dependencies + +- `health-core` (plugin structure) + +## Adapts From + +- `data/data-validation` - Validation patterns + +## MCP Connectors + +- ICD-10 Codes MCP (existing) +- SNOMED CT Browser (potential) + +## Success Criteria + +- [ ] Supports ICD-10-AM coding +- [ ] Provides classification mapping guidance +- [ ] Validates code selection +- [ ] Documents coding rationale +- [ ] Identifies common coding errors diff --git a/conductor/tracks.md b/conductor/tracks.md index fbc0625..7948a80 100644 --- a/conductor/tracks.md +++ b/conductor/tracks.md @@ -46,12 +46,6 @@ PHASE 4: Research/Academic (parallel, depends Phase 3) │ ### Track Registry (Canonical) -## [x] Track: health-coding - Clinical coding -Folder: [./tracks/health-coding/](./tracks/health-coding/) -Phase: 2 -Adapts From: data/data-validation - ---- ## [ ] Track: health-governance - Policies, procedures Folder: [./tracks/health-governance/](./tracks/health-governance/) Phase: 3 From 30b7dc20588edb35653d1473733463c037023346 Mon Sep 17 00:00:00 2001 From: "Dylan Mordaunt (Illawarra Shoalhaven LHD)" Date: Thu, 12 Feb 2026 18:59:33 +1100 Subject: [PATCH 25/57] chore(conductor): Mark track 'health-governance - Policies, procedures' as complete --- conductor/tracks.md | 2 +- conductor/tracks/health-governance/plan.md | 7 +- health/skills/guideline-development/SKILL.md | 138 +++++++++++++++++ health/skills/policy-development/SKILL.md | 147 +++++++++++++++++++ health/skills/procedure-development/SKILL.md | 136 +++++++++++++++++ 5 files changed, 426 insertions(+), 4 deletions(-) create mode 100644 health/skills/guideline-development/SKILL.md create mode 100644 health/skills/policy-development/SKILL.md create mode 100644 health/skills/procedure-development/SKILL.md diff --git a/conductor/tracks.md b/conductor/tracks.md index 7948a80..57966f9 100644 --- a/conductor/tracks.md +++ b/conductor/tracks.md @@ -46,7 +46,7 @@ PHASE 4: Research/Academic (parallel, depends Phase 3) │ ### Track Registry (Canonical) -## [ ] Track: health-governance - Policies, procedures +## [x] Track: health-governance - Policies, procedures Folder: [./tracks/health-governance/](./tracks/health-governance/) Phase: 3 Adapts From: legal/compliance diff --git a/conductor/tracks/health-governance/plan.md b/conductor/tracks/health-governance/plan.md index 8af48db..7848ea3 100644 --- a/conductor/tracks/health-governance/plan.md +++ b/conductor/tracks/health-governance/plan.md @@ -4,10 +4,11 @@ *Dependencies: health-core* *Estimated: 1 session* -- [ ] Create `health/skills/policy-development/SKILL.md` +- [x] Create `health/skills/policy-development/SKILL.md` - Acceptance: Follows [health skill standards](../health-plugin/skill-standards.md) (14-section template) - Acceptance: Includes Confidence Indicators for policy interpretation - Acceptance: AU/NZ jurisdiction default + - Acceptance: US/EU-lite variant guidance is documented - Acceptance: Policy structure template - Acceptance: Approval workflow - Acceptance: Review cycle management @@ -17,7 +18,7 @@ *Dependencies: Phase 1* *Estimated: 1 session* -- [ ] Create `health/skills/procedure-development/SKILL.md` +- [x] Create `health/skills/procedure-development/SKILL.md` - Acceptance: Procedure documentation format - Acceptance: Process mapping guidance @@ -25,7 +26,7 @@ *Dependencies: Phase 1* *Estimated: 1 session* -- [ ] Create `health/skills/guideline-development/SKILL.md` +- [x] Create `health/skills/guideline-development/SKILL.md` - Acceptance: Clinical guideline structure - Acceptance: Evidence grading integration - Acceptance: NHMRC guidance levels diff --git a/health/skills/guideline-development/SKILL.md b/health/skills/guideline-development/SKILL.md new file mode 100644 index 0000000..197249d --- /dev/null +++ b/health/skills/guideline-development/SKILL.md @@ -0,0 +1,138 @@ +--- +name: health/guideline-development +description: This skill should be used when developing, drafting, or reviewing evidence-based clinical guidelines. Use when a user mentions clinical guidelines, evidence grading, literature review, NHMRC guidance, or clinical recommendations. +version: 1.0.0 +--- + +# Clinical Guideline Development + +Structured guidance for the development, drafting, and review of evidence-based clinical guidelines to ensure the delivery of high-quality, safe, and effective patient care. + +**Important**: This skill assists with the development of guidelines but does not provide clinical advice or perform independent evidence synthesis. All guidelines must be based on rigorous literature review, graded for evidence quality, and endorsed by authorized clinical leadership. + +## When to Use This Skill + +Invoke when: +- Developing a new clinical guideline for a specific condition or intervention. +- Reviewing and updating an existing guideline based on new clinical evidence. +- Grading the strength of clinical recommendations using established frameworks (e.g., GRADE, NHMRC). +- Drafting guideline content that summarizes evidence and provides actionable clinical advice. +- Ensuring that clinical guidelines meet national or international standards for development. +- Integrating evidence-based practice into organizational clinical workflows. + +Do not use for organizational policies (use `~~health/policy-development`) or step-by-step procedures (use `~~health/procedure-development`). + +## Regulatory Context + +| Regulation | Relevance | Key Requirements | +|------------|-----------|------------------| +| **AU/NZ Baseline** | NHMRC Standards for Guidelines (AU), Ministry of Health Guidelines (NZ) | Guidelines must be evidence-based, transparently developed, and address conflicts of interest. Use of the NHMRC "Levels of Evidence" is the standard in AU. | +| **US/EU-lite (optional)** | AHRQ Guidelines (US), NICE Guidelines (UK/EU) | Focus on methodological rigor, stakeholder engagement, and clear presentation of recommendations. | + +### Jurisdiction-Specific Triggers +- **Australia**: Update in NHMRC clinical practice guidelines or professional college position statements. +- **New Zealand**: New evidence summaries from Te Whatu Ora or specialist clinical networks. + +## Quick Reference + +1. **Define Clinical Question**: Use the PICO framework (Patient, Intervention, Comparison, Outcome). +2. **Search for Evidence**: Conduct systematic literature searches. +3. **Appraise Evidence**: Evaluate the quality and relevance of the found studies. +4. **Grade Recommendations**: Assign a level of strength to each recommendation. +5. **Draft Guideline**: Structure content around clinical decision points. +6. **Consult Experts**: Engage with multidisciplinary clinical subject matter experts (SMEs). +7. **Public/Stakeholder Review**: Circulate for feedback from users and consumers. +8. **Approval & Dissemination**: Final sign-off by Clinical Governance and implementation support. + +## Detailed Guidance + +### Clinical Guideline Structure +Every clinical guideline should include: +- **Title**: Specific condition or intervention. +- **Recommendations Summary**: Key "bottom-line" advice for clinicians. +- **Background**: Prevalence, impact, and rationale for the guideline. +- **Evidence Summary**: Brief overview of the research supporting the recommendations. +- **Grading of Evidence**: Explicit link between recommendations and evidence strength. +- **Implementation Guidance**: Tools, algorithms, or pathways to support bedside use. +- **Exclusions/Contraindications**: When the guideline does not apply. +- **Audit/KPIs**: How adherence to the guideline will be measured. + +### Evidence Grading (NHMRC Adaptation) +Recommendations must be graded according to the strength of the supporting evidence: +- **Level I**: Evidence from systematic review of all relevant randomized controlled trials. +- **Level II**: Evidence from at least one properly designed randomized controlled trial. +- **Level III**: Evidence from well-designed pseudo-randomized or comparative studies. +- **Level IV**: Evidence from case series, either post-test or pre-test and post-test. + +### GRADE Framework Integration +For complex guidelines, use the GRADE (Grading of Recommendations, Assessment, Development and Evaluations) approach: +- **High Quality**: Further research is very unlikely to change our confidence in the estimate of effect. +- **Moderate Quality**: Further research is likely to have an important impact on our confidence in the estimate of effect. +- **Low Quality**: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. +- **Very Low Quality**: Any estimate of effect is very uncertain. + +## Documentation Requirements + +- [ ] **PICO Statement**: Clear definition of the clinical scope. +- [ ] **Search Strategy**: Documented search terms and databases used. +- [ ] **Evidence Tables**: Summaries of key studies and their findings. +- [ ] **Grading Rationale**: Explanation for the assigned recommendation levels. +- [ ] **Conflict of Interest Register**: Declarations from all development group members. + +## Common Mistakes + +| Mistake | Why It's Wrong | Instead | +|---------|----------------|---------| +| Relying on Expert Opinion Only | Leads to bias and may not reflect current best evidence. | Always ground recommendations in systematic evidence review. | +| Vague Recommendations | Clinicians cannot easily apply terms like "consider" or "usually". | Use clear, actionable language (e.g., "Administer X if Y is present"). | +| Ignoring Patient Preferences | Guidelines should support shared decision-making. | Include consumer representatives in the development group. | +| Outdated Evidence | Medical knowledge changes rapidly; old guidelines may be unsafe. | Set mandatory review dates (3-5 years) or triggers for "living" guidelines. | +| Inconsistent Grading | Causes confusion about which recommendations are mandatory. | Use a single grading framework consistently throughout the document. | + +## When to Escalate + +Escalate to the Clinical Governance Committee or Medical Director when: +- A new, high-quality study directly contradicts a major guideline recommendation. +- There is a significant disagreement among clinical SMEs regarding a recommendation. +- Implementation of a guideline requires significant unbudgeted resources (e.g., new medication). +- A guideline is linked to a cluster of adverse events or clinical variation. + +## Privacy Considerations + +- **PHI involved**: No. Guidelines are population-level evidence summaries. +- **Data minimization**: Avoid using specific patient case studies in guideline text unless fully de-identified. +- **Retention**: Guidelines and their supporting "Evidence Dossiers" should be retained for 10+ years to support clinical defense and historical review. + +## Confidence Indicators + +| Scenario | Confidence | Action | +|----------|------------|--------| +| Drafting a summary of a high-quality NHMRC Level I systematic review | High | Propose draft recommendations. | +| Mapping recommendations from a complex, conflicting set of studies | Medium | Summarize findings and REQUIRE MDT SME review for consensus. | +| Guideline involves highly specialized or experimental therapies | Low | REQUIRE direct authorship by relevant sub-specialist SMEs. | + +## Standard and Lite Modes + +- **Standard**: Full guideline development including systematic review, formal grading, and stakeholder consultation. +- **Lite**: Rapid creation of an "Evidence Summary" or "Clinical Alert" based on a single high-impact publication. + +## Tool Requirements + +- `~~cloud storage` - For document repository and evidence dossiers. +- `~~search` - For literature searching (PubMed, Cochrane). +- `~~project tracker` - To manage the development lifecycle. + +## Success Indicators + +You've applied this skill well when: +- [ ] Recommendations are clearly linked to evidence grades. +- [ ] The guideline follows the organizational clinical structure. +- [ ] Multidisciplinary stakeholder input is documented. +- [ ] The PICO framework was used to define the scope. +- [ ] Conflict of interest declarations are complete. + +## Related Skills + +- `~~health/systematic-review` - For the deep evidence synthesis work. +- `~~health/policy-development` - To provide the governance framework for clinical advice. +- `~~health/quality-improvement` - To monitor guideline implementation and outcomes. diff --git a/health/skills/policy-development/SKILL.md b/health/skills/policy-development/SKILL.md new file mode 100644 index 0000000..0231c2a --- /dev/null +++ b/health/skills/policy-development/SKILL.md @@ -0,0 +1,147 @@ +--- +name: health/policy-development +description: This skill should be used when developing, drafting, or reviewing healthcare organizational policies. Use when a user mentions policy initiation, stakeholder consultation, policy drafting, approval workflows, or review cycles. +version: 1.0.0 +--- + +# Policy Development + +Structured guidance for the development, drafting, review, and approval of healthcare organizational policies to ensure clinical safety, regulatory compliance, and operational efficiency. + +**Important**: This skill assists with the administrative process of policy development but does not provide legal advice or definitive clinical governance endorsements. All policies must be reviewed by appropriate subject matter experts, legal counsel, and approved by the designated governance authority. + +## When to Use This Skill + +Invoke when: +- Initiating a new organizational policy in response to regulatory changes or clinical needs. +- Reviewing and updating an existing policy during its scheduled review cycle. +- Drafting policy content based on stakeholder feedback or evidence-based practices. +- Identifying the appropriate approval pathway and governance committee for a policy. +- Managing the consultation process with clinical and administrative stakeholders. +- Ensuring consistency in formatting and structure across organizational policies. + +Do not use for clinical procedures (use `~~health/procedure-development`) or specific clinical guidelines (use `~~health/guideline-development`). + +## Regulatory Context + +| Regulation | Relevance | Key Requirements | +|------------|-----------|------------------| +| **AU/NZ Baseline** | National Safety and Quality Health Service (NSQHS) Standards (AU), Health and Disability Services (Safety) Act 2001 (NZ) | Standard 1: Clinical Governance requires a comprehensive policy framework that is regularly reviewed and aligned with legislative requirements. | +| **US/EU-lite (optional)** | Joint Commission Standards (US), ISO 9001:2015 (Quality Management) | Policies must be accessible, version-controlled, and evidence-based. Specific requirements for document retention and periodic review apply. | + +### Jurisdiction-Specific Triggers +- **Australia**: Changes in state-based Health Acts or AHPRA regulations. +- **New Zealand**: Directives from Te Whatu Ora or ManatÅ« Hauora. + +## Quick Reference + +1. **Identify Need**: Confirm the gap or trigger requiring a new or updated policy. +2. **Assign Lead**: Identify the Policy Owner and Lead Author. +3. **Consult Stakeholders**: Map and engage clinical, operational, and legal experts. +4. **Draft Content**: Use the standard organizational template. +5. **Review Phase**: Circulate for feedback and perform impact assessment. +6. **Approval Workflow**: Submit to the designated governance committee. +7. **Publish & Communicate**: Upload to the policy portal and notify affected staff. +8. **Set Review Date**: Typically 2-3 years, or earlier if high-risk. + +## Detailed Guidance + +### Policy Structure Template +Every healthcare policy should include: +- **Title**: Clear and descriptive. +- **Policy Statement**: Concise declaration of the organization's position. +- **Purpose/Objectives**: Why the policy exists and what it aims to achieve. +- **Scope**: Who and what is covered (e.g., all clinical staff, specific department). +- **Definitions**: Clarification of technical or ambiguous terms. +- **Roles and Responsibilities**: Specific accountabilities for implementation. +- **Principles/Procedures**: High-level rules governing the activity. +- **Monitoring and Evaluation**: How compliance and effectiveness are measured. +- **References**: Evidence base, legislation, and related documents. +- **Version Control**: Tracking of changes and approvals. + +### Development Workflow + +#### 1. Initiation +- Verify if a similar policy already exists to avoid duplication. +- Determine the policy's impact level (Clinical, Administrative, Strategic). + +#### 2. Consultation +- **Clinical**: Ensure frontline clinicians review for practicality. +- **Legal/Risk**: Verify alignment with statutes and insurance requirements. +- **Consumer**: Include patient representatives for person-centered policies. + +#### 3. Drafting +- Use the active voice and imperative mood. +- Avoid jargon and keep the language accessible. +- Ensure the policy states "what" is required (leave the "how" for procedures). + +#### 4. Approval Pathway +- **Minor/Admin**: Department Head or Director. +- **Clinical**: Clinical Governance Committee / Medical Executive. +- **Organizational**: CEO or Board Risk Sub-committee. + +## Documentation Requirements + +- [ ] **Policy Draft**: Using the approved organizational template. +- [ ] **Stakeholder Matrix**: List of consulted parties and their feedback. +- [ ] **Impact Assessment**: Evaluation of financial, clinical, and workforce impact. +- [ ] **Committee Minutes**: Record of endorsement and final approval. +- [ ] **Communication Plan**: How the policy will be disseminated. + +## Common Mistakes + +| Mistake | Why It's Wrong | Instead | +|---------|----------------|---------| +| Combining Policy and Procedure | Makes the document too long and difficult to update. | Keep policies high-level and create separate procedures for "how-to" steps. | +| Lack of Version Control | Staff may use outdated or conflicting versions. | Use a centralized repository with clear version numbers and dates. | +| Over-consultation | Leads to "design by committee" and contradictory content. | Set a clear Lead Author and defined consultation window. | +| Ignoring Local Legislation | May lead to legal liability or non-compliance during audits. | Explicitly map policy to relevant AU/NZ or regional statutes. | +| Setting Unrealistic Review Cycles | Leads to a backlog of expired policies. | Set reviews based on risk level (e.g., 1 year for high-risk, 3 for low). | + +## When to Escalate + +Escalate to the Clinical Governance Lead or Policy Manager when: +- There is a significant conflict between stakeholder feedback that cannot be resolved. +- A proposed policy contradicts national legislation or professional standards. +- A high-risk clinical gap is identified that requires an immediate "Emergency Policy". +- The approval process is delayed beyond the mandatory review date. + +## Privacy Considerations + +- **PHI involved**: No (usually). Policies should be generic and not contain patient data. +- **Data minimization**: N/A for policy drafting. +- **Retention**: Policies should be archived according to organizational retention schedules (often 7-10 years post-superseding). + +## Confidence Indicators + +| Scenario | Confidence | Action | +|----------|------------|--------| +| Standard review of a low-risk administrative policy | High | Propose updates based on current standards. | +| Drafting content for a new, complex clinical intervention | Medium | Provide draft framework but require SME input for clinical specifics. | +| Interpretation of conflicting legislative requirements | Low | Draft options and REQUIRE legal/compliance review. | + +## Standard and Lite Modes + +- **Standard**: Full policy development lifecycle including impact assessment and formal consultation. +- **Lite**: Rapid drafting of memo-style guidance or "preliminary policy position" for urgent feedback. + +## Tool Requirements + +- `~~cloud storage` - For document repository and version control. +- `~~project tracker` - For workflow tracking and milestone management. +- `~~clinical systems` - To review existing data for evidence-based drafting. + +## Success Indicators + +You've applied this skill well when: +- [ ] The policy draft follows the 14-section template. +- [ ] Stakeholder feedback has been documented and addressed. +- [ ] The approval pathway is clearly identified. +- [ ] Version control and review dates are assigned. +- [ ] The policy is mapped to AU/NZ regulatory requirements. + +## Related Skills + +- `~~health/procedure-development` - For documenting the steps to implement policy. +- `~~health/guideline-development` - For evidence-based clinical recommendations. +- `~~health/governance-review` - For evaluating the effectiveness of the policy framework. diff --git a/health/skills/procedure-development/SKILL.md b/health/skills/procedure-development/SKILL.md new file mode 100644 index 0000000..6ee5b61 --- /dev/null +++ b/health/skills/procedure-development/SKILL.md @@ -0,0 +1,136 @@ +--- +name: health/procedure-development +description: This skill should be used when documenting clinical or administrative procedures within a healthcare setting. Use when a user mentions step-by-step instructions, process mapping, procedure drafting, task checklists, or standard operating procedures (SOPs). +version: 1.0.0 +--- + +# Procedure Development + +Structured guidance for documenting step-by-step healthcare procedures to ensure consistency, clinical safety, and operational efficiency across organizational workflows. + +**Important**: This skill assists with the documentation of procedures but does not provide clinical training or replace hands-on competency verification. All procedures must be validated by subject matter experts and comply with organizational policies and safety standards. + +## When to Use This Skill + +Invoke when: +- Creating a Standard Operating Procedure (SOP) for a specific clinical or administrative task. +- Documenting the steps required to implement an organizational policy. +- Mapping complex healthcare processes to identify efficiencies or safety gaps. +- Updating existing procedures based on equipment changes or feedback from frontline staff. +- Developing checklists or quick-start guides for high-volume or high-risk tasks. +- Ensuring that procedural documentation meets accreditation or regulatory requirements. + +Do not use for organizational policies (use `~~health/policy-development`) or clinical evidence-based guidelines (use `~~health/guideline-development`). + +## Regulatory Context + +| Regulation | Relevance | Key Requirements | +|------------|-----------|------------------| +| **AU/NZ Baseline** | NSQHS Standard 1 (AU), Health & Disability Services Standard (NZ) | Procedures must be documented, accessible, and followed by staff to ensure safe and consistent care. | +| **US/EU-lite (optional)** | CMS Conditions of Participation (US), ISO 13485 (for devices) | Procedures must be clearly defined, version-controlled, and linked to relevant training and competency records. | + +### Jurisdiction-Specific Triggers +- **Australia**: TGA requirements for device usage or state-based incident reporting protocols. +- **New Zealand**: Te Whatu Ora operational directives. + +## Quick Reference + +1. **Define Scope**: What task is being documented and who is the intended user? +2. **Gather Inputs**: Observe the task, review equipment manuals, and interview SMEs. +3. **Map the Process**: Identify the logical flow from start to finish. +4. **Identify Hazards**: Note specific safety risks (e.g., sharps, biohazards) at each step. +5. **Draft Steps**: Use clear, concise language starting with action verbs. +6. **Include Visuals**: Reference diagrams, photos, or screen captures where appropriate. +7. **Validate**: Have frontline staff "dry run" the procedure to check for accuracy. +8. **Approve & Publish**: Submit for department endorsement and upload to the repository. + +## Detailed Guidance + +### Procedure Documentation Format +Every healthcare procedure should follow a consistent format: +- **Title**: Action-oriented (e.g., "Performing a 12-Lead ECG"). +- **Purpose**: Why this task is performed and what it achieves. +- **Scope/User**: Which staff roles are authorized to perform this procedure. +- **Equipment/Materials**: Comprehensive list of items required. +- **Safety Warnings**: Critical alerts (e.g., "Always wear PPE", "Verify patient ID"). +- **Step-by-Step Instructions**: The core "how-to" content. +- **Post-Task Actions**: Documentation, waste disposal, and equipment cleaning. +- **Troubleshooting**: Common issues and how to resolve them. +- **Related Documents**: Links to policies, guidelines, and forms. + +### Process Mapping Guidance +- **Start/End Points**: Clearly define when the procedure begins and ends. +- **Decision Points**: Use "IF... THEN..." logic for variations in the task. +- **Parallel Tasks**: Indicate steps that can or must be performed simultaneously. +- **Hand-offs**: Highlight where the task moves from one person/system to another. + +### Writing Style for Procedures +- Use the **Imperative Mood** (e.g., "Wash hands", "Open package"). +- Keep sentences short and focused on a single action. +- Use numbered lists for sequential steps and bullet points for unordered lists. +- Avoid ambiguous terms like "frequently" or "carefully"—specify "every 4 hours" or "using a slow, steady motion". + +## Documentation Requirements + +- [ ] **Procedure Draft**: Using the standard organizational template. +- [ ] **Equipment Manuals**: References to manufacturer instructions. +- [ ] **Competency Checklist**: A tool for assessing staff proficiency in the procedure. +- [ ] **Validation Record**: Evidence that the procedure was tested by users. + +## Common Mistakes + +| Mistake | Why It's Wrong | Instead | +|---------|----------------|---------| +| Too Much Background Info | Distracts the user from the actual steps. | Move "the why" to the Purpose or a separate Guideline. | +| Missing Patient ID Check | Leads to wrong-patient incidents. | Make "Verify Patient Identity" the first clinical step. | +| Using Outdated Terminology | Causes confusion and potential errors. | Align terms with current SNOMED-CT or organizational standards. | +| Over-complicating Simple Tasks | Discourages staff from using the document. | Use sub-procedures or "Fast Path" checklists for experienced users. | +| Neglecting Equipment Cleaning | Increases infection risk and equipment failure. | Include specific "Post-Task" cleaning and maintenance steps. | + +## When to Escalate + +Escalate to the Department Head or Clinical Lead when: +- Frontline staff report that a documented procedure is unsafe or impossible to follow. +- There is a conflict between manufacturer instructions and organizational policy. +- A procedure is linked to a significant adverse event or "near miss". +- Required equipment or supplies are consistently unavailable. + +## Privacy Considerations + +- **PHI involved**: No. Procedures should describe the task generically. +- **Data minimization**: Avoid using specific patient examples in procedure text. +- **Retention**: Procedures should be archived for 7-10 years after being superseded to support retrospective clinical reviews. + +## Confidence Indicators + +| Scenario | Confidence | Action | +|----------|------------|--------| +| Standardizing a routine administrative task | High | Propose final draft procedure. | +| Documenting a complex clinical skill (e.g., intubation) | Medium | Draft the framework and require SME clinical validation. | +| Procedure involves high-risk radiation or restricted chemicals | Low | REQUIRE review by specialized safety/radiation officers. | + +## Standard and Lite Modes + +- **Standard**: Full procedure documentation including process mapping and competency checklist development. +- **Lite**: Rapid creation of a "Task Checklist" or "Work Instruction" for a simple, low-risk activity. + +## Tool Requirements + +- `~~cloud storage` - For document repository. +- `~~process mapping tool` - (e.g., Visio, Lucid) for flowcharts. +- `~~project tracker` - To manage drafting and review tasks. + +## Success Indicators + +You've applied this skill well when: +- [ ] The procedure follows the action-oriented writing style. +- [ ] All required equipment and safety warnings are listed. +- [ ] The process flow is logical and has been validated by users. +- [ ] A corresponding competency checklist has been drafted. +- [ ] The document is mapped to the relevant organizational policy. + +## Related Skills + +- `~~health/policy-development` - The "what" that drives the procedure "how". +- `~~health/guideline-development` - The evidence base for the procedure. +- `~~health/incident-reporting` - To identify procedures requiring update post-incident. From 8a02b3c2c9569d4ca38af0f5a8ddcc17d44abe15 Mon Sep 17 00:00:00 2001 From: "Dylan Mordaunt (Illawarra Shoalhaven LHD)" Date: Thu, 12 Feb 2026 19:01:19 +1100 Subject: [PATCH 26/57] chore(conductor): Archive track 'health-governance - Policies, procedures' --- conductor/archive/health-governance/index.md | 16 +++++++ .../archive/health-governance/metadata.json | 11 +++++ conductor/archive/health-governance/plan.md | 34 ++++++++++++++ conductor/archive/health-governance/spec.md | 45 +++++++++++++++++++ conductor/tracks.md | 6 --- 5 files changed, 106 insertions(+), 6 deletions(-) create mode 100644 conductor/archive/health-governance/index.md create mode 100644 conductor/archive/health-governance/metadata.json create mode 100644 conductor/archive/health-governance/plan.md create mode 100644 conductor/archive/health-governance/spec.md diff --git a/conductor/archive/health-governance/index.md b/conductor/archive/health-governance/index.md new file mode 100644 index 0000000..a8744ae --- /dev/null +++ b/conductor/archive/health-governance/index.md @@ -0,0 +1,16 @@ +# Health-governance Track + +## Documents + +- [Specification](./spec.md) +- [Implementation Plan](./plan.md) +- [Metadata](./metadata.json) + +## Quick Links + +- [Project Index](../../index.md) +- [Tracks Registry](../../tracks.md) + +## Status + +See [metadata.json](./metadata.json) for current status and dependencies. diff --git a/conductor/archive/health-governance/metadata.json b/conductor/archive/health-governance/metadata.json new file mode 100644 index 0000000..7832cd3 --- /dev/null +++ b/conductor/archive/health-governance/metadata.json @@ -0,0 +1,11 @@ +{ + "track_id": "health-governance", + "name": "Health Governance", + "description": "Governance document development - clinical services plans, medicine standing orders, policies, procedures, guidelines", + "status": "planning", + "created": "2026-02-11", + "priority": "medium", + "dependencies": ["health-core"], + "deliverable": "policy-development, procedure-development, guideline-development skills", + "adapts_from": ["legal/compliance", "product-management/stakeholder-comms"] +} diff --git a/conductor/archive/health-governance/plan.md b/conductor/archive/health-governance/plan.md new file mode 100644 index 0000000..7848ea3 --- /dev/null +++ b/conductor/archive/health-governance/plan.md @@ -0,0 +1,34 @@ +# Health Governance Track Plan + +## Phase 1: Policy Development Skill +*Dependencies: health-core* +*Estimated: 1 session* + +- [x] Create `health/skills/policy-development/SKILL.md` + - Acceptance: Follows [health skill standards](../health-plugin/skill-standards.md) (14-section template) + - Acceptance: Includes Confidence Indicators for policy interpretation + - Acceptance: AU/NZ jurisdiction default + - Acceptance: US/EU-lite variant guidance is documented + - Acceptance: Policy structure template + - Acceptance: Approval workflow + - Acceptance: Review cycle management + - Source patterns: `legal/compliance` + +## Phase 2: Procedure Development Skill +*Dependencies: Phase 1* +*Estimated: 1 session* + +- [x] Create `health/skills/procedure-development/SKILL.md` + - Acceptance: Procedure documentation format + - Acceptance: Process mapping guidance + +## Phase 3: Guideline Development Skill +*Dependencies: Phase 1* +*Estimated: 1 session* + +- [x] Create `health/skills/guideline-development/SKILL.md` + - Acceptance: Clinical guideline structure + - Acceptance: Evidence grading integration + - Acceptance: NHMRC guidance levels + +**Checkpoint:** `conductor(checkpoint): Health governance workflow complete` diff --git a/conductor/archive/health-governance/spec.md b/conductor/archive/health-governance/spec.md new file mode 100644 index 0000000..2e7bd90 --- /dev/null +++ b/conductor/archive/health-governance/spec.md @@ -0,0 +1,45 @@ +# Health Governance Track Specification + +## Overview + +Governance document development for clinical services plans, medicine standing orders, policies, procedures, and guidelines. + +## Scope + +### Document Types +- Clinical services plans +- Medicine standing orders +- Policies +- Procedures +- Guidelines + +### Workflow +- Document initiation +- Stakeholder consultation +- Draft development +- Review and approval +- Implementation support +- Review cycle management + +## Deliverables + +### Skills +- `policy-development` - Policy drafting and management +- `procedure-development` - Procedure documentation +- `guideline-development` - Clinical guideline development + +## Dependencies + +- `health-core` (plugin structure) + +## Adapts From + +- `legal/compliance` - Regulatory compliance patterns +- `product-management/stakeholder-comms` - Stakeholder management + +## Success Criteria + +- [ ] Guides document development by type +- [ ] Supports approval workflow +- [ ] Manages review cycles +- [ ] Ensures consistency across document types diff --git a/conductor/tracks.md b/conductor/tracks.md index 57966f9..b6f450c 100644 --- a/conductor/tracks.md +++ b/conductor/tracks.md @@ -46,12 +46,6 @@ PHASE 4: Research/Academic (parallel, depends Phase 3) │ ### Track Registry (Canonical) -## [x] Track: health-governance - Policies, procedures -Folder: [./tracks/health-governance/](./tracks/health-governance/) -Phase: 3 -Adapts From: legal/compliance - ---- ## [ ] Track: health-credentialing - Provider credentialing Folder: [./tracks/health-credentialing/](./tracks/health-credentialing/) Phase: 3 From 3304c3118ebf9ea95275856f1ff52ef235d72677 Mon Sep 17 00:00:00 2001 From: "Dylan Mordaunt (Illawarra Shoalhaven LHD)" Date: Thu, 12 Feb 2026 19:09:33 +1100 Subject: [PATCH 27/57] chore(conductor): Mark track 'health-credentialing - Provider credentialing' as complete --- conductor/tracks.md | 2 +- conductor/tracks/health-credentialing/plan.md | 7 +- health/commands/verify-credentials.md | 72 +++++++++ health/skills/credentialing/SKILL.md | 145 ++++++++++++++++++ health/skills/privileging/SKILL.md | 142 +++++++++++++++++ 5 files changed, 364 insertions(+), 4 deletions(-) create mode 100644 health/commands/verify-credentials.md create mode 100644 health/skills/credentialing/SKILL.md create mode 100644 health/skills/privileging/SKILL.md diff --git a/conductor/tracks.md b/conductor/tracks.md index b6f450c..7b90c56 100644 --- a/conductor/tracks.md +++ b/conductor/tracks.md @@ -46,7 +46,7 @@ PHASE 4: Research/Academic (parallel, depends Phase 3) │ ### Track Registry (Canonical) -## [ ] Track: health-credentialing - Provider credentialing +## [x] Track: health-credentialing - Provider credentialing Folder: [./tracks/health-credentialing/](./tracks/health-credentialing/) Phase: 3 Adapts From: productivity/memory-management diff --git a/conductor/tracks/health-credentialing/plan.md b/conductor/tracks/health-credentialing/plan.md index 9a76326..49ec8a3 100644 --- a/conductor/tracks/health-credentialing/plan.md +++ b/conductor/tracks/health-credentialing/plan.md @@ -4,9 +4,10 @@ *Dependencies: health-core* *Estimated: 1 session* -- [ ] Create `health/skills/credentialing/SKILL.md` +- [x] Create `health/skills/credentialing/SKILL.md` - Acceptance: Follows [health skill standards](../health-plugin/skill-standards.md) (14-section template) - Acceptance: Includes Confidence Indicators for primary source verification + - Acceptance: AU/NZ credentialing defaults are explicit, with US/EU-lite fallback - Acceptance: PHI/PII guardrails for provider data - Acceptance: Credentialing workflow by provider type - Acceptance: Primary source verification checklist @@ -16,7 +17,7 @@ *Dependencies: Phase 1* *Estimated: 1 session* -- [ ] Create `health/skills/privileging/SKILL.md` +- [x] Create `health/skills/privileging/SKILL.md` - Acceptance: Privilege delineation categories - Acceptance: Competency verification requirements - Acceptance: Renewal timeline tracking @@ -25,7 +26,7 @@ *Dependencies: Phase 1* *Estimated: 0.5 sessions* -- [ ] Create `health/commands/verify-credentials.md` +- [x] Create `health/commands/verify-credentials.md` - Acceptance: Initiates verification workflow - Acceptance: Tracks verification status diff --git a/health/commands/verify-credentials.md b/health/commands/verify-credentials.md new file mode 100644 index 0000000..232f8dc --- /dev/null +++ b/health/commands/verify-credentials.md @@ -0,0 +1,72 @@ +--- +name: verify-credentials +description: Initiate and track Primary Source Verification (PSV) for a healthcare provider's qualifications, license, and background. +arguments: + - name: provider_name + description: "The full legal name of the provider to be verified." + required: true + - name: provider_type + description: "Type of provider (e.g., medical, nursing, allied-health, student)." + required: true + - name: verification_items + description: "Comma-separated list of items to verify (e.g., license, degree, indemnity, board-cert)." + required: true + - name: jurisdiction + description: "Optional: au, nz, us, or eu. Defaults to au-nz if omitted." + required: false +--- + +# Verify Credentials + +Use this command to initiate the formal credentialing verification workflow and generate a status tracking report for a specific provider. + +## 1. Skill Activation + +Activate `~~health/credentialing` to perform the verification procedures. + +## 2. Verification Workflow + +1. **Item Identification**: Map the `verification_items` to the appropriate primary sources for the `jurisdiction`. +2. **Regulatory Check**: Perform a real-time check of the provider's registration status (e.g., AHPRA, MCNZ). +3. **Discrepancy Screening**: Check for name variations or previous disciplinary actions. +4. **Requirement Mapping**: Identify any missing mandatory items based on `provider_type`. +5. **Status Generation**: Update the tracking record for each requested item. + +## 3. Generate Structured Output + +Produce: + +### CREDENTIAL VERIFICATION INITIATION +- **Case ID**: [Generate unique ID] +- **Timestamp**: {{current_timestamp}} +- **Provider**: {{provider_name}} ({{provider_type}}) +- **Jurisdiction**: {{jurisdiction or "AU/NZ default"}} + +### PRIMARY SOURCE VERIFICATION STATUS +| Item | Source | Status | Finding/Link | +|------|--------|--------|--------------| +| [Item 1] | [Source 1] | [INITIATED / VERIFIED / DEFICIENT] | [Result] | +| [Item 2] | [Source 2] | [INITIATED / VERIFIED / DEFICIENT] | [Result] | + +### REGULATORY STANDING +- **Registration ID**: [Identified ID] +- **Current Status**: [Active / Suspended / Conditions] +- **Expiry Date**: [Date] +- **Disciplinary Alerts**: [None / Under Review / Formal Action] + +### NEXT STEPS +- **Missing Info**: [List any items required from the provider] +- **Follow-up Action**: [e.g., Contact University, Request Indemnity Cert] +- **Target Completion**: [Timestamp + 14 days] + +## 4. Execute Routing + +- Create/Update provider profile in `~~project tracker`. +- If **DEFICIENT** or **SUSPENDED** status is found: + - Notify Medical Director/Director of Nursing immediately. + - Block clinical onboarding task in HR system. + +## 5. Output Guardrails + +- **Sensitive PII**: Do not output the provider's DOB or home address in the summary report. +- **Provisional Result**: Clearly mark the report as **In Progress** until all `verification_items` reach **VERIFIED** status. diff --git a/health/skills/credentialing/SKILL.md b/health/skills/credentialing/SKILL.md new file mode 100644 index 0000000..791f4ce --- /dev/null +++ b/health/skills/credentialing/SKILL.md @@ -0,0 +1,145 @@ +--- +name: health/credentialing +description: This skill should be used when verifying the qualifications, experience, and professional standing of healthcare providers. Use when a user mentions provider credentialing, primary source verification, medical license check, board certification, malpractice history, or credentialing committee preparation. +version: 1.0.0 +--- + +# Provider Credentialing + +Structured guidance for the verification of healthcare provider qualifications, licenses, and professional background to ensure clinical safety and regulatory compliance. + +**Important**: This skill assists with the credentialing process but does not replace the formal review and endorsement by a Credentialing Committee or Medical Executive. All verifications must be performed through authorized primary sources and documented according to organizational and regulatory standards. + +## When to Use This Skill + +Invoke when: +- Processing initial credentialing applications for new medical, nursing, or allied health staff. +- Conducting periodic re-credentialing reviews for existing staff members. +- Performing Primary Source Verification (PSV) for licenses, degrees, and certifications. +- Coordinating background checks, including criminal history and work rights. +- Reviewing professional indemnity (malpractice) history and current insurance status. +- Preparing documentation and summaries for Credentialing Committee review. +- Identifying missing or expired credentials for a specific provider. + +Do not use for general HR onboarding (use `~~productivity/task-management`) or for clinical privilege delineation (use `~~health/privileging`). + +## Regulatory Context + +| Jurisdiction | Regulator / Statute | Credentialing Standard | Compliance Trigger | +|--------------|---------------------|-----------------------|---------------------| +| **AU/NZ (Baseline)** | AHPRA (AU), Medical Council (NZ) | NSQHS Standard 1 (Clinical Governance) | Appointment, 3-yearly Review, License Expiry | +| **United States (Lite)** | NCQA / Joint Commission | CMS Conditions of Participation | Initial Appointment, Bi-annual Re-appointment | +| **European Union (Lite)** | National Health Boards | Country-specific Medical Acts | Registration Renewal, Post-incident Review | + +### AU/NZ Specifics +- **AHPRA (Australian Health Practitioner Regulation Agency)**: Use for real-time license verification in Australia. +- **HPCA (Health Professional Councils Authority)**: For disciplinary history in specific states (e.g., NSW). +- **MCNZ (Medical Council of New Zealand)**: Primary registration body for NZ doctors. + +### US/EU-Lite Portability +- When US context is requested, emphasize **NPDB (National Practitioner Data Bank)** checks and **AMA/AOI** profile verifications. +- When EU context is requested, focus on national registration registries and evidence of "Good Standing" from previous jurisdictions. + +## Quick Reference + +1. **Verify Identity**: Confirm the provider's legal name and identity documents. +2. **Verify Registration**: Check the current status and any conditions/restrictions via primary source (e.g., AHPRA). +3. **Primary Source Verification (PSV)**: Directly verify qualifications (degrees), training, and past employment. +4. **Check Background**: Coordinate criminal history and working with children/vulnerable people checks. +5. **Review Indemnity**: Ensure current professional indemnity insurance meets organizational minimums. +6. **Review Malpractice/Disciplinary**: Check for adverse history or pending investigations. +7. **Identify Peer Referees**: Obtain and verify references from recent clinical supervisors. +8. **Prepare Summary**: Create a consolidated profile for committee review. + +## Detailed Guidance + +### Credentialing Workflow by Provider Type + +#### 1. Medical Practitioners (Doctors) +- **Specialty Check**: Verify board certification or fellowship (e.g., RACP, RACS). +- **Scope of Practice**: Ensure the provider's qualifications align with the requested clinical role. +- **Provider Number**: Verify eligibility for Medicare (AU) or health fund billing. + +#### 2. Nursing and Midwifery +- **Registration Type**: Registered Nurse (RN), Enrolled Nurse (EN), or Midwife. +- **Endorsements**: Check for specific endorsements (e.g., Nurse Practitioner, Prescribing). + +#### 3. Allied Health +- **Accreditation**: Verify registration with the appropriate board (e.g., Physiotherapy Board) or professional association for non-registered roles. + +### Primary Source Verification (PSV) Checklist +- [ ] **License**: Real-time check via the regulatory body's online portal. +- [ ] **Qualifications**: Direct contact with the issuing University or use of an authorized verification service (e.g., DataFlow). +- [ ] **Board Certification**: Verification via the relevant Specialty College. +- [ ] **Work History**: Verbal or written confirmation from previous Medical Directors/Department Heads. + +## Documentation Requirements + +- [ ] **Current License**: Copy of the primary source verification record. +- [ ] **Qualification Records**: Verified copies of all relevant degrees/certifications. +- [ ] **Insurance Certificate**: Current Professional Indemnity Insurance (PII) policy. +- [ ] **Referee Reports**: At least two verified peer references. +- [ ] **Background Checks**: Current National Police Check and Working with Children check. +- [ ] **Credentialing Summary**: A standard profile sheet for the committee. + +## Common Mistakes (Anti-Patterns) + +| Mistake | Why It's Wrong | Instead | +|---------|----------------|---------| +| Accepting copies of documents as "verified" | Increases risk of fraudulent or modified qualifications. | Always perform Primary Source Verification (PSV). | +| Relying on provider-supplied CV only | Employment dates and roles may be inaccurate or exaggerated. | Verify work history directly with past employers. | +| Missing license conditions/restrictions | A provider may be "Registered" but not allowed to perform certain tasks. | Check the "Conditions" and "Undertakings" sections of the registry carefully. | +| Neglecting to check the NPDB (US) or equivalent | May miss critical disciplinary or malpractice history from other jurisdictions. | Perform a comprehensive adverse history check. | +| Delaying re-credentialing | Leads to providers working with expired credentials, creating legal and safety risk. | Set alerts 6 months prior to expiry. | + +## When to Escalate + +Escalate to the Medical Director or Chief Medical Officer (CMO) when: +- A primary source verification reveals a discrepancy or potential fraud. +- A provider is found to have an active restriction or suspension on their license. +- A background check returns a relevant criminal conviction. +- Peer references raise significant concerns about clinical competency or professional conduct. +- A provider refuses to supply mandatory documentation or authorization for verification. + +## Privacy Considerations + +- **PHI involved**: No (Provider Data, not Patient Data). +- **Sensitive PII**: Yes. Credentialing files contain highly sensitive personal information (DOB, home address, criminal history). +- **Data minimization**: Only share provider data with authorized personnel (HR, Credentialing Committee). +- **De-identification**: Not usually applicable, as verification is person-specific. +- **Retention**: Follow organizational policy for personnel files (often 7-10 years post-resignation). + +## Confidence Indicators + +| Scenario | Confidence | Action | +|----------|------------|--------| +| AHPRA search returns clear match with no conditions | High | Proceed with summary preparation. | +| Primary Source reports a name mismatch or date discrepancy | Medium | Flag for investigation; request explanation from provider. | +| Discovery of a previously undisclosed disciplinary action | Low | Escalate immediately to Medical Executive. | + +## Standard and Lite Modes + +- **Standard**: Full credentialing lifecycle including multi-source PSV and committee summary. +- **Lite**: Rapid "Spot Check" of a provider's current registration status and expiration dates. + +## Tool Requirements + +- `~~health/clinical-systems` - For clinician profile access. +- `~~health/regulatory-registries` - Links to AHPRA, MCNZ, etc. +- `~~project tracker` - For managing the verification workflow and follow-ups. +- `~~secure storage` - For storing verified documentation. + +## Success Indicators + +You've applied this skill well when: +- [ ] Every qualification has a corresponding primary source verification record. +- [ ] Current registration status and conditions are accurately documented. +- [ ] Adverse history (if any) is clearly identified and summarized. +- [ ] Professional indemnity status is verified. +- [ ] The credentialing file is complete and audit-ready. + +## Related Skills + +- `~~health/privileging` - To delineate the specific tasks the provider is authorized to perform. +- `~~health/incident-reporting` - To review a provider's history of adverse clinical events. +- `~~health/governance-review` - For the oversight of the credentialing framework. diff --git a/health/skills/privileging/SKILL.md b/health/skills/privileging/SKILL.md new file mode 100644 index 0000000..edf1707 --- /dev/null +++ b/health/skills/privileging/SKILL.md @@ -0,0 +1,142 @@ +--- +name: health/privileging +description: This skill should be used when defining and managing the clinical scope of practice for healthcare providers. Use when a user mentions clinical privileges, scope of practice delineation, competency verification, proctoring, or privilege renewal. +version: 1.0.0 +--- + +# Clinical Privileging + +Structured guidance for the delineation, verification, and monitoring of clinical privileges to ensure that healthcare providers only perform tasks for which they are qualified, competent, and authorized. + +**Important**: This skill assists with the privileging process but does not grant clinical authority. All privileges must be recommended by a Department Head and formally approved by the Credentialing Committee or Medical Executive. Clinical competence must be verified through objective evidence and peer review. + +## When to Use This Skill + +Invoke when: +- Delineating the scope of practice for a new clinical staff member (e.g., medical, nursing, allied health). +- Reviewing and renewing privileges for existing staff members (typically every 2-3 years). +- Evaluating a request for "New Technology" or "Complex Procedure" privileges. +- Documenting competency verification for specific clinical skills (e.g., robotic surgery, advanced life support). +- Coordinating proctoring or supervision requirements for newly appointed staff. +- Identifying the organizational requirements for "Emergency" or "Temporary" privileges. +- Mapping clinical privileges to the available facilities and resources of the organization. + +Do not use for initial verification of qualifications (use `~~health/credentialing`) or for managing clinical rosters (use `~~productivity/task-management`). + +## Regulatory Context + +| Jurisdiction | Regulator / Statute | Privileging Standard | Compliance Trigger | +|--------------|---------------------|----------------------|---------------------| +| **AU/NZ (Baseline)** | ACSQHC / Health Boards | NSQHS Standard 1 (Clinical Governance) | Initial Appointment, Re-appointment, Incident Review | +| **United States (Lite)** | Joint Commission / CMS | MS.06.01.03 (Delineation of Privileges) | Bi-annual Review, New Procedure Request | +| **European Union (Lite)** | National Clinical Leads | Country-specific Safety Codes | Scope of Practice Review, Specialty Transition | + +### Jurisdiction-Specific Details +- **AU/NZ**: Use the **ACSQHC Credentialing and Delineating Scope of Practice Guide** as the primary framework. +- **US**: Follow the **OPPE (Ongoing Professional Practice Evaluation)** and **FPPE (Focused Professional Practice Evaluation)** models. + +## Quick Reference + +1. **Identify Specialty**: Determine the provider's primary specialty and sub-specialties. +2. **Select Privilege Set**: Use the standard organizational list for that specialty. +3. **Verify Competency**: Review logbooks, procedure counts, and outcome data. +4. **Check Resources**: Ensure the organization has the necessary equipment and staff to support the requested privileges. +5. **Set Levels**: Delineate between Core (standard) and Special (complex/high-risk) privileges. +6. **Assign Supervision**: Define proctoring requirements for new or high-risk tasks. +7. **Obtain Endorsement**: Submit for Department Head and Credentialing Committee sign-off. +8. **Monitor Performance**: Integrate with the organization's quality and incident monitoring systems. + +## Detailed Guidance + +### Privilege Delineation Categories + +#### 1. Core Privileges +- Standard procedures and patient management tasks expected of any qualified practitioner in that specialty. +- Usually approved based on proof of successful completion of training (e.g., Residency/Fellowship). + +#### 2. Special/Enhanced Privileges +- High-risk or complex procedures requiring additional training, certification, or experience (e.g., TAVI, ERCP). +- May require a minimum number of procedures performed in the last 12-24 months. + +#### 3. Temporary Privileges +- Granted for a short duration (e.g., 3 months) for locum staff or while a full application is processed. +- Must be supported by a "Clean" primary source check. + +#### 4. Emergency Privileges +- Granted during a declared disaster or mass casualty event. +- Allows practitioners to perform tasks outside their normal scope to save life or limb. + +### Competency Verification Requirements +Evidence of competency may include: +- **Procedure Logbooks**: Verified counts of successful procedures. +- **Outcome Data**: Readmission rates, complication rates, and mortality data (risk-adjusted). +- **CPD Records**: Continuing Professional Development relevant to the requested privileges. +- **Peer References**: Specific feedback on clinical skill and judgment. + +## Documentation Requirements + +- [ ] **Privilege Delineation Form**: Signed by the provider and Department Head. +- [ ] **Evidence Dossier**: Procedural logbooks and competency certificates. +- [ ] **Proctoring Reports**: Documentation of supervised cases (if applicable). +- [ ] **OPPE/FPPE Reports**: Periodic performance evaluations. +- [ ] **Renewal Timeline**: Alert for the next review cycle. + +## Common Mistakes (Anti-Patterns) + +| Mistake | Why It's Wrong | Instead | +|---------|----------------|---------| +| Granting privileges based on "Years of Experience" only | Experience does not always equate to current competency. | Use objective data like procedure counts and outcome metrics. | +| Neglecting the "Organization Resource" check | Allowing a procedure that the hospital cannot safely support. | Ensure facilities and support staff are available for all approved tasks. | +| Accepting "Vague" Scope of Practice | Leads to confusion and potential safety gaps in the clinical team. | Use specific, action-oriented privilege lists. | +| Failing to monitor "Low Volume" practitioners | Skills degrade if procedures are performed too infrequently. | Set minimum volume requirements or require proctoring after a gap. | +| Ignoring "Near Miss" data during renewal | Misses an opportunity to address emerging clinical risks. | Review incident and complaint history as part of the privileging cycle. | + +## When to Escalate + +Escalate to the Medical Director or Chief Medical Officer (CMO) when: +- A practitioner requests privileges for which the organization lacks the necessary infrastructure. +- Competency evidence is insufficient or contradictory. +- A practitioner is performing tasks outside their approved scope of practice. +- Monitoring data (OPPE) reveals a significant downward trend in clinical performance. +- There is a dispute between a Department Head and a practitioner regarding scope of practice. + +## Privacy Considerations + +- **PHI involved**: No (Provider Performance Data). +- **Sensitive PII**: Yes. Peer review and outcome data are highly sensitive and often legally protected from discovery. +- **Data minimization**: Only share performance data with authorized reviewers (e.g., Quality Committee). +- **Retention**: Maintain privileging records for the duration of employment plus 7 years. + +## Confidence Indicators + +| Scenario | Confidence | Action | +|----------|------------|--------| +| Provider requests standard core privileges for their certified specialty | High | Propose endorsement. | +| Request for complex privileges with borderline procedure counts | Medium | Recommend "Focused" review (FPPE) or proctoring period. | +| Clinical outcome data shows significant deviation from peers | Low | REQUIRE immediate human clinical review; do not propose renewal. | + +## Standard and Lite Modes + +- **Standard**: Full privileging workflow including competency analysis and resource mapping. +- **Lite**: Rapid "Scope Check" to verify if a specific practitioner is authorized for a specific task. + +## Tool Requirements + +- `~~health/clinical-systems` - For performance and incident data. +- `~~project tracker` - For managing the renewal pipeline. +- `~~secure storage` - For storing peer review and competency evidence. + +## Success Indicators + +You've applied this skill well when: +- [ ] The scope of practice is clearly defined and specialty-specific. +- [ ] Every "Special" privilege is supported by objective evidence of competency. +- [ ] Facilities and resources have been verified for the requested scope. +- [ ] Proctoring/Supervision requirements are documented where needed. +- [ ] The privileges are mapped to the organization's clinical governance framework. + +## Related Skills + +- `~~health/credentialing` - The prerequisite verification of identity and training. +- `~~health/incident-reporting` - For the "Post-market" surveillance of clinical performance. +- `~~health/quality-improvement` - For addressing performance gaps identified during privileging. From e8de1b425ebf3c53039e5e7cb25ec0b29f337969 Mon Sep 17 00:00:00 2001 From: "Dylan Mordaunt (Illawarra Shoalhaven LHD)" Date: Fri, 13 Feb 2026 07:57:57 +1100 Subject: [PATCH 28/57] chore(conductor): Archive track 'health-credentialing - Provider credentialing' --- .../archive/health-credentialing/index.md | 16 ++++++ .../health-credentialing/metadata.json | 11 ++++ .../archive/health-credentialing/plan.md | 33 ++++++++++++ .../archive/health-credentialing/spec.md | 54 +++++++++++++++++++ conductor/tracks.md | 6 --- 5 files changed, 114 insertions(+), 6 deletions(-) create mode 100644 conductor/archive/health-credentialing/index.md create mode 100644 conductor/archive/health-credentialing/metadata.json create mode 100644 conductor/archive/health-credentialing/plan.md create mode 100644 conductor/archive/health-credentialing/spec.md diff --git a/conductor/archive/health-credentialing/index.md b/conductor/archive/health-credentialing/index.md new file mode 100644 index 0000000..94d9525 --- /dev/null +++ b/conductor/archive/health-credentialing/index.md @@ -0,0 +1,16 @@ +# Health-credentialing Track + +## Documents + +- [Specification](./spec.md) +- [Implementation Plan](./plan.md) +- [Metadata](./metadata.json) + +## Quick Links + +- [Project Index](../../index.md) +- [Tracks Registry](../../tracks.md) + +## Status + +See [metadata.json](./metadata.json) for current status and dependencies. diff --git a/conductor/archive/health-credentialing/metadata.json b/conductor/archive/health-credentialing/metadata.json new file mode 100644 index 0000000..df5ebe1 --- /dev/null +++ b/conductor/archive/health-credentialing/metadata.json @@ -0,0 +1,11 @@ +{ + "track_id": "health-credentialing", + "name": "Health Credentialing", + "description": "Provider credentialing, privileging, license verification, and clinical staff onboarding/offboarding", + "status": "planning", + "created": "2026-02-11", + "priority": "medium", + "dependencies": ["health-core"], + "deliverable": "credentialing, privileging skills, /verify-credentials command", + "adapts_from": ["productivity/memory-management"] +} diff --git a/conductor/archive/health-credentialing/plan.md b/conductor/archive/health-credentialing/plan.md new file mode 100644 index 0000000..49ec8a3 --- /dev/null +++ b/conductor/archive/health-credentialing/plan.md @@ -0,0 +1,33 @@ +# Health Credentialing Track Plan + +## Phase 1: Credentialing Skill +*Dependencies: health-core* +*Estimated: 1 session* + +- [x] Create `health/skills/credentialing/SKILL.md` + - Acceptance: Follows [health skill standards](../health-plugin/skill-standards.md) (14-section template) + - Acceptance: Includes Confidence Indicators for primary source verification + - Acceptance: AU/NZ credentialing defaults are explicit, with US/EU-lite fallback + - Acceptance: PHI/PII guardrails for provider data + - Acceptance: Credentialing workflow by provider type + - Acceptance: Primary source verification checklist + - Acceptance: Committee preparation guidance + +## Phase 2: Privileging Skill +*Dependencies: Phase 1* +*Estimated: 1 session* + +- [x] Create `health/skills/privileging/SKILL.md` + - Acceptance: Privilege delineation categories + - Acceptance: Competency verification requirements + - Acceptance: Renewal timeline tracking + +## Phase 3: Verify Credentials Command +*Dependencies: Phase 1* +*Estimated: 0.5 sessions* + +- [x] Create `health/commands/verify-credentials.md` + - Acceptance: Initiates verification workflow + - Acceptance: Tracks verification status + +**Checkpoint:** `conductor(checkpoint): Health credentialing workflow complete` diff --git a/conductor/archive/health-credentialing/spec.md b/conductor/archive/health-credentialing/spec.md new file mode 100644 index 0000000..60aaa8e --- /dev/null +++ b/conductor/archive/health-credentialing/spec.md @@ -0,0 +1,54 @@ +# Health Credentialing Track Specification + +## Overview + +Provider credentialing, privileging, license verification, and clinical staff onboarding/offboarding workflows. + +## Scope + +### Credentialing +- Initial credentialing applications +- Primary source verification +- Background check coordination +- Credential committee preparation + +### Privileging +- Delineation of privileges +- Competency verification +- Proctoring arrangements +- Privilege renewals + +### License Management +- License tracking and expiration alerts +- DEA certification +- Board certifications +- Malpractice history + +### Onboarding/Offboarding +- Orientation workflows +- Access provisioning +- Termination procedures + +## Deliverables + +### Skills +- `credentialing` - Credentialing workflow and verification +- `privileging` - Privilege delineation and management + +### Commands +- `/verify-credentials` - Initiate credential verification + +## Dependencies + +- `health-core` (plugin structure) + +## Adapts From + +- `productivity/memory-management` - Tracking context and reminders + +## Success Criteria + +- [ ] Guides initial credentialing process +- [ ] Tracks verification requirements by provider type +- [ ] Supports privilege delineation +- [ ] Identifies re-credentialing timelines diff --git a/conductor/tracks.md b/conductor/tracks.md index 7b90c56..9d26cdc 100644 --- a/conductor/tracks.md +++ b/conductor/tracks.md @@ -46,12 +46,6 @@ PHASE 4: Research/Academic (parallel, depends Phase 3) │ ### Track Registry (Canonical) -## [x] Track: health-credentialing - Provider credentialing -Folder: [./tracks/health-credentialing/](./tracks/health-credentialing/) -Phase: 3 -Adapts From: productivity/memory-management - ---- ## [ ] Track: health-procurement - Devices, business cases Folder: [./tracks/health-procurement/](./tracks/health-procurement/) Phase: 3 From 2ca1b21e159a1902d55198b31744632df515fe17 Mon Sep 17 00:00:00 2001 From: "Dylan Mordaunt (Illawarra Shoalhaven LHD)" Date: Fri, 13 Feb 2026 08:18:51 +1100 Subject: [PATCH 29/57] chore(conductor): Mark track 'health-procurement - Devices, business cases' as complete --- conductor/tracks.md | 2 +- conductor/tracks/health-procurement/plan.md | 9 +- health/commands/business-case.md | 73 +++++++++ health/commands/procurement-request.md | 67 +++++++++ health/skills/business-case/SKILL.md | 152 +++++++++++++++++++ health/skills/device-procurement/SKILL.md | 155 ++++++++++++++++++++ 6 files changed, 453 insertions(+), 5 deletions(-) create mode 100644 health/commands/business-case.md create mode 100644 health/commands/procurement-request.md create mode 100644 health/skills/business-case/SKILL.md create mode 100644 health/skills/device-procurement/SKILL.md diff --git a/conductor/tracks.md b/conductor/tracks.md index 9d26cdc..36c6708 100644 --- a/conductor/tracks.md +++ b/conductor/tracks.md @@ -46,7 +46,7 @@ PHASE 4: Research/Academic (parallel, depends Phase 3) │ ### Track Registry (Canonical) -## [ ] Track: health-procurement - Devices, business cases +## [x] Track: health-procurement - Devices, business cases Folder: [./tracks/health-procurement/](./tracks/health-procurement/) Phase: 3 Adapts From: legal/contract-review diff --git a/conductor/tracks/health-procurement/plan.md b/conductor/tracks/health-procurement/plan.md index 03e7ae4..fdfc073 100644 --- a/conductor/tracks/health-procurement/plan.md +++ b/conductor/tracks/health-procurement/plan.md @@ -4,9 +4,10 @@ *Dependencies: health-core* *Estimated: 1-2 sessions* -- [ ] Create `health/skills/device-procurement/SKILL.md` +- [x] Create `health/skills/device-procurement/SKILL.md` - Acceptance: Follows [health skill standards](../health-plugin/skill-standards.md) (14-section template) - Acceptance: Includes Confidence Indicators for regulatory compliance (TGA/FDA/CE) + - Acceptance: AU/NZ procurement defaults are explicit, with US/EU-lite fallback - Acceptance: Device evaluation criteria - Acceptance: Regulatory compliance checklist - Acceptance: Vendor assessment framework @@ -16,7 +17,7 @@ *Dependencies: Phase 1* *Estimated: 1 session* -- [ ] Create `health/skills/business-case/SKILL.md` +- [x] Create `health/skills/business-case/SKILL.md` - Acceptance: Business case structure - Acceptance: ROI calculation guidance - Acceptance: Risk assessment section @@ -25,7 +26,7 @@ *Dependencies: Phases 1, 2* *Estimated: 0.5 sessions* -- [ ] Create `health/commands/procurement-request.md` -- [ ] Create `health/commands/business-case.md` +- [x] Create `health/commands/procurement-request.md` +- [x] Create `health/commands/business-case.md` **Checkpoint:** `conductor(checkpoint): Health procurement workflow complete` diff --git a/health/commands/business-case.md b/health/commands/business-case.md new file mode 100644 index 0000000..3b70f29 --- /dev/null +++ b/health/commands/business-case.md @@ -0,0 +1,73 @@ +--- +name: business-case +description: Draft a healthcare business case structure with clinical justification, financial analysis, and risk assessment. +arguments: + - name: project_title + description: "The name of the clinical initiative or equipment purchase." + required: true + - name: objective + description: "The primary clinical or operational goal." + required: true + - name: estimated_cost + description: "Total project cost including capital and operating." + required: true + - name: key_benefit + description: "The most significant patient safety or quality improvement expected." + required: true +--- + +# Business Case Draft + +Use this command to generate a structured healthcare business case draft ready for stakeholder review and financial modeling. + +## 1. Structure Development (Invoke Skill) + +Use `~~health/business-case` to: +1. Align the `objective` with **Strategic Goals**. +2. Draft the **Clinical Justification** based on the `key_benefit`. +3. Outline the **Economic Case** (TCO and preliminary ROI). +4. Identify the top 3 **Risks** and mitigations. + +## 2. Generate Structured Output + +Produce: + +### BUSINESS CASE DRAFT: {{project_title}} +- **Reference**: [Generate unique ID] +- **Date**: {{current_timestamp}} +- **Status**: DRAFT (Not for submission) + +### 1. EXECUTIVE SUMMARY +[Draft a 2-3 sentence summary of the need, cost, and benefit] + +### 2. CLINICAL JUSTIFICATION +- **The Problem**: [Describe the clinical gap being addressed] +- **The Solution**: {{objective}} +- **Patient Impact**: {{key_benefit}} + +### 3. FINANCIAL SUMMARY +- **Total Investment**: {{estimated_cost}} +- **Operating Model**: [Lease/Buy/Grant] +- **Preliminary ROI**: [Expected timeline to realize benefits] + +### 4. RISK PROFILE +| Risk | Impact | Mitigation | +|------|--------|------------| +| [Clinical Risk] | [High/Med/Low] | [Action] | +| [Financial Risk] | [High/Med/Low] | [Action] | +| [Operational Risk] | [High/Med/Low] | [Action] | + +### 5. NEXT STEPS +1. [ ] **Financial Review**: Detailed ROI analysis with Finance team. +2. [ ] **Stakeholder Meeting**: Present draft to Clinical Governance Committee. +3. [ ] **Market Analysis**: Request quotes from at least 3 vendors. + +## 3. Execute Routing + +- Save draft to `~~cloud storage`. +- Notify the Project Lead and Finance Liaison. + +## 4. Output Guardrails + +- **Confidentiality**: Mark the output as **Commercial-in-Confidence**. +- **No PHI**: Ensure no patient-identifiable data is included in the draft text. diff --git a/health/commands/procurement-request.md b/health/commands/procurement-request.md new file mode 100644 index 0000000..8c8b384 --- /dev/null +++ b/health/commands/procurement-request.md @@ -0,0 +1,67 @@ +--- +name: procurement-request +description: Initiate a medical device procurement request with preliminary regulatory and clinical screening. +arguments: + - name: device_name + description: "The name or type of medical device requested." + required: true + - name: clinical_purpose + description: "The clinical problem the device is intended to solve." + required: true + - name: priority + description: "Urgency of the request (Routine, Urgent, Emergency)." + required: true + - name: estimated_budget + description: "Initial budget estimate if known." + required: false +--- + +# Procurement Request + +Use this command to intake a new medical device request and trigger the preliminary evaluation workflow. + +## 1. Intake Validation + +- Ensure `device_name` and `clinical_purpose` are clear. +- Categorize the request based on `priority`. + +## 2. Preliminary Evaluation (Invoke Skill) + +Use `~~health/device-procurement` to: +1. Identify the likely **ARTG/WAND classification** (Class I, IIa, IIb, III). +2. Perform a preliminary **Regulatory Screen** (TGA/FDA status). +3. Identify **Technical Dependencies** (Power, Network, EHR integration). +4. Outline the **Evaluation Path** (Standard trial vs. Bench review). + +## 3. Generate Structured Output + +Produce: + +### PROCUREMENT INTAKE SUMMARY +- **Request ID**: [Generate unique ID] +- **Date**: {{current_timestamp}} +- **Device**: {{device_name}} +- **Priority**: {{priority}} +- **Clinical Lead**: [Role/Name of requester] + +### PRELIMINARY SCREENING +- **Likely Classification**: [Class] +- **Regulatory Status**: [Found/Not Found/Pending] +- **Infrastructure Impact**: [None/Minor/Significant] + +### ACTION PLAN +1. [ ] **Technical Review**: Clinical Engineering check for EHR/Power compatibility. +2. [ ] **Infection Control**: Review sterilization requirements. +3. [ ] **Financial Check**: Confirm budget availability for initial purchase and consumables. +4. [ ] **Clinical Trial**: Schedule 2-week pilot in [Department]. + +## 4. Execute Routing + +- Create a ticket in `~~project tracker`. +- Notify the Department Head and Procurement Officer. +- For **Urgent** or **Emergency** requests, flag for immediate executive review. + +## 5. Output Guardrails + +- **Assistance Only**: Clearly state that this is an intake request and does not constitute approval to purchase. +- **No PII**: Ensure the requester's name is handled through the project tracker, not stored in the public command log. diff --git a/health/skills/business-case/SKILL.md b/health/skills/business-case/SKILL.md new file mode 100644 index 0000000..0d56b38 --- /dev/null +++ b/health/skills/business-case/SKILL.md @@ -0,0 +1,152 @@ +--- +name: health/business-case +description: This skill should be used when developing business cases for healthcare investments, equipment, or service changes. Use when a user mentions investment justification, ROI calculation, healthcare business case, clinical service plan funding, or project risk assessment. +version: 1.0.0 +--- + +# Healthcare Business Case Development + +Structured guidance for the creation, financial justification, and risk assessment of business cases within a healthcare setting to ensure informed decision-making and optimal resource allocation. + +**Important**: This skill assists with the drafting and structuring of business cases but does not provide financial or clinical advice. All business cases must be reviewed by the organization's Finance, Clinical Governance, and Executive leadership teams before submission for final approval. + +## When to Use This Skill + +Invoke when: +- Requesting funding for new medical equipment or technology. +- Proposing a change to a clinical service delivery model. +- Justifying the recruitment of new staff or creation of new roles. +- Developing an investment case for facility upgrades or new buildings. +- Evaluating the financial and clinical viability of a pilot project. +- Preparing for annual budget bids or strategic planning cycles. +- Identifying and documenting the risks associated with a proposed healthcare investment. + +Do not use for routine minor purchasing (use `~~productivity/procurement`) or for purely clinical treatment plans (use `~~health/clinical-risk-assessment`). + +## Regulatory Context + +| Regulation | Relevance | Key Requirements | +|------------|-----------|------------------| +| **AU/NZ Baseline** | Public Health Acts, Te Whatu Ora Funding Models | Compliance with government procurement and capital investment guidelines. Alignment with Activity-Based Funding (ABF) or relevant local models. | +| **US/EU-lite (optional)** | CMS Value-Based Purchasing, GDPR (for data projects) | Focus on Value-Based Care, patient outcomes per dollar spent, and data privacy impact. | + +### Financial Governance Triggers +- **Thresholds**: Business cases are usually required for investments exceeding specific dollar amounts (e.g., >$50k). +- **Audit**: Every approved business case creates a baseline for post-implementation review (PIR). + +## Quick Reference + +1. **Define Executive Summary**: State the "bottom line" clinical and financial impact. +2. **State the Problem/Opportunity**: Why is this investment needed now? +3. **Align with Strategy**: How does this link to the organization's 5-year plan? +4. **Identify Options**: Compare "Do Nothing", "Preferred Option", and "Alternative Option". +5. **Clinical Justification**: Document the patient safety and quality benefits. +6. **Financial Analysis**: Calculate TCO, ROI, and Payback Period. +7. **Risk Assessment**: Identify clinical, financial, and operational risks. +8. **Implementation Plan**: Outline the high-level roadmap and milestones. +9. **Stakeholder Endorsement**: List the clinical and administrative supporters. + +## Detailed Guidance + +### 1. Business Case Structure +A high-quality healthcare business case must include: + +#### Strategic Case +- **Strategic Fit**: Link to national health targets or local strategic pillars. +- **Benefits Realization**: Specific, measurable clinical and operational improvements. + +#### Economic Case +- **Options Appraisal**: Qualitative and quantitative comparison of different paths. +- **Value for Money**: Why the preferred option provides the best outcome for the cost. + +#### Commercial Case +- **Market Analysis**: Overview of available vendors and solutions. +- **Procurement Strategy**: Leasing vs. buying, or Managed Service contracts. + +#### Financial Case +- **Capital Cost**: Initial purchase and installation. +- **Operating Cost**: Annual maintenance, consumables, and staffing impact. +- **Funding Source**: Identified budget line or grant opportunity. + +#### Management Case +- **Governance**: Project board and reporting structure. +- **Timeline**: Critical path and expected "Go-Live" date. + +### 2. ROI Calculation Guidance +In healthcare, ROI includes both financial and "Social/Clinical ROI": +- **Financial Savings**: Reduced length of stay (LOS), lower complication rates, or reduced outsourcing costs. +- **Efficiency Gains**: Clinician time saved (expressed in FTE equivalents). +- **Revenue Generation**: Increased throughput or access to new funding streams (e.g., private patients). +- **Clinical ROI**: Improved survival rates, reduced readmissions, or improved patient reported outcome measures (PROMs). + +### 3. Risk Assessment Section +Every business case must address: +- **Clinical Risk**: Risk of the new service/device failing or causing harm. +- **Financial Risk**: Cost overruns or failure to realize expected savings. +- **Operational Risk**: Disruption to existing services during implementation. +- **Regulatory Risk**: Non-compliance with TGA/FDA or privacy laws. + +## Documentation Requirements + +- [ ] **Business Case Document**: Using the approved organizational template. +- [ ] **Financial Worksheet**: Detailed spreadsheet showing 5-10 year cash flow. +- [ ] **Stakeholder Matrix**: Record of consultation with Clinicians, IT, and Finance. +- [ ] **Risk Register**: Mitigation plans for the top 5 project risks. + +## Common Mistakes (Anti-Patterns) + +| Mistake | Why It's Wrong | Instead | +|---------|----------------|---------| +| Underestimating Ongoing Costs | Operating costs usually outweigh capital costs within 3 years. | Include service contracts, consumables, and electricity/gas needs. | +| Ignoring "Hidden" Stakeholders | Missing IT or Facilities input leads to installation delays and unbudgeted costs. | Consult every department affected by the device/service. | +| Over-optimistic Benefits | Leads to failure in post-implementation reviews and loss of credibility. | Use conservative, evidence-based projections for savings and gains. | +| Vague Clinical Justification | "Improved quality" is not a business case; it needs data. | Use specific metrics like "Expected reduction in infection rate by 15%". | +| Forgetting the "Do Nothing" Option | Fails to provide a baseline for comparison and evaluation. | Always document the clinical and financial risk of the status quo. | + +## When to Escalate + +Escalate to the Project Sponsor or Finance Director when: +- The preferred option involves a significant conflict of interest. +- The financial analysis reveals that the investment will never reach a break-even point. +- A critical clinical stakeholder opposes the proposed service change. +- The project involves high-risk "Sovereign Data" or offshore hosting. + +## Privacy Considerations + +- **PHI involved**: Usually No, unless the business case contains patient data for research justification. +- **Data minimization**: Use aggregated clinical data rather than individual patient records. +- **Retention**: Business cases should be retained for 10-15 years according to capital investment policies. + +## Confidence Indicators + +| Scenario | Confidence | Action | +|----------|------------|--------| +| Standard equipment replacement with a clear positive ROI | High | Propose the draft business case and financial summary. | +| New service model with complex cross-departmental impacts | Medium | Guide the structure but require SME input for operational flow. | +| Investment in experimental technology with no established ROI | Low | REQUIRE a detailed "Pre-mortem" and Ethics Committee review. | + +## Standard and Lite Modes + +- **Standard**: Full multi-disciplinary business case for major capital or service changes. +- **Lite**: Short-form "Memorandum of Justification" for low-cost items or urgent clinical needs. + +## Tool Requirements + +- `~~finance/roi-template` - For financial modeling. +- `~~project tracker` - For milestone and task tracking. +- `~~cloud storage` - For document collaboration. + +## Success Indicators + +You've applied this skill well when: +- [ ] The strategic link to organizational goals is explicit. +- [ ] Financial analysis includes Total Cost of Ownership (TCO). +- [ ] Clinical benefits are defined with measurable KPIs. +- [ ] A multi-disciplinary stakeholder group has been consulted. +- [ ] Risks are identified with corresponding mitigation strategies. + +## Related Skills + +- `~~health/device-procurement` - For the technical evaluation of the items being requested. +- `~~finance/audit-support` - For aligning with organizational financial standards. +- `~~health/quality-improvement` - For tracking the benefits after implementation. diff --git a/health/skills/device-procurement/SKILL.md b/health/skills/device-procurement/SKILL.md new file mode 100644 index 0000000..e4f66a7 --- /dev/null +++ b/health/skills/device-procurement/SKILL.md @@ -0,0 +1,155 @@ +--- +name: health/device-procurement +description: This skill should be used when evaluating, selecting, and procuring medical devices for healthcare organizations. Use when a user mentions medical device procurement, TGA/FDA/CE compliance, vendor assessment, medical equipment evaluation, or healthcare device contracts. +version: 1.0.0 +--- + +# Medical Device Procurement + +Structured guidance for the evaluation, regulatory verification, and procurement of medical devices to ensure clinical safety, operational efficiency, and financial viability. + +**Important**: This skill assists with the procurement workflow and regulatory screening but does not provide legal advice or definitive clinical endorsement. All device selections must be reviewed by the organization's Clinical Engineering (Biomedical), Infection Control, and Clinical Governance committees. + +## When to Use This Skill + +Invoke when: +- A clinical department requests a new medical device or piece of equipment. +- Reviewing vendor proposals for medical technology. +- Verifying the regulatory status (TGA, FDA, CE marking) of a device. +- Conducting a clinical trial or pilot of a new medical device. +- Drafting or reviewing healthcare-specific contract terms for equipment. +- Managing the replacement cycle for aging medical devices. +- Evaluating the total cost of ownership (TCO) for a medical investment. + +Do not use for general office supply procurement (use `~~productivity/procurement`) or for pharmaceutical procurement (use `~~health/pharmacy-management`). + +## Regulatory Context + +| Regulation | Relevance | Key Requirements | +|------------|-----------|------------------| +| **AU/NZ Baseline** | TGA (AU), Medsafe (NZ), AS/NZS 3551 | Devices must be on the ARTG (AU) or WAND (NZ). Compliance with AS/NZS 3551 for management of medical devices. | +| **US/EU-lite (optional)** | FDA (US), MDR/IVDR (EU) | FDA 510(k) or PMA approval. CE marking under MDR (2017/745) or IVDR (2017/746). | + +### Compliance Triggers +- **New Device Intake**: Immediate verification of ARTG/Medsafe registration. +- **Safety Alerts**: Ongoing monitoring of TGA/FDA recall databases. +- **Maintenance**: Annual safety testing according to AS/NZS 3551. + +## Quick Reference + +1. **Define Clinical Need**: Document the specific problem the device solves. +2. **Regulatory Screen**: Verify the device is registered for use in the jurisdiction. +3. **Technical Evaluation**: Review specifications against organizational infrastructure. +4. **Clinical Evaluation**: Conduct trials or review peer-reviewed clinical data. +5. **Financial Analysis**: Calculate TCO including consumables and maintenance. +6. **Vendor Assessment**: Evaluate vendor stability, support, and security. +7. **Risk Assessment**: Identify safety, privacy, and integration risks. +8. **Contract Review**: Ensure healthcare-specific clauses are present. +9. **Governance Approval**: Submit to relevant committees for endorsement. + +## Detailed Guidance + +### 1. Device Evaluation Criteria +Evaluation must cover three primary domains: + +#### Clinical Suitability +- **Efficacy**: Does the device improve patient outcomes according to Level I/II evidence? +- **Usability**: Is the interface intuitive for the intended clinical user? +- **Ergonomics**: Does the device design minimize physical strain or error? +- **Patient Safety**: Are there built-in fail-safes and clear alarms? + +#### Technical Compatibility +- **Interoperability**: Does it connect to the EHR (HL7/FHIR) or VNA (DICOM)? +- **Infrastructure**: Does it require specific power, gas, or network (Wi-Fi/Ethernet)? +- **Maintenance**: Can the local Clinical Engineering team service it, or is it "Vendor-Only"? +- **Longevity**: What is the expected lifecycle and "End of Support" date? + +#### Operational Impact +- **Workflow**: How does it change the current clinical workflow? +- **Training**: What is the learning curve and ongoing training requirement? +- **Storage**: Does the device require specialized storage or charging stations? + +### 2. Regulatory Compliance Checklist (AU/NZ Default) +Before any medical device is purchased, verify: +- [ ] **ARTG Entry (Australia)**: Valid entry number and correct classification (Class I, IIa, IIb, III). +- [ ] **WAND Entry (New Zealand)**: Verification of notification to Medsafe. +- [ ] **Manufacturer Evidence**: Proof of QMS (ISO 13485) and Essential Principles compliance. +- [ ] **GMDN Code**: Correct Global Medical Device Nomenclature assigned. +- [ ] **IVD Status**: If diagnostic, verify In-Vitro Diagnostic compliance. + +### 3. Vendor Assessment Framework +Evaluate potential vendors based on: +- **Financial Stability**: Can they support the device lifecycle? +- **Clinical Support**: Availability of clinical application specialists. +- **Technical Support**: Response times for repairs and spare parts availability. +- **Cybersecurity**: Compliance with the Manufacturer Disclosure Statement for Medical Device Security (MDS2). +- **Sustainability**: Environmental impact of the device and its disposal. + +## Documentation Requirements + +- [ ] **Business Case**: Justification for the investment. +- [ ] **Clinical Trial Report**: Summary of user feedback and outcomes. +- [ ] **TCO Worksheet**: 5-10 year cost projection. +- [ ] **MDS2 Form**: For networked or software-based devices. +- [ ] **Acceptance Testing Record**: Baseline safety and functional check. + +## Common Mistakes (Anti-Patterns) + +| Mistake | Why It's Wrong | Instead | +|---------|----------------|---------| +| Ignoring Consumable Costs | Long-term costs can exceed the initial purchase price by 5x. | Perform a full Lifecycle Cost Analysis (LCA). | +| Skipping Infrastructure Check | Device arrives but cannot connect to Wi-Fi or fit through doors. | Involve Clinical Engineering and IT at the "Discovery" phase. | +| Accepting "Demo" Units without ARTG | Clinical use of unregistered devices is a major regulatory breach. | Verify registration before any patient contact occurs. | +| Buying Based on "Feature Bloat" | Unused features increase cost and complexity without clinical benefit. | Buy against documented "Minimum Essential Requirements". | +| Neglecting De-commissioning | Old devices create storage clutter and safety/privacy risks. | Include disposal/data-wipe costs in the initial business case. | + +## When to Escalate + +Escalate to the Chief Medical Officer or Procurement Director when: +- A device is identified as being used without valid regulatory registration. +- A vendor is unable to provide an MDS2 for a network-connected device. +- Significant clinical variation or adverse events are reported during a trial. +- There is a conflict of interest between a clinician and a vendor. +- The procurement exceeds the delegated financial authority of the department. + +## Privacy Considerations + +- **PHI involved**: Software-based devices often store or transmit patient data. +- **Data minimization**: Ensure devices only capture and transmit necessary clinical parameters. +- **De-identification**: Verify that "Export" functions for research de-identify data appropriately. +- **Retention**: Local storage on devices should be encrypted and cleared according to policy. + +## Confidence Indicators + +| Scenario | Confidence | Action | +|----------|------------|--------| +| Standard replacement of an ARTG-registered, Class I device | High | Propose procurement path and checklist. | +| Procurement of a new Class III invasive device | Medium | Guide the evaluation but require SME clinical lead review. | +| Device involves novel AI/ML clinical decision support | Low | REQUIRE review by the Clinical Governance and Ethics committees. | + +## Standard and Lite Modes + +- **Standard**: Full procurement lifecycle including multi-disciplinary trials and TCO analysis. +- **Lite**: Rapid assessment for low-cost, low-risk (Class I) replacement items. + +## Tool Requirements + +- `~~health/artg-lookup` - For AU regulatory verification. +- `~~finance/tco-calculator` - For lifecycle costing. +- `~~legal/contract-templates` - For healthcare-specific terms. +- `~~project tracker` - For workflow tracking. + +## Success Indicators + +You've applied this skill well when: +- [ ] Regulatory registration (TGA/FDA) is verified and documented. +- [ ] Total Cost of Ownership includes all hidden costs (maintenance, consumables). +- [ ] Infrastructure and IT compatibility is confirmed. +- [ ] Cybersecurity risk assessment (MDS2) is complete. +- [ ] Clinical and operational stakeholders have endorsed the selection. + +## Related Skills + +- `~~health/business-case` - For drafting the investment justification. +- `~~legal/contract-review` - For the final analysis of purchase terms. +- `~~health/incident-reporting` - For monitoring device safety post-procurement. From 94e5be560d0a43385ad8b56ab103f1efb40b61f3 Mon Sep 17 00:00:00 2001 From: "Dylan Mordaunt (Illawarra Shoalhaven LHD)" Date: Sat, 14 Feb 2026 10:54:22 +1100 Subject: [PATCH 30/57] feat(health): Create quality-improvement skill with PDSA framework and accreditation guidance --- conductor/tracks/health-quality/plan.md | 3 +- health/skills/quality-improvement/SKILL.md | 332 +++++++++++++++++++++ 2 files changed, 334 insertions(+), 1 deletion(-) create mode 100644 health/skills/quality-improvement/SKILL.md diff --git a/conductor/tracks/health-quality/plan.md b/conductor/tracks/health-quality/plan.md index 95c5199..bd499fc 100644 --- a/conductor/tracks/health-quality/plan.md +++ b/conductor/tracks/health-quality/plan.md @@ -4,9 +4,10 @@ *Dependencies: health-core* *Estimated: 1-2 sessions* -- [ ] Create `health/skills/quality-improvement/SKILL.md` +- [~] Create `health/skills/quality-improvement/SKILL.md` - Acceptance: Follows [health skill standards](../health-plugin/skill-standards.md) (14-section template) - Acceptance: Includes Confidence Indicators for QI project outcomes + - Acceptance: AU/NZ quality and accreditation defaults are explicit, with US/EU-lite fallback - Acceptance: QI project framework - Acceptance: PDSA cycle guidance - Acceptance: Data collection planning diff --git a/health/skills/quality-improvement/SKILL.md b/health/skills/quality-improvement/SKILL.md new file mode 100644 index 0000000..5c138d8 --- /dev/null +++ b/health/skills/quality-improvement/SKILL.md @@ -0,0 +1,332 @@ +--- +name: health/quality-improvement +description: This skill should be used when planning, executing, or reporting quality improvement (QI) projects in healthcare settings. Use for PDSA cycles, accreditation preparation, clinical indicator monitoring, and continuous quality improvement initiatives. +version: 1.0.0 +--- + +# Quality Improvement + +A comprehensive framework for healthcare quality improvement projects, supporting clinicians and administrators in systematic approaches to enhance patient care, safety, and service delivery. This skill integrates evidence-based methodologies with healthcare regulatory requirements. + +**Important**: This skill assists with quality improvement workflows but does not replace clinical judgment or statutory reporting obligations. Always verify compliance with local regulatory requirements. + +## When to Use This Skill + +Invoke this skill when: +- Planning a new quality improvement project or initiative. +- Designing or executing a Plan-Do-Study-Act (PDSA) cycle. +- Preparing for accreditation surveys or quality audits. +- Analyzing clinical indicator data and identifying improvement opportunities. +- Developing data collection plans for quality monitoring. +- Writing QI project reports for governance or regulatory submission. +- Implementing statistical process control (SPC) charts. +- Conducting root cause analysis for quality gaps. +- Mapping QI activities to jurisdictional accreditation standards (AU/NZ default). + +## Regulatory Context + +### Australia & New Zealand (Default) + +| Regulation/Standard | Relevance | Key Requirements | +|---------------------|-----------|------------------| +| **NSQHS Standards** (AU) | Acute care quality | Standard 1: Governance; Standard 3: Preventing Controlling Healthcare-Associated Infection | +| **ACHS EQuIP6** (AU) | Accreditation program | Assessment, monitoring, and improvement of clinical care and service delivery | +| **HQSC NZ** | National quality agency | National Patient Safety Framework; Learning from adverse events | +| **CQC Standards** (NZ) | Health and disability services | Quality assurance and risk management requirements | +| **State/Territory Acts** | Jurisdiction-specific | Mandatory reporting of serious incidents; QI data retention | + +### US/EU-lite Fallback + +| Regulation/Standard | Relevance | Key Requirements | +|---------------------|-----------|------------------| +| **Joint Commission** (US) | Hospital accreditation | ORYX performance measurement; PI.01.01.01 systematic improvement | +| **CMS Quality Measures** (US) | Federal programs | Core quality measures for reimbursement; mandatory reporting | +| **ISO 9001:2015** | International | Quality management systems; PDCA methodology alignment | + +### Jurisdiction Matrix + +| Jurisdiction | Applicable Regulator | Reporting Trigger | Timeframe | Required Artifacts | Escalation Point | +|--------------|---------------------|-------------------|-----------|-------------------|------------------| +| **AU - National** | ACSQHC (NSQHS) | Accreditation survey | 3-4 years | QI portfolio; SPC charts; RCA reports | Quality Manager | +| **AU - State** | State Health Dept | Serious incident review | 24-72 hours | Root cause analysis; action plans | Chief Medical Officer | +| **NZ - National** | HQSC | Sentinel event | Immediate | Notification form; preliminary review | Quality & Risk Director | +| **US** | Joint Commission/CMS | Hospital-acquired condition | Quarterly | Core measure data; improvement plans | VP Quality | + +## Quick Reference + +1. **Define the Problem**: Use operational definitions and baseline data. +2. **Form the Team**: Include frontline staff, data analyst, and executive sponsor. +3. **PDSA Cycles**: Plan small, test small, scale gradually. +4. **Data Quality**: Ensure valid, reliable, and timely data collection. +5. **Statistical Thinking**: Distinguish common cause vs. special cause variation. +6. **Patient-Centered**: Include patient/family input in design and evaluation. +7. **Sustainability**: Plan for control phase before implementation. +8. **Documentation**: Maintain QI file for accreditation and audit purposes. + +## Operating Modes + +### Standard Mode +Full quality improvement methodology with complete documentation, statistical process control, multidisciplinary team engagement, and formal reporting to governance. Use for accreditation-mandated QI projects and clinical indicator monitoring. + +### Lite Mode +Streamlined guidance for rapid cycle improvements or informal "just do it" changes. Focuses on essential PDSA elements and basic data collection. Never suppresses high-risk escalation requirements or mandatory reporting obligations. + +## Detailed Guidance + +### 1. QI Project Framework + +Every quality improvement project should follow a structured approach: + +#### Phase 1: Initiation +- **Problem Statement**: Describe the gap between current and desired performance. +- **Operational Definition**: Precisely define the process or outcome being measured. +- **Aim Statement**: SMART format (Specific, Measurable, Achievable, Relevant, Time-bound). +- **Business Case**: Resources required, expected benefits, alignment with strategic priorities. + +#### Phase 2: Analysis +- **Baseline Measurement**: Current state data collection (minimum 20-30 data points). +- **Process Mapping**: Flowchart the current process; identify value-add vs. waste steps. +- **Root Cause Analysis**: Fishbone diagrams, 5 Whys, or FMEA for complex issues. +- **Driver Diagram**: Primary drivers → Secondary drivers → Change ideas. + +#### Phase 3: Intervention +- **Change Package**: Bundle of evidence-based interventions. +- **PDSA Cycles**: Sequential testing and refinement (see PDSA section below). +- **Implementation Strategy**: Planned adaptation using frameworks like i-PARIHS. + +#### Phase 4: Evaluation +- **Outcome Measures**: Did we achieve the aim? +- **Process Measures**: Are we doing what we planned? +- **Balancing Measures**: Did we cause unintended harm? +- **Statistical Analysis**: Control charts, run charts, or appropriate statistical tests. + +#### Phase 5: Sustainability +- **Control Plan**: Monitoring strategy post-implementation. +- **Spread Strategy**: Dissemination to other units or organizations. +- **Lessons Learned**: Document successes, failures, and adaptations. + +### 2. PDSA Cycle Guidance + +The Plan-Do-Study-Act cycle is the engine of quality improvement: + +#### PLAN +- **Objective**: What are we trying to accomplish? +- **Questions**: What change might result in improvement? How will we know? +- **Prediction**: Hypothesize the outcome. +- **Plan**: Who, what, where, when for the test. +- **Data Collection**: Define measures and collection method. + +**Key Questions**: +- Is the change idea feasible? +- What is the smallest scale we can test? +- What could go wrong? +- How will we collect data during the test? + +#### DO +- **Execute**: Run the test according to plan. +- **Document**: Record observations, unexpected events, and deviations. +- **Collect Data**: Gather planned measures. +- **Protect Patients**: Safety monitoring throughout. + +**Common Pitfalls**: +- Changing multiple variables simultaneously. +- Inadequate documentation of context. +- Not involving frontline staff in execution. + +#### STUDY +- **Analyze Data**: Compare results to prediction. +- **Reflection**: What did we learn? +- **Variation**: Consider special cause vs. common cause. +- **Refinement**: What modifications are needed? + +**Key Questions**: +- Did the change result in improvement? +- What contextual factors influenced results? +- Should we adapt, adopt, or abandon the change? + +#### ACT +- **Decision**: What is our next action? + - **Adopt**: Standardize the change. + - **Adapt**: Modify and test again. + - **Abandon**: Try a different change idea. +- **Next Cycle**: Plan the subsequent PDSA. +- **Communication**: Share learnings with stakeholders. + +### 3. Data Collection Planning + +#### Types of Measures + +| Measure Type | Definition | Example | +|--------------|------------|---------| +| **Outcome** | Impact on patients/population | Mortality rate; patient satisfaction | +| **Process** | Steps in care delivery | % compliance with hand hygiene | +| **Structure** | Resources and capacity | Staff-to-patient ratio | +| **Balancing** | Unintended consequences | Time to treatment; staff workload | + +#### Data Collection Methods + +**Manual Collection**: +- Checklists and observation forms +- Chart audits (retrospective) +- Surveys and interviews +- Focus groups + +**Automated Collection**: +- EHR reporting (FHIR queries) +- Clinical data warehouses +- Administrative databases +- Real-time monitoring systems + +#### Sampling Strategy +- **Convenience**: Easiest to collect (risk of bias). +- **Random**: Every member of population has equal chance. +- **Systematic**: Every nth case (e.g., every 10th patient). +- **Stratified**: Ensure representation across subgroups. + +**Sample Size Considerations**: +- Baseline: Minimum 20-30 data points for run charts. +- Control charts: 20-25 subgroups of 3-5 samples each. +- Statistical significance: Power analysis for hypothesis testing. + +#### Measurement Reliability +- **Operational Definition**: Clear, precise definition of what is being measured. +- **Data Collection Tool**: Validated instrument or form. +- **Training**: Standardized training for data collectors. +- **Inter-rater Reliability**: Multiple collectors measuring same cases (target: kappa ≥ 0.8). +- **Pilot Testing**: Small-scale validation before full implementation. + +### 4. Statistical Process Control + +#### Run Charts +- **Use**: Track performance over time; detect trends. +- **Rules**: Non-random patterns (trend, shift, astronomical point). +- **Minimum**: 10-12 data points to apply rules. + +#### Control Charts (SPC) +- **Purpose**: Distinguish common cause vs. special cause variation. +- **Types**: + - p-chart: Proportions (e.g., infection rates). + - c-chart: Counts (e.g., falls per month). + - X-bar/R chart: Continuous data with subgroups. + - I-MR chart: Individual measurements. +- **Interpretation**: + - Points outside control limits = special cause. + - Non-random patterns = special cause. + - Points within limits = common cause (requires fundamental redesign). + +### 5. Quality Improvement Methodologies + +#### Model for Improvement (MFI) +Three fundamental questions: +1. What are we trying to accomplish? +2. How will we know that a change is an improvement? +3. What change can we make that will result in improvement? + +#### Lean Healthcare +- **Focus**: Eliminate waste (muda) and optimize flow. +- **Waste Categories**: Defects, overproduction, waiting, non-utilized talent, transportation, inventory, motion, extra-processing (DOWNTIME). +- **Tools**: Value stream mapping, 5S, standard work, visual management. + +#### Six Sigma +- **Goal**: Reduce variation (target: 3.4 defects per million). +- **DMAIC**: Define, Measure, Analyze, Improve, Control. +- **Tools**: Statistical analysis, process capability, design of experiments. + +## Documentation Requirements + +### QI Project File +- [ ] Project charter with aim statement and scope +- [ ] Team membership and roles +- [ ] Literature review or evidence summary +- [ ] Baseline data and operational definitions +- [ ] Process maps and flowcharts +- [ ] Root cause analysis documentation +- [ ] PDSA cycle documentation (all iterations) +- [ ] Run/control charts with interpretation +- [ ] Sustainability and control plan +- [ ] Lessons learned and spread strategy + +### Accreditation Evidence +- [ ] Alignment with applicable standards (NSQHS, EQuIP6, Joint Commission) +- [ ] Evidence of governance oversight and approval +- [ ] Demonstration of systematic improvement methodology +- [ ] Patient/family engagement documentation +- [ ] Staff training and competency records +- [ ] Evaluation of outcomes and balancing measures + +## Common Mistakes + +| Mistake | Why It's Wrong | Instead | +|---------|----------------|---------| +| **No operational definition** | Ambiguity leads to inconsistent measurement | Define precisely what is being measured, including inclusion/exclusion criteria | +| **Insufficient baseline data** | Cannot distinguish improvement from random variation | Collect minimum 20-30 data points before intervention | +| **Multiple simultaneous changes** | Cannot determine which change caused effect | Test one change at a time using PDSA | +| **Ignoring balancing measures** | May cause unintended harm elsewhere | Always monitor for negative consequences | +| **Concluding too early** | Special cause may be temporary | Wait for sustained improvement over time | +| **Confusing audit with QI** | Audits identify gaps; QI improves systems | Use QI methodology to address audit findings | +| **Top-down mandates** | Frontline staff lack ownership | Engage those doing the work in design and testing | +| **No sustainability plan** | Improvements revert after project ends | Develop control plan before implementation | +| **Data without context** | Numbers alone don't explain variation | Annotate charts with contextual events | +| **Complex interventions first** | High risk of failure and resource waste | Start with small-scale tests of change | + +## When to Escalate + +Escalate to Quality Manager or Chief Medical Officer when: +- Patient safety is or may be compromised by the improvement effort. +- Data reveals sentinel events or serious incidents requiring statutory reporting. +- Project requires resources beyond team authority or budget. +- Resistance from clinical leaders or significant stakeholder conflict. +- Results suggest fundamental system redesign is needed (common cause variation). +- Accreditation survey is imminent and QI documentation is incomplete. +- Project timeline cannot meet regulatory or accreditation deadlines. + +## Privacy Considerations + +- **PHI Involved**: Yes - QI projects often use patient-level data. +- **Data Minimization**: Collect only data elements necessary for the specific QI question. +- **De-identification**: Use patient identifiers only for data linkage; remove before analysis and reporting. +- **Access Controls**: Limit QI data access to project team members with legitimate need. +- **Retention**: Retain QI records according to organizational policy (typically 7+ years for accreditation). +- **Aggregation**: Report results in aggregate to protect individual privacy. +- **No Persistence**: Do not store PHI in temporary workspaces or chat history. + +## Confidence Indicators + +| Scenario | Confidence | Action | +|----------|------------|--------| +| Standard PDSA cycle with clear outcome measure and stable baseline | High | Proceed with testing; document and monitor | +| Complex system intervention with multiple variables | Medium | Consult with statistician or QI expert; consider stepped-wedge design | +| Results suggest patient harm or safety compromise | Low | **BLOCKER**: Escalate immediately; halt intervention pending review | +| Ambiguous data or unclear causation | Medium | Flag for QI specialist review; collect additional data before proceeding | +| Accreditation-critical QI project with survey imminent | Medium | Escalate to Quality Manager for oversight and resource allocation | +| Novel intervention without evidence base | Low | Require literature review and ethics consideration; involve Research Office if research intent | + +## Tool Requirements + +- `~~project tracker` - For QI project management and milestone tracking +- `~~cloud storage` - For QI file storage and team collaboration +- `~~health/clinical-systems` - For accessing EHR data and clinical indicators +- `~~data analysis` - For statistical analysis and visualization (SPC charts) +- `~~document collaboration` - For team documentation and reporting + +## Success Indicators + +You've applied this skill well when: +- [ ] Aim statement is SMART and aligned with organizational priorities +- [ ] Operational definitions are clear and measurement is reliable +- [ ] PDSA cycles are documented with predictions and reflections +- [ ] Data is displayed over time using run or control charts +- [ ] Team includes frontline staff and has executive sponsor +- [ ] Balancing measures are monitored and reported +- [ ] Documentation is complete for accreditation purposes +- [ ] Sustainability plan is in place before implementation +- [ ] Patient/family perspective is incorporated +- [ ] Results are statistically significant or practically important + +## Related Skills + +- `~~health/incident-reporting` - When QI reveals serious incidents requiring formal reporting +- `~~health/clinical-risk-assessment` - For risk assessment in QI project design +- `~~health/policy-development` - When QI results require policy changes +- `~~data/statistical-analysis` - For advanced statistical methods in QI evaluation +- `product-management/roadmap-management` - For prioritizing QI projects in organizational strategy From 05f35115ef7f693c9211c793d2d7520b347c112f Mon Sep 17 00:00:00 2001 From: "Dylan Mordaunt (Illawarra Shoalhaven LHD)" Date: Sat, 14 Feb 2026 10:55:20 +1100 Subject: [PATCH 31/57] conductor(plan): Mark task 'Create quality-improvement skill' as complete --- conductor/tracks/health-quality/plan.md | 2 +- 1 file changed, 1 insertion(+), 1 deletion(-) diff --git a/conductor/tracks/health-quality/plan.md b/conductor/tracks/health-quality/plan.md index bd499fc..81c55a1 100644 --- a/conductor/tracks/health-quality/plan.md +++ b/conductor/tracks/health-quality/plan.md @@ -4,7 +4,7 @@ *Dependencies: health-core* *Estimated: 1-2 sessions* -- [~] Create `health/skills/quality-improvement/SKILL.md` +- [x] Create `health/skills/quality-improvement/SKILL.md` [94e5be5] - Acceptance: Follows [health skill standards](../health-plugin/skill-standards.md) (14-section template) - Acceptance: Includes Confidence Indicators for QI project outcomes - Acceptance: AU/NZ quality and accreditation defaults are explicit, with US/EU-lite fallback From 4df6a0c7a9edf7497e5d15a4458ae275c13adbd2 Mon Sep 17 00:00:00 2001 From: "Dylan Mordaunt (Illawarra Shoalhaven LHD)" Date: Sat, 14 Feb 2026 11:05:50 +1100 Subject: [PATCH 32/57] feat(health): Add accreditation-prep skill for survey preparation --- conductor/tracks/health-quality/plan.md | 2 +- health/skills/accreditation-prep/SKILL.md | 380 ++++++++++++++++++++++ 2 files changed, 381 insertions(+), 1 deletion(-) create mode 100644 health/skills/accreditation-prep/SKILL.md diff --git a/conductor/tracks/health-quality/plan.md b/conductor/tracks/health-quality/plan.md index 81c55a1..8456c14 100644 --- a/conductor/tracks/health-quality/plan.md +++ b/conductor/tracks/health-quality/plan.md @@ -17,7 +17,7 @@ *Dependencies: Phase 1* *Estimated: 1-2 sessions* -- [ ] Create `health/skills/accreditation-prep/SKILL.md` +- [x] Create `health/skills/accreditation-prep/SKILL.md` - Acceptance: Survey preparation checklist - Acceptance: Tracer methodology - Acceptance: Continuous readiness diff --git a/health/skills/accreditation-prep/SKILL.md b/health/skills/accreditation-prep/SKILL.md new file mode 100644 index 0000000..cb24c64 --- /dev/null +++ b/health/skills/accreditation-prep/SKILL.md @@ -0,0 +1,380 @@ +--- +name: health/accreditation-prep +description: This skill should be used when preparing for healthcare accreditation surveys, conducting tracer methodology exercises, maintaining continuous readiness programs, or responding to accreditation findings. Supports ACSQHC NSQHS Standards, ACHS EQuIP6, Joint Commission, and other accreditation programs. +version: 1.0.0 +--- + +# Accreditation Preparation + +A comprehensive framework for preparing healthcare organizations for accreditation surveys and maintaining continuous readiness. This skill guides quality and clinical teams through systematic survey preparation, tracer methodology, and response to accreditation findings. + +**Important**: This skill assists with accreditation preparation workflows but does not guarantee survey success. Survey outcomes depend on actual organizational performance, documentation accuracy, and surveyor judgment. Always verify current standards with your accrediting body. + +## When to Use This Skill + +Invoke this skill when: +- Preparing for an upcoming accreditation survey (announced or unannounced). +- Conducting internal mock surveys or tracer exercises. +- Developing continuous readiness programs between survey cycles. +- Responding to accreditation findings or requirements for improvement (RFI). +- Training staff on tracer methodology and survey processes. +- Conducting pre-survey gap analyses against accreditation standards. +- Planning for re-accreditation or initial accreditation applications. +- Addressing standards non-compliance identified through internal audits. +- Coordinating evidence collection for accreditation documentation. +- Preparing leadership and staff for surveyor interviews. + +## Regulatory Context + +### Australia & New Zealand (Default) + +| Regulation/Standard | Relevance | Key Requirements | +|---------------------|-----------|------------------| +| **NSQHS Standards** (AU) | National safety and quality | 8 standards with 200+ actions; mandatory for acute services | +| **ACHS EQuIP6** (AU) | Accreditation program | Organization-wide assessment; patient-centered care focus | +| **NQPS** (AU) | National standards | Aged care quality standards (8 standards) | +| **HQSC NZ Standards** | National quality | Safe and effective care standards; learning systems | +| **CQC Standards** (NZ) | Health and disability | Outcome-based standards; consumer rights protection | +| **State Licensing** | Jurisdiction-specific | Additional requirements beyond national standards | + +### US/EU-lite Fallback + +| Regulation/Standard | Relevance | Key Requirements | +|---------------------|-----------|------------------| +| **Joint Commission** (US) | Hospital accreditation | Standards chapters (PC, EC, IC, HR, etc.); tracer methodology | +| **DNV NIAHO** (US) | Alternative accreditation | ISO 9001 integration; annual surveys | +| **CMS CoPs** (US) | Federal participation | Conditions of Participation; deemed status through accreditation | +| **ISO 15189** (EU/Int'l) | Laboratory accreditation | Quality management for medical laboratories | +| **CAP Standards** (US) | Laboratory accreditation | Checklist-based standards; peer inspection | + +### Jurisdiction Matrix + +| Jurisdiction | Applicable Regulator | Reporting Trigger | Timeframe | Required Artifacts | Escalation Point | +|--------------|---------------------|-------------------|-----------|-------------------|------------------| +| **AU - National** | ACSQHC (NSQHS) | Accreditation survey | 3-4 years cycle | QI portfolio; evidence library; policies | Quality Director | +| **AU - ACHS** | ACHS EQuIP6 | Organization assessment | 4 years cycle | EQuIP6 submission; patient feedback | Accreditation Manager | +| **NZ - National** | HQSC | Standards assessment | 3-4 years cycle | Quality reports; incident data; policies | Quality & Risk Director | +| **US** | Joint Commission | Triennial survey | 3 years | Standards compliance evidence; tracer docs | VP Quality/Compliance | + +## Quick Reference + +1. **Start Early**: Begin preparation 6-12 months before anticipated survey. +2. **Know Your Standards**: Maintain current versions of applicable standards. +3. **Document Library**: Organize policies, procedures, and evidence by standard. +4. **Tracer Ready**: Ensure staff understand tracer methodology and can demonstrate compliance. +5. **Mock Surveys**: Conduct internal surveys 3-6 months before accreditation. +6. **Gap Analysis**: Identify and remediate non-compliance systematically. +7. **Staff Training**: All staff should know where to find documents and how to respond. +8. **Continuous Readiness**: Don't just prepare for surveys—embed readiness in operations. +9. **Patient Focus**: Accreditors prioritize patient safety and experience. +10. **Be Honest**: Acknowledge gaps and show improvement efforts rather than conceal problems. + +## Operating Modes + +### Standard Mode +Full accreditation preparation program including comprehensive gap analysis, mock tracer exercises, document library organization, staff education, and formal survey simulation. Use for initial accreditation or major re-accreditation cycles. + +### Lite Mode +Streamlined readiness checklist for maintaining continuous compliance between surveys or addressing specific standards. Focuses on critical safety standards and high-risk areas. Does not replace comprehensive preparation for full surveys. + +## Detailed Guidance + +### 1. Survey Preparation Framework + +#### Phase 1: Foundation (12+ months before) +- **Standards Review**: Obtain current versions of all applicable standards. +- **Gap Analysis**: Assess current compliance against each standard element. +- **Documentation Audit**: Verify all required policies and procedures exist and are current. +- **Governance Engagement**: Secure executive sponsorship and resources. +- **Team Formation**: Establish accreditation steering committee with representation from all disciplines. + +#### Phase 2: Remediation (6-12 months before) +- **Priority Setting**: Address critical non-compliance and patient safety issues first. +- **Policy Updates**: Revise or create missing policies, procedures, and protocols. +- **Process Implementation**: Roll out new workflows and validate effectiveness. +- **Evidence Collection**: Gather documentation demonstrating compliance. +- **Staff Education**: Train all staff on standards requirements and expected behaviors. + +#### Phase 3: Validation (3-6 months before) +- **Mock Surveys**: Conduct comprehensive internal survey using tracer methodology. +- **Tracer Exercises**: Practice patient journey reviews with mock surveyors. +- **Staff Interviews**: Prepare leadership and frontline staff for surveyor questions. +- **Document Refinement**: Ensure evidence is organized, current, and accessible. +- **Remediation Sprint**: Address remaining gaps identified in mock surveys. + +#### Phase 4: Survey Week +- **Logistics**: Prepare survey space, technology, and scheduling. +- **Daily Huddles**: Brief and debrief staff each day of survey. +- **Document Access**: Ensure rapid access to any requested documentation. +- **Issue Response**: Address surveyor questions promptly and accurately. +- **Professional Courtesy**: Maintain professional, cooperative demeanor. + +### 2. Tracer Methodology + +Tracer methodology is the primary survey technique used by accrediting bodies to assess actual performance by following the experience of individual patients through the healthcare system. + +#### Pre-Survey Tracer Preparation + +**Patient Selection**: +- Select representative patients across service lines and risk levels. +- Include patients with complex care (transfers, procedures, multiple services). +- Review closed records to identify potential tracer candidates. +- Consider high-risk populations (pediatrics, geriatrics, behavioral health). + +**Document Preparation**: +- Ensure medical records are complete and well-organized. +- Verify all required documentation elements are present: + - Patient identification and consent + - Clinical assessments and reassessments + - Care plans and interventions + - Medication administration records + - Infection control documentation + - Discharge planning and instructions + +**Staff Preparation**: +- Train staff to explain their roles and demonstrate competency. +- Prepare staff to discuss care decisions and rationale. +- Ensure staff know where to find policies and procedures. +- Practice explaining care coordination and handoffs. + +#### During Tracer Activity + +**Opening Conference**: +- Surveyor explains tracer process and patient selection. +- Organization presents brief overview of patient case (if allowed). +- Clarify logistics and schedule for the day. + +**Patient Journey Review**: +- Surveyor follows patient from admission through current status or discharge. +- Interviews staff involved in care at each stage. +- Reviews documentation in real-time with staff. +- Observes current care processes and environment. + +**Staff Interview Expectations**: +- Describe your role in this patient's care. +- Explain why specific interventions were chosen. +- Demonstrate knowledge of relevant policies. +- Show how you communicated with the patient and team. +- Discuss how you identified and addressed risks. + +**Common Tracer Focus Areas**: +- Medication management and reconciliation +- Infection prevention and control +- Patient rights and communication +- Care planning and coordination +- Staff competence and credentialing +- Environment of care and safety +- Quality monitoring and improvement + +#### System Tracers + +Some accrediting bodies use "system tracers" to assess organization-wide processes: + +| System Tracer | Focus Areas | Documentation to Prepare | +|---------------|-------------|-------------------------| +| **Medication Management** | Ordering, dispensing, administration, monitoring | Pharmacy policies; MARs; error reports | +| **Infection Control** | Prevention, surveillance, response | IC policies; surveillance data; outbreak logs | +| **Data Management** | Information accuracy, security, availability | IT policies; downtime procedures; breach logs | +| **Environment of Care** | Safety, security, hazardous materials | EC rounds; maintenance logs; safety data sheets | + +### 3. Continuous Readiness Program + +Rather than episodic "survey prep," mature organizations embed accreditation readiness into daily operations. + +#### Elements of Continuous Readiness + +**Monthly Activities**: +- Update policies and procedures as practices change. +- Review quality data for trends indicating compliance drift. +- Conduct targeted tracer exercises on specific units. +- Audit documentation for required elements. + +**Quarterly Activities**: +- Comprehensive mock tracer across service line. +- Staff competency validation and documentation review. +- Environment of care rounds with standards focus. +- Update evidence library and documentation. + +**Annual Activities**: +- Full organizational gap analysis against standards. +- Update standards crosswalk as standards evolve. +- Comprehensive staff education on accreditation. +- Leadership review of accreditation readiness metrics. + +#### Readiness Metrics + +| Metric | Target | Measurement | +|--------|--------|-------------| +| Policy currency | 100% reviewed within 2 years | Policy metadata review | +| Documentation completeness | >95% charts complete | Monthly chart audit | +| Staff competency current | 100% within renewal period | HR dashboard | +| Mock tracer findings closed | <5 open >30 days | Action item tracking | +| Environment of care rounds | 100% units monthly | Rounds completion log | + +### 4. Responding to Findings + +#### Immediate Response (During Survey) + +When a surveyor identifies a potential finding: +1. **Listen Carefully**: Understand the specific concern without becoming defensive. +2. **Ask Clarifying Questions**: Ensure you understand the standard being referenced. +3. **Acknowledge**: Accept the finding professionally; don't argue or make excuses. +4. **Explain Context**: If appropriate, explain circumstances without being defensive. +5. **Demonstrate Action**: Show any immediate actions taken or planned. +6. **Document**: Record the finding and discussion for post-survey follow-up. + +#### Requirements for Improvement (RFI) + +For formal findings requiring written response: + +**Standard of Improvement (SOI)**: +- Acknowledge the finding and standard. +- Describe the root cause analysis conducted. +- Outline specific actions taken to address the finding. +- Provide evidence of implementation. +- Describe monitoring to sustain improvement. + +**Evidence of Standards Compliance (ESC)**: +- Demonstrate actual compliance with the standard. +- Provide specific examples and documentation. +- Show the practice is sustained over time. +- Include data supporting compliance. + +**Timeline**: +- Immediate jeopardy: Hours to days +- Conditional accreditation: 45-90 days +- Standard findings: 60-120 days + +### 5. Documentation Library Organization + +Maintain an organized, accessible evidence library organized by standard: + +``` +Accreditation Library/ +├── Standard 1 - Governance/ +│ ├── Policies/ +│ ├── Committee Minutes/ +│ └── Evidence/ +├── Standard 2 - Partnering with Consumers/ +│ ├── Patient Feedback/ +│ ├── Complaints Data/ +│ └── Advisory Council/ +├── Standard 3 - Preventing and Controlling HAI/ +│ ├── Infection Control Policies/ +│ ├── Surveillance Reports/ +│ └── Outbreak Investigations/ +└── ... +``` + +**Key Documents to Maintain**: +- Current policies and procedures (with review dates) +- Committee minutes and governance records +- Quality improvement project documentation +- Staff credentialing and competency records +- Environment of care inspection reports +- Incident and complaint investigation reports +- Patient feedback and satisfaction data +- Training and education records + +## Documentation Requirements + +### Survey Preparation File +- [ ] Current standards documents with organizational crosswalk +- [ ] Gap analysis with remediation plan and timeline +- [ ] Mock survey reports with action items +- [ ] Tracer exercise documentation and lessons learned +- [ ] Staff education records and competency assessments +- [ ] Evidence library index and access protocols + +### Survey Week Documentation +- [ ] Daily survey schedule and logistics +- [ ] Staff contact list and roles +- [ ] Document access procedures +- [ ] Issue log for surveyor questions and responses +- [ ] Daily debrief notes and action items + +### Post-Survey Response +- [ ] Survey report with findings categorized +- [ ] Root cause analysis for each finding +- [ ] Action plans with responsible parties and due dates +- [ ] Evidence of improvement implementation +- [ ] Monitoring plan to sustain compliance + +## Common Mistakes + +| Mistake | Why It's Wrong | Instead | +|---------|----------------|---------| +| **Last-minute preparation** | Insufficient time for meaningful improvement | Start 6-12 months before anticipated survey | +| **Focusing only on documents** | Surveyors assess actual practice, not just paper | Prepare staff to demonstrate care, not just show policies | +| **Hiding problems from surveyors** | Concealment suggests systemic issues | Be transparent about gaps and show improvement efforts | +| **Inconsistent staff preparation** | Some staff unprepared creates negative impression | Train all staff on basic survey expectations | +| **Outdated policies** | Surveyors check currency; outdated docs indicate drift | Implement policy review cycle (annual minimum) | +| **Ignoring mock survey findings** | Missed opportunity to remediate before real survey | Treat mock surveys seriously; close all action items | +| **Poor document organization** | Cannot find evidence when surveyor requests it | Organize evidence library by standard; test access speed | +| **Defensive responses** | Creates adversarial relationship with surveyor | Listen professionally; acknowledge and explain | +| **No continuous readiness** | Compliance drifts between surveys | Embed readiness into monthly quality activities | +| **Neglecting environment of care** | Physical environment creates first impression | Maintain clean, safe, well-maintained physical plant | + +## When to Escalate + +Escalate to Quality Director, Chief Medical Officer, or Executive Team when: +- Surveyor identifies immediate jeopardy to patient safety. +- Conditional accreditation or denial of accreditation is threatened. +- Significant non-compliance is identified across multiple standards. +- Staff are unable to answer surveyor questions or demonstrate competency. +- Critical documentation cannot be located when requested. +- Serious incident is discovered during tracer review. +- Surveyor expresses concern about organizational culture or leadership. +- Organization is unprepared for announced survey date. +- Accreditation is essential for licensure, reimbursement, or contracts. + +## Privacy Considerations + +- **PHI Involved**: Yes - tracer methodology requires review of actual patient records. +- **De-identification**: Tracer records are reviewed with surveyors; ensure HIPAA/APP compliance for external sharing. +- **Minimum Necessary**: Only provide records specifically requested; do not volunteer additional patient information. +- **Access Controls**: Limit survey preparation team access to patient records to those needed for tracer planning. +- **Staff Privacy**: Credentialing and competency records contain personal information; handle per HR privacy policies. +- **Secure Storage**: Maintain accreditation documents in secure location; do not leave in open areas during survey. +- **Retention**: Retain survey reports and response documentation per organizational policy (typically 7+ years). + +## Confidence Indicators + +| Scenario | Confidence | Action | +|----------|------------|--------| +| Standard documentation exists and staff can articulate compliance | High | Proceed; maintain current practices | +| Minor gaps identified with clear remediation path | Medium | Develop action plan; monitor closely | +| Significant non-compliance or patient safety concerns identified | Low | **BLOCKER**: Escalate immediately; suspend activities if safety risk | +| Staff unprepared or unable to demonstrate competency | Low | Emergency education and competency validation required | +| Accreditation body issues conditional status or denial | Low | Executive leadership involvement; legal review if necessary | +| Documentation missing or significantly non-compliant | Medium | Immediate remediation sprint; consider survey delay request | + +## Tool Requirements + +- `~~cloud storage` - For accreditation documentation library and evidence storage +- `~~project tracker` - For remediation action items and survey preparation milestones +- `~~health/clinical-systems` - For accessing patient records during tracer preparation +- `~~document collaboration` - For team coordination on policy development and response writing +- `~~survey tools` - For conducting mock surveys and staff feedback + +## Success Indicators + +You've applied this skill well when: +- [ ] Gap analysis identifies all non-compliance areas with remediation timeline +- [ ] Mock tracer exercises demonstrate staff readiness and competency +- [ ] Documentation library is organized and easily accessible +- [ ] Staff can articulate standards requirements and their role in compliance +- [ ] All policies and procedures are current and evidence-based +- [ ] Continuous readiness program maintains compliance between surveys +- [ ] Response to findings is timely, thorough, and evidence-based +- [ ] Accreditation is achieved/maintained without conditions or jeopardy +- [ ] Survey process is professional and collaborative +- [ ] Lessons learned from survey are incorporated into quality improvement + +## Related Skills + +- `~~health/quality-improvement` - For systematic improvement methodology to address findings +- `~~health/policy-development` - When accreditation requires new or revised policies +- `~~health/incident-reporting` - When tracer reveals incidents requiring formal reporting +- `~~health/clinical-risk-assessment` - For risk assessment in survey preparation +- `~~health/guideline-development` - When standards require clinical guideline updates From c5231c15fe2d3a5a5ef8153345988aa9cafba436 Mon Sep 17 00:00:00 2001 From: "Dylan Mordaunt (Illawarra Shoalhaven LHD)" Date: Sat, 14 Feb 2026 11:06:21 +1100 Subject: [PATCH 33/57] conductor(plan): Mark task 'Create accreditation-prep skill' as complete --- conductor/tracks/health-quality/plan.md | 2 +- 1 file changed, 1 insertion(+), 1 deletion(-) diff --git a/conductor/tracks/health-quality/plan.md b/conductor/tracks/health-quality/plan.md index 8456c14..b1dc480 100644 --- a/conductor/tracks/health-quality/plan.md +++ b/conductor/tracks/health-quality/plan.md @@ -17,7 +17,7 @@ *Dependencies: Phase 1* *Estimated: 1-2 sessions* -- [x] Create `health/skills/accreditation-prep/SKILL.md` +- [x] Create `health/skills/accreditation-prep/SKILL.md` [4df6a0c] - Acceptance: Survey preparation checklist - Acceptance: Tracer methodology - Acceptance: Continuous readiness From f6ea7a4e50ba33dd58cf42bb007e6751735b8fe7 Mon Sep 17 00:00:00 2001 From: "Dylan Mordaunt (Illawarra Shoalhaven LHD)" Date: Sat, 14 Feb 2026 11:10:06 +1100 Subject: [PATCH 34/57] feat(health): Add qi-project command for QI project initiation --- conductor/tracks/health-quality/plan.md | 2 +- health/commands/qi-project.md | 188 ++++++++++++++++++++++++ 2 files changed, 189 insertions(+), 1 deletion(-) create mode 100644 health/commands/qi-project.md diff --git a/conductor/tracks/health-quality/plan.md b/conductor/tracks/health-quality/plan.md index b1dc480..3346937 100644 --- a/conductor/tracks/health-quality/plan.md +++ b/conductor/tracks/health-quality/plan.md @@ -26,6 +26,6 @@ *Dependencies: Phase 1* *Estimated: 0.5 sessions* -- [ ] Create `health/commands/qi-project.md` +- [x] Create `health/commands/qi-project.md` **Checkpoint:** `conductor(checkpoint): Health quality workflow complete` diff --git a/health/commands/qi-project.md b/health/commands/qi-project.md new file mode 100644 index 0000000..554b5e0 --- /dev/null +++ b/health/commands/qi-project.md @@ -0,0 +1,188 @@ +--- +name: qi-project +alias: + - qip + - quality-project +description: Initiate a healthcare quality improvement (QI) project with structured planning, PDSA cycle setup, and data collection framework. +arguments: + - name: project_title + description: "Name of the quality improvement project." + required: true + - name: aim_statement + description: "The SMART aim statement describing what the project will achieve." + required: true + - name: current_state + description: "Brief description of the current problem or baseline performance." + required: true + - name: team_lead + description: "Name or role of the QI project team lead." + required: true + - name: target_metric + description: "The primary outcome measure to track improvement." + required: true + - name: timeline_weeks + description: "Estimated project duration in weeks." + required: false +--- + +# QI Project Initiation + +Use this command to kick off a structured quality improvement project with proper planning, PDSA cycle framework, and documentation setup. + +## 1. Validate Input + +- Ensure `aim_statement` follows SMART criteria (Specific, Measurable, Achievable, Relevant, Time-bound). +- If `aim_statement` is vague or incomplete, prompt for clarification. +- If `timeline_weeks` is not provided, default to 12 weeks for typical QI cycles. + +## 2. Invoke Skill + +Use `~~health/quality-improvement` to: +1. Validate the project structure against QI methodology. +2. Design the first PDSA cycle with specific objectives. +3. Define outcome, process, and balancing measures. +4. Identify required team members and stakeholders. +5. Map regulatory requirements for QI documentation. + +## 3. Generate Structured Output + +Produce: + +### QI PROJECT CHARTER: {{project_title}} +- **Project ID**: [Generate unique ID: QI-YYYY-NNN] +- **Initiated**: {{current_timestamp}} +- **Team Lead**: {{team_lead}} +- **Timeline**: {{timeline_weeks or "12"}} weeks +- **Status**: INITIATED + +--- + +### 1. AIM STATEMENT +{{aim_statement}} + +**SMART Criteria Check**: +- [ ] Specific: Target population and scope defined +- [ ] Measurable: {{target_metric}} identified +- [ ] Achievable: Within organizational capacity +- [ ] Relevant: Aligns with strategic priorities +- [ ] Time-bound: {{timeline_weeks or "12"}}-week timeframe + +--- + +### 2. CURRENT STATE ANALYSIS +**Problem Description**: +{{current_state}} + +**Baseline Data Requirements**: +- Minimum 20-30 data points for {{target_metric}} +- Collection method: [Manual/Automated/Mixed] +- Data source: [EHR/Administrative/Chart audit] +- Operational definition: [To be defined] + +--- + +### 3. MEASURES FRAMEWORK + +| Measure Type | Measure Name | Operational Definition | Target | Collection Frequency | +|--------------|--------------|------------------------|--------|---------------------| +| **Outcome** | {{target_metric}} | [To be defined] | [To be set] | [Weekly/Monthly] | +| **Process** | [To be identified] | [To be defined] | [To be set] | [Daily/Weekly] | +| **Balancing** | [To be identified] | [To be defined] | No negative impact | [Weekly] | + +--- + +### 4. PDSA CYCLE 1 PLAN + +**Objective**: [First small test of change] + +**Change Idea**: [Specific intervention to test] + +**Prediction**: What we expect to happen + +**Plan Details**: +- **Who**: Team members involved +- **What**: Specific actions +- **Where**: Unit/location +- **When**: Start and end dates +- **How**: Implementation approach + +**Data Collection**: +- Measures to track +- Collection tools/forms +- Responsible person + +--- + +### 5. TEAM STRUCTURE + +| Role | Name/Position | Responsibility | +|------|---------------|----------------| +| **Team Lead** | {{team_lead}} | Overall project coordination | +| **Clinical Lead** | [To be assigned] | Clinical expertise and stakeholder engagement | +| **Data Analyst** | [To be assigned] | Measurement and statistical support | +| **Executive Sponsor** | [To be assigned] | Resource allocation and barrier removal | +| **Frontline Staff** | [To be identified] | Implementation and feedback | + +--- + +### 6. PROJECT TIMELINE + +| Phase | Activities | Duration | Week Target | +|-------|-----------|----------|-------------| +| **Initiation** | Charter, team formation, baseline | 1-2 weeks | Weeks 1-2 | +| **PDSA 1** | First test of change | 2-3 weeks | Weeks 3-5 | +| **PDSA 2** | Adapt and test again | 2-3 weeks | Weeks 6-8 | +| **PDSA 3+** | Scale or refine | 2-4 weeks | Weeks 9-12 | +| **Sustain** | Control plan, spread | Ongoing | Week 12+ | + +--- + +### 7. REGULATORY & DOCUMENTATION + +**NSQHS/EQuIP6 Alignment**: +- Standard 1: Governance for Safety and Quality +- Standard 3: Preventing and Controlling Healthcare-Associated Infections (if applicable) + +**Required Documentation**: +- [ ] Project charter (this document) +- [ ] Ethics consideration (if research intent) +- [ ] Evidence/literature review +- [ ] Stakeholder communication plan +- [ ] Sustainability plan + +**Privacy Considerations**: +- PHI access limited to project team +- De-identified data for analysis +- Secure storage in organizational QI repository + +--- + +### 8. NEXT STEPS + +1. [ ] **Finalize Team**: Confirm all team member assignments +2. [ ] **Collect Baseline**: Gather 20-30 data points for {{target_metric}} +3. [ ] **Operational Definitions**: Define precise measurement criteria +4. [ ] **Stakeholder Brief**: Present charter to relevant governance committee +5. [ ] **Kickoff Meeting**: Schedule team launch meeting (Week 1) +6. [ ] **Set Up Tracking**: Create run/control chart for {{target_metric}} +7. [ ] **Begin PDSA 1**: Execute first test of change + +--- + +## 4. Execute Routing + +- Save charter to `~~cloud storage` in QI project folder. +- Create project tracker entry in `~~project tracker` with milestones. +- Notify {{team_lead}} of project initiation. +- Schedule reminder for Week 2 baseline data review. + +## 5. Output Guardrails + +- **No PHI**: Do not include patient identifiers in project documentation. +- **Ethics Check**: If project involves research (generalizable knowledge), flag for Research Ethics Committee review. +- **QI vs Research**: This is a QI project (local improvement) unless generalizable knowledge is the primary goal. +- **Lite Mode**: If user requests quick start, generate minimal charter with just aim, measure, and first PDSA. + +--- + +**Note**: This charter establishes the foundation for systematic improvement. Update with actual data as the project progresses through PDSA cycles. From 814b03deaf6a35b1ff961cee0cd33d6c3c8acca3 Mon Sep 17 00:00:00 2001 From: "Dylan Mordaunt (Illawarra Shoalhaven LHD)" Date: Sat, 14 Feb 2026 11:10:26 +1100 Subject: [PATCH 35/57] conductor(plan): Mark task 'Create qi-project command' as complete --- conductor/tracks/health-quality/plan.md | 2 +- 1 file changed, 1 insertion(+), 1 deletion(-) diff --git a/conductor/tracks/health-quality/plan.md b/conductor/tracks/health-quality/plan.md index 3346937..7652be2 100644 --- a/conductor/tracks/health-quality/plan.md +++ b/conductor/tracks/health-quality/plan.md @@ -26,6 +26,6 @@ *Dependencies: Phase 1* *Estimated: 0.5 sessions* -- [x] Create `health/commands/qi-project.md` +- [x] Create `health/commands/qi-project.md` [f6ea7a4] **Checkpoint:** `conductor(checkpoint): Health quality workflow complete` From a9a05569e1d0c8a6cc4d72aeb0739afd8aa0c382 Mon Sep 17 00:00:00 2001 From: "Dylan Mordaunt (Illawarra Shoalhaven LHD)" Date: Sat, 14 Feb 2026 11:10:34 +1100 Subject: [PATCH 36/57] conductor(checkpoint): Health quality workflow complete From de2b6b68b338daf4ac923e95cf67f5b44fc74e40 Mon Sep 17 00:00:00 2001 From: "Dylan Mordaunt (Illawarra Shoalhaven LHD)" Date: Sat, 14 Feb 2026 11:11:01 +1100 Subject: [PATCH 37/57] conductor(plan): Mark checkpoint for health-quality track completion --- conductor/tracks/health-quality/plan.md | 2 +- 1 file changed, 1 insertion(+), 1 deletion(-) diff --git a/conductor/tracks/health-quality/plan.md b/conductor/tracks/health-quality/plan.md index 7652be2..752fca3 100644 --- a/conductor/tracks/health-quality/plan.md +++ b/conductor/tracks/health-quality/plan.md @@ -28,4 +28,4 @@ - [x] Create `health/commands/qi-project.md` [f6ea7a4] -**Checkpoint:** `conductor(checkpoint): Health quality workflow complete` +**Checkpoint:** `conductor(checkpoint): Health quality workflow complete` [a9a0556] From d0285602bdd28e7e715e6b0b3bdb02b98c26e773 Mon Sep 17 00:00:00 2001 From: "Dylan Mordaunt (Illawarra Shoalhaven LHD)" Date: Sat, 14 Feb 2026 11:11:16 +1100 Subject: [PATCH 38/57] conductor(tracks): Mark health-quality track as complete --- conductor/tracks.md | 2 +- 1 file changed, 1 insertion(+), 1 deletion(-) diff --git a/conductor/tracks.md b/conductor/tracks.md index 36c6708..2ffe0f5 100644 --- a/conductor/tracks.md +++ b/conductor/tracks.md @@ -52,7 +52,7 @@ Phase: 3 Adapts From: legal/contract-review --- -## [ ] Track: health-quality - QI, accreditation +## [x] Track: health-quality - QI, accreditation Folder: [./tracks/health-quality/](./tracks/health-quality/) Phase: 3 Adapts From: product-management From d64d41b0f86066e83a18c75bb035a43e9163c7d8 Mon Sep 17 00:00:00 2001 From: "Dylan Mordaunt (Illawarra Shoalhaven LHD)" Date: Sat, 14 Feb 2026 11:56:08 +1100 Subject: [PATCH 39/57] feat(health): Add payer-contracts skill for healthcare contract review --- conductor/tracks/health-financial/plan.md | 3 +- health/skills/payer-contracts/SKILL.md | 370 ++++++++++++++++++++++ 2 files changed, 372 insertions(+), 1 deletion(-) create mode 100644 health/skills/payer-contracts/SKILL.md diff --git a/conductor/tracks/health-financial/plan.md b/conductor/tracks/health-financial/plan.md index 0c71a53..7588061 100644 --- a/conductor/tracks/health-financial/plan.md +++ b/conductor/tracks/health-financial/plan.md @@ -4,9 +4,10 @@ *Dependencies: health-core* *Estimated: 1-2 sessions* -- [ ] Create `health/skills/payer-contracts/SKILL.md` +- [x] Create `health/skills/payer-contracts/SKILL.md` - Acceptance: Follows [health skill standards](../health-plugin/skill-standards.md) (14-section template) - Acceptance: Includes Confidence Indicators for contract risk + - Acceptance: AU/NZ financial and payer defaults are explicit, with US/EU-lite fallback - Acceptance: Healthcare-specific contract review checklist - Acceptance: Key term identification (rates, timeliness, medical necessity) - Acceptance: Renewal tracking guidance diff --git a/health/skills/payer-contracts/SKILL.md b/health/skills/payer-contracts/SKILL.md new file mode 100644 index 0000000..7b884b2 --- /dev/null +++ b/health/skills/payer-contracts/SKILL.md @@ -0,0 +1,370 @@ +--- +name: health/payer-contracts +description: This skill should be used when reviewing, analyzing, or negotiating healthcare payer contracts including private health insurance agreements, Medicare/DVA schedules, and managed care contracts. Use for rate analysis, term identification, renewal tracking, and compliance verification. +version: 1.0.0 +--- + +# Payer Contract Review + +A specialized framework for reviewing healthcare payer contracts, supporting finance and contracting teams in analyzing insurance agreements, government schedules, and managed care arrangements. This skill addresses healthcare-specific financial terms, regulatory requirements, and revenue cycle implications. + +**Important**: This skill assists with contract analysis workflows but does not provide legal advice or definitive financial guidance. All contract reviews must be validated by qualified legal counsel and finance professionals before execution. + +## When to Use This Skill + +Invoke this skill when: +- Reviewing proposed payer contracts or contract amendments. +- Analyzing fee schedules and reimbursement rates against benchmarks. +- Preparing for contract renewals or renegotiations. +- Evaluating value-based care or risk-sharing arrangements. +- Assessing contract terms for medical necessity and prior authorization requirements. +- Reviewing timely filing limitations and claims submission requirements. +- Identifying compliance obligations for government payer contracts. +- Tracking contract expiration dates and renewal notice periods. +- Comparing multiple payer contracts for standardization opportunities. +- Responding to payer contract termination or non-renewal notices. +- Analyzing out-of-network provisions and balance billing restrictions. +- Evaluating capitation, bundled payment, or other alternative payment models. + +## Regulatory Context + +### Australia & New Zealand (Default) + +| Regulation/Standard | Relevance | Key Requirements | +|---------------------|-----------|------------------| +| **Private Health Insurance Act** (AU) | PHI contracts | Prostheses List pricing; benefit limitation periods; waiting periods | +| **National Health Act** (AU) | Medicare benefits | Schedule fees; bulk billing; patient gap payments | +| **DVA Schedule** (AU) | Veterans care | Department of Veterans' Affairs fee schedule requirements | +| **Accident Compensation Act** (NZ) | ACC contracts | No-fault scheme; regulated fee schedules; provider enrollment | +| **Health and Disability Services** (NZ) | Service contracts | Ministry of Health funding agreements; outcome requirements | +| **State Funding Arrangements** | State-specific | Activity-based funding (ABF); block grants; service agreements | + +### US/EU-lite Fallback + +| Regulation/Standard | Relevance | Key Requirements | +|---------------------|-----------|------------------| +| **CMS Conditions of Participation** (US) | Medicare/Medicaid | Enrollment requirements; compliance obligations; payment rules | +| **No Surprises Act** (US) | Balance billing | Out-of-network emergency and air ambulance protections | +| **Affordable Care Act** (US) | Market reforms | Medical loss ratio; essential health benefits; network adequacy | +| **State Prompt Pay Laws** (US) | Payment timing | Maximum days to pay clean claims; interest penalties | +| **GDPR** (EU) | Data protection | Patient data handling in claims processing | + +### Jurisdiction Matrix + +| Jurisdiction | Applicable Regulator | Reporting Trigger | Timeframe | Required Artifacts | Escalation Point | +|--------------|---------------------|-------------------|-----------|-------------------|------------------| +| **AU - Federal** | DoHAC (PHI/Medicare) | Contract execution | 30 days notification | Signed agreement; fee schedule; compliance attestation | Chief Financial Officer | +| **AU - State** | State Health Dept | Service agreement renewal | Annual cycle | Performance report; activity data; budget reconciliation | Director of Revenue Cycle | +| **NZ - National** | Health NZ/Te Whatu Ora | Service level agreement | As specified | Contract variation requests; performance metrics | Finance Manager | +| **US - Federal** | CMS | Medicare enrollment changes | 30-60 days | CMS-855 forms; compliance documentation | Compliance Officer | +| **US - State** | State Medicaid Agency | Medicaid contract renewal | Annual/biennial | Encounter data; quality metrics; financial reports | VP Payer Relations | + +## Quick Reference + +1. **Rate Analysis**: Compare proposed rates to fee schedule benchmarks and cost data. +2. **Term Length**: Note initial term, renewal periods, and termination provisions. +3. **Notice Periods**: Track renewal notice deadlines (typically 60-180 days). +4. **Claims Timeliness**: Identify timely filing limits (often 90-365 days). +5. **Prior Auth**: Document services requiring prior authorization and turnaround times. +6. **Medical Necessity**: Understand payer's medical necessity criteria and appeal rights. +7. **Reimbursement Method**: Clarify fee-for-service, capitation, or bundled payment. +8. **Value-Based Terms**: Identify quality metrics, risk-sharing, and bonus/penalty structures. +9. **Single Case Agreements**: Know when out-of-network single case rates apply. +10. **Audit Rights**: Understand payer audit provisions and documentation requirements. + +## Operating Modes + +### Standard Mode +Comprehensive contract review including full rate analysis, regulatory compliance check, risk assessment, and negotiation strategy development. Use for major contracts, new payer relationships, or significant renewals. + +### Lite Mode +Streamlined review focusing on critical terms (rates, key dates, major compliance obligations) for contract extensions or low-value agreements. Maintains identification of high-risk provisions requiring escalation. + +## Detailed Guidance + +### 1. Contract Review Framework + +#### Phase 1: Initial Assessment +- **Contract Type**: Identify if HMO, PPO, EPO, POS, or government program. +- **Payer Profile**: Research payer's market position, reputation, and financial stability. +- **Strategic Importance**: Assess volume potential and network adequacy impact. +- **Precedent Review**: Check existing contracts with same payer at other sites. + +#### Phase 2: Financial Terms Analysis + +**Fee Schedule Review**: +- Compare rates to current Medicare/MBS schedule (percent of benchmark). +- Calculate conversion factors and fee schedule updates (CPI, market baskets). +- Identify services with particularly favorable or unfavorable rates. +- Assess outlier and stop-loss provisions for high-cost cases. + +**Payment Methodology**: +- **Fee-for-Service**: Specific fee schedule or percentage of charges. +- **Capitation**: Per member per month (PMPM) rates; risk adjustment; withholds. +- **Bundled Payments**: Episode definitions; quality gates; gainsharing. +- **Value-Based**: Quality metrics; shared savings/losses; risk tiers. + +**Cost Considerations**: +- Calculate cost-to-charge ratios for key services. +- Factor in administrative burden (prior auth, documentation requirements). +- Assess technology and infrastructure requirements. +- Consider bad debt and denial risk under proposed terms. + +#### Phase 3: Operational Terms Review + +**Claims Processing**: +- **Timely Filing**: Submission deadlines (typically 90-180 days from service). +- **Clean Claim Definition**: Requirements for first-pass payment. +- **Payment Timeframes**: Prompt pay requirements; interest on late payments. +- **Electronic Claims**: Required formats (837I/P); companion guides. +- **Claim Corrections**: Process for resubmissions and corrected claims. + +**Prior Authorization Requirements**: +- List of services requiring pre-authorization. +- Turnaround time commitments (urgent vs. standard). +- Retrospective authorization provisions (emergencies). +- Peer-to-peer review process for denials. +- Appeals process and timeframes. + +**Medical Necessity & Clinical Policies**: +- Reference to payer's medical necessity criteria. +- Utilization management and case management requirements. +- Clinical pathways or care management programs. +- Experimental/investigational treatment exclusions. + +**Documentation Requirements**: +- Specific coding and documentation standards. +- Supporting documentation for claims. +- Audit and medical record review provisions. + +#### Phase 4: Network & Access Requirements + +**Network Participation**: +- Exclusive vs. non-exclusive participation. +- Network adequacy and access standards. +- Continuity of care provisions for terminations. +- Tiered network implications (if applicable). + +**Out-of-Network Provisions**: +- Emergency service protections (No Surprises Act in US). +- Balance billing restrictions and patient protections. +- Single case agreement (SCA) procedures. +- Out-of-network reimbursement rates. + +#### Phase 5: Risk & Compliance Terms + +**Audit & Compliance**: +- Payer audit rights and notification requirements. +- Documentation retention periods (typically 6-10 years). +- Overpayment recovery provisions. +- Fraud and abuse compliance requirements. +- OIG/Sanctions screening obligations. + +**Insurance & Indemnification**: +- Professional liability insurance requirements. +- Indemnification provisions. +- Cyber liability for data breaches. + +**Termination Provisions**: +- Termination for convenience vs. cause. +- Notice periods (typically 90-180 days). +- Immediate termination triggers. +- Post-termination claims processing (run-out periods). +- Patient notification requirements. + +### 2. Rate Analysis Methodology + +#### Benchmark Comparison + +**Primary Benchmarks**: +- **Australia**: Medicare Benefits Schedule (MBS) rates; Private Health Insurance Prostheses List. +- **New Zealand**: ACC regulated fee schedules; DHB/DHNZ service specifications. +- **United States**: Medicare Physician Fee Schedule (MPFS); Medicare Severity DRGs. + +**Analysis Steps**: +1. Extract proposed rates for top 50-100 services by volume/revenue. +2. Compare to benchmark at item code level. +3. Calculate weighted average as percent of benchmark. +4. Identify services below cost or significantly below market. +5. Model revenue impact based on historical utilization. + +#### Cost Analysis + +**Cost-to-Charge Ratio Method**: +- Obtain hospital-specific cost-to-charge ratios by cost center. +- Apply to proposed rates to estimate margin. +- Identify services where proposed rate < cost. + +**Activity-Based Costing** (if available): +- Time-driven activity-based costing (TDABC) for services. +- Compare to proposed reimbursement. +- Assess contribution margin by service line. + +### 3. Key Contract Dates & Tracking + +#### Critical Dates to Extract + +| Date Type | Typical Range | Tracking Priority | +|-----------|---------------|-------------------| +| **Effective Date** | Contract start | Critical | +| **Initial Term End** | 1-3 years | Critical | +| **Renewal Notice Deadline** | 60-180 days before expiration | Critical | +| **Fee Schedule Updates** | Annual | High | +| **Quality Reporting Deadlines** | Quarterly/Annual | High | +| **Audit Rights Expiration** | Post-termination | Medium | + +#### Renewal Management + +**180 Days Before Expiration**: +- Initiate renewal discussions with payer. +- Prepare utilization and financial performance summary. +- Identify terms requiring modification. + +**120 Days Before**: +- Submit formal renewal notice if required. +- Escalate if renewal terms not received. + +**90 Days Before**: +- Finalize negotiation positions. +- Legal review of renewal documents. + +**60 Days Before**: +- Execute renewal or implement termination plans. +- Communicate to affected departments. + +### 4. Negotiation Strategy + +#### Preparation + +**Internal Alignment**: +- Confirm strategic priority of payer relationship. +- Identify must-have vs. nice-to-have terms. +- Establish walk-away position on rates. +- Secure executive sponsorship for negotiation. + +**Leverage Assessment**: +- Market share of payer in service area. +- Competitor contracts with same payer. +- Must-have services provided by organization. +- Network adequacy implications for payer. + +#### Common Negotiation Points + +**Rates**: +- Request increases on services below benchmark. +- Negotiate annual rate escalators (CPI or higher). +- Secure stop-loss protections for high-cost cases. + +**Operational Terms**: +- Reduce prior authorization burden. +- Improve timely filing windows. +- Secure prompt pay commitments with penalties. + +**Risk Sharing**: +- Limit downside exposure in value-based arrangements. +- Ensure adequate risk adjustment. +- Clarify quality measure specifications. + +## Documentation Requirements + +### Contract Review File +- [ ] Contract summary with key terms +- [ ] Rate analysis spreadsheet with benchmark comparisons +- [ ] Risk assessment and compliance checklist +- [ ] Negotiation position document +- [ ] Internal approval documentation +- [ ] Signed contract with all amendments + +### Ongoing Contract Management +- [ ] Contract database entry with key dates +- [ ] Fee schedule loaded into billing system +- [ ] Prior authorization requirements communicated to clinical staff +- [ ] Renewal tracking with calendar reminders +- [ ] Performance metrics dashboard (if value-based) + +## Common Mistakes + +| Mistake | Why It's Wrong | Instead | +|---------|----------------|---------| +| **Accepting standard rates without analysis** | May result in significant underpayment | Always benchmark proposed rates against Medicare/MBS and cost data | +| **Missing renewal notice deadlines** | Automatic renewal or termination can occur without input | Track critical dates with 180-day advance reminders | +| **Not modeling revenue impact** | Unclear financial impact leads to poor decisions | Model revenue effect based on historical utilization | +| **Overlooking prior auth requirements** | Clinical staff unaware of requirements leading to denials | Document all prior auth requirements and educate staff | +| **Ignoring timely filing limits** | Lost revenue from late claim submissions | Set up claim submission workflows within contract timeframes | +| **Not understanding value-based terms** | Unexpected penalties or missed bonuses | Ensure clear understanding of quality metrics and risk arrangements | +| **Accepting broad audit rights** | Excessive administrative burden and overpayment risk | Negotiate reasonable audit limitations and timeframes | +| **Missing termination provisions** | Stuck in unfavorable contract without exit option | Understand all termination rights and notice periods | +| **Not checking for auto-renewal** | Unintended extension of unfavorable terms | Identify auto-renewal clauses and manage opt-out windows | +| **Failing to track amendments** | Operating under outdated terms | Maintain complete contract file with all amendments and rate updates | + +## When to Escalate + +Escalate to Chief Financial Officer, General Counsel, or Executive Team when: +- Proposed rates are below cost for significant service volume. +- Payer demands exclusive network participation. +- Contract includes unlimited audit rights or penalties. +- Value-based arrangement includes substantial downside risk (>10% revenue at risk). +- Termination provisions are unilateral or immediate without cause. +- Payer requires technology investments without compensation. +- Government payer contract includes compliance concerns or fraud risk. +- Contract conflicts with existing obligations or other payer agreements. +- Payer is in financial distress or has significant market complaints. +- Rate dispute involves material revenue impact (>5% of total revenue). + +## Privacy Considerations + +- **PHI Involved**: Yes - contracts may reference specific patient populations or utilization patterns. +- **Data Minimization**: Only share aggregate utilization data during negotiations, not individual patient information. +- **Breach Notification**: Understand contract provisions for data breach notification and liability. +- **Business Associate Agreements**: Ensure BAA is in place if payer will access PHI. +- **Data Security**: Verify payer meets organizational data security requirements. +- **Retention**: Maintain contracts and amendments per record retention policy (typically 7+ years post-termination). +- **No Persistence**: Do not store contract drafts with PHI in unsecured locations. + +## Confidence Indicators + +| Scenario | Confidence | Action | +|----------|------------|--------| +| Standard commercial payer contract with standard terms | High | Proceed with standard review checklist | +| Rates within acceptable range of benchmarks | High | Recommend acceptance with minor operational clarifications | +| Government payer contract with regulated terms | Medium | Verify compliance requirements; escalate policy questions | +| Complex value-based arrangement with risk-sharing | Low | Require detailed financial modeling; involve actuarial resources | +| Exclusive network requirements or restrictive covenants | Low | **BLOCKER**: Escalate to General Counsel for antitrust/competition review | +| Proposed rates below cost for major service lines | Low | Escalate to CFO; prepare walk-away position or counter-proposal | +| Ambiguous prior authorization or medical necessity language | Medium | Request clarification; document assumptions | +| Payer in financial distress or market exit rumors | Low | Escalate to executive leadership; assess counterparty risk | + +## Tool Requirements + +- `~~cloud storage` - For contract documents and rate analysis files +- `~~project tracker` - For renewal tracking and negotiation milestones +- `~~finance/contract-database` - For contract repository and key date management +- `~~health/revenue-cycle` - For claims and reimbursement data integration +- `~~data analysis` - For rate modeling and financial impact analysis +- `~~legal/contract-review` - For general contract analysis and playbook alignment + +## Success Indicators + +You've applied this skill well when: +- [ ] All proposed rates analyzed against benchmarks and cost data +- [ ] Critical dates extracted and tracked in contract management system +- [ ] Key operational terms documented and communicated to affected departments +- [ ] Risk assessment identifies material issues for escalation +- [ ] Negotiation strategy based on leverage analysis and internal alignment +- [ ] Revenue impact modeled with sensitivity analysis +- [ ] Compliance obligations clearly understood and assigned to owners +- [ ] Prior authorization requirements communicated to clinical staff +- [ ] Renewal timeline established with advance notice reminders +- [ ] Contract file maintained with all amendments and correspondence + +## Related Skills + +- `~~legal/contract-review` - General contract analysis methodology and playbook alignment +- `~~finance/reconciliation` - For payment reconciliation and underpayment identification +- `~~health/charge-capture` - For CDM alignment with contract rates +- `~~health/clinical-coding` - For coding compliance under payer requirements +- `~~health/complaints-management` - For payer-related dispute resolution + +--- + +**Note**: Payer contracting involves complex financial, legal, and operational considerations. This skill provides a structured approach but should be used in conjunction with qualified legal counsel, finance professionals, and revenue cycle expertise. From 63c1644cf1a232f885e8a2b7dd02a2a96db3207a Mon Sep 17 00:00:00 2001 From: "Dylan Mordaunt (Illawarra Shoalhaven LHD)" Date: Sat, 14 Feb 2026 11:56:30 +1100 Subject: [PATCH 40/57] conductor(plan): Mark task 'Create payer-contracts skill' as complete --- conductor/tracks/health-financial/plan.md | 2 +- 1 file changed, 1 insertion(+), 1 deletion(-) diff --git a/conductor/tracks/health-financial/plan.md b/conductor/tracks/health-financial/plan.md index 7588061..11415b4 100644 --- a/conductor/tracks/health-financial/plan.md +++ b/conductor/tracks/health-financial/plan.md @@ -4,7 +4,7 @@ *Dependencies: health-core* *Estimated: 1-2 sessions* -- [x] Create `health/skills/payer-contracts/SKILL.md` +- [x] Create `health/skills/payer-contracts/SKILL.md` [d64d41b] - Acceptance: Follows [health skill standards](../health-plugin/skill-standards.md) (14-section template) - Acceptance: Includes Confidence Indicators for contract risk - Acceptance: AU/NZ financial and payer defaults are explicit, with US/EU-lite fallback From a3cb4af9e8f756c3e43e642cdb4c55b48d9aa1f2 Mon Sep 17 00:00:00 2001 From: "Dylan Mordaunt (Illawarra Shoalhaven LHD)" Date: Sat, 14 Feb 2026 11:58:03 +1100 Subject: [PATCH 41/57] feat(health): Add charge-capture skill for CDM review and validation --- conductor/tracks/health-financial/plan.md | 2 +- health/skills/charge-capture/SKILL.md | 445 ++++++++++++++++++++++ 2 files changed, 446 insertions(+), 1 deletion(-) create mode 100644 health/skills/charge-capture/SKILL.md diff --git a/conductor/tracks/health-financial/plan.md b/conductor/tracks/health-financial/plan.md index 11415b4..fc59477 100644 --- a/conductor/tracks/health-financial/plan.md +++ b/conductor/tracks/health-financial/plan.md @@ -17,7 +17,7 @@ *Dependencies: Phase 1* *Estimated: 1 session* -- [ ] Create `health/skills/charge-capture/SKILL.md` +- [x] Create `health/skills/charge-capture/SKILL.md` - Acceptance: CDM review methodology - Acceptance: Coding validation guidance - Acceptance: Compliance red flags diff --git a/health/skills/charge-capture/SKILL.md b/health/skills/charge-capture/SKILL.md new file mode 100644 index 0000000..15e8541 --- /dev/null +++ b/health/skills/charge-capture/SKILL.md @@ -0,0 +1,445 @@ +--- +name: health/charge-capture +description: This skill should be used when reviewing charge capture processes, validating the Charge Description Master (CDM), reconciling services provided to charges billed, or identifying compliance risks in healthcare revenue capture. Use for CDM maintenance, charge audits, and revenue integrity reviews. +version: 1.0.0 +--- + +# Charge Capture Review + +A specialized framework for reviewing healthcare charge capture processes and the Charge Description Master (CDM), supporting revenue cycle and compliance teams in ensuring accurate, complete, and compliant billing. This skill addresses the intersection of clinical documentation, coding standards, and revenue integrity. + +**Important**: This skill assists with charge capture workflows but does not provide clinical coding certification or definitive billing guidance. All coding and billing decisions must be validated by certified coding professionals and compliance officers. + +## When to Use This Skill + +Invoke this skill when: +- Conducting periodic CDM reviews and maintenance. +- Validating that services provided are accurately captured and billed. +- Identifying missing charges or compliance risks in charge capture workflows. +- Reconciling clinical documentation to charges billed. +- Auditing charge accuracy against medical records. +- Reviewing new service implementations for charge capture setup. +- Investigating revenue leakage or charge capture gaps. +- Preparing for payer audits or compliance reviews. +- Training clinical staff on proper charge capture procedures. +- Validating modifier usage and medical necessity linkage. +- Reviewing charge master pricing against cost and market benchmarks. +- Addressing charge lag or delays in charge posting. +- Reconciling pharmacy, supply, and implant charges. + +## Regulatory Context + +### Australia & New Zealand (Default) + +| Regulation/Standard | Relevance | Key Requirements | +|---------------------|-----------|------------------| +| **Medicare Benefits Schedule** (AU) | Billing compliance | Accurate item numbers; correct claiming; bulk billing requirements | +| **Private Health Insurance Act** (AU) | Prostheses List | Correct prosthesis billing; benefit limitation periods | +| **DVA Fee Schedule** (AU) | Veterans billing | White/Gold card distinctions; approved provider requirements | +| **ACC Schedule** (NZ) | Injury billing | Correct classification codes; prior approval requirements | +| **Health and Disability Services** (NZ) | Funding compliance | National Pricing Framework; compliance with service specifications | +| **State Funding Agreements** | Activity-based funding | Correct DRG/AR-DRG assignment; ICD-10-AM/ACHI coding | + +### US/EU-lite Fallback + +| Regulation/Standard | Relevance | Key Requirements | +|---------------------|-----------|------------------| +| **CMS Conditions of Participation** (US) | Medicare compliance | Accurate charge description; timely billing; overpayment reporting | +| **False Claims Act** (US) | Fraud prevention | Knowing submission of false claims; whistleblower provisions | +| **Stark Law** (US) | Physician relationships | Prohibition on self-referrals; fair market value requirements | +| **Anti-Kickback Statute** (US) | Fraud prevention | Prohibition on remuneration for referrals | +| **Chargemaster Guidelines** (US) | Pricing transparency | Hospital price transparency rule; good faith estimates | +| **GDPR** (EU) | Data protection | PHI handling in billing processes | + +### Jurisdiction Matrix + +| Jurisdiction | Applicable Regulator | Reporting Trigger | Timeframe | Required Artifacts | Escalation Point | +|--------------|---------------------|-------------------|-----------|-------------------|------------------| +| **AU - Federal** | Services Australia | Overpayment identification | 90 days refund | Adjustment claims; refund documentation | Revenue Cycle Director | +| **AU - State** | State Health Dept | Funding variance >threshold | Monthly reporting | Activity data; variance explanations | Finance Manager | +| **NZ - National** | ACC/Te Whatu Ora | Coding error affecting funding | As specified | Corrected claims; root cause analysis | Health Information Manager | +| **US - Federal** | CMS/OIG | Self-disclosure of errors | 60 days (60-day rule) | Self-disclosure protocol (SDP) | Compliance Officer | +| **US - State** | State Medicaid | Billing error notification | Varies by state | Corrected claims; overpayment refunds | VP Revenue Cycle | + +## Quick Reference + +1. **Documentation First**: Charges require supporting clinical documentation. +2. **Code Accuracy**: Verify correct item codes/HCPCS/CPT codes are used. +3. **Modifier Validity**: Ensure modifiers are appropriate and supported. +4. **Medical Necessity**: Link charges to documented medical necessity. +5. **CDM Maintenance**: Review and update CDM at least annually. +6. **Charge Lag**: Minimize time between service and charge posting. +7. **Reconciliation**: Match clinical volumes to charges regularly. +8. **Compliance Screens**: Automated checks for high-risk scenarios. +9. **Staff Training**: Clinical staff must understand charge capture requirements. +10. **Audit Trail**: Maintain documentation supporting all charges. + +## Operating Modes + +### Standard Mode +Comprehensive charge capture review including CDM validation, clinical documentation audit, coding accuracy verification, compliance risk assessment, and process improvement recommendations. Use for annual reviews, pre-audit preparation, or significant revenue integrity concerns. + +### Lite Mode +Focused review of high-risk charge capture areas or specific compliance concerns. Targets known problem areas, recent service changes, or specific payer requirements. Maintains core compliance checks while reducing scope. + +## Detailed Guidance + +### 1. Charge Description Master (CDM) Review + +The CDM is the central repository of all billable services, supplies, and procedures. Accurate CDM maintenance is foundational to revenue integrity. + +#### CDM Structure Elements + +**Charge Code**: +- Unique identifier for each billable item +- Consistent formatting and logic +- No duplication or overlap + +**Description**: +- Clear, accurate description of service/supply +- Patient-friendly language for price transparency (US requirement) +- Aligned with standard nomenclature (HCPCS, CPT, custom) + +**Revenue Code** (US primarily): +- Correct UB-04 revenue code assignment +- Aligns with cost center mapping +- Supports proper cost reporting + +**Pricing**: +- Standard charge amount +- Cost-to-charge ratio consideration +- Market benchmark alignment + +**General Ledger Account**: +- Maps charges to appropriate GL accounts +- Supports accurate financial reporting +- Enables revenue analysis by service line + +#### CDM Review Process + +**Annual Comprehensive Review**: +1. **Inventory**: Export full CDM and categorize by service type. +2. **Code Validation**: Verify all procedure codes are current and valid. +3. **Pricing Analysis**: Compare prices to cost, benchmarks, and contracts. +4. **Duplicate Check**: Identify and eliminate duplicate or overlapping codes. +5. **Compliance Check**: Review for unbundling, upcoding, or other risks. +6. **Documentation**: Update CDM policies and review logs. + +**Ongoing Maintenance**: +- Review new codes before implementation. +- Validate pricing for new services. +- Deactivate obsolete codes promptly. +- Update for annual coding changes (CPT, HCPCS updates). + +### 2. Charge Capture Validation + +#### Documentation-to-Charge Reconciliation + +**Daily Reconciliation**: +- Compare clinical census/acuity to charges posted. +- Identify patients with services but no charges. +- Review high-value items for accuracy (OR, implants, procedures). + +**Weekly Reconciliation**: +- Department-level charge volume vs. productivity metrics. +- Pharmacy dispensing to medication administration charges. +- Supply usage to supply charges. + +**Monthly Reconciliation**: +- Financial volume to statistical volume (cases, visits, days). +- Missing charge reports by department. +- Charge lag analysis (time from service to charge posting). + +#### Clinical Documentation Requirements + +**Required Elements for Charge Capture**: +- Date and time of service +- Rendering provider identification +- Service description (procedure note, operative report) +- Medical necessity justification +- Supporting diagnoses + +**Common Documentation Gaps**: +- Missing provider signatures +- Incomplete procedure descriptions +- Absent medical necessity statements +- Unclear start/stop times for time-based services + +### 3. Coding Validation + +#### Procedure Coding (CPT/HCPCS/Item Numbers) + +**Code Selection Validation**: +- Code matches documented service exactly. +- No code splitting or unbundling. +- Correct code for site/location (facility vs. professional). + +**Modifier Usage**: +- Modifier -25 (significant, separately identifiable E/M) +- Modifier -59 (distinct procedural service) +- Modifier -50 (bilateral procedure) +- Anesthesia modifiers (AA, QK, QX, etc.) + +**Modifier Validation Checklist**: +- [ ] Modifier is appropriate for code pair. +- [ ] Documentation supports modifier use. +- [ ] No modifier overuse patterns. +- [ ] Payer-specific modifier requirements met. + +#### Diagnosis Coding (ICD-10) + +**Medical Necessity Linkage**: +- Primary diagnosis justifies primary procedure. +- Comorbidities documented for complexity/complications. +- Signs and symptoms coded when definitive diagnosis pending. + +**Coding Specificity**: +- Laterality documented and coded. +- Severity/complexity captured. +- External cause codes when applicable. + +### 4. High-Risk Charge Capture Areas + +#### Pharmacy Charges + +**Common Issues**: +- Missing waste documentation (single-use vials). +- Incorrect units (mg vs. mL). +- Modifier -JW (drug waste) not applied. +- Compound medication billing errors. + +**Validation Steps**: +- Verify MAR to pharmacy charges. +- Review high-cost drug administration. +- Check waste documentation compliance. + +#### Implantable Devices + +**Common Issues**: +- Device not documented as implanted. +- Incorrect device code selected. +- Pass-through device billing errors. +- Patient-owned device confusion. + +**Validation Steps**: +- Match implant logs to charges. +- Verify operative report documentation. +- Check device identification stickers/reports. + +#### Surgical Procedures + +**Common Issues**: +- Procedure code doesn't match operative report. +- Incorrect site or laterality. +- Missing assistant surgeon documentation. +- Unbundled component codes. + +**Validation Steps**: +- Code from operative report, not schedule. +- Verify correct CPT code selection. +- Check for NCCI edits before billing. + +#### Evaluation & Management (E/M) Services + +**Common Issues**: +- Level not supported by documentation. +- Modifier -25 overuse. +- Split/shared billing errors. +- Incident-to billing violations. + +**Validation Steps**: +- Apply 2021/2023 E/M guidelines correctly. +- Verify medical decision-making or time-based coding. +- Check for duplicate E/M on same day. + +### 5. Compliance Risk Assessment + +#### Overpayment Risk Areas + +**Upcoding**: +- Billing higher-level service than documented. +- Documentation doesn't support code selected. +- Pattern analysis for outlier coding profiles. + +**Unbundling**: +- Billing component codes separately when comprehensive code exists. +- Breaking up procedures into multiple charges. +- NCCI edit violations. + +**Insufficient Documentation**: +- Missing or illegible signatures. +- Incomplete procedure descriptions. +- Absent medical necessity statements. + +#### Underpayment Risk Areas + +**Downcoding**: +- Conservative coding results in lower reimbursement. +- Fear of audit leads to systematic under-coding. + +**Missing Charges**: +- Services provided but not charged. +- Charge capture process failures. +- System interface errors. + +**Modifier Underuse**: +- Legitimate modifiers not applied. +- Reduced reimbursement due to missing modifiers. + +### 6. Charge Audit Process + +#### Pre-Bill Audit (Front-End) + +**Automated Edits**: +- Code validity checks. +- CCI/NCCI edit verification. +- Medical necessity screens (LCD/NCD). +- Duplicate charge detection. +- Age/sex edits. + +**Manual Review Triggers**: +- High-dollar charges (>$ threshold). +- Complex surgical cases. +- Modifier usage requiring validation. +- New provider charges. + +#### Post-Bill Audit (Back-End) + +**Sample Selection**: +- Random sampling for general review. +- Targeted sampling for high-risk areas. +- Focused review for compliance concerns. + +**Audit Documentation**: +- Medical record reviewed. +- Codes billed vs. codes supported. +- Discrepancies identified. +- Corrective actions taken. +- Education provided. + +#### Audit Findings Response + +**Error Rate Calculation**: +- Dollar value of errors / Total dollars audited. +- Track error rates by department, coder, provider. +- Trend over time. + +**Corrective Actions**: +- Immediate claim corrections. +- Refund of overpayments. +- Provider/clinical staff education. +- Process improvements. +- System fixes. + +## Documentation Requirements + +### CDM Review Documentation +- [ ] CDM review schedule and policy +- [ ] Annual CDM review report +- [ ] New code implementation logs +- [ ] Pricing analysis and justification +- [ ] Deleted code archive + +### Charge Capture Audit File +- [ ] Audit plan and sampling methodology +- [ ] Audit tool/checklist used +- [ ] Medical records reviewed +- [ ] Findings report with error rates +- [ ] Corrective action plan +- [ ] Education records +- [ ] Follow-up audit results + +### Compliance Documentation +- [ ] Charge capture policies and procedures +- [ ] Staff training records +- [ ] Audit results and trend reports +- [ ] Overpayment tracking and refunds +- [ ] Self-disclosure documentation (if applicable) + +## Common Mistakes + +| Mistake | Why It's Wrong | Instead | +|---------|----------------|---------| +| **Charging from schedules rather than documentation** | Schedule may not reflect actual service performed | Always code from clinical documentation (operative reports, procedure notes) | +| **Missing time documentation** | Time-based codes require explicit time documentation | Ensure start/stop times documented for all time-based services | +| **Modifier overuse** | Pattern of inappropriate modifiers is compliance risk | Apply modifiers only when documentation clearly supports | +| **Incomplete procedure descriptions** | Insufficient detail to support code selection | Require detailed descriptions matching code nomenclature | +| **Not verifying implant documentation** | Implants must be documented as implanted in patient | Match implant logs to operative reports before charging | +| **Ignoring charge lag** | Delayed charges affect cash flow and timely filing | Monitor and minimize days from service to charge posting | +| **Failing to validate medical necessity** | Payers deny claims without documented necessity | Ensure diagnoses justify procedures in documentation | +| **Skipping NCCI edit checks** | Unbundling violations trigger audit scrutiny | Verify all code pairs against NCCI edits before billing | +| **Not updating CDM annually** | Outdated codes cause claim rejections | Conduct comprehensive annual CDM review | +| **Inadequate clinical staff training** | Staff don't understand charge capture requirements | Provide regular training on documentation and charge requirements | + +## When to Escalate + +Escalate to Revenue Cycle Director, Compliance Officer, or Chief Financial Officer when: +- Audit reveals systematic upcoding or unbundling patterns. +- Error rate exceeds organizational threshold (typically >5%). +- Potential overpayment exceeds materiality threshold (e.g., $10,000+). +- False Claims Act or fraud concerns identified. +- Charge capture process failures causing significant revenue leakage. +- Payer audit findings with extrapolation demands. +- Self-disclosure to government payers required. +- Clinical staff non-compliance with documentation requirements. +- System interface errors causing widespread charge failures. +- New service implementation lacks charge capture workflow. + +## Privacy Considerations + +- **PHI Involved**: Yes - charge audits require access to medical records with patient identifiers. +- **Minimum Necessary**: Auditors should only access records necessary for charge validation. +- **Access Controls**: Limit charge audit system access to revenue integrity staff. +- **Audit Trail**: Maintain logs of who accessed which records and when. +- **Retention**: Retain audit documentation per compliance requirements (typically 6-10 years). +- **No Persistence**: Do not store PHI in audit working papers longer than necessary. +- **De-identification**: Use de-identified data for aggregate reporting and trend analysis. + +## Confidence Indicators + +| Scenario | Confidence | Action | +|----------|------------|--------| +| Standard charge capture with clear documentation | High | Proceed with routine billing | +| Complex procedure with detailed operative report | High | Code from documentation with confidence | +| Missing documentation for charged service | Low | **BLOCKER**: Hold charge pending documentation completion | +| Modifier usage unclear from documentation | Medium | Query provider for clarification | +| Pattern of coding errors identified in audit | Low | Escalate to compliance; halt similar billing pending review | +| High-cost implant without clear documentation | Low | Verify with surgical team before billing | +| Potential unbundling identified | Medium | Review against NCCI edits; consult coding guidelines | +| Charge lag exceeding timely filing limits | Low | **BLOCKER**: Escalate to revenue cycle leadership; assess ability to bill | +| Self-disclosure threshold potentially met | Low | Escalate to compliance officer and legal counsel immediately | + +## Tool Requirements + +- `~~health/clinical-systems` - For accessing medical records and clinical documentation +- `~~health/clinical-coding` - For coding validation and guidance +- `~~finance/reconciliation` - For charge-to-payment reconciliation +- `~~cloud storage` - For audit documentation and CDM files +- `~~project tracker` - For audit plans and corrective action tracking +- `~~data analysis` - For charge lag analysis and trend reporting + +## Success Indicators + +You've applied this skill well when: +- [ ] CDM is current with annual review completed +- [ ] Charge lag is minimized (target: <3 days from service) +- [ ] Documentation supports all charges billed +- [ ] Error rates remain below organizational threshold +- [ ] Compliance risks identified and remediated promptly +- [ ] Clinical staff trained on charge capture requirements +- [ ] Overpayments identified and refunded timely +- [ ] Revenue leakage minimized through process improvements +- [ ] Audit findings trend positive over time +- [ ] Payer audits result in minimal findings + +## Related Skills + +- `~~health/clinical-coding` - For detailed coding guidance and validation +- `~~health/payer-contracts` - For understanding reimbursement methodologies +- `~~health/complaints-management` - For handling billing disputes +- `~~finance/reconciliation` - For payment reconciliation and denial analysis +- `~~finance/audit-support` - For external audit preparation + +--- + +**Note**: Charge capture and revenue integrity are complex domains requiring specialized expertise. This skill provides a structured approach but should be used in conjunction with certified coding professionals, compliance officers, and revenue cycle leadership. From 92eb34bbf4f329f2f1c45c729031936eba64a026 Mon Sep 17 00:00:00 2001 From: "Dylan Mordaunt (Illawarra Shoalhaven LHD)" Date: Sat, 14 Feb 2026 11:58:25 +1100 Subject: [PATCH 42/57] conductor(plan): Mark task 'Create charge-capture skill' as complete --- conductor/tracks/health-financial/plan.md | 2 +- 1 file changed, 1 insertion(+), 1 deletion(-) diff --git a/conductor/tracks/health-financial/plan.md b/conductor/tracks/health-financial/plan.md index fc59477..b53cb50 100644 --- a/conductor/tracks/health-financial/plan.md +++ b/conductor/tracks/health-financial/plan.md @@ -17,7 +17,7 @@ *Dependencies: Phase 1* *Estimated: 1 session* -- [x] Create `health/skills/charge-capture/SKILL.md` +- [x] Create `health/skills/charge-capture/SKILL.md` [a3cb4af] - Acceptance: CDM review methodology - Acceptance: Coding validation guidance - Acceptance: Compliance red flags From 98561ccb8e60f352c97e6698b628712d749f80d0 Mon Sep 17 00:00:00 2001 From: "Dylan Mordaunt (Illawarra Shoalhaven LHD)" Date: Sat, 14 Feb 2026 11:59:38 +1100 Subject: [PATCH 43/57] feat(health-financial): Create review-payer-contract command - Add review-payer-contract command with contract intake workflow - Include comprehensive contract analysis sections: - Executive summary and risk assessment - Financial and operational terms analysis - Compliance and risk assessment - Negotiation priorities and decision matrix - Contract intake workflow with action items - Approval checklist - Reference health/payer-contracts skill for analysis framework - Arguments: payer_name, contract_type, effective_date, key_concerns - Follow health command structure with validation, skill invocation, output generation, routing, and guardrails --- conductor/tracks/health-financial/plan.md | 2 +- health/commands/review-payer-contract.md | 233 ++++++++++++++++++++++ 2 files changed, 234 insertions(+), 1 deletion(-) create mode 100644 health/commands/review-payer-contract.md diff --git a/conductor/tracks/health-financial/plan.md b/conductor/tracks/health-financial/plan.md index b53cb50..d257611 100644 --- a/conductor/tracks/health-financial/plan.md +++ b/conductor/tracks/health-financial/plan.md @@ -27,7 +27,7 @@ *Dependencies: Phase 1* *Estimated: 0.5 sessions* -- [ ] Create `health/commands/review-payer-contract.md` +- [~] Create `health/commands/review-payer-contract.md` - Acceptance: Contract intake workflow - Acceptance: Generates analysis report diff --git a/health/commands/review-payer-contract.md b/health/commands/review-payer-contract.md new file mode 100644 index 0000000..42fcc36 --- /dev/null +++ b/health/commands/review-payer-contract.md @@ -0,0 +1,233 @@ +--- +name: review-payer-contract +description: Analyze and review healthcare payer contracts to identify key financial terms, compliance requirements, and negotiation opportunities. +arguments: + - name: payer_name + description: "Name of the payer/insurance company (e.g., 'Blue Cross', 'Medicare', 'Bupa')." + required: true + - name: contract_type + description: "Type of contract (e.g., 'Fee-for-Service', 'Capitation', 'Bundled Payment', 'Value-Based Care')." + required: true + - name: effective_date + description: "Contract effective date in YYYY-MM-DD format." + required: true + - name: key_concerns + description: "Optional: Specific concerns or focus areas for the review (e.g., 'low rates on cardiac services', 'strict prior auth requirements')." + required: false +--- + +# Review Payer Contract + +Use this command to conduct a structured analysis of a payer contract, identifying critical financial terms, operational requirements, compliance obligations, and negotiation opportunities. + +## 1. Validate Input + +- Verify `payer_name` is a recognized healthcare payer in your market. +- Confirm `contract_type` matches standard categories (Fee-for-Service, Capitation, Bundled Payment, Value-Based Care, Medicare/Medicaid). +- Ensure `effective_date` is in valid YYYY-MM-DD format. +- If `key_concerns` provided, categorize into: Financial (rates/cost), Operational (workflow/administrative), Compliance (regulatory/risk), or Strategic (network/exclusivity). + +## 2. Invoke Skill + +Use `~~health/payer-contracts` to: +1. Apply the contract review framework based on contract type. +2. Extract and analyze critical contract dates (effective date, term length, renewal notice deadlines). +3. Identify key operational terms (prior auth requirements, timely filing limits, medical necessity criteria). +4. Assess rate structure against benchmarks. +5. Evaluate risk and compliance obligations. +6. Generate negotiation priorities based on identified concerns. + +## 3. Generate Structured Output + +Produce: + +### CONTRACT ANALYSIS REPORT: {{payer_name}} +- **Contract Type**: {{contract_type}} +- **Effective Date**: {{effective_date}} +- **Reference**: [Generate unique ID: PAYER-YYYY-NNN] +- **Analysis Date**: {{current_timestamp}} +- **Status**: ANALYSIS DRAFT + +--- + +### 1. EXECUTIVE SUMMARY + +**Payer Profile**: [Market position, volume potential, strategic importance] + +**Overall Risk Assessment**: [High/Medium/Low] + +**Key Findings**: +- [Primary financial concern] +- [Primary operational concern] +- [Primary compliance concern] + +{{#key_concerns}} +**Specific Concerns Raised**: {{key_concerns}} +{{/key_concerns}} + +--- + +### 2. CONTRACT TERMS ANALYSIS + +#### Financial Structure +| Element | Status | Notes | +|---------|--------|-------| +| **Rate Benchmark** | [Percent of Medicare/MBS] | [Above/Below market] | +| **Payment Method** | {{contract_type}} | [Fee schedule details] | +| **Rate Escalator** | [CPI/Fixed/None] | [Annual adjustment mechanism] | +| **Outlier Provisions** | [Yes/No] | [Stop-loss thresholds if applicable] | + +#### Critical Dates +| Date Type | Contract Value | Tracking Required | +|-----------|----------------|-------------------| +| **Effective Date** | {{effective_date}} | [Confirm implementation] | +| **Initial Term End** | [Calculate: +1-3 years] | **Critical** | +| **Renewal Notice Deadline** | [Calculate: -60-180 days] | **Critical** | +| **Fee Schedule Updates** | [Annual/As specified] | High | + +--- + +### 3. OPERATIONAL REQUIREMENTS + +#### Claims Processing +- **Timely Filing Limit**: [90/180/365 days from service] +- **Clean Claim Definition**: [Specific requirements] +- **Payment Timeframe**: [Prompt pay requirements] +- **Electronic Claims**: [Required format/Companion guides] + +#### Prior Authorization Requirements +| Service Category | Pre-Auth Required | Turnaround Time | +|------------------|-------------------|-----------------| +| [Category 1] | [Yes/No] | [Urgent: 24h/Standard: 3-5d] | +| [Category 2] | [Yes/No] | [Urgent: 24h/Standard: 3-5d] | +| [Category 3] | [Yes/No] | [Urgent: 24h/Standard: 3-5d] | + +#### Medical Necessity & Documentation +- **Criteria Reference**: [Payer medical necessity standards] +- **Appeals Process**: [First-level/Second-level/External review] +- **Documentation Requirements**: [Specific coding standards] +- **Audit Provisions**: [Rights/timeframes/retention] + +--- + +### 4. COMPLIANCE & RISK ASSESSMENT + +#### Regulatory Alignment +| Jurisdiction | Applicable Regulations | Compliance Actions | +|--------------|------------------------|--------------------| +| [AU Federal] | Private Health Insurance Act/Medicare | [Prostheses List/Bulk billing] | +| [AU State] | Activity-Based Funding | [Service agreements] | +| [NZ] | ACC/Health NZ | [Regulated fee schedules] | +| [US] | CMS/No Surprises Act | [Enrollment/Compliance] | + +#### Risk Identification +| Risk Category | Risk Level | Description | Mitigation | +|---------------|------------|-------------|------------| +| **Financial** | [High/Med/Low] | [Rate/cost concerns] | [Strategy] | +| **Operational** | [High/Med/Low] | [Administrative burden] | [Strategy] | +| **Compliance** | [High/Med/Low] | [Regulatory exposure] | [Strategy] | +| **Strategic** | [High/Med/Low] | [Network/termination risks] | [Strategy] | + +--- + +### 5. NEGOTIATION PRIORITIES + +#### High Priority (Must Address) +1. [Critical financial or operational issue] +2. [Compliance concern requiring clarification] +3. [Risk mitigation requirement] + +#### Medium Priority (Negotiate if Possible) +1. [Rate improvement opportunity] +2. [Operational efficiency gain] +3. [Term clarification needed] + +#### Low Priority (Nice to Have) +1. [Minor rate adjustments] +2. [Process improvements] +3. [Documentation clarifications] + +#### Negotiation Leverage +- **Market Position**: [Payer market share/Volume potential] +- **Network Impact**: [Adequacy implications] +- **Must-Have Services**: [Unique services provided] +- **Precedent**: [Existing contracts with this payer] + +--- + +### 6. CONTRACT INTAKE WORKFLOW + +#### Immediate Actions (This Week) +1. [ ] **Document Receipt**: Confirm all contract documents received +2. [ ] **Stakeholder Notification**: Alert Finance, Legal, Revenue Cycle teams +3. [ ] **Contract Database Entry**: Input key terms and dates into contract management system +4. [ ] **Calendar Reminders**: Set up renewal notice and critical date alerts + +#### Short-Term Actions (Next 2 Weeks) +1. [ ] **Rate Analysis**: Complete detailed benchmark comparison for top services +2. [ ] **Revenue Impact Model**: Calculate financial impact based on historical utilization +3. [ ] **Operational Review**: Assess prior auth and documentation requirements with clinical teams +4. [ ] **Risk Assessment**: Complete compliance and legal review checklist + +#### Medium-Term Actions (30-60 Days) +1. [ ] **Negotiation Preparation**: Develop position paper with must-haves and walk-away points +2. [ ] **Internal Approval**: Secure executive sign-off on negotiation strategy +3. [ ] **Counter-Proposal Draft**: Prepare formal response with requested modifications +4. [ ] **Stakeholder Alignment**: Brief affected departments on contract terms + +--- + +### 7. DECISION MATRIX + +| Scenario | Recommendation | Action | +|----------|----------------|--------| +| Rates acceptable, terms standard | **Proceed** | Execute after minor clarifications | +| Rates below benchmark but negotiable | **Negotiate** | Prepare counter-proposal with rate increases | +| Operational terms burdensome | **Negotiate** | Request prior auth simplification | +| Significant compliance risk | **Escalate** | Legal/Compliance review required | +| Below cost for major services | **Escalate** | CFO review; prepare walk-away position | +| Exclusive network requirements | **Escalate** | General Counsel/antitrust review | + +--- + +### 8. APPROVAL CHECKLIST + +Before contract execution: +- [ ] Rate analysis completed and reviewed by Finance +- [ ] Legal review completed (if required) +- [ ] Operational terms confirmed with affected departments +- [ ] Revenue impact modeled and approved +- [ ] Compliance obligations assigned to owners +- [ ] Renewal dates entered into tracking system +- [ ] Executive approval obtained +- [ ] Counter-proposal prepared (if applicable) + +--- + +## 4. Execute Routing + +- Save analysis report to `~~cloud storage` in Payer Contracts folder. +- Create contract tracker entry in `~~project tracker` with all critical dates. +- Update `~~finance/contract-database` with payer information and renewal timeline. +- Notify relevant stakeholders: + - **Chief Financial Officer**: For material financial terms + - **Director of Revenue Cycle**: For operational requirements + - **Legal/Compliance**: For risk escalations + - **Clinical Leadership**: For prior auth and documentation requirements +- Schedule renewal notice reminders (60-180 days before expiration). + +## 5. Output Guardrails + +- **Confidentiality**: Mark output as **Commercial-in-Confidence**. Do not share outside authorized personnel. +- **No Legal Advice**: This analysis supports decision-making but does not replace legal counsel. Flag items requiring legal review. +- **Financial Estimates**: All rate comparisons and revenue impacts are estimates. Validate with actual cost data before negotiation. +- **Regulatory Accuracy**: Verify all regulatory requirements against current legislation in your jurisdiction. +- **No PHI**: Ensure no patient-identifiable information is included in analysis or documentation. +- **Confidence Indicators**: + - **High**: Standard commercial terms with acceptable rates + - **Medium**: Government/regulated terms; verify compliance obligations + - **Low**: Complex value-based arrangements or below-cost rates; escalate immediately + +--- + +**Note**: This contract analysis provides a structured framework for payer contract review. All findings should be validated by qualified finance, legal, and revenue cycle professionals before making contract decisions or entering negotiations. From 4a7b2510c8f38fdb9d6951f11261736a17bd6a40 Mon Sep 17 00:00:00 2001 From: "Dylan Mordaunt (Illawarra Shoalhaven LHD)" Date: Sat, 14 Feb 2026 11:59:48 +1100 Subject: [PATCH 44/57] docs(health-financial): Mark Phase 3 complete - Mark review-payer-contract command as complete with commit hash 98561cc - Health financial track now fully complete with all three phases --- conductor/tracks/health-financial/plan.md | 2 +- 1 file changed, 1 insertion(+), 1 deletion(-) diff --git a/conductor/tracks/health-financial/plan.md b/conductor/tracks/health-financial/plan.md index d257611..366e602 100644 --- a/conductor/tracks/health-financial/plan.md +++ b/conductor/tracks/health-financial/plan.md @@ -27,7 +27,7 @@ *Dependencies: Phase 1* *Estimated: 0.5 sessions* -- [~] Create `health/commands/review-payer-contract.md` +- [x] Create `health/commands/review-payer-contract.md` [98561cc] - Acceptance: Contract intake workflow - Acceptance: Generates analysis report From fb4ac61bb4848feccac97ec8b5df9bc1d2502803 Mon Sep 17 00:00:00 2001 From: "Dylan Mordaunt (Illawarra Shoalhaven LHD)" Date: Sat, 14 Feb 2026 11:59:51 +1100 Subject: [PATCH 45/57] conductor(checkpoint): Health financial workflow complete From c12bd7dc4770e3490390db2fdc113e9d9d372af6 Mon Sep 17 00:00:00 2001 From: "Dylan Mordaunt (Illawarra Shoalhaven LHD)" Date: Sat, 14 Feb 2026 12:00:51 +1100 Subject: [PATCH 46/57] feat(health): Create health-data-report skill with epidemiological analysis guidance --- health/skills/health-data-report/SKILL.md | 497 ++++++++++++++++++++++ 1 file changed, 497 insertions(+) create mode 100644 health/skills/health-data-report/SKILL.md diff --git a/health/skills/health-data-report/SKILL.md b/health/skills/health-data-report/SKILL.md new file mode 100644 index 0000000..53253fd --- /dev/null +++ b/health/skills/health-data-report/SKILL.md @@ -0,0 +1,497 @@ +--- +name: health/health-data-report +description: This skill should be used when analyzing health data, generating epidemiological reports, creating statistical summaries, or producing population health visualizations. Use when users mention health statistics, epidemiological analysis, cohort studies, survival analysis, forest plots, Kaplan-Meier curves, population health metrics, or health data dashboards. +version: 1.0.0 +--- + +# Health Data Analysis and Reporting + +Comprehensive guidance for epidemiological data analysis, statistical reporting, and population health visualization. Supports descriptive and analytical epidemiology, survival analysis, and evidence-based health reporting. + +**Important**: This skill assists with health data analysis workflows but does not replace biostatistical expertise, epidemiological consultation, or institutional review board oversight. All analyses involving human subjects data require appropriate ethical approvals. + +## When to Use This Skill + +Invoke when: +- A user needs to analyze health or epidemiological data (cohort, cross-sectional, case-control). +- Population health metrics need calculation and interpretation (incidence, prevalence, SMR). +- Statistical reports for clinical governance, quality improvement, or research are required. +- Survival analysis outputs (Kaplan-Meier curves, hazard ratios) need generation. +- Meta-analysis visualizations (forest plots, funnel plots) are requested. +- Health data visualization for dashboards or publications is needed. +- Epidemiological study design guidance is required before analysis. +- Risk adjustment or comparative outcome reporting is requested. +- Users need guidance on appropriate statistical tests for health data. + +Do not use this skill for: +- Individual patient diagnosis or treatment decisions (use clinical decision support tools). +- Real-time clinical monitoring or alert systems. +- Pharmaceutical trial regulatory submissions without biostatistical oversight. +- Analyses requiring protected health information (PHI) without proper de-identification protocols. + +## Operating Modes + +### Standard Mode +Use full epidemiological analysis workflow: +- Complete study design review and data quality assessment. +- Formal statistical analysis plan with power calculations where applicable. +- Full regulatory and ethical compliance verification (AU/NZ default). +- Comprehensive visualization package with publication-ready figures. +- Detailed interpretation with confidence intervals and uncertainty quantification. +- Hybrid evidence management with strict citations and narrative referencing. + +### Lite Mode +Use for constrained contexts (exploratory analysis, limited data, or rapid insights): +- Basic descriptive statistics and summary measures only. +- Preliminary visualizations without formal statistical testing. +- High-level population health metrics with clear uncertainty flags. +- Flag limitations and recommend full analysis when conclusions are needed. +- Lite mode is not acceptable for regulatory submissions, peer-reviewed publications, or clinical decision-making. + +Lite mode must never suppress high-risk findings or statistical significance warnings. + +## Regulatory Context + +Default jurisdiction is Australia/New Zealand. Use US/EU-lite framing only when explicitly requested. + +| Jurisdiction | Regulator/Statute | Trigger | Timeframe/SLA | Required Artifacts | Escalation Point | +|---|---|---|---|---|---| +| Australia | Privacy Act 1988 (Cth), NHMRC National Statement on Ethical Conduct in Human Research, state health privacy principles | Research involving human data, identifiable health records, population health reporting | Ethics approval required before analysis; privacy impact assessments for identifiable data | Ethics approval certificate, data governance agreement, statistical analysis plan, de-identification protocol | Human Research Ethics Committee (HREC), Privacy Officer, Chief Medical Officer | +| New Zealand | Privacy Act 2020, Health Information Privacy Code 2020, HDC Code of Health and Disability Services Consumers' Rights, Te Whatu Ora governance | Research with health data, identifiable information, population health surveillance | Ethics approval via HDEC (Health and Disability Ethics Committee); privacy assessments for identifiable data | Ethics approval, data access agreement, statistical analysis plan, privacy impact assessment | HDEC, Privacy Officer, Clinical Governance | +| United States (lite) | HIPAA Privacy Rule, Common Rule (45 CFR 46), FDA regulations for clinical trials | Human subjects research, identifiable health data, clinical trial analyses | IRB approval required; data use agreements for PHI | IRB approval, DUA, statistical analysis plan | IRB, Privacy Officer, Compliance | +| European Union (lite) | GDPR (health data special category), Clinical Trials Regulation (EU) No 536/2014, national health research laws | Health data processing, clinical trials, epidemiological studies | Ethics committee approval; DPIA for high-risk processing; GDPR lawful basis documented | Ethics approval, DPIA, statistical analysis plan, data processing agreements | Ethics Committee, DPO, Clinical Governance | + +## Quick Reference + +1. **Define study question** - Specify hypothesis, outcomes, and target population. +2. **Assess data quality** - Completeness, validity, and bias assessment. +3. **Select analysis type** - Descriptive, analytical, survival, or meta-analysis. +4. **Choose appropriate metrics** - Incidence, prevalence, rates, ratios as appropriate. +5. **Apply risk adjustment** - Account for confounders and case-mix differences. +6. **Calculate confidence intervals** - Always report uncertainty with point estimates. +7. **Create visualizations** - Forest plots, survival curves, or population dashboards. +8. **Interpret cautiously** - Distinguish association from causation; note limitations. +9. **Document methods** - Reproducible analysis with version control and code. +10. **Report ethically** - De-identified outputs; appropriate data governance. + +## Detailed Guidance + +### Step-by-Step Analysis Workflow + +#### Step 1: Study Design and Question Specification +- Define primary research question using PICO/PECO framework (Population, Exposure/Intervention, Comparator, Outcome). +- Specify study type: descriptive (cross-sectional), analytical (cohort, case-control), or experimental. +- Identify target population and sampling strategy. +- Define inclusion/exclusion criteria explicitly. +- Document potential biases (selection, information, confounding). + +#### Step 2: Data Quality Assessment +- Evaluate completeness: missing data patterns and proportions. +- Assess validity: range checks, logical consistency, outlier detection. +- Check accuracy: comparison with gold standard or duplicate verification. +- Document data provenance: source systems, extraction date, transformation history. +- Flag data quality issues before analysis begins. + +#### Step 3: Statistical Analysis Plan +- Pre-specify primary and secondary analyses before data inspection. +- Define statistical significance threshold (typically alpha = 0.05). +- Specify adjustment for multiple comparisons (Bonferroni, FDR). +- Plan for missing data handling (complete case, imputation, sensitivity analysis). +- Document subgroup analyses and interaction tests. +- Calculate required sample size/power for primary hypothesis. + +#### Step 4: Descriptive Analysis +- Report baseline characteristics: demographics, comorbidities, exposure distribution. +- Use appropriate summary statistics: mean (SD) or median (IQR) for continuous; counts (%) for categorical. +- Calculate stratified summaries by key variables (e.g., exposure groups). +- Visualize distributions: histograms, box plots, bar charts. +- Report data completeness for each variable. + +#### Step 5: Analytical Epidemiology +- **Cohort Studies**: Calculate incidence rates, rate ratios, risk ratios, risk differences. Use survival analysis for time-to-event outcomes. +- **Case-Control Studies**: Calculate odds ratios with confidence intervals. Assess for selection bias and recall bias. +- **Cross-Sectional Studies**: Calculate prevalence, prevalence ratios. Note inability to establish temporality. +- **Risk Adjustment**: Use multivariable regression (logistic, Poisson, Cox) to control for confounders. +- **Sensitivity Analyses**: Test robustness to assumptions and missing data methods. + +#### Step 6: Survival Analysis (when applicable) +- Calculate Kaplan-Meier estimates with log-rank tests for group comparisons. +- Fit Cox proportional hazards models for adjusted hazard ratios. +- Check proportional hazards assumption (Schoenfeld residuals, time-dependent covariates). +- Handle competing risks (Fine-Gray subdistribution hazards) when appropriate. +- Report median survival times with confidence intervals. +- Create Kaplan-Meier plots with number-at-risk tables. + +#### Step 7: Meta-Analysis (when applicable) +- Assess heterogeneity (I² statistic, Cochran's Q). +- Choose fixed-effect or random-effects model based on heterogeneity. +- Calculate pooled effect estimates with confidence intervals. +- Assess publication bias (funnel plots, Egger's test). +- Conduct sensitivity analyses (leave-one-out, subgroup analyses). +- Create forest plots showing individual and pooled estimates. + +#### Step 8: Interpretation and Reporting +- Distinguish statistical significance from clinical importance. +- Report confidence intervals to show precision of estimates. +- Discuss generalizability to target population. +- Acknowledge limitations: residual confounding, selection bias, measurement error. +- Provide actionable conclusions with appropriate caveats. + +## Analysis Types and Selection Guidance + +| Analysis Type | When to Use | Key Metrics | Visualizations | +|---|---|---|---| +| **Descriptive Epidemiology** | Characterizing population health; generating hypotheses | Prevalence, incidence, rates, proportions | Bar charts, pie charts, population pyramids, maps | +| **Cohort Study Analysis** | Following exposed vs. unexposed over time | Incidence rate, rate ratio, risk ratio, risk difference, NNT | Survival curves, incidence plots, cumulative incidence | +| **Case-Control Analysis** | Rare diseases or outcomes with long latency | Odds ratio, exposure odds, matched OR | Forest plots, exposure distribution charts | +| **Cross-Sectional Analysis** | Snapshot of health status; prevalence studies | Prevalence, prevalence ratio, prevalence odds ratio | Bar charts, prevalence maps, age-standardized rates | +| **Survival Analysis** | Time-to-event outcomes; censored data | Hazard ratio, median survival, survival probability | Kaplan-Meier curves, Nelson-Aalen plots, hazard plots | +| **Trend Analysis** | Temporal patterns; surveillance data | Annual percent change, joinpoint regression | Time series plots, trend lines, heatmaps by time | +| **Comparative Effectiveness** | Comparing interventions or exposures | Relative risk reduction, absolute risk reduction, NNT | Forest plots, waterfall plots, volcano plots | +| **Risk Prediction** | Predicting individual outcomes | C-statistic, calibration slope, Brier score | ROC curves, calibration plots, risk score distributions | +| **Meta-Analysis** | Synthesizing multiple studies | Pooled effect size, I², prediction intervals | Forest plots, funnel plots, L'Abbe plots | +| **Geospatial Analysis** | Geographic variation in health | SMR, local Moran's I, spatial scan statistics | Choropleth maps, disease cluster maps, spatial smoothed rates | + +## Epidemiological Methods Overview + +### Measures of Disease Frequency + +| Measure | Formula | Interpretation | When to Use | +|---|---|---|---| +| **Prevalence** | Cases / Total population | Proportion with disease at a point or period | Burden of disease; resource planning | +| **Incidence Rate** | New cases / Person-time at risk | Rate of new cases per unit time | Dynamic populations; varying follow-up | +| **Cumulative Incidence** | New cases / Initial population at risk | Risk of developing disease over time | Fixed cohorts with complete follow-up | +| **Attack Rate** | Cases / Exposed population | Cumulative incidence during outbreak | Outbreak investigations | +| **Secondary Attack Rate** | Cases among contacts / Total contacts | Transmissibility of infectious disease | Contact tracing; infectious disease control | + +### Measures of Association + +| Measure | Formula | Interpretation | Study Type | +|---|---|---|---| +| **Risk Ratio (RR)** | Risk exposed / Risk unexposed | Relative increase/decrease in risk | Cohort studies; RCTs | +| **Odds Ratio (OR)** | (a×d)/(b×c) | Approximates RR when disease rare | Case-control studies | +| **Rate Ratio** | Rate exposed / Rate unexposed | Relative difference in incidence rates | Cohort studies with person-time | +| **Risk Difference (RD)** | Risk exposed - Risk unexposed | Absolute difference in risk | Public health impact; NNT calculation | +| **Hazard Ratio (HR)** | h₁(t)/h₀(t) | Relative instantaneous risk | Survival analysis; Cox models | +| **Number Needed to Treat (NNT)** | 1 / Absolute risk reduction | Patients to treat to prevent one outcome | Clinical trials; intervention studies | +| **Population Attributable Fraction** | (Pₑ×(RR-1))/(Pₑ×(RR-1)+1) | Proportion of disease due to exposure | Public health policy; prevention priorities | + +### Risk Adjustment Methods + +| Method | Description | When to Use | +|---|---|---| +| **Direct Standardization** | Apply stratum-specific rates to standard population | Comparing rates across populations with different age structures | +| **Indirect Standardization** | Apply standard rates to study population; calculate SMR | Small strata; limited data; comparing to standard population | +| **Regression Adjustment** | Include covariates in multivariable model | Controlling for multiple confounders simultaneously | +| **Propensity Scores** | Match or weight on probability of exposure | Observational studies with many confounders | +| **Instrumental Variables** | Use external variation to isolate causal effect | Unmeasured confounding suspected | +| **Stratification/Matching** | Analyze within homogeneous subgroups | Simple confounder control; ensuring balance | + +## Standard Health Metrics + +### Population Health Indicators + +| Metric | Definition | Benchmark/Interpretation | +|---|---|---| +| **Age-Standardized Rate** | Rate adjusted to standard population structure | Enables fair comparison across populations | +| **Standardized Mortality Ratio (SMR)** | Observed deaths / Expected deaths | SMR > 1 indicates excess mortality; < 1 indicates protective effect | +| **Years of Life Lost (YLL)** | Sum of (standard life expectancy - age at death) | Burden of premature mortality | +| **Disability-Adjusted Life Years (DALY)** | YLL + Years Lived with Disability (YLD) | Comprehensive burden of disease measure | +| **Quality-Adjusted Life Years (QALY)** | Life years weighted by quality of life | Health economic evaluation; cost-utility analysis | +| **Life Expectancy** | Average years of life remaining at given age | Population health status indicator | +| **Healthy Life Expectancy (HALE)** | Years lived in full health | Quality-adjusted longevity | +| **Infant Mortality Rate** | Deaths < 1 year / Live births | Sensitive indicator of population health | +| **Maternal Mortality Ratio** | Maternal deaths / 100,000 live births | Healthcare system performance | + +### Healthcare Quality Metrics + +| Metric | Definition | Use Case | +|---|---|---| +| **Readmission Rate** | Readmissions / Index admissions | Care transition quality; post-discharge outcomes | +| **Mortality Rate** | Deaths / Admissions or procedures | Outcome quality; safety indicator | +| **Length of Stay (LOS)** | Mean/median days from admission to discharge | Efficiency; resource utilization | +| **Complication Rate** | Complications / Procedures or admissions | Safety; process quality | +| **Infection Rate** | HAI cases / Patient days or device days | Infection control effectiveness | +| **Medication Error Rate** | Errors / Medication orders or doses | Medication safety | +| **Patient Satisfaction Score** | Mean or proportion satisfied | Patient experience; service quality | +| **Mortality/Hospital Volume Relationship** | Outcomes by hospital procedure volume | Volume-outcome relationship; care centralization | + +## Visualization Types + +### Forest Plots + +**Purpose**: Display effect estimates from multiple studies or subgroups in meta-analysis or subgroup analysis. + +**Components**: +- Left column: Study/subgroup labels +- Center: Effect estimates (squares) with confidence intervals (horizontal lines) +- Right column: Numerical values (effect size, CI, weight) +- Bottom: Pooled estimate (diamond) + +**Best Practices**: +- Use log scale for ratio measures (OR, RR, HR). +- Show weights for meta-analysis (square size proportional to weight). +- Include heterogeneity statistics (I², p-value). +- Sort studies by effect size or chronologically. +- Use consistent color scheme (e.g., blue for benefit, red for harm). + +**Tools**: R (meta, metafor), Python (matplotlib, forestplot), Stata, RevMan. + +### Kaplan-Meier Survival Curves + +**Purpose**: Estimate and visualize survival probability over time; compare survival between groups. + +**Components**: +- X-axis: Time from origin (e.g., diagnosis, treatment) +- Y-axis: Survival probability (0-1 or 0-100%) +- Step function: Kaplan-Meier estimate +- Tick marks: Censoring events +- Shaded areas or dashed lines: Confidence intervals + +**Best Practices**: +- Include number-at-risk table below plot. +- Show confidence intervals (95% typical). +- Mark censoring with vertical ticks. +- Use log-rank test p-value for group comparisons. +- State time origin and event definition clearly. +- Truncate x-axis when number-at-risk becomes small (<10-20). + +**Tools**: R (survival, survminer), Python (lifelines, scikit-survival), Stata, SAS. + +### Additional Health Data Visualizations + +| Visualization Type | Purpose | Best Practices | +|---|---|---| +| **Funnel Plots** | Assess publication bias; compare institutional performance | Plot effect size vs. precision; add confidence limits; flag outliers | +| **ROC Curves** | Evaluate diagnostic/predictive model discrimination | Plot sensitivity vs. 1-specificity; show AUC with CI; mark optimal threshold | +| **Calibration Plots** | Assess prediction model calibration | Observed vs. predicted; perfect calibration line; Hosmer-Lemeshow or Brier score | +| **Heatmaps** | Show patterns across two dimensions (e.g., time × geography) | Use colorblind-safe palette; add values for key cells; dendrogram for clustering | +| **Population Pyramids** | Compare age-sex structure across populations | Centered at zero; consistent age groups; percentages or counts | +| **Choropleth Maps** | Geographic variation in health outcomes | Use rate ratios or SMRs; account for small area variation; provide uncertainty | +| **Volcano Plots** | Display significance vs. effect size (omics, multiple outcomes) | Log-scale axes; highlight significant findings; color by category | +| **Waterfall Plots** | Show change in continuous outcome (tumor response, biomarkers) | Sort by magnitude; add reference lines; color by response category | +| **Lexis Diagrams** | Show exposure, outcome, and follow-up in cohort studies | Calendar time vs. age; mark entry/exit/events; show person-time | +| **Bland-Altman Plots** | Assess agreement between two measurement methods | Mean difference ± 1.96 SD limits; scatter of differences vs. mean | + +## Report Structure Templates + +### Standard Epidemiological Report Template + +``` +1. EXECUTIVE SUMMARY + - Key findings (2-3 bullet points) + - Recommendations + - Confidence level in conclusions + +2. INTRODUCTION + - Background and rationale + - Research question/objectives + - Scope and limitations + +3. METHODS + - Study design + - Data sources and population + - Variables and measurements + - Statistical analysis plan + - Ethical considerations + +4. RESULTS + - Data quality summary + - Baseline characteristics (Table 1) + - Primary outcome results + - Secondary outcomes + - Subgroup analyses + - Sensitivity analyses + +5. FIGURES + - Figure 1: Study flow diagram + - Figure 2: Primary outcome visualization + - Figure 3: Secondary analyses + - Supplementary figures + +6. TABLES + - Table 1: Baseline characteristics + - Table 2: Primary analysis results + - Table 3: Secondary/subgroup analyses + - Supplementary tables + +7. DISCUSSION + - Summary of main findings + - Comparison with existing literature + - Strengths and limitations + - Implications for practice/policy + - Future research needs + +8. CONCLUSIONS + - Key takeaways + - Actionable recommendations + - Confidence statements + +9. REFERENCES + - Citations in Vancouver or APA format + - Evidence quality indicators (GRADE, NHMRC levels) + +10. APPENDICES + - Statistical code + - Data dictionary + - Ethics approval + - Sensitivity analysis results +``` + +### Rapid Health Data Summary Template (Lite Mode) + +``` +HEALTH DATA SUMMARY +Date: [Date] +Analyst: [Role/Name] +Data Source: [System/Database] + +RESEARCH QUESTION +[One sentence] + +POPULATION +- Total N: [Number] +- Key characteristics: [Brief summary] + +KEY FINDINGS +1. [Primary finding with CI] +2. [Secondary finding] +3. [Notable pattern] + +METRICS +| Metric | Value | 95% CI | +|--------|-------|--------| +| [Metric 1] | [Value] | [CI] | +| [Metric 2] | [Value] | [CI] | + +LIMITATIONS +- [Data quality issue] +- [Analysis limitation] + +RECOMMENDATIONS +- [Action item 1] +- [Action item 2] + +CONFIDENCE: [High/Medium/Low] +NEXT STEPS: [Full analysis / Data collection / None] +``` + +## Security & Privacy Considerations + +### PHI/PII Handling +- **Never include identifiers** in analysis outputs, logs, or reports (names, MRN, dates of birth, full dates, geographic detail < SA3 level in AU). +- **De-identify by default**: Use study IDs, age bands, and aggregated geography. +- **Secure data environments**: Analyze data only in approved secure environments with access controls. +- **Audit trails**: Log all data access and analysis activities for compliance. +- **Output review**: Review all outputs for potential re-identification risks before sharing. + +### Data Minimization +- Use only variables necessary for the analysis objective. +- Aggregate small cells (<5 counts in AU; <11 in some jurisdictions) to prevent disclosure. +- Remove indirect identifiers (rare combinations of demographics) that could enable re-identification. +- Consider k-anonymity, l-diversity, or differential privacy for high-risk datasets. + +### Retention and Disposal +- Retain analysis outputs only as long as required by governance or research protocols. +- Dispose of temporary analysis files securely when analysis is complete. +- Maintain documentation of data provenance and transformations for reproducibility without retaining raw identifiers. + +### Jurisdiction-Specific Privacy + +| Jurisdiction | Key Requirements | +|---|---| +| **Australia** | Privacy Act 1988 (APPs), state health privacy principles, AIHW small cell guidelines (suppress <5), ABS Census and Statistics Act | +| **New Zealand** | Privacy Act 2020, Health Information Privacy Code 2020, HDC guidance, Stats NZ confidentiality rules | +| **United States** | HIPAA Safe Harbor (18 identifiers), de-identification expert determination, state privacy laws | +| **European Union** | GDPR Article 9 (health data special category), Article 89 (research exemption), pseudonymization requirements | + +## Confidence Indicators + +| Scenario | Confidence | Action | +|---|---|---| +| Large sample size (>1000), complete data, clear study design, well-established statistical methods | High | Proceed with analysis; draft report; flag for peer review if publication intended | +| Moderate sample (100-1000), minimal missing data, standard methods but novel population or outcome | Medium | Complete analysis; explicitly document assumptions and limitations; recommend biostatistical review | +| Small sample (<100), substantial missing data (>20%), complex methods, potential confounding | Low | Proceed cautiously; conduct extensive sensitivity analyses; require biostatistical and clinical review before any conclusions | +| Data quality concerns (outliers, inconsistencies), unclear provenance, potential selection bias | Low | Halt analysis pending data clarification; document concerns; escalate to data governance | +| Results showing serious safety concerns, unexpected harms, or major public health implications | Low | Do not finalize autonomously; escalate to clinical governance and ethics immediately | +| Real-world evidence with strong confounding, immortal time bias, or indication bias potential | Medium-Low | Acknowledge limitations prominently; avoid causal language; recommend confirmatory studies | + +## Common Mistakes (Anti-Patterns) + +| Mistake | Why It's Wrong | Instead | +|---|---|---| +| Reporting only p-values without effect sizes or confidence intervals | Misleading significance; no measure of precision | Always report point estimates with confidence intervals | +| Treating association as causation | Leads to incorrect conclusions and harmful decisions | Use cautious language; consider study design limitations; triangulate evidence | +| Ignoring missing data | Biased estimates; reduced power; misleading precision | Assess missingness pattern; use multiple imputation or sensitivity analyses | +| Not adjusting for multiple comparisons | Inflated Type I error; false positives | Apply Bonferroni, FDR, or pre-specify primary outcomes | +| Overfitting prediction models | Poor generalization; optimistic performance | Use cross-validation; restrict model complexity; validate externally | +| Using inappropriate statistical tests | Invalid conclusions; violated assumptions | Check assumptions; use non-parametric or robust methods when needed | +| Presenting unadjusted and adjusted analyses inconsistently | Confusing interpretation; selective reporting | Present both clearly; justify covariates in adjusted models | +| Ignoring competing risks in survival analysis | Biased cumulative incidence estimates | Use Fine-Gray or cause-specific hazards models | +| Failing to check proportional hazards assumption | Invalid hazard ratios; misleading inference | Test Schoenfeld residuals; use time-dependent covariates or stratification | +| Producing visualizations without uncertainty | Overconfidence in point estimates | Always show confidence intervals or uncertainty bands | +| Aggregating data without accounting for clustering | Underestimated standard errors; false positives | Use mixed effects models, GEE, or cluster-robust standard errors | +| Releasing small cell counts | Risk of individual disclosure; privacy breach | Suppress cells <5 (AU) or aggregate to higher level | +| Using causal language in observational studies | Overstates evidence strength; misleads decision-makers | Use "associated with," "higher risk of," not "causes" or "prevents" | +| Not documenting analysis code | Irreproducible results; scientific misconduct | Use version control; document code thoroughly; share analysis scripts | +| Analyzing data without ethics approval | Ethical violation; potential legal consequences | Obtain HREC/IRB approval before accessing or analyzing data | + +## When to Escalate + +Escalate immediately when: +- Analysis involves identifiable patient data without proper governance. +- Results suggest serious patient harm, safety signals, or unexpected adverse events. +- Statistical analysis exceeds your expertise (complex methods, advanced modeling). +- Data quality issues suggest potential data corruption or systematic errors. +- Analysis requires regulatory submission (TGA, FDA, EMA) or will inform clinical guidelines. +- Publication in high-impact journal is intended (requires rigorous methodology). +- Public health emergency implications (outbreak detection, epidemic thresholds). + +Escalation targets: +- **Biostatistical**: Senior biostatistician, epidemiologist, or methodologist. +- **Clinical**: Clinical director, chief medical officer, or subject matter expert. +- **Governance**: Human Research Ethics Committee (HREC), privacy officer, data governance committee. +- **Regulatory**: Regulatory affairs team, compliance officer, quality assurance. + +## Tool Requirements + +- `~~research literature` (PubMed, Cochrane) for evidence synthesis and literature context. +- `~~clinical terminology` (SNOMED-CT, LOINC, ICD-10-AM/ICD-11) for standardized coding and phenotype definitions. +- `~~data/statistical-analysis` for statistical methods guidance and test selection. +- `~~data/data-visualization` for visualization best practices and figure generation. +- `~~document-skills/xlsx` for data extraction and tabular outputs. +- `~~document-skills/pdf` for report generation and publication outputs. +- `~~health/clinical-systems` for validated data retrieval from EHR/EMR systems. +- `~~health/coding` for ICD-10-AM/ACHI coding support when analyzing coded data. + +## Success Indicators + +You have applied this skill correctly when: +- [ ] Study design and analysis approach are documented and appropriate for the research question. +- [ ] Data quality has been assessed and limitations acknowledged. +- [ ] Appropriate statistical methods have been selected and applied correctly. +- [ ] Effect estimates are reported with confidence intervals, not just p-values. +- [ ] Visualizations follow health data best practices (forest plots, survival curves, etc.). +- [ ] Risk adjustment or confounding control has been applied where necessary. +- [ ] All outputs are de-identified and privacy-protective. +- [ ] Jurisdiction assumptions are explicit (AU/NZ default unless requested otherwise). +- [ ] Causal language is avoided in observational studies. +- [ ] Analysis code and methods are documented for reproducibility. +- [ ] Ethics and governance requirements have been verified. +- [ ] Limitations are clearly stated and interpreted cautiously. + +## Related Skills + +- `~~health/quality-improvement` for QI project data analysis and statistical process control. +- `~~health/clinical-coding` for working with ICD-10-AM/ACHI coded datasets. +- `~~health/clinical-decision-support` for translating evidence into clinical recommendations. +- `~~data/statistical-analysis` for detailed statistical methodology and test selection. +- `~~data/data-visualization` for visualization design and implementation guidance. +- `~~document-skills/xlsx` for spreadsheet-based analysis and reporting. +- `~~document-skills/pdf` for PDF report generation and formatting. + +## Version History + +| Version | Date | Changes | +|---|---|---| +| 1.0.0 | 2026-02-14 | Initial health-data-report skill with epidemiological methods, statistical analysis guidance, and health-specific visualization standards | From b7d56a119990a7ab03295433b076ee9739bbf5ec Mon Sep 17 00:00:00 2001 From: "Dylan Mordaunt (Illawarra Shoalhaven LHD)" Date: Sat, 14 Feb 2026 12:01:10 +1100 Subject: [PATCH 47/57] conductor(plan): Mark Phase 1 'Health Data Report Skill' as complete --- conductor/tracks/health-data-analysis/plan.md | 2 +- 1 file changed, 1 insertion(+), 1 deletion(-) diff --git a/conductor/tracks/health-data-analysis/plan.md b/conductor/tracks/health-data-analysis/plan.md index bfa8b85..8de0e49 100644 --- a/conductor/tracks/health-data-analysis/plan.md +++ b/conductor/tracks/health-data-analysis/plan.md @@ -4,7 +4,7 @@ *Dependencies: health-core, health-coding* *Estimated: 1-2 sessions* -- [ ] Create `health/skills/health-data-report/SKILL.md` +- [x] Create `health/skills/health-data-report/SKILL.md` [c12bd7d] - Acceptance: Follows [health skill standards](../health-plugin/skill-standards.md) (14-section template) - Acceptance: Includes Confidence Indicators for statistical validity - Acceptance: AU/NZ reporting defaults are explicit, with US/EU-lite fallback From fcee3fe36ffb065863efcedfee33a1bf29f6e7b7 Mon Sep 17 00:00:00 2001 From: "Dylan Mordaunt (Illawarra Shoalhaven LHD)" Date: Sat, 14 Feb 2026 12:01:15 +1100 Subject: [PATCH 48/57] conductor(checkpoint): Checkpoint end of Phase 1 - Health Data Report Skill From 6b196f247be250e9aace385a25346371e79fa14a Mon Sep 17 00:00:00 2001 From: "Dylan Mordaunt (Illawarra Shoalhaven LHD)" Date: Sat, 14 Feb 2026 13:38:40 +1100 Subject: [PATCH 49/57] feat(health): Complete all conductor tracks implementation Implement all remaining health plugin conductor tracks: - health-evidence: systematic-review, evidence-synthesis skills, /start-review command - health-ethics: research-ethics, clinical-ethics skills, /ethics-review command - health-economics: health-econ-eval, hta-submission skills, /economic-evaluation command - health-manuscripts: manuscript-prep skill, /prepare-manuscript command - health-doc-coauthoring: clinical-doc-coauthoring skill, /coauthor command - health-grants: grant-writer skill, /grant-application command - health-medicolegal: medicolegal-reports, child-protection, affidavit-drafting skills, /prepare-report command - skill-quality: health skill templates, validation checklist, validate_health_skills.py script Also implement missing pieces: - health-data-analysis: /analyze-health-data command - health-public-health: notifiable-diseases, public-health-surveillance skills, /report-notifiable command Track infrastructure: - Move health-core, health-coding, health-governance from archive to tracks - Update all track metadata to 'complete' status - Fix tracks.md format for validator compatibility - All 14 tracks now pass validation (0 errors) Total: 34 skills, 19 commands, 12,000+ lines of documentation All skills follow 14-section health skill standards with AU/NZ defaults --- .claude/settings.local.json | 9 + .../workflows/conductor-track-validation.yml | 30 + .pre-commit-config.yaml | 9 + conductor/archive/health-coding/metadata.json | 12 - conductor/archive/health-coding/plan.md | 30 - conductor/archive/health-coding/spec.md | 57 -- .../archive/health-complaints/metadata.json | 12 +- conductor/archive/health-core/index.md | 16 - conductor/archive/health-core/metadata.json | 11 - conductor/archive/health-core/plan.md | 21 - conductor/archive/health-core/spec.md | 60 -- .../health-credentialing/metadata.json | 10 +- conductor/archive/health-governance/index.md | 16 - .../archive/health-governance/metadata.json | 11 - conductor/archive/health-governance/plan.md | 34 - conductor/archive/health-governance/spec.md | 45 - .../archive/health-information/metadata.json | 11 +- .../index.md | 2 +- .../archive/health-procurement/metadata.json | 16 + conductor/archive/health-procurement/plan.md | 32 + conductor/archive/health-procurement/spec.md | 45 + conductor/archive/health-risk/metadata.json | 20 +- conductor/index.md | 1 - conductor/scripts/validate_health_skills.py | 585 +++++++++++++ conductor/scripts/validate_tracks.py | 252 ++++++ conductor/tracks.md | 153 ++-- conductor/tracks/health-coding/metadata.json | 18 +- conductor/tracks/health-complaints/index.md | 20 +- .../tracks/health-complaints/metadata.json | 14 +- conductor/tracks/health-complaints/plan.md | 49 +- conductor/tracks/health-complaints/spec.md | 81 +- .../tracks/health-credentialing/index.md | 20 +- .../tracks/health-credentialing/metadata.json | 10 +- conductor/tracks/health-credentialing/plan.md | 29 +- conductor/tracks/health-credentialing/spec.md | 86 +- .../tracks/health-data-analysis/metadata.json | 2 +- conductor/tracks/health-data-analysis/plan.md | 2 +- .../health-doc-coauthoring/metadata.json | 2 +- .../tracks/health-doc-coauthoring/plan.md | 28 +- .../tracks/health-economics/metadata.json | 2 +- conductor/tracks/health-economics/plan.md | 6 +- conductor/tracks/health-ethics/metadata.json | 2 +- conductor/tracks/health-ethics/plan.md | 6 +- .../tracks/health-evidence/metadata.json | 2 +- conductor/tracks/health-evidence/plan.md | 6 +- .../tracks/health-financial/metadata.json | 2 +- .../tracks/health-governance/metadata.json | 11 +- conductor/tracks/health-grants/metadata.json | 2 +- conductor/tracks/health-grants/plan.md | 4 +- conductor/tracks/health-incidents/index.md | 16 + .../tracks/health-incidents/metadata.json | 11 + conductor/tracks/health-incidents/plan.md | 41 + conductor/tracks/health-incidents/spec.md | 78 ++ conductor/tracks/health-information/index.md | 20 +- .../tracks/health-information/metadata.json | 10 +- conductor/tracks/health-information/plan.md | 32 +- conductor/tracks/health-information/spec.md | 74 +- .../tracks/health-manuscripts/metadata.json | 2 +- conductor/tracks/health-manuscripts/plan.md | 4 +- .../tracks/health-medicolegal/metadata.json | 2 +- conductor/tracks/health-medicolegal/plan.md | 8 +- conductor/tracks/health-plugin/index.md | 8 +- conductor/tracks/health-plugin/metadata.json | 8 +- conductor/tracks/health-plugin/plan.md | 24 +- conductor/tracks/health-procurement/index.md | 20 +- .../tracks/health-procurement/metadata.json | 10 +- conductor/tracks/health-procurement/plan.md | 29 +- conductor/tracks/health-procurement/spec.md | 83 +- .../tracks/health-public-health/metadata.json | 2 +- conductor/tracks/health-public-health/plan.md | 6 +- conductor/tracks/health-quality/metadata.json | 11 +- conductor/tracks/health-risk/index.md | 20 +- conductor/tracks/health-risk/metadata.json | 12 +- conductor/tracks/health-risk/plan.md | 59 +- conductor/tracks/health-risk/spec.md | 95 ++- conductor/tracks/skill-quality/index.md | 23 +- conductor/tracks/skill-quality/metadata.json | 9 +- conductor/tracks/skill-quality/plan.md | 92 +- conductor/tracks/skill-quality/spec.md | 35 +- conductor/workflow.md | 8 + health/README.md | 73 +- health/commands/analyze-health-data.md | 167 ++++ health/commands/coauthor.md | 184 ++++ health/commands/economic-evaluation.md | 203 +++++ health/commands/ethics-review.md | 362 ++++++++ health/commands/grant-application.md | 99 +++ health/commands/prepare-manuscript.md | 398 +++++++++ health/commands/prepare-report.md | 620 ++++++++++++++ health/commands/report-incident.md | 82 ++ health/commands/report-notifiable.md | 275 ++++++ health/commands/start-review.md | 620 ++++++++++++++ health/commands/submit-complaint.md | 51 ++ .../.templates/health-skill-template.md | 255 ++++++ .../skills/.templates/validation-checklist.md | 409 +++++++++ health/skills/affidavit-drafting/SKILL.md | 442 ++++++++++ health/skills/child-protection/SKILL.md | 366 ++++++++ .../skills/clinical-doc-coauthoring/SKILL.md | 721 ++++++++++++++++ health/skills/clinical-ethics/SKILL.md | 724 ++++++++++++++++ .../skills/clinical-risk-assessment/SKILL.md | 381 +++++++++ health/skills/complaints-management/SKILL.md | 134 +++ health/skills/evidence-synthesis/SKILL.md | 558 ++++++++++++ health/skills/grant-writer/SKILL.md | 546 ++++++++++++ health/skills/health-econ-eval/SKILL.md | 603 +++++++++++++ health/skills/hta-submission/SKILL.md | 802 ++++++++++++++++++ health/skills/incident-reporting/SKILL.md | 242 ++++++ health/skills/manuscript-prep/SKILL.md | 696 +++++++++++++++ health/skills/medicolegal-reports/SKILL.md | 350 ++++++++ health/skills/notifiable-diseases/SKILL.md | 254 ++++++ .../public-health-surveillance/SKILL.md | 247 ++++++ health/skills/research-ethics/SKILL.md | 614 ++++++++++++++ health/skills/systematic-review/SKILL.md | 521 ++++++++++++ 111 files changed, 13863 insertions(+), 892 deletions(-) create mode 100644 .claude/settings.local.json create mode 100644 .github/workflows/conductor-track-validation.yml create mode 100644 .pre-commit-config.yaml delete mode 100644 conductor/archive/health-coding/metadata.json delete mode 100644 conductor/archive/health-coding/plan.md delete mode 100644 conductor/archive/health-coding/spec.md delete mode 100644 conductor/archive/health-core/index.md delete mode 100644 conductor/archive/health-core/metadata.json delete mode 100644 conductor/archive/health-core/plan.md delete mode 100644 conductor/archive/health-core/spec.md delete mode 100644 conductor/archive/health-governance/index.md delete mode 100644 conductor/archive/health-governance/metadata.json delete mode 100644 conductor/archive/health-governance/plan.md delete mode 100644 conductor/archive/health-governance/spec.md rename conductor/archive/{health-coding => health-procurement}/index.md (91%) create mode 100644 conductor/archive/health-procurement/metadata.json create mode 100644 conductor/archive/health-procurement/plan.md create mode 100644 conductor/archive/health-procurement/spec.md create mode 100644 conductor/scripts/validate_health_skills.py create mode 100644 conductor/scripts/validate_tracks.py create mode 100644 conductor/tracks/health-incidents/index.md create mode 100644 conductor/tracks/health-incidents/metadata.json create mode 100644 conductor/tracks/health-incidents/plan.md create mode 100644 conductor/tracks/health-incidents/spec.md create mode 100644 health/commands/analyze-health-data.md create mode 100644 health/commands/coauthor.md create mode 100644 health/commands/economic-evaluation.md create mode 100644 health/commands/ethics-review.md create mode 100644 health/commands/grant-application.md create mode 100644 health/commands/prepare-manuscript.md create mode 100644 health/commands/prepare-report.md create mode 100644 health/commands/report-incident.md create mode 100644 health/commands/report-notifiable.md create mode 100644 health/commands/start-review.md create mode 100644 health/commands/submit-complaint.md create mode 100644 health/skills/.templates/health-skill-template.md create mode 100644 health/skills/.templates/validation-checklist.md create mode 100644 health/skills/affidavit-drafting/SKILL.md create mode 100644 health/skills/child-protection/SKILL.md create mode 100644 health/skills/clinical-doc-coauthoring/SKILL.md create mode 100644 health/skills/clinical-ethics/SKILL.md create mode 100644 health/skills/clinical-risk-assessment/SKILL.md create mode 100644 health/skills/complaints-management/SKILL.md create mode 100644 health/skills/evidence-synthesis/SKILL.md create mode 100644 health/skills/grant-writer/SKILL.md create mode 100644 health/skills/health-econ-eval/SKILL.md create mode 100644 health/skills/hta-submission/SKILL.md create mode 100644 health/skills/incident-reporting/SKILL.md create mode 100644 health/skills/manuscript-prep/SKILL.md create mode 100644 health/skills/medicolegal-reports/SKILL.md create mode 100644 health/skills/notifiable-diseases/SKILL.md create mode 100644 health/skills/public-health-surveillance/SKILL.md create mode 100644 health/skills/research-ethics/SKILL.md create mode 100644 health/skills/systematic-review/SKILL.md diff --git a/.claude/settings.local.json b/.claude/settings.local.json new file mode 100644 index 0000000..3f7b7e3 --- /dev/null +++ b/.claude/settings.local.json @@ -0,0 +1,9 @@ +{ + "enabledMcpjsonServers": [ + "outlook", + "betterbird", + "thunderbird_tk", + "thunderbird_bb1" + ], + "enableAllProjectMcpServers": true +} diff --git a/.github/workflows/conductor-track-validation.yml b/.github/workflows/conductor-track-validation.yml new file mode 100644 index 0000000..a99e9b5 --- /dev/null +++ b/.github/workflows/conductor-track-validation.yml @@ -0,0 +1,30 @@ +name: Conductor Track Validation + +on: + pull_request: + paths: + - "conductor/**" + - "health/**" + - ".pre-commit-config.yaml" + push: + branches: + - main + paths: + - "conductor/**" + - "health/**" + - ".pre-commit-config.yaml" + +jobs: + validate-tracks: + runs-on: ubuntu-latest + steps: + - name: Checkout + uses: actions/checkout@v4 + + - name: Setup Python + uses: actions/setup-python@v5 + with: + python-version: "3.11" + + - name: Validate Conductor tracks + run: python conductor/scripts/validate_tracks.py diff --git a/.pre-commit-config.yaml b/.pre-commit-config.yaml new file mode 100644 index 0000000..343e2b3 --- /dev/null +++ b/.pre-commit-config.yaml @@ -0,0 +1,9 @@ +repos: + - repo: local + hooks: + - id: conductor-track-validator + name: Conductor Track Validator + entry: python conductor/scripts/validate_tracks.py + language: system + pass_filenames: false + files: ^(conductor/|health/) diff --git a/conductor/archive/health-coding/metadata.json b/conductor/archive/health-coding/metadata.json deleted file mode 100644 index 29ea8aa..0000000 --- a/conductor/archive/health-coding/metadata.json +++ /dev/null @@ -1,12 +0,0 @@ -{ - "track_id": "health-coding", - "name": "Health Clinical Coding", - "description": "Clinical coding and classification - ICD-10, ICD-11, SNOMED, ACHI mapping and validation", - "status": "planning", - "created": "2026-02-11", - "priority": "medium", - "dependencies": ["health-core"], - "deliverable": "clinical-coding skill, /validate-coding command", - "adapts_from": ["data/data-validation"], - "classifications": ["ICD-10-AM", "ICD-11", "SNOMED-CT", "ACHI", "DRG"] -} diff --git a/conductor/archive/health-coding/plan.md b/conductor/archive/health-coding/plan.md deleted file mode 100644 index 33eb95d..0000000 --- a/conductor/archive/health-coding/plan.md +++ /dev/null @@ -1,30 +0,0 @@ -# Health Clinical Coding Track Plan - -## Phase 1: Clinical Coding Skill -*Dependencies: health-core* -*Estimated: 1-2 sessions* - -- [x] Create `health/skills/clinical-coding/SKILL.md` - - Acceptance: Follows [health skill standards](../health-plugin/skill-standards.md) (14-section template) - - Acceptance: AU/NZ coding and compliance defaults are explicit, with US/EU-lite mapping notes - - Acceptance: Standard mode and Lite mode are explicitly documented - - Acceptance: Includes Confidence Indicators for diagnosis mapping - - Acceptance: PHI/PII guardrails for patient records - - Acceptance: ICD-10-AM coding guidance - - Acceptance: Classification system overview - - Acceptance: Code selection methodology - - Acceptance: Mapping between systems - - Acceptance: Common coding errors - - Acceptance: Documentation requirements - - Source patterns: `data/data-validation` - - MCP: `~~medical coding` (ICD-10), `~~clinical terminology` (SNOMED) - -## Phase 2: Validate Coding Command -*Dependencies: Phase 1* -*Estimated: 0.5 sessions* - -- [x] Create `health/commands/validate-coding.md` - - Acceptance: Code validation workflow - - Acceptance: Generates validation report - -**Checkpoint:** `conductor(checkpoint): Health clinical coding workflow complete` diff --git a/conductor/archive/health-coding/spec.md b/conductor/archive/health-coding/spec.md deleted file mode 100644 index 24b1805..0000000 --- a/conductor/archive/health-coding/spec.md +++ /dev/null @@ -1,57 +0,0 @@ -# Health Clinical Coding Track Specification - -## Overview - -Clinical coding and classification support including ICD-10, ICD-11, SNOMED-CT, ACHI mapping, and coding validation for research datasets and clinical documentation. - -## Scope - -### Classification Systems -- **ICD-10-AM** (Australian Modification) -- **ICD-11** (WHO) -- **SNOMED-CT** (Clinical terminology) -- **ACHI** (Australian Classification of Health Interventions) -- **DRG** (Diagnosis Related Groups) - -### Use Cases -- Research dataset coding -- Clinical documentation improvement -- Classification mapping/conversion -- Coding audit support -- Population health data - -### Workflow -- Code lookup and selection -- Multi-system mapping -- Validation checking -- Documentation requirements -- Common errors avoidance - -## Deliverables - -### Skills -- `clinical-coding` - Clinical coding guidance and validation - -### Commands -- `/validate-coding` - Validate coding accuracy - -## Dependencies - -- `health-core` (plugin structure) - -## Adapts From - -- `data/data-validation` - Validation patterns - -## MCP Connectors - -- ICD-10 Codes MCP (existing) -- SNOMED CT Browser (potential) - -## Success Criteria - -- [ ] Supports ICD-10-AM coding -- [ ] Provides classification mapping guidance -- [ ] Validates code selection -- [ ] Documents coding rationale -- [ ] Identifies common coding errors diff --git a/conductor/archive/health-complaints/metadata.json b/conductor/archive/health-complaints/metadata.json index 036babc..b7d3465 100644 --- a/conductor/archive/health-complaints/metadata.json +++ b/conductor/archive/health-complaints/metadata.json @@ -2,10 +2,16 @@ "track_id": "health-complaints", "name": "Health Complaints", "description": "Patient complaints management - clinician complaints, service/organizational complaints, resolution workflows", - "status": "planning", + "status": "complete", "created": "2026-02-11", "priority": "high", - "dependencies": ["health-core"], + "dependencies": [ + "health-core" + ], "deliverable": "complaints-management skill, /submit-complaint command", - "adapts_from": ["customer-support/ticket-triage", "customer-support/escalation", "customer-support/response-drafting"] + "adapts_from": [ + "customer-support/ticket-triage", + "customer-support/escalation", + "customer-support/response-drafting" + ] } diff --git a/conductor/archive/health-core/index.md b/conductor/archive/health-core/index.md deleted file mode 100644 index 58ebe43..0000000 --- a/conductor/archive/health-core/index.md +++ /dev/null @@ -1,16 +0,0 @@ -# Health-core Track - -## Documents - -- [Specification](./spec.md) -- [Implementation Plan](./plan.md) -- [Metadata](./metadata.json) - -## Quick Links - -- [Project Index](../../index.md) -- [Tracks Registry](../../tracks.md) - -## Status - -See [metadata.json](./metadata.json) for current status and dependencies. diff --git a/conductor/archive/health-core/metadata.json b/conductor/archive/health-core/metadata.json deleted file mode 100644 index cd9e4ee..0000000 --- a/conductor/archive/health-core/metadata.json +++ /dev/null @@ -1,11 +0,0 @@ -{ - "track_id": "health-core", - "name": "Health Core", - "description": "Foundation plugin structure, shared utilities, and connector configuration for all health tracks", - "status": "complete", - "created": "2026-02-11", - "completed": "2026-02-11", - "priority": "high", - "dependencies": [], - "deliverable": "health/ plugin skeleton with plugin.json, README, .mcp.json" -} diff --git a/conductor/archive/health-core/plan.md b/conductor/archive/health-core/plan.md deleted file mode 100644 index 7243878..0000000 --- a/conductor/archive/health-core/plan.md +++ /dev/null @@ -1,21 +0,0 @@ -# Health Core Track Plan - -## Phase 1: Plugin Skeleton [checkpoint: 524aca0] -*Estimated: 1 session* - -- [x] Create `health/` directory structure (524aca0) - - Acceptance: Matches spec structure -- [x] Create `health/.claude-plugin/plugin.json` (524aca0) - - Acceptance: Valid JSON, installs successfully -- [x] Create `health/README.md` (524aca0) - - Acceptance: Documents the planned health domains (complaints, incidents, risk, governance, ethics, compliance, procurement) -- [x] Create `health/CONNECTORS.md` (524aca0) - - Acceptance: Lists document storage, issue tracking, clinical systems categories -- [x] Create `health/.mcp.json` (524aca0) - - Acceptance: At least 2 connector templates - -**Checkpoint:** `conductor(checkpoint): Health core plugin foundation` - -## Notes - -This track must complete before any other health tracks can begin implementation. diff --git a/conductor/archive/health-core/spec.md b/conductor/archive/health-core/spec.md deleted file mode 100644 index 6e6a661..0000000 --- a/conductor/archive/health-core/spec.md +++ /dev/null @@ -1,60 +0,0 @@ -# Health Core Track Specification - -## Overview - -Foundation track for the health plugin ecosystem. Creates the plugin skeleton, shared infrastructure, and connector configuration that all other health tracks will build upon. - -## Deliverable - -A minimal but complete plugin structure that: -- Installs successfully via Claude Code -- Provides connector templates for healthcare tools -- Documents the overall health plugin vision -- Establishes patterns for other tracks to follow - -## Components - -### File Structure -``` -health/ -├── .claude-plugin/ -│ └── plugin.json # Plugin manifest -├── .mcp.json # Connector configurations -├── README.md # Plugin overview -└── CONNECTORS.md # Connector documentation -``` - -### plugin.json -- Name: `health` -- Version: `0.1.0` -- Description: Healthcare organization workflows -- Dependencies: None - -### .mcp.json -Template connectors for: -- Document storage (SharePoint) -- Issue tracking (Jira) -- Clinical systems (FHIR) - -### README.md -- Plugin purpose and scope -- Available skills/commands (placeholder list) -- Installation instructions -- Customization guidance - -### CONNECTORS.md -- Connector categories -- Setup instructions per connector -- Authentication requirements -- Troubleshooting - -## Success Criteria - -- [ ] `claude plugin install ./health` succeeds -- [ ] plugin.json validates against schema -- [ ] README documents all planned domains -- [ ] At least 2 connector templates configured - -## Dependencies - -None - this is the foundation track. diff --git a/conductor/archive/health-credentialing/metadata.json b/conductor/archive/health-credentialing/metadata.json index df5ebe1..b6cf61b 100644 --- a/conductor/archive/health-credentialing/metadata.json +++ b/conductor/archive/health-credentialing/metadata.json @@ -2,10 +2,14 @@ "track_id": "health-credentialing", "name": "Health Credentialing", "description": "Provider credentialing, privileging, license verification, and clinical staff onboarding/offboarding", - "status": "planning", + "status": "complete", "created": "2026-02-11", "priority": "medium", - "dependencies": ["health-core"], + "dependencies": [ + "health-core" + ], "deliverable": "credentialing, privileging skills, /verify-credentials command", - "adapts_from": ["productivity/memory-management"] + "adapts_from": [ + "productivity/memory-management" + ] } diff --git a/conductor/archive/health-governance/index.md b/conductor/archive/health-governance/index.md deleted file mode 100644 index a8744ae..0000000 --- a/conductor/archive/health-governance/index.md +++ /dev/null @@ -1,16 +0,0 @@ -# Health-governance Track - -## Documents - -- [Specification](./spec.md) -- [Implementation Plan](./plan.md) -- [Metadata](./metadata.json) - -## Quick Links - -- [Project Index](../../index.md) -- [Tracks Registry](../../tracks.md) - -## Status - -See [metadata.json](./metadata.json) for current status and dependencies. diff --git a/conductor/archive/health-governance/metadata.json b/conductor/archive/health-governance/metadata.json deleted file mode 100644 index 7832cd3..0000000 --- a/conductor/archive/health-governance/metadata.json +++ /dev/null @@ -1,11 +0,0 @@ -{ - "track_id": "health-governance", - "name": "Health Governance", - "description": "Governance document development - clinical services plans, medicine standing orders, policies, procedures, guidelines", - "status": "planning", - "created": "2026-02-11", - "priority": "medium", - "dependencies": ["health-core"], - "deliverable": "policy-development, procedure-development, guideline-development skills", - "adapts_from": ["legal/compliance", "product-management/stakeholder-comms"] -} diff --git a/conductor/archive/health-governance/plan.md b/conductor/archive/health-governance/plan.md deleted file mode 100644 index 7848ea3..0000000 --- a/conductor/archive/health-governance/plan.md +++ /dev/null @@ -1,34 +0,0 @@ -# Health Governance Track Plan - -## Phase 1: Policy Development Skill -*Dependencies: health-core* -*Estimated: 1 session* - -- [x] Create `health/skills/policy-development/SKILL.md` - - Acceptance: Follows [health skill standards](../health-plugin/skill-standards.md) (14-section template) - - Acceptance: Includes Confidence Indicators for policy interpretation - - Acceptance: AU/NZ jurisdiction default - - Acceptance: US/EU-lite variant guidance is documented - - Acceptance: Policy structure template - - Acceptance: Approval workflow - - Acceptance: Review cycle management - - Source patterns: `legal/compliance` - -## Phase 2: Procedure Development Skill -*Dependencies: Phase 1* -*Estimated: 1 session* - -- [x] Create `health/skills/procedure-development/SKILL.md` - - Acceptance: Procedure documentation format - - Acceptance: Process mapping guidance - -## Phase 3: Guideline Development Skill -*Dependencies: Phase 1* -*Estimated: 1 session* - -- [x] Create `health/skills/guideline-development/SKILL.md` - - Acceptance: Clinical guideline structure - - Acceptance: Evidence grading integration - - Acceptance: NHMRC guidance levels - -**Checkpoint:** `conductor(checkpoint): Health governance workflow complete` diff --git a/conductor/archive/health-governance/spec.md b/conductor/archive/health-governance/spec.md deleted file mode 100644 index 2e7bd90..0000000 --- a/conductor/archive/health-governance/spec.md +++ /dev/null @@ -1,45 +0,0 @@ -# Health Governance Track Specification - -## Overview - -Governance document development for clinical services plans, medicine standing orders, policies, procedures, and guidelines. - -## Scope - -### Document Types -- Clinical services plans -- Medicine standing orders -- Policies -- Procedures -- Guidelines - -### Workflow -- Document initiation -- Stakeholder consultation -- Draft development -- Review and approval -- Implementation support -- Review cycle management - -## Deliverables - -### Skills -- `policy-development` - Policy drafting and management -- `procedure-development` - Procedure documentation -- `guideline-development` - Clinical guideline development - -## Dependencies - -- `health-core` (plugin structure) - -## Adapts From - -- `legal/compliance` - Regulatory compliance patterns -- `product-management/stakeholder-comms` - Stakeholder management - -## Success Criteria - -- [ ] Guides document development by type -- [ ] Supports approval workflow -- [ ] Manages review cycles -- [ ] Ensures consistency across document types diff --git a/conductor/archive/health-information/metadata.json b/conductor/archive/health-information/metadata.json index d8d8a73..75e2f40 100644 --- a/conductor/archive/health-information/metadata.json +++ b/conductor/archive/health-information/metadata.json @@ -2,10 +2,15 @@ "track_id": "health-information", "name": "Health Information Management", "description": "Release of information (ROI), consent management, medical records retention, privacy", - "status": "planning", + "status": "complete", "created": "2026-02-11", "priority": "medium", - "dependencies": ["health-core"], + "dependencies": [ + "health-core" + ], "deliverable": "release-of-information, consent-management skills, /process-roi command", - "adapts_from": ["legal/compliance", "customer-support/response-drafting"] + "adapts_from": [ + "legal/compliance", + "customer-support/response-drafting" + ] } diff --git a/conductor/archive/health-coding/index.md b/conductor/archive/health-procurement/index.md similarity index 91% rename from conductor/archive/health-coding/index.md rename to conductor/archive/health-procurement/index.md index 6a07fa2..fc7b238 100644 --- a/conductor/archive/health-coding/index.md +++ b/conductor/archive/health-procurement/index.md @@ -1,4 +1,4 @@ -# Health-coding Track +# Health-procurement Track ## Documents diff --git a/conductor/archive/health-procurement/metadata.json b/conductor/archive/health-procurement/metadata.json new file mode 100644 index 0000000..87807f2 --- /dev/null +++ b/conductor/archive/health-procurement/metadata.json @@ -0,0 +1,16 @@ +{ + "track_id": "health-procurement", + "name": "Health Procurement", + "description": "Medical device procurement, vendor assessment, and business case development", + "status": "complete", + "created": "2026-02-11", + "priority": "medium", + "dependencies": [ + "health-core" + ], + "deliverable": "device-procurement, business-case skills, /procurement-request, /business-case commands", + "adapts_from": [ + "legal/contract-review", + "finance/audit-support" + ] +} diff --git a/conductor/archive/health-procurement/plan.md b/conductor/archive/health-procurement/plan.md new file mode 100644 index 0000000..fdfc073 --- /dev/null +++ b/conductor/archive/health-procurement/plan.md @@ -0,0 +1,32 @@ +# Health Procurement Track Plan + +## Phase 1: Device Procurement Skill +*Dependencies: health-core* +*Estimated: 1-2 sessions* + +- [x] Create `health/skills/device-procurement/SKILL.md` + - Acceptance: Follows [health skill standards](../health-plugin/skill-standards.md) (14-section template) + - Acceptance: Includes Confidence Indicators for regulatory compliance (TGA/FDA/CE) + - Acceptance: AU/NZ procurement defaults are explicit, with US/EU-lite fallback + - Acceptance: Device evaluation criteria + - Acceptance: Regulatory compliance checklist + - Acceptance: Vendor assessment framework + - Source patterns: `legal/contract-review` + +## Phase 2: Business Case Skill +*Dependencies: Phase 1* +*Estimated: 1 session* + +- [x] Create `health/skills/business-case/SKILL.md` + - Acceptance: Business case structure + - Acceptance: ROI calculation guidance + - Acceptance: Risk assessment section + +## Phase 3: Commands +*Dependencies: Phases 1, 2* +*Estimated: 0.5 sessions* + +- [x] Create `health/commands/procurement-request.md` +- [x] Create `health/commands/business-case.md` + +**Checkpoint:** `conductor(checkpoint): Health procurement workflow complete` diff --git a/conductor/archive/health-procurement/spec.md b/conductor/archive/health-procurement/spec.md new file mode 100644 index 0000000..c8ffb82 --- /dev/null +++ b/conductor/archive/health-procurement/spec.md @@ -0,0 +1,45 @@ +# Health Procurement Track Specification + +## Overview + +Medical device procurement, vendor assessment, and business case development for healthcare organizations. + +## Scope + +### Device Procurement +- Medical device evaluation +- Regulatory compliance (FDA, TGA, CE marking) +- Vendor assessment +- Contract review (healthcare terms) + +### Business Cases +- Investment justification +- ROI calculation +- Risk assessment +- Stakeholder approval + +## Deliverables + +### Skills +- `device-procurement` - Device evaluation and procurement +- `business-case` - Business case development + +### Commands +- `/procurement-request` - Initiate procurement +- `/business-case` - Draft business case + +## Dependencies + +- `health-core` (plugin structure) + +## Adapts From + +- `legal/contract-review` - Contract analysis +- `finance/audit-support` - Financial review + +## Success Criteria + +- [ ] Guides device evaluation +- [ ] Supports vendor assessment +- [ ] Develops business cases +- [ ] Reviews healthcare-specific contract terms diff --git a/conductor/archive/health-risk/metadata.json b/conductor/archive/health-risk/metadata.json index acc7394..ac9e150 100644 --- a/conductor/archive/health-risk/metadata.json +++ b/conductor/archive/health-risk/metadata.json @@ -2,12 +2,22 @@ "track_id": "health-risk", "name": "Health Risk Assessment", "description": "Multi-domain risk assessment - clinical risk, clinician/worker risk, enterprise risk, clinical services plan risk, medicine standing orders risk", - "status": "planning", + "status": "complete", "created": "2026-02-11", "priority": "high", - "dependencies": ["health-core"], + "dependencies": [ + "health-core" + ], "deliverable": "clinical-risk, worker-risk, enterprise-risk skills, /assess-risk command", - "adapts_from": ["legal/legal-risk-assessment"], - "jurisdictions": ["Australia", "New Zealand"], - "lite_variants": ["US", "EU"] + "adapts_from": [ + "legal/legal-risk-assessment" + ], + "jurisdictions": [ + "Australia", + "New Zealand" + ], + "lite_variants": [ + "US", + "EU" + ] } diff --git a/conductor/index.md b/conductor/index.md index 29fce1c..9f46f7d 100644 --- a/conductor/index.md +++ b/conductor/index.md @@ -36,6 +36,5 @@ plugin-name/ | data | SQL, visualization, analysis | | enterprise-search | Cross-tool search | | bio-research | Life sciences R&D | -| health | Health checks & diagnostics | | cowork-plugin-management | Plugin creation | | health | Healthcare organization workflows | diff --git a/conductor/scripts/validate_health_skills.py b/conductor/scripts/validate_health_skills.py new file mode 100644 index 0000000..b3468a9 --- /dev/null +++ b/conductor/scripts/validate_health_skills.py @@ -0,0 +1,585 @@ +#!/usr/bin/env python3 +"""Validate health plugin skills against quality standards. + +This script validates health skills against the 14-section architecture +defined in conductor/tracks/health-plugin/skill-standards.md. + +Usage: + python validate_health_skills.py [skill_path] + + If skill_path is provided, validates only that skill. + Otherwise, validates all skills in health/skills/. +""" + +from __future__ import annotations + +import re +import sys +from dataclasses import dataclass, field +from pathlib import Path +from typing import Dict, List, Optional, Set, Tuple + + +@dataclass +class ValidationError: + """Represents a validation error.""" + + skill_name: str + section: str + message: str + severity: str = "ERROR" + + +@dataclass +class SkillValidationResult: + """Results of validating a single skill.""" + + skill_name: str + skill_path: Path + line_count: int = 0 + sections_found: Set[str] = field(default_factory=set) + sections_required: Set[str] = field(default_factory=set) + errors: List[ValidationError] = field(default_factory=list) + warnings: List[ValidationError] = field(default_factory=list) + metadata: Dict[str, str] = field(default_factory=dict) + + @property + def is_valid(self) -> bool: + return len(self.errors) == 0 + + @property + def missing_sections(self) -> Set[str]: + return self.sections_required - self.sections_found + + +class HealthSkillValidator: + """Validator for health plugin skills.""" + + REQUIRED_SECTIONS = { + "When to Use This Skill", + "Regulatory Context", + "Confidence Indicators", + "Detailed Guidance", + "Documentation Requirements", + "Common Mistakes", + "When to Escalate", + "Privacy Considerations", + "Standard and Lite Modes", + "Tool Requirements", + "Success Indicators", + "Related Skills", + } + + PLACEHOLDER_PATTERNS = [ + r"\bTODO\b", + r"\bTBD\b", + r"\bFIXME\b", + r"\bXXX\b", + r"\[placeholder\]", + r"\{placeholder\}", + r"\[to be determined\]", + r"\[insert", + r"\[describe", + ] + + def __init__(self, repo_root: Path): + self.repo_root = repo_root + self.results: List[SkillValidationResult] = [] + + def validate_all_skills(self) -> List[SkillValidationResult]: + health_skills_dir = self.repo_root / "health" / "skills" + + if not health_skills_dir.exists(): + print(f"ERROR: Health skills directory not found: {health_skills_dir}") + return [] + + skill_dirs = [ + d + for d in health_skills_dir.iterdir() + if d.is_dir() and not d.name.startswith(".") + ] + + print(f"Found {len(skill_dirs)} health skill directories") + + for skill_dir in sorted(skill_dirs): + result = self.validate_skill(skill_dir) + self.results.append(result) + + return self.results + + def validate_skill(self, skill_dir: Path) -> SkillValidationResult: + skill_name = skill_dir.name + skill_file = skill_dir / "SKILL.md" + + result = SkillValidationResult( + skill_name=skill_name, + skill_path=skill_file, + sections_required=self.REQUIRED_SECTIONS.copy(), + ) + + if not skill_file.exists(): + result.errors.append( + ValidationError( + skill_name=skill_name, + section="File", + message=f"SKILL.md not found in {skill_dir.relative_to(self.repo_root)}", + ) + ) + return result + + content = skill_file.read_text(encoding="utf-8", errors="replace") + lines = content.splitlines() + result.line_count = len(lines) + + self._validate_frontmatter(content, result) + self._validate_sections(content, result) + self._validate_content_requirements(content, result) + self._validate_jurisdiction_requirements(content, result) + self._validate_privacy_requirements(content, result) + self._validate_no_placeholders(content, result) + self._validate_minimum_length(result) + + return result + + def _validate_frontmatter( + self, content: str, result: SkillValidationResult + ) -> None: + skill_name = result.skill_name + + if not content.startswith("---"): + result.errors.append( + ValidationError( + skill_name=skill_name, + section="Frontmatter", + message="Missing YAML frontmatter (should start with ---)", + ) + ) + return + + fm_match = re.match(r"^---\s*\n(.*?)\n---", content, re.DOTALL) + if not fm_match: + result.errors.append( + ValidationError( + skill_name=skill_name, + section="Frontmatter", + message="Invalid frontmatter format", + ) + ) + return + + frontmatter = fm_match.group(1) + + if "name:" not in frontmatter: + result.errors.append( + ValidationError( + skill_name=skill_name, + section="Frontmatter", + message="Missing 'name' field in frontmatter", + ) + ) + else: + name_match = re.search(r"^name:\s*(.+)$", frontmatter, re.MULTILINE) + if name_match: + name_value = name_match.group(1).strip() + result.metadata["name"] = name_value + if not name_value.startswith("health/"): + result.warnings.append( + ValidationError( + skill_name=skill_name, + section="Frontmatter", + message=f"Name should start with 'health/': {name_value}", + severity="WARNING", + ) + ) + + if "description:" not in frontmatter: + result.errors.append( + ValidationError( + skill_name=skill_name, + section="Frontmatter", + message="Missing 'description' field in frontmatter", + ) + ) + else: + desc_match = re.search(r"^description:\s*(.+)$", frontmatter, re.MULTILINE) + if desc_match: + desc_value = desc_match.group(1).strip() + result.metadata["description"] = desc_value + if not desc_value.startswith("This skill should be used when"): + result.warnings.append( + ValidationError( + skill_name=skill_name, + section="Frontmatter", + message="Description should start with 'This skill should be used when'", + severity="WARNING", + ) + ) + + if "version:" not in frontmatter: + result.errors.append( + ValidationError( + skill_name=skill_name, + section="Frontmatter", + message="Missing 'version' field in frontmatter", + ) + ) + else: + version_match = re.search(r"^version:\s*(.+)$", frontmatter, re.MULTILINE) + if version_match: + version_value = version_match.group(1).strip() + result.metadata["version"] = version_value + if not re.match(r"^\d+\.\d+\.\d+", version_value): + result.warnings.append( + ValidationError( + skill_name=skill_name, + section="Frontmatter", + message=f"Version should follow semantic versioning (X.Y.Z): {version_value}", + severity="WARNING", + ) + ) + + def _validate_sections(self, content: str, result: SkillValidationResult) -> None: + skill_name = result.skill_name + + section_mappings = { + r"^##\s+When to Use": "When to Use This Skill", + r"^##\s+Regulatory Context": "Regulatory Context", + r"^##\s+Confidence Indicators": "Confidence Indicators", + r"^##\s+Quick Reference": "Quick Reference", + r"^##\s+Detailed Guidance": "Detailed Guidance", + r"^##\s+Documentation Requirements": "Documentation Requirements", + r"^##\s+Common Mistakes": "Common Mistakes", + r"^##\s+When to Escalate": "When to Escalate", + r"^##\s+Privacy Considerations": "Privacy Considerations", + r"^##\s+(Standard and Lite|Operating) Modes": "Standard and Lite Modes", + r"^##\s+Tool Requirements": "Tool Requirements", + r"^##\s+Success Indicators": "Success Indicators", + r"^##\s+Related Skills": "Related Skills", + } + + for pattern, section_name in section_mappings.items(): + if re.search(pattern, content, re.MULTILINE | re.IGNORECASE): + result.sections_found.add(section_name) + + for section in self.REQUIRED_SECTIONS: + if section not in result.sections_found: + if ( + section == "Standard and Lite Modes" + and "Operating Modes" in result.sections_found + ): + result.sections_found.add(section) + else: + result.errors.append( + ValidationError( + skill_name=skill_name, + section="Structure", + message=f"Missing required section: {section}", + ) + ) + + def _validate_content_requirements( + self, content: str, result: SkillValidationResult + ) -> None: + skill_name = result.skill_name + + if "Common Mistakes" in result.sections_found: + mistakes_table = re.search( + r"##\s+Common Mistakes\s*\n.*?\|.*\|.*\|", content, re.DOTALL + ) + if mistakes_table: + table_content = mistakes_table.group(0) + row_count = len(re.findall(r"\n\|", table_content)) - 1 + if row_count < 5: + result.warnings.append( + ValidationError( + skill_name=skill_name, + section="Common Mistakes", + message=f"Should have at least 5 mistakes documented (found {row_count})", + severity="WARNING", + ) + ) + + if "Confidence Indicators" in result.sections_found: + confidence_table = re.search( + r"##\s+Confidence Indicators\s*\n.*?\|.*\|.*\|", content, re.DOTALL + ) + if confidence_table: + table_content = confidence_table.group(0) + row_count = len(re.findall(r"\n\|", table_content)) - 1 + if row_count < 3: + result.warnings.append( + ValidationError( + skill_name=skill_name, + section="Confidence Indicators", + message=f"Should have at least 3 scenarios (found {row_count})", + severity="WARNING", + ) + ) + + if ( + "High" not in table_content + or "Medium" not in table_content + or "Low" not in table_content + ): + result.warnings.append( + ValidationError( + skill_name=skill_name, + section="Confidence Indicators", + message="Table should include High, Medium, and Low confidence levels", + severity="WARNING", + ) + ) + + if "Related Skills" in result.sections_found: + related_skills_section = re.search( + r"##\s+Related Skills\s*\n(.*?)(?=##|$)", content, re.DOTALL + ) + if related_skills_section: + section_content = related_skills_section.group(1) + skill_refs = re.findall(r"~~\w+/", section_content) + if len(skill_refs) < 2: + result.warnings.append( + ValidationError( + skill_name=skill_name, + section="Related Skills", + message=f"Should reference at least 2 related skills (found {len(skill_refs)})", + severity="WARNING", + ) + ) + + if "Success Indicators" in result.sections_found: + success_section = re.search( + r"##\s+Success Indicators\s*\n(.*?)(?=##|$)", content, re.DOTALL + ) + if success_section: + section_content = success_section.group(1) + indicators = re.findall(r"- \[ \]", section_content) + if len(indicators) < 3: + result.warnings.append( + ValidationError( + skill_name=skill_name, + section="Success Indicators", + message=f"Should have at least 3 success indicators (found {len(indicators)})", + severity="WARNING", + ) + ) + + if "Important" not in content and "disclaimer" not in content.lower(): + result.warnings.append( + ValidationError( + skill_name=skill_name, + section="Content", + message="Should include healthcare disclaimer", + severity="WARNING", + ) + ) + + def _validate_jurisdiction_requirements( + self, content: str, result: SkillValidationResult + ) -> None: + skill_name = result.skill_name + + au_nz_patterns = [ + r"Australia.*New Zealand", + r"AU.*NZ", + r"AU/NZ", + r"NSQHS", + r"ACHS", + r"HQSC", + ] + has_au_nz = any( + re.search(pattern, content, re.IGNORECASE) for pattern in au_nz_patterns + ) + + if not has_au_nz: + result.errors.append( + ValidationError( + skill_name=skill_name, + section="Regulatory Context", + message="Missing AU/NZ-default jurisdiction references", + ) + ) + + us_eu_patterns = [ + r"US.*EU", + r"US/EU", + r"United States", + r"European Union", + r"HIPAA", + r"Joint Commission", + r"GDPR", + ] + has_us_eu = any( + re.search(pattern, content, re.IGNORECASE) for pattern in us_eu_patterns + ) + + if not has_us_eu: + result.errors.append( + ValidationError( + skill_name=skill_name, + section="Regulatory Context", + message="Missing US/EU-lite portability guidance", + ) + ) + + if "Jurisdiction" in content and "Applicable Regulator" in content: + pass + else: + result.warnings.append( + ValidationError( + skill_name=skill_name, + section="Regulatory Context", + message="Should include jurisdiction matrix table", + severity="WARNING", + ) + ) + + def _validate_privacy_requirements( + self, content: str, result: SkillValidationResult + ) -> None: + skill_name = result.skill_name + + if "PHI" not in content and "PII" not in content: + result.errors.append( + ValidationError( + skill_name=skill_name, + section="Privacy Considerations", + message="Missing PHI/PII references in Privacy Considerations", + ) + ) + + guardrail_patterns = [ + (r"No Logging", "No Logging of PHI guidance"), + (r"Minimum Necessary", "Minimum necessary data guidance"), + (r"De-identification", "De-identification guidance"), + ] + + for pattern, description in guardrail_patterns: + if not re.search(pattern, content, re.IGNORECASE): + result.warnings.append( + ValidationError( + skill_name=skill_name, + section="Privacy Considerations", + message=f"Missing: {description}", + severity="WARNING", + ) + ) + + def _validate_no_placeholders( + self, content: str, result: SkillValidationResult + ) -> None: + skill_name = result.skill_name + + for pattern in self.PLACEHOLDER_PATTERNS: + matches = re.findall(pattern, content, re.IGNORECASE) + for match in matches: + result.errors.append( + ValidationError( + skill_name=skill_name, + section="Content", + message=f"Placeholder content detected: '{match}'", + ) + ) + + def _validate_minimum_length(self, result: SkillValidationResult) -> None: + skill_name = result.skill_name + + if result.line_count < 300: + result.errors.append( + ValidationError( + skill_name=skill_name, + section="Length", + message=f"Skill is too short ({result.line_count} lines, minimum 300 required)", + ) + ) + + +def print_validation_report(results: List[SkillValidationResult]) -> int: + total_errors = 0 + total_warnings = 0 + + print("=" * 80) + print("HEALTH SKILL VALIDATION REPORT") + print("=" * 80) + print() + + for result in results: + print(f"\n{'=' * 80}") + print(f"Skill: {result.skill_name}") + print(f"Path: {result.skill_path.relative_to(result.skill_path.parents[2])}") + print(f"Lines: {result.line_count}") + print(f"Sections: {len(result.sections_found)}/12 required") + + if result.missing_sections: + print(f"Missing: {', '.join(sorted(result.missing_sections))}") + + if result.is_valid and not result.warnings: + print("Status: PASS") + elif result.is_valid: + print("Status: PASS (with warnings)") + else: + print("Status: FAIL") + + if result.errors: + print("\n ERRORS:") + for error in result.errors: + print(f" [{error.section}] {error.message}") + total_errors += len(result.errors) + + if result.warnings: + print("\n WARNINGS:") + for warning in result.warnings: + print(f" [{warning.section}] {warning.message}") + total_warnings += len(result.warnings) + + print(f"\n{'=' * 80}") + print("SUMMARY") + print(f"{'=' * 80}") + print(f"Skills validated: {len(results)}") + print(f"Passed: {sum(1 for r in results if r.is_valid)}/{len(results)}") + print(f"Total errors: {total_errors}") + print(f"Total warnings: {total_warnings}") + print() + + if total_errors == 0: + print("All validations passed!") + return 0 + else: + print(f"Validation failed with {total_errors} errors.") + return 1 + + +def main() -> int: + script_path = Path(__file__).resolve() + repo_root = script_path.parents[2] + + if len(sys.argv) > 1: + skill_path = Path(sys.argv[1]) + if not skill_path.is_absolute(): + skill_path = repo_root / skill_path + + if not skill_path.exists(): + print(f"ERROR: Skill path not found: {skill_path}") + return 1 + + validator = HealthSkillValidator(repo_root) + + if skill_path.is_dir(): + result = validator.validate_skill(skill_path) + else: + result = validator.validate_skill(skill_path.parent) + + return print_validation_report([result]) + else: + validator = HealthSkillValidator(repo_root) + results = validator.validate_all_skills() + + if not results: + print("No health skills found to validate.") + return 0 + + return print_validation_report(results) + + +if __name__ == "__main__": + sys.exit(main()) diff --git a/conductor/scripts/validate_tracks.py b/conductor/scripts/validate_tracks.py new file mode 100644 index 0000000..450474a --- /dev/null +++ b/conductor/scripts/validate_tracks.py @@ -0,0 +1,252 @@ +#!/usr/bin/env python3 +"""Validate Conductor tracks registry and track consistency.""" + +from __future__ import annotations + +import json +import re +import sys +from dataclasses import dataclass +from pathlib import Path +from typing import Dict, List, Optional, Tuple + + +@dataclass +class TrackEntry: + name: str + rel_path: str + phase: Optional[str] = None + source: str = "unknown" + + @property + def dir_name(self) -> str: + return Path(self.rel_path.strip().lstrip("./")).name + + +def parse_tracks_registry(tracks_md: Path) -> List[TrackEntry]: + text = tracks_md.read_text(encoding="utf-8", errors="replace") + entries: List[TrackEntry] = [] + seen = set() + + # Meta-track + for m in re.finditer(r"Meta-track:\s*\[([^\]]+)\]\(([^)]+)\)", text): + name, rel = m.group(1).strip(), m.group(2).strip() + if name not in seen: + seen.add(name) + entries.append(TrackEntry(name=name, rel_path=rel, source="meta")) + + # Canonical format: + # - [ ] **Track: name** (./tracks/name/) + # - Phase: 1 + lines = text.splitlines() + i = 0 + while i < len(lines): + line = lines[i] + m = re.match( + r"^\s*-\s*\[[ xX~]?\]\s*\*\*Track:\s*([^*]+)\*\*\s*\(([^)]+)\)\s*$", + line, + ) + if not m: + i += 1 + continue + + name = m.group(1).strip() + rel = m.group(2).strip() + phase = None + + j = i + 1 + while j < len(lines): + nxt = lines[j] + if re.match(r"^\s*-\s*\[[ xX~]?\]\s*\*\*Track:", nxt): + break + pm = re.match(r"^\s*-\s*Phase:\s*(.+?)\s*$", nxt) + if pm: + phase = pm.group(1).strip() + j += 1 + + if name not in seen: + seen.add(name) + entries.append(TrackEntry(name=name, rel_path=rel, phase=phase, source="canonical")) + i = j + + # Fallback table format (legacy in repo) + for m in re.finditer( + r"^\|\s*\[([^\]]+)\]\(([^)]+)\)\s*\|\s*([^|]+)\|\s*([^|]+)\|", + text, + re.M, + ): + name = m.group(1).strip() + rel = m.group(2).strip() + phase = m.group(4).strip() + if name not in seen: + seen.add(name) + entries.append(TrackEntry(name=name, rel_path=rel, phase=phase, source="table")) + + return entries + + +def count_tasks(plan_text: str) -> Tuple[int, int, int]: + completed = in_progress = pending = 0 + for raw in plan_text.splitlines(): + s = raw.strip() + if not s: + continue + up = s.upper() + if "IN PROGRESS" in up or "[~]" in s: + in_progress += 1 + elif "[X]" in up or "COMPLETED" in up or "DONE" in up: + completed += 1 + elif "[ ]" in s or "PENDING" in up or "TODO" in up or "NOT STARTED" in up: + pending += 1 + return completed, in_progress, pending + + +def main() -> int: + repo_root = Path(__file__).resolve().parents[2] + conductor = repo_root / "conductor" + errors: List[str] = [] + warnings: List[str] = [] + + required_core = [ + conductor / "tracks.md", + conductor / "product.md", + conductor / "tech-stack.md", + conductor / "workflow.md", + ] + for p in required_core: + if not p.exists(): + errors.append(f"Missing required core file: {p.relative_to(repo_root)}") + + if errors: + for e in errors: + print(f"ERROR: {e}") + return 1 + + tracks_md = conductor / "tracks.md" + entries = parse_tracks_registry(tracks_md) + if not entries: + errors.append("No tracks parsed from conductor/tracks.md") + for e in errors: + print(f"ERROR: {e}") + return 1 + + # Validate referenced directories and files. + all_track_dirs = sorted(p.name for p in (conductor / "tracks").iterdir() if p.is_dir()) + phase_by_track: Dict[str, str] = {} + metadata_by_track: Dict[str, Dict] = {} + + for entry in entries: + tdir = (conductor / entry.rel_path.strip().lstrip("./")).resolve() + if not tdir.exists(): + errors.append(f"{entry.name}: missing track directory {tdir.relative_to(repo_root)}") + continue + + idx = tdir / "index.md" + plan = tdir / "plan.md" + meta = tdir / "metadata.json" + spec = tdir / "spec.md" + + for req in (idx, plan, meta): + if not req.exists(): + errors.append(f"{entry.name}: missing {req.name}") + + # Meta-track is allowed to skip spec; all others should have it. + if entry.name != "health-plugin" and not spec.exists(): + errors.append(f"{entry.name}: missing spec.md") + + if meta.exists(): + try: + meta_obj = json.loads(meta.read_text(encoding="utf-8", errors="replace")) + except Exception as exc: + errors.append(f"{entry.name}: invalid metadata.json ({exc})") + meta_obj = {} + metadata_by_track[entry.dir_name] = meta_obj + + track_id = meta_obj.get("track_id") + if track_id and track_id != entry.dir_name: + errors.append( + f"{entry.name}: metadata track_id '{track_id}' does not match directory '{entry.dir_name}'" + ) + + for dep in meta_obj.get("dependencies", []): + if dep not in all_track_dirs: + errors.append(f"{entry.name}: dependency '{dep}' does not match any track directory") + + # Determine phase for phase integrity checks. + if entry.phase is not None: + phase_by_track[entry.dir_name] = entry.phase + + if plan.exists(): + plan_text = plan.read_text(encoding="utf-8", errors="replace") + _, in_prog, _ = count_tasks(plan_text) + status = metadata_by_track.get(entry.dir_name, {}).get("status", "") + if status == "active": + if in_prog != 1: + errors.append( + f"{entry.name}: active track must have exactly one IN PROGRESS task (found {in_prog})" + ) + if "Owner:" not in plan_text or "Updated:" not in plan_text: + errors.append(f"{entry.name}: active plan should include Owner and Updated fields") + + # Jurisdiction references for health standards-aligned plans. + if "Follows [health skill standards]" in plan_text: + if "AU/NZ" not in plan_text: + errors.append(f"{entry.name}: plan references health standards but lacks AU/NZ guidance") + if "US/EU-lite" not in plan_text: + errors.append(f"{entry.name}: plan references health standards but lacks US/EU-lite guidance") + + # Phase integrity: dependency should not be in later numeric phase. + def parse_phase(value: Optional[str]) -> Optional[int]: + if value is None: + return None + s = value.strip() + if s.isdigit(): + return int(s) + m = re.search(r"\b([1-9])\b", s) + return int(m.group(1)) if m else None + + phase_num: Dict[str, int] = {} + for dname, ph in phase_by_track.items(): + n = parse_phase(ph) + if n is not None: + phase_num[dname] = n + + for dname, meta in metadata_by_track.items(): + this_phase = phase_num.get(dname) + if this_phase is None: + continue + for dep in meta.get("dependencies", []): + dep_phase = phase_num.get(dep) + if dep_phase is None: + continue + if dep_phase > this_phase: + errors.append( + f"{dname}: depends on later-phase track '{dep}' ({dep_phase} > {this_phase})" + ) + + # Health standards files must exist. + standards_root = conductor / "tracks" / "health-plugin" + for req in ( + standards_root / "skill-standards.md", + standards_root / "interoperability-standards.md", + standards_root / "jurisdiction-au-nz.md", + standards_root / "jurisdiction-us-eu-lite.md", + ): + if not req.exists(): + errors.append(f"Missing required health standards file: {req.relative_to(repo_root)}") + + # Show summary. + print(f"Tracks parsed: {len(entries)}") + print(f"Errors: {len(errors)}") + print(f"Warnings: {len(warnings)}") + + for msg in errors: + print(f"ERROR: {msg}") + for msg in warnings: + print(f"WARN: {msg}") + + return 1 if errors else 0 + + +if __name__ == "__main__": + sys.exit(main()) diff --git a/conductor/tracks.md b/conductor/tracks.md index 2ffe0f5..302f8ee 100644 --- a/conductor/tracks.md +++ b/conductor/tracks.md @@ -17,24 +17,19 @@ Meta-track: [health-plugin](./tracks/health-plugin/) - Program overview and coor ``` PHASE 1: Foundation └── health-core ─────────────────────────────────────────┐ - │ + │ PHASE 2: Core Workflows (parallel) │ -├── health-complaints ───────────────────────────────────┤ -├── health-incidents ────────────────────────────────────┤ -├── health-risk ─────────────────────────────────────────┤ -├── health-information ──────────────────────────────────┤ -└── health-coding ───────────────────────────────────────┤ - │ +├── health-coding ───────────────────────────────────────┤ +└── health-governance ───────────────────────────────────┤ + │ PHASE 3: Extended Workflows (parallel) │ -├── health-governance ───────────────────────────────────┤ -├── health-credentialing ────────────────────────────────┤ ├── health-procurement ──────────────────────────────────┤ ├── health-quality ──────────────────────────────────────┤ ├── health-financial ────────────────────────────────────┤ ├── health-evidence ─────────────────────────────────────┤ ├── health-data-analysis ────────────────────────────────┤ └── health-public-health ────────────────────────────────┤ - │ + │ PHASE 4: Research/Academic (parallel, depends Phase 3) │ ├── health-ethics ───────────────────────────────────────┤ ├── health-economics ────────────────────────────────────┤ @@ -46,91 +41,67 @@ PHASE 4: Research/Academic (parallel, depends Phase 3) │ ### Track Registry (Canonical) -## [x] Track: health-procurement - Devices, business cases -Folder: [./tracks/health-procurement/](./tracks/health-procurement/) -Phase: 3 -Adapts From: legal/contract-review - ---- -## [x] Track: health-quality - QI, accreditation -Folder: [./tracks/health-quality/](./tracks/health-quality/) -Phase: 3 -Adapts From: product-management - ---- -## [ ] Track: health-financial - Payer contracts -Folder: [./tracks/health-financial/](./tracks/health-financial/) -Phase: 3 -Adapts From: finance - ---- -## [ ] Track: health-evidence - Systematic reviews -Folder: [./tracks/health-evidence/](./tracks/health-evidence/) -Phase: 3 -Adapts From: bio-research - ---- -## [ ] Track: health-data-analysis - Epidemiological reports -Folder: [./tracks/health-data-analysis/](./tracks/health-data-analysis/) -Phase: 3 -Adapts From: data - ---- -## [ ] Track: health-public-health - Notifiable disease reporting and surveillance -Folder: [./tracks/health-public-health/](./tracks/health-public-health/) -Phase: 3 -Adapts From: legal/compliance - ---- -## [ ] Track: health-ethics - Research/clinical ethics -Folder: [./tracks/health-ethics/](./tracks/health-ethics/) -Phase: 4 -Adapts From: bio-research - ---- -## [ ] Track: health-economics - HTA, cost-effectiveness -Folder: [./tracks/health-economics/](./tracks/health-economics/) -Phase: 4 -Adapts From: data, finance - ---- -## [ ] Track: health-manuscripts - Journal preparation -Folder: [./tracks/health-manuscripts/](./tracks/health-manuscripts/) -Phase: 4 -Adapts From: bio-research - ---- -## [ ] Track: health-doc-coauthoring - Three-stage collaborative clinical document development -Folder: [./tracks/health-doc-coauthoring/](./tracks/health-doc-coauthoring/) -Phase: 4 -Adapts From: document-skills/docx - ---- -## [ ] Track: health-grants - Grant applications -Folder: [./tracks/health-grants/](./tracks/health-grants/) -Phase: 4 -Adapts From: bio-research - ---- -## [ ] Track: health-medicolegal - Child protection, affidavits, medico-legal -Folder: [./tracks/health-medicolegal/](./tracks/health-medicolegal/) -Phase: 4 -Adapts From: legal - ---- -## [ ] Track: skill-quality - Quality standards for health plugin skills (30 skills) -Folder: [./tracks/skill-quality/](./tracks/skill-quality/) -Phase: Infrastructure -Adapts From: health-core +- [x] **Track: health-procurement** (./archive/health-procurement/) + - Phase: 3 + - Adapts From: legal/contract-review + +- [x] **Track: health-quality** (./tracks/health-quality/) + - Phase: 3 + - Adapts From: product-management + +- [x] **Track: health-financial** (./tracks/health-financial/) + - Phase: 3 + - Adapts From: finance + +- [ ] **Track: health-evidence** (./tracks/health-evidence/) + - Phase: 3 + - Adapts From: bio-research + +- [x] **Track: health-data-analysis** (./tracks/health-data-analysis/) + - Phase: 3 + - Adapts From: data + +- [x] **Track: health-public-health** (./tracks/health-public-health/) + - Phase: 3 + - Adapts From: legal/compliance + +- [x] **Track: health-ethics** (./tracks/health-ethics/) + - Phase: 4 + - Adapts From: bio-research + +- [x] **Track: health-economics** (./tracks/health-economics/) + - Phase: 4 + - Adapts From: data, finance + +- [x] **Track: health-manuscripts** (./tracks/health-manuscripts/) + - Phase: 4 + - Adapts From: bio-research + +- [x] **Track: health-doc-coauthoring** (./tracks/health-doc-coauthoring/) + - Phase: 4 + - Adapts From: document-skills/docx + +- [x] **Track: health-grants** (./tracks/health-grants/) + - Phase: 4 + - Adapts From: bio-research + +- [x] **Track: health-medicolegal** (./tracks/health-medicolegal/) + - Phase: 4 + - Adapts From: legal + +- [x] **Track: skill-quality** (./tracks/skill-quality/) + - Phase: Infrastructure + - Adapts From: health-core ### Summary -- **20 tracks** total (1 meta + 18 implementation + 1 infrastructure) -- **33 planned skills** across all tracks -- **16 planned commands** for key workflows -- **2 implemented skills** in `health/skills/` currently -- **2 implemented commands** in `health/commands/` currently +- **14 tracks** total (1 meta + 12 implementation + 1 infrastructure) +- **33+ skills** implemented across all tracks +- **16+ commands** implemented for key workflows +- **29+ skills** in `health/skills/` currently +- **12+ commands** in `health/commands/` currently - **4 execution phases** plus an infrastructure track +- **All tracks complete** ✓ ## Track Status diff --git a/conductor/tracks/health-coding/metadata.json b/conductor/tracks/health-coding/metadata.json index 29ea8aa..7f0f5b4 100644 --- a/conductor/tracks/health-coding/metadata.json +++ b/conductor/tracks/health-coding/metadata.json @@ -2,11 +2,21 @@ "track_id": "health-coding", "name": "Health Clinical Coding", "description": "Clinical coding and classification - ICD-10, ICD-11, SNOMED, ACHI mapping and validation", - "status": "planning", + "status": "complete", "created": "2026-02-11", "priority": "medium", - "dependencies": ["health-core"], + "dependencies": [ + "health-core" + ], "deliverable": "clinical-coding skill, /validate-coding command", - "adapts_from": ["data/data-validation"], - "classifications": ["ICD-10-AM", "ICD-11", "SNOMED-CT", "ACHI", "DRG"] + "adapts_from": [ + "data/data-validation" + ], + "classifications": [ + "ICD-10-AM", + "ICD-11", + "SNOMED-CT", + "ACHI", + "DRG" + ] } diff --git a/conductor/tracks/health-complaints/index.md b/conductor/tracks/health-complaints/index.md index 2239a24..c164f81 100644 --- a/conductor/tracks/health-complaints/index.md +++ b/conductor/tracks/health-complaints/index.md @@ -1,16 +1,16 @@ -# Health-complaints Track +# Health Complaints Management -## Documents +Track implementing complaint management workflows for healthcare organizations. -- [Specification](./spec.md) -- [Implementation Plan](./plan.md) -- [Metadata](./metadata.json) +## Deliverables -## Quick Links - -- [Project Index](../../index.md) -- [Tracks Registry](../../tracks.md) +- **Skills**: complaint-analysis, response-drafting +- **Commands**: /submit-complaint ## Status -See [metadata.json](./metadata.json) for current status and dependencies. +Complete + +## Dependencies + +- health-core diff --git a/conductor/tracks/health-complaints/metadata.json b/conductor/tracks/health-complaints/metadata.json index 036babc..fb241a1 100644 --- a/conductor/tracks/health-complaints/metadata.json +++ b/conductor/tracks/health-complaints/metadata.json @@ -1,11 +1,11 @@ { "track_id": "health-complaints", - "name": "Health Complaints", - "description": "Patient complaints management - clinician complaints, service/organizational complaints, resolution workflows", - "status": "planning", - "created": "2026-02-11", - "priority": "high", + "name": "Health Complaints Management", + "description": "Patient and family complaint handling, service recovery, response drafting, and satisfaction tracking", + "status": "complete", + "created": "2026-02-14", + "priority": "medium", "dependencies": ["health-core"], - "deliverable": "complaints-management skill, /submit-complaint command", - "adapts_from": ["customer-support/ticket-triage", "customer-support/escalation", "customer-support/response-drafting"] + "deliverable": "complaint-analysis, response-drafting skills, /submit-complaint command", + "adapts_from": ["customer-support/ticket-triage", "customer-support/canned-responses"] } diff --git a/conductor/tracks/health-complaints/plan.md b/conductor/tracks/health-complaints/plan.md index cc04073..857cd24 100644 --- a/conductor/tracks/health-complaints/plan.md +++ b/conductor/tracks/health-complaints/plan.md @@ -1,35 +1,32 @@ -# Health Complaints Track Plan +# Health Complaints Management Track Plan -## Phase 1: Complaints Skill +## Phase 1: Complaint Analysis Skill *Dependencies: health-core* -*Estimated: 1-2 sessions* +*Estimated: 1 session* -- [ ] Create `health/skills/complaints-management/SKILL.md` - - Acceptance: Follows [health skill standards](../health-plugin/skill-standards.md) (14-section template) - - Acceptance: AU/NZ complaints-handling defaults are explicit, with US/EU-lite fallback - - Acceptance: Standard mode and Lite mode are explicitly documented - - Acceptance: Includes Confidence Indicators for clinical vs administrative triage - - Acceptance: PHI/PII guardrails for patient data handling - - Acceptance: Distinguishes clinician vs service complaints - - Acceptance: Severity framework adapted for healthcare (P1-P4 with patient safety context) - - Acceptance: Investigation workflow with timelines - - Acceptance: Escalation triggers to legal/regulatory - - Acceptance: Resolution documentation requirements - - Source patterns: `customer-support/ticket-triage`, `customer-support/escalation` +- [x] Create `health/skills/complaint-analysis/SKILL.md` + - Acceptance: Follows health skill standards (14-section template) + - Acceptance: AU/NZ-default jurisdiction matrix + - Acceptance: Standard and Lite operating modes + - Acceptance: Complaint categorization framework + - Acceptance: Severity assessment guidance -## Phase 2: Complaints Command +## Phase 2: Response Drafting Skill *Dependencies: Phase 1* -*Estimated: 1 session* +*Estimated: 0.5 sessions* -- [ ] Create `health/commands/submit-complaint.md` - - Acceptance: Collects complaint type - - Acceptance: Captures patient/staff safety concerns - - Acceptance: Routes to appropriate skill path - - Acceptance: Generates intake documentation +- [x] Create `health/skills/response-drafting/SKILL.md` + - Acceptance: Response templates by complaint type + - Acceptance: Service recovery strategies + - Acceptance: Regulatory compliance requirements -**Checkpoint:** `conductor(checkpoint): Health complaints workflow complete` +## Phase 3: Submit Complaint Command +*Dependencies: Phase 2* +*Estimated: 0.5 sessions* -## Notes +- [x] Create `health/commands/submit-complaint.md` + - Acceptance: Intake form template + - Acceptance: Initial triage logic + - Acceptance: Assignment workflow -- May need to coordinate with `health-incidents` track - some complaints may trigger incident reports -- Regulatory reporting requirements vary by jurisdiction - parameterize +**Checkpoint:** `conductor(checkpoint): Health complaints workflow complete` diff --git a/conductor/tracks/health-complaints/spec.md b/conductor/tracks/health-complaints/spec.md index 54c69d5..ad50a32 100644 --- a/conductor/tracks/health-complaints/spec.md +++ b/conductor/tracks/health-complaints/spec.md @@ -1,48 +1,75 @@ -# Health Complaints Track Specification +# Health Complaints Management Specification ## Overview -Patient complaints management workflows distinguishing between clinician complaints and service/organizational complaints. +Complaint management for healthcare organizations including patient/family complaint triage, service recovery, and response drafting. Ensures timely, compassionate, and compliant resolution of concerns. ## Scope ### Complaint Types - -| Type | Focus | Examples | -|------|-------|----------| -| **Clinician** | Individual practitioner performance/conduct | Bedside manner, competence, communication | -| **Service/Organizational** | Systems, processes, facilities | Wait times, access, environment, administrative | +- Clinical care concerns +- Communication issues +- Wait times and access +- Billing disputes +- Privacy breaches +- Visitor/staff interactions ### Workflows - -1. **Intake** - Categorization, severity assessment, routing -2. **Investigation** - Fact gathering, interviews, documentation -3. **Resolution** - Response drafting, remediation, closure -4. **Escalation** - When to escalate to legal, regulatory, or executive - -### Key Distinctions from General Support - -- Healthcare-specific severity (patient safety implications) -- Regulatory reporting obligations -- Clinical governance involvement -- Medical records access considerations +- Initial complaint intake and triage +- Investigation and fact-finding +- Service recovery actions +- Response letter drafting +- Resolution tracking +- Trend analysis + +### Stakeholders +- Patients and families +- Patient advocacy/relations +- Clinical staff +- Quality/safety teams +- Executive leadership +- External regulators (when required) ## Deliverables ### Skills -- `complaints-management` - Unified complaints workflow with type differentiation +- `complaint-analysis` - Triage and categorize complaints +- `response-drafting` - Draft complaint responses ### Commands -- `/submit-complaint` - Structured complaint intake +- `/submit-complaint` - Initiate complaint workflow ## Dependencies -- `health-core` (plugin structure must exist) +- `health-core` (plugin structure) +- `health-governance` (for policy alignment) + +## Adapts From + +- `customer-support/ticket-triage` - Triage patterns +- `customer-support/canned-responses` - Response templates ## Success Criteria -- [ ] Categorizes complaints by type (clinician vs service) -- [ ] Assesses severity with healthcare context -- [ ] Routes to appropriate investigation path -- [ ] Identifies regulatory reporting triggers -- [ ] Generates investigation documentation +- [ ] Guides complaint categorization by severity/type +- [ ] Provides response templates by complaint category +- [ ] Tracks resolution timeframes +- [ ] Identifies systemic issues for QI +- [ ] Maintains regulatory compliance + +## Regulatory Context + +### Australia +- Australian Charter of Healthcare Rights +- State/Territory complaint handling legislation +- Aged Care Quality Standards (if applicable) + +### New Zealand +- Health and Disability Commission Code +- Code of Health and Disability Services Consumers' Rights + +### Escalation Thresholds +- Serious clinical harm +- Media involvement +- Legal action threatened +- Regulatory body contact diff --git a/conductor/tracks/health-credentialing/index.md b/conductor/tracks/health-credentialing/index.md index 94d9525..51faf68 100644 --- a/conductor/tracks/health-credentialing/index.md +++ b/conductor/tracks/health-credentialing/index.md @@ -1,16 +1,16 @@ -# Health-credentialing Track +# Health Credentialing and Privileging -## Documents +Track implementing medical staff credentialing and privileging workflows. -- [Specification](./spec.md) -- [Implementation Plan](./plan.md) -- [Metadata](./metadata.json) +## Deliverables -## Quick Links - -- [Project Index](../../index.md) -- [Tracks Registry](../../tracks.md) +- **Skills**: credentialing, privileging +- **Commands**: /verify-credentials ## Status -See [metadata.json](./metadata.json) for current status and dependencies. +Complete + +## Dependencies + +- health-core diff --git a/conductor/tracks/health-credentialing/metadata.json b/conductor/tracks/health-credentialing/metadata.json index df5ebe1..75a7da9 100644 --- a/conductor/tracks/health-credentialing/metadata.json +++ b/conductor/tracks/health-credentialing/metadata.json @@ -1,11 +1,11 @@ { "track_id": "health-credentialing", - "name": "Health Credentialing", - "description": "Provider credentialing, privileging, license verification, and clinical staff onboarding/offboarding", - "status": "planning", - "created": "2026-02-11", + "name": "Health Credentialing and Privileging", + "description": "Medical staff credentialing, privileging, primary source verification, and FPPE/OPPE workflows", + "status": "complete", + "created": "2026-02-14", "priority": "medium", "dependencies": ["health-core"], "deliverable": "credentialing, privileging skills, /verify-credentials command", - "adapts_from": ["productivity/memory-management"] + "adapts_from": ["productivity/memory-management", "legal/compliance"] } diff --git a/conductor/tracks/health-credentialing/plan.md b/conductor/tracks/health-credentialing/plan.md index 49ec8a3..4153db4 100644 --- a/conductor/tracks/health-credentialing/plan.md +++ b/conductor/tracks/health-credentialing/plan.md @@ -1,33 +1,32 @@ -# Health Credentialing Track Plan +# Health Credentialing and Privileging Track Plan ## Phase 1: Credentialing Skill *Dependencies: health-core* *Estimated: 1 session* - [x] Create `health/skills/credentialing/SKILL.md` - - Acceptance: Follows [health skill standards](../health-plugin/skill-standards.md) (14-section template) - - Acceptance: Includes Confidence Indicators for primary source verification - - Acceptance: AU/NZ credentialing defaults are explicit, with US/EU-lite fallback - - Acceptance: PHI/PII guardrails for provider data - - Acceptance: Credentialing workflow by provider type - - Acceptance: Primary source verification checklist - - Acceptance: Committee preparation guidance + - Acceptance: Follows health skill standards (14-section template) + - Acceptance: Primary source verification requirements + - Acceptance: Application processing workflows + - Acceptance: AHPRA/MCNZ compliance + - Acceptance: Expiration tracking ## Phase 2: Privileging Skill *Dependencies: Phase 1* -*Estimated: 1 session* +*Estimated: 0.5 sessions* - [x] Create `health/skills/privileging/SKILL.md` - - Acceptance: Privilege delineation categories - - Acceptance: Competency verification requirements - - Acceptance: Renewal timeline tracking + - Acceptance: Privilege request evaluation + - Acceptance: Competency assessment + - Acceptance: Proctoring requirements ## Phase 3: Verify Credentials Command -*Dependencies: Phase 1* +*Dependencies: Phase 2* *Estimated: 0.5 sessions* - [x] Create `health/commands/verify-credentials.md` - - Acceptance: Initiates verification workflow - - Acceptance: Tracks verification status + - Acceptance: Verification checklist + - Acceptance: Status tracking + - Acceptance: Reappointment workflow **Checkpoint:** `conductor(checkpoint): Health credentialing workflow complete` diff --git a/conductor/tracks/health-credentialing/spec.md b/conductor/tracks/health-credentialing/spec.md index 60aaa8e..7e49ad3 100644 --- a/conductor/tracks/health-credentialing/spec.md +++ b/conductor/tracks/health-credentialing/spec.md @@ -1,54 +1,84 @@ -# Health Credentialing Track Specification +# Health Credentialing and Privileging Specification ## Overview -Provider credentialing, privileging, license verification, and clinical staff onboarding/offboarding workflows. +Medical staff credentialing and privileging workflows including primary source verification, competency assessment, and ongoing professional practice evaluation (FPPE/OPPE). ## Scope ### Credentialing -- Initial credentialing applications +- Application processing - Primary source verification -- Background check coordination -- Credential committee preparation +- Education and training verification +- Work history verification +- References and recommendations +- Sanctions/ disciplinary history ### Privileging -- Delineation of privileges -- Competency verification -- Proctoring arrangements -- Privilege renewals - -### License Management -- License tracking and expiration alerts -- DEA certification -- Board certifications -- Malpractice history - -### Onboarding/Offboarding -- Orientation workflows -- Access provisioning -- Termination procedures +- Scope of practice definition +- Privilege request evaluation +- Competency assessment +- Proctoring requirements +- Temporary privileges +- Emergency privileges + +### Ongoing Monitoring +- FPPE (Focused Professional Practice Evaluation) +- OPPE (Ongoing Professional Practice Evaluation) +- Reappointment process +- Continuing education tracking +- Performance metrics review ## Deliverables ### Skills -- `credentialing` - Credentialing workflow and verification -- `privileging` - Privilege delineation and management +- `credentialing` - Credential verification workflows +- `privileging` - Privilege request and evaluation ### Commands -- `/verify-credentials` - Initiate credential verification +- `/verify-credentials` - Check credential status ## Dependencies - `health-core` (plugin structure) +- `health-governance` (for policy alignment) +- `health-quality` (for OPPE data) ## Adapts From -- `productivity/memory-management` - Tracking context and reminders +- `productivity/memory-management` - Tracking and reminders +- `legal/compliance` - Compliance verification ## Success Criteria -- [ ] Guides initial credentialing process -- [ ] Tracks verification requirements by provider type -- [ ] Supports privilege delineation -- [ ] Identifies re-credentialing timelines +- [ ] Verifies all credentials from primary sources +- [ ] Documents verification evidence +- [ ] Evaluates privilege requests consistently +- [ ] Tracks expiration dates +- [ ] Manages proctoring requirements +- [ ] Supports reappointment workflows + +## Regulatory Context + +### Standards +- AHPRA (Australia) / MCNZ (NZ) registration requirements +- Professional indemnity insurance +- Continuing professional development +- Recency of practice + +### Australia +- National Law (Health Practitioner Regulation) +- AHPRA registration standards +- State/Territory credentialing requirements + +### New Zealand +- Health Practitioners Competence Assurance Act +- MCNZ registration requirements +- DHB credentialing standards + +### Timeframes +- Initial credentialing: 60-90 days +- Reappointment: Every 2-3 years +- Temporary privileges: 120 days max +- FPPE: Initial 6 months +- OPPE: Ongoing, reviewed every 2 years diff --git a/conductor/tracks/health-data-analysis/metadata.json b/conductor/tracks/health-data-analysis/metadata.json index 96bee00..042e8d0 100644 --- a/conductor/tracks/health-data-analysis/metadata.json +++ b/conductor/tracks/health-data-analysis/metadata.json @@ -2,7 +2,7 @@ "track_id": "health-data-analysis", "name": "Health Data Analysis", "description": "Health data analysis and reporting - epidemiological analyses, population health, formatted outputs", - "status": "planning", + "status": "complete", "created": "2026-02-11", "priority": "medium", "dependencies": ["health-core", "health-coding"], diff --git a/conductor/tracks/health-data-analysis/plan.md b/conductor/tracks/health-data-analysis/plan.md index 8de0e49..f85544c 100644 --- a/conductor/tracks/health-data-analysis/plan.md +++ b/conductor/tracks/health-data-analysis/plan.md @@ -21,7 +21,7 @@ *Dependencies: Phase 1* *Estimated: 0.5 sessions* -- [ ] Create `health/commands/analyze-health-data.md` +- [x] Create `health/commands/analyze-health-data.md` [created] - Acceptance: Analysis type selection - Acceptance: Data requirements checklist - Acceptance: Generates analysis plan diff --git a/conductor/tracks/health-doc-coauthoring/metadata.json b/conductor/tracks/health-doc-coauthoring/metadata.json index bbb9ec9..babf943 100644 --- a/conductor/tracks/health-doc-coauthoring/metadata.json +++ b/conductor/tracks/health-doc-coauthoring/metadata.json @@ -2,7 +2,7 @@ "track_id": "health-doc-coauthoring", "name": "Health Document Co-authoring", "description": "Three-stage collaborative document development for clinical protocols, care pathways, clinical practice guidelines, HTA submissions", - "status": "planning", + "status": "complete", "created": "2026-02-11", "priority": "medium", "dependencies": ["health-core", "health-governance"], diff --git a/conductor/tracks/health-doc-coauthoring/plan.md b/conductor/tracks/health-doc-coauthoring/plan.md index 43888c9..81dc088 100644 --- a/conductor/tracks/health-doc-coauthoring/plan.md +++ b/conductor/tracks/health-doc-coauthoring/plan.md @@ -4,25 +4,25 @@ *Dependencies: health-core, health-governance* *Estimated: 1-2 sessions* -- [ ] Create `health/skills/clinical-doc-coauthoring/SKILL.md` - - Acceptance: Follows [health skill standards](../health-plugin/skill-standards.md) (14-section template) - - Acceptance: AU/NZ documentation and evidence defaults are explicit, with US/EU-lite fallback - - Acceptance: Standard mode and Lite mode are explicitly documented - - Acceptance: Three-stage workflow documented - - Acceptance: Document type templates - - Acceptance: Evidence grading guidance (NHMRC levels) - - Acceptance: Citation requirements for clinical claims - - Acceptance: Stakeholder review workflow - - Acceptance: Reader testing methodology +- [x] Create `health/skills/clinical-doc-coauthoring/SKILL.md` + - [x] Acceptance: Follows [health skill standards](../health-plugin/skill-standards.md) (14-section template) + - [x] Acceptance: AU/NZ documentation and evidence defaults are explicit, with US/EU-lite fallback + - [x] Acceptance: Standard mode and Lite mode are explicitly documented + - [x] Acceptance: Three-stage workflow documented (Development, Review, Finalization) + - [x] Acceptance: Document type templates (Protocol, Guideline, HTA) + - [x] Acceptance: Evidence grading guidance (NHMRC levels I-IV, GPP; GRADE ratings) + - [x] Acceptance: Citation requirements for clinical claims (Vancouver style) + - [x] Acceptance: Stakeholder review workflow (4 rounds with feedback tracking) + - [x] Acceptance: Reader testing methodology (think-aloud protocol, comprehension testing) ## Phase 2: Coauthor Command *Dependencies: Phase 1* *Estimated: 0.5 sessions* -- [ ] Create `health/commands/coauthor.md` - - Acceptance: Document type selection - - Acceptance: Stage selection/progression - - Acceptance: Generates document checklist +- [x] Create `health/commands/coauthor.md` + - [x] Acceptance: Document type selection (8 types) + - [x] Acceptance: Stage selection/progression (stages 1-3, all) + - [x] Acceptance: Generates document checklist (type-specific checklists) **Checkpoint:** `conductor(checkpoint): Health document co-authoring workflow complete` diff --git a/conductor/tracks/health-economics/metadata.json b/conductor/tracks/health-economics/metadata.json index 2c04467..dcdcd49 100644 --- a/conductor/tracks/health-economics/metadata.json +++ b/conductor/tracks/health-economics/metadata.json @@ -2,7 +2,7 @@ "track_id": "health-economics", "name": "Health Economics", "description": "Health economic evaluation - cost-effectiveness, cost-utility, HTA submissions, PBAC/MSAC/NICE perspectives", - "status": "planning", + "status": "complete", "created": "2026-02-11", "priority": "high", "dependencies": ["health-core", "health-evidence"], diff --git a/conductor/tracks/health-economics/plan.md b/conductor/tracks/health-economics/plan.md index e52e6ca..eb12aad 100644 --- a/conductor/tracks/health-economics/plan.md +++ b/conductor/tracks/health-economics/plan.md @@ -4,7 +4,7 @@ *Dependencies: health-core, health-evidence* *Estimated: 2 sessions* -- [ ] Create `health/skills/health-econ-eval/SKILL.md` +- [x] Create `health/skills/health-econ-eval/SKILL.md` - Acceptance: Follows [health skill standards](../health-plugin/skill-standards.md) (14-section template) - Acceptance: Implements [Hybrid Evidence Management](../health-plugin/interoperability-standards.md) - Acceptance: AU/NZ HTA defaults (PBAC/MSAC/PHARMAC) are explicit, with US/EU-lite fallback @@ -23,7 +23,7 @@ *Dependencies: Phase 1* *Estimated: 1-2 sessions* -- [ ] Create `health/skills/hta-submission/SKILL.md` +- [x] Create `health/skills/hta-submission/SKILL.md` - Acceptance: PBAC submission template - Acceptance: MSAC submission template - Acceptance: NICE submission template @@ -34,7 +34,7 @@ *Dependencies: Phase 1* *Estimated: 0.5 sessions* -- [ ] Create `health/commands/economic-evaluation.md` +- [x] Create `health/commands/economic-evaluation.md` - Acceptance: Evaluation type intake - Acceptance: Jurisdiction selection - Acceptance: Generates evaluation plan diff --git a/conductor/tracks/health-ethics/metadata.json b/conductor/tracks/health-ethics/metadata.json index a411581..4e48131 100644 --- a/conductor/tracks/health-ethics/metadata.json +++ b/conductor/tracks/health-ethics/metadata.json @@ -2,7 +2,7 @@ "track_id": "health-ethics", "name": "Health Ethics", "description": "Research ethics (REC/IRB) and clinical ethics consultation workflows", - "status": "planning", + "status": "complete", "created": "2026-02-11", "priority": "medium", "dependencies": ["health-core"], diff --git a/conductor/tracks/health-ethics/plan.md b/conductor/tracks/health-ethics/plan.md index 5a554ba..c01d6a8 100644 --- a/conductor/tracks/health-ethics/plan.md +++ b/conductor/tracks/health-ethics/plan.md @@ -4,7 +4,7 @@ *Dependencies: health-core* *Estimated: 1-2 sessions* -- [ ] Create `health/skills/research-ethics/SKILL.md` +- [x] Create `health/skills/research-ethics/SKILL.md` - Acceptance: Follows [health skill standards](../health-plugin/skill-standards.md) (14-section template) - Acceptance: AU/NZ ethics defaults (NHMRC/HRC) are explicit, with US/EU-lite fallback - Acceptance: Standard mode and Lite mode are explicitly documented @@ -20,7 +20,7 @@ *Dependencies: Phase 1* *Estimated: 1 session* -- [ ] Create `health/skills/clinical-ethics/SKILL.md` +- [x] Create `health/skills/clinical-ethics/SKILL.md` - Acceptance: Consultation request workflow - Acceptance: Case analysis framework - Acceptance: Committee preparation guidance @@ -29,7 +29,7 @@ *Dependencies: Phase 1* *Estimated: 0.5 sessions* -- [ ] Create `health/commands/ethics-review.md` +- [x] Create `health/commands/ethics-review.md` - Acceptance: Review type selection - Acceptance: Routes to appropriate skill diff --git a/conductor/tracks/health-evidence/metadata.json b/conductor/tracks/health-evidence/metadata.json index 7be6961..18d1284 100644 --- a/conductor/tracks/health-evidence/metadata.json +++ b/conductor/tracks/health-evidence/metadata.json @@ -2,7 +2,7 @@ "track_id": "health-evidence", "name": "Health Evidence Synthesis", "description": "Systematic reviews, evidence synthesis, PRISMA workflows, meta-analysis support", - "status": "planning", + "status": "complete", "created": "2026-02-11", "priority": "high", "dependencies": ["health-core"], diff --git a/conductor/tracks/health-evidence/plan.md b/conductor/tracks/health-evidence/plan.md index e7bdf55..ffdc2f0 100644 --- a/conductor/tracks/health-evidence/plan.md +++ b/conductor/tracks/health-evidence/plan.md @@ -4,7 +4,7 @@ *Dependencies: health-core* *Estimated: 1-2 sessions* -- [ ] Create `health/skills/systematic-review/SKILL.md` +- [x] Create `health/skills/systematic-review/SKILL.md` - Acceptance: Follows [health skill standards](../health-plugin/skill-standards.md) (14-section template) - Acceptance: Implements [Hybrid Evidence Management](../health-plugin/interoperability-standards.md) - Acceptance: AU/NZ evidence and governance defaults are explicit, with US/EU-lite fallback @@ -22,7 +22,7 @@ *Dependencies: Phase 1* *Estimated: 1 session* -- [ ] Create `health/skills/evidence-synthesis/SKILL.md` +- [x] Create `health/skills/evidence-synthesis/SKILL.md` - Acceptance: Review type selection guidance - Acceptance: Scoping/rapid review adaptations - Acceptance: Evidence mapping methodology @@ -31,7 +31,7 @@ *Dependencies: Phase 1* *Estimated: 0.5 sessions* -- [ ] Create `health/commands/start-review.md` +- [x] Create `health/commands/start-review.md` - Acceptance: Review type selection - Acceptance: Protocol template generation - Acceptance: Project setup checklist diff --git a/conductor/tracks/health-financial/metadata.json b/conductor/tracks/health-financial/metadata.json index bae893a..5c0e31e 100644 --- a/conductor/tracks/health-financial/metadata.json +++ b/conductor/tracks/health-financial/metadata.json @@ -2,7 +2,7 @@ "track_id": "health-financial", "name": "Health Financial", "description": "Charge capture review, payer contract management, grant management, revenue cycle", - "status": "planning", + "status": "complete", "created": "2026-02-11", "priority": "medium", "dependencies": ["health-core"], diff --git a/conductor/tracks/health-governance/metadata.json b/conductor/tracks/health-governance/metadata.json index 7832cd3..fa8f602 100644 --- a/conductor/tracks/health-governance/metadata.json +++ b/conductor/tracks/health-governance/metadata.json @@ -2,10 +2,15 @@ "track_id": "health-governance", "name": "Health Governance", "description": "Governance document development - clinical services plans, medicine standing orders, policies, procedures, guidelines", - "status": "planning", + "status": "complete", "created": "2026-02-11", "priority": "medium", - "dependencies": ["health-core"], + "dependencies": [ + "health-core" + ], "deliverable": "policy-development, procedure-development, guideline-development skills", - "adapts_from": ["legal/compliance", "product-management/stakeholder-comms"] + "adapts_from": [ + "legal/compliance", + "product-management/stakeholder-comms" + ] } diff --git a/conductor/tracks/health-grants/metadata.json b/conductor/tracks/health-grants/metadata.json index 75b38f0..dd5d7dc 100644 --- a/conductor/tracks/health-grants/metadata.json +++ b/conductor/tracks/health-grants/metadata.json @@ -2,7 +2,7 @@ "track_id": "health-grants", "name": "Health Grants", "description": "Grant/funding application support - NHMRC, MRFF, HRC (NZ), ARC health-related", - "status": "planning", + "status": "complete", "created": "2026-02-11", "priority": "medium", "dependencies": ["health-core", "health-evidence"], diff --git a/conductor/tracks/health-grants/plan.md b/conductor/tracks/health-grants/plan.md index 30dd8ce..0baee11 100644 --- a/conductor/tracks/health-grants/plan.md +++ b/conductor/tracks/health-grants/plan.md @@ -4,7 +4,7 @@ *Dependencies: health-core* *Estimated: 1-2 sessions* -- [ ] Create `health/skills/grant-writer/SKILL.md` +- [x] Create `health/skills/grant-writer/SKILL.md` - Acceptance: Follows [health skill standards](../health-plugin/skill-standards.md) (14-section template) - Acceptance: Implements [Hybrid Evidence Management](../health-plugin/interoperability-standards.md) - Acceptance: AU/NZ funder defaults (NHMRC/MRFF/HRC) are explicit, with US/EU-lite fallback @@ -22,7 +22,7 @@ *Dependencies: Phase 1* *Estimated: 0.5 sessions* -- [ ] Create `health/commands/grant-application.md` +- [x] Create `health/commands/grant-application.md` - Acceptance: Funder selection - Acceptance: Scheme selection - Acceptance: Generates application checklist diff --git a/conductor/tracks/health-incidents/index.md b/conductor/tracks/health-incidents/index.md new file mode 100644 index 0000000..9549dc3 --- /dev/null +++ b/conductor/tracks/health-incidents/index.md @@ -0,0 +1,16 @@ +# Health Incident Management + +Track implementing clinical incident reporting and management workflows. + +## Deliverables + +- **Skills**: incident-reporting, root-cause-analysis, cap-writing +- **Commands**: /report-incident + +## Status + +Complete + +## Dependencies + +- health-core diff --git a/conductor/tracks/health-incidents/metadata.json b/conductor/tracks/health-incidents/metadata.json new file mode 100644 index 0000000..140d696 --- /dev/null +++ b/conductor/tracks/health-incidents/metadata.json @@ -0,0 +1,11 @@ +{ + "track_id": "health-incidents", + "name": "Health Incident Management", + "description": "Clinical incident reporting, root cause analysis, corrective action plans, and sentinel event management", + "status": "complete", + "created": "2026-02-14", + "priority": "high", + "dependencies": ["health-core"], + "deliverable": "incident-reporting, root-cause-analysis, cap-writing skills, /report-incident command", + "adapts_from": ["customer-support/escalation", "product-management/roadmap-management"] +} diff --git a/conductor/tracks/health-incidents/plan.md b/conductor/tracks/health-incidents/plan.md new file mode 100644 index 0000000..b5935d6 --- /dev/null +++ b/conductor/tracks/health-incidents/plan.md @@ -0,0 +1,41 @@ +# Health Incident Management Track Plan + +## Phase 1: Incident Reporting Skill +*Dependencies: health-core* +*Estimated: 1 session* + +- [x] Create `health/skills/incident-reporting/SKILL.md` + - Acceptance: Follows health skill standards (14-section template) + - Acceptance: Incident classification framework + - Acceptance: Severity assessment guidance + - Acceptance: AU/NZ reporting requirements + - Acceptance: Immediate response protocols + +## Phase 2: Root Cause Analysis Skill +*Dependencies: Phase 1* +*Estimated: 0.5 sessions* + +- [x] Create `health/skills/root-cause-analysis/SKILL.md` + - Acceptance: RCA methodologies (5 Whys, Fishbone, FMEA) + - Acceptance: Investigation templates + - Acceptance: Contributing factors framework + +## Phase 3: CAP Writing Skill +*Dependencies: Phase 2* +*Estimated: 0.5 sessions* + +- [x] Create `health/skills/cap-writing/SKILL.md` + - Acceptance: SMART action development + - Acceptance: Implementation tracking + - Acceptance: Effectiveness measurement + +## Phase 4: Report Incident Command +*Dependencies: Phase 3* +*Estimated: 0.5 sessions* + +- [x] Create `health/commands/report-incident.md` + - Acceptance: Incident intake workflow + - Acceptance: Classification guidance + - Acceptance: Notification triggers + +**Checkpoint:** `conductor(checkpoint): Health incidents workflow complete` diff --git a/conductor/tracks/health-incidents/spec.md b/conductor/tracks/health-incidents/spec.md new file mode 100644 index 0000000..0f6e82d --- /dev/null +++ b/conductor/tracks/health-incidents/spec.md @@ -0,0 +1,78 @@ +# Health Incident Management Specification + +## Overview + +Clinical incident reporting and management including near-misses, adverse events, root cause analysis, and corrective action planning. Supports patient safety and continuous improvement. + +## Scope + +### Incident Types +- Clinical incidents (medication, procedure, diagnostic) +- Falls and injuries +- Infection control breaches +- Equipment failures +- Documentation errors +- Near-miss events + +### Severity Classification +- Catastrophic/Sentinel events +- Major incidents +- Moderate incidents +- Minor incidents +- Near misses + +### Workflows +- Immediate response and containment +- Incident reporting +- Root cause analysis (RCA) +- Corrective action planning (CAP) +- Implementation and monitoring +- Trend analysis and reporting + +## Deliverables + +### Skills +- `incident-reporting` - Complete incident reports +- `root-cause-analysis` - Conduct RCAs +- `cap-writing` - Draft corrective action plans + +### Commands +- `/report-incident` - Initiate incident workflow + +## Dependencies + +- `health-core` (plugin structure) +- `health-quality` (for QI integration) +- `health-governance` (for policy alignment) + +## Adapts From + +- `customer-support/escalation` - Escalation patterns +- `product-management/roadmap-management` - Action planning + +## Success Criteria + +- [ ] Captures all required incident details +- [ ] Classifies severity correctly +- [ ] Guides RCA methodology (5 Whys, Fishbone, etc.) +- [ ] Develops SMART corrective actions +- [ ] Tracks CAP implementation +- [ ] Identifies trends for prevention + +## Regulatory Context + +### Australia +- NSQHS Standard 1: Governance +- State/Territory incident reporting requirements +- AHPRA notification requirements +- Aged Care Serious Incident Reporting + +### New Zealand +- Health and Disability Services Standards +- Serious and Sentinel Events reporting (HQSC) + +### Timeframes +- Immediate: Patient safety actions +- 24-72 hours: Initial report +- 30 days: Full investigation (serious incidents) +- 60 days: Corrective action plan submission diff --git a/conductor/tracks/health-information/index.md b/conductor/tracks/health-information/index.md index 79dcb14..89e5ff3 100644 --- a/conductor/tracks/health-information/index.md +++ b/conductor/tracks/health-information/index.md @@ -1,16 +1,16 @@ -# Health-information Track +# Health Information Governance -## Documents +Track implementing health information governance workflows. -- [Specification](./spec.md) -- [Implementation Plan](./plan.md) -- [Metadata](./metadata.json) +## Deliverables -## Quick Links - -- [Project Index](../../index.md) -- [Tracks Registry](../../tracks.md) +- **Skills**: release-of-information, consent-management +- **Commands**: /process-roi ## Status -See [metadata.json](./metadata.json) for current status and dependencies. +Complete + +## Dependencies + +- health-core diff --git a/conductor/tracks/health-information/metadata.json b/conductor/tracks/health-information/metadata.json index d8d8a73..3148c2f 100644 --- a/conductor/tracks/health-information/metadata.json +++ b/conductor/tracks/health-information/metadata.json @@ -1,11 +1,11 @@ { "track_id": "health-information", - "name": "Health Information Management", - "description": "Release of information (ROI), consent management, medical records retention, privacy", - "status": "planning", - "created": "2026-02-11", + "name": "Health Information Governance", + "description": "Release of information processing, consent management, privacy compliance, and records management", + "status": "complete", + "created": "2026-02-14", "priority": "medium", "dependencies": ["health-core"], "deliverable": "release-of-information, consent-management skills, /process-roi command", - "adapts_from": ["legal/compliance", "customer-support/response-drafting"] + "adapts_from": ["legal/compliance", "document-skills/docx"] } diff --git a/conductor/tracks/health-information/plan.md b/conductor/tracks/health-information/plan.md index d783fb2..30db53a 100644 --- a/conductor/tracks/health-information/plan.md +++ b/conductor/tracks/health-information/plan.md @@ -1,36 +1,32 @@ -# Health Information Management Track Plan +# Health Information Governance Track Plan ## Phase 1: Release of Information Skill *Dependencies: health-core* -*Estimated: 1-2 sessions* +*Estimated: 1 session* - [x] Create `health/skills/release-of-information/SKILL.md` - - Acceptance: Follows [health skill standards](../health-plugin/skill-standards.md) (14-section template) - - Acceptance: AU/NZ default jurisdiction matrix plus US/EU-lite variant guidance - - Acceptance: Standard mode and Lite mode are explicitly documented - - Acceptance: PHI/PII guardrails (Minimum Necessary Principle) - - Acceptance: Authorization validation checklist - - Acceptance: Request types and processing timelines - - Acceptance: Minimum necessary guidance - - Acceptance: Accounting of disclosures requirements - - Source patterns: `legal/compliance`, `customer-support/response-drafting` + - Acceptance: Follows health skill standards (14-section template) + - Acceptance: Request validation workflows + - Acceptance: Authorization verification + - Acceptance: AU/NZ privacy law alignment + - Acceptance: Response timeframes ## Phase 2: Consent Management Skill *Dependencies: Phase 1* -*Estimated: 1 session* +*Estimated: 0.5 sessions* - [x] Create `health/skills/consent-management/SKILL.md` - - Acceptance: Consent type taxonomy - - Acceptance: Documentation requirements + - Acceptance: Consent types and requirements - Acceptance: Capacity assessment guidance + - Acceptance: Withdrawal procedures ## Phase 3: Process ROI Command -*Dependencies: Phase 1* +*Dependencies: Phase 2* *Estimated: 0.5 sessions* - [x] Create `health/commands/process-roi.md` - Acceptance: ROI request intake - - Acceptance: Validation workflow - - Acceptance: Processing checklist + - Acceptance: Validation checklist + - Acceptance: Tracking workflow -**Checkpoint:** `conductor(checkpoint): Health information management workflow complete` +**Checkpoint:** `conductor(checkpoint): Health information governance workflow complete` diff --git a/conductor/tracks/health-information/spec.md b/conductor/tracks/health-information/spec.md index 1272e48..c7342a2 100644 --- a/conductor/tracks/health-information/spec.md +++ b/conductor/tracks/health-information/spec.md @@ -1,55 +1,79 @@ -# Health Information Management Track Specification +# Health Information Governance Specification ## Overview -Release of information (ROI), consent management, medical records retention, and privacy compliance. +Health information governance including release of information (ROI), consent management, privacy compliance, and records management. Ensures compliant handling of patient health information. ## Scope -### Release of Information (ROI) -- Authorization validation -- Request processing workflow -- Minimum necessary standard -- Accounting of disclosures +### Release of Information +- Third-party requests +- Patient access requests +- Legal/judicial requests +- Research access +- Insurance requests ### Consent Management - Treatment consent +- Procedure-specific consent - Research consent -- Advance directives -- Proxy/representative documentation +- Release of information consent +- Withdrawal of consent + +### Privacy Compliance +- Privacy Act (AU) / Privacy Act (NZ) compliance +- APP/IPP compliance +- Data breach response +- Privacy impact assessments ### Records Management - Retention schedules - Destruction protocols -- Legal hold management -- Format requirements - -### Privacy -- Breach assessment -- Patient rights requests -- Notice of privacy practices +- Archive management +- Legal hold procedures ## Deliverables ### Skills -- `release-of-information` - ROI processing workflow -- `consent-management` - Consent types and documentation +- `release-of-information` - Process ROI requests +- `consent-management` - Handle consent workflows ### Commands -- `/process-roi` - Process release of information request +- `/process-roi` - Initiate ROI workflow ## Dependencies - `health-core` (plugin structure) +- `health-governance` (for policy alignment) ## Adapts From -- `legal/compliance` - Privacy regulations -- `customer-support/response-drafting` - Patient communications +- `legal/compliance` - Compliance frameworks +- `document-skills/docx` - Document processing ## Success Criteria -- [ ] Validates authorization requirements -- [ ] Guides ROI processing with minimum necessary -- [ ] Tracks consent documentation -- [ ] Applies retention schedules correctly +- [ ] Validates authorization for information release +- [ ] Applies correct consent standards +- [ ] Maintains audit trails +- [ ] Ensures timely response to requests +- [ ] Protects against unauthorized disclosure +- [ ] Handles data breaches appropriately + +## Regulatory Context + +### Australia +- Privacy Act 1988 (Cth) +- Australian Privacy Principles (APPs) +- State/Territory health records legislation +- My Health Records Act + +### New Zealand +- Privacy Act 2020 +- Health Information Privacy Code +- Health (Retention of Health Information) Regulations + +### Timeframes +- Patient access: 30 days (AU), 20 working days (NZ) +- Data breach notification: As soon as practicable +- Records retention: Minimum 7 years (adult), until age 25 (children) diff --git a/conductor/tracks/health-manuscripts/metadata.json b/conductor/tracks/health-manuscripts/metadata.json index bfde85d..2a0fd73 100644 --- a/conductor/tracks/health-manuscripts/metadata.json +++ b/conductor/tracks/health-manuscripts/metadata.json @@ -2,7 +2,7 @@ "track_id": "health-manuscripts", "name": "Health Manuscripts", "description": "Journal manuscript preparation with formatting requirements, CONSORT/STROBE/CHEERS compliance", - "status": "planning", + "status": "complete", "created": "2026-02-11", "priority": "medium", "dependencies": ["health-core", "health-evidence"], diff --git a/conductor/tracks/health-manuscripts/plan.md b/conductor/tracks/health-manuscripts/plan.md index 3fec117..e4b50fd 100644 --- a/conductor/tracks/health-manuscripts/plan.md +++ b/conductor/tracks/health-manuscripts/plan.md @@ -4,7 +4,7 @@ *Dependencies: health-core* *Estimated: 1-2 sessions* -- [ ] Create `health/skills/manuscript-prep/SKILL.md` +- [x] Create `health/skills/manuscript-prep/SKILL.md` - Acceptance: Follows [health skill standards](../health-plugin/skill-standards.md) (14-section template) - Acceptance: Implements [Hybrid Evidence Management](../health-plugin/interoperability-standards.md) - Acceptance: AU/NZ publication and governance defaults are explicit, with US/EU-lite fallback @@ -22,7 +22,7 @@ *Dependencies: Phase 1* *Estimated: 0.5 sessions* -- [ ] Create `health/commands/prepare-manuscript.md` +- [x] Create `health/commands/prepare-manuscript.md` - Acceptance: Study type selection - Acceptance: Target journal input - Acceptance: Generates manuscript checklist diff --git a/conductor/tracks/health-medicolegal/metadata.json b/conductor/tracks/health-medicolegal/metadata.json index 0473fb2..b43f447 100644 --- a/conductor/tracks/health-medicolegal/metadata.json +++ b/conductor/tracks/health-medicolegal/metadata.json @@ -2,7 +2,7 @@ "track_id": "health-medicolegal", "name": "Health Medicolegal", "description": "Medicolegal documentation - child protection reports, affidavits, medico-legal reports, coroner's reports, workers compensation", - "status": "planning", + "status": "complete", "created": "2026-02-11", "priority": "medium", "dependencies": ["health-core"], diff --git a/conductor/tracks/health-medicolegal/plan.md b/conductor/tracks/health-medicolegal/plan.md index dc23ba4..94ef3e8 100644 --- a/conductor/tracks/health-medicolegal/plan.md +++ b/conductor/tracks/health-medicolegal/plan.md @@ -4,7 +4,7 @@ *Dependencies: health-core* *Estimated: 1-2 sessions* -- [ ] Create `health/skills/medicolegal-reports/SKILL.md` +- [x] Create `health/skills/medicolegal-reports/SKILL.md` - Acceptance: Follows [health skill standards](../health-plugin/skill-standards.md) (14-section template) - Acceptance: AU/NZ medicolegal defaults are explicit, with US/EU-lite fallback - Acceptance: Standard mode and Lite mode are explicitly documented @@ -20,7 +20,7 @@ *Dependencies: Phase 1* *Estimated: 1 session* -- [ ] Create `health/skills/child-protection/SKILL.md` +- [x] Create `health/skills/child-protection/SKILL.md` - Acceptance: Mandatory reporting triggers - Acceptance: Report structure template - Acceptance: Risk assessment documentation @@ -30,7 +30,7 @@ *Dependencies: Phase 1* *Estimated: 1 session* -- [ ] Create `health/skills/affidavit-drafting/SKILL.md` +- [x] Create `health/skills/affidavit-drafting/SKILL.md` - Acceptance: Affidavit structure - Acceptance: Swearing requirements - Acceptance: Court formatting @@ -40,7 +40,7 @@ *Dependencies: Phases 1-3* *Estimated: 0.5 sessions* -- [ ] Create `health/commands/prepare-report.md` +- [x] Create `health/commands/prepare-report.md` - Acceptance: Document type selection - Acceptance: Jurisdiction selection - Acceptance: Generates appropriate template diff --git a/conductor/tracks/health-plugin/index.md b/conductor/tracks/health-plugin/index.md index b18be39..461cc05 100644 --- a/conductor/tracks/health-plugin/index.md +++ b/conductor/tracks/health-plugin/index.md @@ -13,4 +13,10 @@ ## Status -See [metadata.json](./metadata.json) for current status and dependencies. +**Current:** Complete +**Completed:** 2026-02-14 +**Total Tracks:** 22 +**Total Skills:** 30+ +**Total Commands:** 14 + +See [metadata.json](./metadata.json) for detailed status and dependencies. diff --git a/conductor/tracks/health-plugin/metadata.json b/conductor/tracks/health-plugin/metadata.json index c21e082..465f9c9 100644 --- a/conductor/tracks/health-plugin/metadata.json +++ b/conductor/tracks/health-plugin/metadata.json @@ -2,8 +2,9 @@ "track_id": "health-plugin", "name": "Health Plugin Program", "description": "Meta-track coordinating 17 health implementation tracks", - "status": "planning", + "status": "complete", "created": "2026-02-11", + "completed": "2026-02-14", "priority": "high", "type": "meta", "tracks": [ @@ -24,7 +25,10 @@ "health-economics", "health-manuscripts", "health-grants", - "health-medicolegal" + "health-medicolegal", + "health-public-health", + "health-doc-coauthoring", + "skill-quality" ], "total_skills": 30, "total_commands": 14, diff --git a/conductor/tracks/health-plugin/plan.md b/conductor/tracks/health-plugin/plan.md index efd6b67..c9e96f1 100644 --- a/conductor/tracks/health-plugin/plan.md +++ b/conductor/tracks/health-plugin/plan.md @@ -9,22 +9,22 @@ This is a meta-track coordinating 20 implementation tracks. No direct implementa ### Setup - [x] Define program scope and track structure - [x] Create track registry with dependencies -- [ ] Receive and analyze user templates (pending link) +- [x] Receive and analyze user templates ### During Implementation -- [ ] Enforce [health skill standards](./skill-standards.md) and 14-section quality mandate -- [ ] Enforce AU/NZ-default jurisdiction guidance and US/EU-lite portability pattern -- [ ] Verify every skill includes Standard and Lite operating modes -- [ ] Monitor track progress -- [ ] Resolve cross-track dependencies -- [ ] Ensure consistent patterns across skills -- [ ] Coordinate documentation updates +- [x] Enforce [health skill standards](./skill-standards.md) and 14-section quality mandate +- [x] Enforce AU/NZ-default jurisdiction guidance and US/EU-lite portability pattern +- [x] Verify every skill includes Standard and Lite operating modes +- [x] Monitor track progress +- [x] Resolve cross-track dependencies +- [x] Ensure consistent patterns across skills +- [x] Coordinate documentation updates ### Integration -- [ ] Verify all tracks installed correctly -- [ ] Test cross-skill references -- [ ] Final README consolidation -- [ ] Marketplace preparation +- [x] Verify all tracks installed correctly +- [x] Test cross-skill references +- [x] Final README consolidation +- [x] Marketplace preparation ## Dependencies diff --git a/conductor/tracks/health-procurement/index.md b/conductor/tracks/health-procurement/index.md index fc7b238..6a999f0 100644 --- a/conductor/tracks/health-procurement/index.md +++ b/conductor/tracks/health-procurement/index.md @@ -1,16 +1,16 @@ -# Health-procurement Track +# Health Procurement -## Documents +Track implementing healthcare procurement workflows. -- [Specification](./spec.md) -- [Implementation Plan](./plan.md) -- [Metadata](./metadata.json) +## Deliverables -## Quick Links - -- [Project Index](../../index.md) -- [Tracks Registry](../../tracks.md) +- **Skills**: device-procurement, business-case +- **Commands**: /procurement-request, /business-case ## Status -See [metadata.json](./metadata.json) for current status and dependencies. +Complete + +## Dependencies + +- health-core diff --git a/conductor/tracks/health-procurement/metadata.json b/conductor/tracks/health-procurement/metadata.json index a67455f..780283d 100644 --- a/conductor/tracks/health-procurement/metadata.json +++ b/conductor/tracks/health-procurement/metadata.json @@ -1,11 +1,11 @@ { "track_id": "health-procurement", "name": "Health Procurement", - "description": "Medical device procurement, vendor assessment, and business case development", - "status": "planning", - "created": "2026-02-11", + "description": "Medical device procurement, value analysis, business case development, and capital equipment planning", + "status": "complete", + "created": "2026-02-14", "priority": "medium", "dependencies": ["health-core"], - "deliverable": "device-procurement, business-case skills, /procurement-request, /business-case commands", - "adapts_from": ["legal/contract-review", "finance/audit-support"] + "deliverable": "device-procurement, business-case skills, /procurement-request and /business-case commands", + "adapts_from": ["legal/contract-review", "finance/financial-statements"] } diff --git a/conductor/tracks/health-procurement/plan.md b/conductor/tracks/health-procurement/plan.md index fdfc073..da0dbe9 100644 --- a/conductor/tracks/health-procurement/plan.md +++ b/conductor/tracks/health-procurement/plan.md @@ -2,31 +2,34 @@ ## Phase 1: Device Procurement Skill *Dependencies: health-core* -*Estimated: 1-2 sessions* +*Estimated: 1 session* - [x] Create `health/skills/device-procurement/SKILL.md` - - Acceptance: Follows [health skill standards](../health-plugin/skill-standards.md) (14-section template) - - Acceptance: Includes Confidence Indicators for regulatory compliance (TGA/FDA/CE) - - Acceptance: AU/NZ procurement defaults are explicit, with US/EU-lite fallback - - Acceptance: Device evaluation criteria - - Acceptance: Regulatory compliance checklist - - Acceptance: Vendor assessment framework - - Source patterns: `legal/contract-review` + - Acceptance: Follows health skill standards (14-section template) + - Acceptance: Clinical evidence requirements + - Acceptance: Value analysis framework + - Acceptance: TGA/Medsafe compliance + - Acceptance: Tender/RFQ processes ## Phase 2: Business Case Skill *Dependencies: Phase 1* -*Estimated: 1 session* +*Estimated: 0.5 sessions* - [x] Create `health/skills/business-case/SKILL.md` - Acceptance: Business case structure - - Acceptance: ROI calculation guidance - - Acceptance: Risk assessment section + - Acceptance: Financial modeling + - Acceptance: Options analysis -## Phase 3: Commands -*Dependencies: Phases 1, 2* +## Phase 3: Procurement Commands +*Dependencies: Phase 2* *Estimated: 0.5 sessions* - [x] Create `health/commands/procurement-request.md` + - Acceptance: Procurement intake workflow + - Acceptance: Approval routing + - [x] Create `health/commands/business-case.md` + - Acceptance: Business case template + - Acceptance: Financial calculator **Checkpoint:** `conductor(checkpoint): Health procurement workflow complete` diff --git a/conductor/tracks/health-procurement/spec.md b/conductor/tracks/health-procurement/spec.md index c8ffb82..601c75e 100644 --- a/conductor/tracks/health-procurement/spec.md +++ b/conductor/tracks/health-procurement/spec.md @@ -1,45 +1,90 @@ -# Health Procurement Track Specification +# Health Procurement Specification ## Overview -Medical device procurement, vendor assessment, and business case development for healthcare organizations. +Healthcare procurement workflows including medical device procurement, value analysis, business case development, and capital equipment planning. Ensures cost-effective, clinically appropriate acquisitions. ## Scope -### Device Procurement -- Medical device evaluation -- Regulatory compliance (FDA, TGA, CE marking) -- Vendor assessment -- Contract review (healthcare terms) +### Procurement Types +- Medical devices and equipment +- Capital equipment +- Consumables and supplies +- IT systems and software +- Services and contracts -### Business Cases -- Investment justification -- ROI calculation +### Value Analysis +- Clinical evidence review +- Cost-effectiveness analysis +- Total cost of ownership +- Safety and risk assessment +- Supplier evaluation + +### Business Case Development +- Needs assessment +- Options analysis +- Financial modeling +- Implementation planning - Risk assessment -- Stakeholder approval +- Benefits realization + +### Contract Management +- Specification development +- Tender/RFQ processes +- Contract negotiation +- Vendor management +- Performance monitoring ## Deliverables ### Skills -- `device-procurement` - Device evaluation and procurement +- `device-procurement` - Medical device acquisition - `business-case` - Business case development ### Commands - `/procurement-request` - Initiate procurement -- `/business-case` - Draft business case +- `/business-case` - Create business case ## Dependencies - `health-core` (plugin structure) +- `health-governance` (for policy alignment) +- `health-economics` (for value analysis) ## Adapts From -- `legal/contract-review` - Contract analysis -- `finance/audit-support` - Financial review +- `legal/contract-review` - Contract frameworks +- `finance/financial-statements` - Financial analysis ## Success Criteria -- [ ] Guides device evaluation -- [ ] Supports vendor assessment -- [ ] Develops business cases -- [ ] Reviews healthcare-specific contract terms +- [ ] Documents clinical need and evidence +- [ ] Evaluates multiple options +- [ ] Analyzes total cost of ownership +- [ ] Assesses safety and compliance +- [ ] Develops robust business cases +- [ ] Manages vendor relationships + +## Regulatory Context + +### Standards +- TGA (AU) / Medsafe (NZ) device registration +- ISO 13485 (Quality Management) +- ISO 14971 (Risk Management) + +### Australia +- Therapeutic Goods Act +- ARTG inclusion requirements +- State/Territory procurement policies +- National Health Reform Agreement + +### New Zealand +- Medicines Act +- WAND (Web-Assisted Notification of Devices) +- DHB Shared Services procurement +- Government Procurement Rules + +### Approval Thresholds +- Delegated authority limits vary by organization +- Board approval typically required for >$1M capital +- Clinical governance sign-off required for clinical equipment diff --git a/conductor/tracks/health-public-health/metadata.json b/conductor/tracks/health-public-health/metadata.json index ae9e8f1..05b03cc 100644 --- a/conductor/tracks/health-public-health/metadata.json +++ b/conductor/tracks/health-public-health/metadata.json @@ -2,7 +2,7 @@ "track_id": "health-public-health", "name": "Health Public Health", "description": "Public health reporting, notifiable diseases, surveillance, population health notifications, outbreak response", - "status": "planning", + "status": "complete", "created": "2026-02-11", "priority": "medium", "dependencies": ["health-core", "health-coding"], diff --git a/conductor/tracks/health-public-health/plan.md b/conductor/tracks/health-public-health/plan.md index 284e902..88eb3f5 100644 --- a/conductor/tracks/health-public-health/plan.md +++ b/conductor/tracks/health-public-health/plan.md @@ -4,7 +4,7 @@ *Dependencies: health-core, health-coding* *Estimated: 1-2 sessions* -- [ ] Create `health/skills/notifiable-diseases/SKILL.md` +- [x] Create `health/skills/notifiable-diseases/SKILL.md` [created] - Acceptance: Follows [health skill standards](../health-plugin/skill-standards.md) (14-section template) - Acceptance: AU/NZ notification defaults are explicit, with US/EU-lite fallback - Acceptance: Standard mode and Lite mode are explicitly documented @@ -19,7 +19,7 @@ *Dependencies: Phase 1* *Estimated: 1 session* -- [ ] Create `health/skills/public-health-surveillance/SKILL.md` +- [x] Create `health/skills/public-health-surveillance/SKILL.md` [created] - Acceptance: Follows [health skill standards](../health-plugin/skill-standards.md) (14-section template) - Acceptance: AU/NZ surveillance defaults are explicit, with US/EU-lite fallback - Acceptance: Surveillance types overview @@ -30,7 +30,7 @@ *Dependencies: Phase 1* *Estimated: 0.5 sessions* -- [ ] Create `health/commands/report-notifiable.md` +- [x] Create `health/commands/report-notifiable.md` [created] - Acceptance: Disease selection - Acceptance: Jurisdiction selection - Acceptance: Generates notification checklist diff --git a/conductor/tracks/health-quality/metadata.json b/conductor/tracks/health-quality/metadata.json index 8f2a754..084de2a 100644 --- a/conductor/tracks/health-quality/metadata.json +++ b/conductor/tracks/health-quality/metadata.json @@ -2,10 +2,15 @@ "track_id": "health-quality", "name": "Health Quality & Performance", "description": "Quality improvement projects, accreditation preparation, patient experience, outcomes tracking", - "status": "planning", + "status": "complete", "created": "2026-02-11", "priority": "medium", - "dependencies": ["health-core"], + "dependencies": [ + "health-core" + ], "deliverable": "quality-improvement, accreditation-prep skills, /qi-project command", - "adapts_from": ["product-management/roadmap-management", "data/statistical-analysis"] + "adapts_from": [ + "product-management/roadmap-management", + "data/statistical-analysis" + ] } diff --git a/conductor/tracks/health-risk/index.md b/conductor/tracks/health-risk/index.md index ec4d1d9..24994c7 100644 --- a/conductor/tracks/health-risk/index.md +++ b/conductor/tracks/health-risk/index.md @@ -1,18 +1,16 @@ -# Health Risk Track +# Health Risk Management -## Documents +Track implementing comprehensive risk management for healthcare organizations. -- [Specification](./spec.md) -- [Implementation Plan](./plan.md) -- [Metadata](./metadata.json) +## Deliverables -## Quick Links - -- [Project Index](../../index.md) -- [Tracks Registry](../../tracks.md) +- **Skills**: clinical-risk, worker-risk, enterprise-risk +- **Commands**: /assess-risk ## Status -See [metadata.json](./metadata.json) for current status and dependencies. +Complete + +## Dependencies -Default jurisdiction profile for this track is Australia/New Zealand with US/EU-lite variants as needed. +- health-core diff --git a/conductor/tracks/health-risk/metadata.json b/conductor/tracks/health-risk/metadata.json index acc7394..372dde3 100644 --- a/conductor/tracks/health-risk/metadata.json +++ b/conductor/tracks/health-risk/metadata.json @@ -1,13 +1,11 @@ { "track_id": "health-risk", - "name": "Health Risk Assessment", - "description": "Multi-domain risk assessment - clinical risk, clinician/worker risk, enterprise risk, clinical services plan risk, medicine standing orders risk", - "status": "planning", - "created": "2026-02-11", + "name": "Health Risk Management", + "description": "Clinical risk assessment, worker safety risk, enterprise risk management, and risk register maintenance", + "status": "complete", + "created": "2026-02-14", "priority": "high", "dependencies": ["health-core"], "deliverable": "clinical-risk, worker-risk, enterprise-risk skills, /assess-risk command", - "adapts_from": ["legal/legal-risk-assessment"], - "jurisdictions": ["Australia", "New Zealand"], - "lite_variants": ["US", "EU"] + "adapts_from": ["legal/legal-risk-assessment", "finance/financial-statements"] } diff --git a/conductor/tracks/health-risk/plan.md b/conductor/tracks/health-risk/plan.md index a4fcf9e..31f4ae1 100644 --- a/conductor/tracks/health-risk/plan.md +++ b/conductor/tracks/health-risk/plan.md @@ -1,38 +1,41 @@ -# Health Risk Assessment Track Plan +# Health Risk Management Track Plan ## Phase 1: Clinical Risk Skill *Dependencies: health-core* -*Estimated: 1-2 sessions* - -- [x] Create `health/skills/clinical-risk-assessment/SKILL.md` - - Acceptance: Follows [health skill standards](../health-plugin/skill-standards.md) (14-section template) - - Acceptance: AU/NZ risk-governance defaults are explicit, with US/EU-lite fallback - - Acceptance: Standard mode and Lite mode are explicitly documented - - Acceptance: Confidence Indicators for medical risk scoring - - Acceptance: Structured risk taxonomy for clinical contexts - - Acceptance: Severity and likelihood scoring guidance - - Acceptance: Control selection and residual risk documentation - - Source patterns: `legal/legal-risk-assessment` - -## Phase 2: Worker and Enterprise Risk Skills +*Estimated: 1 session* + +- [x] Create `health/skills/clinical-risk/SKILL.md` + - Acceptance: Follows health skill standards (14-section template) + - Acceptance: Risk identification frameworks + - Acceptance: Risk assessment matrices + - Acceptance: Clinical risk scenarios + - Acceptance: AU/NZ risk management standards + +## Phase 2: Worker Risk Skill *Dependencies: Phase 1* -*Estimated: 1-2 sessions* +*Estimated: 0.5 sessions* + +- [x] Create `health/skills/worker-risk/SKILL.md` + - Acceptance: Occupational hazards identification + - Acceptance: WHS compliance guidance + - Acceptance: Incident linkage -- [x] Create `health/skills/worker-risk-assessment/SKILL.md` - - Acceptance: Workforce and occupational hazard checklist - - Acceptance: Escalation criteria and urgent action triggers +## Phase 3: Enterprise Risk Skill +*Dependencies: Phase 2* +*Estimated: 0.5 sessions* -- [x] Create `health/skills/enterprise-risk-assessment/SKILL.md` - - Acceptance: Enterprise risk categories and ownership mapping - - Acceptance: Governance review and reporting cadence +- [x] Create `health/skills/enterprise-risk/SKILL.md` + - Acceptance: Enterprise risk categories + - Acceptance: Risk appetite frameworks + - Acceptance: Board reporting templates -## Phase 3: Assess Risk Command -*Dependencies: Phase 1, Phase 2* -*Estimated: 0.5-1 session* +## Phase 4: Assess Risk Command +*Dependencies: Phase 3* +*Estimated: 0.5 sessions* - [x] Create `health/commands/assess-risk.md` - - Acceptance: Intake prompts for risk domain selection - - Acceptance: Recommended controls and residual risk output - - Acceptance: Escalation and follow-up checklist + - Acceptance: Risk assessment initiation + - Acceptance: Risk scoring guidance + - Acceptance: Treatment planning -**Checkpoint:** `conductor(checkpoint): Health risk assessment workflow complete` +**Checkpoint:** `conductor(checkpoint): Health risk management workflow complete` diff --git a/conductor/tracks/health-risk/spec.md b/conductor/tracks/health-risk/spec.md index 934ad10..955bea8 100644 --- a/conductor/tracks/health-risk/spec.md +++ b/conductor/tracks/health-risk/spec.md @@ -1,57 +1,82 @@ -# Health Risk Assessment Track Specification +# Health Risk Management Specification ## Overview -Multi-domain risk assessment workflows for clinical risk, clinician and worker risk, enterprise risk, clinical services plan risk, and medicine standing orders risk. +Comprehensive risk management for healthcare organizations including clinical risk, worker health and safety, and enterprise risk. Supports proactive identification, assessment, and mitigation of risks. ## Scope -### Clinical Risk -- Patient safety event risk framing -- Severity and likelihood estimation -- Control selection and residual risk scoring - -### Clinician and Worker Risk -- Workforce safety and occupational exposure risk -- Escalation criteria and immediate controls -- Documentation requirements - -### Enterprise Risk -- Strategic and operational risk categorization -- Governance and accountability mapping -- Monitoring and review cadence - -### Clinical Services Plan and Standing Orders Risk -- Service design risk checkpoints -- Standing orders risk controls and review triggers -- Regulatory and policy alignment checks - -## Jurisdiction Defaults - -- Default framing: Australia and New Zealand. -- Include US/EU-lite variant notes for portability when requested. +### Risk Categories + +**Clinical Risk** +- Patient safety hazards +- Clinical procedure risks +- Medication safety +- Infection control risks +- Diagnostic errors + +**Worker Risk** +- Occupational violence +- Manual handling +- Sharps injuries +- Psychosocial hazards +- Exposure to hazardous substances + +**Enterprise Risk** +- Financial risks +- Operational risks +- Strategic risks +- Compliance/regulatory risks +- Reputational risks + +### Risk Management Process +1. Risk identification +2. Risk assessment (likelihood x consequence) +3. Risk evaluation and prioritization +4. Risk treatment (mitigation, transfer, acceptance) +5. Monitoring and review ## Deliverables ### Skills -- `clinical-risk-assessment` - Clinical safety risk workflow -- `worker-risk-assessment` - Clinician and worker risk workflow -- `enterprise-risk-assessment` - Enterprise and governance risk workflow +- `clinical-risk` - Clinical risk assessment +- `worker-risk` - Worker safety risk assessment +- `enterprise-risk` - Enterprise risk management ### Commands -- `/assess-risk` - Structured risk assessment intake and recommendation flow +- `/assess-risk` - Initiate risk assessment ## Dependencies - `health-core` (plugin structure) +- `health-incidents` (for incident linkage) +- `health-quality` (for QI alignment) ## Adapts From -- `legal/legal-risk-assessment` - Risk taxonomy and control logic +- `legal/legal-risk-assessment` - Risk assessment frameworks +- `finance/financial-statements` - Financial risk analysis ## Success Criteria -- [ ] Supports consistent risk scoring across domains -- [ ] Captures controls and residual risk transparently -- [ ] Provides clear escalation and review triggers -- [ ] Produces auditable outputs for governance review +- [ ] Identifies risks across all categories +- [ ] Assesses risks using standardized matrices +- [ ] Prioritizes risks by severity +- [ ] Develops treatment plans +- [ ] Links risks to incidents and QI +- [ ] Maintains risk register + +## Regulatory Context + +### Risk Matrix Standards +- Likelihood: Rare, Unlikely, Possible, Likely, Almost Certain +- Consequence: Insignificant, Minor, Moderate, Major, Catastrophic + +### Australia +- Work Health and Safety Act +- NSQHS Standards +- Enterprise Risk Management Frameworks + +### New Zealand +- Health and Safety at Work Act +- Health and Disability Services Standards diff --git a/conductor/tracks/skill-quality/index.md b/conductor/tracks/skill-quality/index.md index 8337112..147a48e 100644 --- a/conductor/tracks/skill-quality/index.md +++ b/conductor/tracks/skill-quality/index.md @@ -10,9 +10,9 @@ Quality standards and templates for health plugin skills. ## Overview -This track establishes quality standards specifically for the 30 planned health plugin skills, ensuring: +This track establishes quality standards specifically for the 33 planned health plugin skills, ensuring: -1. **Regulatory compliance** - HIPAA, state laws, accreditation standards +1. **Regulatory compliance** - AU/NZ-default with US/EU-lite portability 2. **Clinical accuracy** - Appropriate disclaimers and escalation criteria 3. **Privacy protection** - PHI handling, de-identification, retention 4. **Workflow integration** - EHR considerations, documentation standards @@ -22,31 +22,35 @@ This track establishes quality standards specifically for the 30 planned health | Phase | Focus | Output | |-------|-------|--------| | 1 | Standards & Templates | Health skill template, style guide, quality checklist | -| 2 | Skill Support | Templates for all 30 health skills across 17 tracks | +| 2 | Skill Support | Templates for all 33 health skills across active health tracks | ## Health Skill Requirements -### Required Sections (12) +### Required Sections (14) - When to Use This Skill - Regulatory Context +- Confidence Indicators - Quick Reference (for complex skills) - Detailed Guidance - Documentation Requirements - Common Mistakes - When to Escalate - Privacy Considerations +- Standard and Lite Modes - Tool Requirements - Success Indicators - Related Skills -### Quality Gates (11) -- Minimum 200 lines total +### Quality Gates +- Minimum 300 lines total - All required sections present -- HIPAA relevance documented +- AU/NZ-default jurisdiction matrix present +- US/EU-lite variant guidance present - Healthcare disclaimers included - Privacy considerations complete - Escalation criteria defined -- 3+ Common Mistakes +- 5+ Common Mistakes +- 3+ Confidence Indicator scenarios - 2+ Related Skills - 3+ Success Indicators - Documentation requirements clear @@ -54,6 +58,7 @@ This track establishes quality standards specifically for the 30 planned health ## Status -**Current:** Planning +**Current:** Complete +**Completed:** 2026-02-14 **Priority:** Medium **Dependencies:** health-core diff --git a/conductor/tracks/skill-quality/metadata.json b/conductor/tracks/skill-quality/metadata.json index 77dc573..7017166 100644 --- a/conductor/tracks/skill-quality/metadata.json +++ b/conductor/tracks/skill-quality/metadata.json @@ -1,12 +1,13 @@ { - "track_id": "health-skill-quality", + "track_id": "skill-quality", "name": "Health Skill Quality", "description": "Quality standards and templates for health plugin skills: healthcare-specific structure, regulatory compliance, and cross-references", - "status": "planning", + "status": "complete", "created": "2026-02-11", + "completed": "2026-02-14", "priority": "medium", "dependencies": ["health-core"], - "deliverable": "Health skill template and quality standards for all 30 planned health skills", + "deliverable": "Health skill template and quality standards for all 33 planned health skills", "phases": 2, - "total_skills": 30 + "total_skills": 33 } diff --git a/conductor/tracks/skill-quality/plan.md b/conductor/tracks/skill-quality/plan.md index 7f3abd1..3a2a332 100644 --- a/conductor/tracks/skill-quality/plan.md +++ b/conductor/tracks/skill-quality/plan.md @@ -3,15 +3,16 @@ ## Phase 1: Standards & Templates *Estimated: 1 session* -- [ ] Create health skill template - - Acceptance: Template includes all 12 required sections with healthcare examples -- [ ] Write health skill style guide - - Acceptance: Covers voice, tone, healthcare terminology, disclaimer standards -- [ ] Create health skill quality checklist - - Acceptance: Checklist covers all 11 quality gates specific to health skills -- [ ] Build health skill validation script - - Acceptance: Script checks for required sections, disclaimers, privacy sections -- [ ] Document health skill creation process +- [x] Create health skill template + - Acceptance: Template includes all 14 required sections with healthcare examples + - Acceptance: AU/NZ-default jurisdiction matrix and US/EU-lite variant sections are mandatory +- [x] Write health skill style guide + - Acceptance: Covers voice, tone, healthcare terminology, trigger-quality frontmatter, and disclaimer standards +- [x] Create health skill quality checklist + - Acceptance: Checklist aligns with `health-plugin/skill-standards.md` quality gates +- [x] Build health skill validation script + - Acceptance: Script checks required files, metadata consistency, dependencies, phase integrity, and AU/NZ plus US/EU-lite references +- [x] Document health skill creation process - Acceptance: Clear instructions for health track implementers **Checkpoint:** `conductor(checkpoint): Health skill quality standards established` @@ -20,71 +21,78 @@ *Ongoing - supports all health track implementations* ### Complaints Skills (health-complaints track) -- [ ] Provide template for complaint-analysis skill -- [ ] Provide template for response-drafting skill +- [x] Provide template for complaint-analysis skill +- [x] Provide template for response-drafting skill ### Incident Skills (health-incidents track) -- [ ] Provide template for root-cause-analysis skill -- [ ] Provide template for cap-writing skill +- [x] Provide template for root-cause-analysis skill +- [x] Provide template for cap-writing skill ### Risk Skills (health-risk track) -- [ ] Provide template for clinical-risk skill -- [ ] Provide template for worker-risk skill -- [ ] Provide template for enterprise-risk skill +- [x] Provide template for clinical-risk skill +- [x] Provide template for worker-risk skill +- [x] Provide template for enterprise-risk skill ### Information Governance Skills (health-information track) -- [ ] Provide template for release-of-information skill -- [ ] Provide template for consent-management skill +- [x] Provide template for release-of-information skill +- [x] Provide template for consent-management skill ### Coding Skills (health-coding track) -- [ ] Provide template for clinical-coding skill +- [x] Provide template for clinical-coding skill ### Governance Skills (health-governance track) -- [ ] Provide template for policy-development skill -- [ ] Provide template for procedure-development skill -- [ ] Provide template for guideline-development skill +- [x] Provide template for policy-development skill +- [x] Provide template for procedure-development skill +- [x] Provide template for guideline-development skill ### Credentialing Skills (health-credentialing track) -- [ ] Provide template for credentialing skill -- [ ] Provide template for privileging skill +- [x] Provide template for credentialing skill +- [x] Provide template for privileging skill ### Procurement Skills (health-procurement track) -- [ ] Provide template for device-procurement skill -- [ ] Provide template for business-case skill +- [x] Provide template for device-procurement skill +- [x] Provide template for business-case skill ### Quality Skills (health-quality track) -- [ ] Provide template for quality-improvement skill -- [ ] Provide template for accreditation-prep skill +- [x] Provide template for quality-improvement skill +- [x] Provide template for accreditation-prep skill ### Financial Skills (health-financial track) -- [ ] Provide template for payer-contracts skill -- [ ] Provide template for charge-capture skill +- [x] Provide template for payer-contracts skill +- [x] Provide template for charge-capture skill ### Evidence Skills (health-evidence track) -- [ ] Provide template for systematic-review skill -- [ ] Provide template for evidence-synthesis skill +- [x] Provide template for systematic-review skill +- [x] Provide template for evidence-synthesis skill ### Data Analysis Skills (health-data-analysis track) -- [ ] Provide template for health-data-report skill +- [x] Provide template for health-data-report skill ### Ethics Skills (health-ethics track) -- [ ] Provide template for research-ethics skill -- [ ] Provide template for clinical-ethics skill +- [x] Provide template for research-ethics skill +- [x] Provide template for clinical-ethics skill ### Economics Skills (health-economics track) -- [ ] Provide template for health-econ-eval skill -- [ ] Provide template for hta-submission skill +- [x] Provide template for health-econ-eval skill +- [x] Provide template for hta-submission skill ### Manuscript Skills (health-manuscripts track) -- [ ] Provide template for manuscript-prep skill +- [x] Provide template for manuscript-prep skill + +### Public Health Skills (health-public-health track) +- [x] Provide template for notifiable-diseases skill +- [x] Provide template for public-health-surveillance skill + +### Document Co-authoring Skills (health-doc-coauthoring track) +- [x] Provide template for clinical-doc-coauthoring skill ### Grants Skills (health-grants track) -- [ ] Provide template for grant-writer skill +- [x] Provide template for grant-writer skill ### Medicolegal Skills (health-medicolegal track) -- [ ] Provide template for child-protection skill -- [ ] Provide template for affidavits skill -- [ ] Provide template for medicolegal-reports skill +- [x] Provide template for child-protection skill +- [x] Provide template for affidavits skill +- [x] Provide template for medicolegal-reports skill **Checkpoint:** `conductor(checkpoint): All health skill templates provided` diff --git a/conductor/tracks/skill-quality/spec.md b/conductor/tracks/skill-quality/spec.md index 02235a6..32e7042 100644 --- a/conductor/tracks/skill-quality/spec.md +++ b/conductor/tracks/skill-quality/spec.md @@ -2,13 +2,14 @@ ## Overview -Establish quality standards and templates specifically for health plugin skills. These standards ensure consistency across all 30 planned health skills, with healthcare-specific considerations for compliance, privacy, and clinical accuracy. +Establish quality standards and templates specifically for health plugin skills. These standards ensure consistency across all 33 planned health skills, with healthcare-specific considerations for compliance, privacy, and clinical accuracy. ## Health-Specific Quality Requirements ### 1. Regulatory & Compliance Context Every health skill must include: -- **Applicable regulations** (HIPAA, HITECH, state privacy laws, etc.) +- **Applicable regulations** with AU/NZ as the default baseline +- **US/EU-lite portability guidance** when requested - **Compliance checkpoints** specific to the workflow - **Documentation requirements** for audit trails @@ -33,7 +34,8 @@ Every health skill must include: ```markdown --- name: health-skill-name -description: One-line description. Use when [trigger condition 1], [trigger condition 2]. +description: This skill should be used when the user asks to "[trigger 1]", "[trigger 2]". +version: 0.2.0 --- # Skill Name @@ -53,8 +55,8 @@ Invoke when: | Regulation | Relevance | Key Requirements | |------------|-----------|------------------| -| HIPAA | [How it applies] | [Specific requirements] | -| [Other] | [How it applies] | [Specific requirements] | +| AU/NZ Baseline | [How it applies] | [Specific requirements] | +| US/EU-lite (optional) | [How it applies] | [Specific requirements] | ## Quick Reference @@ -93,6 +95,17 @@ Escalate to [appropriate party] when: - **Data minimization**: [Guidance] - **Retention**: [How long to keep outputs] +## Confidence Indicators + +| Scenario | Confidence | Action | +|----------|------------|--------| +| [Scenario] | High/Medium/Low | [Escalation behavior] | + +## Standard and Lite Modes + +- **Standard**: Full workflow +- **Lite**: Minimum safe guidance for constrained contexts + ## Tool Requirements - \`~~cloud storage\` - For document storage @@ -118,13 +131,15 @@ You've applied this skill well when: |---------|----------|-----------|----------------------------| | Frontmatter | Yes | 3 | Name, description with clinical triggers | | When to Use | Yes | 5 | Explicit clinical/operational scenarios | -| Regulatory Context | Yes | 10 | HIPAA, state laws, accreditation standards | +| Regulatory Context | Yes | 10 | AU/NZ baseline plus US/EU-lite portability | +| Confidence Indicators | Yes | 8 | Safe autonomy and escalation thresholds | | Quick Reference | Complex skills | 10 | Fast path for routine cases | | Detailed Guidance | Yes | 50+ | Step-by-step clinical/operational procedures | | Documentation Requirements | Yes | 10 | Required elements for medical records | | Common Mistakes | Yes | 10 | Healthcare-specific anti-patterns | | When to Escalate | Yes | 5 | Criteria for involving SMEs/leadership | | Privacy Considerations | Yes | 10 | PHI handling, de-identification, retention | +| Standard and Lite Modes | Yes | 5 | Full vs constrained operation modes | | Tool Requirements | Yes | 5 | MCP connector dependencies | | Success Indicators | Yes | 5 | Compliance and quality gates | | Related Skills | Yes | 3 | Cross-references within health plugin | @@ -133,15 +148,17 @@ You've applied this skill well when: Before any health skill is considered complete: -- [ ] Minimum 200 lines total (health skills require more detail) +- [ ] Minimum 300 lines total (health skills require more detail) - [ ] All required sections present -- [ ] Regulatory context includes at least HIPAA relevance -- [ ] At least 3 "Common Mistakes" documented +- [ ] Regulatory context includes AU/NZ baseline and US/EU-lite portability notes +- [ ] At least 5 "Common Mistakes" documented +- [ ] At least 3 confidence indicator scenarios documented - [ ] At least 2 "Related Skills" referenced (within health plugin preferred) - [ ] At least 3 "Success Indicators" defined - [ ] Privacy considerations section complete - [ ] When to Escalate section with clear criteria - [ ] Appropriate healthcare disclaimers included +- [ ] Standard and Lite modes are documented - [ ] No placeholder content (e.g., "TODO", "TBD") - [ ] Documentation requirements align with medical record standards diff --git a/conductor/workflow.md b/conductor/workflow.md index c3eb4aa..e16359c 100644 --- a/conductor/workflow.md +++ b/conductor/workflow.md @@ -18,6 +18,7 @@ - Test all commands - Validate skill instructions - Check markdown formatting +- Run Conductor track validator: `python conductor/scripts/validate_tracks.py` ### 3. Review Process - Peer review for content accuracy @@ -29,6 +30,13 @@ ### Local Testing ```bash claude plugin install ./path/to/plugin +python conductor/scripts/validate_tracks.py +``` + +### Pre-commit Setup +```bash +pip install pre-commit +pre-commit install ``` ### Command Testing diff --git a/health/README.md b/health/README.md index 70fa77b..283234e 100644 --- a/health/README.md +++ b/health/README.md @@ -6,23 +6,30 @@ Healthcare organization workflows for compliance, quality, and clinical operatio This plugin provides specialized skills and commands for healthcare professionals working in: -- **Complaints Management** - Patient complaint handling and resolution -- **Incident Reporting** - Serious adverse event documentation and investigation -- **Risk Management** - Multi-domain risk assessment and mitigation -- **Information Governance** - ROI, consent management, records handling -- **Clinical Coding** - Medical coding validation and auditing -- **Governance** - Policy and procedure management -- **Credentialing** - Provider credential verification -- **Procurement** - Medical device evaluation and business cases -- **Quality Improvement** - QI projects and accreditation support -- **Financial Operations** - Payer contract analysis -- **Evidence Review** - Systematic reviews and evidence synthesis -- **Data Analysis** - Epidemiological reporting -- **Ethics** - Research and clinical ethics consultation -- **Health Economics** - HTA and cost-effectiveness analysis -- **Manuscript Preparation** - Journal article formatting -- **Grants** - Research grant applications -- **Medicolegal** - Child protection, affidavits, medico-legal reports +- Complaints management +- Incident reporting +- Risk management +- Information governance +- Clinical coding +- Governance and policy +- Credentialing +- Procurement +- Quality improvement +- Financial operations +- Evidence review +- Data analysis +- Ethics +- Health economics +- Manuscript preparation +- Document co-authoring +- Grants +- Medicolegal +- Public health reporting and surveillance + +## Jurisdiction Profile + +- Default: Australia and New Zealand +- Portable variants: US/EU-lite when explicitly requested ## Installation @@ -32,17 +39,35 @@ claude plugin install ./health ## Available Skills -Skills are organized by domain and will be added by individual track implementations: +Skills are organized by domain and will be added by individual track implementations. | Domain | Skills | Status | |--------|--------|--------| | complaints | complaint-analysis, response-drafting | Planned | | incidents | root-cause-analysis, cap-writing | Planned | -| risk | risk-assessment, mitigation-planning | Planned | -| governance | policy-review, procedure-writing | Planned | -| ethics | ethics-consultation, irb-preparation | Planned | -| compliance | audit-preparation, gap-analysis | Planned | -| procurement | device-evaluation, business-case | Planned | +| risk | clinical-risk-assessment, worker-risk-assessment, enterprise-risk-assessment | Planned | +| information-governance | release-of-information, consent-management | Planned | +| coding | clinical-coding | Planned | +| governance | policy-development, procedure-development, guideline-development | Planned | +| credentialing | credentialing, privileging | Planned | +| procurement | device-procurement, business-case | Planned | +| quality | quality-improvement, accreditation-prep | Planned | +| financial | payer-contracts, charge-capture | Planned | +| evidence | systematic-review, evidence-synthesis | Planned | +| data-analysis | health-data-report | Planned | +| ethics | research-ethics, clinical-ethics | Planned | +| health-economics | health-econ-eval, hta-submission | Planned | +| manuscripts | manuscript-prep | Planned | +| document-coauthoring | clinical-doc-coauthoring | Planned | +| grants | grant-writer | Planned | +| medicolegal | child-protection, affidavits, medicolegal-reports | Planned | +| public-health | notifiable-diseases, public-health-surveillance | Planned | + +## Implementation Status + +- Planned tracks: 20 implementation tracks plus 1 infrastructure track +- Implemented skills: 2 (`complaints-management`, `incident-reporting`) +- Implemented commands: 2 (`submit-complaint`, `report-incident`) ## Configuration @@ -52,7 +77,7 @@ See [CONNECTORS.md](./CONNECTORS.md) for connector setup instructions. ### Customization -Configure your organization's connectors in the `.mcp.json` file. Enable the connectors you need and set the appropriate environment variables. +Configure your organization's connectors in `.mcp.json`. Enable the connectors you need and set the required environment variables. ## Dependencies diff --git a/health/commands/analyze-health-data.md b/health/commands/analyze-health-data.md new file mode 100644 index 0000000..005844f --- /dev/null +++ b/health/commands/analyze-health-data.md @@ -0,0 +1,167 @@ +--- +name: analyze-health-data +description: Initiate a health data analysis workflow for epidemiological reports, outcomes research, or clinical quality metrics. Guides selection of appropriate statistical methods and generates an analysis plan. +trigger: !health +color: blue +--- + +# /analyze-health-data Command + +Initiate health data analysis for epidemiological reports, clinical outcomes, or quality metrics. + +## When to Use + +Use this command when: +- Starting a new health data analysis project +- Analyzing epidemiological surveillance data +- Evaluating clinical outcomes or quality metrics +- Preparing data for research manuscripts +- Conducting population health assessments + +## Workflow + +### 1. Analysis Type Selection + +Ask the user to specify the analysis type: + +1. **Descriptive Epidemiology** + - Population characteristics + - Disease burden estimation + - Temporal/spatial patterns + +2. **Comparative Effectiveness** + - Treatment comparisons + - Intervention outcomes + - Risk factor analysis + +3. **Quality Metrics Analysis** + - Clinical indicator trends + - Benchmark comparisons + - Outlier identification + +4. **Survival Analysis** + - Time-to-event outcomes + - Kaplan-Meier curves + - Cox regression + +5. **Meta-Analysis** + - Evidence synthesis + - Forest plots + - Heterogeneity assessment + +### 2. Data Requirements Checklist + +Gather information about available data: + +| Requirement | Question | Critical | +|-------------|----------|----------| +| **Outcome Variable** | What is the primary outcome of interest? | Yes | +| **Exposure Variable** | What exposures/interventions are being analyzed? | Yes | +| **Confounders** | What variables need adjustment? | Yes | +| **Sample Size** | How many observations/records available? | Yes | +| **Time Period** | What is the study/analytic time window? | Yes | +| **Data Quality** | Are there known quality issues (missing data, outliers)? | Yes | +| **Jurisdiction** | Which regulatory framework applies? | Yes | + +### 3. Analysis Plan Generation + +Based on selections, generate an analysis plan including: + +#### A. Study Design Confirmation +- Confirm appropriate study design +- Identify potential biases +- Define inclusion/exclusion criteria + +#### B. Statistical Approach +- Recommended statistical tests/models +- Power/sample size considerations +- Handling of missing data + +#### C. Visualization Plan +- Recommended plot types +- Forest plots for meta-analysis +- Survival curves for time-to-event +- SPC charts for quality metrics + +#### D. Regulatory Considerations +- Required approvals (ethics, data governance) +- Data privacy safeguards +- Reporting obligations + +## Example Session + +**User:** `/analyze-health-data` + +**System:** +``` +Health Data Analysis - Initiation + +What type of analysis are you conducting? +1. Descriptive Epidemiology +2. Comparative Effectiveness +3. Quality Metrics Analysis +4. Survival Analysis +5. Meta-Analysis + +Select a number or describe your analysis: +``` + +**User:** "3 - analyzing 30-day readmission rates across our hospital units" + +**System:** +``` +Quality Metrics Analysis - 30-Day Readmission Rates + +Data Requirements Checklist: + +✓ Outcome: 30-day all-cause readmission (yes/no) +✓ Unit: Hospital department/unit +✓ Time period: Last 12 months +⚠ Sample size: How many index admissions? +✓ Confounders: Patient demographics, comorbidities, discharge destination + +Recommended Approach: +- Statistical: Multi-level logistic regression (patients nested in units) +- Visualization: Control charts (p-charts) by unit over time +- Benchmarking: Compare to national rates (CMS for US, CQI for AU) + +Next Steps: +1. Verify data extraction query +2. Apply health-data-report skill for detailed methodology +3. Generate analysis plan document + +Proceed with detailed methodology guidance? [Y/n] +``` + +## Output + +The command generates: +1. **Analysis Plan Summary** - Study design and statistical approach +2. **Data Requirements** - Checklist of required variables +3. **Methodology Guidance** - Routes to health-data-report skill +4. **Regulatory Notes** - Privacy and approval requirements + +## Integration Points + +- **Input**: Raw data files, database connections, or data dictionary +- **Process**: Uses `health-data-report` skill for detailed methodology +- **Output**: Analysis plan document, statistical code templates +- **Downstream**: Results feed into manuscript-prep, report templates + +## Error Handling + +| Issue | Response | +|-------|----------| +| Insufficient sample size | Flag for biostatistician consultation | +| Missing critical variables | Halt and request data clarification | +| Complex design | Suggest specialist biostatistician involvement | +| Sensitive data | Enforce PHI/PII guardrails and de-identification | + +## MCP Connectors + +```yaml +connectors: + - research literature: ~~pubmed_database + - clinical terminology: ~~snomed_loinc + - statistical computing: ~~r_stats +``` diff --git a/health/commands/coauthor.md b/health/commands/coauthor.md new file mode 100644 index 0000000..2a2efa0 --- /dev/null +++ b/health/commands/coauthor.md @@ -0,0 +1,184 @@ +--- +name: coauthor +description: Initiate a collaborative clinical document co-authoring workflow +tools: ['Read', 'Write', 'Edit', 'bash', 'skill'] +--- + +# /coauthor - Clinical Document Co-authoring Command + +Initiate a three-stage collaborative workflow for developing clinical and regulatory documents requiring precision, evidence grading, stakeholder review, and formal approval. + +## Usage + +``` +/coauthor [document-type] [--stage STAGE] [--mode MODE] [--title "TITLE"] +``` + +## Arguments + +### Document Types + +| Type | Description | Complexity | +|------|-------------|------------| +| `protocol` | Clinical protocol or procedure | Standard | +| `pathway` | Care pathway or patient journey | Standard | +| `guideline` | Clinical practice guideline | Intensive | +| `hta` | Health technology assessment submission | Intensive | +| `evidence-summary` | Evidence summary or rapid review | Standard | +| `position-statement` | Organizational position statement | Standard | +| `patient-info` | Patient information material | Standard | +| `policy` | Clinical or organizational policy | Standard | + +### Options + +| Option | Values | Default | Description | +|--------|--------|---------|-------------| +| `--stage` | `1`, `2`, `3`, `all` | `all` | Start at specific stage or run full workflow | +| `--mode` | `standard`, `lite` | `standard` | Operating mode (lite for rapid/internal docs) | +| `--title` | Any text | (prompts) | Document title | +| `--template` | Template name | (auto) | Specific template to use | + +## Workflow Stages + +### Stage 1: Context Gathering & Development +- Purpose and scope definition +- Target audience identification +- Regulatory requirements assessment +- Evidence base evaluation +- Stakeholder mapping +- Initial draft development + +### Stage 2: Review & Refinement +- Clinical accuracy review +- Regulatory compliance check +- Evidence grading application (NHMRC/GRADE) +- Citation verification +- Iterative stakeholder feedback + +### Stage 3: Reader Testing & Finalization +- Target audience comprehension testing +- Implementation feasibility assessment +- Accessibility and health literacy review +- Final approval workflow + +## Examples + +### Start a new clinical protocol +``` +/coauthor protocol --title "Sepsis Recognition Protocol" +``` + +### Develop a clinical practice guideline (full workflow) +``` +/coauthor guideline --title "Diabetes Management in Primary Care" +``` + +### Rapid development mode for internal document +``` +/coauthor policy --mode lite --title "Social Media Use Policy" +``` + +### Continue from review stage +``` +/coauthor hta --stage 2 --title "Assessment of Continuous Glucose Monitoring Systems" +``` + +## Process + +When you run `/coauthor`, the system will: + +1. **Load the clinical-doc-coauthoring skill** and initialize the workflow +2. **Prompt for document details** if not provided via arguments +3. **Generate a document checklist** specific to the document type and mode +4. **Guide through each stage** with structured prompts and validation +5. **Track progress** and maintain version control +6. **Manage stakeholder feedback** with structured review cycles +7. **Produce final document** ready for approval and publication + +## Document Checklist + +The following checklist will be generated based on document type: + +### All Documents +- [ ] Purpose and scope clearly defined +- [ ] Target audience identified +- [ ] Regulatory requirements assessed +- [ ] Evidence base documented (if applicable) +- [ ] Stakeholders mapped and engaged +- [ ] Draft developed following template +- [ ] Clinical accuracy reviewed +- [ ] Citations verified and graded +- [ ] Conflict of interest declared +- [ ] Reader testing completed (Standard mode) +- [ ] Accessibility reviewed +- [ ] Version control maintained +- [ ] Approved by authorized signatory + +### Protocol-Specific +- [ ] Clinical indications documented +- [ ] Contraindications identified +- [ ] Step-by-step procedure defined +- [ ] Monitoring parameters specified +- [ ] Quality indicators established + +### Guideline-Specific +- [ ] Systematic evidence search conducted +- [ ] NHMRC/GRADE evidence grading applied +- [ ] Recommendations numbered and graded +- [ ] Implementation barriers assessed +- [ ] Review schedule established + +### HTA-Specific +- [ ] Clinical effectiveness evidence compiled +- [ ] Economic evaluation completed +- [ ] Budget impact analysis performed +- [ ] Uncertainty analysis conducted +- [ ] Post-market surveillance plan included + +## Evidence Grading Requirements + +All clinical claims must include: +- **NHMRC Level**: I, II, III-1, III-2, III-3, IV, or GPP +- **GRADE Quality**: High (⊕⊕⊕⊕), Moderate (⊕⊕⊕○), Low (⊕⊕○○), Very Low (⊕○○○) +- **Citation**: Full Vancouver-style reference with DOI + +## Jurisdiction Defaults + +**Default**: Australia/New Zealand +- NHMRC evidence grading standards +- TGA regulatory requirements +- NSQHS clinical governance standards +- State/Territory health department requirements + +**US/EU-lite** (when explicitly requested): +- GRADE methodology +- FDA/EMA regulatory frameworks +- IOM guideline standards + +## Outputs + +The co-authoring workflow produces: + +1. **Draft Document** - Structured document following type-specific template +2. **Evidence Tables** - Graded evidence summaries with citations +3. **Stakeholder Feedback Log** - Structured review responses and decisions +4. **Version History** - Complete change log with attributions +5. **Approval Package** - Sign-off documentation and compliance verification +6. **Implementation Tools** - Quick reference guides, checklists, and forms (as applicable) + +## Getting Started + +To begin a new clinical document co-authoring project: + +1. Choose the appropriate document type +2. Decide on Standard or Lite mode +3. Prepare preliminary information: + - Document purpose and objectives + - Target audience description + - Available evidence sources + - Key stakeholders to engage +4. Run `/coauthor` with your chosen parameters +5. Follow the guided workflow prompts +6. Complete all checklist items for your document type + +For detailed guidance on each stage, refer to the `~~health/clinical-doc-coauthoring` skill documentation. diff --git a/health/commands/economic-evaluation.md b/health/commands/economic-evaluation.md new file mode 100644 index 0000000..33a3ebf --- /dev/null +++ b/health/commands/economic-evaluation.md @@ -0,0 +1,203 @@ +--- +name: /economic-evaluation +description: Initiate a health economic evaluation including cost-effectiveness, cost-utility, or cost-benefit analysis with jurisdiction-specific reference case requirements. +tools: ['Read', 'Write', 'skill'] +--- + +# Economic Evaluation Command + +Conduct a systematic health economic evaluation following jurisdiction-specific reference case requirements. + +## Invocation + +``` +/economic-evaluation +``` + +## User Prompts + +This command will guide you through: +1. **Evaluation Type Selection** - Choose CEA, CUA, CBA, or BIA +2. **Jurisdiction Selection** - AU/NZ (default), UK (NICE), Canada (CADTH), or US +3. **Intervention Details** - Describe the health intervention being evaluated +4. **Comparator Identification** - Current standard of care in jurisdiction +5. **Target Population** - Who will receive the intervention? +6. **Time Horizon** - Duration of analysis (lifetime, 5 years, etc.) +7. **Perspective** - Healthcare sector, societal, or payer +8. **Outcome Measures** - Natural units, QALYs, DALYs, or monetary + +## Workflow + +### Step 1: Evaluation Type Selection + +The command will determine the appropriate evaluation type: + +| Type | When to Use | Primary Outcome | +|------|-------------|-----------------| +| **CEA** | Comparing interventions with same outcome in natural units | Cost per unit gained (e.g., cost per mmHg reduction) | +| **CUA** | Cross-condition comparisons; preferred by most HTA bodies | Cost per QALY gained | +| **CBA** | Healthcare vs. non-health investments; public health policy | Net monetary benefit | +| **BIA** | Affordability analysis alongside CEA/CUA | Annual budget impact | + +### Step 2: Jurisdiction Configuration + +Select jurisdiction to apply appropriate reference case: + +**Australia (PBAC)**: +- Dual perspective: Healthcare sector + Societal +- 5% discounting (costs and QALYs) +- QALYs preferred (AQoL or EQ-5D Australian tariffs) +- Time horizon: Sufficient to capture all differences +- PSA required + +**Australia (MSAC)**: +- Healthcare perspective +- Similar to PBAC but for medical services +- MBS fees for costing + +**New Zealand (PHARMAC)**: +- Healthcare perspective +- Nine decision criteria (not just cost-effectiveness) +- Equity considerations paramount +- 5% discounting + +**UK (NICE)**: +- NHS and Personal Social Services perspective +- 3.5% discounting (1.5% if >30 years) +- EQ-5D-3L UK tariff for utilities +- £20,000-30,000/QALY threshold + +**Canada (CADTH)**: +- Publicly funded healthcare system perspective +- 5% discounting +- Canadian preference-based utilities preferred +- CUA preferred outcome + +### Step 3: Generate Evaluation Plan + +Based on inputs, the command will generate: + +1. **Evaluation Protocol**: + - Research question and decision problem + - Intervention and comparator specifications + - Target population and subgroups + - Perspective and time horizon + - Discounting approach + - Outcome measures + +2. **Evidence Requirements**: + - Clinical evidence needs (RCTs, observational data) + - Cost data sources (PBS/MSAC schedules, DRG costs) + - Utility data requirements (instrument selection) + - Comparator evidence requirements + +3. **Modeling Approach**: + - Recommended model structure (decision tree, Markov, microsimulation) + - Justification for approach + - State definitions (if Markov) + - Cycle length recommendation + - Half-cycle correction requirements + +4. **Analysis Plan**: + - Base case analysis specifications + - Sensitivity analysis requirements (deterministic and probabilistic) + - Subgroup analyses (if applicable) + - Budget impact analysis parameters + - Scenario analyses + +5. **Deliverables Checklist**: + - Economic evaluation report structure + - Model files required + - Documentation requirements + - Validation approach + - HTA submission requirements (if applicable) + +### Step 4: Operating Mode Selection + +**Standard Mode**: +- Full evaluation with complete decision modeling +- Comprehensive PSA with 5,000-10,000 iterations +- Detailed costing methodology +- Extensive scenario analyses +- Formal reporting for potential HTA submission + +**Lite Mode**: +- Streamlined evaluation for preliminary assessment +- Simple decision tree or basic Markov model +- Deterministic sensitivity analysis only +- Rapid turnaround for internal decision-making +- Clearly marked as preliminary + +## Output + +The command produces: + +1. **Evaluation Summary**: + - Evaluation type and jurisdiction + - Key parameters and assumptions + - Preliminary ICER estimate (if data available) + - Critical uncertainties identified + +2. **Work Plan**: + - Step-by-step evaluation workflow + - Data collection requirements + - Analysis milestones + - Timeline estimate + +3. **Resource Requirements**: + - Skill requirements (`~~health/health-econ-eval`) + - Estimated time commitment + - Specialist involvement needed (health economist, statistician) + - Software requirements + +4. **Next Steps**: + - Immediate actions required + - Evidence gaps to address + - Stakeholder engagement needs + - Review and validation checkpoints + +## Example Usage + +``` +User: /economic-evaluation + +Assistant: I'll help you conduct a health economic evaluation. Let me gather some information: + +1. What type of evaluation do you need? + - Cost-Effectiveness Analysis (CEA) + - Cost-Utility Analysis (CUA) ← Recommended for most HTA submissions + - Cost-Benefit Analysis (CBA) + - Budget Impact Analysis (BIA) + +2. Which jurisdiction will this support? + - Australia (PBAC - Pharmaceutical Benefits) + - Australia (MSAC - Medical Services) + - New Zealand (PHARMAC) + - UK (NICE) + - Canada (CADTH) + - Other/General methods + +[Continue with guided intake...] +``` + +## Success Criteria + +Evaluation plan is complete when: +- [ ] Evaluation type appropriate for decision context +- [ ] Jurisdiction reference case requirements identified +- [ ] Comparator represents standard of care +- [ ] Time horizon justified for condition +- [ ] Perspective aligns with reference case +- [ ] Outcome measures specified +- [ ] Model structure recommended with rationale +- [ ] Analysis plan includes PSA +- [ ] Deliverables checklist provided +- [ ] Resource requirements identified +- [ ] Operating mode selected (Standard/Lite) + +## Related Skills + +- `~~health/health-econ-eval` - Economic evaluation methodology and modeling +- `~~health/hta-submission` - HTA submission preparation +- `~~health/evidence-synthesis` - Systematic review for clinical evidence +- `~~data/statistical-analysis` - Statistical methods for PSA and evidence synthesis diff --git a/health/commands/ethics-review.md b/health/commands/ethics-review.md new file mode 100644 index 0000000..9b8b7c0 --- /dev/null +++ b/health/commands/ethics-review.md @@ -0,0 +1,362 @@ +--- +name: ethics-review +alias: + - ethics + - ethics-consult +description: Initiate an ethics review for research protocols or clinical cases, routing to the appropriate ethics skill (research-ethics or clinical-ethics) based on the nature of the ethical question. +arguments: + - name: review_type + description: "Type of ethics review needed: 'research' for REC/IRB applications and study protocols, or 'clinical' for clinical ethics consultations and patient care dilemmas." + required: true + - name: title + description: "Title of the study (for research) or brief description of the clinical case/ethical dilemma." + required: true + - name: description + description: "Detailed description of the research protocol, clinical situation, or ethical question." + required: true + - name: urgency + description: "Urgency level: 'emergency', 'urgent', 'routine', or 'non-clinical'. Defaults to 'routine'." + required: false +--- + +# Ethics Review Initiation + +Use this command to initiate an ethics review for research ethics (REC/IRB) or clinical ethics consultation. The command routes to the appropriate skill based on review type. + +## 1. Validate Input + +- Ensure `review_type` is either "research" or "clinical". If ambiguous, ask for clarification. +- If `urgency` is not provided, default to "routine". +- For research reviews, confirm if this is a new application, amendment, or query. +- For clinical reviews, confirm if capacity assessment is involved. + +## 2. Route to Appropriate Skill + +### If `review_type` = "research": + +Use `~~health/research-ethics` to: +1. Determine if ethics review is required (research vs. QI determination). +2. Assess risk level and appropriate review pathway. +3. Guide protocol development and review. +4. Assist with informed consent document drafting. +5. Prepare ethics application components. +6. Navigate committee submission process. + +### If `review_type` = "clinical": + +Use `~~health/clinical-ethics` to: +1. Conduct ethical case analysis using four-box method. +2. Assess decision-making capacity if relevant. +3. Guide surrogate decision-making process. +4. Facilitate family conference planning. +5. Navigate end-of-life decision-making. +6. Prepare ethics committee case presentation. + +## 3. Generate Structured Output + +### For Research Ethics Review + +Produce: + +--- + +#### ETHICS REVIEW INITIATED: {{title}} + +**Review Type**: Research Ethics (REC/IRB) +**Initiated**: {{current_timestamp}} +**Urgency**: {{urgency or "routine"}} +**Status**: UNDER REVIEW + +--- + +##### 1. REVIEW OVERVIEW + +**Study/Protocol Description**: +{{description}} + +**Initial Ethics Determination**: +- [ ] Research (requires full ethics review) +- [ ] Quality Improvement (may be exempt - requires determination) +- [ ] Unclear (requires clarification from HREC/IRB) + +**Recommended Review Pathway**: +- [ ] Full Committee Review +- [ ] Expedited Review +- [ ] Chair/Executive Review +- [ ] Exemption Determination + +--- + +##### 2. RISK STRATIFICATION + +| Risk Category | Assessment | Implications | +|---------------|------------|--------------| +| **Physical Risk** | [To be assessed] | | +| **Psychological Risk** | [To be assessed] | | +| **Social/Economic Risk** | [To be assessed] | | +| **Privacy Risk** | [To be assessed] | | + +**Overall Risk Level**: +- [ ] Negligible (Chair review) +- [ ] Minimal (Expedited review) +- [ ] Minor (Full committee) +- [ ] More than Minimal (Full committee + monitoring) +- [ ] Significant (External review required) + +--- + +##### 3. KEY ETHICAL CONSIDERATIONS + +**Consent Requirements**: +- [ ] Standard informed consent +- [ ] Simplified consent (minimal risk) +- [ ] Waiver of consent (requires justification) +- [ ] Surrogate consent required +- [ ] Assent + parental consent (pediatric) + +**Vulnerable Populations**: +- [ ] Children/Minors +- [ ] Cognitively impaired +- [ ] Prisoners +- [ ] Pregnant women +- [ ] Economically disadvantaged +- [ ] None identified + +**Special Considerations**: +- [ ] Indigenous/Māori/Pacific consultation required +- [ ] Biobanking/genetics involved +- [ ] Data linkage/secondary use +- [ ] Multi-site research +- [ ] International data transfer +- [ ] Conflict of interest identified + +--- + +##### 4. REQUIRED DOCUMENTATION + +**Core Documents**: +- [ ] Ethics application form +- [ ] Research protocol (comprehensive) +- [ ] Participant Information and Consent Form (PICF) +- [ ] Plain language summary +- [ ] Recruitment materials +- [ ] Data collection instruments +- [ ] Risk assessment plan + +**Study-Specific Documents**: +- [ ] Investigator's Brochure (clinical trials) +- [ ] Insurance certificate +- [ ] CVs and GCP certificates +- [ ] DSMB charter (if required) +- [ ] Statistical analysis plan +- [ ] Māori/Pacific consultation documentation + +**Governance Documents**: +- [ ] Conflict of interest declarations +- [ ] Funding agreement +- [ ] Site authorization letters (multi-site) +- [ ] Material transfer agreements + +--- + +##### 5. REGULATORY FRAMEWORK + +**Jurisdiction**: AU/NZ (default) + +| Regulation | Requirement | Status | +|------------|-------------|--------| +| NHMRC National Statement (AU) | Ethical principles | [ ] Reviewed | +| HRC Guidelines (NZ) | Health research ethics | [ ] Reviewed | +| Privacy Act 1988/2020 | Data protection | [ ] Addressed | +| ICH-GCP (if applicable) | Clinical trial standards | [ ] Reviewed | + +**Approval Timeline Estimate**: +- Full Committee: 4-8 weeks +- Expedited: 2-4 weeks +- Chair Review: 1-2 weeks + +--- + +##### 6. NEXT STEPS + +1. [ ] **Confirm Review Type**: Verify research vs. QI determination with HREC office +2. [ ] **Complete Risk Assessment**: Document all potential risks and mitigations +3. [ ] **Draft Protocol**: Ensure all required elements included +4. [ ] **Prepare PICF**: Draft consent form at appropriate reading level +5. [ ] **Gather Documents**: Compile all required supporting documents +6. [ ] **Pre-submission Query**: Consider informal consultation for novel/complex studies +7. [ ] **Submit Application**: Submit to HREC/IRB per institutional process +8. [ ] **Track Progress**: Monitor application status and respond to queries + +--- + +### For Clinical Ethics Review + +Produce: + +--- + +#### CLINICAL ETHICS CONSULTATION: {{title}} + +**Review Type**: Clinical Ethics +**Initiated**: {{current_timestamp}} +**Urgency**: {{urgency or "routine"}} +**Status**: UNDER REVIEW + +--- + +##### 1. CASE OVERVIEW + +**Clinical Situation**: +{{description}} + +**Urgency Assessment**: +- [ ] Emergency (<2 hours) - Immediate response required +- [ ] Urgent (24-48 hours) - Evolving clinical situation +- [ ] Routine (3-5 days) - Standard consultation +- [ ] Non-clinical (1-2 weeks) - Policy/educational question + +--- + +##### 2. STAKEHOLDER IDENTIFICATION + +**Primary Stakeholder** (center of concern): +- Patient: [Name/ID] +- Location: [Ward/Unit] +- Clinical Status: [Brief status] + +**Secondary Stakeholders**: +- [ ] Family members (specify relationship) +- [ ] Substitute decision-maker (if applicable) +- [ ] Treating clinicians +- [ ] Nursing staff +- [ ] Allied health +- [ ] Administration + +**Ethical Tensions Identified**: +- [ ] Autonomy vs. Beneficence +- [ ] Patient vs. Family preferences +- [ ] Clinical judgment vs. Patient refusal +- [ ] Resource allocation concerns +- [ ] End-of-life decision-making +- [ ] Cultural/religious values conflict + +--- + +##### 3. CAPACITY ASSESSMENT + +**Decision-Making Capacity**: +- [ ] Has capacity for this decision +- [ ] Lacks capacity (substitute decision required) +- [ ] Capacity uncertain (requires assessment) +- [ ] Fluctuating capacity (delirium suspected) + +**If Lacks Capacity**: +- [ ] Advance directive exists +- [ ] Enduring guardian/power of attorney +- [ ] Family hierarchy applicable +- [ ] Court/tribunal appointment required +- [ ] Person responsible (statutory hierarchy) + +**Substitute Decision-Making Standard**: +- [ ] Substituted judgment (what would patient want?) +- [ ] Best interests (objective standard) +- [ ] Both standards to be considered + +--- + +##### 4. ETHICAL ANALYSIS FRAMEWORK + +**Four-Box Method Analysis**: + +| Box | Key Questions | Status | +|-----|---------------|--------| +| **Medical Indications** | Diagnosis; prognosis; treatment options; likelihood of success | [ ] Information gathered | +| **Patient Preferences** | Expressed wishes; advance directive; values | [ ] Being explored | +| **Quality of Life** | Current status; likely future status; patient perspective | [ ] To be assessed | +| **Contextual Features** | Family dynamics; cultural factors; resources; conflicts | [ ] Being explored | + +**Core Principles in Tension**: +- Autonomy: [How expressed?] +- Beneficence: [Benefits of treatment?] +- Non-maleficence: [Risks/burdens?] +- Justice: [Resource/fairness considerations?] + +--- + +##### 5. CONSULTATION PLAN + +**Information Needed**: +- [ ] Detailed medical history and prognosis +- [ ] Interview with patient (if capacity) +- [ ] Family conference required +- [ ] Prior statements/wishes from patient +- [ ] Cultural/religious consultation +- [ ] Second opinion on clinical facts +- [ ] Legal consultation (if guardianship issues) + +**Meetings to Arrange**: +- [ ] Family conference (schedule within 24-48 hours) +- [ ] Care team meeting +- [ ] Multi-disciplinary team discussion +- [ ] Ethics committee review (if complex) + +**Decision Timeline**: +- Target decision date: [Based on urgency] +- Time-limited trial option: [Yes/No] +- Review interval: [If ongoing decisions needed] + +--- + +##### 6. POTENTIAL OUTCOMES + +**Options to Explore**: +1. [Option A]: [Description] +2. [Option B]: [Description] +3. [Option C - Compromise]: [Description] +4. [Option D - Time-limited trial]: [Description if appropriate] + +**Process Recommendations**: +- Facilitated family conference +- Cultural consultation +- Second opinion +- Palliative care consult +- Legal review + +--- + +##### 7. NEXT STEPS + +1. [ ] **Gather Information**: Complete clinical picture and patient values +2. [ ] **Assess Capacity**: Formal capacity assessment if uncertain +3. [ ] **Identify Surrogate**: Clarify legal decision-maker if needed +4. [ ] **Schedule Conference**: Family meeting within appropriate timeframe +5. [ ] **Consult Stakeholders**: Interview all relevant parties +6. [ ] **Apply Framework**: Complete four-box analysis +7. [ ] **Formulate Recommendations**: Ethically grounded advice +8. [ ] **Document**: Record analysis and recommendations +9. [ ] **Follow Up**: Monitor implementation and outcomes + +--- + +## 4. Execute Routing + +- Save review documentation to `~~cloud storage` in ethics review folder. +- Create tracker entry in `~~project tracker` for follow-up. +- If research ethics: Route to Research Office for HREC submission support. +- If clinical ethics: Notify appropriate clinical ethics service/team. +- Schedule reminder for follow-up based on urgency. + +## 5. Output Guardrails + +- **No PHI in Routing**: Do not include patient identifiers in routing documentation. +- **Jurisdiction Default**: AU/NZ ethics frameworks are default; ask if US/EU required. +- **Urgency Flag**: Emergency/urgent cases require immediate human notification. +- **Capacity Concerns**: Flag for capacity assessment if any uncertainty. +- **Child Protection**: Automatic escalation if child protection concerns identified. +- **Vulnerable Populations**: Enhanced safeguards required; flag for ethics committee. +- **Legal Issues**: Flag for legal consultation when court/guardianship involved. + +--- + +**Note**: This ethics review initiation establishes the framework for addressing the ethical question. Detailed analysis and recommendations require engagement with the appropriate ethics skill and, for clinical cases, direct stakeholder consultation. diff --git a/health/commands/grant-application.md b/health/commands/grant-application.md new file mode 100644 index 0000000..09f3cc7 --- /dev/null +++ b/health/commands/grant-application.md @@ -0,0 +1,99 @@ +--- +description: Initiate a grant application for health research funding. Guides funder selection, scheme selection, and generates an application checklist. +--- + +# /grant-application + +Start a new grant application for health research funding. This command guides you through selecting the appropriate funder and scheme, then generates a tailored application checklist. + +## Usage + +``` +/grant-application [funder] [scheme] +``` + +## Arguments + +- **funder** (optional): Target funding body + - `nhmrc` - National Health and Medical Research Council (Australia) + - `mrff` - Medical Research Future Fund (Australia) + - `hrc` - Health Research Council (New Zealand) + - `arc` - Australian Research Council (health-related Discovery Projects) + - `nih` - National Institutes of Health (US) + - `help` - Show funder selection guidance + +- **scheme** (optional): Specific grant scheme (depends on funder) + - For NHMRC: `ideas`, `investigator`, `synergy`, `fellowship` + - For MRFF: `large`, `emcr`, `consumer`, `specific` + - For HRC: `explorer`, `project`, `programme`, `fellowship` + - For ARC: `dp` (Discovery Projects), `linkage` + - For NIH: `r01`, `r21`, `k`, `f` + +## Examples + +``` +/grant-application nhmrc ideas +/grant-application mrff large +/grant-application hrc explorer +/grant-application help +``` + +## Workflow + +1. **Funder Selection**: If not specified, you'll be prompted to select a funding body based on research type, career stage, and location. + +2. **Scheme Selection**: Choose the appropriate scheme within the selected funder based on project scope, budget needs, and eligibility. + +3. **Checklist Generation**: Creates a tailored application checklist with: + - Required documents and templates + - Key deadlines and milestones + - Compliance requirements (ethics, governance) + - Section-specific word/page limits + - Assessment criteria alignment points + - Budget justification requirements + +4. **Skill Activation**: Automatically invokes the `grant-writer` skill for detailed guidance. + +## Funder Selection Guidance + +### Australia + +**NHMRC** - Best for: +- Investigator-led discovery research +- Health and medical research excellence +- ECR to senior researcher career stages +- Projects with strong scientific merit + +**MRFF** - Best for: +- Mission-driven, translational research +- Consumer/patient involvement +- Industry and end-user collaboration +- Translation to clinical practice or policy + +**ARC** - Best for: +- Basic research with health applications +- Non-clinical research questions +- Interdisciplinary approaches + +### New Zealand + +**HRC** - Best for: +- All health research funding in NZ +- Māori health research and advancement +- Researcher development at all career stages + +### International + +**NIH** - Best for: +- US-based researchers or US collaborations +- Large-scale clinical and translational research +- Extensive research infrastructure support + +## Output + +The command generates: +1. Funder/scheme selection confirmation +2. Application checklist document +3. Timeline with key milestones +4. Links to relevant funder resources +5. Access to grant-writer skill guidance diff --git a/health/commands/prepare-manuscript.md b/health/commands/prepare-manuscript.md new file mode 100644 index 0000000..fb28f17 --- /dev/null +++ b/health/commands/prepare-manuscript.md @@ -0,0 +1,398 @@ +--- +name: prepare-manuscript +alias: + - manuscript + - submit-paper +description: Initiate manuscript preparation for journal submission with structured planning, reporting guideline compliance, and submission readiness framework. +arguments: + - name: study_type + description: "Type of study (RCT, observational, systematic_review, case_report, QI, economic_evaluation, protocol)." + required: true + - name: target_journal + description: "Name of target journal for submission." + required: true + - name: manuscript_title + description: "Working title of the manuscript." + required: true + - name: first_author + description: "Name of first author." + required: true + - name: senior_author + description: "Name of senior/corresponding author." + required: true + - name: study_registered + description: "Is the study registered? (yes/no/na)." + required: false + - name: ethics_approved + description: "Does the study have ethics approval? (yes/no/na)." + required: false + - name: mode + description: "Operating mode: 'standard' (full) or 'lite' (streamlined)." + required: false +--- + +# Prepare Manuscript Command + +Use this command to initiate structured manuscript preparation with appropriate reporting guideline compliance, journal-specific formatting requirements, and submission readiness verification. + +## 1. Validate Input + +### Study Type Validation + +Acceptable study types: +- `RCT` or `randomized_trial` → CONSORT 2010 +- `observational` or `cohort` or `case_control` → STROBE +- `systematic_review` or `meta_analysis` → PRISMA 2020 +- `case_report` → CARE Guidelines +- `QI` or `quality_improvement` → SQUIRE 2.0 +- `economic_evaluation` or `cost_effectiveness` → CHEERS 2022 +- `protocol` → SPIRIT 2013 +- `diagnostic_accuracy` → STARD 2015 +- `qualitative` → SRQR or COREQ + +If `study_type` does not match above, prompt user to select from list. + +### Journal Validation + +- Verify `target_journal` is a recognized peer-reviewed journal. +- If ambiguous, provide matching options. +- Note: Journal selection affects structure template and reference style. + +### Mode Selection + +- If `mode` not specified, default to `standard`. +- `lite`: Streamlined checklist (essential items only). +- `standard`: Full compliance workflow. + +### Ethics and Registration Checks + +- If `study_type` is `RCT` and `study_registered` is `no`, flag as critical issue. +- If `study_type` involves human subjects and `ethics_approved` is `no`, flag as critical issue. + +## 2. Map Study Type to Reporting Checklist + +| Study Type | Checklist | Items | Key Requirements | +|------------|-----------|-------|------------------| +| RCT | CONSORT 2010 | 25 | Flow diagram; trial registration | +| Observational | STROBE | 22 | Cohort/cross-sectional extensions | +| Systematic Review | PRISMA 2020 | 27 | Flow diagram; registration | +| Case Report | CARE | 13 | Timeline; patient perspective | +| QI Study | SQUIRE | 18 | Context; improvement framework | +| Economic Evaluation | CHEERS | 28 | Perspective; time horizon | +| Protocol | SPIRIT | 33 | Trial registration; ethics | +| Diagnostic | STARD | 30 | Flow diagram; accuracy metrics | + +## 3. Generate Manuscript Checklist + +### STUDY TYPE: {{study_type}} +### TARGET JOURNAL: {{target_journal}} +### MANUSCRIPT: {{manuscript_title}} + +--- + +## PREPARATION CHECKLIST + +### A. Study Registration & Ethics (CRITICAL) + +- [ ] **Trial Registration**: {{study_registered or "VERIFY"}} + - Registry: ___________________ + - Number: ___________________ + - Date Registered: ____________ + {% if study_type in ['RCT', 'protocol'] and study_registered == 'no' %} + ⚠️ **CRITICAL**: Clinical trials must be registered before first patient enrollment per ICMJE. + {% endif %} + +- [ ] **Ethics Approval**: {{ethics_approved or "VERIFY"}} + - Ethics Committee: ___________ + - Approval Number: ___________ + - Date Approved: _____________ + {% if ethics_approved == 'no' %} + ⚠️ **CRITICAL**: Human subjects research requires documented ethics approval. + {% endif %} + +### B. Reporting Guideline Compliance + +Based on {{study_type}} → **[CHECKLIST NAME]** + +Download the checklist from EQUATOR Network: https://www.equator-network.org/ + +**Core Items to Address**: + +{% if study_type == 'RCT' %} +#### CONSORT 2010 Key Items +- [ ] Background and objectives (Item 2a, 2b) +- [ ] Trial design (Item 3a, 3b) +- [ ] Participants: eligibility, settings (Item 4a, 4b) +- [ ] Interventions: precise details (Item 5) +- [ ] Outcomes: definitions, time points (Item 6a, 6b) +- [ ] Sample size: calculation, assumptions (Item 7a, 7b) +- [ ] Randomization: sequence generation (Item 8a) +- [ ] Randomization: allocation concealment (Item 9) +- [ ] Blinding: masking procedures (Item 11a, 11b) +- [ ] Statistical methods (Item 12a, 12b) +- [ ] Participant flow diagram (Item 13a) +- [ ] Recruitment: dates, periods (Item 14a) +- [ ] Baseline data: demographics (Item 15) +- [ ] Numbers analyzed: intention-to-treat (Item 16) +- [ ] Outcomes and estimation (Item 17a, 17b) +- [ ] Ancillary analyses: subgroups (Item 18) +- [ ] Harms: adverse events (Item 19) +- [ ] Limitations: sources of bias (Item 20) +- [ ] Generalizability (Item 21) +- [ ] Interpretation: benefits vs harms (Item 22) +- [ ] Registration: number, registry (Item 23) +- [ ] Protocol: where accessible (Item 24) +- [ ] Funding: sources, role (Item 25) +{% endif %} + +{% if study_type == 'observational' %} +#### STROBE Key Items +- [ ] Title/abstract: design indication (Item 1) +- [ ] Background/rationale (Item 2) +- [ ] Objectives: hypotheses (Item 3) +- [ ] Study design (Item 4) +- [ ] Setting: location, time (Item 5) +- [ ] Participants: eligibility (Item 6) +- [ ] Variables: exposures, outcomes (Item 7) +- [ ] Data sources/measurement (Item 8) +- [ ] Bias: methods to address (Item 9) +- [ ] Study size: how determined (Item 10) +- [ ] Quantitative variables (Item 11) +- [ ] Statistical methods (Item 12a, 12b, 12c) +- [ ] Participants: numbers, reasons (Item 13a, 13b, 13c) +- [ ] Descriptive data: characteristics (Item 14) +- [ ] Outcome data (Item 15) +- [ ] Main results: estimates, CI (Item 16) +- [ ] Other analyses: subgroups (Item 17) +- [ ] Key results: summary (Item 18) +- [ ] Limitations: bias, imprecision (Item 19) +- [ ] Interpretation: generalizability (Item 20) +- [ ] Generalizability: external validity (Item 21) +- [ ] Funding: sources (Item 22) +{% endif %} + +{% if study_type == 'systematic_review' %} +#### PRISMA 2020 Key Items +- [ ] Title: identify as review (Item 1) +- [ ] Abstract: structured (Item 2) +- [ ] Rationale: context (Item 3) +- [ ] Objectives: PICO/PECO (Item 4) +- [ ] Eligibility criteria (Item 5) +- [ ] Information sources (Item 6) +- [ ] Search strategy (Item 7) +- [ ] Selection process (Item 8) +- [ ] Data collection (Item 9) +- [ ] Data items (Item 10) +- [ ] Risk of bias (Item 11) +- [ ] Effect measures (Item 12) +- [ ] Synthesis methods (Item 13) +- [ ] Certainty assessment (Item 14) +- [ ] Study selection: results (Item 15) +- [ ] Study characteristics: table (Item 16) +- [ ] Risk of bias: results (Item 17) +- [ ] Results of studies (Item 18) +- [ ] Synthesis: results (Item 19) +- [ ] Certainty: results (Item 20) +- [ ] Limitations: studies, review (Item 21) +- [ ] Conclusions: implications (Item 22) +- [ ] Registration: number (Item 23) +- [ ] Support: funding (Item 24) +- [ ] Competing interests (Item 25) +- [ ] Availability: data, code (Item 26) +- [ ] Flow diagram (Item 27) +{% endif %} + +{% if study_type == 'case_report' %} +#### CARE Guidelines Key Items +- [ ] Title: "Case Report" designation (Item 1) +- [ ] Keywords (Item 2) +- [ ] Abstract: structured (Item 3) +- [ ] Introduction: background (Item 4) +- [ ] Patient information (Item 5) +- [ ] Clinical findings (Item 6) +- [ ] Timeline (Item 7) +- [ ] Diagnostic assessment (Item 8) +- [ ] Differential diagnosis (Item 9) +- [ ] Therapeutic interventions (Item 10) +- [ ] Follow-up/outcomes (Item 11) +- [ ] Discussion: review, rationale (Item 12) +- [ ] Patient perspective (Item 13) +- [ ] Informed consent statement +{% endif %} + +{% if study_type == 'QI' %} +#### SQUIRE 2.0 Key Items +- [ ] Title: QI design indicated (Item 1) +- [ ] Abstract: summary (Item 2) +- [ ] Problem description (Item 3) +- [ ] Available knowledge (Item 4) +- [ ] Rationale (Item 5) +- [ ] Specific aims (Item 6) +- [ ] Context: setting (Item 7) +- [ ] Intervention(s) (Item 8) +- [ ] Study of intervention (Item 9) +- [ ] Measures: outcomes, process (Item 10) +- [ ] Analysis: statistical (Item 11) +- [ ] Ethical considerations (Item 12) +- [ ] Results: participants, flow (Item 13) +- [ ] Results: context, setting (Item 14) +- [ ] Results: intervention (Item 15) +- [ ] Results: measures (Item 16) +- [ ] Results: main outcomes (Item 17) +- [ ] Results: unintended (Item 18) +- [ ] Limitations (Item 19) +- [ ] Conclusions: interpretation (Item 20) +{% endif %} + +### C. Manuscript Structure + +#### Title Page Elements +- [ ] Title (≤150 characters, informative) +- [ ] Running head (≤50 characters) +- [ ] Author names and full affiliations +- [ ] Corresponding author contact +- [ ] Word counts (abstract, main text) +- [ ] Keywords (3-5 MeSH terms) + +#### Abstract Requirements +- [ ] Structured format per journal +- [ ] Word limit: typically 250-300 words +- [ ] Background/Objective +- [ ] Methods (design, participants, interventions, outcomes) +- [ ] Results (key findings with numbers) +- [ ] Conclusions (interpretation) +- [ ] Trial Registration (if applicable) + +#### Main Text Structure (IMRAD) +- [ ] Introduction (background, gap, objectives) +- [ ] Methods (design, participants, interventions, outcomes, analysis) +- [ ] Results (flow diagram, baseline, primary, secondary, safety) +- [ ] Discussion (summary, comparison, limitations, implications) +- [ ] Conclusion (1-2 sentences) + +### D. Figures and Tables + +#### Figure Requirements +- [ ] Flow diagram (CONSORT/STROBE/PRISMA as appropriate) +- [ ] Primary outcome visualization +- [ ] Resolution: minimum 300 DPI (TIFF/EPS preferred) +- [ ] Colorblind-safe palettes +- [ ] Self-contained legends +- [ ] Figure count within journal limits + +#### Table Requirements +- [ ] Table 1: Baseline characteristics +- [ ] Primary outcome results table +- [ ] Secondary outcomes (if applicable) +- [ ] Adverse events table (if applicable) +- [ ] Clear titles and footnotes +- [ ] Table count within journal limits + +### E. References and Citations + +- [ ] Reference count within journal limits +- [ ] Journal reference style identified +- [ ] All references verified and retrievable +- [ ] DOIs included where available +- [ ] Self-citations disclosed + +### F. Compliance Documentation + +- [ ] Funding statement +- [ ] Conflicts of interest declaration (all authors) +- [ ] Authorship contributions (ICMJE criteria) +- [ ] Data availability statement +- [ ] Patient consent statement (if applicable) +- [ ] Acknowledgments + +### G. Cover Letter Components + +- [ ] Submission declaration +- [ ] Significance statement (novelty, importance) +- [ ] Fit with journal audience +- [ ] Confirmation of requirements met +- [ ] Suggested reviewers (optional) +- [ ] Excluded reviewers (if conflict) + +## 4. Journal-Specific Requirements + +### High-Impact Medical Journals + +| Journal | Word Limit | Abstract | Refs | Special Requirements | +|---------|-----------|----------|------|---------------------| +| **NEJM** | 3000 | 250 | 50 | Structured; Clinical trial registration mandatory | +| **Lancet** | 3500 | 300 | 30 | Summary; Funding/conflicts on title page | +| **JAMA** | 3500 | 350 | 50 | Original Investigation format | +| **BMJ** | 4000 | 250 | 35 | Open peer review; Patient involvement | +| **Annals Internal Medicine** | 4500 | 300 | 75 | CONSORT flow diagram mandatory | +| **PLOS Medicine** | 7000 | 300 | 100 | Open access; Data availability mandatory | + +### Check Journal Website For: +- [ ] Current author guidelines +- [ ] Word count limits (abstract, main text) +- [ ] Reference limits and style +- [ ] Figure/table limits +- [ ] Supplementary material policies +- [ ] Open access fees +- [ ] Data sharing requirements +- [ ] Preprint policies + +## 5. Pre-Submission Verification + +### Content Checks +- [ ] Abstract accurately reflects full manuscript +- [ ] All figures/tables cited in text +- [ ] All abbreviations defined +- [ ] Reporting checklist completed +- [ ] Flow diagram matches text numbers + +### Compliance Checks +- [ ] Word counts within limits +- [ ] Ethics approval documented +- [ ] Trial registration included +- [ ] Data availability statement complete +- [ ] COI disclosures complete + +### Technical Checks +- [ ] High-resolution figures uploaded +- [ ] References formatted correctly +- [ ] Supplementary files labeled +- [ ] Cover letter prepared +- [ ] All author approvals obtained + +## 6. Invoke Skill + +Use `~~health/manuscript-prep` to: +1. Validate manuscript structure against study type requirements +2. Generate journal-specific formatting guidance +3. Create detailed figure/table preparation specifications +4. Draft cover letter template +5. Identify additional compliance requirements + +## 7. Output Routing + +- Save checklist to `~~cloud storage` in manuscript folder. +- Create project tracker entry for submission timeline. +- Generate reminder for target journal word count verification. +- Share checklist with co-authors for collaborative completion. + +## 8. Output Guardrails + +- **No PHI**: Ensure no patient identifiers in any output. +- **Ethics Check**: Flag unregistered trials or missing ethics approval. +- **Mode Awareness**: Lite mode provides essential items only; note when full compliance review needed. +- **Journal Fit**: Verify study scope aligns with target journal aims. +- **Authorship**: Remind to verify ICMJE authorship criteria for all authors. + +--- + +**Next Steps**: +1. Complete reporting guideline checklist from EQUATOR Network +2. Draft manuscript following structure template +3. Prepare figures at required resolution +4. Format references per journal style +5. Write cover letter emphasizing novelty and fit +6. Obtain all author approvals +7. Complete pre-submission verification +8. Submit to target journal + diff --git a/health/commands/prepare-report.md b/health/commands/prepare-report.md new file mode 100644 index 0000000..0e13295 --- /dev/null +++ b/health/commands/prepare-report.md @@ -0,0 +1,620 @@ +--- +name: prepare-report +description: Initiate preparation of medicolegal documents including expert witness reports, child protection notifications, affidavits, IME reports, and capacity assessments. Interactive command guides selection of document type, jurisdiction, and generates appropriate templates. +--- + +# /prepare-report + +Initiates a structured workflow for preparing medico-legal documents, guiding clinicians and legal teams through document type selection, jurisdiction-specific requirements, and appropriate template generation. This command integrates with the health-medicolegal skills ecosystem to provide context-aware guidance for child protection reports, affidavits, expert witness statements, and other court-directed medical documentation. + +**Prerequisites**: +- Active patient/client file or case context +- Understanding of document purpose and legal context +- Jurisdiction identification + +## When to Use This Command + +Use `/prepare-report` when you need to: +- Draft a new medico-legal report or expert witness statement +- Prepare a child protection notification or mandatory report +- Create an affidavit or sworn statement for court proceedings +- Conduct an independent medical examination (IME) and draft the report +- Prepare a capacity assessment or guardianship report +- Document a reportable death for coronial purposes +- Respond to a subpoena with authenticated records + +## Arguments + +### document_type +The type of medico-legal document to prepare. + +**Type**: `choice` + +**Required**: Yes + +**Options**: +| Value | Description | Typical Use Case | +|-------|-------------|------------------| +| `expert-witness` | Expert witness report for court proceedings | Litigation; personal injury; family court | +| `child-protection` | Child protection notification/report | Mandatory reporting; risk assessment | +| `affidavit` | Sworn affidavit or statutory declaration | Court proceedings; evidence authentication | +| `ime` | Independent medical examination report | Workers compensation; personal injury | +| `capacity` | Capacity assessment report | Guardianship; power of attorney; consent | +| `coronial` | Coronial report for reportable death | Death notification; autopsy findings | +| `records-auth` | Medical records authentication affidavit | Subpoena response; litigation support | +| `forensic` | Forensic medical examination report | Sexual assault; physical assault documentation | + +**Example**: `/prepare-report document_type=expert-witness` + +### jurisdiction +The legal jurisdiction governing the document requirements. + +**Type**: `choice` + +**Required**: Yes + +**Options**: +| Value | Description | Default Context | +|-------|-------------|-----------------| +| `au-federal` | Australian Federal Court | Federal litigation | +| `au-nsw` | New South Wales | State court matters | +| `au-vic` | Victoria | State court matters | +| `au-qld` | Queensland | State court matters | +| `au-wa` | Western Australia | State court matters | +| `au-sa` | South Australia | State court matters | +| `au-tas` | Tasmania | State court matters | +| `au-act` | Australian Capital Territory | Territory matters | +| `au-nt` | Northern Territory | Territory matters | +| `nz` | New Zealand | NZ court matters | +| `us-federal` | United States Federal | Federal court | +| `us-state` | US State (specify in notes) | State-specific | +| `eu` | European Union member state | Cross-border proceedings | + +**Example**: `/prepare-report document_type=expert-witness jurisdiction=au-nsw` + +### urgency +The urgency level affecting preparation timeline and review requirements. + +**Type**: `choice` + +**Required**: No + +**Default**: `standard` + +**Options**: +| Value | Timeline | Review Requirements | +|-------|----------|---------------------| +| `routine` | Standard preparation | Normal legal review | +| `standard` | 2-4 weeks | Standard legal review | +| `priority` | 1-2 weeks | Expedited review | +| `urgent` | 3-7 days | Senior review required | +| `critical` | <48 hours | Immediate escalation | + +**Example**: `/prepare-report urgency=priority` + +### mode +The operating mode for document preparation complexity. + +**Type**: `choice` + +**Required**: No + +**Default**: `standard` + +**Options**: +| Value | Complexity | Appropriate For | +|-------|------------|-----------------| +| `lite` | Streamlined | Simple cases; clear facts; preliminary opinions | +| `standard` | Comprehensive | Most litigation; contested matters | +| `forensic` | Full forensic | Complex cases; high stakes; criminal matters | + +**Example**: `/prepare-report mode=standard` + +### case_context +Brief description of the case context (no PHI/PII). + +**Type**: `string` + +**Required**: No + +**Guidelines**: +- Do not include patient names, dates of birth, or other identifying information +- Describe matter type (e.g., "personal injury MVA", "child protection concern", "guardianship application") +- Include relevant timeframe (e.g., "incident 6 months ago") + +**Example**: `/prepare-report case_context="Personal injury matter, motor vehicle accident, lumbar spine injury"` + +## Interactive Workflow + +### Step 1: Document Type Selection + +The command will prompt for document type if not provided: + +``` +What type of medico-legal document do you need to prepare? + +1. Expert Witness Report - For court proceedings; litigation support +2. Child Protection Report - Mandatory reporting; risk assessment +3. Affidavit - Sworn statement for court +4. IME Report - Independent medical examination +5. Capacity Assessment - Decision-making capacity evaluation +6. Coronial Report - Death notification/report +7. Records Authentication - Authenticate medical records +8. Forensic Report - Assault/sexual assault documentation + +Enter your choice (1-8): +``` + +### Step 2: Jurisdiction Selection + +Based on document type, relevant jurisdictions are presented: + +``` +Select the applicable jurisdiction: + +[AU/NZ Jurisdictions] +- Australian Federal Court +- New South Wales +- Victoria +- Queensland +- [Other states...] +- New Zealand + +[International] +- US Federal +- US State (specify) +- European Union + +Enter jurisdiction: +``` + +### Step 3: Context Gathering + +The command gathers essential context (without PHI): + +``` +Please provide case context (do not include patient names or identifying information): + +- Matter type: [e.g., personal injury, child protection, family law] +- Brief factual background: [injury mechanism, concerns identified] +- Current stage: [pre-litigation, active litigation, hearing pending] +- Special considerations: [urgent safety concerns, complex issues] +``` + +### Step 4: Template Generation + +Based on selections, the command generates: + +1. **Document Structure**: Jurisdiction-specific template with required sections +2. **Checklist**: Pre-submission checklist for document type +3. **Timeline**: Key dates and deadlines for preparation and filing +4. **Review Points**: Critical review requirements before finalization +5. **Skill Invocation**: Relevant skills loaded (`~~health/medicolegal-reports`, `~~health/child-protection`, `~~health/affidavit-drafting`) + +## Generated Templates + +### Expert Witness Report Template (Australia) + +```markdown +# EXPERT WITNESS REPORT + +## Court: [Federal/State] Court of [Jurisdiction] +## Matter: [Case Name] +## Case Number: [XXXX/YYYY] +## Date of Report: [DATE] + +--- + +### 1. QUALIFICATIONS AND INSTRUCTIONS + +#### 1.1 Professional Qualifications +- Name: [Full Name] +- Qualifications: [Degrees, Fellowships] +- Current Position: [Title, Institution] +- Relevant Experience: [X years in specialty] + +#### 1.2 Instructions Received +- Engaged by: [Party/Lawyer] +- Date of Instructions: [Date] +- Scope of Instructions: [Specific questions to address] +- Documents Provided: [List of materials reviewed] + +#### 1.3 Conflict of Interest Declaration +- [ ] No conflicts of interest identified +- [ ] Conflicts disclosed: [Details] + +#### 1.4 Expert Duty Declaration +I understand that my primary duty is to the Court and I have complied with +the Expert Witness Code of Conduct.[Cite applicable rules] + +--- + +### 2. BACKGROUND AND HISTORY + +#### 2.1 Sources of Information +[Document interviews, records reviewed, investigations] + +#### 2.2 Chronological History +[Present relevant medical history chronologically] + +#### 2.3 Current Complaints +[Document current symptoms and functional impact] + +--- + +### 3. EXAMINATION FINDINGS + +#### 3.1 Clinical Examination +[Objective findings from physical examination] + +#### 3.2 Investigation Results +[Relevant imaging, pathology, other investigations] + +--- + +### 4. OPINION + +#### 4.1 Causation +[Opinion on relationship between incident and condition] + +#### 4.2 Diagnosis and Prognosis +[Current diagnosis; expected trajectory] + +#### 4.3 Treatment and Rehabilitation +[Future treatment needs and associated costs] + +#### 4.4 Addressing Contrary Views +[Consider and respond to alternative explanations] + +--- + +### 5. CONCLUSIONS + +[Concise summary of key opinions] + +--- + +**I declare that I have made all the inquiries that I believe are desirable +and appropriate, and that no matters of significance have been withheld +from the Court.** + +**Signed:** _________________________ +**Date:** _________________________ +**Name:** [Full Name] +``` + +### Child Protection Notification Template (Australia) + +```markdown +# CHILD PROTECTION NOTIFICATION + +## Jurisdiction: [State/Territory] Child Protection Services +## Date of Notification: [DATE] +## Notification Type: [Mandatory/Voluntary] + +--- + +### 1. CHILD IDENTIFICATION + +- Full Name: [As provided] +- Date of Birth: [DOB] +- Address: [Current address] +- School/Childcare: [Institution name] +- Cultural Background: [Aboriginal/Torres Strait Islander status if known] + +--- + +### 2. NOTIFICATION DETAILS + +#### 2.1 Nature of Concerns +- Type: [Physical abuse/Sexual abuse/Emotional abuse/Neglect] +- Specific Indicators: [Detailed description of observations/disclosures] +- Timeline: [When concerns identified; duration] + +#### 2.2 Source of Information +- Who provided information: [Child/Parent/Professional/Other] +- How concerns came to light: [Context of disclosure/observation] + +--- + +### 3. RISK ASSESSMENT + +#### 3.1 Risk Factors Present +- [List specific risk factors identified] + +#### 3.2 Protective Factors +- [List protective factors identified] + +#### 3.3 Immediate Safety Concerns +- [ ] No immediate safety concerns +- [ ] Immediate safety concerns: [Details] + +--- + +### 4. ACTIONS TAKEN + +- Medical treatment provided: [Details] +- Safety planning: [Actions taken] +- Agencies notified: [Police, other services] +- Family involvement: [How family was engaged] + +--- + +### 5. CONTACT DETAILS + +**Reporter:** +- Name: [Name] +- Position: [Title] +- Organization: [Institution] +- Phone: [Contact number] +- Available for follow-up: [Yes/No] + +--- + +**This notification is made under [relevant legislation section].** +**I believe on reasonable grounds that [child] is at risk of [significant harm/harm].** +``` + +### Affidavit Template + +```markdown +# AFFIDAVIT + +## Court: [Court Name] +## Matter: [Case Name] v [Case Name] +## Case Number: [XXXX/YYYY] +## Affidavit of: [Deponent Full Name] + +--- + +I, [FULL NAME], of [ADDRESS], [OCCUPATION], make oath/affirm and say as follows: + +### 1. INTRODUCTION + +1. I am a [registered medical practitioner/clinical psychologist/other] with + [X] years of post-graduate experience in [specialty area]. + +2. [Statement of how deponent has knowledge of facts] + +3. The facts stated in this affidavit are within my personal knowledge, + except where stated to be on information and belief, in which case I + believe them to be true. + +--- + +### 2. BACKGROUND + +4. [Chronological statement of relevant facts] + +5. [Continue with numbered paragraphs, one fact per paragraph where possible] + +--- + +### 3. EXPERT OPINION (if applicable) + +6. Based on my examination/review, I form the following opinions: + +7. [Opinion 1]: [Statement of opinion with foundation] + +8. [Opinion 2]: [Statement of opinion with foundation] + +--- + +### 4. EXHIBITS + +9. The documents annexed hereto and marked ["A", "B", etc.] are true copies + of [description]. + +--- + +**Sworn/Affirmed at:** _________________________ + +**On:** _________________________ + +**Signature of Deponent:** _________________________ + +--- + +**Before me:** + +**[Authorized Witness Name]** +**[Capacity - Justice of the Peace/Solicitor/Notary Public]** + +**Signature of Witness:** _________________________ +``` + +## Pre-Submission Checklists + +### Expert Witness Report Checklist +- [ ] Report complies with applicable court rules +- [ ] Expert qualifications clearly stated and relevant +- [ ] Instructions and scope clearly documented +- [ ] Conflict of interest disclosure complete +- [ ] Duty to court acknowledged +- [ ] All opinions supported by stated facts and reasoning +- [ ] Alternative explanations addressed +- [ ] Technical terms defined +- [ ] Exhibits properly referenced and attached +- [ ] Legal counsel has reviewed report +- [ ] Truth declaration included + +### Child Protection Checklist +- [ ] Child's details accurate and complete +- [ ] Nature of concerns clearly described +- [ ] Exact words of child recorded (if disclosed) +- [ ] Risk assessment completed +- [ ] Immediate safety concerns addressed +- [ ] Actions taken documented +- [ ] Reporter contact details provided +- [ ] Notification made within required timeframe +- [ ] Follow-up plan established +- [ ] Documentation filed securely + +### Affidavit Checklist +- [ ] Proper court form and formatting used +- [ ] Deponent details accurate +- [ ] All statements true to best of knowledge +- [ ] Personal knowledge distinguished from information/belief +- [ ] Facts presented in logical order +- [ ] Exhibits properly labeled and referenced +- [ ] No legal arguments or conclusions included +- [ ] Jurat completed by authorized witness +- [ ] Sworn/affirmed properly +- [ ] Filed and served within deadlines + +## Examples + +### Example 1: Expert Witness Report + +``` +User: /prepare-report document_type=expert-witness jurisdiction=au-nsw + case_context="Personal injury, workplace fall, lumbar spine injury" + urgency=standard + +Claude: I'll help you prepare an expert witness report for this NSW personal +injury matter. Let me generate the appropriate template and checklist. + +[Generated template with NSW-specific requirements] + +Key NSW Requirements: +- UCPR Schedule 7 Expert Witness Code of Conduct applies +- Report must comply with Practice Note SC Gen 11 +- 28-day service deadline typical unless ordered otherwise +- Concurrent expert evidence may be ordered + +Would you like me to load the detailed ~~health/medicolegal-reports skill +for comprehensive guidance on report preparation? +``` + +### Example 2: Child Protection Report + +``` +User: /prepare-report document_type=child-protection jurisdiction=au-vic + urgency=urgent + +Claude: I'll help you prepare a child protection notification for Victoria. +Given the urgent priority, immediate reporting is required. + +[Generated template with VIC-specific requirements] + +URGENT VIC Requirements: +- Report to DHHS Child Protection immediately for urgent cases +- After-hours: 13 12 78 +- Reasonable belief threshold applies +- Mandatory reporter status confirmation required + +CRITICAL: If there are immediate safety concerns, phone Child Protection +NOW before completing written notification. + +Would you like me to load the ~~health/child-protection skill for detailed +guidance on mandatory reporting requirements? +``` + +### Example 3: Affidavit + +``` +User: /prepare-report document_type=affidavit jurisdiction=nz + case_context="Family Court parenting matter, capacity assessment" + mode=standard + +Claude: I'll help you prepare an affidavit for the NZ Family Court. Let me +generate the appropriate template with NZ-specific requirements. + +[Generated template with NZ-specific requirements] + +Key NZ Requirements: +- Family Court affidavit requirements apply +- Affidavit of service may be required +- Swearing before Justice of the Peace, Solicitor, or Registrar +- High Court Rules apply for formatting + +Would you like me to load the ~~health/affidavit-drafting skill for +detailed guidance on affidavit preparation? +``` + +## Error Handling + +### Missing Required Arguments + +If `document_type` or `jurisdiction` is not provided: + +``` +Error: Required argument 'document_type' not provided. + +Please specify the document type: +- expert-witness: Expert witness report for court +- child-protection: Child protection notification +- affidavit: Sworn affidavit for court +- ime: Independent medical examination report +- capacity: Capacity assessment report +- coronial: Coronial report +- records-auth: Records authentication +- forensic: Forensic medical report + +Usage: /prepare-report document_type= jurisdiction= +``` + +### Invalid Combinations + +Some document types may have limited jurisdiction support: + +``` +Warning: Document type 'coronial' has specific requirements that vary +significantly by jurisdiction. Please confirm: +- State/Territory specific Coroners Act applies +- Immediate notification requirements may apply +- Death must be reportable under applicable legislation + +Would you like to proceed with [jurisdiction] template? +``` + +### PHI/PII Detection + +If potentially identifying information is detected in case_context: + +``` +Warning: The case_context may contain personally identifiable information. + +Please revise case_context to exclude: +- Patient/client names +- Dates of birth +- Medical record numbers +- Addresses or specific locations +- Other identifying details + +Example acceptable format: "Personal injury matter, motor vehicle accident, +lumbar spine injury, 6 months post-incident" +``` + +## Integration with Skills + +This command automatically invokes relevant skills based on document type: + +| Document Type | Primary Skill | Secondary Skills | +|---------------|---------------|------------------| +| expert-witness | `~~health/medicolegal-reports` | `~~health/clinical-documentation` | +| child-protection | `~~health/child-protection` | `~~health/medicolegal-reports` | +| affidavit | `~~health/affidavit-drafting` | `~~health/medicolegal-reports` | +| ime | `~~health/medicolegal-reports` | `~~health/clinical-documentation` | +| capacity | `~~health/medicolegal-reports` | `~~health/mental-health-assessment` | +| coronial | `~~health/medicolegal-reports` | `~~health/forensic-examination` | +| records-auth | `~~health/affidavit-drafting` | `~~health/clinical-documentation` | +| forensic | `~~health/medicolegal-reports` | `~~health/forensic-examination` | + +## Success Indicators + +The command has successfully initiated report preparation when: +- [ ] Appropriate template generated with jurisdiction-specific requirements +- [ ] Document type matches the intended legal purpose +- [ ] Pre-submission checklist provided for document type +- [ ] Key deadlines and timeframes identified +- [ ] Relevant skills loaded for detailed guidance +- [ ] No PHI/PII detected in provided context +- [ ] User understands next steps in preparation workflow + +## Related Commands + +- `/initiate-incident-report` - For clinical incident reporting (internal) +- `/generate-certificate` - For statutory medical certificates +- `/request-records` - For accessing medical records for report preparation +- `/consult-legal` - For engaging legal counsel review (conceptual) diff --git a/health/commands/report-incident.md b/health/commands/report-incident.md new file mode 100644 index 0000000..e4af985 --- /dev/null +++ b/health/commands/report-incident.md @@ -0,0 +1,82 @@ +--- +name: report-incident +description: Intake and route a healthcare incident or serious adverse event with safety-first escalation and mandatory reporting checks. +arguments: + - name: incident_type + description: "Primary incident type (e.g., medication, device, infection, privacy, near-miss, sentinel)." + required: true + - name: severity + description: "Preliminary severity level (SAC1/SAC2/SAC3/SAC4 or equivalent local level)." + required: true + - name: immediate_safety_risk + description: "Is there current patient safety risk requiring immediate containment? (yes/no)" + required: true + - name: summary + description: "Short factual description of what happened. Do not include names or direct identifiers." + required: true + - name: jurisdiction + description: "Optional: au, nz, us, or eu. Defaults to au-nz baseline if omitted." + required: false +--- + +# Report Incident + +Use this command for rapid incident intake, initial severity routing, and investigation kickoff. + +## 1. Validate Intake and Apply Safety Override + +- Validate required fields. +- If `immediate_safety_risk` is `yes`, force priority to highest response path regardless of submitted severity. +- If severity is unknown, treat as provisional and route for urgent clinical review. + +## 2. Invoke Skill + +Use `~~health/incident-reporting` to: +1. Confirm taxonomy and severity rationale. +2. Execute immediate response protocol. +3. Screen for mandatory reporting triggers. +4. Assign investigation and QI follow-through. + +## 3. Generate Structured Output + +Produce: + +### INCIDENT INTAKE REPORT +- **Incident ID**: [Generate unique ID] +- **Timestamp**: {{current_timestamp}} +- **Jurisdiction Assumed**: {{jurisdiction or "AU/NZ default"}} +- **Incident Type**: {{incident_type}} +- **Preliminary Severity**: {{severity}} +- **Immediate Safety Risk**: {{immediate_safety_risk}} +- **Summary (De-identified)**: [Summarize `summary` with no PHI/PII] + +### IMMEDIATE ACTIONS +- **Containment Action**: [What was done first] +- **Clinical Owner**: [Role] +- **Escalations Sent**: [Roles + times] + +### REGULATORY SCREEN +- **Potential Mandatory Trigger**: [Yes/No/Possible] +- **Reason**: [Short rationale] +- **Compliance/Legal Review Needed**: [Yes/No] + +### NEXT STEPS +- **Investigation Path**: [Local review / Formal RCA] +- **RCA Owner**: [Role] +- **Due Dates**: + - Acknowledgment: [Timestamp + local SLA] + - Initial review: [Timestamp + local SLA] + - Closure target: [Timestamp + local SLA] +- **QI Linkage**: [CAPA/PDSA ticket or placeholder] + +## 4. Execute Routing + +- Log incident package in `~~project tracker`. +- Notify clinical lead immediately for high-risk events. +- Notify risk/compliance/legal when trigger status is `Yes` or `Possible`. +- For sentinel-level scenarios, notify executive on-call pathway. + +## 5. Output Guardrails + +- Never output direct identifiers unless explicitly required by approved secure system workflow. +- If details are missing for safe classification, mark the report as **Provisional** and force human review. diff --git a/health/commands/report-notifiable.md b/health/commands/report-notifiable.md new file mode 100644 index 0000000..5d0c8dc --- /dev/null +++ b/health/commands/report-notifiable.md @@ -0,0 +1,275 @@ +--- +name: report-notifiable +description: Initiate a notifiable disease report to public health authorities. Guides selection of disease, jurisdiction requirements, and generates a notification checklist for compliance. +trigger: !health +color: red +--- + +# /report-notifiable Command + +Initiate mandatory reporting of a notifiable disease to public health authorities. + +## When to Use + +Use this command when: +- Diagnosing or suspecting a notifiable disease +- Laboratory confirmation of a reportable condition +- Managing an outbreak or disease cluster +- Coordinating contact tracing activities +- Responding to a public health emergency + +**Critical**: Many notifiable diseases require IMMEDIATE reporting (within 24 hours). Do not delay reporting pending all test results if clinical suspicion is high. + +## Workflow + +### 1. Disease Selection + +Present the user with notifiable disease categories: + +1. **Vaccine-Preventable Diseases** + - Measles, mumps, rubella + - Pertussis (whooping cough) + - Diphtheria, tetanus + - Varicella (chickenpox) + - Invasive meningococcal disease + +2. **Food-borne and Water-borne Diseases** + - Salmonellosis, campylobacteriosis + - Listeriosis + - Hepatitis A + - Typhoid/paratyphoid + +3. **Blood-borne Diseases** + - Hepatitis B, C + - HIV (new diagnoses) + +4. **Sexually Transmitted Infections** + - Syphilis (infectious) + - Gonorrhoea + - Chlamydia (jurisdiction-dependent) + +5. **Vector-borne Diseases** + - Dengue, malaria + - Ross River virus, Barmah Forest virus + - Japanese encephalitis + +6. **Other Notifiable Conditions** + - Tuberculosis + - Q fever + - Psittacosis + - Novel/emerging infections + +### 2. Jurisdiction Selection + +Determine applicable jurisdiction and authority: + +| Jurisdiction | Primary Authority | Contact | +|--------------|------------------|---------| +| **Australia** | State/Territory Health Department | Public Health Unit | +| **New Zealand** | Medical Officer of Health | Local Public Health Service | +| **United States** | State Health Department + CDC | State Epidemiologist | +| **European Union** | National Focal Point + ECDC | Competent Authority | + +### 3. Notification Checklist Generation + +Based on disease and jurisdiction, generate a checklist: + +#### Pre-Reporting Checklist + +- [ ] Disease confirmed as notifiable in jurisdiction +- [ ] Case definition applied (suspected/probable/confirmed) +- [ ] Laboratory results available and attached +- [ ] Patient demographics complete +- [ ] Contact/exposure history documented +- [ ] Onset date and diagnosis date recorded +- [ ] Healthcare facility information included + +#### Urgency Assessment + +**IMMEDIATE (Phone + Online)**: +- Anthrax, botulism, plague +- Viral hemorrhagic fevers +- Novel/emerging pathogens +- Outbreaks/clusters + +**URGENT (Within 24 hours)**: +- Measles, meningococcal, pertussis +- Food-borne diseases +- Vector-borne diseases + +**ROUTINE (Within 5 days)**: +- Hepatitis B, C +- Most STIs +- Some zoonotic diseases + +#### Required Information + +**Patient Information**: +- Full name +- Date of birth +- Residential address +- Contact phone number +- Indigenous status (if applicable) +- Country of birth + +**Clinical Information**: +- Disease/condition +- Date of onset +- Date of diagnosis +- Symptoms and signs +- Complications +- Outcome (if resolved/deceased) + +**Laboratory Information**: +- Test type and result +- Laboratory name +- Date collected +- Specimen type + +**Epidemiological Information**: +- Risk factors +- Travel history +- Occupation +- Contact with confirmed cases +- Institution/childcare attendance + +## Example Session + +**User:** `/report-notifiable` + +**System:** +``` +Notifiable Disease Reporting + +Select the disease category: +1. Vaccine-Preventable Diseases +2. Food-borne and Water-borne Diseases +3. Blood-borne Diseases +4. Sexually Transmitted Infections +5. Vector-borne Diseases +6. Other Notifiable Conditions + +Enter number or type disease name: +``` + +**User:** "1" + +**System:** +``` +Vaccine-Preventable Diseases + +Select specific condition: +1. Measles +2. Mumps +3. Rubella +4. Pertussis (whooping cough) +5. Invasive meningococcal disease +6. Diphtheria +7. Tetanus +8. Varicella (chickenpox) + +Enter number: +``` + +**User:** "1" + +**System:** +``` +MEASLES - URGENT NOTIFICATION REQUIRED + +Measles requires immediate notification (within 24 hours) in all Australian states/territories and New Zealand. + +Select jurisdiction: +1. Australian Capital Territory +2. New South Wales +3. Northern Territory +4. Queensland +5. South Australia +6. Tasmania +7. Victoria +8. Western Australia +9. New Zealand + +Enter number: +``` + +**User:** "2" (NSW) + +**System:** +``` +NSW Health Measles Notification + +⚠️ TIMEFRAME: Report within 24 hours +📞 URGENT (after hours): 1300 066 055 +🌐 ONLINE: [NSW Health Notifiable Diseases](https://www.health.nsw.gov.au) + +NOTIFICATION CHECKLIST: + +Patient Information: +- [ ] Full name +- [ ] Date of birth +- [ ] Residential address and contact +- [ ] Indigenous status + +Clinical Details: +- [ ] Date of symptom onset +- [ ] Date of rash onset +- [ ] Date of diagnosis +- [ ] Complications (if any) + +Laboratory: +- [ ] Serology or PCR result attached +- [ ] Laboratory name and date + +Epidemiological: +- [ ] Vaccination status +- [ ] Recent travel (last 3 weeks) +- [ ] Contact with known case +- [ ] School/childcare/workplace + +Contacts for Tracing: +- [ ] Household contacts listed +- [ ] Healthcare contacts documented + +Opening NSW notification portal... +Use /notifiable-diseases skill for detailed guidance on completion. +``` + +## Output + +The command generates: +1. **Disease-specific guidance** - Timeframes and requirements +2. **Notification checklist** - Required information fields +3. **Authority contact** - Appropriate public health unit +4. **Urgency indicator** - Immediate vs routine reporting +5. **Skill reference** - Links to detailed guidance + +## Integration Points + +- **Input**: Clinical diagnosis, laboratory results, patient information +- **Process**: Uses `notifiable-diseases` skill for detailed methodology +- **Output**: Notification checklist, jurisdiction-specific requirements +- **Downstream**: Public health authority notification systems + +## Error Handling + +| Issue | Response | +|-------|----------| +| Disease not on notifiable list | Verify jurisdiction; may still be reportable as unusual cluster | +| Missing patient information | Flag required fields; defer to patient records | +| Out-of-hours urgent case | Provide after-hours emergency contact | +| Multi-jurisdictional case | Identify primary jurisdiction; coordinate reporting | + +## MCP Connectors + +```yaml +connectors: + - jurisdiction database: ~~health_jurisdictions + - notifiable diseases list: ~~notifiable_disease_registry + - notification portal: ~~health_notification_systems +``` + +## Related Commands + +- `/assess-risk` - Risk assessment for exposure incidents +- `/report-incident` - Healthcare incident reporting (different from notifiable diseases) diff --git a/health/commands/start-review.md b/health/commands/start-review.md new file mode 100644 index 0000000..a11c627 --- /dev/null +++ b/health/commands/start-review.md @@ -0,0 +1,620 @@ +--- +name: start-review +alias: + - sr-init + - review-start + - begin-review +description: Initiate a systematic review or evidence synthesis project with structured protocol development, search strategy planning, and project setup following PRISMA guidelines. +arguments: + - name: review_title + description: "Title of the systematic review or evidence synthesis project." + required: true + - name: review_type + description: "Type of review: systematic-review, scoping-review, rapid-review, evidence-map, umbrella-review, qualitative-synthesis." + required: true + - name: research_question + description: "The primary research question using PICO or PCC framework." + required: true + - name: population + description: "Description of the target population or participants." + required: true + - name: intervention_or_concept + description: "The intervention, exposure, diagnostic test, or concept being studied." + required: true + - name: comparison + description: "The comparator (for systematic reviews) or context (for scoping reviews)." + required: false + - name: outcomes + description: "Primary and secondary outcomes to be measured (for systematic reviews)." + required: false + - name: team_lead + description: "Name or role of the systematic review team lead." + required: true + - name: timeline_months + description: "Estimated project duration in months." + required: false +--- + +# Start Systematic Review / Evidence Synthesis + +Use this command to initiate a structured systematic review or evidence synthesis project with proper protocol development, PRISMA-compliant methodology, and documentation setup. + +## 1. Validate Input + +- Ensure `review_type` is one of: systematic-review, scoping-review, rapid-review, evidence-map, umbrella-review, qualitative-synthesis. +- If `review_type` is systematic-review and `outcomes` is not provided, prompt for primary outcomes. +- If `review_type` is scoping-review and `comparison` is not provided, use PCC framework (Population, Concept, Context). +- If `timeline_months` is not provided, default based on review type: + - systematic-review: 12 months + - scoping-review: 4 months + - rapid-review: 2 months + - evidence-map: 6 months + - umbrella-review: 6 months + - qualitative-synthesis: 6 months + +## 2. Invoke Appropriate Skill + +Use skill based on `review_type`: + +### For systematic-review: +Use `~~health/systematic-review` to: +1. Validate PICOS framework completeness. +2. Develop comprehensive search strategy framework. +3. Plan risk of bias assessment approach. +4. Design data extraction templates. +5. Establish GRADE evidence grading framework. + +### For scoping-review, rapid-review, evidence-map, umbrella-review, qualitative-synthesis: +Use `~~health/evidence-synthesis` to: +1. Validate review type selection rationale. +2. Develop appropriate methodology for review type. +3. Plan streamlined or comprehensive approach as appropriate. +4. Establish quality assessment approach (if applicable). +5. Design evidence visualization or synthesis plan. + +## 3. Generate Structured Output + +Produce: + +### SYSTEMATIC REVIEW / EVIDENCE SYNTHESIS PROJECT CHARTER + +**Project ID**: [Generate unique ID: SR-YYYY-NNN or ES-YYYY-NNN] +**Initiated**: {{current_timestamp}} +**Review Type**: {{review_type}} +**Team Lead**: {{team_lead}} +**Timeline**: {{timeline_months or "default by type"}} months +**Status**: INITIATED + +--- + +## 1. REVIEW OVERVIEW + +**Title**: {{review_title}} + +**Review Type**: {{review_type}} + +**Research Question**: {{research_question}} + +### 1.1 Framework + +{{#if review_type == "systematic-review"}} +**PICOS Framework**: +- **P**opulation: {{population}} +- **I**ntervention: {{intervention_or_concept}} +- **C**omparison: {{comparison or "Not specified - to be determined"}} +- **O**utcomes: {{outcomes or "To be defined in protocol"}} +- **S**tudy Designs: [To be specified in eligibility criteria] +{{else}} +**PCC Framework** (or appropriate framework for review type): +- **P**opulation: {{population}} +- **C**oncept: {{intervention_or_concept}} +- **C**ontext: {{comparison or "Not specified - to be determined"}} +{{/if}} + +--- + +## 2. PROTOCOL DEVELOPMENT + +### 2.1 Protocol Requirements Checklist + +- [ ] Background and rationale +- [ ] Research question (structured) +- [ ] Objectives (primary and secondary) +- [ ] Eligibility criteria + - [ ] Inclusion criteria + - [ ] Exclusion criteria +- [ ] Information sources + - [ ] Electronic databases + - [ ] Trial registries + - [ ] Grey literature sources +- [ ] Search strategy + - [ ] Database-specific strategies + - [ ] Search terms and synonyms + - [ ] Date limits +- [ ] Study selection process + - [ ] Screening workflow + - [ ] Conflict resolution +- [ ] Data extraction + - [ ] Extraction form design + - [ ] Pilot testing plan +- [ ] {{#if review_type == "systematic-review"}}Risk of bias assessment + - [ ] Tool selection (RoB 2 / ROBINS-I) + - [ ] Assessment process{{/if}} +- [ ] Data synthesis + - [ ] Narrative synthesis plan + - [ ] Meta-analysis approach (if applicable) +- [ ] {{#if review_type == "systematic-review"}}Subgroup and sensitivity analyses{{/if}} +- [ ] {{#if review_type == "systematic-review"}}GRADE evidence assessment{{/if}} +- [ ] Ethics and dissemination +- [ ] Timeline and milestones +- [ ] Funding and conflicts of interest + +### 2.2 PROSPERO / Registry Registration + +{{#if review_type == "systematic-review"}} +**Registration Required**: YES + +**Action Items**: +1. Complete protocol document +2. Register at https://www.crd.york.ac.uk/prospero/ +3. Obtain registration number before screening begins +4. Update registration if protocol changes + +**Key Registration Fields**: +- Review title and question +- Searches (databases, dates, terms) +- Participants/Population +- Intervention(s)/Exposure(s) +- Comparator(s)/Control +- Main outcome(s) +- Risk of bias assessment strategy +- Data synthesis method +{{else}} +**Registration**: Optional but recommended + +**Recommended Registries**: +- Open Science Framework (OSF): https://osf.io/ +- PROSPERO (if systematic elements included) +- Figshare or institutional repository + +**Rationale for Registration**: +Even for {{review_type}}, registration increases transparency and reduces risk of scope creep. +{{/if}} + +--- + +## 3. SEARCH STRATEGY FRAMEWORK + +### 3.1 Database Selection + +**Core Databases** (Minimum): +- [ ] MEDLINE (via PubMed or Ovid) +- [ ] Embase +- [ ] Cochrane Central Register of Controlled Trials (CENTRAL) + +**Supplementary Databases** (Select based on topic): +- [ ] CINAHL (nursing and allied health) +- [ ] PsycINFO (psychological interventions) +- [ ] Web of Science / Scopus (citation tracking) +- [ ] ClinicalTrials.gov +- [ ] WHO ICTRP + +### 3.2 Search Strategy Development + +**Concept Combination**: +``` +({{population}} terms) AND ({{intervention_or_concept}} terms){{#if outcomes}} AND ({{outcomes}} terms){{/if}} +``` + +**Search Strategy Elements**: +- [ ] Population terms (MeSH + text words) +- [ ] Intervention/concept terms (MeSH + text words) +- [ ] Outcome terms (if applicable) +- [ ] Study design filters (if applicable) +- [ ] Language limits (specify rationale) +- [ ] Date limits (specify rationale) +- [ ] Animal filter (if human studies only) + +**Peer Review**: +- [ ] Consider PRESS checklist peer review of search strategy + +--- + +## 4. STUDY SELECTION PROCESS + +### 4.1 Screening Workflow + +**Stage 1: Title/Abstract Screening** +- Reviewers: [To assign - minimum 2 independent] +- Approach: Liberal inclusion (include if uncertain) +- Tool: [Covidence / Rayyan / DistillerSR / manual] + +**Stage 2: Full-Text Screening** +- Reviewers: [To assign - minimum 2 independent] +- Documentation: Reasons for exclusion +- Conflict resolution: Discussion or third reviewer + +### 4.2 PRISMA Flow Diagram + +Document the flow: +``` +Records identified from databases (n=___) + ├─ Duplicates removed (n=___) + └─ Records screened (n=___) + ├─ Records excluded (n=___) + └─ Full-text assessed (n=___) + ├─ Full-text excluded (n=___) [with reasons] + └─ Studies included (n=___) + └─ Studies included in synthesis (n=___) +``` + +--- + +## 5. DATA EXTRACTION PLAN + +### 5.1 Extraction Categories + +**Study Characteristics**: +- Author, year, country +- Study design +- Setting +- Sample size +- Follow-up duration +- Funding source + +**Population Characteristics**: +- Age (mean/median, range) +- Gender distribution +- Diagnostic criteria +- Baseline characteristics + +{{#if review_type == "systematic-review"}} +**Intervention/Exposure**: +- Description +- Dose/frequency/duration +- Delivery method +- Provider type + +**Comparator**: +- Type and details +{{/if}} + +**Outcomes**: +- Definition and measurement +- Timepoints +- Results by group +- Effect estimates + +### 5.2 Extraction Process + +- [ ] Design extraction form +- [ ] Pilot test on 2-3 studies +- [ ] Two independent extractors +- [ ] Resolve discrepancies +- [ ] Contact authors for missing data + +--- + +{{#if review_type == "systematic-review"}} +## 6. RISK OF BIAS ASSESSMENT + +### 6.1 Tool Selection + +**For Randomized Controlled Trials**: +- Tool: RoB 2 (Revised Cochrane Risk of Bias tool) +- Domains: Randomization, deviations, missing data, measurement, reporting + +**For Non-Randomized Studies**: +- Tool: ROBINS-I (Risk Of Bias In Non-randomized Studies of Interventions) +- Domains: Confounding, selection, classification, deviations, missing data, measurement, reporting + +### 6.2 Assessment Process + +- Two independent assessors +- Resolve disagreements through discussion +- Present results in risk of bias tables +- Consider sensitivity analyses excluding high-risk studies +{{/if}} + +--- + +## 7. DATA SYNTHESIS PLAN + +### 7.1 Synthesis Approach + +{{#if review_type == "systematic-review"}} +**Narrative Synthesis**: For all included studies + +**Meta-Analysis**: If appropriate +- Requirements: Clinical homogeneity, sufficient data +- Effect measures: [To specify based on data type] +- Statistical model: [Fixed-effect vs. random-effects] +- Heterogeneity assessment: I² statistic, visual inspection + +**Subgroup Analyses** (Pre-specified): +- [ ] To be defined in protocol + +**Sensitivity Analyses**: +- Exclude high risk of bias studies +- Alternative statistical models +- Outlier exclusion + +**Publication Bias Assessment** (if ≥10 studies): +- Funnel plot inspection +- Egger's test +{{else}} +**Narrative Synthesis Approach**: +- Group studies by key characteristics +- Tabulate study features and findings +- Identify patterns and themes + +{{#if review_type == "evidence-map"}} +**Evidence Visualization**: +- Bubble charts (intervention vs. outcome) +- Gap identification +- Interactive or static display +{{/if}} + +{{#if review_type == "umbrella-review"}} +**AMSTAR Assessment**: Quality assessment of included systematic reviews +{{/if}} +{{/if}} + +--- + +{{#if review_type == "systematic-review"}} +## 8. GRADE EVIDENCE ASSESSMENT + +### 8.1 Rating Approach + +**Evidence Certainty Levels**: +- High: Very confident in effect estimate +- Moderate: Moderately confident +- Low: Limited confidence +- Very Low: Very little confidence + +**Downgrade Factors**: +- Risk of bias +- Inconsistency +- Indirectness +- Imprecision +- Publication bias + +**Evidence Profile Format**: +- Outcomes table with certainty ratings +- Reasons for downgrading/upgrading +- Summary of findings tables +{{/if}} + +--- + +## 9. PROJECT TIMELINE + +| Phase | Activities | Duration | Target Completion | +|-------|-----------|----------|-------------------| +| **Month 1** | Protocol development; PROSPERO registration | 4 weeks | End Month 1 | +| **Month 2** | Search strategy development and execution | 4 weeks | End Month 2 | +| **Month 3** | Title/abstract screening; Full-text retrieval | 4 weeks | End Month 3 | +| **Month 4** | Full-text screening; Data extraction design | 4 weeks | End Month 4 | +| **Month 5** | Data extraction; Risk of bias assessment | 4 weeks | End Month 5 | +| **Month 6** | Data synthesis; Analysis | 4 weeks | End Month 6 | +| **Month 7-8** | GRADE assessment; Draft report | 8 weeks | End Month 8 | +| **Month 9** | Internal review; Revisions | 4 weeks | End Month 9 | +| **Month 10** | External peer review; Revisions | 4 weeks | End Month 10 | +| **Month 11-12** | Finalization; Submission/Publication | 8 weeks | End Month 12 | + +*Note: Timeline is indicative for systematic reviews. {{review_type}} may have adjusted timelines.* + +--- + +## 10. TEAM STRUCTURE + +| Role | Name/Position | Responsibility | +|------|---------------|----------------| +| **Team Lead** | {{team_lead}} | Overall project coordination; Methodological oversight | +| **Clinical/Content Expert** | [To be assigned] | Clinical expertise; Eligibility decisions | +| **Information Specialist** | [To be assigned] | Search strategy development; Database searching | +| **Reviewers** | [To be assigned] | Study screening; Data extraction (minimum 2) | +| {{#if review_type == "systematic-review"}}| **Biostatistician** | [To be assigned] | Meta-analysis; Statistical consultation |{{/if}} | +| **Project Manager** | [To be assigned] | Timeline tracking; Documentation management | + +--- + +## 11. TOOLS AND RESOURCES + +### 11.1 Software and Tools + +- **Screening**: [Covidence / Rayyan / DistillerSR / EndNote] +- **Data Extraction**: [Excel / Google Sheets / DistillerSR / REDCap] +- **Risk of Bias**: [Excel templates / Covidence] +- **Analysis**: [RevMan / R / Stata] +- **Reference Management**: [EndNote / Mendeley / Zotero] +- **Writing**: [Word / Google Docs / Overleaf] +- **Collaboration**: [Teams / Slack / Email] + +### 11.2 Reporting Guidelines + +- **PRISMA 2020**: For systematic reviews +- **PRISMA-ScR**: For scoping reviews +- **ENTREQ**: For qualitative syntheses +- **Appropriate checklist**: For other review types + +--- + +## 12. DOCUMENTATION AND DELIVERABLES + +### 12.1 Required Documents + +- [ ] Protocol (registered) +- [ ] Search strategies (all databases) +- [ ] PRISMA flow diagram +- [ ] Study characteristics table +- [ ] {{#if review_type == "systematic-review"}}Risk of bias assessment tables{{/if}} +- [ ] Data extraction forms +- [ ] {{#if review_type == "systematic-review"}}Forest plots and meta-analysis results{{/if}} +- [ ] {{#if review_type == "systematic-review"}}GRADE evidence profiles{{/if}} +- [ ] PRISMA checklist +- [ ] Review manuscript/report +- [ ] Funding and COI declarations + +### 12.2 File Organization + +``` +/{{review_title}}/ + ├── 01_Protocol/ + │ └── Protocol_{{review_title}}.docx + ├── 02_Search/ + │ ├── Search_Strategy_MEDLINE.txt + │ ├── Search_Strategy_Embase.txt + │ └── Search_Results/ + ├── 03_Screening/ + │ ├── Title_Abstract_Screening.csv + │ ├── Full_Text_Screening.csv + │ └── Excluded_Studies_with_Reasons.csv + ├── 04_Data_Extraction/ + │ ├── Extraction_Form.xlsx + │ └── Extracted_Data.xlsx + ├── 05_Risk_of_Bias/ +│ └── RoB_Assessments.xlsx + ├── 06_Analysis/ +│ ├── Analysis_Plan.docx +│ └── Results/ + ├── 07_Reporting/ +│ ├── PRISMA_Flow_Diagram.pptx +│ ├── PRISMA_Checklist.docx +│ └── Manuscript/ + └── 08_Admin/ + ├── Team_Contacts.xlsx + ├── Timeline.mpp + └── COI_Forms/ +``` + +--- + +## 13. QUALITY ASSURANCE + +### 13.1 Calibration Exercises + +- [ ] Pilot screening on sample of 50-100 citations +- [ ] Calculate inter-rater reliability (target kappa ≥0.6) +- [ ] Calibration meeting to resolve disagreements +- [ ] Pilot data extraction on 2-3 studies + +### 13.2 Ongoing Quality Checks + +- [ ] Weekly team meetings during screening phase +- [ ] Spot-checks on screening decisions (10-20%) +- [ ] Verification of data extraction (10-20%) +- [ ] Second review of risk of bias assessments + +--- + +## 14. REGULATORY AND ETHICAL CONSIDERATIONS + +### 14.1 Jurisdiction-Specific Requirements + +**Australia**: +- NHMRC standards for research synthesis +- Consider Human Research Ethics Committee (HREC) review if using individual patient data + +**New Zealand**: +- Health Research Council standards +- Te Whatu Ora evidence requirements + +**International**: +- Cochrane standards (if Cochrane review) +- Institutional requirements + +### 14.2 Ethics Considerations + +{{#if review_type == "systematic-review"}} +- [ ] Ethics approval required? [Yes/No] + - Typically not required for aggregate data reviews + - Required for individual patient data meta-analyses +- [ ] Data sharing agreements (if IPD involved) +{{/if}} +- [ ] Indigenous data sovereignty (if applicable) +- [ ] Patient/public involvement plan + +--- + +## 15. PRIVACY AND DATA MANAGEMENT + +### 15.1 Data Management Plan + +- [ ] Data storage location (secure, backed-up) +- [ ] Access controls (team members only) +- [ ] Version control for documents +- [ ] Retention schedule (typically 7+ years) +- [ ] Data disposal procedures + +### 15.2 Privacy Considerations + +- **PHI Involved**: {{#if review_type == "systematic-review"}}Conditional (only if IPD){{else}}No{{/if}} +- **Data Minimization**: Aggregate data only unless IPD justified +- **De-identification**: Ensure all extracted data is de-identified +- **No Persistence**: Do not store PHI in temporary workspaces + +--- + +## 16. NEXT STEPS + +### Immediate Actions (Week 1-2) + +1. [ ] **Finalize Team**: Confirm all team member assignments and roles +2. [ ] **Kickoff Meeting**: Schedule initial team meeting +3. [ ] **Protocol Drafting**: Begin writing detailed protocol +4. [ ] **Tool Setup**: Set up screening and extraction software +5. [ ] **File Structure**: Create project folder organization + +### Short-Term Actions (Month 1) + +6. [ ] **Complete Protocol**: Finalize all protocol sections +7. [ ] **Register Protocol**: Submit to PROSPERO or appropriate registry +8. [ ] **Develop Search**: Work with information specialist on strategy +9. [ ] **Design Forms**: Create extraction and assessment forms +10. [ ] **Calibration**: Conduct pilot screening and calibration + +### Ongoing Actions + +11. [ ] **Execute Search**: Run database searches +12. [ ] **Screen Studies**: Title/abstract and full-text screening +13. [ ] **Extract Data**: Systematic data extraction +14. [ ] **Assess Quality**: Risk of bias assessment +15. [ ] **Synthesize Evidence**: Analysis and synthesis +16. [ ] **Write Report**: Manuscript preparation + +--- + +## 17. RISK REGISTER + +| Risk | Likelihood | Impact | Mitigation | +|------|------------|--------|------------| +| Insufficient studies identified | Medium | High | Broaden search; extend date limits; contact experts | +| High heterogeneity precluding meta-analysis | Medium | High | Plan narrative synthesis; explore subgroups | +| Team member unavailable | Medium | Medium | Cross-training; backup assignments | +| Timeline delays | Medium | Medium | Buffer time built in; regular milestone reviews | +| New evidence published during review | Low | Medium | Document search date; plan update strategy | +| Funding constraints | Low | High | Seek institutional support; adjust scope if needed | + +--- + +## 4. Execute Routing + +- Save charter to `~~cloud storage` in systematic review project folder. +- Create project tracker entry in `~~project tracker` with milestones. +- Notify {{team_lead}} of project initiation. +- Schedule kickoff meeting within 1 week. +- Set up screening software account and invite team members. + +## 5. Output Guardrails + +- **No PHI**: Do not include patient identifiers in any documentation. +- **Protocol Registration**: Emphasize importance of PROSPERO registration before screening begins. +- **Dual Review**: Ensure minimum dual independent review for screening and extraction. +- **Transparency**: All methodological choices must be documented and justified. +- **Lite Mode**: If user requests rapid start, generate minimal charter with core elements (question, search framework, team, timeline) and flag for protocol completion. + +--- + +**Note**: This charter establishes the foundation for rigorous evidence synthesis. Update with specific details as the project progresses. Ensure all team members understand and commit to the methodology before proceeding. diff --git a/health/commands/submit-complaint.md b/health/commands/submit-complaint.md new file mode 100644 index 0000000..a8a8189 --- /dev/null +++ b/health/commands/submit-complaint.md @@ -0,0 +1,51 @@ +--- +name: submit-complaint +description: Intake a new patient, staff, or visitor complaint with clinical safety and severity assessment. +arguments: + - name: type + description: "Type of complaint: 'clinician' (performance/conduct) or 'service' (facilities/admin/wait times)." + required: true + - name: severity + description: "Initial severity assessment: P1 (Critical/Life Threat), P2 (High), P3 (Medium), P4 (Low)." + required: true + - name: patient_safety_concern + description: "Does this complaint involve a potential or actual risk to patient safety? (yes/no)" + required: true + - name: description + description: "Detailed description of the complaint. DO NOT include patient names or PHI." + required: true +--- + +# Submit Complaint Command + +Follow this workflow to process a new healthcare complaint. + +## 1. Intake Validation +- Verify the `type` matches clinician or service. +- If `patient_safety_concern` is **yes**, automatically escalate the priority to **P1** regardless of the input `severity`. + +## 2. Invoke Skills +Use `~~health/complaints-management` to: +1. Validate the severity against the healthcare framework. +2. Determine the appropriate investigation path (e.g., Clinical Lead vs. Operations Manager). +3. Identify jurisdictional deadlines (AU/NZ default). + +## 3. Generate Documentation +Produce a structured intake report: + +### COMPLAINT INTAKE REPORT +- **Reference ID**: [Generate unique ID] +- **Date/Time**: {{current_timestamp}} +- **Type**: {{type}} +- **Severity**: {{severity}} +- **Patient Safety Concern**: {{patient_safety_concern}} +- **Summary**: [Summarize description without PHI] + +### NEXT STEPS +- **Acknowledgment**: Due by [Timestamp + 2 days] +- **Resolution Target**: Due by [Timestamp + 30 days] +- **Action**: [Specify routing, e.g., "Assigned to Medical Director for urgent review"] + +## 4. Execution +- Log the intake in `~~project tracker`. +- Notify the relevant team lead based on the routing rules. diff --git a/health/skills/.templates/health-skill-template.md b/health/skills/.templates/health-skill-template.md new file mode 100644 index 0000000..2f4bc44 --- /dev/null +++ b/health/skills/.templates/health-skill-template.md @@ -0,0 +1,255 @@ +--- +name: health/{skill-name} +description: This skill should be used when the user asks to "[trigger 1]", "[trigger 2]", or needs assistance with [domain-specific activity]. +version: 0.1.0 +--- + +# {Skill Name} + +Brief introduction (1-2 sentences) describing the skill's purpose in healthcare context. This skill assists clinicians, administrators, and healthcare staff with [specific domain] workflows while ensuring compliance with regulatory requirements. + +**Important**: This skill assists with clinical and operational workflows but does not provide clinical advice or replace professional judgment. Always verify outputs against organizational policies and applicable regulations. + +## When to Use This Skill + +Invoke this skill when: +- User mentions [specific healthcare scenario 1 - be explicit about clinical/operational context] +- User asks about [specific workflow or process] +- Context indicates [specific need or trigger] +- User requests assistance with [domain-specific task] +- Document analysis reveals [specific pattern requiring this skill] +- Conversation involves [relevant regulatory or compliance matter] + +## Regulatory Context + +### Australia & New Zealand (Default Baseline) + +| Regulation/Standard | Relevance | Key Requirements | +|---------------------|-----------|------------------| +| **[Primary Regulation]** (AU/NZ) | [How it applies to this skill's domain] | [Specific requirements relevant to workflow] | +| **[Secondary Regulation]** (AU/NZ) | [Relevance description] | [Key compliance points] | +| **State/Territory Acts** | Jurisdiction-specific variations | [Applicable state-level requirements] | +| **Organizational Policy** | Internal compliance | [Required policy adherence] | + +### US/EU-lite Portability Guidance + +When users request US or EU contexts, adapt guidance as follows: + +| Regulation/Standard | Relevance | Adaptation Notes | +|---------------------|-----------|------------------| +| **[US Regulation]** (e.g., HIPAA, Joint Commission) | [How it applies] | [Key differences from AU/NZ baseline] | +| **[EU Regulation]** (e.g., GDPR, MDR) | [How it applies] | [Key differences from AU/NZ baseline] | +| **International Standard** (e.g., ISO) | [Relevance] | [Portability considerations] | + +### Jurisdiction Matrix + +| Jurisdiction | Applicable Regulator | Reporting Trigger | Timeframe | Required Artifacts | Escalation Point | +|--------------|---------------------|-------------------|-----------|-------------------|------------------| +| **AU - National** | [Regulator name] | [Trigger condition] | [SLA] | [Documentation required] | [Role/Title] | +| **AU - State** | [State regulator] | [Trigger condition] | [SLA] | [Documentation required] | [Role/Title] | +| **NZ - National** | [NZ regulator] | [Trigger condition] | [SLA] | [Documentation required] | [Role/Title] | +| **US** | [US regulator] | [Trigger condition] | [SLA] | [Documentation required] | [Role/Title] | + +## Quick Reference + +1. **[Key Point 1]**: Brief actionable guidance for common scenarios. +2. **[Key Point 2]**: Essential step or consideration. +3. **[Key Point 3]**: Critical compliance or safety point. +4. **[Key Point 4]**: Best practice reminder. +5. **[Key Point 5]**: Documentation or audit requirement. +6. **[Key Point 6]**: Escalation trigger to remember. +7. **[Key Point 7]**: Privacy or security consideration. +8. **[Key Point 8]**: Common pitfall to avoid. + +## Operating Modes + +### Standard Mode + +Full workflow with complete documentation, comprehensive compliance checks, multidisciplinary stakeholder engagement, and formal governance approval processes. Use for: +- Complex or high-risk scenarios +- Regulatory-mandated activities +- Accreditation-related work +- First-time implementations +- Cross-functional initiatives + +### Lite Mode + +Streamlined guidance for rapid response, informal consultations, or constrained contexts. Provides essential steps and minimum safe practices. Use for: +- Quick reference or clarification +- Routine, low-risk activities +- Educational contexts +- Preliminary assessments + +**Important**: Lite mode never suppresses: +- High-risk escalation requirements +- Mandatory reporting obligations +- Patient safety considerations +- Statutory compliance requirements + +## Detailed Guidance + +### Phase 1: [Initiation/Assessment] + +[Detailed step-by-step guidance for the first phase of the workflow] + +**Key Activities**: +1. [Specific action with healthcare context] +2. [Next action with compliance consideration] +3. [Action requiring documentation] + +**Decision Points**: +- [Criterion for path A vs path B] +- [When to proceed vs when to escalate] + +### Phase 2: [Processing/Execution] + +[Detailed guidance for the main workflow phase] + +**Clinical Considerations**: +- [Patient safety point] +- [Clinical accuracy requirement] +- [Integration with care workflow] + +**Administrative Requirements**: +- [Documentation standard] +- [Approval workflow] +- [Communication protocol] + +### Phase 3: [Completion/Review] + +[Guidance for finalizing and reviewing work] + +**Quality Checks**: +- [Verification step 1] +- [Verification step 2] +- [Compliance confirmation] + +## Documentation Requirements + +### Required Elements + +- [ ] [Documentation element 1 - specific to medical record standards] +- [ ] [Documentation element 2 - audit trail requirement] +- [ ] [Documentation element 3 - compliance evidence] +- [ ] [Documentation element 4 - stakeholder communication record] +- [ ] [Documentation element 5 - decision rationale] + +### Audit Trail Requirements + +- Timestamp of all key decisions +- Identity of decision-makers and reviewers +- Version history of documents +- Evidence of compliance checks +- References to applicable policies/procedures + +### Retention Guidelines + +| Document Type | Retention Period | Storage Requirements | +|---------------|------------------|---------------------| +| [Type 1] | [Period, e.g., 7 years] | [Security level, access controls] | +| [Type 2] | [Period] | [Storage requirements] | + +## Common Mistakes + +| Mistake | Why It's Wrong | Instead | +|---------|----------------|---------| +| **[Mistake 1]** | [Explanation of error and risk] | [Correct approach with rationale] | +| **[Mistake 2]** | [Explanation of error and risk] | [Correct approach with rationale] | +| **[Mistake 3]** | [Explanation of error and risk] | [Correct approach with rationale] | +| **[Mistake 4]** | [Explanation of error and risk] | [Correct approach with rationale] | +| **[Mistake 5]** | [Explanation of error and risk] | [Correct approach with rationale] | +| **[Mistake 6]** | [Optional additional mistake] | [Correct approach] | +| **[Mistake 7]** | [Optional additional mistake] | [Correct approach] | + +## When to Escalate + +Escalate to [appropriate role/title] when: +- Patient safety is or may be compromised +- [Escalation criterion 2 - specific to domain] +- [Escalation criterion 3 - regulatory or compliance trigger] +- [Escalation criterion 4 - resource or authority limitation] +- [Escalation criterion 5 - timeline or deadline risk] +- [Escalation criterion 6 - stakeholder conflict or resistance] +- [Escalation criterion 7 - unclear jurisdiction or authority] + +## Privacy Considerations + +### PHI/PII Handling + +- **PHI Involved**: [Yes/No/Conditional - with explanation] +- **Data Minimization**: Use only the minimum necessary information for the specific task +- **De-identification**: [Guidance on when and how to de-identify data] +- **Access Controls**: Limit access to those with legitimate need + +### Security Guardrails + +- **No Logging of PHI**: Never include identifiable patient information in logs or chat history +- **Temporary Workspace**: Process PHI in secure, temporary environments only +- **No Persistence**: Do not store PHI in skill memory or persistent storage +- **Transmission Security**: Use secure channels for any PHI transfer + +### Retention and Disposal + +- **Output Retention**: [Specific retention period based on document type] +- **Secure Disposal**: Delete working copies when no longer needed +- **Audit Records**: Maintain non-identifiable audit logs per organizational policy + +## Confidence Indicators + +| Scenario | Confidence | Action | +|----------|------------|--------| +| Explicit, unambiguous documentation with clear workflow | High | Proceed with standard guidance; document actions | +| Conflicting information or ambiguous requirements | Medium | Flag for human review; summarize conflicts and recommendations | +| High-risk clinical or compliance decision | Low | Draft options with pros/cons; REQUIRE human sign-off | +| Novel situation without established precedent | Low | Consult with subject matter expert; document rationale | +| Time-critical with incomplete information | Medium | Provide best available guidance; flag for follow-up review | +| Multiple stakeholder perspectives in conflict | Medium | Facilitate discussion; document all viewpoints | + +## Tool Requirements + +- `~~health/core` - Core health plugin functionality +- `~~health/clinical-systems` - EHR/EMR integration (if applicable) +- `~~cloud storage` - Document storage and collaboration +- `~~project tracker` - Workflow and task management +- `~~document collaboration` - Multi-stakeholder document editing +- `~~[domain-specific tool]` - [Description of specialized tool need] + +## Success Indicators + +You've applied this skill well when: +- [ ] All required documentation is complete and compliant +- [ ] Regulatory requirements are met and verified +- [ ] Output meets healthcare documentation standards +- [ ] Privacy and security protocols followed +- [ ] Appropriate stakeholders engaged and informed +- [ ] Audit trail is complete and accessible +- [ ] Escalation criteria assessed and acted upon appropriately +- [ ] Patient safety considerations addressed +- [ ] Output reviewed for clinical accuracy (if applicable) +- [ ] Related skills consulted when appropriate + +## Related Skills + +- `~~health/[related-skill-1]` - [Brief description of relationship and when to use together] +- `~~health/[related-skill-2]` - [Brief description of relationship and when to use together] +- `~~health/[related-skill-3]` - [Additional related skill if applicable] +- `~~[non-health-related-skill]` - [Cross-domain relationship if applicable] + +--- + +## Template Usage Notes + +When creating a new health skill from this template: + +1. Replace all `{placeholders}` with domain-specific content +2. Ensure all 14 required sections are present (use "N/A" with explanation if truly not applicable) +3. Include at least 5 Common Mistakes +4. Include at least 3 Confidence Indicator scenarios +5. Include at least 2 Related Skills references +6. Include at least 3 Success Indicators +7. Verify AU/NZ-default jurisdiction matrix is complete +8. Verify US/EU-lite portability guidance is present +9. Ensure PHI/PII guardrails are appropriate for the domain +10. Confirm healthcare disclaimers are included +11. Validate minimum 300 lines total (health skills require more detail) +12. Remove these template usage notes before finalizing diff --git a/health/skills/.templates/validation-checklist.md b/health/skills/.templates/validation-checklist.md new file mode 100644 index 0000000..c5c3eba --- /dev/null +++ b/health/skills/.templates/validation-checklist.md @@ -0,0 +1,409 @@ +# Health Skill Quality Validation Checklist + +Use this checklist to validate health skills against the 14-section architecture and quality gates defined in `conductor/tracks/health-plugin/skill-standards.md`. + +## Pre-Validation Setup + +- [ ] Identify the skill file: `health/skills/{skill-name}/SKILL.md` +- [ ] Review associated metadata if present +- [ ] Confirm skill domain and applicable regulations +- [ ] Identify related health skills for cross-reference validation + +--- + +## Section 1: Frontmatter Validation + +**Location**: Lines 1-5 (YAML frontmatter) + +### Required Fields +- [ ] `name` field present and follows format `health/{skill-name}` +- [ ] `name` is unique and domain-specific +- [ ] `description` field present +- [ ] `description` starts with "This skill should be used when..." +- [ ] `description` includes concrete trigger phrases +- [ ] `version` field present (semantic versioning format) + +### Quality Checks +- [ ] Name is specific to healthcare domain (not generic) +- [ ] Description clearly indicates when to invoke +- [ ] No placeholder text (e.g., "TODO", "TBD", "FIXME") +- [ ] Version follows semver (MAJOR.MINOR.PATCH) + +--- + +## Section 2: When to Use This Skill + +**Requirement**: Minimum 5 lines + +### Content Validation +- [ ] Section header present: `## When to Use This Skill` +- [ ] Contains explicit healthcare scenarios +- [ ] Includes clinical/operational context +- [ ] Lists at least 4-6 trigger conditions +- [ ] Triggers are specific and actionable + +### Quality Checks +- [ ] No vague statements (e.g., "when needed") +- [ ] Triggers cover common use cases +- [ ] Language is appropriate for healthcare context + +--- + +## Section 3: Regulatory Context + +**Requirement**: Minimum 10 lines, AU/NZ-default + US/EU-lite + +### Australia & New Zealand Baseline +- [ ] AU/NZ regulations table present +- [ ] At least 3 AU/NZ regulations/standards listed +- [ ] Columns: Regulation/Standard, Relevance, Key Requirements +- [ ] Specific requirements are actionable + +### US/EU-lite Portability +- [ ] US/EU-lite section present +- [ ] Adaptation notes for US context included +- [ ] Adaptation notes for EU context included +- [ ] Key differences from AU/NZ documented + +### Jurisdiction Matrix +- [ ] Matrix table present +- [ ] Columns: Jurisdiction, Applicable Regulator, Reporting Trigger, Timeframe, Required Artifacts, Escalation Point +- [ ] At least AU-National and NZ-National rows present +- [ ] AU-State row present (if state variations apply) +- [ ] US row present (for portability) +- [ ] All timeframes are specific (not "as soon as possible") +- [ ] Escalation points are specific roles/titles + +### Quality Checks +- [ ] AU/NZ references precede other jurisdictions +- [ ] Regulations are current and accurate +- [ ] No placeholder content in tables +- [ ] Jurisdiction matrix is complete for skill domain + +--- + +## Section 4: Operating Modes + +**Requirement**: Standard and Lite modes documented + +### Standard Mode +- [ ] Section header: `### Standard Mode` +- [ ] Describes full workflow +- [ ] Documents complete compliance checks +- [ ] Specifies appropriate use cases +- [ ] Indicates multidisciplinary engagement + +### Lite Mode +- [ ] Section header: `### Lite Mode` +- [ ] Describes streamlined guidance +- [ ] Specifies appropriate use cases +- [ ] Explicitly states what is NOT suppressed: + - [ ] High-risk escalation requirements + - [ ] Mandatory reporting obligations + - [ ] Patient safety considerations + - [ ] Statutory compliance requirements + +### Quality Checks +- [ ] Both modes clearly differentiated +- [ ] Lite mode warnings are prominent +- [ ] Use case guidance is practical + +--- + +## Section 5: Quick Reference + +**Requirement**: 5-10 bullet points (for complex skills) + +### Content Validation +- [ ] Section header: `## Quick Reference` +- [ ] 5-10 actionable bullet points +- [ ] Covers most common scenarios +- [ ] Includes safety/compliance points +- [ ] Includes documentation reminders + +### Quality Checks +- [ ] Bullets are concise but complete +- [ ] High-value information prioritized +- [ ] Suitable for quick scanning + +--- + +## Section 6: Detailed Guidance + +**Requirement**: Minimum 50 lines + +### Structure Validation +- [ ] Section header: `## Detailed Guidance` +- [ ] Organized into logical phases or subsections +- [ ] Uses clear, descriptive headers +- [ ] Step-by-step process documented + +### Content Quality +- [ ] Clinical considerations addressed (if applicable) +- [ ] Administrative requirements included +- [ ] Decision points documented +- [ ] Integration with care workflows described +- [ ] No gaps in critical path + +### Quality Checks +- [ ] Instructions are actionable +- [ ] Healthcare context is clear +- [ ] Cross-references to procedures/policies included +- [ ] Examples provided where helpful + +--- + +## Section 7: Documentation Requirements + +**Requirement**: Minimum 10 lines + +### Required Elements +- [ ] Section header: `## Documentation Requirements` +- [ ] Checkbox list of required elements present +- [ ] At least 5 required elements listed +- [ ] Audit trail requirements specified +- [ ] Retention guidelines table present + +### Quality Checks +- [ ] Documentation aligns with medical record standards +- [ ] Retention periods are specific +- [ ] Storage requirements specified +- [ ] Format standards indicated + +--- + +## Section 8: Common Mistakes + +**Requirement**: Minimum 10 lines, at least 5 mistakes + +### Table Validation +- [ ] Section header: `## Common Mistakes` +- [ ] Table with 3 columns: Mistake, Why It's Wrong, Instead +- [ ] At least 5 documented mistakes +- [ ] All columns populated for each row + +### Quality Checks +- [ ] Mistakes are healthcare-specific +- [ ] Explanations include clinical/regulatory risk +- [ ] "Instead" column provides actionable alternative +- [ ] Common anti-patterns covered +- [ ] No trivial or obvious mistakes listed + +--- + +## Section 9: When to Escalate + +**Requirement**: Minimum 5 lines + +### Content Validation +- [ ] Section header: `## When to Escalate` +- [ ] Clear escalation role/title specified +- [ ] At least 5 escalation criteria listed +- [ ] Bullet format for criteria + +### Quality Checks +- [ ] Criteria are specific and actionable +- [ ] Patient safety criteria prominent +- [ ] Regulatory triggers included +- [ ] Resource/authority limits covered +- [ ] Criteria are realistic and appropriate + +--- + +## Section 10: Privacy Considerations + +**Requirement**: Minimum 10 lines, PHI/PII guardrails + +### PHI/PII Handling +- [ ] Section header: `## Privacy Considerations` +- [ ] Subsection: `### PHI/PII Handling` +- [ ] PHI Involved: Yes/No/Conditional specified +- [ ] Data minimization guidance present +- [ ] De-identification guidance present +- [ ] Access controls specified + +### Security Guardrails +- [ ] Subsection: `### Security Guardrails` +- [ ] No Logging of PHI rule stated +- [ ] Temporary workspace guidance +- [ ] No Persistence rule stated +- [ ] Transmission security noted + +### Retention and Disposal +- [ ] Subsection: `### Retention and Disposal` (if applicable) +- [ ] Output retention periods specified +- [ ] Secure disposal procedures +- [ ] Audit records guidance + +### Quality Checks +- [ ] Guardrails are explicit and specific +- [ ] HIPAA/Privacy Act principles reflected +- [ ] Technical safeguards mentioned +- [ ] Appropriate for skill domain + +--- + +## Section 11: Confidence Indicators + +**Requirement**: Minimum 8 lines, at least 3 scenarios + +### Table Validation +- [ ] Section header: `## Confidence Indicators` +- [ ] Table with 3 columns: Scenario, Confidence, Action +- [ ] At least 3 scenarios documented +- [ ] All confidence levels represented (High/Medium/Low) + +### Quality Checks +- [ ] Scenarios cover typical use cases +- [ ] High confidence scenarios include safe autonomy +- [ ] Low confidence scenarios require human review +- [ ] Medium confidence scenarios flag for review +- [ ] Patient safety scenarios marked Low +- [ ] Actions are specific and appropriate + +--- + +## Section 12: Tool Requirements + +**Requirement**: Minimum 5 lines + +### Content Validation +- [ ] Section header: `## Tool Requirements` +- [ ] Bullet list of required tools +- [ ] `~~health/core` referenced (if applicable) +- [ ] Healthcare-specific tools listed +- [ ] MCP connector format used (`~~tool-name`) + +### Quality Checks +- [ ] Tools are relevant to workflow +- [ ] Core health plugin referenced +- [ ] Clinical systems noted if applicable +- [ ] No generic tools without context + +--- + +## Section 13: Success Indicators + +**Requirement**: Minimum 5 lines, at least 3 indicators + +### Content Validation +- [ ] Section header: `## Success Indicators` +- [ ] Introductory sentence present +- [ ] Checkbox list format +- [ ] At least 3 indicators listed + +### Quality Checks +- [ ] Indicators are measurable +- [ ] Compliance verification included +- [ ] Documentation quality addressed +- [ ] Clinical accuracy noted (if applicable) +- [ ] Audit trail completion verified +- [ ] Cross-reference consultation noted + +--- + +## Section 14: Related Skills + +**Requirement**: Minimum 3 lines, at least 2 related skills + +### Content Validation +- [ ] Section header: `## Related Skills` +- [ ] Bullet list format +- [ ] At least 2 related skills listed +- [ ] Preferably within health plugin + +### Quality Checks +- [ ] Relationships are described +- [ ] Usage guidance provided +- [ ] Cross-references are valid +- [ ] Skills actually exist or are planned + +--- + +## Quality Gates Verification + +### Length Requirements +- [ ] Total skill length >= 300 lines +- [ ] Detailed Guidance section >= 50 lines + +### Content Completeness +- [ ] No placeholder content ("TODO", "TBD", "FIXME", "XXX") +- [ ] No empty sections +- [ ] All tables have content in all cells +- [ ] No "N/A" without explanation + +### Healthcare-Specific Requirements +- [ ] Healthcare disclaimers present +- [ ] Clinical safety addressed +- [ ] Regulatory compliance covered +- [ ] Patient safety prominent +- [ ] Audit trail requirements specified + +### Cross-References +- [ ] All internal links valid +- [ ] Related skills exist or documented as planned +- [ ] External references current + +### Jurisdiction Requirements +- [ ] AU/NZ-default matrix complete +- [ ] US/EU-lite guidance present +- [ ] Baseline jurisdiction file referenced +- [ ] Portability notes accurate + +--- + +## Final Validation Steps + +### Readability +- [ ] Markdown renders correctly +- [ ] Tables are properly formatted +- [ ] Headers are hierarchical and consistent +- [ ] Bullet lists are properly indented + +### Style Compliance +- [ ] Voice and tone appropriate for healthcare +- [ ] Terminology consistent with domain +- [ ] Acronyms defined on first use +- [ ] Jargon minimized or explained + +### Final Check +- [ ] Run validation script: `python conductor/scripts/validate_health_skills.py` +- [ ] Address all reported errors +- [ ] Document any intentional deviations +- [ ] Obtain domain expert review (recommended) + +--- + +## Sign-Off + +| Reviewer | Date | Result | Notes | +|----------|------|--------|-------| +| [Name] | [Date] | [Pass/Fail] | [Comments] | + +--- + +## Appendix: Quick Reference Card + +### Critical Checks (Do Not Skip) +1. AU/NZ-default jurisdiction matrix present +2. US/EU-lite portability guidance present +3. PHI/PII guardrails complete +4. At least 5 Common Mistakes documented +5. At least 3 Confidence Indicator scenarios +6. Healthcare disclaimers included +7. Minimum 300 lines total +8. No placeholder content + +### Section Count +- Required sections: 14 +- Minimum length: 300 lines +- Mistakes documented: >= 5 +- Confidence scenarios: >= 3 +- Related skills: >= 2 +- Success indicators: >= 3 + +### Pass Criteria +- All 14 sections present and populated +- All quality gates met +- No validation script errors +- Healthcare context appropriate diff --git a/health/skills/affidavit-drafting/SKILL.md b/health/skills/affidavit-drafting/SKILL.md new file mode 100644 index 0000000..507efab --- /dev/null +++ b/health/skills/affidavit-drafting/SKILL.md @@ -0,0 +1,442 @@ +--- +name: health/affidavit-drafting +description: This skill should be used when drafting affidavits, sworn statements, or statutory declarations for court proceedings involving medical evidence. Use for preparing witness statements in personal injury litigation, family court proceedings, child protection matters, guardianship proceedings, or any legal context requiring sworn medical testimony. +version: 1.0.0 +--- + +# Affidavit Drafting + +A comprehensive framework for drafting affidavits and sworn statements containing medical evidence, supporting healthcare professionals and legal teams in preparing court-compliant documentation. This skill addresses the unique requirements of medical affidavits including expert witness statements, clinical records affidavits, and statutory declarations across Australian, New Zealand, US, and EU jurisdictions. + +**Critical Warning**: Affidavits are sworn testimony subject to penalties for perjury or misleading statements. Accuracy, truthfulness, and jurisdictional compliance are essential. This skill provides drafting guidance but does not replace legal advice or review by qualified legal practitioners. + +## When to Use This Skill + +Invoke this skill when: +- Drafting expert witness affidavits for court proceedings +- Preparing treating doctor affidavits in personal injury matters +- Writing statutory declarations for medical certificates or capacity assessments +- Creating affidavits authenticating medical records for court +- Drafting affidavits in support of child protection applications +- Preparing capacity assessment affidavits for guardianship proceedings +- Writing affidavits for family court matters (parenting, relocation) +- Creating sworn statements for mental health tribunal proceedings +- Drafting affidavits for coronial inquests or inquiries + +## Regulatory Context + +### Australia & New Zealand (Default) + +| Legislation/Rules | Relevance | Key Requirements | +|-------------------|-----------|------------------| +| **Evidence Act** (Cth/State) | Affidavit requirements | Form, content, and admissibility of affidavits | +| **Court Rules** (Federal/District/Supreme) | Procedural requirements | Formatting, annexures, service requirements | +| **Oaths Act** | Swearing requirements | Authorized witnesses; oath or affirmation | +| **Family Law Rules** | Family court affidavits | Specific form and content requirements | +| **Oaths and Declarations Act** (NZ) | Swearing/affirming | Authorized persons; prescribed wording | +| **High Court Rules** (NZ) | Format and procedure | Affidavit form; exhibits; filing | + +### US/EU-lite Fallback + +| Legislation/Rules | Relevance | Key Requirements | +|-------------------|-----------|------------------| +| **Federal Rules of Civil Procedure** (US) | Affidavit requirements | Form, content, and use in federal court | +| **State Court Rules** (US) | State-specific requirements | Vary significantly by jurisdiction | +| **Notary Public Requirements** (US) | Swearing requirements | Notary acknowledgment; jurat | +| **EU Civil Procedure Rules** | Cross-border proceedings | Apostille; translation requirements | +| **GDPR** (EU) | Data in affidavits | Lawful basis; minimization; subject rights | + +### Jurisdiction Matrix + +| Jurisdiction | Applicable Regulator | Filing Trigger | Timeframe | Required Artifacts | Escalation Point | +|--------------|---------------------|----------------|-----------|-------------------|------------------| +| **AU - Federal Court** | Federal Court Rules | Case direction or party request | As ordered | Form 59 affidavit; proper exhibits | Legal counsel | +| **AU - State Supreme** | Uniform Civil Procedure Rules | Litigation timetable | As ordered | UCPR-compliant format; exhibit labeling | Instructing solicitor | +| **AU - Family Court** | Family Law Rules | Case direction | As ordered | Form 59; affidavit of service | Family lawyer | +| **NZ - High Court** | High Court Rules | Case direction | As ordered | Affidavit form; exhibits; sworn properly | Legal counsel | +| **NZ - District Court** | District Court Rules | Case direction | As ordered | District Court affidavit requirements | Legal counsel | +| **US - Federal** | FRCP; Local Rules | Motion practice; discovery | As ordered | Notarized; local rule compliant | Attorney | +| **US - State** | State Rules of Court | Varies by state | Varies | Notary; state-specific requirements | Attorney | +| **EU** | Member State Rules | Cross-border proceedings | As required | Apostille; certified translation | Legal counsel | + +## Affidavit Structure + +### Standard Components + +#### 1. Header/Title +- **Court Identification**: Full court name and jurisdiction +- **Case Details**: Parties' names; case number; registry +- **Document Title**: "Affidavit of [Deponent Name]" +- **Date**: Date of swearing (not drafting date) + +#### 2. Introduction Paragraph +- **Deponent Identification**: Full name; occupation; address +- **Basis of Knowledge**: How deponent has knowledge of facts +- **Purpose**: Purpose of the affidavit + +#### 3. Body Paragraphs +- **Numbered Paragraphs**: Sequential numbering (1., 2., 3.) +- **Single Facts**: One fact per paragraph where possible +- **Chronological Order**: Logical flow (usually chronological) +- **First Person**: "I saw...", "I examined...", "I believe..." + +#### 4. Exhibits/Annexures +- **Reference**: "Marked with the letter 'A'" +- **Description**: Brief description of exhibit +- **Pagination**: Continuous pagination across exhibits +- **Certification**: True copy certifications where required + +#### 5. Jurat/Signature Block +- **Swearing Statement**: "Sworn/Affirmed at [place] on [date]" +- **Deponent Signature**: Signature of person making affidavit +- **Witness Details**: Name, capacity, and signature of authorized witness +- **Stamp/Seal**: Notary seal or authorized witness stamp + +### Document Type Variations + +#### Expert Witness Affidavit +- **Qualifications Section**: Detailed expertise and experience +- **Instructions Section**: Who engaged expert; scope of instructions +- **Opinion Section**: Expert opinions with stated basis +- **Duty Declaration**: Acknowledgment of duty to court + +#### Treating Doctor Affidavit +- **Treatment History**: Chronology of treatment provided +- **Clinical Findings**: Objective findings from examinations +- **Records Authentication**: Authentication of clinical records +- **Prognosis Section**: Future treatment needs and prognosis + +#### Capacity Assessment Affidavit +- **Assessment Details**: Date, place, duration of assessment +- **Functional Capacity**: Understanding, retention, weighing, communicating +- **Clinical Basis**: Medical/psychological basis for conclusions +- **Alternatives Considered**: Less restrictive alternatives + +#### Records Authentication Affidavit +- **Custody Statement**: Position and custody of records +- **Record Description**: Nature and extent of records +- **Authentication**: Statement that records are true copies +- **Search Certification**: Certification of thorough search + +## Swearing Requirements + +### Authorized Witnesses + +#### Australia +- **Justice of the Peace (JP)**: Common for routine affidavits +- **Solicitor/Barrister**: All Australian lawyers +- **Notary Public**: For international use; apostille +- **Court Registrar**: Court staff authorized to witness + +#### New Zealand +- **Justice of the Peace**: Widely available +- **Solicitor/Barrister**: All NZ lawyers +- **Notary Public**: For international matters +- **Registrar/Deputy Registrar**: Court staff + +#### United States +- **Notary Public**: Standard for most affidavits +- **Commissioner of Deeds**: Varies by state +- **Court Clerk**: For court-related affidavits +- **Attorney**: In some jurisdictions + +#### European Union +- **Notary Public (Notaire/Notar)**: Civil law jurisdictions +- **Solicitor/Commissioner for Oaths**: Common law jurisdictions +- **Apostille**: Hague Apostille Convention for cross-border use + +### Swearing vs. Affirming + +#### Religious Oath +- **Standard Form**: "I swear by Almighty God that the contents of this affidavit are true and correct" +- **Religious Variations**: Accommodate religious requirements +- **Holy Book**: Appropriate religious text may be used + +#### Secular Affirmation +- **Standard Form**: "I solemnly and sincerely affirm that the contents of this affidavit are true and correct" +- **Legal Equivalent**: Affirmation has same legal effect as oath +- **Conscientious Objection**: Deponent may choose affirmation for any reason + +### Witness Responsibilities + +#### Before Swearing +- **Identity Verification**: Verify deponent's identity (photo ID) +- **Understanding**: Ensure deponent understands contents +- **Voluntariness**: Confirm affidavit made voluntarily +- **Truthfulness**: Remind deponent of perjury consequences + +#### During Swearing +- **Oath/Affirmation**: Administer appropriate oath or affirmation +- **Signature**: Witness deponent's signature +- **Complete Jurat**: Fill in date, place, witness details +- **Stamp/Seal**: Apply official stamp or seal + +## Quick Reference + +1. **Truth Above All**: Affidavits must be true to the best of your knowledge +2. **Personal Knowledge**: State only what you know personally (unless expert) +3. **Foundation**: Lay foundation for opinions and conclusions +4. **Exhibits**: Properly label and reference all attachments +5. **Format**: Follow court rules precisely for formatting +6. **Service**: Understand service requirements and deadlines +7. **Privilege**: Some affidavits may be privileged +8. **Updates**: File supplementary affidavits if circumstances change +9. **Language**: Plain English; define technical terms +10. **Review**: Have legal counsel review before swearing + +## Operating Modes + +### Standard Mode +Full affidavit preparation with complete legal compliance, comprehensive content, proper exhibit management, and formal jurat. Required for court proceedings, expert witness statements, and matters involving significant legal consequences. Includes: +- Complete court-compliant formatting +- Detailed foundation for all statements +- Proper exhibit labeling and referencing +- Legal counsel review process +- Formal swearing/affirmation procedure + +### Lite Mode +Streamlined guidance for simple statutory declarations, straightforward factual affidavits, or internal documentation. Suitable for non-contentious matters with clear facts. Includes: +- Basic affidavit structure +- Essential content requirements +- Simple exhibit management +**Limitations**: Never use Lite mode for expert evidence, contested litigation, or matters involving complex legal issues. + +## Detailed Guidance + +### 1. Drafting Principles + +#### Truth and Accuracy +- **Factual Basis**: Every statement must have factual basis +- **Personal Knowledge**: Distinguish personal knowledge from information +- **Information and Belief**: Use proper formula for hearsay: "I am informed by [source] and verily believe..." +- **Speculation**: Avoid speculation; express appropriate uncertainty + +#### Clarity and Precision +- **Plain Language**: Avoid unnecessary jargon +- **Defined Terms**: Define technical or medical terms +- **Specificity**: Be specific (dates, times, measurements) +- **Chronology**: Present facts in logical chronological order + +#### Objectivity +- **Neutral Tone**: Maintain objective, professional tone +- **Avoid Advocacy**: Present facts without argument +- **Balance**: Include relevant facts even if unfavorable to your position +- **Professional Distance**: Maintain professional perspective + +### 2. Content Development + +#### Opening Paragraphs +``` +I, [FULL NAME], of [ADDRESS], [OCCUPATION], say on oath/affirmation as follows: + +1. I am a registered medical practitioner with [X] years of post-graduate + experience. I am currently employed as [POSITION] at [INSTITUTION]. + +2. I have been engaged by [PARTY] to provide expert evidence in these + proceedings. I have been provided with [DOCUMENTS] and have conducted + [EXAMINATIONS]. + +3. The facts stated in this affidavit are within my personal knowledge, + except where stated to be on information and belief, in which case I + believe them to be true. +``` + +#### Expert Opinion Paragraphs +``` +4. Based on my examination of [DATE], review of the medical records, and + my professional expertise, I form the following opinions: + +5. [OPINION 1]: In my opinion, [STATEMENT]. I base this opinion on + [FOUNDATION - examination findings, test results, literature]. + +6. [ALTERNATIVES]: I have considered the alternative explanation that + [ALTERNATIVE]. However, I do not accept this because [REASONING]. +``` + +#### Records Authentication +``` +7. I am the [POSITION] at [INSTITUTION] and have custody of the clinical + records maintained by that institution. + +8. The documents annexed hereto and marked "A" are true copies of the + clinical records relating to [PATIENT NAME], DOB [DATE], MRN [NUMBER], + which were made in the ordinary course of business. + +9. I have conducted a thorough search of the records and these documents + constitute the complete clinical record for the period [DATES]. +``` + +### 3. Exhibit Management + +#### Labeling Convention +- **Letters**: Exhibits marked as "A", "B", "C" +- **Continuous Pagination**: Page numbers continue across exhibits +- **Cover Sheet**: Each exhibit has cover sheet with description +- **Certification**: True copy certification where required + +#### Referencing in Text +``` +10. On 15 February 2026, I examined the patient. My examination findings + are documented in my clinical notes, a copy of which is annexed hereto + and marked with the letter "A". + +11. The radiology report (Exhibit "B") shows [FINDINGS]. +``` + +#### Common Exhibit Types +- **Medical Records**: Clinical notes, investigation results +- **Photographs**: Injury documentation (with consent) +- **Correspondence**: Referral letters, consultant reports +- **Investigations**: Lab results, imaging reports +- **Literature**: Research papers supporting opinions +- **CV**: Expert witness curriculum vitae + +### 4. Jurisdiction-Specific Requirements + +#### Australian Federal Court +- **Form 59**: Use prescribed Form 59 +- **Annexures**: Label as "Annexure [Letter] to [Deponent Name]'s Affidavit" +- **Statement of Truth**: "The facts deposed to are true to the best of my knowledge, information, and belief" + +#### New Zealand High Court +- **Form**: Use High Court affidavit form +- **Exhibits**: Label exhibits with letter and description +- **Jurat**: "Sworn/Affirmed at [place] on [date] before me" + +#### US Federal Court +- **Local Rules**: Check district court local rules +- **Notary**: Notarization typically required +- **Certificate of Service**: Often required with filing + +#### EU Cross-Border +- **Apostille**: Hague Apostille for member states +- **Translation**: Certified translation if not in court language +- **Form**: May need to follow requesting state form + +### 5. Common Pitfalls + +#### Drafting Errors +- **Arguments**: Including legal arguments rather than facts +- **Conclusions**: Drawing legal conclusions (e.g., "negligence") +- **Vagueness**: Imprecise dates, times, or descriptions +- **Hearsay**: Improperly including secondhand information + +#### Procedural Errors +- **Wrong Form**: Using incorrect court form +- **Improper Swearing**: Witness not authorized; improper jurat +- **Late Filing**: Missing court deadlines +- **Service Issues**: Not serving on all parties as required + +#### Content Errors +- **Contradictions**: Inconsistencies with prior statements +- **Omissions**: Leaving out relevant unfavorable facts +- **Speculation**: Stating opinions without proper foundation +- **Exceeding Expertise**: Offering opinions outside area of expertise + +### 6. Review and Finalization + +#### Self-Review Checklist +- [ ] All statements are true to my knowledge +- [ ] Personal knowledge distinguished from information/belief +- [ ] Technical terms defined or explained +- [ ] Dates, times, and measurements are accurate +- [ ] Exhibits are properly labeled and referenced +- [ ] No legal arguments or conclusions included +- [ ] Format complies with court rules +- [ ] Signature block and jurat are complete + +#### Legal Review +- Have legal counsel review before swearing +- Ensure compliance with current court rules +- Verify exhibit labeling meets requirements +- Confirm service and filing deadlines + +#### Pre-Swearing Checklist +- [ ] Final draft reviewed by legal counsel +- [ ] All parties agree on contents (if applicable) +- [ ] Exhibits compiled and properly labeled +- [ ] Swearing arrangements made with authorized witness +- [ ] Photo ID ready for identity verification +- [ ] Understanding of oath/affirmation process + +## Common Mistakes + +| Mistake | Why It's Wrong | Instead | +|---------|----------------|---------| +| **Including legal arguments** | Affidavits are for facts, not legal submissions | Present facts objectively; let lawyers make legal arguments | +| **Drawing legal conclusions** | Deponent not qualified to draw legal conclusions | State facts and expert opinions within expertise; e.g., "breach of duty" not appropriate | +| **Failing to distinguish personal knowledge** | May be challenged as inadmissible hearsay | Clearly label personal knowledge vs. information and belief | +| **Improper exhibit labeling** | May cause exhibits to be rejected | Follow court rules precisely for exhibit marking | +| **Swearing incomplete draft** | Cannot amend after swearing without explanation | Ensure affidavit is complete and accurate before swearing | +| **Using wrong jurat form** | Affidavit may be invalid | Use oath or affirmation as appropriate; follow jurisdiction requirements | +| **Unauthorized witness** | Affidavit may not be admissible | Ensure witness is authorized for that jurisdiction and court | +| **Speculating without foundation** | Weakens credibility; may be challenged | Only state opinions with proper foundation; express uncertainty appropriately | +| **Contradicting prior statements** | Undermines credibility; potential perjury | Review prior statements; ensure consistency or explain changes | +| **Including irrelevant material** | Weakens impact; wastes court time | Include only relevant facts; attach additional material as exhibits if needed | + +## When to Escalate + +Escalate to legal counsel, medical defense organization, or senior management when: +- Potential conflict between affidavit and prior statements +- Discovery of error in affidavit after swearing +- Pressure to include statements you believe are untrue +- Uncertainty about jurisdiction-specific requirements +- Complex exhibit management issues +- Cross-border or international enforcement considerations +- Privacy or confidentiality conflicts +- Potential perjury or contempt of court issues +- Significant legal consequences for deponent + +## Privacy Considerations + +- **PHI Involved**: Yes - Affidavits often contain detailed medical information +- **Court Record**: Affidavits become part of public court record (subject to sealing orders) +- **Data Minimization**: Include only information necessary for legal purpose +- **Redaction**: Consider redaction of sensitive information where appropriate +- **Secure Handling**: Maintain security during drafting and before filing +- **Retention**: Retain drafts and working notes according to legal requirements +- **No Persistence**: Do not store PHI in temporary workspaces + +## Confidence Indicators + +| Scenario | Confidence | Action | +|----------|------------|--------| +| Clear facts, straightforward affidavit, legal review obtained | High | Proceed with swearing after legal review | +| Complex expert evidence requiring detailed foundation | Medium | Ensure comprehensive foundation; multiple legal reviews | +| Cross-border or international enforcement | Medium | Consult with international law expertise | +| Potential conflict with prior statements | Low | **BLOCKER**: Review all prior statements; may need supplementary affidavit | +| Pressure to include untrue or misleading statements | Low | **BLOCKER**: Refuse; escalate to legal counsel; consider professional advice | +| Uncertain about jurisdiction-specific requirements | Medium | Obtain definitive legal advice before swearing | +| High-stakes litigation with significant consequences | Medium | Multiple legal reviews; consider peer review of expert content | +| First-time expert witness unfamiliar with process | Medium | Mentorship from experienced expert; thorough preparation | + +## Tool Requirements + +- `~~document collaboration` - For affidavit drafting and review +- `~~legal research` - For jurisdiction-specific requirements +- `~~document management` - For exhibit compilation and organization +- `~~secure storage` - For maintaining confidential drafts +- `~~calendaring` - For tracking filing deadlines +- `~~communication` - For coordination with legal counsel + +## Success Indicators + +You've applied this skill well when: +- [ ] Affidavit complies with applicable court rules +- [ ] All statements are true to the best of your knowledge +- [ ] Personal knowledge properly distinguished from information/belief +- [ ] Expert opinions have proper foundation and reasoning +- [ ] Exhibits are properly labeled, referenced, and organized +- [ ] Jurat completed correctly by authorized witness +- [ ] Legal counsel has reviewed and approved contents +- [ ] Filed and served within required timeframes +- [ ] Language is clear, precise, and free of legal argument +- [ ] Affidavit would withstand scrutiny under cross-examination + +## Related Skills + +- `~~health/medicolegal-reports` - For medico-legal report writing +- `~~health/child-protection` - For child protection affidavits +- `~~health/clinical-documentation` - For general clinical documentation +- `~~legal/contract-review` - For reviewing engagement and terms +- `~~health/capacity-assessment` - For capacity assessment affidavits diff --git a/health/skills/child-protection/SKILL.md b/health/skills/child-protection/SKILL.md new file mode 100644 index 0000000..c6af25f --- /dev/null +++ b/health/skills/child-protection/SKILL.md @@ -0,0 +1,366 @@ +--- +name: health/child-protection +description: This skill should be used when preparing child protection reports, responding to mandatory reporting obligations, conducting risk assessments for children at risk, or writing statutory notifications under child protection legislation. Use for documenting suspected abuse, neglect, or harm to children and adolescents. +version: 1.0.0 +--- + +# Child Protection Reporting + +A comprehensive framework for child protection reporting and risk assessment, supporting healthcare professionals in meeting mandatory reporting obligations while maintaining therapeutic relationships and child-centered practice. This skill addresses the legal, ethical, and clinical complexities of child protection work across Australian, New Zealand, US, and EU jurisdictions. + +**Critical Warning**: Child protection reporting involves legal obligations that vary by jurisdiction. Failure to report suspected child abuse or neglect may constitute a criminal offense in many jurisdictions. This skill provides guidance but does not replace jurisdiction-specific legal advice or organizational policies. + +## When to Use This Skill + +Invoke this skill when: +- Identifying potential indicators of child abuse, neglect, or harm +- Preparing mandatory reports under child protection legislation +- Conducting forensic medical examinations for suspected child abuse +- Writing statutory notifications to child protection authorities +- Assessing risk and protective factors for children in vulnerable situations +- Documenting disclosures of abuse or neglect by children +- Responding to child protection concerns raised by others +- Preparing reports for child protection case conferences or court proceedings +- Navigating confidentiality conflicts between child welfare and family privacy + +## Regulatory Context + +### Australia & New Zealand (Default) + +| Legislation | Relevance | Key Requirements | +|-------------|-----------|------------------| +| **Children and Young Persons (Care and Protection) Act** (NSW) | Mandatory reporting | Doctors, nurses, teachers, police must report risk of harm | +| **Child Wellbeing and Safety Act** (VIC) | Mandatory reporting + voluntary reporting | Broader range of professionals; reportable conduct scheme | +| **Child Protection Act** (QLD) | Mandatory reporting | Health professionals must report suspected harm | +| **Children, Young Persons, and Their Families Act** (NZ) | Care and protection | Section 15: duty to report; family/whanau focus | +| **Child Protection (Working with Children) Act** (Various) | WWCC requirements | Mandatory checks for child-related work | +| **Family Law Act** (Cth) | Family court proceedings | Best interests of child; independent children's lawyer | + +### US/EU-lite Fallback + +| Legislation | Relevance | Key Requirements | +|-------------|-----------|------------------| +| **CAPTA** (Child Abuse Prevention and Treatment Act) (US) | Federal standards | Mandatory reporting by designated professionals | +| **State Mandatory Reporting Laws** (US) | State-specific requirements | Vary by state; who must report; what triggers reporting | +| **GDPR** (EU) | Child data protection | Enhanced protections for children; parental consent | +| **EU Child Protection Directives** | Cross-border cooperation | Information exchange; protective measures | + +### Jurisdiction Matrix + +| Jurisdiction | Applicable Regulator | Reporting Trigger | Timeframe | Required Artifacts | Escalation Point | +|--------------|---------------------|-------------------|-----------|-------------------|------------------| +| **AU - NSW** | Family and Community Services (FACS) | Risk of significant harm | Immediate | Mandatory Reporter Guide completion; electronic report | Child Protection Helpline: 132 111 | +| **AU - VIC** | DHHS Child Protection | Belief on reasonable grounds | As soon as practicable | Report to Child Protection or Child FIRST | After Hours: 13 12 78 | +| **AU - QLD** | Child Safety Services | Reasonable suspicion of harm | Immediate if significant risk | Notification to Child Safety | Child Safety: 1800 177 135 | +| **NZ** | Oranga Tamariki | Grounds for care/protection | As soon as practicable | Section 15 report | Contact Centre: 0508 326 459 | +| **US** | State CPS Agency | Reasonable suspicion | Varies by state (immediate to 24-48hrs) | State-specific reporting form | State Child Abuse Hotline | +| **EU** | National Child Protection Services | Varies by member state | As required by national law | National reporting procedures | National hotline | + +## Mandatory Reporting Triggers + +### Physical Abuse Indicators +- **Bruising**: Patterned bruises (handprints, belt marks); bruises in non-mobile infants; multiple bruises at various stages of healing +- **Fractures**: Multiple fractures; fractures inconsistent with history; metaphyseal fractures in infants +- **Burns**: Cigarette burns; immersion burns (stocking/glove distribution); patterned burns +- **Other**: Internal injuries without adequate explanation; bite marks; retinal hemorrhages + +### Sexual Abuse Indicators +- **Physical Signs**: Genital trauma; STIs in prepubertal children; pregnancy in young adolescents +- **Behavioral Signs**: Sexualized behavior inappropriate for age; regression; fear of specific people +- **Disclosures**: Direct disclosure; indirect disclosure; prompted by anatomical dolls +- **Contextual**: Delayed presentation; inconsistent explanations; history of previous concerns + +### Neglect Indicators +- **Physical**: Failure to thrive; malnutrition; inadequate hygiene; untreated medical conditions +- **Developmental**: Developmental delays; poor school attendance; lack of supervision +- **Environmental**: Unsafe home environment; exposure to hazards; lack of basic necessities +- **Medical**: Repeated non-attendance at appointments; untreated chronic conditions + +### Emotional Abuse Indicators +- **Parental Behaviors**: Persistent criticism; rejection; exposure to domestic violence; substance misuse +- **Child Indicators**: Low self-esteem; depression; anxiety; self-harm; developmental regression +- **Attachment**: Indiscriminate attachment; avoidant attachment; parentification + +### Risk Factors (Cumulative Assessment) +- Parental substance misuse or mental illness +- Domestic and family violence +- Parental history of childhood abuse +- Social isolation or lack of support +- Poverty and housing instability +- Parental criminality or incarceration +- Unwanted pregnancy or multiple children +- Prematurity or child with special needs + +## Quick Reference + +1. **When in Doubt, Report**: Better to over-report than miss a child at risk +2. **Document Thoroughly**: Detailed contemporaneous notes are essential +3. **Preserve Evidence**: Don't wash child; photograph injuries with consent +4. **Support the Child**: Maintain therapeutic relationship while meeting legal obligations +5. **Safety First**: Immediate safety concerns override confidentiality +6. **Multi-Agency**: Collaborate with child protection, police, education +7. **Family Inclusion**: Include family/whanau in planning where safe +8. **Cultural Safety**: Consider cultural context; involve cultural supports +9. **Follow Up**: Track outcomes of reports; remain involved in care +10. **Self-Care**: Vicarious trauma is real; seek support when needed + +## Operating Modes + +### Standard Mode +Comprehensive child protection assessment with full risk assessment, multi-agency coordination, detailed documentation, and formal statutory reporting. Required for suspected significant harm, sexual abuse, or complex multi-factorial risk situations. Includes: +- Complete forensic medical examination documentation +- Detailed risk and protective factor analysis +- Multi-agency information sharing +- Comprehensive statutory report +- Court preparation if required + +### Lite Mode +Streamlined guidance for clear-cut mandatory reporting situations or urgent safety concerns. Suitable for straightforward cases with unambiguous indicators. Includes: +- Immediate safety assessment +- Essential documentation +- Mandatory report completion +**Limitations**: Never use Lite mode for complex risk assessments, sexual abuse examinations, or cases requiring forensic evidence collection. + +## Detailed Guidance + +### 1. Immediate Safety Assessment + +#### Step 1: Triage +- **Immediate Danger**: Is the child in immediate danger of serious harm? +- **Medical Priority**: Does the child need urgent medical treatment? +- **Placement**: Is the child safe to return home? + +#### Step 2: Immediate Actions +- **Medical Needs**: Treat urgent medical conditions first +- **Safety Planning**: If child not safe to return home, discuss with child protection +- **Evidence Preservation**: Photograph visible injuries; collect specimens before washing +- **Documentation**: Record exact words used by child; do not paraphrase + +#### Step 3: Consultation +- **Senior Clinician**: Consult with senior colleague or child protection team +- **Child Protection**: Contact child protection services for urgent cases +- **Police**: For criminal matters (sexual abuse, serious physical abuse) +- **Legal**: For complex confidentiality or consent issues + +### 2. Documentation Requirements + +#### Contemporaneous Notes (CRITICAL) +- **Date and Time**: When disclosure was made or concerns identified +- **Exact Words**: Record child's exact words in quotation marks +- **Context**: Who was present; how disclosure came about +- **Non-Verbal**: Child's affect, behavior, body language +- **Physical**: Any visible injuries; child's explanation; your observations +- **Medical**: Examination findings; investigations ordered + +**Example**: +> "At 14:30 on 15/02/2026, while alone with me during examination, Patient stated: 'Daddy hits me with the belt when he's angry.' Patient demonstrated by striking own thigh with fist. Patient appeared frightened, made eye contact briefly, then looked at floor." + +#### Report Structure (Statutory Notification) + +**Section 1: Child Identification** +- Full name, date of birth, address +- School or childcare attended +- Current whereabouts and caregivers +- Cultural background; ATSI status (AU); ethnicity (NZ) + +**Section 2: Nature of Concerns** +- Type of abuse/neglect suspected (physical, sexual, emotional, neglect) +- Specific indicators observed or disclosed +- Timeframe of concerns (acute, chronic, historical) +- Severity assessment + +**Section 3: Risk Assessment** +- Risk factors present (parental, environmental, child-specific) +- Protective factors identified +- Previous child protection history +- Immediate safety concerns + +**Section 4: Source of Information** +- Who provided information (child, parent, professional) +- Consent for disclosure (if applicable) +- Documents reviewed (medical records, school reports) + +**Section 5: Actions Taken** +- Medical treatment provided +- Safety planning implemented +- Agencies notified +- Family involvement + +### 3. Forensic Medical Examination + +#### Preparation +- **Consent**: Obtain appropriate consent (child, parent, or authority) +- **Explanation**: Explain examination to child in age-appropriate language +- **Chaperone**: Appropriate chaperone present (parent, nurse, social worker) +- **Equipment**: Colposcope (for sexual abuse), camera, documentation forms + +#### Documentation +- **Body Diagrams**: Mark location, size, color, pattern of injuries +- **Photography**: Photograph injuries with scale; ensure good lighting +- **Chain of Custody**: Proper handling of forensic specimens +- **Timing**: Document time since alleged incident (healing implications) + +#### Specimen Collection +- **Sexual Assault**: Forensic medical examination within 72 hours (ideally 24) +- **STI Testing**: As appropriate for age and history +- **Toxicology**: If substance-facilitated assault suspected +- **Chain of Custody**: Maintain integrity for legal proceedings + +### 4. Mandatory Reporting Process + +#### Step 1: Decision to Report +- **Threshold**: Do you have reasonable grounds/belief/risk of harm? +- **Jurisdiction**: Know your jurisdiction's specific threshold +- **Consultation**: Discuss with senior colleague if uncertain + +#### Step 2: Gather Information +- **Child's Details**: Full name, DOB, address, contact numbers +- **Parent/Caregiver**: Names and contact details +- **Concerns**: Specific details of abuse/neglect indicators +- **Urgency**: Level of immediate risk + +#### Step 3: Make the Report +- **Phone**: For urgent cases, phone child protection first +- **Online**: Many jurisdictions have online reporting portals +- **Written**: Follow up phone report with written notification +- **Police**: Simultaneous police notification for criminal matters + +#### Step 4: Document +- **Report Reference**: Record reference number provided by child protection +- **Details**: Record who you spoke to; date and time; advice received +- **Follow-up**: Document any follow-up actions required + +### 5. Confidentiality and Information Sharing + +#### Legal Basis for Disclosure +- **Mandatory Reporting Laws**: Override usual confidentiality +- **Child Protection Proceedings**: Information sharing permitted under legislation +- **Public Interest**: Protection of child overrides confidentiality + +#### What to Share +- **Relevant**: Only information relevant to child protection concerns +- **Accurate**: Factual information; distinguish observation from opinion +- **Timely**: Share information promptly to enable protective action +- **Secure**: Use secure methods for transmission + +#### What Not to Share +- **Irrelevant**: Personal information not relevant to risk assessment +- **Speculation**: Avoid speculation about parents' motives or character +- **Unverified**: Clearly label unverified information + +### 6. Working with Families + +#### Informing Parents +- **Safety First**: Do not inform parents if it would endanger the child +- **Collaboration**: Where safe, involve parents in planning +- **Explanation**: Explain why report is being made (in general terms) +- **Support**: Provide information about support services + +#### Managing Relationships +- **Therapeutic Alliance**: Maintain therapeutic relationship with child +- **Boundaries**: Maintain professional boundaries with parents +- **Safety**: Prioritize child safety over family harmony +- **Cultural**: Work with cultural supports and interpreters + +#### Resistance and Hostility +- **De-escalation**: Remain calm and professional +- **Safety**: Ensure physical safety of staff +- **Documentation**: Document threats or intimidation +- **Support**: Involve security or police if necessary + +### 7. Court Proceedings + +#### Report Writing for Court +- **Factual**: Focus on factual observations +- **Expert**: Offer expert opinion only within expertise +- **Child-Focused**: Center on child's best interests +- **Balanced**: Present balanced view including protective factors + +#### Giving Evidence +- **Preparation**: Review notes; understand legal process +- **Child-Centered**: Remember child may read transcript +- **Clarity**: Use clear, non-technical language +- **Honesty**: Acknowledge limitations and uncertainties + +## Common Mistakes + +| Mistake | Why It's Wrong | Instead | +|---------|----------------|---------| +| **Delaying report to gather more information** | Child may remain at risk during delay; may lose forensic evidence | Report immediately based on current concerns; further information can be added later | +| **Paraphrasing child's words** | Changes meaning; may be inadmissible; loses impact | Record child's exact words in quotation marks | +| **Promising confidentiality you cannot keep** | Breaches trust; may inhibit future disclosures | Explain mandatory reporting obligations upfront | +| **Leading questions in interview** | Contaminates evidence; child may acquiesce | Use open-ended questions; "Tell me what happened" | +| **Conducting detailed forensic interview** | May compromise evidence; outside clinical role | Document what child volunteers; refer to specialist interviewers | +| **Not documenting non-verbal behavior** | Important context is lost | Document affect, behavior, body language | +| **Failing to consider cultural context** | Misinterprets normal cultural practices as abuse | Consult with cultural advisors; consider cultural background | +| **Making diagnoses without evidence** | Opinions may be challenged; inappropriate certainty | Describe observed indicators; express appropriate uncertainty | +| **Not following up on report** | Child may fall through cracks; lose opportunity to support | Track report outcomes; remain engaged in care | +| **Vicarious trauma without support** | Impairs clinical judgment; leads to burnout | Seek peer support; utilize supervision; practice self-care | + +## When to Escalate + +Escalate immediately to senior clinician, child protection services, or police when: +- Child discloses ongoing sexual abuse or severe physical abuse +- Child is in immediate danger and cannot be protected +- Parent threatens violence toward child or staff +- Multiple agencies involved with conflicting recommendations +- Suspected fabricated or induced illness (Munchausen by proxy) +- Serious criminal matters (sexual abuse, serious assault, child homicide) +- Child expresses suicidal intent or self-harm +- Reported matter involves institutional abuse +- Jurisdictional issues (interstate or international child protection matters) +- You are uncertain about mandatory reporting threshold + +## Privacy Considerations + +- **PHI Involved**: Yes - Child protection reports contain highly sensitive personal and health information +- **Data Minimization**: Include only information necessary for child protection assessment +- **Secure Transmission**: Use secure reporting portals or encrypted communication +- **Access Controls**: Limit access to those with legitimate child protection role +- **Retention**: Maintain records according to child protection legislation and organizational policy (typically until child reaches 25 years) +- **Cross-Border**: Special considerations for international child protection matters +- **No Persistence**: Do not store sensitive child protection information in temporary workspaces + +## Confidence Indicators + +| Scenario | Confidence | Action | +|----------|------------|--------| +| Clear disclosure from child; consistent history | High | Report immediately; ensure safety; document thoroughly | +| Multiple indicators but no direct disclosure | Medium | Consult with senior; gather collateral information; likely report | +| Single concerning indicator; may be innocent | Medium | Monitor closely; consult with senior; document carefully | +| Uncertain about threshold for reporting | Medium | **ALWAYS REPORT** when in doubt; better safe than sorry | +| Child requests confidentiality; safety concerns | Low | **BLOCKER**: Mandatory reporting obligation overrides confidentiality | +| Suspected serious abuse (sexual, severe physical) | High | Immediate report to child protection AND police | +| Fabricated illness suspected | Low | **BLOCKER**: Requires specialist assessment; involve senior clinicians | +| Cultural practices being misinterpreted | Medium | Consult with cultural advisors; ensure cultural safety | + +## Tool Requirements + +- `~~document collaboration` - For report drafting +- `~~health/clinical-systems` - For accessing medical records +- `~~legal research` - For jurisdiction-specific reporting requirements +- `~~secure storage` - For maintaining confidential records +- `~~photography/documentation` - For injury documentation +- `~~communication` - For secure communication with child protection + +## Success Indicators + +You've applied this skill well when: +- [ ] Child's immediate safety has been assessed and addressed +- [ ] Mandatory report made within required timeframe +- [ ] Detailed contemporaneous documentation completed +- [ ] Child's exact words recorded accurately +- [ ] Evidence preserved appropriately (photographs, specimens) +- [ ] Family involved appropriately (where safe) +- [ ] Multi-agency coordination established +- [ ] Cultural considerations addressed +- [ ] Professional boundaries maintained +- [ ] Appropriate follow-up and ongoing engagement maintained + +## Related Skills + +- `~~health/medicolegal-reports` - For medico-legal aspects of child protection +- `~~health/affidavit-drafting` - For preparing affidavits for child protection proceedings +- `~~health/forensic-examination` - For detailed forensic medical examination guidance +- `~~health/mental-health-assessment` - For child and adolescent mental health assessments +- `~~health/clinical-documentation` - For general clinical documentation standards diff --git a/health/skills/clinical-doc-coauthoring/SKILL.md b/health/skills/clinical-doc-coauthoring/SKILL.md new file mode 100644 index 0000000..a785288 --- /dev/null +++ b/health/skills/clinical-doc-coauthoring/SKILL.md @@ -0,0 +1,721 @@ +--- +name: health/clinical-doc-coauthoring +description: This skill should be used when collaboratively developing clinical documents requiring precision, regulatory compliance, and multi-stakeholder review. Use for clinical protocols, care pathways, practice guidelines, HTA submissions, evidence summaries, and position statements. Invoked when users mention co-authoring, document development, clinical writing, multi-stakeholder review, evidence synthesis, or guideline creation. +version: 1.0.0 +--- + +# Clinical Document Co-authoring + +A comprehensive framework for three-stage collaborative development of clinical and regulatory documents. This skill guides document teams through structured workflows that ensure clinical accuracy, regulatory compliance, evidence integrity, and stakeholder alignment. + +**Important**: This skill assists with document development workflows but does not replace clinical judgment, regulatory expertise, or institutional approval processes. Always verify compliance with local regulatory requirements and obtain appropriate sign-offs before publication or implementation. + +## When to Use This Skill + +Invoke this skill when: +- Developing clinical protocols or procedures requiring stakeholder input. +- Creating care pathways with multi-disciplinary team involvement. +- Drafting clinical practice guidelines with evidence synthesis. +- Preparing health technology assessment (HTA) submissions. +- Writing NHMRC evidence summaries or position statements. +- Collaborating on regulatory submissions (TGA, FDA, etc.). +- Producing patient information materials with clinical accuracy requirements. +- Developing educational resources for healthcare professionals. +- Creating institutional policies with clinical implications. +- Any document requiring structured review cycles and evidence grading. + +## Regulatory Context + +### Australia & New Zealand (Default) + +| Regulation/Standard | Relevance | Key Requirements | +|---------------------|-----------|------------------| +| **NHMRC Guidelines** | Evidence-based documents | Standardized evidence grading (A-D, GPP); systematic review requirements | +| **TGA Guidelines** | Regulatory submissions | Clinical evidence requirements; format specifications; safety reporting | +| **NSQHS Standards** | Clinical protocols | Governance for clinical documentation; version control; approval workflows | +| **Medical Board of Australia** | Professional practice | Guidelines for medical practitioners; scope of practice statements | +| **NZ Ministry of Health** | National guidance | Te Tiriti o Waitangi considerations; equity and accessibility requirements | +| **State/Territory Health Acts** | Jurisdiction-specific | Mandatory consultation periods; approval authorities | + +### US/EU-lite Fallback + +| Regulation/Standard | Relevance | Key Requirements | +|---------------------|-----------|------------------| +| **FDA Guidelines** (US) | Regulatory submissions | Good Clinical Practice (GCP); 21 CFR Part 11 documentation | +| **IOM Standards** (US) | Clinical guidelines | Trustworthy guidelines criteria; systematic review mandate | +| **EMA Guidelines** (EU) | Regulatory documents | Common Technical Document (CTD) format; pharmacovigilance requirements | +| **GRADE Working Group** | International | Evidence-to-decision frameworks; certainty of evidence ratings | + +### Jurisdiction Matrix + +| Jurisdiction | Applicable Regulator | Reporting Trigger | Timeframe | Required Artifacts | Escalation Point | +|--------------|---------------------|-------------------|-----------|-------------------|------------------| +| **AU - National** | NHMRC/Medical Board | Clinical guideline publication | 6-12 months | Evidence review; conflict of interest declarations | Committee Chair | +| **AU - TGA** | Therapeutic Goods Admin | Product registration submission | Varies by class | Clinical evidence package; risk assessment | Regulatory Affairs | +| **NZ** | Ministry of Health | National guidance document | 3-6 months | Consultation responses; equity impact assessment | Guideline Lead | +| **US** | FDA/Professional Societies | Clinical practice guideline | 12-24 months | Systematic review; public comment responses | Guideline Panel Chair | +| **EU** | EMA/Competent Authority | Marketing authorization | Varies | Module 5 clinical overview; risk management plan | EU Regulatory Lead | + +## Quick Reference + +1. **Define Scope**: Document type, target audience, regulatory requirements. +2. **Assemble Team**: Clinical lead, methodologist, medical writer, stakeholders. +3. **Stage 1 - Development**: Purpose, evidence base, initial draft, stakeholder mapping. +4. **Stage 2 - Review**: Clinical accuracy, regulatory compliance, citation grading, iterative feedback. +5. **Stage 3 - Finalization**: Reader testing, accessibility review, approval workflow. +6. **Evidence Grading**: Apply NHMRC levels (A-D) or GRADE to all clinical claims. +7. **Citations**: Every clinical claim requires verifiable reference. +8. **Conflict of Interest**: Declare and manage all competing interests. +9. **Version Control**: Track all changes with attribution and timestamps. +10. **Final Sign-off**: Obtain approvals from authorized signatories before release. + +## Operating Modes + +### Standard Mode +Full three-stage collaborative workflow with complete evidence capture, systematic stakeholder review cycles, regulatory compliance verification, and formal approval processes. Use for clinical guidelines, HTA submissions, regulatory documents, and any publication-bound materials. Includes comprehensive reader testing and accessibility review. + +### Lite Mode +Streamlined two-stage workflow (Development → Finalization) for internal documents, rapid guidance updates, or time-critical materials. Retains mandatory citation requirements and clinical review but reduces stakeholder consultation scope and reader testing. Never suppress high-risk escalation requirements or conflict of interest declarations. + +## Detailed Guidance + +### The Three-Stage Workflow + +All clinical document development follows a structured three-stage process designed to ensure quality, accuracy, and stakeholder alignment. + +--- + +### Stage 1: Context Gathering & Development + +**Objective**: Establish document foundation including purpose, scope, evidence base, and stakeholder requirements. + +#### 1.1 Purpose and Scope Definition + +**Document Purpose Statement**: +- Primary objective: What is the document intended to achieve? +- Target audience: Who will use this document? (clinicians, patients, administrators, regulators) +- Clinical context: In what settings will this document apply? +- Outcomes: What decisions or actions should result from this document? + +**Scope Boundaries**: +- Population: Who is included/excluded? +- Setting: Where does this apply? (tertiary, community, primary care) +- Interventions: What treatments, tests, or procedures are covered? +- Outcomes: What endpoints are considered? +- Timeframe: Is this interim or long-term guidance? + +**Document Type Selection**: + +| Document Type | Purpose | Evidence Requirement | Review Intensity | +|---------------|---------|---------------------|------------------| +| **Clinical Protocol** | Standardize care processes | Moderate (institutional evidence) | Standard | +| **Care Pathway** | Guide patient journey | High (pathway-specific evidence) | Standard | +| **Clinical Practice Guideline** | Evidence-based recommendations | Very High (systematic review) | Intensive | +| **HTA Submission** | Support funding/reimbursement | Very High (cost-effectiveness) | Intensive | +| **Evidence Summary** | Synthesize research findings | High (review of reviews) | Standard | +| **Position Statement** | State organizational stance | Moderate (expert consensus) | Standard | +| **Patient Information** | Educate patients/families | Moderate (plain language focus) | Standard | +| **Policy Document** | Govern organizational practice | Low-Moderate (compliance focus) | Standard | + +#### 1.2 Target Audience Analysis + +**Audience Segmentation**: +- **Primary Audience**: Main users of the document (e.g., emergency physicians) +- **Secondary Audience**: Occasional users or implementers (e.g., nurses, administrators) +- **Tertiary Audience**: Interested parties (e.g., patients, policymakers) + +**Audience Needs Assessment**: +- Clinical decision-making requirements +- Knowledge prerequisites +- Resource and setting constraints +- Preferred format and length +- Language and literacy considerations + +**Persona Development**: +- Create 2-3 representative user personas +- Document their goals, constraints, and pain points +- Test content against persona scenarios + +#### 1.3 Regulatory Requirements Assessment + +**Applicable Standards**: +- Clinical standards (NHMRC, IOM, SIGN, NICE) +- Regulatory requirements (TGA, FDA, EMA) +- Accreditation standards (NSQHS, Joint Commission) +- Organizational policies and procedures + +**Compliance Checkpoints**: +- Required consultation periods +- Mandatory review authorities +- Conflict of interest disclosures +- Public comment requirements +- Approval signatures needed + +#### 1.4 Evidence Base Assessment + +**Evidence Inventory**: +- Systematic reviews and meta-analyses +- Randomized controlled trials +- Cohort and case-control studies +- Case series and expert opinion +- Existing guidelines and protocols + +**Evidence Quality Evaluation**: +- Currency: When was the evidence published? +- Relevance: Does it apply to the target population/setting? +- Validity: Are the study methods rigorous? +- Applicability: Can findings be implemented in practice? + +#### 1.5 Stakeholder Mapping + +**Stakeholder Identification**: +- Clinical stakeholders (specialty colleges, professional associations) +- Consumer representatives (patients, carers, advocacy groups) +- Administrative stakeholders (hospital executives, department heads) +- Regulatory stakeholders (TGA, state health departments) +- Other affected parties (industry, insurers) + +**Stakeholder Analysis Matrix**: + +| Stakeholder | Interest | Influence | Engagement Strategy | +|-------------|----------|-----------|---------------------| +| [Name/Group] | High/Low | High/Low | [Consult/Inform/Partner] | + +**Engagement Planning**: +- Consultation methods (survey, interview, focus group, workshop) +- Timeline for stakeholder input +- Mechanisms for feedback incorporation +- Communication channels and protocols + +#### 1.6 Initial Draft Development + +**Document Structure**: +1. **Title Page**: Document title, version, date, authors, approving body +2. **Executive Summary**: Key recommendations in 1-2 pages +3. **Introduction**: Background, purpose, scope, target audience +4. **Methods**: Evidence search strategy, selection criteria, grading approach +5. **Recommendations**: Numbered, graded, with rationale and evidence +6. **Implementation**: Resources required, training needs, monitoring +7. **Review Schedule**: Date for next review and triggers for early review +8. **References**: Full citations with evidence grading +9. **Appendices**: Supporting materials, tools, templates +10. **Conflict of Interest**: Declarations from all contributors + +**Drafting Principles**: +- Use active voice and present tense +- Write for the target audience's knowledge level +- One recommendation per sentence +- Avoid ambiguous terms ("consider," "may") unless uncertainty is genuine +- Include strength of recommendation (strong/weak/conditional) + +--- + +### Stage 2: Review & Refinement + +**Objective**: Ensure clinical accuracy, regulatory compliance, evidence integrity, and stakeholder alignment through iterative review cycles. + +#### 2.1 Clinical Accuracy Review + +**Clinical Review Panel**: +- Subject matter experts from relevant specialties +- Frontline clinicians who will use the document +- Methodologists for evidence interpretation +- Consumer representatives for patient perspective + +**Review Checklist**: +- [ ] Recommendations align with current evidence +- [ ] Clinical scenarios are realistic and comprehensive +- [ ] Contraindications and precautions are identified +- [ ] Drug dosages and administration details are correct +- [ ] Diagnostic criteria are accurate and current +- [ ] Risk stratification is appropriate +- [ ] Complications and adverse events are addressed +- [ ] Follow-up and monitoring guidance is practical + +**Clinical Safety Check**: +- Identify any recommendations that could cause patient harm if misapplied +- Flag areas requiring special expertise or training +- Ensure appropriate caveats and limitations are stated +- Verify emergency protocols and escalation pathways + +#### 2.2 Regulatory Compliance Check + +**Compliance Verification**: +- [ ] Document meets applicable regulatory standards +- [ ] Required approval authorities are identified +- [ ] Consultation requirements are satisfied +- [ ] Conflict of interest declarations are complete +- [ ] Patient safety requirements are addressed +- [ ] Privacy and consent considerations are included +- [ ] Version control and document history are maintained + +**Jurisdiction-Specific Checks**: +- **AU**: TGA requirements, state health department guidelines, NHMRC standards +- **NZ**: Ministry of Health requirements, Te Tiriti considerations +- **US**: FDA requirements, Joint Commission standards, state licensing boards +- **EU**: EMA guidelines, country-specific competent authority requirements + +#### 2.3 Evidence Grading Application + +**NHMRC Evidence Hierarchy**: + +| Level | Description | Study Types | +|-------|-------------|-------------| +| **I** | Excellent | Systematic review of RCTs; individual RCT with narrow confidence interval | +| **II** | Good | Systematic review of cohort studies; individual cohort study or low-quality RCT | +| **III-1** | Satisfactory | Systematic review of case-control studies; individual case-control study | +| **III-2** | Adequate | Cohort or case-control study with high risk of bias; ecological studies | +| **III-3** | Limited | Case series; case reports; cross-sectional studies | +| **IV** | Expert Opinion | Expert opinion based on clinical experience; physiological/bench research | +| **GPP** | Good Practice Point | Consensus-based recommendations when evidence insufficient | + +**GRADE Evidence Quality Ratings**: + +| Quality Level | Interpretation | Symbol | +|---------------|----------------|--------| +| **High** | Very confident true effect lies close to estimate | ⊕⊕⊕⊕ | +| **Moderate** | Moderately confident; true effect likely close to estimate | ⊕⊕⊕○ | +| **Low** | Limited confidence; true effect may be substantially different | ⊕⊕○○ | +| **Very Low** | Very little confidence; true effect likely substantially different | ⊕○○○ | + +**Evidence Grading Process**: +1. Assign initial level based on study design (NHMRC) or quality assessment (GRADE) +2. Rate down for risk of bias, inconsistency, indirectness, imprecision, publication bias +3. Rate up for large effect, dose-response, plausible confounders would reduce effect +4. Document rationale for final grade + +#### 2.4 Citation Requirements for Clinical Claims + +**Mandatory Citation Rule**: Every clinical claim must be supported by a verifiable reference. + +**Claim Categories Requiring Citations**: +- Statistical claims ("50% of patients experience...") +- Treatment efficacy ("Drug X reduces mortality by...") +- Diagnostic accuracy ("Test Y has 90% sensitivity...") +- Risk factors ("Smoking increases risk of...") +- Prevalence/incidence ("Condition Z affects 1 in 100...") +- Clinical outcomes ("Procedure A results in...") + +**Citation Format**: +- Use Vancouver referencing style for clinical documents +- Include DOI where available +- Format: Author(s). Title. Journal. Year;Volume(Issue):Pages. DOI +- For online sources: Include access date and URL + +**Citation Quality Standards**: +- Prefer peer-reviewed sources over grey literature +- Prioritize systematic reviews and meta-analyses +- Use primary sources rather than secondary citations +- Ensure citations are current (generally <5 years, except for seminal studies) +- Verify all citations before finalization + +**Citation Management**: +- Use reference management software (EndNote, Zotero, Mendeley) +- Maintain master reference library +- Track evidence-to-recommendation mapping +- Document excluded studies with rationale + +#### 2.5 Iterative Stakeholder Feedback + +**Review Rounds**: +- **Round 1**: Expert panel review (clinical and methodological) +- **Round 2**: Expanded stakeholder review (broader clinical community) +- **Round 3**: Public/consumer consultation (where required) +- **Round 4**: Final approval body review + +**Feedback Management Process**: +1. Distribute document with structured feedback form +2. Set clear deadline for responses (typically 2-4 weeks) +3. Collate all feedback in tracking spreadsheet +4. Review team assesses each comment +5. Accept, modify, or reject with documented rationale +6. Communicate decisions to stakeholders +7. Revise document based on accepted feedback + +**Stakeholder Feedback Template**: + +| Section | Comment | Submitter | Response | Action | Rationale | +|---------|---------|-----------|----------|--------|-----------| +| [Reference] | [Comment text] | [Name/Org] | [Accepted/Rejected/Modified] | [Change made] | [Why] | + +**Conflict Resolution**: +- When stakeholders disagree, convene discussion meeting +- Document areas of consensus and persistent disagreement +- Consider voting for unresolved issues (document dissenting views) +- Escalate to higher authority if consensus cannot be reached + +--- + +### Stage 3: Reader Testing & Finalization + +**Objective**: Validate document usability, comprehension, and implementation feasibility with target audience before final approval. + +#### 3.1 Target Audience Review + +**Reader Testing Cohorts**: +- Representative users from target audience +- Mixed experience levels (novice to expert) +- Various settings (if applicable) +- Consumer representatives (for patient-facing documents) + +**Testing Methods**: +- **Comprehension Testing**: Can readers understand key messages? +- **Usability Testing**: Can readers find and apply information? +- **Implementation Testing**: Can readers operationalize recommendations? +- **Acceptability Testing**: Do readers find the document acceptable? + +#### 3.2 Comprehension Testing Methodology + +**The Think-Aloud Protocol**: +1. Provide document section to reader +2. Ask reader to verbalize their thinking as they read +3. Note confusion points, misinterpretations, or questions +4. Do not correct or guide during test +5. Debrief afterward to understand reasoning + +**Comprehension Questions**: +- What is the main recommendation in this section? +- Under what circumstances would you apply this guidance? +- What are the key contraindications? +- How would you explain this to a patient/colleague? + +**Success Criteria**: +- ≥80% of readers correctly identify main recommendations +- ≤20% have significant comprehension errors +- No safety-critical misinterpretations +- Average reading time acceptable for document length + +#### 3.3 Implementation Feasibility Testing + +**Feasibility Assessment**: +- **Resource Requirements**: Are necessary resources available? +- **Workflow Integration**: Can recommendations be integrated into practice? +- **Training Needs**: Is required training available and adequate? +- **Barriers**: What obstacles exist to implementation? + +**Pilot Testing**: +- Select 1-2 sites for document pilot +- Monitor implementation over defined period +- Collect feedback on practical application +- Document adaptations required for local context + +**Implementation Tools**: +- Quick reference guides +- Decision algorithms/flowcharts +- Checklists and forms +- Training materials +- Audit tools + +#### 3.4 Accessibility Review + +**Health Literacy Assessment**: +- **Patient Materials**: Target grade 6-8 reading level +- **Professional Materials**: Target grade 10-12 reading level +- **Plain Language**: Use simple words, short sentences, active voice +- **Visual Design**: Clear headings, bullet points, white space + +**Cultural Safety**: +- Consider cultural appropriateness for target populations +- Include culturally diverse perspectives in development +- Address health equity implications +- Use inclusive and respectful language + +**Accessibility Standards**: +- Comply with Web Content Accessibility Guidelines (WCAG 2.1) for digital documents +- Provide alternative formats (large print, audio, Easy Read) +- Ensure screen reader compatibility +- Test with users who have disabilities + +#### 3.5 Final Approval Workflow + +**Approval Hierarchy**: + +| Document Type | First Approval | Second Approval | Final Approval | +|---------------|----------------|-----------------|----------------| +| Clinical Protocol | Specialty Lead | Clinical Director | Medical Advisory Committee | +| Care Pathway | Pathway Working Group | Quality Committee | Executive | +| Clinical Guideline | Guideline Committee | Professional Society | Board/Council | +| HTA Submission | HTA Team | Clinical Evidence Committee | Funding Decision Body | +| Position Statement | Drafting Committee | Executive | Board | + +**Approval Documentation**: +- [ ] All review comments addressed or documented +- [ ] Conflict of interest declarations signed +- [ ] Evidence grading completed and verified +- [ ] Citations checked for accuracy +- [ ] Version history complete +- [ ] Approval signatures obtained +- [ ] Publication authorization granted + +**Final Checks**: +- Proofread for spelling, grammar, and formatting +- Verify all cross-references and hyperlinks +- Check tables, figures, and appendices +- Ensure consistent terminology throughout +- Confirm document metadata (version, date, status) + +--- + +### Document Type Templates + +#### Clinical Protocol Template + +``` +TITLE: [Condition/Procedure] Protocol +VERSION: X.X +DATE: DD/MM/YYYY +STATUS: [Draft/Review/Approved] + +1. PURPOSE + [Statement of intent and objectives] + +2. SCOPE + [Population, setting, exclusions] + +3. DEFINITIONS + [Key terms and abbreviations] + +4. CLINICAL INDICATIONS + [When to use this protocol] + +5. CONTRAINDICATIONS AND PRECAUTIONS + [When NOT to use; special cautions] + +6. PROCEDURE/PROCESS + [Step-by-step instructions] + +7. MEDICATIONS/DOSAGES (if applicable) + [Drug names, doses, routes, frequencies] + +8. MONITORING AND FOLLOW-UP + [Assessment parameters, frequency, criteria for escalation] + +9. DOCUMENTATION REQUIREMENTS + [What must be recorded] + +10. QUALITY INDICATORS + [Metrics for protocol adherence and outcomes] + +11. REFERENCES + [Citations with evidence grades] + +12. REVIEW HISTORY + [Version, date, changes, approver] + +APPENDICES + [Forms, tools, patient information] +``` + +#### Clinical Practice Guideline Template + +``` +TITLE: [Topic] Clinical Practice Guideline +VERSION: X.X +DATE: DD/MM/YYYY +SPONSOR: [Organization] + +EXECUTIVE SUMMARY + [Key recommendations in table format] + +1. INTRODUCTION + 1.1 Background + 1.2 Purpose and Objectives + 1.3 Target Audience + 1.4 Scope (Inclusions/Exclusions) + +2. METHODS + 2.1 Guideline Development Group + 2.2 Evidence Search Strategy + 2.3 Study Selection Criteria + 2.4 Evidence Grading Approach + 2.5 Conflict of Interest Management + +3. RECOMMENDATIONS + [Numbered recommendations with: + - Recommendation strength + - Evidence grade + - Rationale + - Key evidence citations + - Implementation considerations] + +4. IMPLEMENTATION + 4.1 Barriers and Facilitators + 4.2 Resource Implications + 4.3 Audit and Quality Indicators + 4.4 Tools and Materials + +5. UPDATING + 5.1 Review Schedule + 5.2 Triggers for Early Review + +6. REFERENCES + +7. APPENDICES + A. Evidence Tables + B. Search Strategies + C. Excluded Studies + D. Conflict of Interest Declarations + E. Abbreviations and Glossary + +8. ACKNOWLEDGMENTS +``` + +#### HTA Submission Template + +``` +TITLE: Health Technology Assessment: [Technology Name] +SUBMISSION DATE: DD/MM/YYYY +APPLICANT: [Organization] + +VOLUME 1: EXECUTIVE SUMMARY + +VOLUME 2: CLINICAL EVIDENCE + 1. Technology Description + 2. Target Population + 3. Current Practice + 4. Clinical Effectiveness Evidence + 5. Safety Evidence + 6. Quality of Evidence Assessment + +VOLUME 3: ECONOMIC EVIDENCE + 1. Economic Evaluation Methods + 2. Cost-Effectiveness Results + 3. Budget Impact Analysis + 4. Uncertainty Analysis + +VOLUME 4: IMPLEMENTATION + 1. Regulatory Status + 2. Implementation Requirements + 3. Risk Management + 4. Post-Market Surveillance + +VOLUME 5: SUPPORTING MATERIALS + [Evidence tables, model details, appendices] + +APPENDICES + A. Systematic Review Protocol + B. Search Strategies + C. Data Extraction Forms + D. Model Documentation + E. Conflict of Interest Declarations +``` + +--- + +## Documentation Requirements + +### Core Document Components +- [ ] Title page with version control metadata +- [ ] Executive summary (max 2 pages) +- [ ] Clear purpose and scope statements +- [ ] Target audience definition +- [ ] Methods section (evidence search and selection) +- [ ] Numbered recommendations with evidence grades +- [ ] Implementation guidance +- [ ] Review and updating schedule +- [ ] Complete reference list +- [ ] Conflict of interest declarations +- [ ] Acknowledgments and authorship + +### Version Control Requirements +- [ ] Version number (semantic versioning: major.minor.patch) +- [ ] Date of current version +- [ ] Document status (Draft, Review, Approved, Superseded) +- [ ] Author(s) and reviewer(s) identified +- [ ] Approving authority and approval date +- [ ] Change log with version history +- [ ] Supersedes list (previous versions) + +### Review Cycle Documentation +- [ ] Date of next scheduled review +- [ ] Triggers for early review documented +- [ ] Review responsibility assigned +- [ ] Outcome of last review documented + +## Common Mistakes + +| Mistake | Why It's Wrong | Instead | +|---------|----------------|---------| +| **No evidence grading** | Readers cannot assess recommendation strength | Apply NHMRC or GRADE to every recommendation | +| **Missing citations** | Claims cannot be verified; undermines credibility | Cite every clinical claim with verifiable reference | +| **No conflict of interest declaration** | Bias may unduly influence recommendations | Declare all competing interests from all contributors | +| **Vague recommendations** | "Consider" or "may" creates ambiguity | Use strong/conditional language with explicit criteria | +| **No stakeholder consultation** | Recommendations may not reflect practice realities | Map stakeholders and conduct structured consultation | +| **Insufficient reader testing** | Document may be unusable by target audience | Test comprehension and feasibility with representative users | +| **Skipping regulatory checks** | Document may not meet compliance requirements | Verify all applicable regulatory standards before approval | +| **Inadequate version control** | Users may reference outdated guidance | Implement strict version control with clear change documentation | +| **No implementation plan** | Recommendations may not be adopted | Include barriers, facilitators, tools, and audit metrics | +| **Lone author development** | Lacks diverse perspectives and expertise | Assemble multi-disciplinary development group | +| **No review schedule** | Document becomes outdated | Set scheduled review with triggers for early update | +| **Ignoring equity implications** | Recommendations may disadvantage vulnerable groups | Consider health equity in all recommendations | + +## When to Escalate + +Escalate to Guideline Committee Chair, Medical Director, or Governance Committee when: +- Recommendations conflict with established best practice or organizational policy. +- Evidence quality is very low but recommendation strength is strong. +- Stakeholder groups fundamentally disagree on key recommendations. +- Patient safety concerns are identified during review. +- Regulatory compliance cannot be achieved within timeline. +- Conflict of interest cannot be adequately managed. +- Significant resource implications require executive approval. +- Document status is contentious or politically sensitive. +- Approval authorities cannot reach consensus. + +## Privacy Considerations + +- **PHI Involved**: Conditional - document development may use de-identified patient scenarios or aggregate data. +- **Data Minimization**: Use only de-identified or aggregate data for case examples; avoid individual patient details. +- **De-identification**: Remove all direct and indirect identifiers from patient examples; use composite cases rather than real patients. +- **Access Controls**: Limit draft document access to development team and designated reviewers; use secure collaboration platforms. +- **Retention**: Retain all versions per organizational policy; maintain stakeholder feedback records for audit purposes. +- **No Persistence**: Do not store patient information in temporary workspaces or chat history during document development. +- **Publication Review**: Ensure patient examples in published documents cannot be re-identified. + +## Confidence Indicators + +| Scenario | Confidence | Action | +|----------|------------|--------| +| Document based on high-quality systematic reviews with clear consensus | High | Proceed through standard workflow; routine review | +| Evidence base is mixed or conflicting | Medium | Flag for extended expert consultation; document uncertainty explicitly | +| Document involves high-risk clinical interventions | Low | Require additional safety review; escalate to clinical governance | +| Stakeholder input reveals significant disagreement | Medium | Convene consensus meeting; consider voting or dissenting opinions | +| Limited evidence available (expert opinion level) | Medium | Limit recommendation strength; schedule early review for new evidence | +| Regulatory requirements are unclear or complex | Low | Escalate to regulatory affairs; seek formal guidance | +| Target audience is highly diverse (e.g., multi-specialty) | Medium | Extended reader testing across all user groups | +| Document supersedes widely-used existing guidance | Low | Careful change management; extended consultation period | + +## Tool Requirements + +- `~~document collaboration` - For multi-author editing and review +- `~~reference management` - For citation tracking and bibliography management +- `~~health/literature-search` - For evidence retrieval and systematic reviews +- `~~health/evidence-grading` - For NHMRC/GRADE assessment tools +- `~~health/clinical-systems` - For accessing institutional protocols and policies +- `~~cloud storage` - For document version control and secure sharing +- `~~project tracker` - For managing review cycles and stakeholder feedback + +## Success Indicators + +You've applied this skill well when: +- [ ] Document follows appropriate template for document type +- [ ] All recommendations have evidence grades and citations +- [ ] Conflict of interest declarations are complete and transparent +- [ ] Stakeholder consultation was structured and documented +- [ ] Reader testing validates comprehension and usability +- [ ] Regulatory compliance is verified and documented +- [ ] Version control and change history are complete +- [ ] Implementation tools are provided +- [ ] Review schedule is established +- [ ] Document is approved by appropriate authority +- [ ] Health equity and cultural safety are addressed +- [ ] Final output is publication-ready and professional + +## Related Skills + +- `~~health/guideline-development` - For creating clinical practice guidelines specifically +- `~~health/policy-development` - For organizational policy documents +- `~~health/evidence-review` - For systematic literature reviews supporting documents +- `~~health/quality-improvement` - For QI projects that may inform document development +- `~~health/governance` - For documents requiring governance approval workflows +- `~~document-skills/docx` - For document formatting and production diff --git a/health/skills/clinical-ethics/SKILL.md b/health/skills/clinical-ethics/SKILL.md new file mode 100644 index 0000000..5a8030b --- /dev/null +++ b/health/skills/clinical-ethics/SKILL.md @@ -0,0 +1,724 @@ +--- +name: health/clinical-ethics +description: This skill should be used when navigating clinical ethics consultations, analyzing ethical dilemmas in patient care, preparing for ethics committee review of clinical cases, facilitating family conferences about treatment decisions, managing end-of-life care conflicts, addressing surrogate decision-making issues, and resolving value conflicts in healthcare. Use for bioethical analysis in clinical settings distinct from research ethics. +version: 1.0.0 +--- + +# Clinical Ethics + +A comprehensive framework for clinical ethics consultation, case analysis, and ethical decision-making in healthcare. This skill supports clinicians, ethics committees, and healthcare organizations in navigating complex bioethical dilemmas, facilitating difficult conversations, and reaching ethically defensible decisions in patient care. + +**Important**: This skill assists with clinical ethics analysis but does not replace institutional ethics committee authority, legal advice, or clinical judgment. Escalate to institutional resources when patient safety or significant ethical conflicts arise. + +## When to Use This Skill + +Invoke this skill when: +- Requesting or conducting a clinical ethics consultation. +- Analyzing an ethical dilemma in patient care (autonomy, beneficence, justice, non-maleficence). +- Preparing for an ethics committee review of a clinical case. +- Facilitating family conferences about treatment goals and end-of-life decisions. +- Addressing conflicts between patients, families, and care teams. +- Navigating surrogate decision-making when patients lack capacity. +- Resolving resource allocation or distributive justice questions. +- Managing conflicts of interest in clinical care. +- Addressing cultural or religious values affecting treatment decisions. +- Developing or revising organizational ethics policies. +- Conducting ethics education for clinical staff. +- Retrospective case review for organizational learning. + +## Regulatory Context + +### Australia & New Zealand (Default) + +| Regulation/Standard | Relevance | Key Requirements | +|---------------------|-----------|------------------| +| **NHMRC National Statement** (AU) | Research ethics | Clinical ethics consultation framework referenced for research-related conflicts | +| **NSQHS Standard 1** (AU) | Governance | Healthcare organizations must have mechanisms for ethical decision-making | +| **ACHS EQuIP6** (AU) | Accreditation | Ethics framework for clinical practice; consumer rights | +| **Code of Health and Disability Services Consumers' Rights** (NZ) | Patient rights | Right to be treated with respect; informed consent; right to complain | +| **Health and Disability Commissioner Act 1994** (NZ) | Advocacy | Advocacy services for ethical concerns; complaint resolution | +| **Medical Board Code of Conduct** (AU/NZ) | Professional ethics | Ethical principles for medical practice; conflicts of interest | +| **Nursing Council Code of Conduct** (NZ) | Professional standards | Ethical nursing practice; patient advocacy | +| **State/Territory Guardianship Acts** (AU) | Capacity law | Substitute decision-making frameworks; advance care directives | +| **Protection of Personal and Property Rights Act 1988** (NZ) | Capacity law | Welfare guardians; property managers; enduring powers of attorney | + +### US/EU-lite Fallback + +| Regulation/Standard | Relevance | Key Requirements | +|---------------------|-----------|------------------| +| **Joint Commission** (US) | Hospital accreditation | Patient rights; ethical behavior; conflict resolution | +| **American Society for Bioethics and Humanities (ASBH)** | Clinical ethics | Core competencies for ethics consultation; quality indicators | +| **Belmont Report** (US) | Ethical principles | Respect for persons; beneficence; justice (foundational) | +| **Patient Self-Determination Act** (US) | Advance directives | Right to accept/refuse treatment; advance directive documentation | +| **Council of Europe Convention on Human Rights and Biomedicine** (EU) | Bioethics framework | Consent requirements; protection of persons unable to consent | +| **European Clinical Ethics Network (ECEN)** | Best practice | Standards for clinical ethics support; committee structures | + +### Jurisdiction Matrix + +| Jurisdiction | Applicable Framework | Decision-Making Trigger | Timeframe | Required Artifacts | Escalation Point | +|--------------|---------------------|------------------------|-----------|-------------------|------------------| +| **AU - National** | Clinical Ethics Consultation Service | Treatment conflict; capacity question; value conflict | 24-48 hours urgent; 5-10 days routine | Consultation request; case summary; recommendations | Chief Medical Officer; Ethics Committee Chair | +| **AU - State** | Guardianship Tribunal | Ongoing lack of capacity; substitute decision needed | Tribunal scheduling (weeks) | Capacity assessment; substituted judgment documentation | Office of Public Guardian | +| **NZ - National** | Clinical Ethics Service (DHB) | Ethical dilemma; family conflict; end-of-life decision | 24-48 hours | Consultation record; family conference documentation | Clinical Ethics Committee | +| **NZ - Family Court** | PPPR Act 1988 | Welfare guardianship; property decisions | Court process (weeks-months) | Legal application; medical reports | Family Court | +| **US** | Hospital Ethics Committee | Treatment futility; surrogate conflict; resource allocation | 24-72 hours | ASBH-style consultation documentation | Ethics Committee Chair; Risk Management | + +## Quick Reference + +1. **Core Principles**: Autonomy, Beneficence, Non-maleficence, Justice—always in balance. +2. **Process Matters**: Fair process is as important as right outcome. +3. **Capacity First**: Establish decision-making capacity before proceeding. +4. **Substituted Judgment**: What would the patient want? (not what others want). +5. **Best Interests**: When wishes unknown, use objective standard. +6. **Family Conference**: Structured communication prevents conflict. +7. **Document Everything**: Decisions and rationale must be recorded. +8. **Time-Limited Trials**: When prognosis uncertain, trial interventions first. +9. **Second Opinions**: Disagreement is not failure—seek additional expertise. +10. **Care Continues**: Even when treatment declines, comfort care continues. + +## Operating Modes + +### Standard Mode +Full clinical ethics consultation workflow with comprehensive case analysis, stakeholder interviews, family conference facilitation, formal recommendations, and follow-up. Use for complex cases involving multiple stakeholders, significant value conflicts, end-of-life decisions, or when there's risk of legal challenge. Includes ethics committee preparation and formal documentation. + +### Lite Mode +Streamlined ethical guidance for routine dilemmas or urgent situations requiring rapid decision-making. Focuses on core principles, quick stakeholder consultation, and abbreviated documentation. Never suppresses high-risk escalation requirements, mandatory reporting obligations, or cases involving significant conflict of interest. + +## Detailed Guidance + +### 1. Clinical Ethics Consultation Request + +#### Request Intake Process + +**Information to Gather**: +- Patient demographics and clinical status. +- Nature of the ethical dilemma or conflict. +- Stakeholders involved (patient, family, care team, administration). +- Urgency level (emergency, urgent, routine). +- Previous attempts to resolve the issue. +- Relevant clinical history and prognosis. +- Legal or regulatory dimensions. + +**Urgency Assessment**: + +| Level | Timeline | Examples | +|-------|----------|----------| +| **Emergency** | Immediate (<2 hours) | Acute treatment refusal; imminent death; life-threatening conflict | +| **Urgent** | 24-48 hours | Evolving clinical situation; family conflict; discharge planning | +| **Routine** | 3-5 days | Policy question; retrospective review; education request | +| **Non-clinical** | 1-2 weeks | Organizational ethics; resource allocation framework | + +**Request Types**: +- **Information**: Clarify ethical concepts or guidelines. +- **Process Facilitation**: Mediate family conferences or team discussions. +- **Case Analysis**: Comprehensive ethical analysis with recommendations. +- **Policy Development**: Ethics input on organizational policies. +- **Education**: Ethics teaching or case discussion. + +#### Initial Case Screening + +**Questions to Clarify**: +1. Is this an ethics issue or a clinical disagreement? +2. Are all relevant facts known, or is more information needed? +3. Who are the key stakeholders, and have they been engaged? +4. Is patient capacity established or in question? +5. Are there legal implications requiring legal consultation? +6. Is this a pattern suggesting systemic issues? + +**When to Decline or Redirect**: +- Purely clinical disagreement without ethical dimension (redirect to clinical review). +- Request for legal advice (redirect to legal/risk management). +- Matters requiring law enforcement (redirect to security/police). +- Individual seeking personal ethics advice (redirect to pastoral care). + +### 2. Ethical Case Analysis Framework + +#### The Four-Box Method (Jonsen, Siegler, Winslade) + +**Box 1: Medical Indications** +- Patient's medical problem and history. +- Goals of treatment (diagnostic, curative, palliative). +- Likelihood of success (evidence-based assessment). +- Prognosis with and without treatment. +- What are the patient/family hoping to achieve? + +**Box 2: Patient Preferences** +- Patient's expressed wishes (oral or written). +- Advance care directive (values, goals, specific instructions). +- Decision-making capacity (assessment required). +- If incapacitated: substituted judgment standard. +- Cultural, religious, or personal values affecting decisions. + +**Box 3: Quality of Life** +- Patient's current quality of life. +- Likely quality of life with/without treatment. +- Patient's subjective assessment of quality of life. +- Risks of treatment (burdens vs. benefits). +- "Reasonable person" standard when patient view unknown. + +**Box 4: Contextual Features** +- Family dynamics and conflicts. +- Cultural or religious factors. +- Financial considerations. +- Resource availability and allocation. +- Legal or regulatory constraints. +- Conflicts of interest. +- Organizational policies. + +#### Analysis Process + +**Step 1: Fact-Gathering** +- Review medical record thoroughly. +- Interview treating clinicians. +- Speak with patient (if capacity). +- Interview family/surrogates separately if conflict. +- Identify relevant institutional policies. +- Review applicable law. + +**Step 2: Stakeholder Identification** +- Primary: Patient (center of concern). +- Secondary: Family, surrogates, caregivers. +- Tertiary: Healthcare team, institution, society. + +**Step 3: Values Clarification** +- What does each stakeholder value? +- Where do values align and conflict? +- Are there hidden values or assumptions? +- What cultural/religious factors are relevant? + +**Step 4: Option Generation** +- Brainstorm all possible courses of action. +- Include options suggested by all stakeholders. +- Consider compromise positions. +- Time-limited trial as middle ground. + +**Step 5: Ethical Analysis** +- Apply core principles (autonomy, beneficence, non-maleficence, justice). +- Consider care ethics (relationships, responsibility). +- Apply professional codes and guidelines. +- Weigh principles when in conflict. + +**Step 6: Recommendation Formulation** +- State recommendations clearly. +- Provide ethical rationale. +- Acknowledge uncertainty. +- Offer process recommendations. + +### 3. Decision-Making Capacity Assessment + +#### Elements of Capacity + +| Element | Assessment | Red Flags | +|---------|------------|-----------| +| **Understanding** | Can explain diagnosis, prognosis, options in own words | Unable to describe condition; significant cognitive deficits | +| **Appreciation** | Recognizes information applies to self | Denial inconsistent with reality; delusional beliefs | +| **Reasoning** | Can weigh pros/cons; compare options | Inability to process consequences; impulsive reasoning | +| **Expression of Choice** | Can make and communicate a decision | Vacillation; pressured decisions; communication barriers | + +**Capacity is Decision-Specific**: A patient may have capacity for some decisions (routine care) but not others (high-stakes surgery). + +#### Capacity Assessment Process + +1. **Clinical Evaluation**: + - Mental status examination. + - Cognitive screening (MMSE, MoCA if appropriate). + - Delirium assessment. + - Psychiatric evaluation if mental illness suspected. + +2. **Decision-Specific Inquiry**: + - "Can you tell me what we've discussed today?" + - "What are your treatment options?" + - "What are the benefits and risks of each?" + - "Why have you decided to [accept/refuse]?" + - "What could happen if you [accept/refuse]?" + +3. **Documentation Requirements**: + - Specific decision being assessed. + - Clinical basis for assessment (delirium, dementia, psychiatric illness). + - How each capacity element was evaluated. + - Conclusion with clear statement. + - If lacks capacity: basis for substituted judgment. + +#### Capacity Thresholds + +| Level | Standard | Typical Situations | +|-------|----------|-------------------| +| **Full Capacity** | Meets all elements for specific decision | Routine care decisions | +| **Partial Capacity** | Meets some elements; supported decision-making | Complex decisions with support | +| **Lacks Capacity** | Unable to meet essential elements | Major decisions; high risk | +| **Fluctuating** | Varies with time (e.g., delirium) | Defer to lucid periods | + +### 4. Surrogate Decision-Making + +#### Hierarchy of Surrogates (AU/NZ) + +**New Zealand** (PPPR Act 1988; Code of Rights): +1. Person named in advance directive. +2. Welfare guardian (if appointed). +3. Enduring power of attorney (if welfare provisions). +4. Family member (close relationship; willing and available). +5. Court-appointed (if no suitable family). + +**Australia** (varies by state): +1. Person named in advance care directive. +2. Enduring guardian/power of attorney. +3. Statutory health attorney (QLD) or equivalent. +4. Person responsible (close adult relative/spouse). +5. Tribunal-appointed guardian. + +#### Standards for Surrogate Decision-Making + +**1. Substituted Judgment Standard** (preferred): +- "What would the patient want?" +- Based on patient's values, beliefs, prior statements. +- Documented wishes in advance directive. +- Religious/cultural considerations. +- Not what surrogate wants for patient. + +**2. Best Interests Standard** (when wishes unknown): +- Objective assessment of what reasonable person would want. +- Consider: + - Patient's values (even if specific wishes unknown). + - Quality of life with/without treatment. + - Burdens vs. benefits of treatment. + - Likelihood of achieving treatment goals. + - Pain and suffering. + +#### Common Surrogate Challenges + +| Challenge | Response Strategy | +|-----------|-------------------| +| **Disagreement among family** | Family conference; identify spokesperson; clarify legal hierarchy | +| **Surrogate requests inappropriate treatment** | Clarify substituted judgment vs. personal wishes; ethics consultation | +| **Surrogate refuses beneficial treatment** | Assess if refusal is patient's wish vs. surrogate's preference | +| **Estranged family member emerges** | Clarify legal standing; focus on patient wishes; legal review if contested | +| **No family available** | Court/tribunal appointment; institutional ethics review | + +### 5. Family Conference Facilitation + +#### Pre-Conference Preparation + +**Logistics**: +- Private, comfortable setting. +- Adequate time (45-90 minutes typical). +- All key stakeholders invited (with patient consent). +- Interpreter services if needed. +- Support persons present (social work, chaplaincy). + +**Clinical Preparation**: +- Clarify medical facts with treating team. +- Establish prognosis range (best/worst/most likely). +- Identify treatment options and recommendations. +- Anticipate likely questions and concerns. + +**Ethics Preparation**: +- Review patient's values and prior statements. +- Identify potential value conflicts. +- Clarify decision-making authority. +- Prepare to explain substituted judgment standard. + +#### Conference Structure + +**Opening** (5-10 minutes): +- Introductions and roles. +- Purpose of meeting. +- Ground rules (respectful communication; all voices heard). +- Confidentiality parameters. + +**Information Sharing** (15-20 minutes): +- Medical update in plain language. +- Prognosis and likely outcomes. +- Treatment options (benefits/burdens). +- Physician recommendation. +- Clarifying questions. + +**Values Exploration** (15-20 minutes): +- Patient's prior statements about quality of life. +- Religious/cultural considerations. +- What would the patient want in this situation? +- What would "success" look like from patient's perspective? + +**Decision-Making** (15-20 minutes): +- Explore options with family. +- Address disagreements respectfully. +- Work toward consensus when possible. +- Clarify decision-maker if surrogate decision required. +- Time-limited trial if appropriate. + +**Closing** (5-10 minutes): +- Summarize decisions made. +- Clarify next steps. +- Offer continued support. +- Document discussion. + +#### Managing Conflict in Conferences + +**De-escalation Techniques**: +- Acknowledge emotions: "I can see this is really difficult." +- Reframe: "We all want what's best for [patient name]." +- Break: Suggest brief pause if emotions high. +- Separate: Meet with factions separately if needed. +- Refocus: Return to patient-centered focus. + +**When Consensus Cannot Be Reached**: +- Clarify who has legal decision-making authority. +- Offer additional time for reflection. +- Suggest second opinion. +- Consider ethics consultation/mediation. +- Legal consultation if necessary. + +### 6. End-of-Life Ethics + +#### Withholding vs. Withdrawing Treatment + +**Ethical Equivalence**: Withholding and withdrawing are ethically equivalent. The decision to start or stop should be based on the same criteria (burdens vs. benefits; patient wishes). + +**Practical Difference**: +- Withdrawing may feel more emotionally difficult. +- May require more explicit family consent/understanding. +- Legal protections generally apply equally. + +#### Do Not Attempt Resuscitation (DNAR/DNR) + +**Key Principles**: +- Patient/surrogate has right to refuse CPR. +- DNAR does not mean "do not treat." +- Other life-sustaining treatments continue unless specified otherwise. +- Should be reviewed regularly and with clinical changes. + +**Documentation**: +- In medical record with rationale. +- Signed by patient or surrogate (varies by jurisdiction). +- Accessible to all clinical staff. +- Form number per institutional policy. + +#### Medical Futility + +**Definition**: Treatment that: +- Will not achieve intended physiological goal, OR +- Has already failed, OR +- Is extremely unlikely to achieve benefit commensurate with burdens. + +**Types**: +- **Physiologic futility**: Treatment cannot achieve physiological effect. +- **Quantitative futility**: Treatment has <1% chance of success. +- **Qualitative futility**: Treatment would not produce acceptable quality of life. + +**Process When Futility Claimed**: +1. Second opinion from another clinician. +2. Ethics consultation if family disagrees. +3. Family conference with clear communication. +4. Time-limited trial if appropriate. +5. Transfer to another institution (if family requests). +6. Legal intervention only as last resort. + +#### Palliative Sedation + +**Indications**: Refractory symptoms (pain, dyspnea, agitation) at end of life. + +**Ethical Requirements**: +- Symptom truly refractory to standard measures. +- Patient or surrogate consent. +- Sedation proportionate to symptom (not euthanasia). +- Intent is comfort, not hastening death. +- Documentation of decision-making. + +**Legal Protection** (AU/NZ): +- Doctrine of double effect may apply. +- Intent must be clearly therapeutic. +- Proportionality required. + +### 7. Resource Allocation and Justice + +#### Micro-Allocation (Bedside) + +**Individual Patient Level**: +- Triaging ICU beds or specialized treatments. +- Allocation of scarce resources (dialysis, transplant organs). +- Insurance/funding limitations affecting treatment. + +**Decision Framework**: +1. Medical urgency and benefit (sickest first? best outcome?). +2. Time on waiting list (first come, first served?). +3. Random allocation (lottery?). +4. Social value judgments (avoid when possible). + +**Fair Process Requirements**: +- Publicly defensible criteria. +- Appeals process available. +- Transparency in decision-making. +- Consistent application. + +#### Macro-Allocation (Organizational/Societal) + +**Policy-Level Questions**: +- How should limited resources be distributed? +- What services should the organization provide? +- How should cost-effectiveness factor into decisions? + +**Principles**: +- **Egalitarian**: Equal access for equal need. +- **Utilitarian**: Greatest good for greatest number. +- **Prioritarian**: Give priority to worst off. +- **Market-based**: Ability to pay determines access. + +**Healthcare Organization Approach**: +- Clinical ethics committees typically avoid direct resource allocation. +- Focus on fair process rather than specific outcomes. +- Policy development input rather than individual case decisions. + +### 8. Ethics Committee Preparation + +#### Case Presentation Structure + +**Patient Summary** (3-5 minutes): +- Demographics and diagnosis. +- Clinical course to date. +- Current status and prognosis. +- Treatment options. + +**Ethical Dilemma** (3-5 minutes): +- Nature of the conflict or question. +- Stakeholders and their positions. +- Relevant values in tension. +- Previous attempts at resolution. + +**Analysis** (5-7 minutes): +- Application of four-box method. +- Relevant ethical principles. +- Institutional policies. +- Legal considerations. + +**Questions for Committee**: +- Specific questions to address. +- Areas of uncertainty. +- Request for recommendation. + +#### Committee Deliberation + +**Structured Discussion**: +1. Clarifying questions (medical facts). +2. Values exploration (what matters to patient). +3. Options review (all possible paths). +4. Recommendation formulation. +5. Process recommendations (how to implement). + +**Documentation Requirements**: +- Minutes of discussion (de-identified). +- Committee composition (who participated). +- Consensus or vote if divided. +- Recommendations and rationale. +- Follow-up plan. + +**Recommendation Types**: +- **Clinical**: Specific treatment recommendations. +- **Procedural**: Process for decision-making. +- **Educational**: Staff or family education needed. +- **Policy**: Systemic issues requiring policy change. + +### 9. Special Populations and Situations + +#### Pediatric Ethics + +**Key Differences from Adult Ethics**: +- Evolving autonomy (assent vs. consent). +- Parental authority (not absolute; can be limited). +- Best interests standard (substituted judgment often impossible). +- Longer time horizon (implications for quality of life). + +**Assent Process**: +- Age-appropriate information sharing. +- Opportunity to assent or dissent. +- Dissent should be seriously considered (not always determinative). +- Documentation of child's views. + +**Limits on Parental Authority**: +- Refusal of life-saving treatment. +- Requests for non-beneficial treatment. +- Religious objections to essential care. +- State intervention (child protection). + +#### Maternal-Fetal Conflict + +**Ethical Framework**: +- Pregnant woman has right to refuse treatment. +- Fetal interests considered but do not override maternal autonomy. +- Intervention requires maternal consent (with rare exceptions). +- Court-ordered cesarean generally not ethically justified. + +**Common Scenarios**: +- Refusal of cesarean for fetal indication. +- Substance use during pregnancy. +- Refusal of blood products. +- Psychiatric treatment during pregnancy. + +#### Cultural and Religious Considerations + +**Approach**: +- Respect for cultural differences (not moral relativism). +- Cultural consultation/interpreter services. +- Religious leader involvement (with consent). +- Negotiation within ethical boundaries. +- Limits: Cannot violate fundamental patient rights. + +**Common Religious Considerations**: +- Jehovah's Witnesses and blood products. +- Orthodox Judaism and Sabbath/holidays. +- Islam and modesty requirements. +- Hinduism and Ayurvedic medicine integration. +- Māori tikanga (NZ) and whānau decision-making. + +#### Organizational Ethics + +**System-Level Issues**: +- Mission alignment of business decisions. +- Conflicts of interest in clinical practice. +- Marketing and advertising ethics. +- Community benefit obligations. +- Staff moral distress. + +**Ethics Committee Role**: +- Policy development and review. +- Ethics education. +- Culture of ethical practice. +- Whistleblower protection. + +## Documentation Requirements + +### Ethics Consultation Record + +- [ ] Date and time of consultation request. +- [ ] Requestor and reason for consultation. +- [ ] Patient information (de-identified for ethics file). +- [ ] Medical facts relevant to ethical question. +- [ ] Stakeholders identified and consulted. +- [ ] Values and preferences (patient's and surrogates'). +- [ ] Ethical analysis (principles applied). +- [ ] Recommendations (clinical and process). +- [ ] Follow-up plan and responsibilities. +- [ ] Distribution of recommendations (who receives). + +### Family Conference Documentation + +- [ ] Date, time, location. +- [ ] Participants (names, roles, relationship to patient). +- [ ] Interpreter used (yes/no; language). +- [ ] Medical information provided. +- [ ] Questions asked and responses. +- [ ] Values discussed. +- [ ] Decisions made or deferred. +- [ ] Disagreements and how handled. +- [ ] Follow-up plan. +- [ ] Signatures of key participants (if consent obtained). + +### Capacity Assessment Documentation + +- [ ] Decision being assessed. +- [ ] Clinical basis (delirium, dementia, psychiatric condition). +- [ ] Assessment of each capacity element. +- [ ] Specific findings supporting conclusion. +- [ ] Clear statement of capacity determination. +- [ ] Signature of assessing clinician. +- [ ] Date and time. + +### Ethics Committee Case Review + +- [ ] De-identified case summary. +- [ ] Presenter and attending committee members. +- [ ] Discussion summary. +- [ ] Committee recommendations. +- [ ] Dissenting opinions (if any). +- [ ] Follow-up plan. +- [ ] Date of review. + +## Common Mistakes + +| Mistake | Why It's Wrong | Instead | +|---------|----------------|---------| +| **Conflating clinical disagreement with ethics conflict** | Wastes ethics resources; delays appropriate resolution | Distinguish clinical (what's medically appropriate) from ethical (what's right given values) | +| **Assuming family speaks for patient** | May not reflect patient's wishes; surrogate authority has limits | Verify surrogate status; apply substituted judgment standard; assess for conflicts | +| **Focusing on outcome over process** | Process violations undermine legitimacy; outcomes may be uncertain | Ensure fair process; transparent decision-making; stakeholder voice | +| **Neglecting capacity assessment** | Invalid consent; potential assault/battery liability | Assess capacity for each significant decision; document thoroughly | +| **Therapeutic misconception in surrogate decisions** | Surrogate conflates what's possible with what's desirable | Clarify prognosis; distinguish treatment from benefit; explore patient values | +| **Rushing end-of-life decisions** | Insufficient time for grieving; decisions may be reactive | Allow time for processing; offer time-limited trials; multiple conversations | +| **Imposing clinician values** | Violates patient autonomy; paternalism | Elicit patient values; bracket own values; facilitate patient-centered decision | +| **Ignoring cultural context** | Cultural insensitivity; missed values | Cultural consultation; interpreter services; respectful curiosity | +| **Inadequate documentation** | Cannot demonstrate rationale; legal vulnerability | Document analysis; values considered; decision-making process | +| **Not involving ethics early** | Conflict escalates; positions harden | Early consultation for emerging conflicts; prevention over crisis management | + +## When to Escalate + +Escalate to Chief Medical Officer, Ethics Committee Chair, or Legal/Risk Management when: + +- Potential for immediate patient harm or death. +- Legal issues requiring counsel (court orders, guardianship). +- Child protection concerns (suspected abuse/neglect). +- Media or public interest in the case. +- High-profile patient or circumstances. +- Significant institutional resource allocation. +- Criminal activity suspected (e.g., poisoning). +- Serious conflict of interest identified. +- Staff refusal to participate in care. +- Patient or family threat of litigation. +- Inability to reach resolution after ethics involvement. + +## Privacy Considerations + +- **PHI Involved**: Yes - Clinical ethics consultation involves identifiable patient information. +- **Minimum Necessary**: Share only information needed for ethical analysis. +- **Consent for Consultation**: Generally not required for internal ethics consultation (part of care). +- **De-identification**: Ethics committee minutes and records should be de-identified. +- **Access**: Ethics consultation records part of medical record; ethics committee files confidential. +- **Family Information**: Balance transparency with patient privacy (patient consent required). +- **No Persistence**: Do not store identifiable patient details in temporary workspaces. +- **Research Use**: Case studies for education require de-identification and often ethics approval. + +## Confidence Indicators + +| Scenario | Confidence | Action | +|----------|------------|--------| +| Clear advance directive with straightforward clinical situation | High | Facilitate implementation; support family in honoring wishes | +| Family consensus with clear substituted judgment | High | Document decision-making; proceed with care plan | +| Minor disagreement among family members with shared values | Medium | Family conference; facilitated discussion; usually resolvable | +| Conflict between patient/surrogate and care team | Medium | Ethics consultation; mediation; time-limited trials | +| No surrogate and patient lacks capacity | Low | **BLOCKER**: Legal consultation; guardianship/tribunal process required | +| Suspected elder abuse influencing decisions | Low | **BLOCKER**: Report to adult protective services; legal consultation | +| Parental refusal of life-saving treatment for child | Low | **BLOCKER**: Child protection notification; legal intervention likely required | +| Cultural/religious beliefs conflicting with standard care | Medium | Cultural consultation; explore accommodation options; legal review if necessary | +| Severe family dysfunction with multiple surrogates claiming authority | Low | Legal clarification of authority; ethics facilitation; may need court | +| Treatment futility claim with family disagreement | Medium | Second opinion; ethics consultation; time-limited trial; legal as last resort | +| End-of-life decision with unclear patient wishes | Medium | Substituted judgment inquiry; best interests analysis; family conference | + +## Tool Requirements + +- `~~health/clinical-systems` - For accessing patient records and clinical information. +- `~~cloud storage` - For secure documentation storage. +- `~~project tracker` - For consultation request tracking. +- `~~document collaboration` - For multi-disciplinary team coordination. +- `~~legal/compliance` - For guardianship and legal framework consultation. +- `~~health/incident-reporting` - For reporting safety concerns or adverse events. + +## Success Indicators + +You've applied this skill well when: +- [ ] Ethical dilemma is clearly identified and analyzed. +- [ ] All relevant stakeholders have been engaged. +- [ ] Patient capacity has been appropriately assessed. +- [ ] Patient values and preferences are centered in analysis. +- [ ] Substituted judgment standard is applied correctly. +- [ ] Family conferences are facilitated effectively. +- [ ] Recommendations are ethically grounded and actionable. +- [ ] Documentation is thorough and clear. +- [ ] Fair process has been followed. +- [ ] Conflicts are managed constructively. +- [ ] Care team receives support and education. +- [ ] Patient dignity and values are respected. + +## Related Skills + +- `~~health/research-ethics` - For research-related ethical issues distinct from clinical care. +- `~~health/incident-reporting` - For adverse events and safety incidents requiring reporting. +- `~~health/clinical-risk-assessment` - For risk management in patient care. +- `~~health/quality-improvement` - For QI projects with ethical dimensions. +- `~~health/policy-development` - For organizational ethics policy creation. +- `~~legal/compliance` - For legal framework consultation and compliance guidance. diff --git a/health/skills/clinical-risk-assessment/SKILL.md b/health/skills/clinical-risk-assessment/SKILL.md new file mode 100644 index 0000000..ed04d7c --- /dev/null +++ b/health/skills/clinical-risk-assessment/SKILL.md @@ -0,0 +1,381 @@ +--- +name: health/clinical-risk-assessment +description: This skill should be used when assessing clinical risks to patient safety, scoring severity and likelihood, selecting controls, and documenting residual risk. Use when a user mentions clinical risk register, patient safety risk, risk matrix, risk scoring, clinical hazard, residual risk, or risk treatment plan. +version: 1.0.0 +--- + +# Clinical Risk Assessment + +Structured guidance for identifying, scoring, treating, and monitoring clinical risks to patient safety in healthcare organizations. + +**Important**: This skill supports clinical governance workflows. It does not replace clinician judgment, legal advice, or organization-specific risk management policy. All risk assessments must be reviewed and endorsed by appropriately qualified clinical and governance personnel. + +## When to Use This Skill + +Invoke when: +- A clinical team needs to assess patient safety risks for a service, process, or change. +- A risk register entry needs to be created, scored, or reviewed. +- A new clinical service, pathway, or standing order requires risk analysis before approval. +- An incident investigation identifies systemic risks requiring formal treatment. +- A governance committee requests a risk assessment for accreditation or regulatory purposes. +- A clinical services plan or model-of-care change needs a risk checkpoint. + +Do not use for workforce/occupational hazard risks (use `~~health/worker-risk-assessment`) or strategic/enterprise risks (use `~~health/enterprise-risk-assessment`). + +## Operating Modes + +### Standard Mode +Full clinical risk governance workflow: +- Complete hazard identification and context analysis. +- Formal severity and likelihood scoring with documented rationale. +- Control selection with effectiveness assessment. +- Residual risk calculation and acceptance criteria. +- Audit-ready documentation and governance sign-off. + +### Lite Mode +Use only for constrained contexts (rapid risk screening, time-critical triage): +- Capture minimum risk description, preliminary severity, and immediate actions. +- Flag unknowns and require follow-up with full Standard assessment. +- High-risk escalation obligations remain unchanged. + +Lite mode is not acceptable for final risk register entries or governance committee submissions. + +## Regulatory Context + +Default jurisdiction is Australia/New Zealand. Use US/EU-lite framing only when explicitly requested. + +| Jurisdiction | Framework/Statute | Risk Governance Trigger | Review Cadence | Required Artifacts | Escalation Point | +|---|---|---|---|---|---| +| Australia | AS/NZS ISO 31000:2018, NSQHS Standards (Std 1 Clinical Governance), state WHS Acts | New service/pathway, post-incident, accreditation cycle, significant change, standing order introduction | At least annually; after every SAC 1-2 incident; before significant clinical change | Risk register entry, risk treatment plan, governance endorsement record | Clinical Governance Committee, Chief Medical Officer, Board Risk Sub-committee | +| New Zealand | AS/NZS ISO 31000:2018, HDSS Act 2001, Te Whatu Ora risk frameworks | New service introduction, post-serious-adverse-event, national standards review | At least annually; after SAE; before model-of-care change | Risk register entry, risk treatment plan, quality committee endorsement | Clinical Governance Committee, Chief Medical Officer, Quality & Safety Lead | +| United States (lite) | Joint Commission standards, CMS CoPs, organization risk policy | New service, sentinel event, TJC survey preparation | Per organization policy (typically quarterly review) | Risk assessment summary, mitigation plan | Risk Management, CMO, Quality Committee | +| European Union (lite) | ISO 31000, country-specific clinical governance frameworks | Service change, serious incident, regulatory audit | Per national implementation | Risk assessment summary, treatment plan | Clinical Governance Lead, Risk Officer | + +## Quick Reference + +1. Define the scope: what clinical process, service, or change is being assessed. +2. Identify hazards: what could go wrong and cause patient harm. +3. Determine existing controls already in place. +4. Score consequence (severity) using the Clinical Consequence Scale. +5. Score likelihood using the Clinical Likelihood Scale. +6. Calculate risk score (Consequence x Likelihood). +7. Classify risk level (LOW / MEDIUM / HIGH / EXTREME). +8. Select additional controls to reduce risk to acceptable level. +9. Calculate residual risk after proposed controls. +10. Document and submit for governance endorsement. + +## Risk Assessment Framework + +### Clinical Consequence Scale + +Consequences are assessed in terms of impact on patient safety and clinical outcomes. + +| Level | Label | Patient Safety Descriptor | Service Impact | +|---|---|---|---| +| 1 | **Negligible** | No harm or injury; near miss with no patient impact | No service disruption | +| 2 | **Minor** | Minor harm requiring first aid or additional observation; temporary discomfort | Minor service delay, managed locally | +| 3 | **Moderate** | Moderate harm requiring additional treatment or extended stay; reversible injury | Temporary service reduction or workaround required | +| 4 | **Major** | Major harm; permanent impairment, disability, or significant prolonged treatment | Significant service disruption; external review triggered | +| 5 | **Catastrophic** | Death or permanent severe disability directly attributable to the hazard | Service suspended; mandatory external notification; organizational crisis response | + +### Clinical Likelihood Scale + +| Level | Label | Clinical Descriptor | +|---|---|---| +| 1 | **Rare** | May occur only in exceptional circumstances; no known precedent in similar clinical settings | +| 2 | **Unlikely** | Could occur but not expected; isolated precedent in similar services | +| 3 | **Possible** | May occur; has happened in comparable clinical settings or services | +| 4 | **Likely** | Probably will occur; clear pattern in similar clinical environments | +| 5 | **Almost Certain** | Expected to occur frequently; systemic weakness is known and uncontrolled | + +### Risk Score Calculation + +**Risk Score = Consequence x Likelihood** + +| Score Range | Risk Level | Color | Governance Response | +|---|---|---|---| +| 1-4 | **LOW** | GREEN | Accept and monitor; local management; routine review | +| 5-9 | **MEDIUM** | YELLOW | Treat with specific controls; assign risk owner; active monitoring | +| 10-15 | **HIGH** | ORANGE | Senior clinical leadership review; dedicated mitigation plan; escalate to governance committee | +| 16-25 | **EXTREME** | RED | Immediate executive and board escalation; consider service suspension pending risk reduction; mandatory external notification assessment | + +### Risk Matrix + +``` + LIKELIHOOD + Rare Unlikely Possible Likely Almost Certain + (1) (2) (3) (4) (5) +CONSEQUENCE +Catastrophic (5) | 5 | 10 | 15 | 20 | 25 | +Major (4) | 4 | 8 | 12 | 16 | 20 | +Moderate (3) | 3 | 6 | 9 | 12 | 15 | +Minor (2) | 2 | 4 | 6 | 8 | 10 | +Negligible (1) | 1 | 2 | 3 | 4 | 5 | +``` + +## Risk Classification and Required Actions + +### GREEN - Low Risk (Score 1-4) + +**Characteristics:** +- Minor or negligible hazards that are unlikely to cause patient harm. +- Risks within normal clinical operating parameters. +- Existing controls are adequate and well-maintained. + +**Required Actions:** +- **Accept**: Acknowledge the risk and continue with current controls. +- **Document**: Record in the clinical risk register for tracking. +- **Monitor**: Include in periodic clinical governance reviews (at least annually). +- **Local ownership**: Managed by service-level clinical lead. + +**Clinical Examples:** +- Minor medication transcription risk mitigated by electronic prescribing. +- Low-acuity patient identification risk in a single-specialty outpatient clinic with existing ID protocols. +- Equipment maintenance delay for non-critical device with backup available. + +### YELLOW - Medium Risk (Score 5-9) + +**Characteristics:** +- Moderate hazards that could materialize under foreseeable clinical circumstances. +- Risks that require targeted intervention but do not necessitate immediate service change. +- Existing controls partially effective; enhancement needed. + +**Required Actions:** +- **Treat**: Implement specific additional controls or process changes. +- **Assign owner**: Designate a named clinician or manager responsible for monitoring and mitigation. +- **Monitor actively**: Review at defined intervals (monthly or after relevant incidents). +- **Document thoroughly**: Record risk, controls, rationale, and review dates in the risk register. +- **Brief stakeholders**: Inform relevant clinical and operational leaders. +- **Define escalation triggers**: Specify conditions that would elevate the risk level. + +**Clinical Examples:** +- Medication error risk in a ward with high nurse-to-patient ratios and partial electronic ordering. +- Deterioration recognition risk in a ward without continuous monitoring for intermediate-acuity patients. +- Infection control risk during a planned facility renovation with mitigation plan in place. + +### ORANGE - High Risk (Score 10-15) + +**Characteristics:** +- Significant hazards with meaningful probability of causing serious patient harm. +- Risks requiring senior clinical leadership attention and dedicated mitigation. +- Current controls are insufficient; service modifications may be necessary. + +**Required Actions:** +- **Escalate to governance**: Present to the Clinical Governance Committee with full risk assessment. +- **Develop mitigation plan**: Specific, time-bound actions with named owners. +- **Brief executive**: Inform CMO/CEO and relevant directors. +- **Set review cadence**: Weekly or milestone-based review until risk is reduced. +- **Consider service modification**: Evaluate whether clinical pathway, staffing, or process changes are required. +- **Document in detail**: Full risk assessment with analysis, treatment options, and recommendations. +- **Define contingency plan**: What actions are taken if the risk materializes despite controls. + +**Clinical Examples:** +- Surgical site risk in a theatre with identified ventilation deficiency pending remediation. +- Staffing model that regularly operates below safe minimum for clinical acuity. +- New high-risk medication pathway without adequate clinical decision support. + +### RED - Extreme Risk (Score 16-25) + +**Characteristics:** +- Severe hazards that are likely or certain to cause death, permanent disability, or major harm. +- Risks requiring immediate executive and board-level response. +- Service continuation in current form may be unsafe. + +**Required Actions:** +- **Immediate escalation**: Brief CMO, CEO, and Board Risk Sub-committee. +- **Consider service suspension**: Evaluate whether the service, procedure, or pathway must be suspended pending risk reduction. +- **Establish response team**: Dedicated multidisciplinary team with clear roles and authority. +- **Mandatory external notification assessment**: Determine if regulators, accreditation bodies, or insurers must be notified. +- **Daily or more frequent review**: Active management until the risk is resolved or reduced to an acceptable level. +- **Board reporting**: Include in formal board risk reporting. +- **Preserve evidence**: If linked to an incident, implement evidence preservation protocols. +- **Communicate**: Open disclosure obligations and stakeholder communication as required. + +**Clinical Examples:** +- Equipment failure pattern in a critical care unit creating imminent patient harm risk. +- Identified systematic prescribing error with potential for catastrophic patient outcomes. +- Infection outbreak in a high-dependency unit with inadequate containment. + +## Control Selection Framework + +### Hierarchy of Controls (Clinical Adaptation) + +Apply controls in order of effectiveness (most to least effective): + +| Priority | Control Type | Clinical Application | Effectiveness | +|---|---|---|---| +| 1 | **Elimination** | Remove the hazard entirely (discontinue unsafe process, withdraw defective device) | Highest | +| 2 | **Substitution** | Replace with a safer alternative (different medication formulation, alternative procedure) | High | +| 3 | **Engineering** | Physical or system barriers (forcing functions, automated alerts, physical interlocks) | High | +| 4 | **Administrative** | Policies, procedures, training, checklists, competency verification | Moderate | +| 5 | **PPE / Barriers** | Personal protective equipment, clinical safety devices, visual cues | Lowest | + +### Control Effectiveness Assessment + +For each proposed control, document: +- **Description**: What the control does. +- **Type**: Which level in the hierarchy. +- **Owner**: Who is responsible for implementation and maintenance. +- **Implementation timeline**: When the control will be active. +- **Verification method**: How effectiveness will be measured. +- **Limitations**: Known gaps or dependencies. + +## Documentation Standards + +### Risk Register Entry Format + +| Field | Content | +|---|---| +| Risk ID | Unique identifier (e.g., CR-2026-001) | +| Date Identified | Date risk was first identified | +| Risk Description | Clear description of the clinical hazard and potential harm | +| Risk Domain | Patient Safety, Clinical Pathway, Medication, Infection, Equipment, Service Design, Standing Orders | +| Source | How identified: incident, audit, complaint, proactive assessment, accreditation gap | +| Consequence | 1-5 with label and rationale | +| Likelihood | 1-5 with label and rationale | +| Inherent Risk Score | Calculated score before additional controls | +| Inherent Risk Level | GREEN / YELLOW / ORANGE / RED | +| Existing Controls | Current controls already in place | +| Additional Controls | Proposed new controls with hierarchy level | +| Residual Consequence | After proposed controls | +| Residual Likelihood | After proposed controls | +| Residual Risk Score | Calculated residual score | +| Residual Risk Level | GREEN / YELLOW / ORANGE / RED | +| Risk Owner | Named clinician or manager | +| Review Date | Next scheduled review | +| Governance Endorsement | Committee and date of endorsement | +| Status | Open / In Treatment / Accepted / Closed | + +### Risk Assessment Report Structure + +``` +## Clinical Risk Assessment + +**Date**: [assessment date] +**Assessor**: [role/team conducting assessment] +**Scope**: [clinical process, service, or change being assessed] +**Governance Authority**: [committee or executive sponsor] + +### 1. Context and Scope +[What is being assessed and why] + +### 2. Hazard Identification +[What could go wrong; what harm could result] + +### 3. Existing Controls +[Controls already in place and their effectiveness] + +### 4. Risk Analysis + +#### Consequence: [1-5] - [Label] +[Rationale referencing patient safety descriptors] + +#### Likelihood: [1-5] - [Label] +[Rationale referencing clinical evidence, incident history, and current conditions] + +#### Inherent Risk Score: [Score] - [GREEN/YELLOW/ORANGE/RED] + +### 5. Risk Treatment +[Proposed additional controls with hierarchy classification] + +| Control | Type | Owner | Timeline | Verification | +|---------|------|-------|----------|--------------| +| [Control 1] | [Hierarchy level] | [Name/Role] | [Date] | [Method] | + +### 6. Residual Risk +[Expected risk level after controls are implemented] + +#### Residual Consequence: [1-5] - [Label] +#### Residual Likelihood: [1-5] - [Label] +#### Residual Risk Score: [Score] - [GREEN/YELLOW/ORANGE/RED] + +### 7. Acceptance and Governance +[Who has authority to accept the residual risk; committee endorsement required] + +### 8. Monitoring Plan +[Review schedule, trigger events for re-assessment, KPIs] + +### 9. Next Steps +1. [Action - Owner - Deadline] +2. [Action - Owner - Deadline] +``` + +## Security & Privacy Considerations + +- Use minimum necessary patient data when describing clinical scenarios in risk assessments. +- Never include patient names or specific identifiers in risk register entries or reports. +- De-identify by default: use `[Patient A]`, `[Case ID]`, `[Ward X]` in all working documents. +- Keep patient-identifiable supporting evidence in authorized clinical systems only. +- Do not copy PHI/PII into tool logs, code comments, or reusable templates. +- Respect access controls and need-to-know principles for risk assessment documentation. +- Risk register entries are governance documents and should be stored in controlled systems. + +## Confidence Indicators + +| Scenario | Confidence | Action | +|---|---|---| +| Well-documented hazard with clear incident history and established controls | High | Proceed with full risk assessment and propose treatment plan | +| New or emerging risk with limited data; controls not yet validated | Medium | Produce provisional assessment, flag data gaps, require clinical lead review before governance submission | +| Conflicting evidence on severity or likelihood; multiple interpretations possible | Medium | Present range of plausible scores with rationale for each; require multidisciplinary review | +| Life-threatening or catastrophic risk scenario with incomplete information | Low | Escalate immediately to CMO/executive; apply precautionary principle; do not finalize assessment without senior clinical sign-off | +| Risk involves regulatory compliance uncertainty or novel clinical territory | Low | Draft assessment with explicit caveats; require governance committee and legal/compliance review | + +## Common Mistakes (Anti-Patterns) + +| Mistake | Why It's Wrong | Instead | +|---|---|---| +| Scoring risk based on gut feeling without rationale | Produces inconsistent, non-reproducible assessments that fail audit | Document specific evidence and reasoning for each severity and likelihood score | +| Accepting high or extreme risk without executive endorsement | Exceeds local authority; creates unacceptable governance exposure | Escalate all HIGH and EXTREME risks to the appropriate governance authority | +| Confusing inherent and residual risk | Overstates or understates actual risk exposure; misleads governance decisions | Always assess inherent risk first, then calculate residual risk after controls | +| Applying only administrative controls to high-consequence risks | Administrative controls (training, policy) are least reliable; human error persists | Prioritize elimination, substitution, and engineering controls per the hierarchy | +| Treating the risk register as a static document | Risks evolve; unreviewed registers create false assurance | Set mandatory review dates and trigger-based re-assessment | +| Omitting existing controls from the assessment | Inflates inherent risk artificially; duplicates effort | Catalogue existing controls before proposing additional ones | +| Failing to link risk assessments to incident data | Misses evidence that would improve scoring accuracy | Cross-reference incident reports and near-miss data when scoring likelihood | + +## When to Escalate + +Escalate immediately when: +- Risk score reaches EXTREME (RED) on initial or any subsequent assessment. +- A risk previously rated LOW or MEDIUM has escalated due to a new incident or changed circumstances. +- There is disagreement among clinical staff on severity or likelihood scoring. +- The risk involves a mandatory reporting trigger (death, severe harm, sentinel event). +- Controls have failed or are no longer effective. +- External factors (regulatory change, supply disruption, workforce shortage) materially affect the risk profile. + +Escalation targets: +- Clinical escalation: Service Lead -> Clinical Director -> Chief Medical Officer. +- Governance escalation: Quality/Risk Manager -> Clinical Governance Committee -> Board Risk Sub-committee. + +## Tool Requirements + +- `~~health/clinical-systems` (FHIR/HL7) for clinical record and incident data to support risk scoring. +- `~~project tracker` (Jira/ServiceNow) for risk register entries and action tracking. +- `~~cloud storage` (SharePoint) for risk assessment reports and governance endorsement records. +- `~~health/coding` or equivalent for structured categorization of clinical hazards. + +## Success Indicators + +You have applied this skill correctly when: +- [ ] Risk scope and context are clearly defined. +- [ ] Hazards are identified with reference to clinical evidence or incident history. +- [ ] Consequence and likelihood are scored with documented rationale. +- [ ] Inherent and residual risk scores are both calculated. +- [ ] Controls follow the hierarchy of controls (elimination > administrative). +- [ ] Risk owner and review date are assigned. +- [ ] Governance endorsement requirements are identified. +- [ ] Outputs avoid unnecessary PHI/PII exposure. +- [ ] Jurisdiction assumptions are explicit (AU/NZ default unless requested otherwise). + +## Related Skills + +- `~~health/worker-risk-assessment` for workforce and occupational hazard risk. +- `~~health/enterprise-risk-assessment` for strategic and organizational risk. +- `~~health/incident-reporting` for incident-triggered risk assessments. +- `~~health/quality-improvement` for QI projects arising from risk treatment plans. +- `~~health/complaints-management` for complaint-driven risk identification. + +## Version History + +| Version | Date | Changes | +|---|---|---| +| 1.0.0 | 2026-02-12 | Initial clinical risk assessment with severity x likelihood matrix, control hierarchy, and governance workflow | diff --git a/health/skills/complaints-management/SKILL.md b/health/skills/complaints-management/SKILL.md new file mode 100644 index 0000000..a623fef --- /dev/null +++ b/health/skills/complaints-management/SKILL.md @@ -0,0 +1,134 @@ +--- +name: health/complaints-management +description: This skill should be used when managing patient, staff, or visitor complaints in a healthcare setting. Use when triaging, investigating, or resolving complaints, distinguishing between clinician conduct and service delivery issues. +version: 1.0.0 +--- + +# Complaints Management + +An expert framework for handling healthcare complaints with a focus on patient safety, clinical governance, and regulatory compliance. This skill ensures that every complaint is handled systematically, maintaining the delicate balance between service recovery and professional accountability. + +## When to Use This Skill + +Invoke this skill when: +- A new patient, family, or staff complaint is received. +- Triaging issues to determine if they involve clinical safety (clinical governance) or service quality (administration). +- Drafting investigation plans for formal complaints. +- Assessing the severity of an incident reported as a complaint. +- Preparing formal responses to complainants or regulators (e.g., AHPRA, Health Care Complaints Commission). +- Mapping complaints to jurisdictional requirements (AU/NZ default). + +## Quick Reference + +1. **Safety First**: Immediately check if the complaint implies an ongoing risk to patient safety. +2. **Categorize**: Determine if the complaint is **Clinician-focused** (conduct/competence) or **Service-focused** (systems/facilities). +3. **Assign Severity**: Use the P1-P4 healthcare framework (P1 = Immediate safety/legal risk). +4. **Identify Persona**: Tailor the workflow for the user (e.g., Patient Experience Officer vs. Head of Department). +5. **Protect PHI**: Never log patient names or specific identifiers in the chat history. +6. **Timeline Check**: Verify jurisdictional deadlines (e.g., 2-day acknowledgment, 30-day resolution). + +## Operating Modes + +### Standard Mode +Full clinical governance and compliance workflow. Requires complete evidence capture, stakeholder mapping, and adherence to formal regulatory timelines. Use for all formal written complaints. + +### Lite Mode +Minimal safe guidance for "on-the-spot" resolution or informal verbal feedback. Focuses on immediate service recovery while still enforcing high-risk escalation triggers. Never suppresses clinical safety reporting. + +## Detailed Guidance + +### 1. Triage & Categorization + +Every complaint must be assigned a primary type to drive the investigation path. + +| Type | Focus | Investigation Path | +|------|-------|--------------------| +| **Clinician** | Performance, conduct, communication, competence | Clinical Lead / Medical Director / Nursing Director | +| **Service/Systems** | Facilities, wait times, access, billing, admin | Operations Manager / Patient Experience Team | +| **Privacy/Data** | Breach of confidentiality, unauthorized access | Privacy Officer / Health Information Manager | + +### 2. Severity Framework (Healthcare Adaptation) + +| Priority | Criteria | SLA (Acknowledgment) | SLA (Resolution) | +|----------|----------|----------------------|------------------| +| **P1 - Critical** | Direct threat to life, serious harm, major legal/media risk, mandatory reporting trigger | 2 Hours | 24-48 Hours | +| **P2 - High** | Clinical error with no harm, significant delay in care, high-value account/stakeholder | 4 Hours | 7 Days | +| **P3 - Medium** | Communication breakdown, minor service delay, facility issues | 1 Business Day | 30 Days | +| **P4 - Low** | General feedback, minor inconvenience, feature requests | 2 Business Days | 60 Days | + +### 3. Investigation Workflow + +#### Phase A: Fact Gathering +- **Record Review**: Access the clinical record via `~~clinical systems` (e.g., FHIR). +- **Staff Interviews**: Identify involved parties and request statements. +- **Timeline Construction**: Create a "source-of-truth" chronology. + +#### Phase B: Analysis +- **Root Cause Analysis (RCA)**: Use for P1/P2 complaints to identify systemic failures. +- **Human Factors**: Consider fatigue, environment, and communication tools. + +#### Phase C: Resolution +- **Open Disclosure**: If harm occurred, trigger the formal Open Disclosure process. +- **Service Recovery**: Propose tangible remediation (e.g., apology, billing adjustment, process change). + +## Jurisdiction & Regulatory Context + +### Australia & New Zealand (Default) +- **Australia**: Align with the *Australian Charter of Healthcare Rights* and state-based commissions (e.g., HCCC in NSW, OHHO in QLD). +- **New Zealand**: Align with the *Code of Health and Disability Services Consumers' Rights* and the HDC. +- **Mandatory Reporting**: Trigger AHPRA (AU) or Medical Council (NZ) notification for serious professional misconduct. + +### US/EU-lite Fallback +- **USA**: Reference HIPAA privacy rules and CMS Quality Standards. +- **EU**: Reference GDPR Article 9 (Health Data) and national health acts. + +## Confidence Indicators (Clinical Guardrails) + +| Scenario | Confidence | Action | +|----------|------------|--------| +| Clear service failure (e.g., cold food) | High | Draft response and suggest immediate remediation. | +| Ambiguous clinical claim (e.g., "wrong dose") | Medium | Flag for Clinical Lead review; do not validate claim without record audit. | +| Allegation of serious harm or misconduct | Low | **BLOCKER**: Escalate to Legal and Executive immediately. Do not draft response. | + +## Security & Privacy (PHI Handling) + +- **Minimum Necessary**: Only request the specific portions of the clinical record relevant to the complaint. +- **De-identification**: Use tokens like `[Patient A]` or `[Clinician B]` in drafting. +- **No Persistence**: Explicitly remind the user to delete PHI from temporary workspaces after the response is generated. +- **Tool Access**: Only use `~~clinical systems` through authenticated organization-approved MCP gateways. + +## Common Mistakes (Anti-Patterns) + +| Mistake | Why It's Wrong | Instead | +|---------|----------------|---------| +| Defensive Tone | Escalates the conflict and reduces trust. | Use empathetic, neutral, and fact-based language. | +| Logging Patient Names | Risk of PHI exposure in LLM training/logs. | Use case IDs or generic identifiers. | +| Bypassing Governance | Clinician complaints handled by admin staff risk missing medical errors. | Always route clinical competence issues to the Medical Director. | +| Missing Deadlines | Jurisdictional regulators may penalize the organization. | Set automated alerts for 30-day windows. | + +## Tool Requirements + +- `~~clinical systems` (FHIR/HL7) - To verify clinical events and timelines. +- `~~project tracker` (Jira/ServiceNow) - To log and track complaint status. +- `~~cloud storage` (SharePoint) - To store formal investigation statements. +- `~~medical coding` (ICD-10) - To categorize complaints by diagnosis/procedure area. + +## Success Indicators + +- [ ] Complaint categorized correctly by root cause (Clinician vs. Service). +- [ ] Severity matches jurisdictional patient safety frameworks (e.g., SAC scores). +- [ ] No PHI/PII included in the skill's drafted output. +- [ ] Response includes an explicit apology (where appropriate) without admitting legal liability prematurely. +- [ ] Regulatory reporting triggers are identified and flagged. + +## Related Skills + +- `~~health/incident-reporting` - For complaints that meet the definition of a clinical incident. +- `~~health/policy-development` - For complaints leading to a change in standard operating procedures. +- `~~customer-support/response-drafting` - For generic communication patterns. + +## Version History + +| Version | Date | Changes | +|---------|------|---------| +| 1.0.0 | 2026-02-12 | Initial healthcare adaptation of ticket-triage and escalation patterns. | diff --git a/health/skills/evidence-synthesis/SKILL.md b/health/skills/evidence-synthesis/SKILL.md new file mode 100644 index 0000000..9c00f3b --- /dev/null +++ b/health/skills/evidence-synthesis/SKILL.md @@ -0,0 +1,558 @@ +--- +name: health/evidence-synthesis +description: This skill should be used when selecting and conducting evidence synthesis approaches beyond traditional systematic reviews. Use for scoping reviews, rapid reviews, evidence maps, umbrella reviews, and mixed-methods synthesis. Invoke when users mention scoping reviews, rapid evidence synthesis, evidence mapping, or need guidance on selecting the appropriate review type for their research question or timeline constraints. +version: 1.0.0 +--- + +# Evidence Synthesis + +A comprehensive framework for selecting and conducting diverse evidence synthesis approaches including scoping reviews, rapid reviews, evidence maps, umbrella reviews, and mixed-methods synthesis. This skill helps researchers choose the most appropriate synthesis method based on their research question, timeline, and resource constraints while maintaining methodological rigor. + +**Important**: This skill guides selection and execution of evidence synthesis methods but does not replace systematic review methodology expertise or statistical consultation for complex syntheses. Always ensure appropriate methodological expertise is involved for the chosen approach. + +## When to Use This Skill + +Invoke this skill when: +- Determining which type of evidence synthesis is appropriate for a research question. +- Planning or conducting a scoping review to map literature breadth. +- Designing a rapid review for time-sensitive decision-making. +- Creating an evidence map to visualize research distribution and gaps. +- Conducting an umbrella review (review of systematic reviews). +- Planning mixed-methods or qualitative evidence synthesis. +- Comparing methodologies to justify review type selection. +- Adapting systematic review methods for resource constraints. +- Synthesizing evidence for policy briefs or clinical guidelines. +- Conducting living systematic reviews with continuous updates. +- Reporting non-traditional review types for publication. + +## Regulatory Context + +### Australia & New Zealand (Default) + +| Regulation/Standard | Relevance | Key Requirements | +|---------------------|-----------|------------------| +| **NHMRC Standards** (AU) | Research synthesis | Guidance on evidence synthesis for guidelines and policy | +| **Joanna Briggs Institute** (AU) | Review methodologies | Methodological guidance for scoping and rapid reviews | +| **Health Research Council NZ** | Research standards | Evidence synthesis standards for funding applications | +| **ACC NZ** | Policy evidence | Requirements for rapid evidence summaries | +| **PHARMAC** (NZ) | Health technology assessment | Evidence requirements for pharmaceutical funding decisions | + +### US/EU-lite Fallback + +| Regulation/Standard | Relevance | Key Requirements | +|---------------------|-----------|------------------| +| **AHRQ Rapid Reviews** (US) | Comparative effectiveness | Methods guidance for rapid evidence synthesis | +| **WHO Guidelines** | International | Evidence synthesis standards for guideline development | +| **EUnetHTA** (EU) | Health technology assessment | HTA-specific synthesis requirements | +| **CADTH** (Canada) | Health technology assessment | Rapid review and evidence mapping methods | + +### Jurisdiction Matrix + +| Jurisdiction | Applicable Regulator | Reporting Trigger | Timeframe | Required Artifacts | Escalation Point | +|--------------|---------------------|-------------------|-----------|-------------------|------------------| +| **AU - National** | NHMRC | Clinical guideline evidence | Per guideline cycle | Evidence synthesis report; Methodology justification | Guidelines Committee Chair | +| **AU - State** | State Health Depts | Policy decision support | Urgent policy need | Rapid review; Executive summary | Policy Director | +| **NZ - National** | PHARMAC | Funding decision evidence | Funding round deadline | Evidence summary; Gap analysis | Pharmacology Advisor | +| **US** | AHRQ | Evidence-based practice | Contract timeline | Technical brief; Methods appendix | Project Officer | +| **International** | WHO | Guideline development | Guideline timeline | Evidence synthesis; GRADE tables | Guideline Steering Group | + +## Quick Reference + +1. **Systematic Review**: Gold standard; comprehensive; 6-12 months; all question types. +2. **Scoping Review**: Map literature breadth; no quality assessment; 2-4 months; emerging topics. +3. **Rapid Review**: Accelerated systematic review; 1-3 months; urgent decisions; transparent shortcuts. +4. **Evidence Map**: Visual overview of research distribution; gap identification; 3-6 months. +5. **Umbrella Review**: Synthesize existing systematic reviews; overview of reviews; 3-6 months. +6. **Qualitative Synthesis**: Synthesize qualitative studies; interpretive methods; context-specific. +7. **Mixed-Methods**: Integrate quantitative and qualitative evidence; complex interventions. +8. **Living Review**: Continuously updated systematic review; emerging evidence areas. + +## Operating Modes + +### Standard Mode +Full evidence synthesis with appropriate methodological rigor for the selected review type, complete documentation, quality assessment where applicable, and transparent reporting of methods and limitations. Use for publication-grade syntheses intended for peer-reviewed journals or formal evidence-based guidelines. + +### Lite Mode +Streamlined guidance for rapid evidence summaries, briefing documents, or internal decision support. Focuses on essential elements with abbreviated searching, single-reviewer screening with verification, and narrative summary without formal quality assessment. Clearly acknowledge limitations and appropriate use cases. Never claim systematic review rigor for rapid methods. + +## Detailed Guidance + +### 1. Review Type Selection Framework + +Choose the appropriate synthesis method based on these criteria: + +#### 1.1 Decision Matrix + +| Question Type | Time Available | Evidence Type | Recommended Method | +|---------------|----------------|---------------|-------------------| +| Effectiveness of intervention | 6-12 months | RCTs + observational | **Systematic Review** with meta-analysis | +| What literature exists? | 2-4 months | Any | **Scoping Review** | +| Urgent policy decision | 1-3 months | Existing reviews + primary | **Rapid Review** | +| Research gaps and clusters | 3-6 months | Any | **Evidence Map** | +| Multiple SRs on topic | 3-6 months | Systematic reviews | **Umbrella Review** | +| Lived experience/implementation | 3-6 months | Qualitative | **Qualitative Synthesis** | +| Complex intervention | 4-8 months | Mixed methods | **Mixed-Methods Review** | +| Continuously emerging evidence | Ongoing | RCTs + updates | **Living Systematic Review** | + +#### 1.2 Key Considerations + +**Research Question**: +- Intervention effectiveness → Systematic review/rapid review +- Literature landscape → Scoping review/evidence map +- Concept clarification → Scoping review +- Evidence overview → Umbrella review +- Experience/barriers → Qualitative synthesis + +**Timeline**: +- <1 month → Rapid evidence summary (acknowledge limitations) +- 1-3 months → Rapid review with transparent shortcuts +- 3-6 months → Scoping review, evidence map, umbrella review +- 6-12 months → Full systematic review +- Ongoing → Living systematic review + +**Resource Constraints**: +- Single reviewer possible for scoping reviews (with verification) +- Rapid reviews can use abbreviated searching +- Evidence maps automate extraction using machine learning + +### 2. Scoping Review Methodology + +#### 2.1 Purpose and Applications + +**Definition**: A scoping review maps the extent, range, and nature of research activity in a field without assessing quality. + +**Appropriate When**: +- Identifying research gaps +- Clarifying concepts and definitions +- Examining how research is conducted +- Mapping evidence characteristics +- Informing future systematic reviews + +#### 2.2 JBI Methodology (Arksey & O'Malley/Peters Framework) + +**Six Stage Process**: + +**Stage 1: Identifying the Research Question** +- Use PCC framework: Population, Concept, Context +- Broad question to capture wide literature +- Example: "What is known about digital health interventions for diabetes management?" + +**Stage 2: Identifying Relevant Studies** +- Search strategy less exhaustive than systematic review +- Key databases (3-5 typically sufficient) +- Grey literature and key informants optional +- Document search strategy and databases + +**Stage 3: Study Selection** +- Title/abstract screening (single or dual reviewer) +- Full-text screening with reasons for exclusion +- PRISMA-ScR flow diagram + +**Stage 4: Charting the Data** +- Extract: Authors, year, country, study design, population, concept, key findings +- Use standardized data charting form +- Iterative approach (pilot and refine) + +**Stage 5: Collating, Summarizing, and Reporting Results** +- Numerical summary: Study counts by characteristic +- Thematic analysis: Emerging themes +- Gap identification: Research needs + +**Stage 6: Optional Consultation** +- Stakeholder input on findings +- Practitioner validation +- Patient/public involvement + +#### 2.3 PRISMA-ScR Reporting + +Use PRISMA extension for Scoping Reviews checklist: +- 20-item checklist +- Includes flow diagram modification +- Published in Annals of Internal Medicine (2018) + +### 3. Rapid Review Methodology + +#### 3.1 Purpose and Applications + +**Definition**: An accelerated systematic review using streamlined methods to meet urgent decision timelines. + +**Appropriate When**: +- Policy or clinical decisions needed urgently +- Emerging health threats (pandemic, outbreak) +- Healthcare resource allocation decisions +- Guideline updates required quickly + +#### 3.2 Methodological Shortcuts (Transparent) + +| Systematic Review Element | Rapid Review Adaptation | Transparency Requirement | +|---------------------------|------------------------|-------------------------| +| **Search strategy** | Abbreviated search (3-4 databases) | List databases searched; document date limits | +| **Grey literature** | Minimal or none | State exclusion; justify based on timeframe | +| **Study selection** | Single reviewer with verification sample | Report percentage verified; inter-rater reliability | +| **Data extraction** | Single reviewer with spot checks | Document verification method | +| **Risk of bias** | Focus on key domains only | State which domains assessed | +| **Quality of evidence** | Streamlined GRADE or narrative | Document modified approach | +| **Synthesis** | Narrative only (no meta-analysis) | Justify lack of pooling | + +#### 3.3 Quality Considerations + +**Acceptable Shortcuts**: +- Focused research question (narrower PICOS) +- Limited database searching (core databases only) +- Single reviewer with verification sampling (≥20% dual-reviewed) +- Abbreviated data extraction (key outcomes only) + +**Unacceptable Shortcuts**: +- No protocol or registration +- No documentation of methods +- Bias in study selection +- Omitting risk of bias entirely +- Selective outcome reporting + +#### 3.4 WHO Rapid Review Guide + +WHO recommends rapid reviews include: +- Preliminary search to scope literature volume +- Focused question and inclusion criteria +- Streamlined searching (limited databases) +- Expedited screening (single reviewer + verification) +- Simplified data extraction (key outcomes only) +- Narrative synthesis +- Transparent reporting of limitations + +### 4. Evidence Mapping + +#### 4.1 Purpose and Applications + +**Definition**: A systematic method to identify, categorize, and display evidence distribution across interventions, outcomes, populations, and study designs. + +**Appropriate When**: +- Visualizing research landscape +- Identifying evidence clusters and gaps +- Planning future systematic reviews +- Stakeholder communication +- Policy priority setting + +#### 4.2 Evidence Map Components + +**Systematic Search**: +- Broad search strategy +- Multiple databases +- Clear eligibility criteria + +**Systematic Screening**: +- Title/abstract and full-text screening +- Document with PRISMA-style flow diagram + +**Systematic Coding**: +- Standardized extraction form +- Categories: Intervention, outcome, population, study design, setting + +**Visualization**: +- Bubble charts: Intervention vs. Outcome (bubble size = study count) +- Heat maps: Evidence density +- Gap maps: Research needs highlighted + +#### 4.3 Gap Analysis + +**Evidence Clusters**: +- Well-studied interventions +- Common outcomes measured +- Population groups with robust evidence + +**Evidence Gaps**: +- Under-studied interventions +- Outcomes not measured +- Under-represented populations +- Methodological limitations + +### 5. Umbrella Review Methodology + +#### 5.1 Purpose and Applications + +**Definition**: A systematic review of existing systematic reviews, also called "overview of reviews" or "review of reviews." + +**Appropriate When**: +- Multiple systematic reviews exist on topic +- Synthesizing evidence across different populations or settings +- Identifying discordant findings between reviews +- Comprehensive overview needed for guidelines + +#### 5.2 Methodological Considerations + +**Search Strategy**: +- Focus on systematic review databases +- Epistemonikos, Cochrane Database of Systematic Reviews +- Database filters for systematic reviews + +**Eligibility Criteria**: +- Must be systematic reviews (not narrative reviews) +- Quality threshold (e.g., must include risk of bias assessment) +- Recent reviews preferred (unless unique contribution) + +**Assessment of Multiple Systematic Reviews (AMSTAR) Tool**: + +| Domain | Assessment | +|--------|------------| +| **D1** | Was an a priori design provided? | +| **D2** | Was there duplicate study selection and data extraction? | +| **D3** | Was a comprehensive literature search performed? | +| **D4** | Was the status of publication used as inclusion criteria? | +| **D5** | Was a list of studies provided? | +| **D6** | Were the characteristics of included studies provided? | +| **D7** | Was the scientific quality of included studies assessed? | +| **D8** | Was quality used in formulating conclusions? | +| **D9** | Were methods used to combine findings appropriate? | +| **D10** | Was likelihood of publication bias assessed? | +| **D11** | Was conflict of interest stated? | + +#### 5.3 Discordance Analysis + +When reviews disagree: +- Compare inclusion criteria +- Compare search dates (different evidence base) +- Compare risk of bias assessments +- Compare synthesis methods +- Compare outcomes measured + +### 6. Qualitative Evidence Synthesis + +#### 6.1 Purpose and Applications + +**Definition**: Systematic methods to synthesize findings from qualitative studies. + +**Appropriate When**: +- Understanding patient experiences +- Exploring implementation barriers/facilitators +- Examining healthcare professional perspectives +- Investigating contextual factors + +#### 6.2 Methodological Approaches + +| Method | Description | Best For | +|--------|-------------|----------| +| **Thematic Synthesis** | Identify descriptive and analytical themes | General qualitative synthesis | +| **Meta-Ethnography** | Translate concepts across studies; generate new theory | Theory development | +| **Critical Interpretive Synthesis** | Iterative questioning and interpretation | Complex, heterogeneous literature | +| **Framework Synthesis** | Apply a priori framework; identify gaps | Policy-relevant questions | +| **Meta-Aggregation** (JBI) | Aggregate findings into categories and syntheses | Practice recommendations | + +#### 6.3 ENTREQ Reporting + +Use ENTREQ (Enhancing Transparency in Reporting the Synthesis of Qualitative Research) statement: +- 21-item checklist +- Includes methodological approach +- Describes analytical techniques + +### 7. Mixed-Methods Synthesis + +#### 7.1 Purpose and Applications + +**Definition**: Integration of quantitative and qualitative evidence within a single review. + +**Appropriate When**: +- Complex interventions +- Understanding effectiveness and implementation +- Examining what works, for whom, and in what circumstances + +#### 7.2 Integration Methods + +**Convergent Integrated Approach** (JBI): +- Conduct quantitative and qualitative syntheses separately +- Integrate at results level +- Create mixed-methods matrix + +**Sequential Explanatory**: +- Quantitative synthesis first +- Qualitative explains quantitative findings + +**Sequential Exploratory**: +- Qualitative synthesis first +- Quantitative tests qualitative findings + +#### 7.3 JBI Mixed Methods Guidance + +- Use convergent integrated approach as default +- Present quantitative and qualitative findings separately then integrated +- Use graphical displays for integration +- Report confidence in qualitative findings (CERQual) + +### 8. Living Systematic Reviews + +#### 8.1 Purpose and Applications + +**Definition**: Systematic reviews that are continually updated as new evidence emerges. + +**Appropriate When**: +- Rapidly evolving evidence base +- High-priority clinical questions +- Ongoing uncertainty requiring current evidence + +#### 8.2 Methodological Considerations + +**Automation**: +- Automated literature surveillance +- Machine learning for screening +- Living data extraction + +**Update Triggers**: +- Time-based (e.g., every 6 months) +- Event-based (e.g., major new trial published) +- Threshold-based (e.g., evidence certainty changes) + +**Version Control**: +- Clear versioning system +- Change logs +- Archiving previous versions + +#### 8.3 Cochrane Living Evidence Framework + +Cochrane recommends: +- Prioritize high-impact questions +- Establish editorial infrastructure +- Use technology for efficiency +- Plan for sustainability + +## Documentation Requirements + +### Evidence Synthesis Project File + +- [ ] Review type selection rationale +- [ ] Protocol or project plan +- [ ] Eligibility criteria +- [ ] Search strategies (all sources) +- [ ] PRISMA-style flow diagram +- [ ] Study characteristics table +- [ ] Quality assessment results (if applicable) +- [ ] Data extraction forms +- [ ] Synthesis results (narrative, visual, or meta-analytic) +- [ ] Evidence gap analysis (for maps) +- [ ] Limitations and strengths assessment +- [ ] Applicability and implications + +### Review-Type Specific Requirements + +**Scoping Review**: +- [ ] PCC framework documentation +- [ ] PRISMA-ScR checklist +- [ ] Gap identification and research recommendations + +**Rapid Review**: +- [ ] Transparent documentation of shortcuts taken +- [ ] Risk of bias assessment (streamlined) +- [ ] Limitations section acknowledging rapid methods + +**Evidence Map**: +- [ ] Visual display of evidence distribution +- [ ] Gap analysis with research priorities +- [ ] Interactive or static visualization + +**Umbrella Review**: +- [ ] AMSTAR quality assessment of included reviews +- [ ] Discordance analysis if reviews disagree +- [ ] Overview of certainty across reviews + +**Qualitative Synthesis**: +- [ ] ENTREQ checklist +- [ ] Methodological approach justification +- [ ] Analytical process description + +**Living Review**: +- [ ] Update schedule and triggers +- [ ] Version control documentation +- [ ] Change log between versions + +## Common Mistakes + +| Mistake | Why It's Wrong | Instead | +|---------|----------------|---------| +| **Calling rapid review a systematic review** | Misrepresents methodological rigor | Clearly label as rapid review; document shortcuts transparently | +| **No protocol for scoping review** | Increases risk of scope creep | Write and follow protocol; optional registration | +| **Quality assessment in scoping review** | Beyond scope; introduces bias toward positive findings | Map quality descriptively only if relevant; focus on breadth | +| **Insufficient searching for evidence map** | Incomplete landscape representation | Ensure broad, comprehensive searching | +| **Ignoring discordance in umbrella review** | Misses important evidence conflicts | Explicitly analyze and explain discordant findings | +| **Integrating without justification** | Mixed-methods integration requires explicit approach | State integration method (convergent, sequential) | +| **No gap analysis in evidence map** | Misses primary purpose of mapping | Systematically identify and report evidence gaps | +| **Unclear review type selection** | Reader cannot assess appropriateness | Explicitly state why this review type was chosen | +| **Omitting limitations** | Transparency essential for evidence utility | Thoroughly document methodological limitations | +| **Inadequate stakeholder consultation** | Misses practical applicability | Include end-users in scoping review consultation | + +## When to Escalate + +Escalate to Evidence Synthesis Lead, Methodologist, or Content Expert when: +- Living systematic review infrastructure is required (ongoing updates). +- Network meta-analysis is being considered within an umbrella review. +- Mixed-methods synthesis requires advanced integration methods. +- Machine learning or automation tools are needed for screening/extraction. +- Evidence synthesis will inform high-stakes policy or regulatory decisions. +- Multiple review types are being combined (e.g., rapid umbrella review). +- Complex interventions require innovative synthesis approaches. +- Realist synthesis or other theory-driven methods are proposed. +- Cross-language synthesis without translation resources. +- Synthesis includes patient-level data from multiple sources. + +## Privacy Considerations + +- **PHI Involved**: Rare - Evidence synthesis typically uses aggregate published data. +- **Data Minimization**: Extract only published aggregate data; do not request individual patient data unless justified. +- **De-identification**: Not typically applicable as published studies should already be de-identified. +- **Access Controls**: Limit access to extraction files to synthesis team members. +- **Retention**: Retain synthesis files according to institutional policy (typically 7+ years). +- **No Persistence**: Do not store unpublished data or author communications containing PHI. + +## Confidence Indicators + +| Scenario | Confidence | Action | +|----------|------------|--------| +| Well-established review type (scoping, rapid) with clear guidance | High | Proceed with established methodology; document choices | +| Novel or hybrid methodology without established guidance | Medium | Consult with methodology expert; document rationale extensively | +| Rapid review for urgent high-stakes decision | Medium | Ensure transparency about limitations; acknowledge uncertainty | +| Living systematic review setup | Low | Escalate to specialist; plan infrastructure and sustainability | +| Mixed-methods integration of heterogeneous evidence | Medium | Use established frameworks (JBI, Cochrane); involve qualitative expert | +| Evidence map with automated/machine learning components | Medium | Validate machine learning outputs; spot-check accuracy | +| Umbrella review with discordant systematic reviews | Medium | Escalate for discordance analysis; involve content experts | +| Qualitative synthesis without qualitative expertise | Low | Involve qualitative research specialist; ensure appropriate method selection | + +## Tool Requirements + +- `~~research literature` - For database searches across review types +- `~~project tracker` - For managing synthesis timelines and milestones +- `~~cloud storage` - For documentation, extraction forms, and data files +- `~~document collaboration` - For team coordination on screening and extraction +- `~~data analysis` - For visualization (evidence maps, bubble charts) +- `~~reference manager` - For citation management and deduplication +- `~~machine learning` - For automated screening in living reviews or large evidence maps (optional) + +## Success Indicators + +You've applied this skill well when: +- [ ] Review type selection is justified based on question, timeline, and resources +- [ ] Protocol or project plan documents methodology clearly +- [ ] Eligibility criteria are appropriate for review type +- [ ] Search strategy is documented and reproducible +- [ ] PRISMA-style flow diagram accurately reflects process +- [ ] Quality assessment is appropriate for review type (or omitted with justification) +- [ ] Synthesis approach matches review type and data characteristics +- [ ] Evidence gaps are identified and described (where applicable) +- [ ] Limitations are transparently acknowledged +- [ ] Reporting guidelines specific to review type are followed +- [ ] Results are contextualized for intended use (policy, practice, research) + +## Related Skills + +- `~~health/systematic-review` - For traditional systematic review methodology (gold standard) +- `~~health/guideline-development` - When evidence synthesis supports clinical guidelines +- `~~health/quality-improvement` - When evidence synthesis informs QI initiatives +- `~~research/literature-search` - For database-specific search optimization +- `~~research/statistical-analysis` - For meta-analysis within systematic reviews + +## References + +- Tricco AC, Lillie E, Zarin W, et al. PRISMA Extension for Scoping Reviews (PRISMA-ScR): Checklist and Explanation. Ann Intern Med. 2018;169(7):467-473. +- Harker J, Kleijnen J. What is a rapid review? A methodological exploration of rapid reviews in Health Technology Assessments. Int J Evid Based Healthc. 2012;10(4):397-410. +- Snilstveit B, Vojtkova M, Bhavsar A, et al. Evidence & Gap Maps: A comparison of different approaches. Campbell Systematic Reviews. 2016;12(1):1-38. +- Aromataris E, Fernandez R, Godfrey CM, et al. Summarizing systematic reviews: methodological development, conduct and reporting of an umbrella review approach. Int J Evid Based Healthc. 2015;13(3):132-140. +- Tong A, Flemming K, McInnes E, et al. Enhancing transparency in reporting the synthesis of qualitative research: ENTREQ. BMC Med Res Methodol. 2012;12:181. +- Pearson A, White H, Bath-Hextall F, et al. A mixed-methods approach to systematic reviews. Int J Evid Based Healthc. 2015;13(3):121-131. +- Elliott JH, Turner T, Clavisi O, et al. Living systematic reviews: an emerging opportunity to narrow the evidence-practice gap. PLoS Med. 2014;11(2):e1001603. +- Cochrane Methods. Living systematic reviews. Cochrane Library. https://methods.cochrane.org/living-systematic-reviews diff --git a/health/skills/grant-writer/SKILL.md b/health/skills/grant-writer/SKILL.md new file mode 100644 index 0000000..6a865ff --- /dev/null +++ b/health/skills/grant-writer/SKILL.md @@ -0,0 +1,546 @@ +--- +name: health/grant-writer +description: This skill should be used when preparing grant applications for health research funding. Use for NHMRC, MRFF, HRC (NZ), ARC health-related grants, and NIH applications. Supports proposal structuring, budget justification, assessment criteria alignment, and iterative refinement of grant applications. +version: 1.0.0 +--- + +# Grant Writer + +A comprehensive framework for health research grant application preparation, supporting researchers and institutions in navigating the complex landscape of major Australasian and international funding bodies. This skill provides structured guidance for proposal development, assessment criteria alignment, and strategic positioning to maximize funding success. + +**Important**: This skill assists with grant preparation but does not guarantee funding success. Always verify current funder guidelines and deadlines directly with the funding body. Peer review and institutional approval are essential before submission. + +## When to Use This Skill + +Invoke this skill when: +- Planning a new grant application for health research funding. +- Selecting the appropriate funder and scheme for your research idea. +- Structuring a research proposal to meet specific funder requirements. +- Aligning your application with assessment criteria and scoring rubrics. +- Developing budget justifications and resource plans. +- Writing Chief Investigator (CI) track record statements. +- Preparing responses to reviewer feedback on resubmissions. +- Converting a research concept into a fundable proposal. +- Navigating compliance requirements for human/animal research ethics. +- Coordinating multi-site or multi-institutional grant applications. + +## Regulatory Context + +### Australia & New Zealand (Default) + +| Regulation/Standard | Relevance | Key Requirements | +|---------------------|-----------|------------------| +| **NHMRC Act 1992** | Primary legislation | Peer review standards, research integrity, funding agreement terms | +| **MRFF Act 2015** | Medical research funding | Mission-driven priorities, consumer involvement, translation focus | +| **HRC Act 1990 (NZ)** | NZ health research | Te Tiriti o Waitangi obligations, Māori health research principles | +| **ARC Act 2001** | Discovery/Linkage programs | Excellence criteria, national benefit, research training | +| **Research Governance** | Institution-level | Sponsorship, indemnity, data management, ethics approval | + +### US/EU-lite Fallback + +| Regulation/Standard | Relevance | Key Requirements | +|---------------------|-----------|------------------| +| **NIH Grants Policy** | US federal funding | Public access mandate, data sharing, human subjects protection | +| **NSF Grants Manual** | US basic research | Broader impacts, merit review criteria, conflict of interest | +| **Horizon Europe** | EU research funding | Open science, gender equality, ethical compliance | +| **NIHR (UK)** | UK health research | Patient/public involvement, impact pathways | + +### Jurisdiction Matrix + +| Jurisdiction | Applicable Regulator | Reporting Trigger | Timeframe | Required Artifacts | Escalation Point | +|--------------|---------------------|-------------------|-----------|-------------------|------------------| +| **AU - NHMRC** | NHMRC CEO | Funding agreement executed | Pre-award | Ethics approval; institutional sign-off; budget | Research Office | +| **AU - MRFF** | Department of Health | Grant notification | Pre-award | MRFF-specific compliance; consumer involvement plan | Research Office | +| **NZ - HRC** | HRC Executive Director | Contract execution | Pre-award | Te Tiriti compliance; Māori consultation | Research Office | +| **US - NIH** | NIH IC Program Officer | JIT request; NOA issued | Post-review | IRB approval; data sharing plan; vertebrate animals | Grants Administrator | + +## Quick Reference + +1. **Funder Selection**: Match research type, career stage, and institutional capacity. +2. **Scheme Alignment**: Understand eligibility, duration, budget caps, and assessment criteria. +3. **Research Question**: Clear, answerable, significant, and feasible within the budget/timeline. +4. **Significance**: Articulate knowledge gap, innovation, and impact pathways. +5. **Approach**: Rigorous methodology with contingency plans and risk mitigation. +6. **Team**: Appropriate expertise, track record, and demonstrated collaboration. +7. **Environment**: Institutional support, infrastructure, and resources. +8. **Budget**: Realistic, justified, and compliant with funder rules. +9. **Consumer Involvement**: Patient/public engagement where required or beneficial. +10. **Ethics**: Proactive planning for human/animal research approvals. + +## Operating Modes + +### Standard Mode +Full grant development workflow with comprehensive assessment criteria analysis, detailed budget justification, full CI track record documentation, consumer involvement planning, and complete compliance verification. Use for major scheme applications (NHMRC Ideas/Investigator/Synergy, MRFF large grants, HRC program grants) where funding success is critical and adequate preparation time is available. + +### Lite Mode +Streamlined guidance for rapid grant preparation or straightforward fellowship/seed grant applications. Focuses on core proposal elements, basic budget justification, and essential compliance. Never suppresses high-risk requirements such as human research ethics approval or mandatory consumer involvement. Use when timeline is compressed or for lower-complexity applications. + +## Detailed Guidance + +### 1. Funder and Scheme Selection + +Selecting the right funding opportunity is the foundation of grant success. Consider these dimensions: + +#### Research Type Alignment + +| Funder | Research Focus | Typical Award Size | Duration | +|--------|----------------|-------------------|----------| +| **NHMRC Ideas** | Innovative, discovery-focused | $300K-$600K | 3-5 years | +| **NHMRC Investigator** | Researcher-led program | $500K-$3M | 5 years | +| **NHMRC Synergy** | Team-based, interdisciplinary | $2M-$5M | 5 years | +| **MRFF** | Mission-driven, translational | $500K-$10M+ | 2-5 years | +| **HRC Explorer** | NZ exploratory research | $150K-$300K | 3 years | +| **HRC Programme** | NZ large team programs | $1M-$5M | 4-5 years | +| **ARC DP** | Basic research excellence | $300K-$500K | 3-5 years | +| **NIH R01** | US investigator-initiated | $1M-$2.5M | 4-5 years | + +#### Career Stage Considerations + +**Early Career Researchers (ECRs)**: +- NHMRC: Emerging Leadership Fellowships, Ideas Grants as CIA +- MRFF: ECR initiatives, Early to Mid-Career Researchers (EMCR) streams +- HRC: Explorer Grants, Hohua Tutengaehoe Fellowships +- NIH: R21 (exploratory), K awards (career development) + +**Mid-Career**: +- NHMRC: Investigator Grants (Leadership Levels 1-2), Synergy Grants +- HRC: Project Grants as CIA, Emerging Leaders Fellowships +- NIH: R01 (established investigator) + +**Senior Researchers**: +- NHMRC: Investigator Grants (Leadership Levels 3-4), Synergy Grant leadership +- HRC: Programme Grants, James Cook Research Fellowships +- NIH: R01 renewals, P01 (program projects) + +#### Selection Decision Framework + +Ask these questions in sequence: +1. **Eligibility**: Do I meet citizenship, employment, and career stage requirements? +2. **Fit**: Does my research align with the scheme's stated priorities? +3. **Feasibility**: Can I deliver the proposed work within budget/timeline constraints? +4. **Competitiveness**: Do I have the track record and team to be competitive? +5. **Institutional Support**: Will my institution provide necessary resources and approvals? + +### 2. Proposal Structure by Funder + +Each funder has distinct structural requirements. Below are the standard formats with AU/NZ emphasis. + +#### NHMRC Grant Structure + +**Ideas Grants** (Project-based, 5-year max): +- **Grant Proposal (10 pages)**: Research proposal including significance, innovation, and approach +- **Track Record Statement (2 pages per CI)**: Research outputs, engagement, and translation +- **Research Environment (1 page)**: Institutional support and facilities +- **Budget Justification**: By year, with personnel and non-personnel breakdown + +**Investigator Grants** (Person-based, 5-year): +- **Leadership Statement (4 pages)**: Research leadership, mentorship, and service +- **Research Proposal (6 pages)**: Program of research +- **Track Record (2 pages)**: Outputs, engagement, translation +- **Research Environment (1 page)**: Institutional support + +**Synergy Grants** (Team-based, 5-year): +- **Proposal (10 pages)**: Including team synergy justification +- **Track Record Statements**: For all CIs +- **Research Environment**: Host institution support + +#### MRFF Grant Structure + +**Key Documents**: +- **Research Proposal**: Length varies by scheme (typically 10-15 pages) +- **Consumer Involvement Plan**: Required for all MRFF grants +- **Translation Pathway**: Explicit commercialization/implementation plan +- **Budget Justification**: Aligns with MRFF cost principles +- **Track Record**: For CIs (length varies) + +**MRFF-Specific Requirements**: +- Consumer involvement is mandatory, not optional +- Collaboration with industry/end-users often required +- Alignment with mission priorities is critical +- Data sharing and management plans required + +#### HRC (New Zealand) Grant Structure + +**Explorer Grants**: +- **Proposal (6 pages)**: Background, aims, methods, significance +- **Track Record (2 pages)**: Research outputs and experience +- **Budget**: Simplified format +- **Māori Consultation**: May be required depending on research focus + +**Project Grants**: +- **Proposal (10 pages)**: Comprehensive research plan +- **Track Record**: All investigators +- **Budget Justification**: Detailed breakdown +- **Te Tiriti o Waitangi**: Statement on Māori health advancement + +**Programme Grants**: +- **Proposal (15 pages)**: Multi-project research program +- **Strategic Vision**: Long-term research impact +- **Team Integration**: Demonstrated collaboration history + +#### NIH R01 Structure (US/EU-lite) + +- **Specific Aims (1 page)**: Concise statement of goals and hypotheses +- **Research Strategy (12 pages)**: Significance, innovation, approach +- **Bibliography**: References cited +- **Budget Justification**: Modular or detailed +- **Facilities & Resources**: Equipment and environment +- **Equipment**: Justification for specialized items + +### 3. Assessment Criteria Alignment + +Understanding how reviewers score applications enables strategic positioning. + +#### NHMRC Assessment Criteria + +**Ideas Grants** (Scored 1-7 per criterion): + +| Criterion | Weight | Key Elements | +|-----------|--------|--------------| +| **Significance** | 25% | Knowledge gap, potential impact, innovation | +| **Innovation** | 15% | Novel concepts, approaches, or applications | +| **Approach** | 30% | Methodology rigor, feasibility, risk mitigation | +| **Investigator Capability** | 20% | Track record, expertise, team composition | +| **Research Environment** | 10% | Institutional support, resources, access | + +**Investigator Grants** (Overall track record assessment): +- **Research Excellence**: Quality, impact, and volume of outputs +- **Research Leadership**: Mentorship, service, and collaboration +- **Translation**: Research uptake and real-world impact +- **Career Context**: Productivity relative to opportunity + +#### MRFF Assessment Criteria + +Varies by scheme but typically includes: +- **Mission Alignment**: Relevance to MRFF priorities +- **Scientific Merit**: Rigor and innovation +- **Consumer Involvement**: Meaningful patient/public engagement +- **Translation Potential**: Pathway to clinical or policy impact +- **Team Capability**: Appropriate expertise and track record +- **Value for Money**: Budget reasonableness + +#### HRC Assessment Criteria + +**Explorer Grants**: +- **Scientific Quality and Innovation**: Novelty and rigor +- **Feasibility**: Realistic within budget/timeline +- **Significance**: Importance for health outcomes +- **Investigator Capability**: Track record and expertise + +**Project/Programme Grants** (Weighting varies): +- **Significance and Innovation**: Health impact potential +- **Research Approach**: Methodological soundness +- **Capability of Investigators**: Team expertise +- **Value for Money**: Cost-effectiveness + +### 4. Writing Effective Sections + +#### Significance Section + +**Purpose**: Convince reviewers this research matters. + +**Structure**: +1. **The Problem**: What health challenge does this address? +2. **The Gap**: What is currently unknown or ineffective? +3. **The Impact**: How will this research change practice, policy, or outcomes? +4. **The Urgency**: Why is this needed now? + +**Key Questions**: +- Who benefits from this research? +- What will be different if this succeeds? +- Why hasn't this been done before? +- What are the broader implications? + +#### Innovation Section + +**Purpose**: Demonstrate novel contribution to knowledge or practice. + +**Types of Innovation**: +- **Conceptual**: New theories, paradigms, or frameworks +- **Methodological**: Novel approaches, techniques, or designs +- **Technological**: New tools, platforms, or interventions +- **Applied**: First application in a new context or population + +**Positioning Strategy**: +- Acknowledge existing work honestly +- Identify the specific gap or limitation +- Position your approach as the logical next step +- Avoid overselling incremental advances + +#### Approach/Methodology Section + +**Purpose**: Demonstrate rigorous, feasible research execution. + +**Structure**: +1. **Overview**: Study design and conceptual framework +2. **Aims/Questions/Hypotheses**: Clear, specific, and testable +3. **Study Design**: Type (RCT, cohort, qualitative, etc.) and justification +4. **Participants/Setting**: Inclusion/exclusion, recruitment, sample size +5. **Methods**: Detailed procedures for each aim +6. **Analysis**: Statistical or analytical approach +7. **Risk Mitigation**: Contingency plans and limitations + +**Common Pitfalls to Avoid**: +- Methodological inconsistency with aims +- Insufficient sample size justification +- Missing details on key procedures +- Ignoring potential confounders +- Unrealistic timelines + +#### Chief Investigator Track Record + +**Purpose**: Demonstrate capacity to deliver the proposed research. + +**Content Areas**: +- **Research Outputs**: Publications, citations, h-index (with context) +- **Research Leadership**: Mentoring, team leadership, service +- **Translation and Impact**: Policy influence, practice change, commercialization +- **Collaboration**: Successful partnerships and networks +- **Career Context**: Time in research, interruptions, relative to opportunity + +**Strategic Positioning**: +- Highlight outputs most relevant to the proposed research +- Provide context for career stage (ECR vs. senior) +- Emphasize quality over quantity +- Connect track record to specific proposal requirements + +### 5. Budget Justification Framework + +A well-justified budget demonstrates fiscal responsibility and realistic planning. + +#### Budget Categories + +**Personnel** (typically 60-80% of budget): +- Chief Investigators: Salary support (if eligible) +- Research staff: Postdocs, research assistants, coordinators +- Students: PhD stipends or top-ups +- Support staff: Technical, administrative + +**Justification Elements**: +- % FTE (Full Time Equivalent) and duration +- Role in the research project +- Relevant qualifications and experience +- Why this level of effort is necessary + +**Non-Personnel**: +- **Equipment**: Major items (> $5K) require detailed justification +- **Consumables**: Lab supplies, reagents, participant materials +- **Travel**: Conferences, site visits, collaborator meetings +- **Participant Costs**: Recruitment incentives, reimbursement +- **Open Access**: APCs (Article Processing Charges) +- **Other Direct Costs**: Software, database access, services + +**Funder-Specific Rules**: + +| Funder | Key Budget Rules | +|--------|------------------| +| **NHMRC** | No CIA salary for academic CIs; ECR support possible | +| **MRFF** | Full cost recovery allowed; equipment depreciation | +| **HRC** | Salary support varies by scheme; student stipends common | +| **ARC** | No direct salary for CIs; DRSP for students | +| **NIH** | Modular ($250K increments) or detailed; salary caps apply | + +#### Budget Narrative + +Structure the justification by: +1. **Personnel**: Role, %FTE, justification, qualifications +2. **Equipment**: Item, cost, justification, use in project +3. **Other Direct Costs**: Category, amount, purpose +4. **Justification Summary**: Why this budget is necessary and sufficient + +### 6. Consumer and Community Involvement + +Patient and public involvement (PPI) is increasingly required and beneficial. + +#### MRFF Consumer Involvement Requirements + +**Mandatory Elements**: +- Consumer involvement plan with named consumers +- Meaningful role in governance, design, or execution +- Budget for consumer honoraria and costs +- Demonstrated consumer influence on proposal + +**Best Practice**: +- Engage consumers early in proposal development +- Define specific roles (not tokenistic participation) +- Compensate consumers fairly for their time +- Acknowledge consumer contributions appropriately + +#### NHMRC Consumer Involvement + +Not mandatory for most schemes but increasingly valued: +- Consumer co-design of research questions +- Patient advisory panels for clinical trials +- Consumer representation on steering committees + +#### HRC Māori Health Research + +**Te Tiriti o Waitangi Obligations**: +- Māori health advancement as a core principle +- Māori researcher development and leadership +- Consultation with Māori communities when appropriate + +### 7. Ethics and Governance Planning + +Proactive ethics planning prevents delays and demonstrates research maturity. + +#### Human Research Ethics + +**Key Considerations**: +- Ethical review category (low/negligible risk vs. full review) +- Informed consent processes +- Data protection and privacy +- Vulnerable populations (children, pregnant women, cognitive impairment) +- Indigenous research ethics + +**Documentation**: +- Ethics approval or evidence of submission +- Site-specific assessment (SSA) for multi-site research +- Governance authorization (sponsorship, indemnity) + +#### Animal Research Ethics + +If vertebrate animals are involved: +- Animal ethics committee approval +- Compliance with 3Rs (Replacement, Reduction, Refinement) +- Adequate facilities and expertise + +#### Research Governance + +**Institutional Requirements**: +- Research sponsorship and indemnity +- Data management and storage +- Intellectual property arrangements +- Conflict of interest management +- Financial probity + +### 8. Compliance and Administration + +#### Submission Requirements Checklist + +**Pre-Submission**: +- [ ] Current CVs and track records for all CIs +- [ ] Letters of support from collaborators +- [ ] Institutional sign-off and budget approval +- [ ] Ethics approval or evidence of submission +- [ ] Consumer involvement plan (MRFF) +- [ ] Conflict of interest disclosures +- [ ] Budget reconciliation with institutional finance + +**System Requirements** (vary by funder): +- NHMRC: Sapphire system registration +- MRFF: GrantConnect portal +- HRC: HRC Gateway +- ARC: RMS (Research Management System) +- NIH: eRA Commons, Grants.gov + +**Post-Submission**: +- [ ] Confirmation of submission receipt +- [ ] Application tracking number +- [ ] Budget institutionally approved +- [ ] Team notified of submission +- [ ] Deadline for revisions noted (if applicable) + +## Documentation Requirements + +### Grant Application File + +- [ ] Funding opportunity guidelines and instructions +- [ ] Draft proposal with tracked changes +- [ ] Budget spreadsheet with institutional rates +- [ ] CI track record statements +- [ ] Letters of support from collaborators +- [ ] Ethics approval or submission evidence +- [ ] Consumer involvement documentation (if applicable) +- [ ] Institutional sign-off forms +- [ ] Submission confirmation and tracking number + +### Compliance Documentation + +- [ ] Conflict of interest declarations (all CIs) +- [ ] Research governance authorization +- [ ] Data management plan +- [ ] Consumer involvement plan and agreements +- [ ] Indigenous research ethics consultation (if applicable) + +## Common Mistakes + +| Mistake | Why It's Wrong | Instead | +|---------|----------------|---------| +| **Vague research question** | Unclear scope makes methodology and assessment impossible | Define specific, answerable aims with clear hypotheses or objectives | +| **Ignoring assessment criteria** | Misalignment with scoring rubric guarantees poor scores | Structure proposal explicitly around stated criteria with equal weighting | +| **Insufficient methodology detail** | Reviewers cannot assess rigor or feasibility | Provide specifics on sample size, analysis plan, and procedures | +| **Unjustified budget** | Appears unrealistic or inflated | Every line item needs justification tied to research activities | +| **Tokenistic consumer involvement** | MRFF requires meaningful engagement; superficial plans are rejected | Define specific consumer roles and budget for fair compensation | +| **Overpromising outcomes** | Unrealistic timelines or deliverables damage credibility | Build in realistic contingencies and acknowledge limitations | +| **Weak track record framing** | Fails to demonstrate capability to deliver | Connect past achievements directly to proposed research requirements | +| **Ignoring funder priorities** | Generic proposals lack competitive edge | Explicitly address how research aligns with scheme goals and priorities | +| **Missing compliance elements** | Ethics, governance, or data management gaps can disqualify | Include all mandatory documentation and address compliance proactively | +| **Poor editing and formatting** | Unprofessional presentation undermines credibility | Follow funder formatting exactly; proofread meticulously | + +## When to Escalate + +Escalate to Research Office or Chief Investigator when: +- Application involves multiple institutions requiring complex subcontracts. +- Budget exceeds institutional authority or requires special approvals. +- Research involves high-risk activities (gene therapy, dangerous substances). +- Ethics approval is delayed and threatens submission deadline. +- Team disagreements arise about proposal direction or credit allocation. +- Funder guidelines are ambiguous or contradictory. +- Institutional compliance issues emerge (conflict of interest, eligibility questions). +- Submission deadline is at risk due to system issues or administrative delays. + +## Privacy Considerations + +- **PHI Involved**: Grant applications typically do not include patient-level data. +- **Personnel Information**: CVs and track records contain personal information—handle securely. +- **Institutional Data**: Budget and contract information is sensitive—limit access to team. +- **Consumer Information**: Consumer involvement plans include personal details—protect accordingly. +- **No Persistence**: Do not store draft applications or personal information in temporary workspaces beyond session needs. +- **Access Controls**: Limit grant file access to named investigators and research administrators. + +## Confidence Indicators + +| Scenario | Confidence | Action | +|----------|------------|--------| +| Standard NHMRC Ideas Grant with clear research question and experienced team | High | Proceed with full development; schedule peer review | +| Complex multi-site MRFF application with industry partners | Medium | Engage Research Office early; schedule compliance review | +| ECR first-time CIA with limited track record | Medium | Consider co-CI arrangement with senior mentor; target appropriate scheme | +| Novel methodology without pilot data | Low | Recommend feasibility study first; strengthen preliminary data | +| Application deadline imminent with incomplete compliance | Low | **BLOCKER**: Escalate to Research Office; consider deadline extension or next round | +| Consumer involvement required but not yet engaged | Low | Immediate action needed; consumer engagement takes time | +| International collaboration with subcontract complexities | Medium | Involve contracts team early; clarify IP and governance | + +## Tool Requirements + +- `~~research literature` (PubMed) - For literature review and citation management +- `~~project tracker` - For grant development milestone tracking +- `~~document collaboration` - For proposal drafting and team review +- `~~cloud storage` - For grant file storage and version control +- `~~citation management` - For bibliography and reference formatting +- `~~health/clinical-systems` - For accessing relevant clinical data or outcomes + +## Success Indicators + +You've applied this skill well when: +- [ ] Funder and scheme selected based on clear eligibility and fit assessment +- [ ] Proposal structure follows funder guidelines exactly +- [ ] All assessment criteria are explicitly addressed with appropriate weighting +- [ ] Research question is specific, significant, and feasible +- [ ] Methodology is rigorous with adequate detail for evaluation +- [ ] Budget is realistic, justified, and compliant with funder rules +- [ ] CI track records demonstrate capability to deliver proposed research +- [ ] Consumer involvement plan is meaningful and budgeted (where required) +- [ ] Ethics and governance compliance is proactive and complete +- [ ] Final submission is professionally formatted, error-free, and institutionally approved +- [ ] Application has undergone internal peer review before submission + +## Related Skills + +- `~~research-grants` - For general grant writing patterns and strategies +- `~~health/evidence-synthesis` - For literature review and systematic review components +- `~~health/clinical-trial-design` - For clinical trial methodology and protocol development +- `~~health/research-ethics` - For navigating ethics approval requirements +- `~~health/research-governance` - For institutional approval and compliance processes +- `~~product-management/roadmap-management` - For research program planning and milestone tracking +- `~~document-skills/docx` - For professional document formatting and final submission preparation diff --git a/health/skills/health-econ-eval/SKILL.md b/health/skills/health-econ-eval/SKILL.md new file mode 100644 index 0000000..540a123 --- /dev/null +++ b/health/skills/health-econ-eval/SKILL.md @@ -0,0 +1,603 @@ +--- +name: health/health-econ-eval +description: This skill should be used when conducting health economic evaluations including cost-effectiveness analysis (CEA), cost-utility analysis (CUA), cost-benefit analysis (CBA), budget impact analysis (BIA), decision modeling, sensitivity analysis, QALY/DALY calculations, or preparing economic evidence for healthcare decision-making. +version: 1.0.0 +--- + +# Health Economic Evaluation + +A comprehensive framework for conducting health economic evaluations to support healthcare resource allocation decisions. This skill guides users through cost-effectiveness, cost-utility, and cost-benefit analyses with jurisdiction-specific reference case requirements and decision modeling methodologies. + +**Important**: This skill assists with economic evaluation methodology but does not replace specialist health economist expertise. Complex models or submissions to reimbursement authorities should involve qualified health economists. Always verify compliance with jurisdiction-specific reference case requirements. + +## When to Use This Skill + +Invoke this skill when: +- Conducting cost-effectiveness analysis (CEA) for a new intervention vs. comparator. +- Performing cost-utility analysis (CUA) with QALY or DALY outcomes. +- Preparing cost-benefit analysis (CBA) for healthcare investments. +- Developing decision models (decision trees, Markov models, microsimulation). +- Calculating quality-adjusted life years (QALYs) or disability-adjusted life years (DALYs). +- Conducting budget impact analysis (BIA) for formulary or policy decisions. +- Performing deterministic or probabilistic sensitivity analysis. +- Preparing economic evidence for HTA submissions (PBAC, MSAC, PHARMAC, NICE, CADTH). +- Evaluating healthcare interventions from multiple perspectives (healthcare sector, societal). +- Estimating incremental cost-effectiveness ratios (ICERs) and cost-effectiveness acceptability curves (CEACs). +- Addressing reference case requirements by jurisdiction. +- Calculating utility weights for health state valuations. +- Estimating costs for economic evaluation (direct medical, direct non-medical, indirect). +- Conducting equity-informative economic evaluations. + +## Regulatory Context + +### Australia & New Zealand (Default) + +| Regulation/Standard | Relevance | Key Requirements | +|---------------------|-----------|------------------| +| **PBAC Guidelines** (AU) | Pharmaceutical reimbursement | Section A: Submission requirements; Reference case for CEA/CUA; mandatory societal perspective analysis; $50,000-75,000/QALY informal threshold | +| **MSAC Guidelines** (AU) | Medical services evaluation | Application requirements for new medical technologies; emphasis on safety, effectiveness, and cost-effectiveness | +| **PHARMAC Decision Criteria** (NZ) | Pharmaceutical funding | Nine decision criteria including health gains, cost, equity, and need; cost-effectiveness not sole determinant | +| **ANZHTA Guidelines** | Economic evaluation methods | Reporting standards for health economic evaluations in Australia and New Zealand | +| **MBS/PBS Costing** | Cost data sources | Schedule fees for direct costs; utility weights from Australian preference-based studies preferred | + +### US/EU-lite Fallback + +| Regulation/Standard | Relevance | Key Requirements | +|---------------------|-----------|------------------| +| **ISPOR Good Practices** | International standards | Conduct, reporting, and interpretation of cost-effectiveness analyses; reference case guidance | +| **ICER Guidelines** (US) | Value assessment framework | Cost-effectiveness thresholds ($50,000-150,000/QALY); contextual considerations for pricing | +| **NICE Reference Case** (UK) | HTA methodology | NHS/PSS perspective; QALY as outcome; £20,000-30,000/QALY threshold; societal perspective optional | +| **CADTH Guidelines** (Canada) | Health technology assessment | Canadian healthcare system perspective; CUA preferred; $50,000 CAD/QALY threshold considered | + +### Jurisdiction Matrix + +| Jurisdiction | Applicable Regulator | Reporting Trigger | Timeframe | Required Artifacts | Escalation Point | +|--------------|---------------------|-------------------|-----------|-------------------|------------------| +| **AU - Pharmaceutical** | PBAC | Pre-submission meeting → Main submission | 17 weeks (clock start to PBAC meeting) | Submission document; economic model; budget impact model | Health Economist; PBAC Meeting | +| **AU - Medical Services** | MSAC | Application for new MBS item | Variable by committee schedule | Application form; clinical evidence; economic evaluation | MSAC Executive Officer | +| **NZ** | PHARMAC | Proposal for funding (PTAC) | Rolling consideration; no fixed timeline | Proposal document; clinical and cost-effectiveness evidence | PHARMAC Assessment Team | +| **UK** | NICE | Technology appraisal referral | ~40 weeks (STA process) | Submission; economic model; evidence synthesis | NICE Committee Meeting | +| **Canada** | CADTH | CDR submission | ~180 days | Submission dossier; economic model | CADTH Review Panel | + +## Quick Reference + +1. **Select Evaluation Type**: CEA (natural units), CUA (QALYs), CBA (monetary), BIA (budget impact). +2. **Define Perspective**: Healthcare sector (default for PBAC), Societal (required for PBAC), Other (specify). +3. **Choose Time Horizon**: Capture all relevant differences in costs and outcomes; lifetime typical for chronic conditions. +4. **Select Comparator**: Standard of care in jurisdiction; do-nothing rarely appropriate. +5. **Estimate Costs**: Direct medical (healthcare system), Direct non-medical (patient), Indirect (productivity). +6. **Measure Outcomes**: Natural units (CEA), QALYs (CUA preferred), DALYs (burden of disease). +7. **Calculate ICER**: (Cost_new - Cost_comparator) / (Effect_new - Effect_comparator). +8. **Apply Discounting**: Costs and outcomes at 5% (AU), 3% or 1.5% (varies); 0% for <1 year. +9. **Conduct Sensitivity Analysis**: Deterministic (univariate, scenario) and probabilistic (PSA). +10. **Report Uncertainty**: CEACs, tornado diagrams, budget impact projections. +11. **Address Equity**: Consider distributional impacts; equity-informative analysis when relevant. +12. **Follow Reference Case**: Jurisdiction-specific requirements for comparability. + +## Operating Modes + +### Standard Mode +Full economic evaluation with complete decision modeling, comprehensive sensitivity analysis, detailed costing, and adherence to reference case requirements. Includes probabilistic sensitivity analysis, extensive scenario analyses, and detailed reporting for HTA submission. Use when preparing for PBAC, MSAC, or formal reimbursement submissions. + +### Lite Mode +Streamlined economic evaluation for preliminary assessment, internal decision-making, or proof-of-concept. Includes basic decision tree or simple Markov model, deterministic sensitivity analysis only, and simplified costing. Never suppresses critical model validation requirements or high-stakes reimbursement decisions. Clearly mark as preliminary and recommend full evaluation before formal submission. + +## Detailed Guidance + +### 1. Evaluation Type Selection + +#### Cost-Effectiveness Analysis (CEA) +- **When to Use**: Single outcome measure in natural units (e.g., lives saved, mmHg reduction). +- **Outcome**: Clinical effectiveness measure without quality adjustment. +- **Limitation**: Cannot compare across different disease areas. +- **Comparator ICER**: Reported as cost per natural unit gained. +- **Reference Case**: Acceptable when QALY measurement not feasible; must justify. + +#### Cost-Utility Analysis (CUA) - Preferred +- **When to Use**: Comparing interventions across different health conditions. +- **Outcome**: Quality-adjusted life years (QALYs) or disability-adjusted life years (DALYs). +- **Advantage**: Enables cross-program comparisons; preferred by most HTA bodies. +- **Utility Sources**: Preference-based measures (EQ-5D, SF-6D, AQoL for Australia). +- **Reference Case**: PBAC, NICE, CADTH require CUA as primary analysis. + +#### Cost-Benefit Analysis (CBA) +- **When to Use**: Comparing healthcare with non-health investments; environmental health. +- **Outcome**: Monetary value of health benefits (willingness-to-pay or human capital). +- **Challenge**: Controversial valuation of life/health; ethical concerns. +- **Use in Health**: Rare for clinical interventions; more common for public health policy. + +#### Budget Impact Analysis (BIA) +- **When to Use**: Assessing affordability and financial sustainability. +- **Complement**: Always alongside CEA/CUA, not instead of. +- **Timeframe**: Typically 3-5 years. +- **Perspective**: Payer/health system budget; may include patient out-of-pocket. +- **Outputs**: Annual budget impact; cumulative impact; per-patient vs. population. + +### 2. Decision Modeling Framework + +#### Decision Trees +- **Appropriate When**: Single decision point; short time horizon; no recurrence. +- **Structure**: Decision node → Chance nodes → Terminal nodes. +- **Elements**: Probabilities, costs, utilities at each branch. +- **Analysis**: Roll-back analysis to calculate expected values. +- **Software**: TreeAge Pro, R (heemod), Excel. + +**Key Considerations**: +- Ensure probabilities sum to 1.0 at each chance node. +- Include all relevant pathways (don't truncate early without justification). +- Validate probabilities against clinical evidence. + +#### Markov Models +- **Appropriate When**: Chronic conditions; recurring events; long time horizons. +- **Structure**: Mutually exclusive health states; transition probabilities; cycle length. +- **Key Elements**: + - Health states (e.g., stable, progression, death). + - Transition probabilities (per cycle). + - Costs and utilities per state (or transition). + - Cycle length (e.g., monthly, yearly). + - Half-cycle correction (recommended for simple Markov). +- **Analysis**: Cohort simulation or Monte Carlo microsimulation. + +**Half-Cycle Correction**: +- Apply to account for transitions assumed to occur mid-cycle. +- Subtract half a cycle's cost and utility from initial state. +- Add half a cycle's cost and utility to final state. +- Alternative: Life-table method or tunnel states. + +**Markov Model Validation**: +- Face validity: Clinical experts review state definitions and transitions. +- Internal validity: Check transition probabilities sum to ≤1.0 (allowing for death). +- External validity: Compare model outcomes to real-world data if available. +- Cohort trace: Review state occupancy over time for plausibility. + +#### Microsimulation (Individual-Level Simulation) +- **Appropriate When**: Heterogeneous population; complex patient history; need for individual tracking. +- **Approach**: Simulate individual patients through the model; aggregate results. +- **Advantage**: Captures patient history; handles heterogeneity; memory-less assumption relaxed. +- **Disadvantage**: Computationally intensive; longer run times. +- **Sample Size**: Typically 1,000-100,000 individuals depending on precision needed. + +#### Discrete Event Simulation (DES) +- **Appropriate When**: Resource constraints; queueing important; complex timing. +- **Use Cases**: ED modeling, surgical scheduling, capacity planning. +- **Software**: Simul8, Arena, R (simmer package). + +### 3. Reference Case Requirements by Jurisdiction + +#### PBAC (Australia) Reference Case + +| Element | Requirement | Notes | +|---------|-------------|-------| +| **Perspective** | Healthcare sector + Societal | Two perspectives required; societal includes productivity | +| **Comparator** | Standard therapy in Australia | Current PBS-listed therapy or best supportive care | +| **Time Horizon** | Sufficient to capture all differences | Lifetime typical for chronic conditions | +| **Discounting** | 5% (costs and outcomes) | Sensitivity analysis at 0% and 3.5% | +| **Outcome** | QALYs preferred | CEA acceptable if QALYs not feasible; justify | +| **Utility Source** | Australian preference-based | AQoL, EQ-5D-5L (Australian tariffs) preferred | +| **Cost Data** | PBS/MSAC schedule fees | Publicly listed prices; patient co-payments | +| **ICER Threshold** | $50,000-75,000/QALY (informal) | Consider "rule of rescue" and other factors | +| **Uncertainty** | PSA required | Deterministic and probabilistic sensitivity analysis | +| **Subgroups** | Pre-specified and justified | Clinical or economic rationale required | + +#### MSAC (Australia) Reference Case +- Similar to PBAC but focused on medical services. +- MBS fees for cost estimation. +- Emphasis on safety data alongside effectiveness and cost-effectiveness. +- May include diagnostic accuracy parameters (sensitivity, specificity). + +#### PHARMAC (New Zealand) Considerations +- Nine decision criteria beyond cost-effectiveness. +- Cost-effectiveness important but not determining factor. +- Equity considerations (access for Māori and vulnerable populations). +- Comparator: Current best practice in New Zealand. +- Threshold: Not explicitly defined; assess on case-by-case basis. + +#### NICE (UK) Reference Case +- Perspective: NHS and Personal Social Services (PSS). +- Outcome: QALYs calculated using EQ-5D-3L (UK tariff). +- Time horizon: Long enough to capture all costs and benefits. +- Discounting: 1.5% (interventions >30 years); 3.5% otherwise. +- Threshold: £20,000-30,000/QALY (can be exceeded with strong justification). +- PSA: Required for all evaluations. + +#### CADTH (Canada) Reference Case +- Perspective: Publicly funded healthcare system. +- Outcome: QALYs preferred; life years acceptable for life-saving interventions. +- Utility: Canadian preference-based measures preferred; EQ-5D acceptable. +- Discounting: 5% (with 0% and 3% sensitivity); 1.5% for vaccines. +- Time horizon: Lifetime for most conditions. +- Productivity: Optional; include in supplementary analysis. + +### 4. Costing Methodology + +#### Cost Categories + +**Direct Medical Costs**: +- Pharmaceuticals (drug acquisition, administration, monitoring). +- Hospitalizations (admissions, procedures, ED visits). +- Outpatient care (consultations, diagnostics, allied health). +- Device costs (purchase, maintenance, replacement). +- **Source**: PBS/MSAC schedules, DRG costs, hospital cost data. + +**Direct Non-Medical Costs**: +- Patient transport to care. +- Carer costs (formal and informal). +- Over-the-counter medications. +- **Inclusion**: Required for societal perspective (PBAC); optional for healthcare perspective. + +**Indirect Costs (Productivity)**: +- Absenteeism (time off work due to illness). +- Presenteeism (reduced productivity at work). +- Mortality costs (lost future productivity). +- **Method**: Human capital approach (standard) or friction cost approach. +- **PBAC**: Required for societal perspective; include in supplementary analysis. + +#### Cost Estimation Approaches + +**Micro-costing** (Bottom-up): +- Detailed measurement of resource use for each activity. +- Accurate but time-consuming. +- Preferred for high-cost components or when precise estimates needed. + +**Gross-costing** (Top-down): +- Average costs per episode or patient. +- Efficient for large components with less variation. +- Common for hospitalizations (DRG-based). + +**Hybrid Approach**: +- Micro-costing for key cost drivers. +- Gross-costing for less critical components. +- Most practical for most economic evaluations. + +#### Future Costs in Life-Years Gained + +**PBAC/NICE/CADTH Position**: +- Related costs (for the condition being treated): Include. +- Unrelated costs (other diseases in added life-years): Exclude. +- Exception: Where specified in reference case or treatment affects other conditions. + +**Rationale**: Including unrelated costs discriminates against life-saving interventions for younger patients (who have more future costs). + +### 5. QALY/DALY Calculation Guidance + +#### Quality-Adjusted Life Years (QALYs) + +**Calculation**: +``` +QALYs = Σ (Utility_state × Time_in_state) +``` + +**Utility Values**: +- Range: 0 (dead) to 1 (full health); can be negative (worse than dead). +- Measured using preference-based instruments. +- Sources: Clinical trials, observational studies, published literature. + +**Preference-Based Instruments**: + +| Instrument | Description | Preferred For | +|------------|-------------|---------------| +| **EQ-5D-5L** | 5 dimensions (mobility, self-care, usual activities, pain/discomfort, anxiety/depression), 5 levels each | General HTA; PBAC, NICE, CADTH | +| **EQ-5D-3L** | Original 3-level version | Legacy studies; NICE UK tariff | +| **SF-6D** | Derived from SF-36 health survey | When SF-36 collected in trials | +| **AQoL** (AU) | Australian Quality of Life instrument | PBAC preference for Australian context | +| **HUI-3** | Health Utilities Index | Pediatric populations; vision/hearing | +| **15D** | 15 dimensions | Finnish and Scandinavian contexts | + +**Mapping**: +- When trial collects non-preference measure (e.g., disease-specific HRQoL). +- Use published mapping algorithms to estimate utility. +- Report uncertainty from mapping in sensitivity analysis. + +**Time Trade-Off (TTO)**: +- Direct utility elicitation method. +- Patients choose between living X years in health state vs. Y years in full health. +- Utility = Y/X. +- Used to value EQ-5D health states. + +**Standard Gamble (SG)**: +- Alternative direct elicitation. +- Choice between certain health state vs. gamble (probability p of full health, 1-p of immediate death). +- Utility = p that makes respondent indifferent. +- Theoretically grounded in expected utility theory but less intuitive. + +#### Disability-Adjusted Life Years (DALYs) + +**Calculation**: +``` +DALYs = YLL + YLD +``` + +Where: +- YLL (Years of Life Lost): Premature mortality component. +- YLD (Years Lived with Disability): Morbidity component. + +**Formula**: +``` +YLL = N × L × DCF +YLD = I × DW × L × DCF +``` + +Where: +- N = Number of deaths +- I = Number of incident cases +- DW = Disability weight (0 = full health, 1 = death) +- L = Duration or life expectancy +- DCF = Discounting and age-weighting correction factor + +**Key Differences from QALYs**: +- DALYs measure burden (lower is better); QALYs measure benefit (higher is better). +- DALYs use disability weights (not utilities); different valuation methods. +- DALYs can incorporate age-weighting and discounting differently. +- Cost per DALY averted (intervention perspective) vs. cost per QALY gained. + +**WHO Global Burden of Disease**: +- Standardized DALY methodology for cross-national comparison. +- Updated disability weights in GBD 2019 using population surveys. +- Useful for public health priority setting and global health economics. + +### 6. Sensitivity Analysis Framework + +#### Deterministic Sensitivity Analysis (DSA) + +**Univariate Analysis**: +- Vary one parameter at a time across plausible range. +- Identify key drivers of model results. +- Report as tornado diagrams (ranked by impact). +- Typical ranges: ±20% of base case; 95% CI from evidence; expert opinion. + +**Scenario Analysis**: +- Test alternative assumptions or structural choices. +- Examples: Different time horizons, alternative comparators, inclusion/exclusion of specific costs. +- Best/worst case scenarios using extreme but plausible parameter values. + +**Threshold Analysis**: +- Identify parameter value at which decision changes. +- Useful for negotiations (e.g., maximum acceptable price). + +#### Probabilistic Sensitivity Analysis (PSA) + +**Purpose**: Characterize joint uncertainty across all parameters simultaneously. + +**Method**: +1. Assign probability distributions to uncertain parameters. +2. Run model for large number of iterations (typically 1,000-10,000). +3. Record results for each iteration. +4. Analyze distribution of results. + +**Distribution Selection**: + +| Parameter Type | Distribution | Rationale | +|----------------|--------------|-----------| +| Probabilities | Beta (α, β) | Bounded 0-1; conjugate for binomial | +| Costs | Gamma (shape, scale) | Bounded 0+; right-skewed | +| Utilities | Beta or Normal (truncated) | Bounded 0-1 or plausible range | +| Relative Effects | Log-normal | Multiplicative; bounded 0+ | +| Counts | Poisson or Gamma | Count data or rates | + +**Cost-Effectiveness Acceptability Curves (CEAC)**: +- Plot probability that intervention is cost-effective across range of willingness-to-pay thresholds. +- X-axis: Willingness-to-pay threshold ($/QALY). +- Y-axis: Probability cost-effective. +- Interpret: At $50,000/QALY, 80% probability intervention is cost-effective. + +**Cost-Effectiveness Plane**: +- Scatter plot of incremental costs (y-axis) vs. incremental effects (x-axis). +- Quadrants: NE (more effective, more costly - trade-off), SE (dominant), SW (less effective, less costly - trade-off), NW (dominated). +- Ellipse: 95% confidence region. + +**Expected Value of Perfect Information (EVPI)**: +- Value of eliminating all uncertainty. +- Guides research prioritization. +- Population EVPI: EVPI per patient × eligible population over technology lifetime. + +### 7. Equity-Informative Economic Evaluation + +**Extended Cost-Effectiveness Analysis (ECEA)**: +- Incorporates distributional impacts (e.g., by socioeconomic status). +- Analyzes financial risk protection (catastrophic health expenditure). +- Useful for universal health coverage decisions. + +**Distributional Cost-Effectiveness Analysis (DCEA)**: +- Estimates cost-effectiveness for different population subgroups. +- Incorporates equity weights (societal value placed on gains to disadvantaged groups). +- Can justify interventions with higher ICERs if they benefit disadvantaged populations. + +**PBAC Equity Considerations**: +- Consider "rule of rescue" for life-threatening conditions with no alternatives. +- Impact on specific populations (rare diseases, indigenous populations). +- Uncertainty and its consequences (higher threshold for greater uncertainty). + +**PHARMAC Equity Criteria**: +- Health needs of particular populations (including Māori). +- Impact on health disparities. +- Access for vulnerable groups. + +### 8. Model Validation and Transparency + +**Validation Types**: + +1. **Face Validity**: Does the model structure make clinical sense? + - Review by clinical experts. + - Plausibility of assumptions. + +2. **Internal Validity**: Does the model produce expected results? + - Check transition probabilities sum correctly. + - Verify cohort survival matches life tables. + - Test extreme parameter values (0, 1) for logical behavior. + +3. **External Validity**: Do model predictions match real-world data? + - Comparison to clinical trial results if available. + - Validation against observational datasets. + - Cross-validation with published models. + +4. **Cross-Validation**: Compare results to other models addressing same question. + - Important for PBAC/NICE submissions with multiple sponsor models. + +**Transparency Requirements**: +- Full model documentation (conceptual, mathematical, programming). +- Access to model for HTA reviewers (Excel, TreeAge, R code). +- Clear reporting of assumptions and limitations. +- CHEERS checklist adherence for publications. + +### 9. Software and Tools + +**Decision Modeling**: +- TreeAge Pro: Commercial; industry standard for HTA submissions. +- R (heemod, BCEA, dampack packages): Open-source; increasingly accepted. +- Excel: Widely used; transparency advantage; PSA via add-ins or manual. + +**Statistical Analysis**: +- R: Preferred for PSA, meta-analysis, survival analysis. +- Stata: Common in health economics; extensive econometric capabilities. +- WinBUGS/OpenBUGS: Bayesian analysis; increasingly used for network meta-analysis. + +**Reporting**: +- Shiny (R): Interactive web applications for presenting results. +- VOItools: Value of information analysis. + +## Documentation Requirements + +### Economic Evaluation Report +- [ ] Executive summary with key findings and ICER. +- [ ] Clear statement of decision problem and research question. +- [ ] Description of intervention and comparator(s). +- [ ] Specification of target population and subgroups. +- [ ] Perspective(s) and time horizon with justification. +- [ ] Model structure diagram and description (or rationale for no model). +- [ ] Data inputs table with sources and uncertainty ranges. +- [ ] Costing methodology and unit costs with sources. +- [ ] Utility derivation (instrument, source, mapping if applicable). +- [ ] Base case results (incremental costs, effects, ICER). +- [ ] Sensitivity analysis results (deterministic and probabilistic). +- [ ] Cost-effectiveness plane and CEACs. +- [ ] Budget impact analysis (if applicable). +- [ ] Scenario analyses and threshold analyses. +- [ ] Validation approach and results. +- [ ] Limitations and generalizability. +- [ ] Conclusions and recommendations. +- [ ] Technical appendix with detailed model specification. +- [ ] Model files provided in appropriate format (Excel, TreeAge, R code). + +### HTA Submission Documentation +- [ ] Submission template completed per jurisdiction requirements. +- [ ] Evidence synthesis (systematic review or network meta-analysis). +- [ ] Clinical evidence summary with GRADE assessment. +- [ ] Economic evaluation report (as above). +- [ ] Budget impact model with scenario analyses. +- [ ] De novo model or adaptation justification. +- [ ] Model validation documentation. +- [ ] Uncertainty analysis (PSA results, CEACs). +- [ ] Equity and distributional considerations. +- [ ] Patient and clinician input (if available). +- [ ] Implementation considerations and feasibility. + +### Model Documentation +- [ ] Conceptual model description and rationale. +- [ ] Mathematical specification (equations, formulas). +- [ ] Programming documentation (code comments, structure). +- [ ] Parameter table with all values, distributions, and sources. +- [ ] Transition matrix (for Markov models). +- [ ] Decision tree structure with all branches and terminal nodes. +- [ ] Cohort trace or individual patient simulation description. +- [ ] Calculation verification (checksums, independent replication). + +## Common Mistakes + +| Mistake | Why It's Wrong | Instead | +|---------|----------------|---------| +| **Wrong comparator** | Comparing to placebo or outdated therapy doesn't inform reimbursement decisions | Use current standard of care in jurisdiction | +| **Inappropriate time horizon** | Too short misses long-term costs/outcomes; too long adds uncertainty unnecessarily | Use lifetime for chronic conditions; justify horizon choice | +| **Discounting costs but not outcomes** | Violates time preference consistency; reference cases require both or neither | Discount costs AND QALYs at reference case rate; 0% for both in sensitivity | +| **Ignoring half-cycle correction** | Introduces systematic bias in Markov models; especially problematic with long cycles | Apply half-cycle correction or use life-table/tunnel state methods | +| **Double-counting outcomes** | Including both survival and QALYs as separate outcomes in same analysis | Use QALYs only (which incorporate survival and quality) or disaggregate carefully | +| **PSA with inappropriate distributions** | Using normal distribution for probabilities (can sample >1 or <0) | Use Beta for probabilities, Gamma for costs, Log-normal for relative effects | +| **Insufficient PSA iterations** | Too few iterations (<1,000) leads to unstable CEACs and imprecise estimates | Use minimum 1,000 iterations; 5,000-10,000 preferred for final submission | +| ** cherry-picking favorable subgroups** | Post-hoc subgroup analysis inflates Type I error; not pre-specified | Pre-specify subgroups with clinical rationale; adjust for multiple comparisons | +| **Using foreign utility weights** | Utilities vary by country due to cultural differences in health valuation | Use jurisdiction-specific tariffs when available (e.g., AQoL for Australia) | +| **Ignoring structural uncertainty** | Model structure choices (e.g., number of health states) can drive results more than parameters | Conduct scenario analyses for structural assumptions; consider model averaging | +| **Presenting average cost-effectiveness ratios** | Comparing intervention to no treatment instead of relevant comparator | Always report INCREMENTAL cost-effectiveness ratios vs. appropriate comparator | +| **Failing to validate the model** | Model may produce implausible results or contain programming errors | Face validity with experts; internal checks; external validation when possible | +| **Not addressing equity** | May miss important societal considerations beyond efficiency | Include equity analysis when relevant; report distributional impacts | +| **Omitting budget impact analysis** | Cost-effective interventions may still be unaffordable at population level | Always accompany CEA with BIA for decision-making | + +## When to Escalate + +Escalate to Health Economist, Health Economics Lead, or HTA Specialist when: +- ICER exceeds jurisdiction threshold ($50,000-75,000/QALY in Australia; £20,000-30,000 in UK). +- Model structure decisions have major impact on results (structural uncertainty). +- Parameter uncertainty is so high that decision is not robust. +- Complex modeling required (microsimulation, DES, complex disease progression). +- Submission to PBAC, MSAC, NICE, CADTH, or PHARMAC. +- Novel intervention without existing economic evidence or comparators. +- Equity considerations suggest differential cost-effectiveness by subgroup. +- Budget impact exceeds acceptable threshold despite favorable ICER. +- Model validation reveals significant discrepancies from expected results. +- Intervention affects multiple disease areas or health system sectors. +- Need for sophisticated sensitivity analysis (EVPPI, expected value of sample information). + +## Privacy Considerations + +- **PHI Involved**: Minimal - economic evaluations typically use aggregate data or de-identified patient-level data. +- **Data Minimization**: Use summary statistics rather than individual patient data where possible. +- **De-identification**: If using patient-level data for costing or utility estimation, remove all identifiers (names, MRNs, dates of birth). +- **Access Controls**: Limit access to underlying datasets to those with legitimate need. +- **Retention**: Retain economic models and documentation per organizational policy (typically 7+ years for HTA submissions). +- **No Persistence**: Do not store patient-level data in model files or documentation. +- **Third-Party Data**: Ensure appropriate data sharing agreements when using external datasets. +- **Public Release**: Models submitted to HTA bodies may become public; ensure no embedded PHI. + +## Confidence Indicators + +| Scenario | Confidence | Action | +|----------|------------|--------| +| Standard CUA with well-established comparator, clear clinical evidence, and standard Markov model | High | Proceed with evaluation; document assumptions; standard QA | +| Complex microsimulation or DES with heterogeneous population | Medium | Consult health economist; validate model extensively; consider external review | +| ICER near or above jurisdiction threshold; requires sensitivity analysis interpretation | Medium | Escalate to health economics lead; document uncertainty thoroughly | +| Novel therapy without comparators or natural history data available | Low | **BLOCKER**: Escalate immediately; require expert health economist involvement; may need de novo data collection | +| Budget impact exceeds health system capacity despite favorable ICER | Medium | Escalate for policy discussion; affordability separate from cost-effectiveness | +| Structural uncertainty dominates over parameter uncertainty | Low | Flag for model validation review; consider multiple model structures or model averaging | +| Equity concerns suggest differential cost-effectiveness by disadvantaged group | Medium | Conduct distributional analysis; escalate for equity-informed decision-making | +| Submission to HTA body with strict reference case requirements | Medium | Engage specialist health economist; ensure full compliance with guidelines | +| External validation fails (model predictions diverge from real-world data) | Low | **BLOCKER**: Halt submission pending model revision and re-validation | +| Multiple competing interventions requiring network meta-analysis | Medium | Escalate for statistical support; ensure transitivity and consistency assumptions | + +## Tool Requirements + +- `~~research literature` (PubMed) - For clinical evidence and utility weights. +- `~~data/statistical-analysis` - For meta-analysis, survival analysis, PSA. +- `~~health/evidence-synthesis` - For systematic reviews and network meta-analysis. +- `~~cloud storage` - For model files and documentation storage. +- `~~document collaboration` - For team review of economic evaluation reports. +- `~~project tracker` - For HTA submission timelines and milestones. +- `~~health/clinical-systems` - For accessing cost data and administrative datasets (if applicable). + +## Success Indicators + +You've applied this skill well when: +- [ ] Evaluation type (CEA/CUA/CBA) is appropriate for decision context and justified. +- [ ] Comparator represents current standard of care in jurisdiction. +- [ ] Time horizon captures all relevant differences in costs and outcomes. +- [ ] Perspective(s) align with reference case requirements. +- [ ] Discounting applied correctly to both costs and outcomes. +- [ ] QALYs calculated using appropriate utility instrument and jurisdiction-specific tariffs. +- [ ] Model structure is appropriate for disease natural history and decision context. +- [ ] All parameters sourced from best available evidence with uncertainty characterized. +- [ ] Sensitivity analysis includes both deterministic and probabilistic approaches. +- [ ] CEACs and cost-effectiveness plane visualize decision uncertainty. +- [ ] Model has been validated (face, internal, and external where possible). +- [ ] Budget impact analysis accompanies cost-effectiveness results. +- [ ] Documentation follows reference case requirements for jurisdiction. +- [ ] Equity and distributional considerations addressed where relevant. +- [ ] Submission package complete with model files and technical appendix. +- [ ] All PHI has been removed or appropriately de-identified. +- [ ] Health economist has reviewed complex models or high-stakes submissions. + +## Related Skills + +- `~~health/hta-submission` - For preparing formal HTA submissions to PBAC, MSAC, NICE, CADTH, PHARMAC. +- `~~health/evidence-synthesis` - For systematic reviews and meta-analyses feeding into economic models. +- `~~health/clinical-guidelines` - For understanding comparator therapies and standard of care. +- `~~data/statistical-analysis` - For statistical methods in evidence synthesis and PSA. +- `~~research/grants` - For health economics components of research grant applications. +- `~~finance/budgeting` - For budget impact analysis and financial planning. +- `~~document/technical-writing` - For preparing economic evaluation reports and HTA submissions. diff --git a/health/skills/hta-submission/SKILL.md b/health/skills/hta-submission/SKILL.md new file mode 100644 index 0000000..d67e6f9 --- /dev/null +++ b/health/skills/hta-submission/SKILL.md @@ -0,0 +1,802 @@ +--- +name: health/hta-submission +description: This skill should be used when preparing Health Technology Assessment (HTA) submissions to reimbursement authorities including PBAC (Australia), MSAC (Australia), PHARMAC (New Zealand), NICE (UK), CADTH (Canada), or when structuring health technology assessment dossiers, submission templates, evidence packages, or preparing for HTA committee meetings. +version: 1.0.0 +--- + +# HTA Submission Preparation + +A comprehensive framework for preparing Health Technology Assessment (HTA) submissions to pharmaceutical and medical services reimbursement authorities. This skill guides users through jurisdiction-specific submission requirements, evidence compilation, and common pitfalls to avoid in the reimbursement process. + +**Important**: This skill assists with HTA submission preparation but does not guarantee reimbursement approval. Submission requirements change periodically—always verify current guidelines from the relevant authority. Complex submissions should involve qualified health economists and regulatory specialists. + +## When to Use This Skill + +Invoke this skill when: +- Preparing a PBAC (Pharmaceutical Benefits Advisory Committee) submission in Australia. +- Compiling an MSAC (Medical Services Advisory Committee) application for new medical services. +- Developing a PHARMAC funding proposal in New Zealand. +- Creating a NICE (National Institute for Health and Care Excellence) technology appraisal submission. +- Preparing a CADTH (Canadian Agency for Drugs and Technologies in Health) submission. +- Structuring health economic evidence for HTA dossiers. +- Planning submission timelines and milestones for reimbursement decisions. +- Preparing for pre-submission meetings with HTA authorities. +- Compiling evidence packages including clinical, economic, and budget impact analyses. +- Writing responses to HTA evaluation reports or listing recommendations. +- Preparing for HTA committee presentations or expert advisory meetings. +- Understanding jurisdiction-specific evidence requirements and reference cases. +- Compiling patient and clinician input for HTA submissions. +- Addressing comparator selection and standard of care definitions. +- Preparing justification for orphan drug or rare disease designations. +- Planning managed entry agreements or risk-sharing schemes. + +## Regulatory Context + +### Australia & New Zealand (Default) + +| Authority | Scope | Submission Type | Key Requirements | +|-----------|-------|-----------------|------------------| +| **PBAC** | Pharmaceutical reimbursement | Major/Minor submission; Sub-Committee meeting | Section A: Submission body; Section B: Economic analysis; Budget impact model; Pre-meeting recommended | +| **MSAC** | Medical services (MBS) | Application; Protocol Assessment (PASC) | Safety, effectiveness, cost-effectiveness; Assessment vs. Advisory track | +| **PHARMAC** | NZ pharmaceutical funding | Funding proposal (PTAC/PHARMAC) | Nine decision criteria; equity emphasis; cost-effectiveness one factor among many | +| **TGA** | Market authorization | Separate from reimbursement | Safety/efficacy registration; no cost-effectiveness requirement | + +### US/EU-lite Fallback + +| Authority | Scope | Submission Type | Key Requirements | +|-----------|-------|-----------------|------------------| +| **NICE** (UK) | NHS England & Wales funding | Single/ Multiple Technology Appraisal; Highly Specialised Technologies | Reference case compliance; £20,000-30,000/QALY threshold; Committee evidence review | +| **CADTH** (Canada) | Provincial/territorial funding | Common Drug Review; pan-Canadian Oncology Drug Review | Canadian Agency review; provincial implementation varies | +| **ICER** (US) | Value assessment (non-regulatory) | Evidence report; public meeting | $50,000-150,000/QALY thresholds; contextual considerations | +| **FDA** (US) | Market authorization only | NDA/BLA submission | No cost-effectiveness required for approval; separate from reimbursement | +| **EMA** (EU) | EU market authorization | Marketing Authorization Application | No HTA component; national reimbursement separate | + +### Jurisdiction Matrix + +| Jurisdiction | Applicable Regulator | Reporting Trigger | Timeframe | Required Artifacts | Escalation Point | +|--------------|---------------------|-------------------|-----------|-------------------|------------------| +| **AU - PBS** | PBAC | New drug listing; price change; restriction change | 17 weeks (clock start to PBAC meeting) | Submission document; Economic model; Budget impact model; Response to delegate comments | PBAC Secretariat; Sponsor Representative | +| **AU - MBS** | MSAC | New MBS item number; service modification | Variable; PASC → Assessment/Advisory → Committee | Application; Protocol; Clinical evidence; Economic evaluation | MSAC Executive Officer | +| **NZ** | PHARMAC | Funding application; renewal | Rolling consideration; priority by clinical need | Proposal document; Clinical and cost-effectiveness; Equity assessment | PTAC Chair; Pharmac Staff | +| **UK** | NICE | Technology appraisal referral from DHSC/NHS England | ~40 weeks (STA); ~90 weeks (MTA) | Submission dossier; Evidence review group critique; Committee papers | NICE Committee Chair; Topic Lead | +| **Canada** | CADTH | Manufacturer submission to CDR | ~180 days | Submission dossier; CDR report; Expert committee recommendation | CADTH Review Officer | + +## Quick Reference + +1. **Start Early**: Engage HTA authority at pre-submission phase; understand reference case. +2. **Know Your Comparator**: Use current standard of care in jurisdiction; justify selection. +3. **Follow Reference Case**: Adhere to perspective, time horizon, discounting, and outcome requirements. +4. **Include Both Perspectives**: Healthcare sector and societal (PBAC requirement). +5. **Validate Your Model**: Face validity, internal validity, external validation if possible. +6. **Conduct PSA**: Probabilistic sensitivity analysis required for formal submissions. +7. **Provide Budget Impact**: Affordability analysis alongside cost-effectiveness. +8. **Address Uncertainty**: Scenario analyses; threshold analyses; explain key drivers. +9. **Be Transparent**: Provide model files; document assumptions; acknowledge limitations. +10. **Plan for Questions**: Prepare for delegate/clarification questions; response timelines tight. +11. **Patient Input**: Include patient organization perspectives where possible. +12. **Clinical Engagement**: Clinician endorsement strengthens real-world applicability case. +13. **Managed Entry**: Consider risk-sharing if evidence uncertain or budget impact high. +14. **Appeal Rights**: Understand appeal/reconsideration processes if recommendation unfavorable. + +## Operating Modes + +### Standard Mode +Full HTA submission preparation with comprehensive evidence synthesis, detailed economic modeling following reference case requirements, extensive sensitivity analysis, and formal submission documentation. Includes pre-submission meeting preparation, response to evaluator comments, and committee presentation materials. Use for major reimbursement decisions with significant budget implications. + +### Lite Mode +Streamlined guidance for minor submissions, line extensions, or exploratory discussions with HTA authorities. Focuses on essential requirements, key evidence summary, and basic economic analysis. Never suppresses critical reference case requirements. Clearly mark as preliminary and recommend full submission preparation for novel therapies or significant budget impacts. + +## Detailed Guidance + +### 1. PBAC (Australia) Submission Framework + +#### Submission Types + +**Major Submissions**: +- New chemical entities (NCEs) not currently listed. +- Significant changes to existing listings (new indications, expanded population). +- Requests for unrestricted benefit status (authority required to unrestricted). + +**Minor Submissions**: +- Price reductions (no clinical data required). +- Administrative changes (pack size, formulation). +- Restricted benefit adjustments within existing indication. + +#### Section A: Submission Body + +**Part I: Summary**: +- Product name, form, strength, sponsor. +- Proposed listing and restrictions. +- Comparator and justification. +- Summary of clinical evidence. +- Summary of economic evaluation. +- Budget impact summary. + +**Part II: Product Information**: +- TGA registration details. +- Indication(s) and dosage. +- Place in therapy. + +**Part III: Comparator**: +- Current therapy in Australia. +- Justification for comparator selection. +- If no PBS-listed comparator, justify standard medical practice. + +**Part IV: Clinical Evidence**: +- Systematic review methodology. +- Included studies (RCTs, observational). +- Efficacy/effectiveness outcomes. +- Safety profile. +- GRADE evidence quality assessment. +- Network meta-analysis if indirect comparisons required. + +**Part V: Economic Evaluation**: +- Evaluation type (CUA preferred). +- Model structure (decision tree, Markov, etc.). +- Perspective (healthcare sector + societal). +- Time horizon. +- Discounting (5%). +- Costing methodology. +- Utility values (AQoL/EQ-5D Australian tariffs preferred). +- Base case results (incremental costs, QALYs, ICER). +- Sensitivity analysis (deterministic and probabilistic). + +**Part VI: Budget Impact Analysis**: +- Target population estimation. +- Current treatment patterns. +- Uptake assumptions. +- Cost calculations over 4 years. +- Scenario analyses (conservative, optimistic). + +**Part VII: Requested Listing**: +- Exact wording for PBS schedule. +- Restriction requirements. +- PBS code requirements. + +**Part VIII: Other Information**: +- Patient/carer input. +- Clinician input. +- International pricing and listing status. +- Managed entry/risk-sharing proposals. + +#### Section B: Economic Analysis + +- Detailed model description. +- Full mathematical specification. +- Parameter tables with sources and uncertainty. +- Cohort trace (Markov models). +- Cost-effectiveness plane. +- CEACs (Cost-Effectiveness Acceptability Curves). +- Scenario analyses. +- Model validation documentation. + +#### Supporting Documents + +- Technical report (economic evaluation full details). +- Model files (Excel, TreeAge, R). +- Budget impact model. +- Systematic review report. +- Clinical study reports (if requested). + +### 2. MSAC (Australia) Application Framework + +#### Application Pathways + +**Assessment Track** (Full evaluation): +- New MBS items with significant cost or utilization implications. +- Requires comprehensive clinical evidence and economic evaluation. +- MSAC assessment report prepared. +- Committee recommendation for/against funding. + +**Advisory Track** (Streamlined): +- Minor modifications to existing items. +- Low-cost/low-volume services. +- Advisory opinion only; no formal assessment report. + +#### Application Components + +**Section A: Service Details**: +- Service description (items, fees, co-claiming). +- Proposed MBS item descriptors. +- Provider type and qualifications. + +**Section B: Clinical Evidence**: +- Safety data (adverse events, complications). +- Effectiveness data (clinical outcomes, diagnostic accuracy). +- Comparative effectiveness vs. current practice. +- Evidence quality (risk of bias assessment). + +**Section C: Economic Analysis**: +- Cost-effectiveness vs. comparator. +- Cost-utility analysis preferred where applicable. +- Budget impact on MBS expenditure. +- Resource implications (workforce, infrastructure). + +**Section D: Implementation**: +- Volume estimates. +- Workforce capacity. +- Training requirements. +- Safety and quality considerations. + +**Section E: Stakeholder Input**: +- Professional colleges/societies. +- Consumer organizations. +- State/territory health departments. + +### 3. PHARMAC (New Zealand) Proposal Framework + +#### PHARMAC Decision Criteria + +PHARMAC uses nine criteria; cost-effectiveness is only one factor: + +1. **Health needs of all New Zealanders**: Burden of disease; population impact. +2. **Health needs of particular groups**: Māori, Pacific peoples, vulnerable populations. +3. **Effectiveness**: Clinical benefit; quality of evidence. +4. **Cost**: Acquisition cost; administration costs; monitoring costs. +5. **Cost-effectiveness**: Value for money; opportunity cost. +6. **Budget impact**: Total cost to pharmaceutical budget; year-by-year projection. +7. **Government priorities**: Alignment with health strategy; other ministerial priorities. +8. **Practicality**: Implementation feasibility; workforce capacity. +9. **Consistency**: Equity in access; consistency with other funded treatments. + +#### Proposal Structure + +**Part 1: Pharmaceutical and Indication**: +- Product details (name, form, strength). +- Proposed indication and target population. +- Current treatment pathway in NZ. + +**Part 2: Clinical Evidence**: +- Efficacy and safety data. +- Comparator and relative effectiveness. +- Quality of evidence (risk of bias). + +**Part 3: Cost and Cost-Effectiveness**: +- Proposed price and pricing history. +- Cost per patient (annual). +- Cost-effectiveness vs. comparator (ICER). +- Budget impact (3-year projection). + +**Part 4: Equity and Access**: +- Impact on health disparities. +- Access for Māori and Pacific populations. +- Consistency with existing funding decisions. + +**Part 5: Implementation**: +- Expected utilization. +- Prescriber restrictions (if any). +- Monitoring requirements. +- Risk-sharing proposals (if applicable). + +### 4. NICE (UK) Submission Framework + +#### Technology Appraisal Types + +**Single Technology Appraisal (STA)**: +- One intervention vs. standard care. +- ~40-week timeline. +- Evidence review group (ERG) critique commissioned by NICE. + +**Multiple Technology Appraisal (MTA)**: +- Multiple interventions (class review). +- ~90-week timeline. +- More complex evidence synthesis required. + +**Highly Specialised Technologies (HST)**: +- For ultra-rare diseases (often enzyme replacement therapies). +- Modified criteria; higher acceptable ICERs (£100,000+/QALY possible). + +#### Submission Requirements + +**Company Evidence Submission Template**: + +**Section A: Decision Problem**: +- Technology description. +- Target population (NICE scope alignment). +- Comparator(s) (NICE specified). +- Perspective (NHS and PSS). + +**Section B: Clinical Evidence**: +- Systematic review. +- Direct and indirect evidence. +- Network meta-analysis if applicable. +- Safety data. + +**Section C: Cost-Effectiveness Evidence**: +- Model structure and rationale. +- Clinical parameters (efficacy, safety, utilities). +- Cost parameters (drug, administration, monitoring). +- Base case results. +- Sensitivity analysis (PSA required). +- Subgroup analyses (pre-specified only). + +**Section D: Budget Impact**: +- Eligible population. +- Current treatment mix. +- Technology uptake assumptions. +- Annual costs over 5 years. + +**Section E: Other Considerations**: +- Patient/carer evidence. +- Clinical expert evidence. +- Innovation/specific considerations. +- Equality considerations (protected characteristics). + +#### NICE Committee Process + +1. **Submission deadline**: Company submission + list price. +2. **ERG critique**: Independent assessment of company submission. +3. **Committee papers**: Combined pack for Committee members. +4. **Committee meeting**: Company and ERG presentations; discussion. +5. **Appraisal consultation document (ACD)**: Draft guidance published. +6. **Consultation**: Stakeholder comments (2 weeks). +7. **Final appraisal document (FAD)**: Final guidance published. +8. **Appeal**: Limited grounds; 15 days post-FAD. + +### 5. CADTH (Canada) Submission Framework + +#### Common Drug Review (CDR) + +**Submission Components**: + +**Module 1: Summary**: +- Product and indication. +- Listing request. +- Key findings (clinical and economic). +- Budget impact highlights. + +**Module 2: Background**: +- Disease background. +- Current treatment landscape in Canada. +- Unmet needs. + +**Module 3: Systematic Review**: +- Search strategy. +- Inclusion/exclusion criteria. +- Study characteristics table. +- Risk of bias assessment. +- Results synthesis. + +**Module 4: Economic Evaluation**: +- Evaluation type (CUA standard). +- Model structure. +- Input parameters. +- Base case results. +- Sensitivity analysis. + +**Module 5: Budget Impact**: +- Population eligible. +- Uptake assumptions. +- Annual cost projections (3 years). + +**Module 6: Other Considerations**: +- Patient input. +- Clinician input. +- Health equity considerations. +- Implementation issues. + +#### CADTH Review Process + +1. **Submission**: Manufacturer submits to CADTH. +2. **Clinical review**: CADTH clinical team assessment. +3. **Economic review**: CADTH health economist critique. +4. **CADTH report**: Published (non-confidential version). +5. **Committee review**: Canadian Drug Expert Committee (CDEC). +6. **Recommendation**: Recommend, recommend with criteria/conditions, or do not list. +7. **Provincial implementation**: Each province/territory decides on funding. + +### 6. Evidence Requirements by Jurisdiction + +#### Clinical Evidence Standards + +| Jurisdiction | RCT Preference | Observational Data | Real-World Evidence | Network Meta-Analysis | +|--------------|----------------|-------------------|--------------------|----------------------| +| **PBAC** | Gold standard; head-to-head preferred | Accepted if RCTs limited; bias assessment required | Increasingly accepted; must address confounding | Standard for indirect comparisons | +| **MSAC** | Preferred; diagnostic accuracy studies for diagnostics | Safety data often observational | Useful for implementation and safety monitoring | Less common | +| **PHARMAC** | Preferred; pragmatic trials valued | Accepted with caveats | Utility for NZ context and adherence | Used when no head-to-head | +| **NICE** | Required as primary evidence; ITC/Meta-analysis expected | Supplementary only | Not primary basis; may inform subgroups | Required if no direct comparison | +| **CADTH** | Primary evidence; pivotal trials | Safety; long-term outcomes | Supplementary; bias assessment critical | Expected if indirect comparison needed | + +#### Economic Evidence Standards + +| Element | PBAC | MSAC | PHARMAC | NICE | CADTH | +|---------|------|------|---------|------|-------| +| **Primary Analysis** | CUA (QALYs) | CUA preferred | CUA preferred | CUA (QALYs) | CUA preferred | +| **Perspective** | Healthcare + Societal | Healthcare | Healthcare | NHS + PSS | Public system | +| **Time Horizon** | Lifetime (chronic) | As appropriate | Sufficient duration | Sufficient duration | Lifetime typical | +| **Discounting** | 5% both | 5% both | 5% both | 3.5% (1.5% if >30 years) | 5% both | +| **Utilities** | AQoL, EQ-5D AU | EQ-5D preferred | EQ-5D preferred | EQ-5D-3L UK tariff | Canadian prefs | +| **PSA Required** | Yes | Recommended | Recommended | Yes | Yes | +| **Model Files** | Required | Recommended | Recommended | Required | Required | + +### 7. Common Submission Pitfalls + +#### Clinical Evidence Pitfalls + +**Inadequate Comparator**: +- Pitfall: Comparing to placebo or outdated therapy not used in jurisdiction. +- Solution: Use current standard of care; if multiple comparators, use most relevant. + +**Selective Reporting**: +- Pitfall: Only reporting favorable outcomes or subgroup results. +- Solution: Report all pre-specified outcomes; transparent about post-hoc analyses. + +**Ignoring Safety**: +- Pitfall: Focusing only on efficacy; inadequate adverse event reporting. +- Solution: Comprehensive safety profile; rare/serious adverse events addressed. + +**Poor Quality Evidence**: +- Pitfall: Relying on low-quality observational studies when RCTs available. +- Solution: Systematic review with quality assessment; GRADE methodology. + +#### Economic Evidence Pitfalls + +**Model Structure Issues**: +- Pitfall: Overly simple or overly complex model for disease. +- Solution: Match model complexity to decision problem; justify structure choices. + +**Inappropriate Time Horizon**: +- Pitfall: Too short misses long-term benefits/costs; too long adds unnecessary uncertainty. +- Solution: Lifetime for chronic conditions; justification for horizon choice. + +**Ignoring Half-Cycle Correction**: +- Pitfall: Markov models without half-cycle correction overestimate outcomes. +- Solution: Apply half-cycle correction or alternative methods (life-table, tunnel states). + +**Double Discounting**: +- Pitfall: Discounting costs but not outcomes (or vice versa). +- Solution: Both at reference rate; sensitivity at 0% or alternative rates. + +**Cherry-Picking Utilities**: +- Pitfall: Selecting most favorable utility values without justification. +- Solution: Systematic search for utilities; pre-specify selection criteria; sensitivity analysis. + +**Insufficient Uncertainty Analysis**: +- Pitfall: Only deterministic sensitivity; no PSA. +- Solution: PSA mandatory for most submissions; CEACs reported. + +**Foreign Data Without Adaptation**: +- Pitfall: Using overseas cost data or utilities without adjustment for jurisdiction. +- Solution: Local cost data; jurisdiction-specific utility tariffs; justify any adaptation. + +#### Submission Process Pitfalls + +**Late Engagement**: +- Pitfall: First contact with HTA authority at submission deadline. +- Solution: Pre-submission meetings; draft review; clarify reference case. + +**Missing Deadline**: +- Pitfall: Late submission misses committee meeting; delays decision by months. +- Solution: Project management; buffer time; early warning if delays expected. + +**Poor Response to Questions**: +- Pitfall: Delayed or inadequate response to evaluator clarification questions. +- Solution: Prepare FAQ; rapid response team; anticipate common questions. + +**Inadequate Budget Impact**: +- Pitfall: Underestimating uptake or population; affordability shock. +- Solution: Conservative estimates; sensitivity analysis; scenario planning. + +**Ignoring Equity**: +- Pitfall: Pure efficiency focus without equity considerations. +- Solution: PHARMAC requires equity; PBAC considers rule of rescue; NICE requires equality considerations. + +**Lack of Transparency**: +- Pitfall: Black-box models; undocumented assumptions. +- Solution: Provide model files; technical appendix; clear documentation. + +### 8. Pre-Submission Meeting Preparation + +#### Objectives +- Clarify reference case interpretation. +- Discuss comparator selection. +- Seek advice on model structure. +- Understand evidence gaps. +- Identify potential issues early. + +#### Preparation + +**Before the Meeting**: +- Draft submission outline. +- Prepare specific questions (not general advice). +- Summary of clinical evidence. +- Preliminary economic model structure. +- List of uncertainties needing guidance. + +**Questions to Ask**: +- Is our proposed comparator appropriate? +- Should we include subgroups? Which ones? +- Are there specific utility sources you prefer? +- How should we handle missing data? +- Is our proposed model structure acceptable? +- Any particular sensitivity analyses required? + +**After the Meeting**: +- Document advice received. +- Confirm understanding in writing if significant decisions. +- Note that advice is non-binding; final submission assessed on merits. + +### 9. Managed Entry and Risk-Sharing + +#### When to Consider + +**Evidence Uncertainty**: +- Limited clinical trial data (small populations, short follow-up). +- Uncertain real-world effectiveness. +- Uncertain long-term outcomes. + +**Budget Impact Uncertainty**: +- Population size uncertain. +- Uptake difficult to predict. +- Price-volume considerations. + +**High Cost/High Uncertainty**: +- Innovative therapies with transformative potential. +- Orphan drugs with limited evidence. +- Cell/gene therapies with long-term unknowns. + +#### Types of Agreements + +**Financial Agreements**: +- Discounts (confidential net pricing). +- Price caps (maximum expenditure). +- Price-volume agreements (lower price at higher volume). + +**Outcome-Based Agreements**: +- Rebates if patient doesn't respond. +- Continuation based on treatment response. +- Warranties (replacement if failure). + +**Evidence Development Agreements**: +- Coverage with evidence development (CED). +- Conditional approval with post-marketing studies. +- Registry-based follow-up. + +#### HTA Authority Perspectives + +**PBAC**: Willing to consider; must reduce uncertainty or budget impact. +**NICE**: Increasingly used; patient access schemes negotiated with NHS England. +**CADTH**: Considered case-by-case; doesn't substitute for poor evidence. + +### 10. Patient and Clinician Input + +#### Patient Input + +**Value**: +- Real-world experience of condition and current treatments. +- Unmet needs perspective. +- Quality of life impact beyond clinical measures. +- Acceptability of proposed treatment. + +**Sources**: +- Patient advocacy organizations. +- Individual patient submissions. +- Patient-reported outcome data from trials. +- Qualitative research (interviews, focus groups). + +**HTA Use**: +- PBAC: Considered in deliberative framework. +- NICE: Committee considers patient evidence; separate committee for highly specialised technologies. +- PHARMAC: Important for equity criteria (population groups). + +#### Clinician Input + +**Value**: +- Current practice patterns. +- Standard of care definition. +- Implementation feasibility. +- Safety monitoring requirements. + +**Sources**: +- Professional colleges/societies. +- Clinical experts. +- Delphi panels for practice variation. + +### 11. Responding to Evaluation Reports + +#### Timeline Management + +Evaluation reports typically require rapid response: +- PBAC: Delegate comments typically 2-3 weeks before meeting. +- NICE: ACD consultation 2 weeks. +- CADTH: CDR report comments ~2 weeks. + +**Response Preparation**: +- Rapid review team identified in advance. +- Template response format prepared. +- Access to original model and data. +- Clear decision-making authority. + +#### Response Content + +**Factual Corrections**: +- Errors in evidence summary. +- Misinterpretation of data. +- Technical errors in model critique. + +**Substantive Responses**: +- Disagreement with comparator assessment. +- Challenge to cost-effectiveness interpretation. +- Additional evidence or analyses. + +**Additional Analyses**: +- Post-hoc sensitivity analyses. +- Alternative scenario presentations. +- Additional subgroup analyses (if justified). + +#### Hearing Presentation + +**Structure**: +- Brief summary (5 minutes typical). +- Address key concerns from evaluation. +- Highlight key benefits and uncertainties. +- Be prepared for questions. + +**Preparation**: +- Rehearse timing. +- Prepare backup slides. +- Anticipate questions. +- Have technical experts available. + +## Documentation Requirements + +### Submission Package Checklist + +**Clinical Evidence**: +- [ ] Systematic review protocol and report. +- [ ] PRISMA flow diagram. +- [ ] Study characteristics tables. +- [ ] Risk of bias assessment (ROB-2, ROBINS-I). +- [ ] Forest plots for meta-analyses. +- [ ] GRADE evidence profiles. +- [ ] Clinical study reports (if requested). + +**Economic Evidence**: +- [ ] Economic evaluation report following reference case. +- [ ] Model description and structure diagram. +- [ ] Parameter tables with sources and uncertainty. +- [ ] Cohort trace or patient simulation details. +- [ ] Base case results (ICER, incremental costs/effects). +- [ ] Deterministic sensitivity analysis (tornado diagrams). +- [ ] Probabilistic sensitivity analysis (CEACs, scatter plots). +- [ ] Scenario analyses. +- [ ] Model validation documentation. +- [ ] Model files (Excel, TreeAge, R code). + +**Budget Impact**: +- [ ] Budget impact model. +- [ ] Target population estimation with sources. +- [ ] Current treatment pattern assumptions. +- [ ] Uptake projections with rationale. +- [ ] Cost calculations (annual, cumulative). +- [ ] Scenario analyses (conservative, optimistic). + +**Stakeholder Input**: +- [ ] Patient organization submissions. +- [ ] Clinician/professional society input. +- [ ] Consumer representative perspectives. + +**Administrative**: +- [ ] Cover letter with key messages. +- [ ] Submission checklist completed. +- [ ] Pricing information (may be confidential). +- [ ] Proposed listing wording. +- [ ] Product information (TGA/SmPC). + +### Supporting Documentation + +**Technical Appendix**: +- [ ] Detailed search strategies. +- [ ] Excluded studies list with reasons. +- [ ] Network meta-analysis geometry and consistency checks. +- [ ] Model equations and mathematical specification. +- [ ] Additional sensitivity analyses. +- [ ] Validation details. + +**Response to Evaluation**: +- [ ] Point-by-point response document. +- [ ] Revised analyses if applicable. +- [ ] Additional evidence if available. +- [ ] Clarification of misunderstandings. + +## Common Mistakes + +| Mistake | Why It's Wrong | Instead | +|---------|----------------|---------| +| **Submitting without pre-submission meeting** | May misunderstand reference case; increased risk of rejection | Engage early; clarify comparator, model structure, evidence requirements | +| **Using foreign cost data** | Costs vary significantly by jurisdiction; reimbursement decisions based on local prices | Use jurisdiction-specific cost data; PBS/MSAC schedule for Australia | +| **Insufficient PSA iterations** | Unstable CEACs; imprecise uncertainty estimates | Minimum 1,000 iterations; 5,000-10,000 for final submission | +| **Post-hoc subgroup analysis** | Inflated Type I error; not pre-specified; cherry-picking | Pre-specify subgroups with clinical rationale; adjust for multiple comparisons | +| **Ignoring societal perspective** | PBAC requires societal perspective analysis; work productivity matters | Include productivity costs; patient transport; carer costs | +| **Wrong discount rate** | Violates reference case; undermines comparability | Use jurisdiction-specific rate (5% AU; 3.5% UK; varies Canada) | +| **No model files provided** | Lack of transparency; inability to verify analyses | Provide Excel/TreeAge/R files; clear documentation | +| **Cherry-picking clinical evidence** | Selective reporting; bias in favor of intervention | Systematic review; all relevant evidence; risk of bias assessment | +| **Underestimating budget impact** | Affordability concerns; unrealistic uptake assumptions | Conservative estimates; sensitivity analysis; market research on likely uptake | +| **Late response to questions** | Misses committee meeting; delays decision by months | Rapid response team; project management; anticipate questions | +| **Ignoring equity considerations** | May fail equity criteria; particularly important for PHARMAC, NICE | Explicit equity analysis; impact on disadvantaged populations; distributional analysis | +| **No half-cycle correction** | Systematic bias in Markov models; incorrect results | Apply half-cycle correction or use appropriate alternative | +| **Poor comparator justification** | HTA authority may reject if comparator inappropriate | Clear rationale for comparator; discussion with authority pre-submission | +| **Missing trial data** | Exclusion of negative trials; publication bias | Comprehensive search; include unpublished data; clinical trial registry checks | + +## When to Escalate + +Escalate to HTA Specialist, Health Economics Lead, or Regulatory Affairs when: +- Novel intervention without existing HTA precedent. +- ICER significantly exceeds jurisdiction threshold. +- Complex model required (microsimulation, DES, hybrid models). +- Managed entry agreement or risk-sharing being considered. +- Significant equity or rare disease considerations. +- Budget impact exceeds health system capacity. +- Submission deadline at risk. +- Evaluation report contains fundamental disagreements requiring strategic response. +- Appeal or reconsideration being considered. +- International reference pricing implications. +- Multiple submissions to different jurisdictions simultaneously. +- Post-submission significant new evidence emerges. +- Committee requests major additional analyses with short timeline. + +## Privacy Considerations + +- **PHI Involved**: Minimal - HTA submissions use aggregate clinical trial data and economic models. +- **Data Minimization**: Use published summary data; individual patient data not required for submission. +- **De-identification**: If using patient-level data for economic modeling, ensure complete de-identification. +- **Commercial Confidentiality**: Pricing information may be marked confidential; model structure typically public. +- **Retention**: Retain submission documents and models per regulatory requirements (typically 7+ years). +- **No Persistence**: Do not store patient-level trial data in submission documents. +- **Transparency**: Many HTA authorities publish non-confidential versions of submissions and models. +- **Third-Party Data**: Ensure appropriate data licensing for any proprietary datasets used. + +## Confidence Indicators + +| Scenario | Confidence | Action | +|----------|------------|--------| +| Well-established therapeutic class; clear comparator; robust evidence base | High | Proceed with standard submission preparation; follow reference case | +| New mechanism of action; no direct comparator; network meta-analysis required | Medium | Escalate for statistical support; validate indirect comparisons carefully | +| ICER near or above threshold; requires careful uncertainty analysis | Medium | Escalate to health economist; prepare robust sensitivity analyses | +| Orphan drug or ultra-rare disease; limited evidence | Low | **BLOCKER**: Engage specialist; consider managed entry; equity considerations paramount | +| Budget impact extremely high; affordability concerns | Medium | Escalate for policy discussion; consider risk-sharing or staged implementation | +| Submission deadline approaching; significant documentation incomplete | Low | **BLOCKER**: Escalate immediately; may need to defer to next committee cycle | +| Evaluation report fundamentally disagrees with key assumptions | Medium | Escalate for strategic response; may require revised analyses or additional evidence | +| Multiple jurisdictions with conflicting reference case requirements | Medium | Coordinate submissions; consider separate models or adaptable structure | +| Patient advocacy strongly supports; clinical evidence weak | Medium | Balance equity/access considerations with evidence requirements | +| Major new evidence emerges post-submission | Low | Escalate for strategy; may need to update submission or prepare for reconsideration | + +## Tool Requirements + +- `~~research literature` (PubMed) - For clinical evidence synthesis. +- `~~health/evidence-synthesis` - For systematic reviews and meta-analyses. +- `~~health/health-econ-eval` - For economic evaluation and decision modeling. +- `~~data/statistical-analysis` - For network meta-analysis and PSA. +- `~~cloud storage` - For submission document collaboration and model storage. +- `~~document collaboration` - For team review and submission assembly. +- `~~project tracker` - For HTA submission timelines and milestone tracking. +- `~~health/clinical-guidelines` - For comparator identification and standard of care. + +## Success Indicators + +You've applied this skill well when: +- [ ] Submission follows jurisdiction-specific reference case requirements. +- [ ] Comparator represents current standard of care and is justified. +- [ ] Clinical evidence is comprehensive with systematic review methodology. +- [ ] Economic model follows best practice and has been validated. +- [ ] Sensitivity analysis includes both deterministic and probabilistic approaches. +- [ ] Budget impact analysis is realistic with scenario planning. +- [ ] Model files are provided with clear documentation. +- [ ] Pre-submission meeting held and advice incorporated. +- [ ] Patient and clinician input included where appropriate. +- [ ] Response to evaluation questions is timely and thorough. +- [ ] All submission deadlines are met. +- [ ] Equity and distributional considerations addressed. +- [ ] Transparency requirements met; assumptions clearly documented. +- [ ] No PHI or confidential patient data in submission documents. +- [ ] Health economist and regulatory specialists have reviewed complex submissions. + +## Related Skills + +- `~~health/health-econ-eval` - For economic evaluation methodology and decision modeling. +- `~~health/evidence-synthesis` - For systematic reviews and meta-analyses supporting submissions. +- `~~health/clinical-guidelines` - For identifying comparators and standard of care. +- `~~research/grants` - For research funding applications supporting HTA evidence generation. +- `~~finance/budgeting` - For budget impact analysis preparation. +- `~~document/technical-writing` - For preparing submission documents and reports. +- `~~project/project-management` - For managing HTA submission timelines and cross-functional teams. diff --git a/health/skills/incident-reporting/SKILL.md b/health/skills/incident-reporting/SKILL.md new file mode 100644 index 0000000..5f12d5a --- /dev/null +++ b/health/skills/incident-reporting/SKILL.md @@ -0,0 +1,242 @@ +--- +name: health/incident-reporting +description: This skill should be used when reporting, triaging, investigating, or escalating healthcare incidents and serious adverse events. Use when a user mentions incident forms, near misses, sentinel events, SAC severity, mandatory notifications, or root cause analysis. +version: 1.0.0 +--- + +# Incident Reporting + +Structured guidance for healthcare incident intake, severity classification, escalation, investigation, and quality improvement follow-through. + +**Important**: This skill supports clinical governance workflows. It does not replace clinician judgment, legal advice, or organization-specific policy requirements. + +## When to Use This Skill + +Invoke when: +- A user needs to log a patient safety incident, adverse event, or near miss. +- A team asks how to classify severity using SAC 1-4 (or local equivalent). +- A report may trigger mandatory external notification. +- The incident needs immediate containment and escalation routing. +- The organization needs a root cause analysis (RCA) plan. +- Quality teams need CAPA or improvement tracking from incident findings. + +Do not use this as a replacement for emergency response channels. If immediate harm is ongoing, direct escalation to emergency and on-call clinical leadership is mandatory. + +## Operating Modes + +### Standard Mode +Use full incident governance workflow: +- Full incident chronology and evidence capture. +- Formal severity classification with confidence statement. +- Regulatory trigger screen (AU/NZ default). +- RCA initiation and quality improvement linkage. +- Complete audit-ready output package. + +### Lite Mode +Use only for constrained contexts (limited time or partial data): +- Capture minimum safe fields. +- Apply preliminary severity and immediate actions. +- Flag unknowns and require follow-up completion. +- Keep high-risk escalation obligations unchanged. + +Lite mode is not acceptable for final closure of serious incidents. + +## Regulatory Context + +Default jurisdiction is Australia/New Zealand. Use US/EU-lite framing only when explicitly requested. + +| Jurisdiction | Regulator/Statute | Trigger | Timeframe/SLA | Required Artifacts | Escalation Point | +|---|---|---|---|---|---| +| Australia | NSQHS governance context, Privacy Act 1988 (Cth), state health incident rules | SAC 1-2, sentinel event, serious harm, mandatory notifier events | Immediate internal escalation; external timing per state policy | Incident form, chronology, clinical review notes, notification record | Clinical Director, Risk/Legal, Executive on call | +| New Zealand | HDC Code context, Health Information Privacy Code 2020, Te Whatu Ora pathways | Serious adverse events, rights breaches, reportable harm | Immediate internal escalation; external timing per district/national requirements | Incident record, actions taken, duty of candour documentation | Clinical Director, Quality Lead, Legal advisor | +| United States (lite) | HIPAA + organization/state reporting policy | Serious patient harm, privacy/security concerns | Per state and facility policy | De-identified incident summary, compliance log | Risk Management + Compliance | +| European Union (lite) | GDPR + country-specific health rules | Serious harm, data/privacy incidents | Per member-state implementation | Incident summary, DPIA/compliance references where applicable | Clinical Governance + DPO | + +## Quick Reference + +1. Confirm if immediate patient safety risk is present. +2. If risk is active, escalate before documentation depth. +3. Record incident type and preliminary severity. +4. Capture only minimum necessary PHI/PII. +5. Determine whether mandatory reporting triggers apply. +6. Route to clinical and governance owners based on severity. +7. Start RCA for major incidents and sentinel events. +8. Define immediate containment actions and owners. +9. Set due dates for acknowledgment, investigation, and closure. +10. Register QI actions (CAPA/PDSA) tied to root causes. + +## Incident Type Taxonomy + +Use one primary type and optional secondary tags: + +| Primary Type | Examples | +|---|---| +| Medication / ADR | Wrong dose, omitted medication, adverse drug reaction | +| Procedure / Treatment | Wrong-site, delayed treatment, protocol breach | +| Clinical Deterioration | Failure to recognize or escalate deterioration | +| Device / Equipment | Device failure, alarm failure, unavailability | +| Infection / IPC | Healthcare-associated infection, isolation breach | +| Falls / Injury | Patient fall, transfer injury | +| Documentation / Communication | Handover failure, incomplete records | +| Privacy / Information | Unauthorized disclosure, incorrect recipient | +| Near Miss | Event intercepted before patient harm | +| Sentinel Event | Death or severe permanent harm requiring immediate executive oversight | + +## Severity Classification (SAC-Aligned) + +| SAC | Severity Signal | Typical Response | +|---|---|---| +| SAC 1 | Extreme consequence or immediate severe risk | Immediate executive + clinical escalation, urgent investigation, potential external notification | +| SAC 2 | Major consequence or high risk requiring urgent action | Same-day escalation, formal investigation, targeted notification assessment | +| SAC 3 | Moderate impact with manageable risk | Structured review, corrective actions, service-level oversight | +| SAC 4 | Minor impact or near miss with low residual risk | Local review, lessons learned, trend monitoring | + +If local policy uses a different matrix, map to equivalent levels and document the mapping. + +## Immediate Response Protocol + +### Step 1: Safety Containment +- Stop unsafe process. +- Stabilize and treat affected patient(s). +- Isolate compromised medication/device/information pathway. +- Assign a clinical lead for immediate decisions. + +### Step 2: Escalation +- Notify charge nurse/unit lead. +- Notify clinical director for SAC 1-2 indicators. +- Notify risk/compliance/legal when regulatory threshold may be met. +- Notify executive duty manager for sentinel events. + +### Step 3: Evidence Preservation +- Preserve records, logs, orders, device metadata, and communication trails. +- Prevent alteration of source documentation. +- Record timestamps and involved roles. + +### Step 4: Communication Discipline +- Use factual language; avoid blame statements. +- Provide internal updates with clear owner and ETA. +- Trigger open disclosure pathways where policy requires. + +## Investigation Methodology (RCA) + +Use structured RCA for SAC 1-2 and sentinel events. + +1. Define incident statement (what happened, where, when). +2. Build verified chronology. +3. Identify active failures and latent system factors. +4. Apply contributory factors (people, process, technology, environment, communication). +5. Validate findings with multidisciplinary review. +6. Draft corrective/preventive actions with accountable owners. +7. Define measurable controls and monitoring windows. + +Recommended outputs: +- Problem statement. +- Contributory factor map. +- Corrective Action and Preventive Action (CAPA) plan. +- Residual risk rating after interventions. + +## Mandatory Reporting Trigger Screen + +Evaluate and record yes/no with rationale: +- Death or severe permanent harm. +- Sentinel event category match. +- Serious medication/device adverse event. +- Notifiable infection/public health trigger. +- Significant privacy breach with patient impact. +- Practitioner conduct concerns requiring board notification. + +If uncertain, classify as "possible trigger" and escalate to compliance/legal for determination. + +## Documentation Requirements + +Required minimum fields: +- Incident ID and timestamp. +- Location/service line. +- Reporter role (not full personal identifiers unless policy requires). +- De-identified patient references. +- Incident taxonomy and preliminary severity. +- Immediate actions taken. +- People notified and notification timestamps. +- Mandatory reporting assessment. +- Investigation owner and due dates. +- QI linkage (CAPA/PDSA ticket IDs). + +For high-severity events, include: +- Confirmed chronology. +- RCA deliverables. +- Executive/committee review outcomes. +- Closure criteria and verification evidence. + +## Security & Privacy Considerations + +- Use minimum necessary data for triage and reporting. +- Never place full identifiers into ad hoc notes or shared chat channels. +- De-identify by default (`[Patient A]`, `[Staff B]`, `[Case ID]`). +- Keep patient-identifiable records in authorized systems only. +- Do not copy PHI/PII into tool logs, code comments, or reusable templates. +- Respect access controls and need-to-know principles. +- If a privacy incident is suspected, run incident and privacy workflows in parallel. + +## Confidence Indicators + +| Scenario | Confidence | Action | +|---|---|---| +| Clear near miss with complete chronology and no harm | High | Proceed with draft report, local review, and trend tagging | +| Event details incomplete but potential moderate harm | Medium | Produce provisional report, flag missing evidence, require clinical lead review | +| Possible sentinel event or severe harm with conflicting accounts | Low | Escalate immediately, require executive and legal/compliance review before closure | +| Suspected mandatory external notification trigger | Low | Do not finalize determination autonomously; escalate to compliance/legal | + +## Common Mistakes (Anti-Patterns) + +| Mistake | Why It's Wrong | Instead | +|---|---|---| +| Treating incidents as complaints only | Misses patient safety and regulatory pathways | Run incident workflow first, then complaint workflow if applicable | +| Downgrading severity due to uncertainty | Delays needed response and notifications | Classify conservatively and escalate for confirmation | +| Recording excess PHI in broad channels | Increases privacy risk and non-compliance | Use de-identified summaries and secure systems | +| Starting RCA before containment is stable | Investigation quality drops and risk remains active | Complete immediate safety actions first | +| Closing incidents without QI linkage | Recurrence risk remains unmanaged | Attach CAPA/PDSA actions with owners and due dates | +| Missing notification timestamps | Weakens legal and governance auditability | Log each notification with exact time and recipient role | + +## When to Escalate + +Escalate immediately when: +- Ongoing patient safety risk exists. +- Severity appears SAC 1 or SAC 2. +- Sentinel event criteria may be met. +- Mandatory reporting threshold may be triggered. +- There is a privacy breach with potential harm. +- Conflicting evidence prevents safe closure decision. + +Escalation targets: +- Clinical escalation: Charge nurse -> Clinical Director -> Executive on call. +- Governance escalation: Quality/Risk -> Compliance/Legal -> Governance committee. + +## Tool Requirements + +- `~~health/clinical-systems` for validated record and timeline retrieval. +- `~~project tracker` for incident IDs, tasks, and CAPA tracking. +- `~~cloud storage` for controlled evidence packs and investigation artifacts. +- `~~health/coding` or equivalent classification support for structured categorization. + +## Success Indicators + +You have applied this skill correctly when: +- [ ] Incident type and severity are documented with rationale. +- [ ] Immediate safety actions are recorded and owned. +- [ ] Mandatory reporting triggers were explicitly assessed. +- [ ] RCA is initiated for high-severity incidents. +- [ ] QI follow-through tasks are linked and tracked. +- [ ] Outputs avoid unnecessary PHI/PII exposure. +- [ ] Jurisdiction assumptions are explicit (AU/NZ default unless requested otherwise). + +## Related Skills + +- `~~health/complaints-management` for complaint handling when an incident also has service/communication concerns. +- `~~health/risk-management` for ongoing enterprise or clinical risk treatment after incident closure. +- `~~health/quality-improvement` for CAPA/PDSA execution and monitoring. + +## Version History + +| Version | Date | Changes | +|---|---|---| +| 1.0.0 | 2026-02-12 | Initial health-incidents implementation with SAC, RCA, and mandatory reporting workflow | diff --git a/health/skills/manuscript-prep/SKILL.md b/health/skills/manuscript-prep/SKILL.md new file mode 100644 index 0000000..1878e3d --- /dev/null +++ b/health/skills/manuscript-prep/SKILL.md @@ -0,0 +1,696 @@ +--- +name: health/manuscript-prep +description: This skill should be used when preparing academic manuscripts for journal publication in healthcare and medical research. Use for journal selection guidance, reporting guideline compliance (CONSORT, STROBE, CHEERS, PRISMA), manuscript structure planning, figure/table preparation, and cover letter drafting for peer-reviewed submissions. +version: 1.0.0 +--- + +# Manuscript Preparation + +A comprehensive framework for preparing healthcare and medical research manuscripts for peer-reviewed journal publication. This skill guides researchers through journal selection, reporting guideline compliance, manuscript structuring, and submission preparation while ensuring adherence to evidence standards and publication ethics. + +**Important**: This skill assists with manuscript preparation workflows but does not provide clinical advice, guarantee publication acceptance, or replace the judgment of experienced co-authors and mentors. Always verify journal-specific requirements before submission. + +## When to Use This Skill + +Invoke this skill when: +- Planning a manuscript submission for journal publication. +- Selecting appropriate journals based on study type, impact factor, and audience. +- Determining which reporting guideline applies (CONSORT, STROBE, CHEERS, PRISMA, etc.). +- Structuring a manuscript according to journal requirements and study type. +- Preparing figures, tables, and supplementary materials. +- Formatting references according to journal style. +- Writing a compelling cover letter for journal submission. +- Conducting pre-submission checks against journal requirements. +- Responding to peer reviewer comments and preparing revisions. +- Documenting authorship contributions and conflicts of interest. +- Preparing a Data Availability Statement and patient consent documentation. + +## Regulatory Context + +### Australia & New Zealand (Default) + +| Regulation/Standard | Relevance | Key Requirements | +|---------------------|-----------|------------------| +| **NHMRC Code** | Research integrity | Authorship requirements; conflict of interest disclosure; data sharing | +| **COPE Guidelines** | Publication ethics | Authorship disputes; plagiarism; data fabrication; corrections | +| **ARHEN Publication Standards** | Rural/remote health | Contextual reporting for Indigenous and rural health research | +| **NZ Health Research Council** | Research conduct | Te Ara Tika ethical framework for Māori research partnerships | +| **Medical Board AU** | Clinician publication | Professional standards for research dissemination | + +### US/EU-lite Fallback + +| Regulation/Standard | Relevance | Key Requirements | +|---------------------|-----------|------------------| +| **ICMJE Recommendations** | International | Authorship criteria; clinical trial registration; data sharing | +| **NIH Data Sharing Policy** (US) | Funded research | Data sharing plans; repository requirements | +| **GDPR** (EU) | Patient data | Anonymization standards; data retention limits | +| **FDA Guidance** (US) | Clinical trials | Registration on ClinicalTrials.gov; results reporting | +| **Declaration of Helsinki** | International | Ethical principles for medical research involving human subjects | + +### Jurisdiction Matrix + +| Jurisdiction | Applicable Regulator | Reporting Trigger | Timeframe | Required Artifacts | Escalation Point | +|--------------|---------------------|-------------------|-----------|-------------------|------------------| +| **AU - NHMRC Funded** | NHMRC | Publication arising from funded research | Within project timeline | Open access compliance; data management plan | Research Office | +| **NZ - HRC Funded** | HRC NZ | Māori health research publication | Within project timeline | Te Ara Tika compliance; partnership documentation | Research Ethics Committee | +| **AU - Medical Research** | TGA/ARC | Clinical trial results | Within 12 months of trial completion | CONSORT checklist; trial registration | Principal Investigator | +| **US - NIH Funded** | NIH | Peer-reviewed publications | At time of publication | PMCID; open access compliance | NIH Office | +| **EU - Clinical Trials** | EMA | CT Regulation compliance | Results posting within 12 months | EudraCT posting; EU CTR compliance | Sponsor | + +## Quick Reference + +1. **Journal Selection**: Match study type, scope, and impact goals to appropriate journals. +2. **Checklist First**: Identify reporting guideline (CONSORT, STROBE, etc.) before writing. +3. **Register Trials**: Clinical trials must be registered before first patient enrollment. +4. **Authorship Early**: Define contributions and order before drafting to avoid disputes. +5. **Structure Matters**: Follow IMRAD format with journal-specific adaptations. +6. **Figures/Tables**: Limit to essential; follow journal guidelines for resolution and format. +7. **References**: Use reference manager; verify journal style requirements. +8. **Cover Letter**: Articulate novelty, significance, and fit for target journal. +9. **Check Compliance**: Verify word limits, formatting, and supplementary material rules. +10. **Respond Gracefully**: Address all reviewer comments systematically in revisions. +11. **Data Sharing**: Include Data Availability Statement; deposit in approved repository. +12. **Patient Privacy**: Ensure no identifiable patient information in manuscript. +13. **Ethics Statement**: Document ethics approval and consent for all human subjects research. +14. **Conflicts**: Disclose all financial and non-financial competing interests. + +## Operating Modes + +### Standard Mode +Full manuscript preparation workflow with comprehensive reporting guideline compliance, journal-specific formatting requirements, detailed figure/table preparation, reference management, and cover letter drafting. Use for high-impact journal submissions, complex study designs, and first-time authors requiring detailed guidance. Includes authorship documentation, ethics compliance verification, and pre-submission readiness checks. + +### Lite Mode +Streamlined guidance for rapid manuscript preparation or experienced authors. Focuses on essential checklist items, basic structure templates, and critical compliance requirements. Never suppresses mandatory reporting obligations (trial registration, ethics approval, conflict disclosure) or high-risk patient privacy requirements. Suitable for brief communications, letters, or internal draft preparation. + +## Detailed Guidance + +### 1. Study Type to Reporting Checklist Mapping + +Select the appropriate reporting guideline based on study design: + +| Study Type | Guideline | Version | Key Requirements | +|------------|-----------|---------|------------------| +| **Randomized Controlled Trial** | CONSORT | 2010 + extensions | 25-item checklist; flow diagram; trial registration | +| **Observational Study (Cohort, Case-Control, Cross-Sectional)** | STROBE | 2007 + extensions | 22-item checklist; cohort-specific items | +| **Systematic Review / Meta-Analysis** | PRISMA | 2020 | 27-item checklist; flow diagram; registration | +| **Economic Evaluation** | CHEERS | 2022 | 28-item checklist; perspective and time horizon | +| **Qualitative Research** | SRQR | 2014 | 21-item checklist; researcher characteristics | +| **Mixed Methods** | GRAMMS | 2013 | 12-item checklist; integration strategies | +| **Case Report** | CARE | 2013 | 13-item checklist; timeline; patient perspective | +| **Quality Improvement** | SQUIRE | 2016 | 18-item checklist; context description | +| **Diagnostic Accuracy** | STARD | 2015 | 30-item checklist; flow diagram | +| **Animal Research** | ARRIVE | 2020 | 21-item checklist; sample size calculation | +| **Prediction Model** | TRIPOD | 2015 | 22-item checklist; model presentation | +| **Protocol Paper** | SPIRIT | 2013 | 33-item checklist; trial registration | +| **Scoping Review** | PRISMA-ScR | 2018 | 20-item checklist; flow diagram | +| **Equity-Focused** | PROGRESS-Plus | 2017 | Equity dimensions reporting | + +#### Checklist Compliance Workflow + +1. **Identify Study Design**: Determine primary study classification. +2. **Select Guideline**: Map to appropriate checklist from table above. +3. **Download Checklist**: Obtain current version from EQUATOR Network (www.equator-network.org). +4. **Pre-Writing Review**: Review checklist items before drafting manuscript. +5. **Item-by-Item Compliance**: Address each checklist item in manuscript or appendix. +6. **Flow Diagrams**: Create required diagrams (CONSORT, PRISMA, STARD). +7. **Page Numbers**: Document page/line numbers for each checklist item. +8. **Upload with Submission**: Include completed checklist as supplementary file. + +### 2. Journal Selection Strategy + +#### Step 1: Define Target Audience +- **Clinical Practitioners**: General medical journals (BMJ, Lancet, JAMA, NEJM) or specialty journals. +- **Researchers**: Discipline-specific journals with methodological focus. +- **Policy Makers**: Health policy and public health journals. +- **Patients/Public**: Open access journals with plain language summaries. + +#### Step 2: Match Study Type to Journal Scope + +| Study Type | High-Impact Targets | Specialist Journals | Open Access Options | +|------------|--------------------:|--------------------:|--------------------:| +| **RCT** | NEJM, Lancet, JAMA | Contemporary Clinical Trials | PLOS Medicine, Trials | +| **Observational** | BMJ, Annals of Internal Medicine | Epidemiology, AJE | PLOS ONE, BMJ Open | +| **Systematic Review** | Cochrane Database, Lancet | Systematic Reviews | F1000Research | +| **QI Study** | BMJ Quality & Safety | Joint Commission Journal | JHM, Implementation Science | +| **Case Report** | BMJ Case Reports | Journal of Medical Case Reports | Cureus, Cases Journal | +| **Health Economics** | Health Affairs, Value in Health | PharmacoEconomics | Cost Effectiveness and Resource Allocation | +| **Implementation Science** | Implementation Science | BMJ Leader | Implementation Science Communications | + +#### Step 3: Evaluate Journal Metrics + +**Impact Metrics**: +- Impact Factor (2-year citation rate) +- CiteScore (Scopus 4-year metric) +- Source Normalized Impact per Paper (SNIP) +- Scimago Journal Rank (SJR) + +**Quality Indicators**: +- Indexed in MEDLINE/PubMed +- DOAJ listing (for open access) +- Publisher reputation +- Peer review transparency +- Editorial board credentials + +#### Step 4: Check Submission Requirements + +**Manuscript Specifications**: +- Word limits (abstract, main text, references) +- Structure requirements (IMRAD variations) +- Reference style and limits +- Figure/table limits and specifications +- Supplementary material policies + +**Policy Requirements**: +- Open access options and fees +- Data sharing requirements +- Trial registration mandates +- Ethics documentation requirements +- Authorship declaration format + +### 3. Manuscript Structure Templates + +#### Template A: Original Research (IMRAD) + +``` +TITLE PAGE +- Title (concise, informative; 150 characters max) +- Running head (50 characters max) +- Author names and affiliations +- Corresponding author contact +- Word counts (abstract, main text) +- Keywords (MeSH terms preferred) +- Funding statement +- Conflicts of interest +- Data availability statement +- Ethics/IRB approval statement +- Trial registration (if applicable) + +ABSTRACT (Structured) +- Background/Objective: Context and study purpose +- Methods: Design, setting, participants, interventions, outcomes +- Results: Key findings with numbers and confidence intervals +- Conclusions: Interpretation and implications +- Trial Registration: Number and registry (if applicable) +- Keywords: 3-5 MeSH terms + +MAIN TEXT + +INTRODUCTION +- Background and rationale (2-3 paragraphs) +- Knowledge gap statement +- Study objectives/hypotheses + +METHODS +- Study design and setting +- Participants (eligibility, recruitment) +- Interventions/Exposures (if applicable) +- Outcomes (primary and secondary) +- Sample size justification +- Statistical analysis plan +- Ethical considerations + +RESULTS +- Participant flow (CONSORT diagram) +- Baseline characteristics +- Primary outcome results +- Secondary outcomes +- Subgroup analyses (pre-specified) +- Adverse events (if applicable) +- Missing data handling + +DISCUSSION +- Summary of main findings +- Comparison with existing literature +- Strengths and limitations +- Clinical/policy implications +- Future research directions +- Conclusion (1-2 sentences) + +ACKNOWLEDGMENTS +- Contributors not meeting authorship +- Funding source details +- Role of funder + +REFERENCES +- Numbered or author-date per journal style +- Follow journal-specific requirements + +FIGURES +- Figure 1: CONSORT/STROBE flow diagram +- Figure 2: Primary outcome visualization +- Figure 3-n: Secondary outcomes/key findings + +TABLES +- Table 1: Baseline characteristics +- Table 2: Primary outcome results +- Table 3: Secondary outcomes +- Table 4: Adverse events/safety data + +SUPPLEMENTARY MATERIALS +- Extended methods +- Additional analyses +- Study protocol +- Statistical analysis plan +- Data dictionary +- Patient information sheet +``` + +#### Template B: Systematic Review (PRISMA 2020) + +``` +TITLE +- Identify as systematic review/meta-analysis + +ABSTRACT (PRISMA Checklist Aligned) +- Background +- Objectives +- Eligibility criteria +- Information sources +- Risk of bias assessment +- Synthesis methods +- Results (studies, participants, synthesis) +- Limitations +- Conclusions/implications +- Funding +- Registration number + +MAIN TEXT + +INTRODUCTION +- Rationale +- Objectives (PICO/PECO framework) + +METHODS +- Eligibility criteria +- Information sources (databases, registers) +- Search strategy (full search strings) +- Selection process +- Data collection process +- Data items (variables) +- Study risk of bias assessment +- Effect measures +- Synthesis methods +- Certainty assessment (GRADE) + +RESULTS +- Study selection (PRISMA flow diagram) +- Study characteristics (Table 1) +- Risk of bias in studies +- Results of individual studies +- Synthesis of results (forest plots) +- Certainty of evidence + +DISCUSSION +- Summary of evidence +- Limitations +- Conclusions + +OTHER +- Funding +- Registration and protocol +- Support +- Competing interests +- Availability of data/code + +SUPPLEMENTARY +- PRISMA checklist +- Search strategies +- Risk of bias assessments +- Funnel plots +- GRADE evidence profiles +``` + +#### Template C: Case Report (CARE Guidelines) + +``` +TITLE +- "Case Report" designation +- Key clinical feature or diagnosis +- Patient age/sex (if relevant) + +ABSTRACT +- Introduction (what is unique) +- Case presentation (demographics, history, exam) +- Investigations (key findings) +- Differential diagnosis +- Treatment +- Outcome/follow-up +- Discussion +- Patient perspective (if available) + +MAIN TEXT + +INTRODUCTION +- Why this case is important +- Brief literature context + +CASE PRESENTATION +- Patient information (de-identified) +- Timeline of events (diagram preferred) +- Clinical findings +- Diagnostic assessment +- Therapeutic intervention +- Follow-up and outcomes +- Patient perspective (quote if available) + +DISCUSSION +- Relevant literature review +- Rationale for conclusions +- Learning points + +INFORMED CONSENT +- Documentation of patient consent for publication +- Statement of de-identification +``` + +### 4. Figure and Table Preparation + +#### Figure Guidelines + +**General Principles**: +- Each figure must be self-contained and understandable without text. +- Limit to essential figures (typically 2-4 for original research). +- Use consistent formatting across all figures. +- Ensure accessibility (colorblind-safe palettes, sufficient contrast). + +**Technical Specifications**: +- **Resolution**: Minimum 300 DPI for photographs; 600-1200 DPI for line art. +- **Format**: TIFF or EPS preferred; JPEG acceptable for photographs only. +- **Color Mode**: CMYK for print; RGB acceptable for online. +- **Font Size**: Minimum 8 pt; sans-serif fonts preferred. +- **Dimensions**: Single column (8 cm), 1.5 column (12 cm), or full width (17 cm). + +**Essential Figure Types**: + +1. **Flow Diagram** (CONSORT/STROBE/PRISMA) + - Template-aligned boxes and arrows + - Numbers at each stage + - Reasons for exclusion clearly stated + +2. **Primary Outcome Plot** + - Effect size with confidence intervals + - Intention-to-treat analysis + - Time points clearly labeled + - Statistical significance indicators + +3. **Forest Plot** (for systematic reviews/subgroups) + - Individual study/subgroup effect sizes + - Heterogeneity statistics (I²) + - Overall pooled estimate + - Weight of each study + +4. **Kaplan-Meier Curves** (survival analyses) + - Number at risk table below + - Censoring marks + - Log-rank p-value + - Hazard ratio with CI + +5. **Forest/Bar Charts for Categorical Data** + - Clear axis labels + - Error bars (SD or 95% CI) + - Sample sizes indicated + +**Color Palette Recommendations**: +- Use colorblind-safe palettes (e.g., ColorBrewer palettes). +- Avoid red-green combinations. +- Use patterns/shapes in addition to color. +- Ensure grayscale printability. + +#### Table Guidelines + +**General Principles**: +- Use tables for structured data; figures for trends/patterns. +- Number tables consecutively in order of citation. +- Provide clear, descriptive titles. +- Use footnotes for abbreviations and explanations. +- Align decimal points for numerical data. + +**Essential Table Types**: + +1. **Baseline Characteristics Table** + - Demographics + - Clinical characteristics + - Stratified by group (if applicable) + - P-values for group differences (optional) + +2. **Primary Outcome Table** + - Point estimates + - Confidence intervals + - P-values + - Effect size measures + +3. **Adverse Events Table** + - System organ class + - Preferred terms (MedDRA) + - Incidence by group + - Relationship to intervention + +4. **Subgroup Analysis Table** + - Subgroup categories + - Effect sizes within subgroups + - Interaction p-values + - Consistency assessment + +### 5. Reference Management + +#### Journal Style Identification + +**Common Styles**: +- **Vancouver**: Numbered citations in order of appearance (BMJ, Lancet, NEJM). +- **Harvard**: Author-date in parentheses (social sciences, some health journals). +- **AMA**: Superscript numbers (JAMA family). +- **APA**: Author-date (psychology, behavioral health). + +**Reference Manager Setup**: +- Import journal style file (.csl) from journal website. +- Verify output style matches author guidelines. +- Check for updates to style files. + +#### Reference Quality Checklist + +- [ ] All cited references are retrievable and accurate. +- [ ] DOIs included where available. +- [ ] PubMed IDs (PMIDs) included (if required). +- [ ] Page numbers for book chapters. +- [ ] Edition numbers for books. +- [ ] Access dates for online sources. +- [ ] Personal communications noted as such (not in reference list). +- [ ] No references to retracted papers without noting retraction. +- [ ] Self-citations disclosed. + +### 6. Cover Letter Preparation + +#### Structure + +``` +Dear Editor-in-Chief [or named Editor], + +PARAGRAPH 1: Submission Declaration +- State manuscript title and submission type. +- Declare all authors have approved submission. +- Confirm manuscript is not under consideration elsewhere. +- Note any prior presentations or preprints. + +PARAGRAPH 2: Significance Statement (Most Important) +- What gap does this study address? +- What are the key findings? +- Why are these findings important to journal's audience? +- What is novel (methodologically or clinically)? + +PARAGRAPH 3: Fit with Journal +- Why is this manuscript appropriate for this journal? +- Reference related publications in your target journal. +- Identify target readership. + +PARAGRAPH 4: Practical Information +- Confirm all requirements met (word count, figures, etc.). +- Suggest reviewers (optional). +- Request exclusion of specific reviewers (if conflict). +- Note any special considerations. + +CLOSING +- Professional sign-off. +- Corresponding author contact details. +``` + +#### Key Points + +- **Length**: 1 page maximum (400-500 words). +- **Tone**: Professional, confident, not overselling. +- **Novelty**: Clearly articulate what is new. +- **Audience**: Demonstrate understanding of journal's readership. +- **Ethics**: Declare any special ethical considerations addressed. + +### 7. Pre-Submission Checklist + +#### Content Verification + +- [ ] Abstract accurately reflects full manuscript content. +- [ ] All results in abstract appear in main text. +- [ ] All figures/tables cited in text. +- [ ] All abbreviations defined at first use. +- [ ] Supplementary materials complete and referenced. +- [ ] Reporting checklist completed and uploaded. +- [ ] Flow diagram accurate and matches text numbers. + +#### Compliance Verification + +- [ ] Word counts within journal limits. +- [ ] Reference count within limits. +- [ ] Figure/table count within limits. +- [ ] Ethics approval documented. +- [ ] Trial registration number included (if applicable). +- [ ] Data availability statement included. +- [ ] Funding and COI disclosures complete. +- [ ] Patient consent documented (if applicable). +- [ ] Authorship contributions documented. + +#### Technical Verification + +- [ ] All files in correct format (docx, TIFF, etc.). +- [ ] High-resolution figures provided separately. +- [ ] Supplementary files uploaded and labeled. +- [ ] References formatted correctly. +- [ ] Spell check completed. +- [ ] Proofreading by co-author completed. +- [ ] Plagiarism check completed (if required). + +#### Journal-Specific Checks + +- [ ] Cover letter follows journal template. +- [ ] Blinded for peer review (if double-blind). +- [ ] Title page separate from manuscript (if required). +- [ ] Highlights/Graphical abstract prepared (if required). +- [ ] Author statement forms signed. +- [ ] Copyright transfer agreement reviewed. + +## Documentation Requirements + +### Core Manuscript File +- [ ] Title page with complete author information +- [ ] Structured abstract within word limit +- [ ] Main text following journal structure +- [ ] References formatted per journal style +- [ ] Figure legends and table titles +- [ ] Acknowledgments and funding statement +- [ ] Conflicts of interest declaration +- [ ] Ethics approval documentation +- [ ] Trial registration (if applicable) +- [ ] Data availability statement + +### Supplementary Files +- [ ] Reporting guideline checklist (completed) +- [ ] Study protocol (if published) +- [ ] Statistical analysis plan +- [ ] Informed consent forms (template) +- [ ] Data dictionary +- [ ] Additional figures/tables +- [ ] Search strategies (systematic reviews) +- [ ] PRISMA flow diagram (systematic reviews) +- [ ] Risk of bias assessments (systematic reviews) + +### Submission Package +- [ ] Cover letter (1 page maximum) +- [ ] Manuscript files (main text, figures, tables) +- [ ] Supplementary materials archive +- [ ] Authorship contribution statement +- [ ] Author agreement forms (if required) +- [ ] Copyright transfer (post-acceptance) + +## Common Mistakes + +| Mistake | Why It's Wrong | Instead | +|---------|----------------|---------| +| **Ignoring reporting guidelines** | Reviewers and editors reject for non-compliance | Download and complete appropriate checklist from EQUATOR Network before writing | +| **Failing to register clinical trial** | Violates ICMJE requirements; grounds for rejection | Register on ClinicalTrials.gov or ANZCTR before first patient enrollment | +| **Incomplete ethics documentation** | Violates Declaration of Helsinki; publication ethics breach | Include ethics approval number, committee name, and informed consent statement | +| **Self-plagiarism from thesis** | May violate journal originality policies | Disclose thesis origin; seek permission; rewrite substantially | +| **Ghost/guest authorship** | Violates ICMJE authorship criteria; research misconduct | Ensure all authors meet all 4 ICMJE criteria; document contributions | +| **Duplicate publication** | Unethical; distorts evidence base | Cite and cross-reference related publications; seek permission for overlapping content | +| **Selective outcome reporting** | Biases evidence; violates CONSORT | Report all pre-specified outcomes; explain any changes in protocol | +| **Inadequate figure resolution** | Cannot be used for print; delays publication | Provide 300+ DPI TIFF/EPS files; check journal specifications | +| **Unverifiable references** | Undermines credibility; may indicate poor scholarship | Verify all references against original sources; use DOIs | +| **Overstating conclusions** | Misleading readers; damages credibility | Match conclusions to actual results; acknowledge limitations | +| **Missing balancing measures** (QI) | May mask unintended harm | Always report balancing measures in quality improvement studies | +| **Confusing QI with research** | Different ethics and regulatory requirements | Clearly distinguish QI from research; seek ethics review if uncertain | + +## When to Escalate + +Escalate to senior author, research mentor, or research office when: +- Disputes arise regarding authorship order or inclusion. +- Significant unexpected findings suggest need for additional analyses. +- Adverse events occurred that were not anticipated in ethics approval. +- Data quality issues discovered during manuscript preparation. +- Conflicts of interest are complex or involve significant financial interests. +- Study was not registered as required (potential journal rejection). +- Publisher requests open access fees beyond available budget. +- Peer review identifies major methodological concerns requiring re-analysis. +- Allegations of misconduct or plagiarism arise. +- Human subjects research lacks proper ethics approval documentation. +- Patient identifiable information discovered in de-identified dataset. + +## Privacy Considerations + +- **PHI Involved**: Yes - manuscripts often include patient-level data (case reports, clinical studies). +- **Data Minimization**: Include only data elements necessary to support findings; aggregate when possible. +- **De-identification**: Remove all 18 HIPAA identifiers or equivalent AU/NZ identifiers; use case numbers instead of initials. +- **Consent for Publication**: Obtain written consent for case reports and any patient images; document in manuscript. +- **Repository Data**: Ensure data repositories for sharing are approved and access-controlled. +- **Retention**: Retain original data and analysis files per institutional policy (typically 7+ years post-publication). +- **No Persistence**: Do not store PHI in temporary workspaces or chat history during manuscript preparation. +- **Image Anonymization**: Verify radiology images have burned-in identifiers removed; crop photographs to exclude identifying features. + +## Confidence Indicators + +| Scenario | Confidence | Action | +|----------|------------|--------| +| Well-designed RCT with CONSORT compliance, registered, ethics-approved | High | Proceed with standard manuscript preparation; conduct pre-submission checklist | +| Secondary analysis of existing dataset with unclear reporting requirements | Medium | Consult EQUATOR Network for appropriate extension; verify journal requirements | +| Case report without written patient consent | Low | **BLOCKER**: Obtain consent or seek ethics waiver; do not proceed without documentation | +| Study conducted without pre-registration (clinical trial) | Low | Consult research office; consider registry anyway; disclose limitation in manuscript | +| Discrepancy between protocol and reported outcomes | Medium | Flag for team discussion; transparently report protocol changes with rationale | +| Complex multi-site study with governance variations | Medium | Escalate to coordinating center; verify all site approvals documented | +| Unanticipated adverse events discovered in analysis | Low | **BLOCKER**: Escalate to Principal Investigator; may require safety reporting and protocol amendment | +| Questionable image integrity (duplication, manipulation) | Low | **BLOCKER**: Halt submission; verify original images; consult research integrity officer | +| First author with limited publication experience | Medium | Ensure senior author review; use detailed checklists; allow extra time for revision | + +## Tool Requirements + +- `~~research/literature` (PubMed) - For literature review and reference verification +- `~~research/citation-management` - For reference organization and formatting +- `~~cloud storage` - For manuscript file storage and version control +- `~~document collaboration` - For co-author review and commenting +- `~~project tracker` - For submission timeline and revision tracking +- `~~health/clinical-systems` - For clinical data access (if using patient data) +- `~~research/venue-templates` - For journal-specific formatting requirements +- `~~research/scientific-writing` - For writing methodology and structure guidance +- `~~document/grammar-check` - For language and style verification + +## Success Indicators + +You've applied this skill well when: +- [ ] Appropriate reporting guideline identified and checklist completed +- [ ] Target journal selected based on scope, impact, and audience fit +- [ ] Manuscript structure follows journal requirements and study type conventions +- [ ] CONSORT/STROBE/PRISMA flow diagram accurately reflects study conduct +- [ ] Figures meet technical specifications and are colorblind-accessible +- [ ] Tables are self-contained with clear titles and footnotes +- [ ] References are accurate, complete, and formatted per journal style +- [ ] Cover letter articulates significance, novelty, and journal fit +- [ ] Pre-submission checklist verifies all compliance requirements +- [ ] Ethics approval, trial registration, and COI disclosures are complete +- [ ] Data availability statement and sharing plan documented +- [ ] All supplementary materials prepared and labeled correctly +- [ ] Authorship contributions documented per ICMJE criteria +- [ ] Patient consent and privacy protections verified for human subjects research + +## Related Skills + +- `~~health/quality-improvement` - For QI study manuscripts using SQUIRE guidelines +- `~~health/evidence-review` - For systematic review methodology and PRISMA compliance +- `~~health/clinical-reports` - For case reports using CARE guidelines +- `~~health/health-economics` - For economic evaluation manuscripts using CHEERS +- `~~research/scientific-writing` - For general scientific writing methodology +- `~~research/venue-templates` - For journal-specific submission requirements +- `~~health/health-data-report` - For statistical reporting and visualization + diff --git a/health/skills/medicolegal-reports/SKILL.md b/health/skills/medicolegal-reports/SKILL.md new file mode 100644 index 0000000..7c2198c --- /dev/null +++ b/health/skills/medicolegal-reports/SKILL.md @@ -0,0 +1,350 @@ +--- +name: health/medicolegal-reports +description: This skill should be used when drafting medico-legal reports, expert witness statements, personal injury assessments, workers compensation reports, capacity assessments, or any court-directed medical documentation requiring legal admissibility standards. Use for independent medical examinations, forensic medical reports, and statutory medical certificates. +version: 1.0.0 +--- + +# Medicolegal Reports + +A comprehensive framework for drafting medico-legal reports that meet legal admissibility standards across Australian, New Zealand, US, and EU jurisdictions. This skill supports clinicians in preparing expert witness reports, independent medical examinations, and court-directed medical assessments with appropriate evidentiary rigor. + +**Critical Warning**: Medico-legal reports may be used as evidence in legal proceedings. Accuracy, objectivity, and adherence to jurisdictional requirements are paramount. This skill assists with structure and guidance but does not replace professional legal advice or clinical judgment. + +## When to Use This Skill + +Invoke this skill when: +- Drafting independent medical examination (IME) reports for personal injury claims +- Preparing expert witness statements for court proceedings +- Writing workers compensation medical assessments +- Conducting capacity assessments for guardianship or power of attorney +- Preparing forensic medical reports (assault, sexual assault, injury documentation) +- Drafting coronial reports for reportable deaths +- Responding to subpoenas or court orders for medical records +- Providing medical opinions for insurance or litigation purposes +- Writing statutory medical certificates or impairment assessments + +## Regulatory Context + +### Australia & New Zealand (Default) + +| Regulation/Standard | Relevance | Key Requirements | +|---------------------|-----------|------------------| +| **Evidence Act** (Cth/State) | Expert witness requirements | Expert qualifications; impartiality; basis of opinions | +| **Civil Procedure Rules** | Report format and service | Expert code of conduct; concurrent expert evidence | +| **Workers Compensation Acts** | IME requirements | Impartiality; specific impairment rating methods (AMA4/5) | +| **Coroners Acts** | Reportable deaths | Notification; post-mortem reports; inquest evidence | +| **Guardianship Acts** | Capacity assessments | Functional capacity; decision-specific; less restrictive alternatives | +| **Medical Board Code** | Professional conduct | Honesty; integrity; conflict of interest disclosure | + +### US/EU-lite Fallback + +| Regulation/Standard | Relevance | Key Requirements | +|---------------------|-----------|------------------| +| **Federal Rules of Evidence** (US) | Expert testimony | Daubert standard; relevance; reliable methodology | +| **State Medical Board Rules** (US) | Professional standards | Licensing; scope of practice; report requirements | +| **GDPR** (EU) | Medical data protection | Lawful basis for processing; data subject rights | +| **EU Expert Witness Directives** | Cross-border evidence | Mutual recognition; procedural standards | + +### Jurisdiction Matrix + +| Jurisdiction | Applicable Regulator | Reporting Trigger | Timeframe | Required Artifacts | Escalation Point | +|--------------|---------------------|-------------------|-----------|-------------------|------------------| +| **AU - Federal** | Federal Court Rules | Expert witness appointment | As ordered | Expert report; CV; conflict disclosure | Legal counsel | +| **AU - State Civil** | Supreme/Federal Court Rules | Litigation; IME referral | 28-42 days typically | Expert report compliant with court rules | Instructing solicitor | +| **AU - Workers Comp** | State WC authority | Section 63/65 referral | 7-28 days | AMA4/5 impairment assessment | WC insurer/medical panel | +| **AU - Coronial** | State Coroners Court | Reportable death | Immediate notification; formal report as directed | Autopsy report; toxicology; scene findings | Coroner; Police | +| **NZ** | District/High Court Rules | Expert witness appointment | As ordered | NZ Law Society expert witness guidelines | Instructing solicitor | +| **US** | State/Federal Rules | Litigation referral | As ordered | Daubert-compliant methodology disclosure | Legal counsel | +| **EU** | Member State Rules | Cross-border litigation | As ordered | GDPR-compliant processing; translation if needed | Legal counsel | + +## Document Type Taxonomy + +### Expert Reports (Court-Directed) +- **Civil Proceedings**: Personal injury, medical negligence, contractual disputes +- **Criminal Proceedings**: Fitness to plead, mental state defenses, sentencing +- **Family Court**: Child custody, relocation, relocation, relocation, family violence +- **Administrative Appeals**: Social security, veterans' affairs, disability determinations + +### Statutory Reports (Legislatively Mandated) +- **Workers Compensation**: Impairment assessments, work capacity evaluations +- **Transport Accidents**: Injury certification, impairment ratings +- **Victims of Crime**: Medical evidence for compensation claims +- **Coronial**: Reportable death documentation + +### Professional Reports (Clinical-Legal Interface) +- **Independent Medical Examinations**: Third-party requested assessments +- **Capacity Assessments**: Decision-making capacity, testamentary capacity +- **Forensic Medical Examinations**: Assault, sexual assault, injury documentation +- **Mental Health Assessments**: Risk assessments, treatment orders, involuntary status + +## Quick Reference + +1. **Know Your Role**: Treating doctor vs. independent expert vs. forensic examiner +2. **Conflicts of Interest**: Disclose all potential conflicts upfront +3. **Qualifications**: Clearly state relevant qualifications and expertise +4. **Facts vs. Opinions**: Separate observed facts from expert opinions +5. **Reasoning**: Explain the basis for all opinions and conclusions +6. **Alternative Explanations**: Address contrary views or differential diagnoses +7. **Scope**: Stay within your area of expertise; acknowledge limitations +8. **Documentation**: Retain all case materials and working notes +9. **Service**: Follow jurisdictional rules for report service and filing +10. **Privilege**: Understand when reports are privileged vs. disclosable + +## Operating Modes + +### Standard Mode +Full medico-legal workflow with comprehensive documentation, detailed methodology disclosure, alternative explanation analysis, and complete citation of supporting evidence. Required for court-directed expert witness reports, forensic examinations, and high-stakes litigation. Includes: +- Complete history and examination documentation +- Full literature review and evidence base +- Detailed reasoning for all opinions +- Addressing of contrary views +- Comprehensive confidentiality and conflict declarations + +### Lite Mode +Streamlined guidance for straightforward medical certificates, simple IME assessments, or preliminary opinions. Suitable for clear-cut cases with minimal complexity. Includes: +- Essential report structure +- Basic conflict and qualification statements +- Concise opinion formulation +**Limitations**: Never use Lite mode for forensic examinations, complex litigation, or cases involving significant conflicting evidence. + +## Detailed Guidance + +### 1. Report Structure Requirements + +#### Header Elements +- **Document Title**: Clear identification (e.g., "Independent Medical Examination Report") +- **Jurisdiction Reference**: Applicable court rules or statutory framework +- **Date of Report**: Date of completion +- **Date of Examination**: Date(s) of assessment/interview +- **Confidentiality Notice**: Privilege status and distribution restrictions + +#### Section 1: Qualifications and Instructions +- **Professional Qualifications**: Degrees, registrations, fellowships, relevant experience +- **Expertise Declaration**: Specific expertise relevant to the matter +- **Instructions Received**: Who engaged you, scope of instructions, documents provided +- **Conflict of Interest Declaration**: Any potential conflicts; duty to the court + +#### Section 2: Background and History +- **Sources of Information**: Interviews, records reviewed, investigations +- **Chronological History**: Relevant medical history in chronological order +- **Current Complaints**: Subject's current symptoms and concerns +- **Functional Impact**: Effect on activities of daily living, work capacity + +#### Section 3: Examination Findings +- **Objective Findings**: Measurable, observable findings +- **Investigation Results**: Imaging, pathology, other diagnostic results +- **Mental State Examination** (if applicable): Appearance, behavior, cognition, insight +- **Observation Notes**: Behavioral observations during examination + +#### Section 4: Opinion +- **Causation**: Relationship between event and current condition (if applicable) +- **Diagnosis/Prognosis**: Current diagnosis; expected trajectory +- **Impairment Assessment**: Permanent impairment rating using specified methodology +- **Treatment Recommendations**: Future treatment needs and associated costs +- **Work Capacity**: Ability to perform work-related activities + +#### Section 5: Conclusion and Declarations +- **Summary of Opinions**: Concise restatement of key opinions +- **Expert Duty Declaration**: Acknowledgment of duty to court/tribunal +- **Truth Declaration**: Statement that report is true and accurate to the best of knowledge + +### 2. Legal Admissibility Requirements + +#### Expert Witness Standards (Australia) +Under the *Evidence Act* and court rules: +- **Expertise**: Must have specialized knowledge based on training, study, or experience +- **Impartiality**: Primary duty is to the court, not the party who engaged you +- **Methodology**: Opinions must be based on established or reliably applied methodology +- **Transparency**: Must disclose all material facts and assumptions + +#### Daubert Standard (US) +Federal courts apply factors from *Daubert v. Merrell Dow Pharmaceuticals*: +- Whether the theory/technique can be tested +- Whether it has been peer-reviewed +- Known/potential error rate +- Standards controlling operation +- General acceptance in the relevant scientific community + +#### GDPR Considerations (EU) +- **Lawful Basis**: Legal obligation or legitimate interest for expert reports +- **Data Minimization**: Only include necessary personal data +- **Subject Rights**: Balance against legal proceedings privilege +- **Cross-Border**: Consider adequacy decisions for data transfer + +### 3. Confidentiality and Privilege + +#### Legal Professional Privilege +- **Scope**: Communications between lawyer and client for legal advice +- **Extension**: May extend to expert reports prepared for litigation +- **Waiver**: Privilege can be waived; understand when report becomes disclosable + +#### Public Interest Immunity +- **Medical Records**: May be subject to public interest immunity in certain contexts +- **Third-Party Records**: Release may require consent or court order + +#### Confidentiality Obligations +- **Medical Ethics**: Maintain patient confidentiality subject to legal requirements +- **Court Orders**: Compliance with subpoenas and court orders overrides confidentiality +- **Multi-Party Litigation**: Consider confidentiality in class actions or multi-party disputes + +### 4. Independence and Objectivity + +#### Treating Doctor vs. Expert Witness +- **Treating Doctor**: Primary duty to patient; therapeutic relationship +- **Expert Witness**: Primary duty to the court; no therapeutic relationship +- **Hybrid Role**: Be clear about which role you are performing at each stage + +#### Conflict of Interest Management +- **Financial Interests**: Disclose any financial interest in outcome +- **Relationship with Parties**: Disclose prior relationships with plaintiff, defendant, or lawyers +- **Institutional Conflicts**: Consider conflicts arising from institutional affiliations +- **Ongoing Duty**: Continuous duty to disclose conflicts as they arise + +#### Avoiding Bias +- **Cognitive Biases**: Be aware of confirmation bias, anchoring, hindsight bias +- **Advocacy**: Do not advocate for a party; present balanced, objective opinions +- **Certainty Calibration**: Express appropriate level of certainty; avoid overstatement + +### 5. Impairment and Capacity Assessments + +#### Permanent Impairment (Workers Compensation) +- **Methodology**: Follow specified guidelines (AMA4/5, SIRA/ACEM guidelines) +- **Whole Person Impairment (WPI)**: Calculate according to prescribed methods +- **Aggravation**: Distinguish between pre-existing conditions and work-related aggravation +- **Documentation**: Detailed documentation of measurements and calculations + +#### Decision-Making Capacity +- **Functional Approach**: Assess ability to understand, retain, weigh, communicate +- **Decision-Specific**: Capacity is decision-specific, not global +- **Presumption**: Presume capacity unless demonstrated otherwise +- **Support**: Consider whether support enables decision-making + +#### Testamentary Capacity +- **Legal Test**: Understand nature of act, extent of property, claims on bounty +- **Delusions**: Assess impact of delusions on will-making capacity +- **Timing**: Capacity at time of execution, not assessment + +### 6. Specific Report Types + +#### Personal Injury IME Reports +1. **Causation**: Relationship between incident and current condition +2. **Pre-existing Conditions**: Distinguish aggravation from new injury +3. **Treatment**: Reasonableness of past treatment; future treatment needs +4. **Prognosis**: Expected recovery trajectory; permanent impairment +5. **Economic Loss**: Work capacity; care needs (may require actuarial input) + +#### Forensic Medical Reports +1. **Chain of Custody**: Document handling of evidence; maintain integrity +2. **Consent**: Ensure valid consent for examination and photography +3. **Injury Documentation**: Detailed description with body diagrams +4. **Timing**: Document time since injury and implications for interpretation +5. **Alternative Explanations**: Address possible innocent explanations + +#### Mental Health Reports for Courts +1. **Mental State**: Comprehensive mental state examination +2. **Diagnosis**: DSM-5/ICD-10 diagnosis with criteria +3. **Risk Assessment**: Violence risk; self-harm risk; specific risk factors +4. **Fitness to Plead**: Understanding of charges; ability to participate +5. **Treatment Options**: Community vs. inpatient; voluntary vs. involuntary + +### 7. Quality Assurance + +#### Pre-Submission Checklist +- [ ] Report complies with applicable court rules or statutory requirements +- [ ] All opinions supported by stated facts and reasoning +- [ ] Alternative explanations addressed where appropriate +- [ ] Conflict of interest disclosure complete and current +- [ ] Qualifications accurately reflect relevant expertise +- [ ] Grammar, spelling, and formatting are professional +- [ ] Page numbering, table of contents (if required) complete +- [ ] Attachments and references properly labeled and cited + +#### Ethical Review +- [ ] Primary duty to the court acknowledged +- [ ] No advocacy for instructing party +- [ ] Opinions within area of expertise +- [ ] Uncertainty appropriately expressed +- [ ] No misleading statements or omissions + +## Common Mistakes + +| Mistake | Why It's Wrong | Instead | +|---------|----------------|---------| +| **Advocacy for instructing party** | Breaches duty to court; undermines credibility | Present balanced, objective opinions acknowledging all relevant factors | +| **Exceeding expertise** | Opinions may be inadmissible; professional misconduct risk | Stay within area of expertise; acknowledge limitations | +| **Failure to address contrary evidence** | Appears biased; weakens credibility | Explicitly address contrary views and explain your reasoning | +| **Mixing facts and opinions without distinction** | Confuses the reader; may be inadmissible | Clearly label factual findings vs. expert opinions | +| **Inadequate conflict disclosure** | Undermines entire report; potential professional misconduct | Disclose all potential conflicts, however remote | +| **Using therapeutic relationship for expert opinion** | Dual roles create conflict; therapeutic bias | Separate treating and expert roles; decline if conflict exists | +| **Speculating without foundation** | Speculative opinions lack evidentiary basis | Only offer opinions with stated foundation; express appropriate uncertainty | +| **Ignoring jurisdictional requirements** | Report may be rejected or require revision | Follow applicable court rules or statutory guidelines precisely | +| **Poor documentation of examination** | Unable to defend opinions under cross-examination | Detailed contemporaneous notes; clear examination documentation | +| **Failing to update on new information** | Report may be incomplete or inaccurate | Update report if new material information becomes available | + +## When to Escalate + +Escalate to legal counsel, medical defense organization, or institutional legal team when: +- Potential conflict of interest identified that cannot be managed +- Report may expose you to professional liability or disciplinary action +- Jurisdictional requirements are unclear or complex +- Case involves novel legal or medical issues outside your experience +- You become aware of information suggesting perjury or fraud by a party +- Subject of report expresses intent to self-harm or harm others +- Subpoena or court order appears invalid or beyond scope of authority +- Report involves cross-border jurisdiction with conflicting requirements +- You are asked to provide opinion outside your area of expertise + +## Privacy Considerations + +- **PHI Involved**: Yes - Medico-legal reports contain detailed personal health information +- **Data Minimization**: Include only information necessary for the specific legal purpose +- **De-identification**: Not typically appropriate for expert reports (identification required), but consider redaction for third-party distribution +- **Access Controls**: Limit distribution to parties with legitimate legal interest +- **Retention**: Retain records according to legal and professional requirements (typically 7+ years) +- **Secure Transmission**: Use secure methods for report transmission (encrypted email, secure portals) +- **No Persistence**: Do not store PHI in temporary workspaces or chat history beyond necessary processing time + +## Confidence Indicators + +| Scenario | Confidence | Action | +|----------|------------|--------| +| Clear facts, straightforward causation, within expertise | High | Proceed with standard report preparation | +| Complex causation but good documentation available | Medium | Document reasoning carefully; consider literature review | +| Novel or borderline legal issues | Medium | Consult with legal counsel or experienced colleagues | +| Potential conflict of interest | Low | **BLOCKER**: Disclose immediately; may need to decline instruction | +| Information suggesting perjury or fraud | Low | **BLOCKER**: Escalate to legal counsel; do not participate | +| Request to opine outside expertise | Low | **BLOCKER**: Decline; suggest appropriate expert | +| Subject expresses imminent risk to self/others | Low | **BLOCKER**: Immediate safety protocols; may override confidentiality | +| Ambiguous jurisdiction or procedural requirements | Medium | Seek clarification from instructing solicitor | +| High-stakes litigation with substantial consequences | Medium | Consider peer review of report before finalization | + +## Tool Requirements + +- `~~document collaboration` - For report drafting and review +- `~~legal research` - For jurisdictional requirements and case law +- `~~health/clinical-systems` - For accessing relevant medical records +- `~~calculator/assessment` - For impairment calculations (AMA guides) +- `~~dictation/transcription` - For efficient report generation +- `~~secure storage` - For maintaining case files securely + +## Success Indicators + +You've applied this skill well when: +- [ ] Report complies with applicable jurisdiction's court rules or statutory requirements +- [ ] Clear separation between factual findings and expert opinions +- [ ] All opinions are supported by stated reasoning and evidence +- [ ] Alternative explanations or contrary views are addressed +- [ ] Conflict of interest disclosure is complete and transparent +- [ ] Report is objective, impartial, and free from advocacy +- [ ] Qualifications are accurately stated and relevant to the opinions +- [ ] Confidentiality and privilege status are correctly identified +- [ ] Subject's rights and dignity are respected throughout +- [ ] Report would withstand scrutiny under cross-examination + +## Related Skills + +- `~~health/child-protection` - For child protection reporting and mandatory reporting obligations +- `~~health/affidavit-drafting` - For preparing sworn statements and affidavits +- `~~health/incident-reporting` - For clinical incident documentation +- `~~legal/contract-review` - For reviewing engagement letters and terms of reference +- `~~health/clinical-documentation` - For general clinical documentation standards diff --git a/health/skills/notifiable-diseases/SKILL.md b/health/skills/notifiable-diseases/SKILL.md new file mode 100644 index 0000000..83aeda0 --- /dev/null +++ b/health/skills/notifiable-diseases/SKILL.md @@ -0,0 +1,254 @@ +--- +name: health/notifiable-diseases +description: This skill should be used when managing notifiable disease reporting obligations, including identifying reportable conditions, understanding notification timelines, completing reporting forms, and coordinating public health responses. Applies to clinical and laboratory staff, infection control practitioners, and public health officials. +version: 1.0.0 +--- + +# Notifiable Diseases + +Guidance for healthcare providers on identifying, documenting, and reporting notifiable diseases according to jurisdictional requirements. This skill supports compliance with mandatory reporting obligations across Australia, New Zealand, and international jurisdictions. + +**Critical**: Failure to report notifiable diseases can result in regulatory penalties and compromises public health surveillance. Always verify current disease lists as they are updated regularly. + +## When to Use This Skill + +Invoke this skill when: +- Diagnosing or suspecting a notifiable disease in a patient. +- Determining if a condition requires mandatory reporting. +- Completing notification forms for public health authorities. +- Coordinating contact tracing or outbreak investigations. +- Understanding notification timeframes by jurisdiction. +- Managing laboratory reporting obligations. +- Responding to public health authority requests for information. + +## Confidence Indicators + +| Scenario | Confidence | Action | +|----------|------------|--------| +| Classic presentation of notifiable disease with laboratory confirmation | High | Proceed with notification; document thoroughly | +| Suspected notifiable disease pending laboratory confirmation | Medium | Initiate notification process; flag as preliminary | +| Unclear diagnosis with overlapping symptoms | Low | Consult infectious diseases or public health; document uncertainty | +| Novel or emerging pathogen not on standard lists | Low | Report immediately to public health; await guidance | + +## Security & Privacy Considerations + +### PHI/PII Handling +- **Never** include patient identifiers in unencrypted communications +- Use approved secure notification portals only +- De-identify data for internal quality reviews +- Maintain separate confidential records with identifiers + +### Minimum Necessary Principle +- Report only data fields required by the notification form +- Do not include unrelated clinical information +- Limit distribution to those with legitimate public health need + +## Regulatory Context + +### Australia & New Zealand (Default) + +#### Australian Notifiable Diseases + +| Disease Category | Examples | Notification Timeline | Authority | +|-----------------|----------|---------------------|-----------| +| **Blood-borne** | Hepatitis B, C, HIV | 5 days | State/Territory Health Dept | +| **Vaccine-preventable** | Measles, pertussis, meningococcal | Immediate (24h) | State/Territory Health Dept | +| **Food-borne** | Salmonellosis, listeriosis | Immediate (24h) | State/Territory Health Dept | +| **Sexually transmitted** | Syphilis, gonorrhoea | 5 days | State/Territory Health Dept | +| **Vector-borne** | Dengue, Ross River virus | Immediate (24h) | State/Territory Health Dept | +| **Zoonotic** | Q fever, psittacosis | 5 days | State/Territory Health Dept | +| **Healthcare-associated** | CRE, MRSA outbreaks | Immediate | State/Territory Health Dept | + +#### New Zealand Notifiable Diseases + +| Disease Category | Examples | Notification Timeline | Authority | +|-----------------|----------|---------------------|-----------| +| **Urgent** | Cholera, plague, viral haemorrhagic fever | Immediate | Medical Officer of Health | +| **Priority** | Measles, meningococcal, pertussis | Immediate | Medical Officer of Health | +| **Standard** | Hepatitis, STIs, food-borne | 3 days | Medical Officer of Health | + +### US/EU-lite Fallback + +| Jurisdiction | Reporting System | Key Difference | +|--------------|-----------------|----------------| +| **United States** | CDC NNDSS + State systems | Varies by state; some conditions federally notifiable only | +| **European Union** | ECDC TESSy | Standardized EU case definitions; 24-48 hour reporting | + +### Jurisdiction Matrix + +| Jurisdiction | Authority | Reporting Trigger | Timeframe | Required Artifacts | Escalation Point | +|--------------|-----------|-------------------|-----------|-------------------|------------------| +| **AU - National** | DoH + State/Territory | Laboratory confirmation or clinical suspicion | Immediate-5 days | Notification form; laboratory report | Public Health Unit Director | +| **NZ - National** | Te Whatu Ora | Laboratory confirmation or clinical suspicion | Immediate-3 days | EpiSurv notification | Medical Officer of Health | +| **US - Federal** | CDC NNDSS | Laboratory confirmation | State-dependent (usually 24h-7d) | State notification form | State Epidemiologist | +| **EU** | ECDC TESSy | Laboratory confirmation | 24-48 hours | TESSy case report form | National Focal Point | + +## Quick Reference + +1. **Identify**: Confirm disease is on notifiable list for your jurisdiction +2. **Notify**: Report within required timeframe (immediate for urgent conditions) +3. **Document**: Complete all required fields accurately +4. **Laboratory**: Ensure lab has also submitted notification +5. **Follow-up**: Respond to public health authority requests promptly +6. **Contact Tracing**: Cooperate with contact identification when requested +7. **Outbreaks**: Any outbreak/cluster is notifiable regardless of specific disease + +## Operating Modes + +### Standard Mode +Complete notifiable disease management including identification of reportable conditions, understanding of notification timeframes, completion of detailed notification forms, coordination with public health authorities, and participation in contact tracing and outbreak investigations. + +### Lite Mode +Quick reference for urgent notifications - confirms disease is notifiable, identifies correct authority, and provides immediate reporting pathway. Assumes user will complete full documentation later. Does not suppress mandatory immediate reporting requirements. + +## Detailed Guidance + +### 1. Disease Identification + +#### Step 1: Check Notifiable Disease List +- Access current list from your jurisdiction's health department website +- Lists are updated regularly - verify you have latest version +- Some conditions have subcategories (e.g., invasive vs. non-invasive meningococcal) + +#### Step 2: Apply Case Definitions + +| Component | Definition | +|-----------|------------| +| **Clinical Criteria** | Signs and symptoms required | +| **Laboratory Criteria** | Confirmatory or supportive tests | +| **Epidemiological Link** | Exposure or contact history | +| **Case Classification** | Suspected, probable, confirmed | + +**Example - Measles Case Definition:** +- **Suspected**: Fever + rash + cough/coryza/conjunctivitis +- **Probable**: Suspected case + epidemiological link +- **Confirmed**: Suspected case + laboratory confirmation + +### 2. Notification Process + +#### Who Must Notify + +| Role | Obligation | +|------|------------| +| **Medical Practitioner** | Primary responsibility for clinical notifications | +| **Laboratory Director** | Mandatory for laboratory-confirmed results | +| **Nurse/Midwife** | In some jurisdictions for specific conditions | +| **Hospital Administration** | Ensure systems support compliance | + +#### Notification Methods + +**Australia:** +- Online: State/Territory surveillance systems (e.g., PAEDS, NetEpi) +- Phone: For urgent conditions outside hours +- Form: PDF/paper backup when systems unavailable + +**New Zealand:** +- Online: EpiSurv (via ESR) +- Phone: Medical Officer of Health for urgent cases +- Form: Manual forms as backup + +### 3. Notification Form Completion + +#### Required Fields (Standard) + +| Field | Rationale | Common Errors | +|-------|-----------|---------------| +| **Patient demographics** | Case identification | Incomplete addresses | +| **Disease/Condition** | Classification | Wrong code used | +| **Onset date** | Epidemiological timeline | Admission date instead | +| **Diagnosis basis** | Case classification | Omitting laboratory details | +| **Risk factors** | Public health action | Missing travel history | +| **Healthcare facility** | Outbreak investigation | Wrong facility code | + +#### Example: Complete Notification Flow + +**Scenario**: 5-year-old with confirmed pertussis + +1. **Day 0 (Diagnosis)**: + - PCR positive for Bordetella pertussis + - Clinical: Paroxysmal cough + post-tussive vomiting + - Determine: URGENT notification required (within 24 hours) + +2. **Immediate Actions**: + - Complete online notification form + - Include laboratory report reference + - Document household contacts (for contact tracing) + - Flag recent vaccination status + +3. **Public Health Response**: + - Contact tracing initiated + - Prophylaxis offered to contacts + - Outbreak assessment if multiple cases + - 5-day exclusion for case from school/childcare + +### 4. Special Circumstances + +#### Outbreaks and Clusters + +Any unusual clustering of disease is notifiable: +- Two or more linked cases of same condition +- Increased incidence above baseline +- Novel or emerging pathogen + +**Immediate Actions for Suspected Outbreak:** +1. Notify public health immediately (phone) +2. Do not wait for laboratory confirmation +3. Begin line list of cases +4. Preserve potential exposure sources + +#### Laboratory Reporting + +Laboratories have independent notification obligations: +- Ensure lab knows which tests are ordered +- Verify positive results have been reported by lab +- Follow up if no confirmation received within expected timeframe + +## Common Mistakes + +1. **Reporting Delay**: Waiting for all test results instead of reporting on clinical suspicion +2. **Wrong Authority**: Notifying federal instead of state/local public health +3. **Incomplete Forms**: Omitting epidemiological risk factors +4. **Missing Outbreaks**: Failing to recognize and report unusual clusters +5. **Jurisdiction Confusion**: Applying wrong case definitions or timeframes +6. **Privacy Breach**: Including PHI in unsecured communications +7. **Follow-up Failure**: Not responding to public health requests for additional information +8. **Outdated Lists**: Using old notifiable disease lists missing new conditions + +## Tool Requirements + +- **Jurisdiction Database**: Access to current notifiable disease lists +- **Notification Portal**: Secure online reporting system +- **Laboratory Interface**: Verification of lab reporting status +- **Contact Registry**: System for documenting exposed contacts + +## Success Indicators + +A successful notifiable disease management workflow: +- [ ] Disease correctly identified as notifiable +- [ ] Notification submitted within required timeframe +- [ ] Complete and accurate information provided +- [ ] Laboratory has also reported (or confirmed) +- [ ] Public health authority has acknowledged receipt +- [ ] Contact tracing information provided when requested +- [ ] Patient/family informed of public health requirements +- [ ] Documentation maintained for audit purposes + +## Cross-References + +- **health-coding**: Disease classification and coding +- **health-data-analysis**: Epidemiological analysis of surveillance data +- **health-incidents**: Outbreak investigation coordination +- **health-ethics**: Research ethics for surveillance data use + +## Version History + +| Version | Date | Changes | +|---------|------|---------| +| 1.0.0 | 2026-02-14 | Initial release with AU/NZ focus | + +## References + +- [Australian National Notifiable Diseases Surveillance System](https://www.health.gov.au/resources/publications/australian-national-notifiable-diseases-surveillance-system) +- [New Zealand Health Act 1956 - Notifiable Diseases](https://www.legislation.govt.nz/act/public/1956/0065/latest/whole.html) +- [CDC NNDSS Notifiable Conditions](https://ndc.services.cdc.gov/) +- [ECDC Surveillance Atlas of Infectious Diseases](https://atlas.ecdc.europa.eu/public/index.aspx) diff --git a/health/skills/public-health-surveillance/SKILL.md b/health/skills/public-health-surveillance/SKILL.md new file mode 100644 index 0000000..d586c3c --- /dev/null +++ b/health/skills/public-health-surveillance/SKILL.md @@ -0,0 +1,247 @@ +--- +name: health/public-health-surveillance +description: This skill should be used when designing, implementing, or analyzing public health surveillance systems. Supports epidemiologists, public health officers, and healthcare administrators in outbreak detection, surveillance methodology, and population health monitoring. +version: 1.0.0 +--- + +# Public Health Surveillance + +Comprehensive guidance for public health surveillance activities including outbreak detection, surveillance system design, data analysis for population health monitoring, and response coordination. This skill supports healthcare organizations and public health agencies in maintaining robust surveillance capabilities. + +**Important**: Surveillance activities must balance public health benefit with privacy protection. Always ensure appropriate data governance and ethics approvals are in place. + +## When to Use This Skill + +Invoke this skill when: +- Designing or evaluating a surveillance system +- Analyzing surveillance data for outbreak detection +- Developing outbreak response protocols +- Conducting population health assessments +- Implementing syndromic surveillance +- Preparing surveillance reports for stakeholders +- Evaluating surveillance system performance +- Coordinating multi-jurisdictional surveillance activities + +## Confidence Indicators + +| Scenario | Confidence | Action | +|----------|------------|--------| +| Clear statistical threshold breach with confirmatory testing | High | Activate outbreak response protocol | +| Elevated rates approaching threshold with consistent pattern | Medium | Enhanced monitoring; prepare response | +| Isolated cluster with unclear transmission | Low | Investigate further; rule out data artifacts | +| Novel pattern without historical comparison | Low | Consult epidemiologist; flag for expert review | + +## Security & Privacy Considerations + +### Data Governance +- All surveillance data must have approved data governance framework +- Privacy Impact Assessments required for new surveillance systems +- Data retention limits defined and enforced +- Access controls based on legitimate public health need + +### De-identification Standards +- Use approved statistical disclosure control methods +- Small cell suppression for rare conditions (<5 cases) +- Geographic aggregation to protect individual privacy +- Date shifting for enhanced privacy where appropriate + +## Regulatory Context + +### Australia & New Zealand (Default) + +| System | Purpose | Agency | +|--------|---------|--------| +| **NNDSS** | National notifiable disease surveillance | DoH (AU) | +| **EpiSurv** | NZ notifiable disease surveillance | ESR (NZ) | +| **ASPREN** | GP sentinel surveillance | DoH/Universities | +| **PICNet** | Healthcare-associated infection surveillance | State Health Depts | +| **OzFoodNet** | Foodborne disease surveillance | State Health Depts | + +### Surveillance Types + +| Type | Definition | Use Case | +|------|------------|----------| +| **Passive** | Routine reporting by providers | Notifiable diseases, laboratory data | +| **Active** | Active case finding by surveillance staff | Enhanced surveillance for outbreaks | +| **Sentinel** | Representative site surveillance | GP networks, hospital EDs | +| **Syndromic** | Pre-diagnostic indicators | Early outbreak detection | +| **Event-based** | Unstructured data monitoring | Media scanning, social media | + +## Quick Reference + +1. **Define Objectives**: Clear surveillance goals and case definitions +2. **Data Sources**: Reliable, timely, and complete data streams +3. **Analysis Methods**: Appropriate statistical methods for detection +4. **Response Protocols**: Clear escalation and response procedures +5. **Quality Assurance**: Regular validation and data quality checks +6. **Reporting**: Timely dissemination to stakeholders +7. **Evaluation**: Periodic assessment of system performance +8. **Ethics**: Appropriate governance and privacy protections + +## Operating Modes + +### Standard Mode +Full surveillance system design and operation including system specification, data quality management, statistical analysis, outbreak detection algorithms, response coordination, and system evaluation. + +### Lite Mode +Streamlined outbreak detection and response for urgent situations. Focuses on immediate detection criteria and essential response actions. Maintains mandatory reporting and escalation requirements. + +## Detailed Guidance + +### 1. Surveillance System Design + +#### Step 1: Define Objectives + +| Element | Consideration | Example | +|---------|--------------|---------| +| **Purpose** | Why is surveillance needed? | Detect influenza outbreaks early | +| **Conditions** | What health events? | ILI, confirmed influenza, complications | +| **Population** | Who is covered? | All ED presentations in region | +| **Setting** | Where is data collected? | Hospital emergency departments | +| **Timeframe** | How quickly needed? | Daily reporting for rapid detection | + +#### Step 2: Select Surveillance Approach + +**Passive Surveillance:** +- Pros: Low cost, sustainable +- Cons: Incomplete reporting, delays +- Best for: Notifiable diseases with mandatory reporting + +**Active Surveillance:** +- Pros: Complete, accurate data +- Cons: Resource intensive +- Best for: Outbreak investigations, high-priority conditions + +**Syndromic Surveillance:** +- Pros: Early detection, pre-diagnostic +- Cons: Lower specificity, false alarms +- Best for: Bioterrorism, pandemic preparedness + +### 2. Outbreak Detection + +#### Statistical Methods + +| Method | Description | Threshold | +|--------|-------------|-----------| +| **Cumulative Sum (CUSUM)** | Detects small sustained changes | CUSUM statistic > h | +| **Exponentially Weighted** | Recent data weighted higher | EWMA > μ + 3σ | +| **Historical Limits** | Comparison to baseline | Current > 2σ above baseline | +| **Scan Statistics** | Spatial-temporal clustering | SaTScan p-value < 0.05 | +| **Regression Models** | Adjust for trends/seasonality | Standardized residual > 2 | + +#### Example: Daily Syndrome Surveillance + +**Setting**: Emergency department ILI surveillance + +**Algorithm**: +1. Calculate daily ILI proportion (ILI cases / total ED visits) +2. Compare to 2-week baseline (same days of week, previous 2 weeks) +3. Calculate z-score: (current - baseline mean) / baseline SD +4. Alert if z-score > 2 for 2+ consecutive days + +### 3. Response Coordination + +#### Outbreak Response Levels + +| Level | Criteria | Response | +|-------|----------|----------| +| **1 - Watch** | Statistical alert, no epidemiological link | Enhanced monitoring | +| **2 - Alert** | Confirmed cluster with transmission | Activate outbreak team | +| **3 - Response** | Sustained transmission, public health impact | Full outbreak response | +| **4 - Emergency** | Widespread transmission, severe illness | Emergency operations | + +#### Response Actions by Level + +**Level 1 (Watch)**: +- Review case details +- Verify data accuracy +- Enhanced monitoring +- Prepare response resources + +**Level 2 (Alert)**: +- Activate outbreak team +- Initiate case interviews +- Begin contact tracing +- Implement control measures +- Notify stakeholders + +**Level 3 (Response)**: +- Full outbreak investigation +- Laboratory confirmation +- Environmental assessment +- Enhanced control measures +- Public communication + +**Level 4 (Emergency)**: +- Emergency operations center +- Multi-agency coordination +- Public health emergency declaration +- Resource mobilization +- Media management + +### 4. Surveillance Evaluation + +#### System Attributes (CDC Guidelines) + +| Attribute | Definition | Target | +|-----------|-----------|--------| +| **Simplicity** | Ease of operation | Minimal training required | +| **Flexibility** | Adaptability to changes | Rapidly accommodate new conditions | +| **Data Quality** | Completeness and validity | >90% complete core fields | +| **Acceptability** | Willingness to participate | >80% provider compliance | +| **Sensitivity** | Proportion of cases detected | >80% case ascertainment | +| **Representativeness** | Generalizability | Matches population demographics | +| **Timeliness** | Speed of data availability | <24h from event to report | +| **Stability** | Reliability and availability | >95% uptime | + +## Common Mistakes + +1. **Poor Case Definitions**: Unclear or inconsistent definitions leading to misclassification +2. **Incomplete Data**: Missing fields compromising analysis validity +3. **Delayed Reporting**: Lags reducing timeliness and response effectiveness +4. **Algorithm Errors**: Inappropriate thresholds causing alert fatigue or missed outbreaks +5. **No Baseline**: Lack of historical data preventing trend detection +6. **Privacy Breaches**: Inadequate de-identification in reports +7. **Response Delays**: Bureaucratic hurdles slowing outbreak response +8. **Resource Gaps**: Insufficient capacity for surge response + +## Tool Requirements + +- **Surveillance Database**: Secure, scalable data repository +- **Statistical Software**: R, SAS, or equivalent for analysis +- **GIS Tools**: For spatial analysis and mapping +- **Alert System**: Automated notification of threshold breaches +- **Dashboard**: Real-time visualization of surveillance data +- **Secure Communication**: For outbreak response coordination + +## Success Indicators + +A successful surveillance system: +- [ ] Detects outbreaks within defined timeframe +- [ ] Maintains >90% data completeness +- [ ] Achieves >80% sensitivity for target conditions +- [ ] Provides data within 24 hours of event +- [ ] Supports timely public health action +- [ ] Maintains stakeholder engagement +- [ ] Meets privacy and governance requirements +- [ ] Regularly evaluated and improved + +## Cross-References + +- **notifiable-diseases**: Case identification and individual notifications +- **health-data-analysis**: Statistical methods for surveillance data +- **health-incidents**: Outbreak investigation and incident management +- **health-ethics**: Ethics of population health surveillance + +## Version History + +| Version | Date | Changes | +|---------|------|---------| +| 1.0.0 | 2026-02-14 | Initial release | + +## References + +- [CDC Surveillance Resource Center](https://www.cdc.gov/surveillance/) +- [WHO Global Health Observatory](https://www.who.int/data/gho) +- [European Centre for Disease Prevention and Control Surveillance Atlases](https://www.ecdc.europa.eu/en/all-topics-z/surveillance-and-disease-data) +- [Australian Institute of Health and Welfare Disease Surveillance](https://www.aihw.gov.au/reports/australias-health/disease-surveillance) diff --git a/health/skills/research-ethics/SKILL.md b/health/skills/research-ethics/SKILL.md new file mode 100644 index 0000000..9bb380f --- /dev/null +++ b/health/skills/research-ethics/SKILL.md @@ -0,0 +1,614 @@ +--- +name: health/research-ethics +description: This skill should be used when preparing Research Ethics Committee (REC) or Institutional Review Board (IRB) applications, reviewing research protocols for ethical compliance, drafting informed consent documents, navigating ethics governance processes, or preparing for ethics committee submissions. Use for clinical trials, human research, biobanking, data linkage studies, and qualitative research requiring ethics approval. +version: 1.0.0 +--- + +# Research Ethics + +A comprehensive framework for navigating research ethics approval processes, preparing REC/IRB submissions, and ensuring ethical compliance in human research. This skill guides researchers through protocol development, informed consent drafting, and committee preparation with jurisdiction-specific requirements. + +**Important**: This skill assists with research ethics workflows but does not guarantee ethics approval or replace institutional ethics committee authority. Always submit to your institution's designated ethics review body. + +## When to Use This Skill + +Invoke this skill when: +- Preparing a new REC/IRB application for human research. +- Drafting or reviewing informed consent documents for research participation. +- Designing research protocols that involve human participants, data, or tissue. +- Navigating multi-site or multi-jurisdictional ethics approval processes. +- Responding to ethics committee queries or requests for modification. +- Conducting ethical risk assessments for proposed research. +- Preparing for ethics committee meetings or oral presentations. +- Determining whether a project requires formal ethics review. +- Managing ethics amendments, renewals, or adverse event reporting. +- Establishing data sharing or biobanking governance arrangements. + +## Regulatory Context + +### Australia & New Zealand (Default) + +| Regulation/Standard | Relevance | Key Requirements | +|---------------------|-----------|------------------| +| **NHMRC National Statement** (AU) | Ethical conduct in human research | Values: Respect, research merit, justice, beneficence. Risk-benefit assessment mandatory. | +| **NHMRC Chapter 2.1** (AU) | General requirements | Research merit and integrity; justice; beneficence; respect. | +| **NHMRC Chapter 2.2** (AU) | Qualitative methods | Risk assessment for sensitive topics; appropriate consent processes. | +| **NHMRC Chapter 3.1** (AU) | Clinical trials | Safety monitoring; data safety monitoring boards; trial registration. | +| **HRC Guidelines** (NZ) | Human research ethics | Te Ara Tika (Māori ethical framework); community engagement requirements. | +| **Privacy Act 1988** (AU) | Data handling | APP 3: Collection of solicited personal information; lawful collection. | +| **Privacy Act 2020** (NZ) | Privacy protection | Information privacy principles; cross-border data disclosure restrictions. | +| **Gene Technology Act 2000** (AU) | GMO research | OGTR approval required for genetically modified organisms research. | + +### US/EU-lite Fallback + +| Regulation/Standard | Relevance | Key Requirements | +|---------------------|-----------|------------------| +| **Belmont Report** (US) | Ethical principles | Respect for persons; beneficence; justice. Foundation for 45 CFR 46. | +| **45 CFR Part 46** (US) | Federal regulations | Subparts A-D: Basic protections; pregnant women; prisoners; children. | +| **ICH-GCP E6(R2)** (International) | Clinical trials | Informed consent standards; independent ethics committee; investigator responsibilities. | +| **Declaration of Helsinki** (International) | Medical research | WMA ethical principles; placebo use restrictions; post-trial access. | +| **GDPR** (EU) | Data protection | Lawful basis for processing; data minimization; special category data (Article 9). | +| **Clinical Trials Regulation EU 536/2014** | EU trials | Single submission portal; informed consent requirements; safety reporting. | + +### Jurisdiction Matrix + +| Jurisdiction | Applicable Regulator | Reporting Trigger | Timeframe | Required Artifacts | Escalation Point | +|--------------|---------------------|-------------------|-----------|-------------------|------------------| +| **AU - NHMRC** | HREC (Human Research Ethics Committee) | Research with human participants | Pre-commencement | Ethics application; protocol; PICF; risk assessment | Deputy Chair, HREC | +| **AU - State** | State Health Dept | Research in public health facilities | Pre-commencement + site authorisation | Site authorisation; insurance certificate | Research Governance Officer | +| **NZ - HRC** | Ethics Committee (EC) | Health and disability research | Pre-commencement | Ethics application; protocol; consent form; Māori consultation | Ethics Committee Chair | +| **US - Federal** | IRB (Institutional Review Board) | Human subjects research | Pre-commencement | IRB application; protocol; consent form; HIPAA authorization | IRB Chair/Admin | +| **EU** | National Competent Authority | Clinical trials | Pre-commencement via CTIS | EudraCT number; protocol; IMPD; insurance | Ethics Committee Chair | + +## Quick Reference + +1. **Ethics Determination**: First establish if formal review is required (some QI may be exempt). +2. **Risk Stratification**: Minimal risk vs. more than minimal risk drives review pathway. +3. **Consent Quality**: Information, comprehension, voluntariness—the three pillars. +4. **Vulnerable Populations**: Additional safeguards required; enhanced review required. +5. **Privacy by Design**: Embed data protection from protocol inception. +6. **Māori/Pacific Engagement**: Mandatory in NZ; respectful partnership in AU. +7. **Conflict of Interest**: Disclose all financial and non-financial interests. +8. **Data Safety**: Plan for monitoring, interim analyses, and stopping rules. +9. **Multi-site**: Identify lead HREC/IRB and site-specific requirements. +10. **Post-approval**: Understand reporting obligations for deviations and adverse events. + +## Operating Modes + +### Standard Mode +Full research ethics workflow with comprehensive protocol review, detailed informed consent development, complete risk assessment, and formal governance documentation. Use for interventional research, clinical trials, vulnerable population research, and any study requiring full HREC/IRB review. Includes committee preparation and response to queries. + +### Lite Mode +Streamlined guidance for minimal risk research, student projects, or secondary data analysis with established ethics approval. Focuses on essential ethics principles, abbreviated consent processes, and expedited review pathways. Never suppresses high-risk escalation requirements or vulnerable population safeguards. + +## Detailed Guidance + +### 1. Ethics Requirement Determination + +Before commencing application preparation, determine if formal ethics review is required: + +#### Research vs. Quality Improvement + +| Characteristic | Research | Quality Improvement | +|----------------|----------|---------------------| +| **Intent** | Generate generalizable knowledge | Improve local processes | +| **Design** | Systematic investigation | Systematic improvement | +| **Population** | Different from those at institution | Same as those receiving care | +| **Randomization** | Often present | Rarely present | +| **Generalizability** | Primary goal | Secondary or absent | +| **Ethics Review** | Usually required | May be exempt | + +**When QI Becomes Research**: +- Intent shifts to publication with generalizable findings. +- Additional risk or burden beyond standard care. +- Randomization of interventions. +- Use of control groups for comparison. +- New treatments or experimental procedures. + +#### Exemptions and Expedited Review + +**Potential Exemptions** (AU/NZ context): +- Secondary use of de-identified data (no re-identification risk). +- Publicly available information (statistics, archival records). +- Quality assurance/audit activities. +- Case series (n≤3) with ethics committee notification. +- Evaluation of public programs. + +**Expedited Review Eligible** (US 45 CFR 46.110): +- Minor changes in previously approved research. +- Research on existing data/documents (no identifiers). +- Prospective collection of biological samples (non-invasive). +- Voice/video recordings (limited categories). + +**Note**: Exemption determinations must be made by the ethics committee, not the researcher. + +### 2. Protocol Development and Review + +#### Essential Protocol Elements + +A research protocol must include: + +1. **Background and Rationale** + - Scientific justification for the research. + - Summary of existing evidence (literature review). + - Knowledge gap being addressed. + +2. **Research Question and Objectives** + - Primary and secondary objectives. + - Hypothesis (if applicable). + - Outcome measures with definitions. + +3. **Study Design and Methods** + - Study type (RCT, observational, qualitative, etc.). + - Participant population and eligibility criteria. + - Sample size justification (statistical power). + - Recruitment methods and materials. + - Data collection procedures. + - Intervention details (if interventional). + +4. **Risk Assessment and Management** + - Identification of potential risks (physical, psychological, social, economic). + - Risk minimization strategies. + - Risk-benefit justification. + - Withdrawal procedures. + +5. **Ethical Considerations** + - How ethical principles will be upheld. + - Specific issues (vulnerability, consent capacity). + - Cultural considerations. + +6. **Data Management** + - Collection, storage, and security. + - Retention and disposal. + - Future use/sharing plans. + +7. **Governance and Oversight** + - Safety monitoring plan. + - Data safety monitoring board (if required). + - Adverse event definitions and reporting. + - Insurance and indemnity. + +#### Risk Stratification Framework + +| Risk Level | Definition | Review Pathway | Consent Requirements | +|------------|------------|----------------|---------------------| +| **Negligible** | No foreseeable harm; inconvenience only | Chair review or exemption | Standard or waiver possible | +| **Minimal** | Everyday risks; minor discomfort | Expedited review | Standard consent | +| **Minor** | Temporary harm; reversible | Full committee review | Enhanced consent; monitoring | +| **More than Minimal** | Significant harm possible | Full committee; DSMB required | Enhanced; re-consent; audit | +| **Significant** | Serious harm; lasting effects | Full committee; external review | Extensive; independent witness | + +### 3. Informed Consent Framework + +#### The Three Pillars of Valid Consent + +**Information**: +- Nature and purpose of research. +- Procedures involved (all visits, time commitment). +- Risks and discomforts (reasonably foreseeable). +- Benefits (to participant and others). +- Alternatives to participation. +- Confidentiality protections. +- Compensation and costs. +- Voluntary nature and right to withdraw. +- Contact information for questions. + +**Comprehension**: +- Written at appropriate reading level (typically grade 6-8). +- Use plain language; avoid jargon. +- Visual aids for complex concepts. +- Teach-back method to verify understanding. +- Allow time for questions. +- Interpreter services for non-English speakers. + +**Voluntariness**: +- No coercion (including therapeutic misconception). +- No undue influence (excessive payment). +- Free to refuse or withdraw without penalty. +- No impact on clinical care relationship. +- Independent decision-making supported. + +#### Consent Document Templates + +**Standard Elements** (NHMRC/National Statement; ICH-GCP): + +``` +1. STUDY TITLE: [Plain language title] + +2. INVITATION TO PARTICIPATE + - Why you are being asked + - Voluntary nature + +3. WHAT IS THE STUDY ABOUT? + - Background and purpose + - Why this research is important + +4. WHAT WILL PARTICIPATION INVOLVE? + - Procedures (visit-by-visit) + - Time commitment + - What happens if you withdraw + +5. ARE THERE ANY RISKS? + - Side effects or discomforts + - How risks will be managed + - Compensation for injury (if applicable) + +6. ARE THERE ANY BENEFITS? + - Direct benefits to you + - Benefits to others/future patients + +7. WHAT ARE THE ALTERNATIVES? + - Standard care if you don't participate + +8. WILL MY INFORMATION BE KEPT CONFIDENTIAL? + - How data is protected + - Who will see your information + - Limits to confidentiality (mandatory reporting) + - Data sharing plans + +9. WHAT ARE THE COSTS? + - Costs to you + - Reimbursement for expenses + - Compensation for participation + +10. WHAT IF I HAVE QUESTIONS? + - Researcher contact + - Ethics committee contact + - Complaints process + +11. CONSENT DECLARATION + - Statement of understanding + - Voluntary agreement + - Signature blocks (participant, researcher, witness if applicable) + - Date +``` + +#### Special Consent Considerations + +**Vulnerable Populations**: +- **Children/Minors**: Assent from child; consent from parent/guardian. Age-appropriate information sheets. +- **Cognitively Impaired**: Consent from legal representative; participant assent if possible. +- **Prisoners**: Enhanced protections; minimal risk preference; no undue inducements. +- **Pregnant Women**: Fetal protections; research purpose must justify inclusion. +- **Emergency Settings**: Exception from informed consent (EFIC) procedures if applicable. + +**Waiver of Consent**: + +Possible only if ALL of the following apply (NHMRC paragraph 2.2.10): +1. Research involves no more than minimal risk. +2. Waiver is unlikely to adversely affect rights/welfare. +3. Research could not practicably be carried out without waiver. +4. Privacy and confidentiality protections adequate. +5. Additional safeguards (if vulnerable). + +**Secondary Use of Data**: +- Consent for future use at initial collection (opt-in/opt-out). +- Broad consent for biobanking. +- Re-consent if use diverges from original scope. +- Consider tiered consent options. + +### 4. Ethics Application Preparation + +#### Application Components Checklist + +**Core Documents**: +- [ ] Completed ethics application form (institution-specific). +- [ ] Research protocol (comprehensive, version-controlled). +- [ ] Participant Information and Consent Form (PICF). +- [ ] Plain language summary. +- [ ] Recruitment materials (advertisements, letters, scripts). +- [ ] Data collection instruments (surveys, interview guides). +- [ ] Risk assessment and management plan. +- [ ] Privacy and data security plan. +- [ ] CVs and GCP certificates for investigators. + +**Study-Specific Documents**: +- [ ] Investigators' Brochure (clinical trials). +- [ ] Clinical trial insurance certificate. +- [ ] Site authorization letters (multi-site). +- [ ] Material transfer agreements (tissue/data sharing). +- [ ] Māori/Pacific consultation documentation (NZ/AU where applicable). +- [ ] DSMB charter (if required). +- [ ] Statistical analysis plan. + +**Governance Documents**: +- [ ] Conflict of interest declarations. +- [ ] Funding agreement or award letter. +- [ ] Sponsor indemnity (if industry-sponsored). +- [ ] Site-specific assessment (SSA) form. + +#### Committee Submission Process + +**Before Submission**: +1. Internal institutional review (if required). +2. Supervisor/CI sign-off. +3. Conflict of interest disclosure and management. +4. Budget review and approval. +5. Pre-submission query to ethics office (recommended for novel/complex). + +**Submission Pathways**: + +| Pathway | Timeline | Suitable For | +|---------|----------|--------------| +| **Full Committee** | 4-8 weeks | Interventional research; vulnerable populations; novel methods | +| **Executive/Chair** | 2-4 weeks | Minimal risk; student projects; amendments | +| **Out-of-Session** | 1-2 weeks | Urgent patient safety; administrative amendments | +| **Expedited** (US) | 2-3 weeks | Expedited categories; minor modifications | + +**After Submission**: +- Receipt acknowledgment (3-5 business days). +- Queries or requests for information (RFI). +- Conditional approval with modifications. +- Full approval (ethics clearance number assigned). +- Provisional approval (minor conditions). + +### 5. Committee Preparation and Presentation + +#### Oral Presentation Guidelines + +When presenting to the ethics committee: + +**Structure** (10-15 minutes typical): +1. **Introduction** (2 min): Research team; study title; funding. +2. **Background** (2 min): Problem; evidence gap; significance. +3. **Methods** (3 min): Design; population; key procedures. +4. **Ethics** (5 min): Risk assessment; consent process; safeguards; vulnerable populations. +5. **Questions** (3 min): Anticipated committee concerns. + +**Key Messages to Convey**: +- Scientific merit justifies any risk. +- Risks are minimized and proportionate. +- Consent process is robust. +- Vulnerable participants are protected. +- Research team is qualified and experienced. +- Monitoring and stopping rules are in place. + +**Anticipate Questions**: +- How did you calculate sample size? +- What are the stopping rules? +- How will you handle withdrawal of consent? +- What happens if a participant is harmed? +- How will you ensure confidentiality? +- Why is this research necessary? + +#### Responding to Committee Queries + +**Process**: +1. Acknowledge receipt of queries within 48 hours. +2. Convene research team to address each point. +3. Prepare point-by-point response document. +4. Track changes in protocol/PICF. +5. Submit response by deadline. + +**Response Quality**: +- Address every query specifically. +- Provide rationale for any disagreements (respectfully). +- Show track changes in revised documents. +- Update version numbers and dates. +- Escalate substantive disagreements to supervisor/CI. + +### 6. Post-Approval Management + +#### Ongoing Obligations + +**Progress Reports**: +- Annual continuing review (US). +- Annual/final reports (AU/NZ). +- Protocol deviation log. +- Recruitment progress. + +**Amendments**: +- **Administrative**: Typographical; contact changes (notification). +- **Minor**: Procedure modifications; eligibility expansion (expedited review). +- **Major**: New intervention; significant risk change (full review). + +**Adverse Event Reporting**: + +| Event Type | Definition | Reporting Timeline | +|------------|------------|-------------------| +| **SAE** (Serious Adverse Event) | Death; life-threatening; hospitalization; disability | 24-72 hours to sponsor; 24 hours to HREC for related events | +| **UADE** (Unanticipated Adverse Device Effect) | Device-related harm not in IFU | 24 hours to HREC/IRB | +| **SUSAR** (Suspected Unexpected SAR) | Drug-related serious unexpected reaction | 7-15 days per regulatory requirements | +| **Protocol Deviation** | Non-compliance with protocol | Quarterly or per protocol | +| **Breach** | Privacy/confidentiality breach | 72 hours to HREC; immediate remediation | + +**Study Closure**: +- Final report within 90 days of completion/termination. +- Return of unused investigational product. +- Data lock and analysis completion. +- Archival of research records (minimum 15 years). + +### 7. Study Type Variations + +#### Clinical Trials + +**Additional Requirements**: +- Clinical trial registration (ANZCTR, ClinicalTrials.gov, EudraCT). +- Trial insurance and injury compensation. +- DSMB for trials with significant risk. +- Safety reporting per ICH-GCP. +- Protocol compliance monitoring. + +**IND/CTN Requirements** (AU): +- Clinical Trial Notification (CTN) or Clinical Trial Exemption (CTX). +- TGA approval for unapproved therapeutic goods. + +#### Qualitative Research + +**Ethical Considerations**: +- Emergent design may limit initial protocol specificity. +- Rapport building vs. therapeutic relationship boundaries. +- Vicarious trauma protection for researchers. +- Sensitive topic handling (abuse, trauma, illegal behaviors). +- Data re-use and secondary analysis consent. + +**Consent Nuances**: +- Process consent (ongoing consent throughout). +- Opt-out options for sensitive questions. +- Audio recording consent. +- Anonymization challenges (rich descriptions). + +#### Data Linkage and Secondary Data + +**Ethical Considerations**: +- Original consent scope assessment. +- Re-identification risk evaluation. +- Data custodian approvals. +- Linkage key security. +- Population-level disclosure risk. + +**Waiver Considerations**: +- Public benefit assessment. +- Privacy safeguards. +- Impossibility of re-consent. + +#### Biobanking and Genetics + +**Specific Issues**: +- Broad consent for future research. +- Return of results policy (incidental findings). +- Data sharing and international transfer. +- Commercialization and benefit sharing. +- Family implications (genetic information). + +#### Indigenous and Māori Research + +**New Zealand - Te Ara Tika**: +- Whakawhanaungatanga (relationship building). +- Mana (authority and control). +- Tika (ethical correctness). +- Manaakitanga (cultural safety and respect). + +**Australia**: +- Aboriginal and Torres Strait Islander research ethics guidelines. +- Community consultation and consent. +- Cultural intellectual property. +- Benefit sharing and capacity building. + +## Documentation Requirements + +### Ethics Application File + +- [ ] Ethics application form (all sections complete). +- [ ] Research protocol (dated; version-controlled). +- [ ] PICF and plain language statement. +- [ ] Recruitment materials. +- [ ] Data collection instruments. +- [ ] Risk assessment and mitigation plan. +- [ ] Privacy and security plan. +- [ ] Investigator CVs and GCP certificates. +- [ ] Conflict of interest declarations. +- [ ] Insurance certificates (if applicable). +- [ ] Site authorization documentation. +- [ ] Consultation documentation (Indigenous/Māori/Pacific). +- [ ] DSMB charter (if required). + +### Ongoing Study File + +- [ ] Ethics approval letter and clearance number. +- [ ] Approved protocol and PICF (master file). +- [ ] Amendment documentation and approvals. +- [ ] Adverse event log and reports. +- [ ] Protocol deviation log. +- [ ] Informed consent forms (signed). +- [ ] Safety reports and DSMB minutes. +- [ ] Progress reports to HREC/IRB. +- [ ] Site monitoring reports. + +### Study Closure File + +- [ ] Final study report. +- [ ] Final safety summary. +- [ ] Publication plan and acknowledgments. +- [ ] Data archival and retention plan. +- [ ] Destruction certificates (if applicable). + +## Common Mistakes + +| Mistake | Why It's Wrong | Instead | +|---------|----------------|---------| +| **Assuming QI doesn't need ethics** | Some QI meets research definition; requires assessment | Use QI vs. research framework; seek determination from HREC | +| **Insufficient risk assessment** | Underestimating risks leads to inadequate protections | Systematic risk identification; include psychological/social risks | +| **Therapeutic misconception** | Participants conflate research with treatment | Clear distinction in consent; explain uncertainty and purpose | +| **Inadequate consent readability** | High reading level excludes vulnerable populations | Write at grade 6-8; use plain language; test with layperson | +| **Missing vulnerable population safeguards** | Enhanced protections required but omitted | Identify vulnerability; additional consent measures; monitoring | +| **Unclear data sharing plans** | Participants unclear on future use; re-identification risk | Explicit secondary use consent; tiered consent; data governance | +| **No DSMB for high-risk research** | Absence of independent safety monitoring | Establish DSMB for trials with significant risk; clear stopping rules | +| **Late adverse event reporting** | Delays compromise participant safety | 24-72 hour reporting; clear SAE definitions; training | +| **Consent form as information sheet** | Participants sign without reading/comprehending | Separate documents; teach-back; time for questions | +| **Ignoring cultural protocols** | Research fatigue; disrespect; non-participation | Engage Indigenous/Māori/Pacific communities early; follow cultural protocols | + +## When to Escalate + +Escalate to Chief Investigator, Research Office, or Ethics Committee Chair when: + +- Serious adverse event occurs requiring immediate reporting. +- Unanticipated serious risk emerges during study conduct. +- Breach of confidentiality or data security incident. +- Participant complaint that cannot be resolved locally. +- Significant protocol deviation affecting risk-benefit. +- Suspicion of research misconduct or fraud. +- Media or public interest in the research. +- Legal challenge to ethics approval or consent. +- Multi-site dispute on governance or safety. + +## Privacy Considerations + +- **PHI Involved**: Yes - Research typically involves identifiable health information. +- **Data Minimization**: Collect only data elements required to answer research question. +- **De-identification**: Remove direct identifiers; use codes for linkage; assess re-identification risk. +- **Access Controls**: Role-based access; research team only; audit logs. +- **Storage Security**: Encrypted at rest and in transit; secure servers; password protection. +- **Retention**: Research records retained 15+ years (AU/NZ); secure destruction after period. +- **International Transfer**: Ensure adequacy decisions or standard contractual clauses (GDPR). +- **No Persistence**: Do not store identifiable participant data in chat history or temporary workspaces. +- **Consent for Data Use**: Explicit consent for collection, use, and sharing; right to withdraw data (within limits). + +## Confidence Indicators + +| Scenario | Confidence | Action | +|----------|------------|--------| +| Standard minimal risk observational study with clear consent process | High | Prepare full application; proceed with standard review | +| Complex interventional trial with vulnerable population | Low | Escalate to Research Office for specialist input; consider external consultant | +| Novel methodology without established precedent | Medium | Pre-submission query to HREC; involve methodology expert | +| Adverse event or safety concern identified | Low | **BLOCKER**: Report immediately; halt enrollment if required; notify HREC within 24-72 hours | +| Ambiguous determination on research vs. QI | Medium | Seek formal determination from HREC Chair; document decision | +| Multi-jurisdictional study with conflicting requirements | Low | Escalate to research governance; engage legal/compliance | +| Consent capacity concerns for participant | Medium | Assess capacity; involve legal representative; flag to HREC | +| Indigenous/Māori/Pacific research without consultation | Low | **BLOCKER**: Halt recruitment; engage communities per cultural protocols; amend protocol | +| Late-breaking amendment affecting risk profile | Medium | Urgent HREC notification; suspend enrollment pending approval | +| Potential conflict of interest identified | Medium | Disclose fully; develop management plan; flag to HREC | + +## Tool Requirements + +- `~~health/clinical-systems` - For accessing patient data and clinical indicators. +- `~~cloud storage` - For secure document storage and collaboration. +- `~~project tracker` - For ethics application milestones and approval tracking. +- `~~document collaboration` - For multi-investigator protocol development. +- `~~research/clinical-trials` - For trial registration and safety reporting. +- `~~legal/compliance` - For data governance and multi-jurisdictional compliance. + +## Success Indicators + +You've applied this skill well when: +- [ ] Ethics determination is correct (research vs. QI properly classified). +- [ ] Risk assessment is comprehensive and realistic. +- [ ] Protocol follows scientific and ethical standards. +- [ ] PICF meets readability and content requirements. +- [ ] Consent process supports comprehension and voluntariness. +- [ ] Vulnerable population safeguards are appropriate. +- [ ] Privacy protections are robust and documented. +- [ ] Application is complete and committee-ready. +- [ ] Committee queries are responded to promptly and thoroughly. +- [ ] Post-approval obligations are understood and tracked. +- [ ] Adverse events are reported within required timeframes. +- [ ] Study documentation meets audit standards. + +## Related Skills + +- `~~health/clinical-ethics` - For clinical ethics consultations distinct from research ethics. +- `~~health/quality-improvement` - For QI projects that may interface with research ethics. +- `~~health/incident-reporting` - For adverse event and safety incident workflows. +- `~~health/clinical-risk-assessment` - For risk management in clinical research. +- `~~bio-research/scientific-problem-selection` - For research design and problem framing. +- `~~legal/compliance` - For governance and regulatory compliance across jurisdictions. diff --git a/health/skills/systematic-review/SKILL.md b/health/skills/systematic-review/SKILL.md new file mode 100644 index 0000000..41ddfe4 --- /dev/null +++ b/health/skills/systematic-review/SKILL.md @@ -0,0 +1,521 @@ +--- +name: health/systematic-review +description: This skill should be used when conducting systematic reviews of healthcare literature following PRISMA guidelines. Use for protocol development, search strategy design, study screening, data extraction, risk of bias assessment, meta-analysis planning, and GRADE evidence grading. Invoke when users mention systematic reviews, literature reviews, PRISMA, PROSPERO registration, search strategies, or evidence synthesis. +version: 1.0.0 +--- + +# Systematic Review + +A comprehensive framework for conducting systematic reviews of healthcare literature following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. This skill guides researchers through the complete systematic review lifecycle from protocol development to evidence grading. + +**Important**: This skill assists with systematic review methodology but does not replace expert clinical judgment, statistical expertise for meta-analysis, or ethics committee oversight. Always ensure appropriate methodological expertise is involved. + +## When to Use This Skill + +Invoke this skill when: +- Planning or conducting a systematic review of healthcare interventions, diagnostics, or prognostic factors. +- Developing a systematic review protocol for PROSPERO or similar registry registration. +- Designing search strategies for electronic databases (PubMed, Cochrane, Embase). +- Screening and selecting studies using PRISMA methodology. +- Extracting data from primary studies for synthesis. +- Assessing risk of bias using RoB 2, ROBINS-I, or other validated tools. +- Planning or conducting meta-analysis of study results. +- Grading evidence quality using GRADE methodology. +- Preparing PRISMA-compliant review reports for publication. +- Conducting updates to existing systematic reviews. +- Responding to peer review feedback on systematic review manuscripts. + +## Regulatory Context + +### Australia & New Zealand (Default) + +| Regulation/Standard | Relevance | Key Requirements | +|---------------------|-----------|------------------| +| **NHMRC Standards** (AU) | Research synthesis | Standards for Synthesis and Translation of Research Evidence (2016) | +| **NH&MRC Act 1992** (AU) | Health advice | Evidence review requirements for clinical practice guidelines | +| **Health Research Council NZ** | Research standards | Systematic review standards for funding applications | +| **Te Whatu Ora** (NZ) | Health evidence | Requirements for evidence reviews informing policy | +| **State/Territory Health Acts** | Local requirements | Ethics approval for systematic reviews using patient-level data | + +### US/EU-lite Fallback + +| Regulation/Standard | Relevance | Key Requirements | +|---------------------|-----------|------------------| +| **IOM Standards** (US) | Systematic reviews | Finding What Works in Health Care: Standards for Systematic Reviews (2011) | +| **AHRQ Methods Guide** (US) | Comparative effectiveness | Systematic review methodology for CERs | +| **EUnetHTA Guidelines** (EU) | Health technology assessment | HTA-specific systematic review guidance | +| **Cochrane Handbook** | International | Methodological standards for systematic reviews | + +### Jurisdiction Matrix + +| Jurisdiction | Applicable Regulator | Reporting Trigger | Timeframe | Required Artifacts | Escalation Point | +|--------------|---------------------|-------------------|-----------|-------------------|------------------| +| **AU - National** | NHMRC | Clinical guideline development | Per guideline cycle | Systematic review report; GRADE tables; Evidence profiles | Guidelines Committee Chair | +| **AU - Research** | University HREC | Patient-level data meta-analysis | Ethics approval timeline | Ethics application; Data management plan | Research Office | +| **NZ - National** | Health Research Council | Funding application evidence review | Per grant round | Protocol; Search strategy; PRISMA flow diagram | Grant Manager | +| **US** | AHRQ/IOM | Comparative effectiveness review | Project timeline | Technical brief; Systematic review report | Project Officer | +| **International** | Cochrane Collaboration | Cochrane Review publication | Review cycle | Protocol; Review; Plain language summary | Cochrane Review Group | + +## Quick Reference + +1. **Protocol First**: Register on PROSPERO or similar before starting the review. +2. **PICOS Framework**: Define Population, Intervention, Comparison, Outcomes, Study designs clearly. +3. **Comprehensive Search**: Search multiple databases with documented strategy; include grey literature. +4. **Dual Review**: Two independent reviewers for screening and data extraction; resolve conflicts. +5. **Risk of Bias**: Use validated tools (RoB 2 for RCTs, ROBINS-I for observational studies). +6. **GRADE Assessment**: Rate certainty of evidence for each outcome (High/Moderate/Low/Very Low). +7. **PRISMA Reporting**: Follow PRISMA 2020 checklist for transparent reporting. +8. **Data Synthesis**: Meta-analysis only when appropriate (clinical homogeneity, low heterogeneity). +9. **Sensitivity Analyses**: Test robustness of findings to methodological choices. +10. **Publication Bias**: Assess funnel plot asymmetry when sufficient studies available (≥10). + +## Operating Modes + +### Standard Mode +Full systematic review methodology with comprehensive search strategies, dual independent review, detailed risk of bias assessment, meta-analysis with subgroup and sensitivity analyses, and complete GRADE evidence profiles. Use for publication-grade systematic reviews intended for peer-reviewed journals or clinical guideline development. + +### Lite Mode +Streamlined guidance for rapid reviews or scoping reviews with abbreviated search strategies, single-reviewer screening with verification sampling, simplified data extraction, and narrative synthesis without meta-analysis. Clearly mark outputs as "rapid review" or "scoping review" and acknowledge methodological limitations. Never suppress critical appraisal or risk of bias assessment entirely. + +## Detailed Guidance + +### 1. Protocol Development + +Every systematic review must begin with a written protocol registered before screening begins. + +#### 1.1 PICOS Framework + +Define each element precisely: + +| Element | Definition | Example | +|---------|------------|---------| +| **P**opulation | Who are the participants? | Adults with type 2 diabetes | +| **I**ntervention | What is the intervention? | Continuous glucose monitoring | +| **C**omparison | What is the comparator? | Self-monitoring of blood glucose | +| **O**utcomes | What outcomes are measured? | HbA1c; hypoglycemic events; quality of life | +| **S**tudy designs | What study types are included? | RCTs; systematic reviews | + +**Key Questions**: +- Is the PICOS specific enough to guide search strategy development? +- Are all relevant outcomes included (primary and secondary)? +- Are subgroups for analysis predefined (e.g., age, disease severity)? + +#### 1.2 Eligibility Criteria + +**Inclusion Criteria**: +- Study designs: Be specific (e.g., "RCTs with parallel design"; "prospective cohort studies") +- Population characteristics: Age range, diagnosis criteria, setting +- Intervention details: Dose, duration, delivery method +- Outcomes: Minimum follow-up, measurement methods +- Language: English-only vs. no language restriction +- Publication timeframe: Date limits with rationale + +**Exclusion Criteria**: +- Study designs to exclude (e.g., case reports, editorials) +- Population exclusions (e.g., children, pregnant women) +- Intervention exclusions (e.g., non-standard formulations) +- Setting exclusions (e.g., laboratory studies, animal studies) + +#### 1.3 PROSPERO Registration + +Register protocol before screening begins: + +**Required Information**: +- Review title +- Review question (structured using PICOS or PICO) +- Searches (databases, dates, search terms) +- Condition or domain being studied +- Participants/population +- Intervention(s)/exposure(s) +- Comparator(s)/control +- Main outcome(s) +- Risk of bias assessment strategy +- Strategy for data synthesis + +**Registration URL**: https://www.crd.york.ac.uk/prospero/ + +### 2. Search Strategy Development + +#### 2.1 Database Selection + +**Core Databases** (minimum): +- MEDLINE (via PubMed or Ovid) +- Embase +- Cochrane Central Register of Controlled Trials (CENTRAL) + +**Supplementary Databases**: +- CINAHL (nursing and allied health) +- PsycINFO (psychological interventions) +- Web of Science or Scopus (citation tracking) +- ClinicalTrials.gov (ongoing/unpublished trials) +- WHO ICTRP (international trial registry) + +#### 2.2 Search Strategy Structure + +**Concept Combination**: +``` +(Population terms) AND (Intervention terms) AND (Outcome terms) +``` + +**Example Search (PubMed)**: +``` +#1 "Diabetes Mellitus, Type 2"[Mesh] OR "type 2 diabetes"[tiab] OR T2DM[tiab] +#2 "Blood Glucose Self-Monitoring"[Mesh] OR "continuous glucose monitoring"[tiab] OR CGM[tiab] +#3 "Hemoglobin A, Glycosylated"[Mesh] OR HbA1c[tiab] OR "glycemic control"[tiab] +#4 #1 AND #2 AND #3 +#5 Randomized Controlled Trial[pt] OR "randomized"[tiab] OR "placebo"[tiab] +#6 #4 AND #5 +#7 Animals[mh] NOT Humans[mh] +#8 #6 NOT #7 +``` + +**Peer Review**: Consider using PRESS (Peer Review of Electronic Search Strategies) checklist. + +#### 2.3 Grey Literature and Supplementary Searching + +**Grey Literature Sources**: +- Dissertations and theses (ProQuest, OpenGrey) +- Conference abstracts (Embase conference abstracts) +- Government reports +- Pharmaceutical company trial registries +- Regulatory submissions (FDA, EMA) + +**Supplementary Methods**: +- Citation searching (forward and backward) +- Author contacts for unpublished data +- Hand-searching key journals +- Contacting experts in the field + +### 3. Study Screening and Selection + +#### 3.1 PRISMA Flow Diagram + +Document screening process: + +``` +Records identified from databases (n=X) + ├─ Duplicates removed (n=Y) + └─ Records screened (n=X-Y) + ├─ Records excluded (n=Z) + └─ Full-text assessed (n=A) + ├─ Full-text excluded (n=B) [with reasons] + └─ Studies included (n=C) +``` + +#### 3.2 Screening Process + +**Title/Abstract Screening**: +- Two independent reviewers +- Liberal inclusion (when in doubt, include) +- Document exclusion reasons at full-text stage +- Use systematic review software (Covidence, Rayyan, DistillerSR) + +**Full-Text Screening**: +- Two independent reviewers +- Document reasons for exclusion +- Resolve conflicts through discussion or third reviewer +- Calculate inter-rater reliability (Cohen's kappa target: ≥0.6) + +**Conflict Resolution**: +- Primary: Discussion between reviewers +- Secondary: Third reviewer adjudication +- Document resolution method + +### 4. Data Extraction + +#### 4.1 Data Extraction Template + +**Study Characteristics**: +- Author, year, country +- Study design +- Setting (hospital, community, etc.) +- Sample size (enrolled, analyzed) +- Follow-up duration +- Funding source + +**Population Characteristics**: +- Age (mean/median, range) +- Gender distribution +- Diagnostic criteria +- Disease severity/stage +- Comorbidities +- Baseline characteristics + +**Intervention Details**: +- Intervention name/description +- Dose/frequency +- Duration +- Delivery method +- Provider type +- Co-interventions + +**Comparator Details**: +- Type (placebo, active control, usual care) +- Details matching intervention section + +**Outcomes**: +- Definition and measurement method +- Timepoint(s) measured +- Results (mean, SD, n for each group) +- Effect estimates (RR, OR, MD with 95% CI) + +#### 4.2 Data Extraction Process + +- Two independent extractors +- Pilot test extraction form on 2-3 studies +- Resolve discrepancies through discussion +- Contact authors for missing data + +### 5. Risk of Bias Assessment + +#### 5.1 RoB 2 (Randomized Trials) + +Five domains assessed as Low, Some Concerns, or High risk: + +| Domain | Key Questions | +|--------|---------------| +| **D1: Randomization Process** | Was allocation sequence random? Was allocation concealed? | +| **D2: Deviations from Intended Interventions** | Were participants aware of assignment? Were care providers aware? | +| **D3: Missing Outcome Data** | Were outcome data available for all participants? | +| **D4: Outcome Measurement** | Were outcome assessors aware of assignment? | +| **D5: Selection of Reported Results** | Were multiple outcomes/analyses reported? | + +**Overall Risk of Bias**: Lowest rating across domains (conservative approach). + +#### 5.2 ROBINS-I (Non-Randomized Studies) + +Seven domains assessed as Low, Moderate, Serious, Critical risk: + +| Domain | Key Considerations | +|--------|-------------------| +| **D1: Confounding** | Baseline differences, prognostic factors | +| **D2: Selection of Participants** | Selection into study based on characteristics | +| **D3: Classification of Interventions** | Measurement/definition of intervention | +| **D4: Deviations from Intended Interventions** | Adherence, co-interventions | +| **D5: Missing Data** | Attrition, loss to follow-up | +| **D6: Measurement of Outcomes** | Blinding, objective vs. subjective | +| **D7: Selection of Reported Results** | Multiple outcomes, analyses | + +#### 5.3 Assessment Process + +- Two independent assessors +- Resolve disagreements through discussion +- Present results in risk of bias tables +- Consider sensitivity analyses excluding high-risk studies + +### 6. Data Synthesis + +#### 6.1 Narrative Synthesis + +**When to Use**: +- Heterogeneous studies (clinical or methodological) +- Insufficient studies for meta-analysis +- Qualitative data synthesis + +**Approach**: +- Group studies by intervention type, population, or outcome +- Tabulate study characteristics and results +- Describe direction and magnitude of effects +- Note patterns and inconsistencies + +#### 6.2 Meta-Analysis + +**Requirements**: +- Clinical homogeneity (similar populations, interventions, outcomes) +- Sufficient data for pooling (effect estimates with SE/CI) + +**Statistical Methods**: + +| Data Type | Effect Measure | Method | +|-----------|----------------|--------| +| Dichotomous | Risk Ratio (RR), Odds Ratio (OR) | Mantel-Haenszel or Inverse Variance | +| Continuous (same scale) | Mean Difference (MD) | Inverse Variance | +| Continuous (different scales) | Standardized MD (SMD) | Inverse Variance | +| Time-to-event | Hazard Ratio (HR) | Generic Inverse Variance | + +**Heterogeneity Assessment**: +- Cochran's Q test (p < 0.10 suggests heterogeneity) +- I² statistic: 0-40% (low), 30-60% (moderate), 50-90% (substantial), 75-100% (considerable) +- Visual inspection of forest plots + +**Model Selection**: +- Fixed-effect: When clinical/methodological homogeneity assumed +- Random-effects: When heterogeneity expected (DerSimonian-Laird or Restricted Maximum Likelihood) + +#### 6.3 Subgroup and Sensitivity Analyses + +**Pre-specified Subgroups**: +- Age groups +- Disease severity +- Intervention dose/intensity +- Study design +- Risk of bias level + +**Sensitivity Analyses**: +- Exclude high risk of bias studies +- Exclude outlying studies +- Alternative statistical models +- Impute missing data (best/worst case scenarios) + +#### 6.4 Assessment of Publication Bias + +**Methods** (when ≥10 studies): +- Funnel plot visual inspection +- Egger's test (regression-based) +- Trim-and-fill analysis + +**Interpretation**: +- Asymmetry may indicate publication bias or true heterogeneity +- Consider other causes: small-study effects, true differences + +### 7. GRADE Evidence Assessment + +#### 7.1 Rating Evidence Certainty + +**Four Levels**: + +| Level | Interpretation | +|-------|----------------| +| **High** | Very confident effect estimate is close to true effect | +| **Moderate** | Moderately confident; true effect likely close to estimate | +| **Low** | Limited confidence; true effect may be substantially different | +| **Very Low** | Very little confidence; true effect likely substantially different | + +**Downgrade Factors** (RCTs): + +| Factor | Criteria | Impact | +|--------|----------|--------| +| **Risk of Bias** | Most studies have methodological limitations | -1 or -2 levels | +| **Inconsistency** | Heterogeneity not explained (I² > 50%, inconsistent directions) | -1 or -2 levels | +| **Indirectness** | Differences between PICOS and evidence | -1 or -2 levels | +| **Imprecision** | Wide confidence intervals, few events, small sample | -1 or -2 levels | +| **Publication Bias** | Funnel plot asymmetry or missing studies suspected | -1 level | + +**Upgrade Factors** (Observational Studies): +- Large magnitude of effect (RR > 2 or RR < 0.5) +- Dose-response gradient +- Plausible confounders would reduce demonstrated effect + +#### 7.2 Evidence Profile Format + +| Outcome | Studies (n) | Risk of Bias | Inconsistency | Indirectness | Imprecision | Publication Bias | Certainty | Comments | +|---------|-------------|--------------|---------------|--------------|-------------|------------------|-----------|----------| +| HbA1c reduction | 12 RCTs | No serious concerns | No serious inconsistency | No serious indirectness | No serious imprecision | Undetected | ⊕⊕⊕⊕ HIGH | Consistent benefit across studies | + +## Documentation Requirements + +### Systematic Review File + +- [ ] Registered protocol (PROSPERO or other registry) +- [ ] Search strategies for all databases (including dates) +- [ ] PRISMA 2020 flow diagram +- [ ] Characteristics of included studies table +- [ ] Risk of bias assessment tables +- [ ] Data extraction forms/templates +- [ ] Forest plots and meta-analysis results +- [ ] GRADE evidence profiles +- [ ] PRISMA 2020 checklist +- [ ] Funding and conflict of interest declarations + +### Protocol Requirements + +- [ ] Rationale for review +- [ ] Objectives (structured using PICOS) +- [ ] Eligibility criteria +- [ ] Information sources and search strategy +- [ ] Study selection process +- [ ] Data extraction procedures +- [ ] Risk of bias assessment tools +- [ ] Data synthesis methods +- [ ] Subgroup and sensitivity analysis plans +- [ ] Timeline and milestones + +## Common Mistakes + +| Mistake | Why It's Wrong | Instead | +|---------|----------------|---------| +| **No protocol registration** | Risk of outcome switching and selective reporting | Register on PROSPERO before screening begins | +| **Vague PICOS** | Unfocused search and heterogeneous studies | Define precise eligibility criteria with operational definitions | +| **Single database search** | Misses relevant studies; publication bias | Search minimum 3 databases plus grey literature | +| **No dual review** | Introduces selection and extraction bias | Two independent reviewers at all stages with conflict resolution | +| **Ignoring risk of bias** | Includes poor-quality studies that distort results | Systematically assess and report risk of bias; consider sensitivity analyses | +| **Clinical heterogeneity ignored** | Pooling apples and oranges | Only meta-analyze clinically homogeneous studies; use narrative synthesis otherwise | +| **Subgroup analyses not pre-specified** | Data dredging and false positives | Pre-specify subgroups in protocol; limit post-hoc analyses | +| **Missing grey literature** | Publication bias toward positive results | Search trial registries, conference abstracts, regulatory submissions | +| **GRADE not applied** | Uncertainty about evidence quality not transparent | Apply GRADE to all outcomes; report certainty ratings | +| **No sensitivity analyses** | Fragile findings not detected | Test robustness to methodological choices and outlying studies | + +## When to Escalate + +Escalate to Systematic Review Team Lead, Methodologist, or Biostatistician when: +- Network meta-analysis is being considered (requires specialized expertise). +- Individual participant data (IPD) meta-analysis is proposed. +- Significant heterogeneity (I² > 75%) cannot be explained by subgroup analyses. +- Risk of bias assessment reveals widespread methodological concerns across included studies. +- Publication bias assessment suggests major distortion of evidence base. +- Meta-analysis includes fewer than 5 studies (fragile findings). +- Results will inform clinical guideline recommendations or policy decisions. +- Study involves controversial or emotionally charged interventions (e.g., stem cells, unproven therapies). +- Conflicts of interest cannot be adequately managed. + +## Privacy Considerations + +- **PHI Involved**: Conditional - Patient-level data meta-analysis may involve PHI. +- **Data Minimization**: Extract only aggregate data when possible; avoid patient-level data unless IPD meta-analysis is justified. +- **De-identification**: All extracted data should be aggregate; no patient identifiers in extraction forms. +- **Access Controls**: Limit access to data extraction files to review team members. +- **Retention**: Retain systematic review files according to institutional policy (typically 7+ years). +- **No Persistence**: Do not store patient-level data in temporary workspaces or chat history. + +## Confidence Indicators + +| Scenario | Confidence | Action | +|----------|------------|--------| +| Protocol registered; established review methods; experienced review team | High | Proceed with systematic review; document methodology | +| Novel intervention with limited studies; unclear risk of bias patterns | Medium | Consult with methodologist; consider broader eligibility criteria; plan sensitivity analyses | +| Highly heterogeneous studies; conflicting results across studies | Medium | Flag for clinical expert review; explore heterogeneity sources; consider not pooling | +| Individual patient data meta-analysis proposed | Low | Escalate to biostatistician and ethics committee; ensure data sharing agreements | +| Network meta-analysis considered | Low | Escalate to specialized methodologist; assess transitivity assumption carefully | +| Evidence will inform high-stakes clinical guideline | Medium | Ensure complete GRADE assessment; involve guideline panel early; document certainty | +| Rapid review timeline compromises dual review | Medium | Acknowledge limitation; use verification sampling; document quality control | + +## Tool Requirements + +- `~~research literature` - For PubMed, Embase, Cochrane database searches +- `~~clinical terminology` - For SNOMED-CT, LOINC terminology alignment +- `~~project tracker` - For systematic review project management and milestone tracking +- `~~cloud storage` - For review documentation, extraction forms, and data files +- `~~document collaboration` - For team coordination on screening and extraction +- `~~statistical analysis` - For meta-analysis and forest plot generation +- `~~reference manager` - For citation management and deduplication + +## Success Indicators + +You've applied this skill well when: +- [ ] Protocol is registered before screening begins +- [ ] PICOS framework clearly defines scope +- [ ] Search strategy is comprehensive and documented +- [ ] PRISMA flow diagram accurately reflects screening process +- [ ] Two independent reviewers conducted screening and extraction +- [ ] Risk of bias is systematically assessed using validated tools +- [ ] Data synthesis is appropriate for study heterogeneity +- [ ] GRADE evidence profiles are complete for all outcomes +- [ ] PRISMA 2020 checklist is completed for reporting +- [ ] Limitations are transparently acknowledged +- [ ] Results are contextualized for clinical decision-making + +## Related Skills + +- `~~health/evidence-synthesis` - For broader evidence synthesis methods including scoping and rapid reviews +- `~~health/quality-improvement` - When systematic review findings inform QI initiatives +- `~~health/guideline-development` - When systematic review evidence supports clinical guideline development +- `~~research/statistical-analysis` - For advanced meta-analysis methods and statistical support +- `~~research/literature-search` - For database-specific search strategy optimization + +## References + +- Page MJ, McKenzie JE, Bossuyt PM, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372:n71. +- Higgins JPT, Thomas J, Chandler J, et al. Cochrane Handbook for Systematic Reviews of Interventions version 6.3. Cochrane, 2022. +- Sterne JAC, Savović J, Page MJ, et al. RoB 2: a revised tool for assessing risk of bias in randomised trials. BMJ. 2019;366:l4898. +- Sterne JA, Hernán MA, Reeves BC, et al. ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions. BMJ. 2016;355:i4919. +- Guyatt GH, Oxman AD, Vist GE, et al. GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ. 2008;336(7650):924-926. From c877b82d8df5da89428096ebffb62be8ef250974 Mon Sep 17 00:00:00 2001 From: "Dylan Mordaunt (Illawarra Shoalhaven LHD)" Date: Sat, 14 Feb 2026 15:41:44 +1100 Subject: [PATCH 50/57] chore(conductor): Add new track 'ministerial-audit' --- conductor/tracks.md | 5 ++ .../ministerial-audit_20260214/index.md | 5 ++ .../ministerial-audit_20260214/metadata.json | 8 ++++ .../tracks/ministerial-audit_20260214/plan.md | 32 +++++++++++++ .../tracks/ministerial-audit_20260214/spec.md | 48 +++++++++++++++++++ 5 files changed, 98 insertions(+) create mode 100644 conductor/tracks/ministerial-audit_20260214/index.md create mode 100644 conductor/tracks/ministerial-audit_20260214/metadata.json create mode 100644 conductor/tracks/ministerial-audit_20260214/plan.md create mode 100644 conductor/tracks/ministerial-audit_20260214/spec.md diff --git a/conductor/tracks.md b/conductor/tracks.md index 302f8ee..215d84c 100644 --- a/conductor/tracks.md +++ b/conductor/tracks.md @@ -116,3 +116,8 @@ PHASE 4: Research/Academic (parallel, depends Phase 3) │ - Tasks should include `Owner:` and `Updated:` context at section level for accountability. - Tracks with no `IN PROGRESS` task should remain `planning`. - Explicit blockers should be marked with `BLOCKER:` or `BLOCKED:` so status tooling can detect them. + +--- + +- [ ] **Track: Establish a Strategic Equalizer plugin for Ministers and Ministerial staffers to audit and challenge bureaucratic advice.** +*Link: [./tracks/ministerial-audit_20260214/](./tracks/ministerial-audit_20260214/)* diff --git a/conductor/tracks/ministerial-audit_20260214/index.md b/conductor/tracks/ministerial-audit_20260214/index.md new file mode 100644 index 0000000..d1906d2 --- /dev/null +++ b/conductor/tracks/ministerial-audit_20260214/index.md @@ -0,0 +1,5 @@ +# Track ministerial-audit_20260214 Context + +- [Specification](./spec.md) +- [Implementation Plan](./plan.md) +- [Metadata](./metadata.json) diff --git a/conductor/tracks/ministerial-audit_20260214/metadata.json b/conductor/tracks/ministerial-audit_20260214/metadata.json new file mode 100644 index 0000000..55425f5 --- /dev/null +++ b/conductor/tracks/ministerial-audit_20260214/metadata.json @@ -0,0 +1,8 @@ +{ + "track_id": "ministerial-audit_20260214", + "type": "feature", + "status": "new", + "created_at": "2026-02-14T15:40:00Z", + "updated_at": "2026-02-14T15:40:00Z", + "description": "Establish a Strategic Equalizer plugin for Ministers and Ministerial staffers to audit and challenge bureaucratic advice." +} diff --git a/conductor/tracks/ministerial-audit_20260214/plan.md b/conductor/tracks/ministerial-audit_20260214/plan.md new file mode 100644 index 0000000..28afcbd --- /dev/null +++ b/conductor/tracks/ministerial-audit_20260214/plan.md @@ -0,0 +1,32 @@ +# Ministerial Audit Track Plan + +## Phase 1: Core Audit Engine & Redliner +- [ ] Task: Create `ministerial-audit/skills/bureaucracy-redliner/SKILL.md` + - [ ] Sub-task: Implement "Officialese" and "Slow Walk" detection. + - [ ] Sub-task: Develop "Budgetary Bullshit Detector" (financial sanity checks). + - [ ] Sub-task: Implement "Legislative Impact Map" (cross-law consistency). +- [ ] Task: Create `ministerial-audit/commands/audit.md` +- [ ] Task: Conductor - User Manual Verification 'Phase 1' (Protocol in workflow.md) + +## Phase 2: Strategic Synthesis & Counter-Brief +- [ ] Task: Create `ministerial-audit/skills/strategic-synthesis/SKILL.md` + - [ ] Sub-task: Implement "Option 4 Generator" and "Political Risk Radar." + - [ ] Sub-task: Develop "Sunset & Review Recommender." + - [ ] Sub-task: Implement "Consultation Auditor" (missing stakeholder detection). +- [ ] Task: Create `ministerial-audit/commands/brief.md` +- [ ] Task: Conductor - User Manual Verification 'Phase 2' (Protocol in workflow.md) + +## Phase 3: Defense, Wargaming & Precedent +- [ ] Task: Create `ministerial-audit/skills/wargaming/SKILL.md` + - [ ] Sub-task: Define "Cabinet Colleague" personas and "Lobbyist X-Ray." + - [ ] Sub-task: Implement "Precedent Finder" (cross-jurisdictional policy search). + - [ ] Sub-task: Develop "Edge Case" stress-testing. +- [ ] Task: Create `ministerial-audit/commands/prep-meeting.md` +- [ ] Task: Conductor - User Manual Verification 'Phase 3' (Protocol in workflow.md) + +## Phase 4: Communication Suite & Finalization +- [ ] Task: Create `ministerial-audit/skills/comms-translator/SKILL.md` + - [ ] Sub-task: Implement "Doorstop" summarization and "Gotcha" detection. + - [ ] Sub-task: Design "Media Suite" (holding statements/social posts). +- [ ] Task: Final README and metadata consolidation. +- [ ] Task: Conductor - User Manual Verification 'Phase 4' (Protocol in workflow.md) diff --git a/conductor/tracks/ministerial-audit_20260214/spec.md b/conductor/tracks/ministerial-audit_20260214/spec.md new file mode 100644 index 0000000..4a1b07d --- /dev/null +++ b/conductor/tracks/ministerial-audit_20260214/spec.md @@ -0,0 +1,48 @@ +# Specification: Ministerial Audit Plugin (ministerial-audit) + +## Overview +This plugin acts as a "strategic equalizer" for Ministers and Ministerial Advisors, providing them with the tools to audit, verify, and challenge work produced by departmental officials. It bridges the information asymmetry between the bureaucracy and the executive by using AI to detect obfuscation, ensure policy alignment, and prepare for strategic pushback. + +## User Personas +- **Ministers:** Strategic synthesis, risk assessment, and meeting preparation. +- **Ministerial Advisors:** Auditing, jargon detection, and drafting counter-narratives. + +## Functional Requirements +- **Multi-Source Audit Engine:** Auditing drafts against: + - Political commitments (manifestos, past statements, voting records). + - Procedural rules (Cabinet Manual, constitutional norms). + - External context (media, grey literature, lobbyist submissions). + - **Budgetary "Bullshit" Detector:** Sanity checking financial assumptions. + - **Legislative Impact Map:** Identifying cross-law conflicts. +- **Bureaucracy "Redlining":** + - **Jargon Detection:** Identifying "officialese" that masks risk. + - **Slow-Walk Detection:** Flagging implementation plans designed for delay (excessive committees/consultation). +- **The "Counter-Brief" Suite:** + - **Traffic Light Report:** High-level political/policy risk summary. + - **Annotated Redline:** Inline commentary on departmental documents. + - **Option 4 Generator:** Developing the omitted ideological alternative to departmental "Option 3s." + - **Sunset & Review Recommender:** Built-in accountability/exit triggers. +- **Strategic Stress-Testing:** + - **Wargaming:** Predicting questions from other Cabinet Ministers (Treasury/AG). + - **Edge Case Finder:** Testing policy against vulnerable personas or sensitive scenarios. + - **Evidence Scrutiny:** Detecting circular citations or cherry-picked data. + - **Precedent Finder:** Cross-jurisdictional "proof of concept" examples (UK, Canada, etc.). + - **Consultation Auditor:** Identifying missing stakeholder perspectives. +- **Communication & Response:** + - **Interrogatory Questions:** Sharp questions for officials. + - **The Doorstop:** 20-second soundbites and deflection lines. + - **Media Suite:** Holding statements and draft social media posts (integrating with `openclaw` conventions). + +## Non-Functional Requirements +- **Preference Profile:** Configuring the audit for the specific Minister's risk tolerance and style. +- **Jurisdictional Awareness:** Defaulting to AU/NZ standards (Cabinet Manual) with portability. + +## Acceptance Criteria +- Commands: `/audit`, `/brief`, `/prep-meeting`, `/check-evidence`. +- Successful detection of "Option 3 traps," "bureaucratic friction," and "consultation gaps." +- Generation of the full "Counter-Brief" suite from a single set of inputs. + +## Out of Scope +- Direct connection to internal government EDRMS. +- Formal legal/constitutional advice. +- Processing of highly classified material. From 43ac63c7df4a7cc44a624c7d9c4f9367ed24988e Mon Sep 17 00:00:00 2001 From: "Dylan Mordaunt (Illawarra Shoalhaven LHD)" Date: Sat, 14 Feb 2026 15:48:44 +1100 Subject: [PATCH 51/57] chore(conductor): Mark track 'ministerial-audit' as complete --- conductor/tracks.md | 3 +- .../ministerial-audit_20260214/metadata.json | 4 +- .../tracks/ministerial-audit_20260214/plan.md | 46 +++--- ministerial-audit/.claude-plugin/plugin.json | 5 + ministerial-audit/.mcp.json | 9 ++ ministerial-audit/CONNECTORS.md | 18 +++ ministerial-audit/README.md | 28 ++++ ministerial-audit/commands/audit.md | 83 ++++++++++ ministerial-audit/commands/brief.md | 83 ++++++++++ ministerial-audit/commands/prep-meeting.md | 82 ++++++++++ .../skills/bureaucracy-redliner/SKILL.md | 145 ++++++++++++++++++ .../skills/comms-translator/SKILL.md | 117 ++++++++++++++ .../skills/strategic-synthesis/SKILL.md | 115 ++++++++++++++ ministerial-audit/skills/wargaming/SKILL.md | 114 ++++++++++++++ 14 files changed, 825 insertions(+), 27 deletions(-) create mode 100644 ministerial-audit/.claude-plugin/plugin.json create mode 100644 ministerial-audit/.mcp.json create mode 100644 ministerial-audit/CONNECTORS.md create mode 100644 ministerial-audit/README.md create mode 100644 ministerial-audit/commands/audit.md create mode 100644 ministerial-audit/commands/brief.md create mode 100644 ministerial-audit/commands/prep-meeting.md create mode 100644 ministerial-audit/skills/bureaucracy-redliner/SKILL.md create mode 100644 ministerial-audit/skills/comms-translator/SKILL.md create mode 100644 ministerial-audit/skills/strategic-synthesis/SKILL.md create mode 100644 ministerial-audit/skills/wargaming/SKILL.md diff --git a/conductor/tracks.md b/conductor/tracks.md index 215d84c..8da9314 100644 --- a/conductor/tracks.md +++ b/conductor/tracks.md @@ -119,5 +119,4 @@ PHASE 4: Research/Academic (parallel, depends Phase 3) │ --- -- [ ] **Track: Establish a Strategic Equalizer plugin for Ministers and Ministerial staffers to audit and challenge bureaucratic advice.** -*Link: [./tracks/ministerial-audit_20260214/](./tracks/ministerial-audit_20260214/)* +- [x] **Track: Establish a Strategic Equalizer plugin for Ministers and Ministerial staffers to audit and challenge bureaucratic advice.** (./tracks/ministerial-audit_20260214/) diff --git a/conductor/tracks/ministerial-audit_20260214/metadata.json b/conductor/tracks/ministerial-audit_20260214/metadata.json index 55425f5..99c49de 100644 --- a/conductor/tracks/ministerial-audit_20260214/metadata.json +++ b/conductor/tracks/ministerial-audit_20260214/metadata.json @@ -1,8 +1,8 @@ { "track_id": "ministerial-audit_20260214", "type": "feature", - "status": "new", + "status": "completed", "created_at": "2026-02-14T15:40:00Z", - "updated_at": "2026-02-14T15:40:00Z", + "updated_at": "2026-02-14T15:48:00Z", "description": "Establish a Strategic Equalizer plugin for Ministers and Ministerial staffers to audit and challenge bureaucratic advice." } diff --git a/conductor/tracks/ministerial-audit_20260214/plan.md b/conductor/tracks/ministerial-audit_20260214/plan.md index 28afcbd..9aeab53 100644 --- a/conductor/tracks/ministerial-audit_20260214/plan.md +++ b/conductor/tracks/ministerial-audit_20260214/plan.md @@ -1,32 +1,32 @@ # Ministerial Audit Track Plan ## Phase 1: Core Audit Engine & Redliner -- [ ] Task: Create `ministerial-audit/skills/bureaucracy-redliner/SKILL.md` - - [ ] Sub-task: Implement "Officialese" and "Slow Walk" detection. - - [ ] Sub-task: Develop "Budgetary Bullshit Detector" (financial sanity checks). - - [ ] Sub-task: Implement "Legislative Impact Map" (cross-law consistency). -- [ ] Task: Create `ministerial-audit/commands/audit.md` -- [ ] Task: Conductor - User Manual Verification 'Phase 1' (Protocol in workflow.md) +- [x] Task: Create `ministerial-audit/skills/bureaucracy-redliner/SKILL.md` + - [x] Sub-task: Implement "Officialese" and "Slow Walk" detection. + - [x] Sub-task: Develop "Budgetary Bullshit Detector" (financial sanity checks). + - [x] Sub-task: Implement "Legislative Impact Map" (cross-law consistency). +- [x] Task: Create `ministerial-audit/commands/audit.md` +- [x] Task: Conductor - User Manual Verification 'Phase 1' (Protocol in workflow.md) ## Phase 2: Strategic Synthesis & Counter-Brief -- [ ] Task: Create `ministerial-audit/skills/strategic-synthesis/SKILL.md` - - [ ] Sub-task: Implement "Option 4 Generator" and "Political Risk Radar." - - [ ] Sub-task: Develop "Sunset & Review Recommender." - - [ ] Sub-task: Implement "Consultation Auditor" (missing stakeholder detection). -- [ ] Task: Create `ministerial-audit/commands/brief.md` -- [ ] Task: Conductor - User Manual Verification 'Phase 2' (Protocol in workflow.md) +- [x] Task: Create `ministerial-audit/skills/strategic-synthesis/SKILL.md` + - [x] Sub-task: Implement "Option 4 Generator" and "Political Risk Radar." + - [x] Sub-task: Develop "Sunset & Review Recommender." + - [x] Sub-task: Implement "Consultation Auditor" (missing stakeholder detection). +- [x] Task: Create `ministerial-audit/commands/brief.md` +- [x] Task: Conductor - User Manual Verification 'Phase 2' (Protocol in workflow.md) ## Phase 3: Defense, Wargaming & Precedent -- [ ] Task: Create `ministerial-audit/skills/wargaming/SKILL.md` - - [ ] Sub-task: Define "Cabinet Colleague" personas and "Lobbyist X-Ray." - - [ ] Sub-task: Implement "Precedent Finder" (cross-jurisdictional policy search). - - [ ] Sub-task: Develop "Edge Case" stress-testing. -- [ ] Task: Create `ministerial-audit/commands/prep-meeting.md` -- [ ] Task: Conductor - User Manual Verification 'Phase 3' (Protocol in workflow.md) +- [x] Task: Create `ministerial-audit/skills/wargaming/SKILL.md` + - [x] Sub-task: Define "Cabinet Colleague" personas and "Lobbyist X-Ray." + - [x] Sub-task: Implement "Precedent Finder" (cross-jurisdictional policy search). + - [x] Sub-task: Develop "Edge Case" stress-testing. +- [x] Task: Create `ministerial-audit/commands/prep-meeting.md` +- [x] Task: Conductor - User Manual Verification 'Phase 3' (Protocol in workflow.md) ## Phase 4: Communication Suite & Finalization -- [ ] Task: Create `ministerial-audit/skills/comms-translator/SKILL.md` - - [ ] Sub-task: Implement "Doorstop" summarization and "Gotcha" detection. - - [ ] Sub-task: Design "Media Suite" (holding statements/social posts). -- [ ] Task: Final README and metadata consolidation. -- [ ] Task: Conductor - User Manual Verification 'Phase 4' (Protocol in workflow.md) +- [x] Task: Create `ministerial-audit/skills/comms-translator/SKILL.md` + - [x] Sub-task: Implement "Doorstop" summarization and "Gotcha" detection. + - [x] Sub-task: Design "Media Suite" (holding statements/social posts). +- [x] Task: Final README and metadata consolidation. +- [x] Task: Conductor - User Manual Verification 'Phase 4' (Protocol in workflow.md) diff --git a/ministerial-audit/.claude-plugin/plugin.json b/ministerial-audit/.claude-plugin/plugin.json new file mode 100644 index 0000000..5b29337 --- /dev/null +++ b/ministerial-audit/.claude-plugin/plugin.json @@ -0,0 +1,5 @@ +{ + "name": "ministerial-audit", + "version": "1.0.0", + "description": "A strategic equalizer for Ministers and Advisors to audit bureaucratic advice, detect obfuscation, and generate policy alternatives." +} diff --git a/ministerial-audit/.mcp.json b/ministerial-audit/.mcp.json new file mode 100644 index 0000000..907eff6 --- /dev/null +++ b/ministerial-audit/.mcp.json @@ -0,0 +1,9 @@ +{ + "mcpServers": { + "google-search": { + "type": "http", + "command": "npx", + "args": ["-y", "@modelcontextprotocol/server-google-search"] + } + } +} diff --git a/ministerial-audit/CONNECTORS.md b/ministerial-audit/CONNECTORS.md new file mode 100644 index 0000000..29c11f9 --- /dev/null +++ b/ministerial-audit/CONNECTORS.md @@ -0,0 +1,18 @@ +# Connectors + +## How tool references work + +Plugin files use `~~category` as a placeholder for whatever tool the user connects in that category. For example, `~~cloud storage` might mean SharePoint, Box, or any other storage provider with an MCP server. + +Plugins are **tool-agnostic** — they describe workflows in terms of categories rather than specific products. The `.mcp.json` pre-configures specific MCP servers, but any MCP server in that category works. + +## Connectors for this plugin + +| Category | Placeholder | Included servers | Other options | +|----------|-------------|-----------------|---------------| +| Cloud storage | `~~cloud storage` | SharePoint | Google Drive, OneDrive, Box | +| Legislative database | `~~legislation` | AustLII / NZLII | Westlaw, LexisNexis | +| Hansard / Parliament | `~~hansard` | ParlInfo | OpenAustralia, TheyWorkForYou | +| Media sentiment | `~~media sentiment` | GNews | Meltwater, Cision | +| Social media | `~~social media` | openclaw | Twitter/X API, LinkedIn | +| Budgetary data | `~~budget data` | Treasury.gov | World Bank, OECD | diff --git a/ministerial-audit/README.md b/ministerial-audit/README.md new file mode 100644 index 0000000..8741a56 --- /dev/null +++ b/ministerial-audit/README.md @@ -0,0 +1,28 @@ +# Ministerial Audit Plugin + +A "strategic equalizer" for Ministers and Ministerial Advisors, providing them with the tools to audit, verify, and challenge work produced by departmental officials. It bridges the information asymmetry between the bureaucracy and the executive. + +## Core Capabilities + +- **Audit & Redline**: Detect "officialese," jargon, and passive voice that masks risk or shifts intent. +- **Slow-Walk Detection**: Identify implementation plans designed for delay (excessive committees/consultation). +- **Strategic Synthesis**: Generate "Option 4" policy alternatives and map political risks. +- **Wargaming**: Prepare for Cabinet or media forums by simulating hostile questioning. +- **Comms Translator**: Distill complex briefs into 30-word "Doorstops" and strategic talking points. + +## Commands + +- `/audit`: Audit a departmental briefing or bill for obfuscation and alignment. +- `/brief`: Generate a "Counter-Brief" with strategic alternatives and risk radars. +- `/prep-meeting`: Wargame a proposal and prepare for Cabinet/Committee pushback. + +## Skills + +- `bureaucracy-redliner`: The core auditing lens. +- `strategic-synthesis`: Generating alternatives and accountability mechanisms. +- `wargaming`: Simulating colleague personas and lobbyist x-rays. +- `comms-translator`: Translating audits into public narratives. + +## Jurisdictional Focus + +Defaults to **AU/NZ** standards (Cabinet Manual, constitutional norms) with explicit **US/EU-Lite** portability modes. diff --git a/ministerial-audit/commands/audit.md b/ministerial-audit/commands/audit.md new file mode 100644 index 0000000..dce4b2d --- /dev/null +++ b/ministerial-audit/commands/audit.md @@ -0,0 +1,83 @@ +--- +name: audit +description: Audit a departmental briefing, draft legislation, or implementation plan against ministerial directives and governance standards. +arguments: + - name: document + description: The departmental document (briefing, bill, or plan) to audit. + - name: baseline + description: (Optional) The ministerial directive, manifesto point, or transcript to audit against. +--- + +# /audit Command + +Analyze departmental advice for obfuscation, "slow-walking," and alignment with the Minister's intent. + +## When to Use + +Use this command when: +- A new departmental briefing arrives and requires critical scrutiny. +- Auditing draft legislation against specific ministerial instructions. +- Reviewing implementation plans for hidden delays or "bureaucratic friction." +- You need a "Traffic Light" assessment of a policy proposal. + +## Workflow + +### 1. Context Gathering + +Ask the user to provide or confirm the "Baseline for Audit": +1. **Ministerial Directive**: Specific written or oral instructions. +2. **Policy Commitment**: Election manifesto or leadership statements. +3. **Procedural Norms**: Cabinet Manual or constitutional rules. +4. **Historical Context**: Previous versions of the document. + +### 2. Strategic Audit (Using bureaucracy-redliner) + +Execute the audit across four dimensions: +- **Redlining**: Identify passive voice, jargon, and accountability shifts. +- **Slow-Walk Check**: Detect committee bloat and vague milestones. +- **Budgetary Sanity**: Flag "gold-plating" or lack of benchmarking. +- **Legislative Impact**: Check for "stealth powers" and cross-law conflicts. + +### 3. Output Generation + +The command produces a **Ministerial Audit Report** containing: +1. **Traffic Light Summary**: Overall status (Red/Amber/Green). +2. **The "Translation" Table**: Converting "Officialese" into Plain English impacts. +3. **Interrogatory Questions**: 3-5 sharp questions for the department. +4. **Strategic Risk Radar**: Who gets angry, and what could go wrong? + +## Example Session + +**User:** `/audit document: briefing_on_housing_v2.pdf baseline: "Election commitment to build 50k houses by 2028"` + +**System:** +``` +Ministerial Audit - Housing Briefing v2 + +Audit baseline: Election commitment (50k houses by 2028). + +[~] SCANNING DOCUMENT... +[~] APPLYING BUREAUCRACY REDLINER... + +AUDIT COMPLETE. + +Overall Status: ⚠ AMBER (Alignment Risk) + +Key Findings: +1. "Officialese" Detected: The brief uses "Commence implementation in 2027" - this masks that actual construction won't start until after the next election. +2. Slow-Walk Flag: Proposes an "Inter-departmental Coordination Group" with a 12-month scoping phase. +3. Budgetary Bullshit: Contingency is set at 45% without clear justification. + +Interrogatory Questions for the Department: +1. "Can you provide a specific date for 'shovels in the ground' rather than 'commencing implementation'?" +2. "Why does the coordination group require 12 months before delivery begins?" +3. "What is the market benchmark for the 45% contingency rate in this sector?" + +Would you like to generate a full "Counter-Brief" based on this audit? [Y/n] +``` + +## Integration Points + +- **Skill**: Uses `~~ministerial-audit/bureaucracy-redliner` for deep analysis. +- **Preference**: Respects the user's "Preference Profile" (e.g., Detail Hawk vs. Strategic Lead). +- **Downstream**: Feeds into `/brief` and `/prep-meeting`. diff --git a/ministerial-audit/commands/brief.md b/ministerial-audit/commands/brief.md new file mode 100644 index 0000000..29cc269 --- /dev/null +++ b/ministerial-audit/commands/brief.md @@ -0,0 +1,83 @@ +--- +name: brief +description: Generate a comprehensive "Counter-Brief" or "Shadow Brief" to challenge a departmental narrative. +arguments: + - name: document + description: The departmental briefing or proposal to counter. + - name: intent + description: (Optional) The Minister's specific goal or ideological direction. +--- + +# /brief Command + +Generate a structured "Counter-Brief" to empower the Minister in Cabinet or departmental meetings. + +## When to Use + +Use this command when: +- You need to challenge a departmental "Preferred Option." +- You want to identify what was *omitted* from a proposal. +- You need to prepare a strategic defense for a radical policy move. +- You want a comprehensive risk/benefit analysis from a political perspective. + +## Workflow + +### 1. Document Analysis + +Perform a deep audit using: +- **bureaucracy-redliner**: Detect jargon, "slow-walk" tactics, and budget gold-plating. +- **strategic-synthesis**: Identify consultation gaps and evidence flaws. + +### 2. Strategic Alternative Generation + +Generate **Option 4**: +- Develop a credible alternative that aligns with the Minister's intent. +- Compare it against the departmental "Preferred Option" on Cost, Risk, and political ROI. + +### 3. Risk & Accountability Mapping + +- **Political Risk Radar**: Identify winners, losers, and media sentiment. +- **Sunset/Review Design**: Build in accountability triggers (Sunset clauses, Independent reviews). + +### 4. The "Counter-Brief" Suite + +Produce a consolidated report including: +1. **Executive Summary**: The "Bottom Line" risk to the Minister. +2. **The "Option 4" Proposal**: A ready-to-use alternative directive. +3. **The "Truth in Jargon" Table**: Decoding the departmental brief. +4. **Stakeholder Gap Report**: Who was missed in consultation. + +## Example Session + +**User:** `/brief document: treasury_advice_on_tax_rebate.pdf intent: "Maximize benefit for working families with children"` + +**System:** +``` +Shadow Briefing - Tax Rebate Proposal + +[~] ANALYZING TREASURY ADVICE... +[~] GENERATING STRATEGIC ALTERNATIVES... + +COUNTER-BRIEF READY. + +1. The "Option 4" (Political Alternative): +Treasury recommends a broad-based rebate (Option 3). We propose "The Working Family Targeted Rebate" which shifts 20% of the funding from high-earners to households with 2+ children. +- Fiscal Impact: Neutral vs Treasury Option 3. +- Political Impact: High (Aligns with election commitment #4). + +2. Bureaucratic "Slow-Walk" Flag: +Treasury claims IT systems require 18 months to update. Our synthesis identifies that a "Payment via Tax Code" manual override could implement the core benefit in 4 months. + +3. Stakeholder Blind Spot: +The brief consults major retailers but ignores the impact on childcare providers. + +4. Proposed Accountability: +Include a 24-month Sunset Clause and a mandatory Review by the Productivity Commission. + +Would you like to draft "Interrogatory Questions" for the Treasury Secretary based on this brief? [Y/n] +``` + +## Integration Points + +- **Skills**: Uses `~~ministerial-audit/bureaucracy-redliner` and `~~ministerial-audit/strategic-synthesis`. +- **Downstream**: Feeds into `/prep-meeting` and `/comms`. diff --git a/ministerial-audit/commands/prep-meeting.md b/ministerial-audit/commands/prep-meeting.md new file mode 100644 index 0000000..7599c54 --- /dev/null +++ b/ministerial-audit/commands/prep-meeting.md @@ -0,0 +1,82 @@ +--- +name: prep-meeting +description: Prepare for a Cabinet Committee, Select Committee, or departmental meeting by simulating pushback and stress-testing. +arguments: + - name: document + description: The proposal, brief, or bill to prepare for. + - name: forum + description: (Optional) The meeting type (Cabinet, Select Committee, Departmental Briefing). +--- + +# /prep-meeting Command + +Wargame your proposal and prepare for hostile questioning from colleagues, officials, or the opposition. + +## When to Use + +Use this command when: +- You are going into a Cabinet Committee meeting (e.g., Social Policy, Expenditure Review). +- You are preparing for a Select Committee appearance. +- You want to "Wargame" a radical proposal against Treasury/Finance skepticism. +- You need to "X-Ray" a stack of industry/lobbyist submissions before a meeting. + +## Workflow + +### 1. Forum Selection + +Identify the pressure points: +- **Cabinet Room**: Focus on inter-departmental conflict (Treasury/AG). +- **Select Committee**: Focus on political "gotchas" and stakeholder criticism. +- **Departmental Brief**: Focus on cutting through "Officialese" and "Slow-walking." + +### 2. Stress-Testing (Using wargaming skill) + +- **Cabinet Sim**: Run the "Hardest 5 Questions" from Treasury and Finance. +- **Lobbyist X-Ray**: If external documents are provided, decode the hidden "Ask." +- **Precedent Search**: Find 1-2 international "Proof of Concept" examples to cite. +- **Edge Case Check**: Run the proposal against a "High-Risk" persona. + +### 3. Preparation Output + +Generate a **Meeting Prep Pack**: +1. **The "Interrogatory List"**: Sharp questions to ask officials (to put *them* on the spot). +2. **Defensive Q&A**: The "Kill Shot" questions you will be asked, and the best strategic answers. +3. **The Precedent Card**: 2-3 "Talking Points" about international success. +4. **The "X-Ray" Summary**: How to respond to lobbyist pressure in the room. + +## Example Session + +**User:** `/prep-meeting document: environment_policy_vfinal.pdf forum: "Cabinet Social Policy Committee"` + +**System:** +``` +Cabinet Prep - Environment Policy + +Forum: Social Policy Committee (Treasury & Finance present) + +[~] WARGAMING CABINET PUSHBACK... +[~] SEARCHING FOR PRECEDENTS... + +PREP PACK READY. + +1. The "Treasury Kill-Shot" (Question for YOU): +"The department estimates $500m, but our modeling suggests the 'Deadweight Loss' could exceed 40% due to market distortion. Why aren't we using a market-led tax credit instead?" +- Strategic Response: "The market-led model in Oregon (2022) failed precisely because it couldn't scale for rural sectors. Our model uses a 'Hybrid Trigger' which international precedent suggests is 15% more efficient." + +2. The "Official Scrutiny" (Questions to ask THEM): +"Can you walk the committee through why the Oregon failure isn't applicable to your proposed tax credit model?" + +3. The Precedent: +Norway (2023) implemented this exact 'Hybrid Trigger' and saw a 12% increase in uptake within 6 months. + +4. Edge Case Warning: +Small farmers (under 50 hectares) will be disproportionately hit by the compliance burden. Suggest a 'Simplified Pathway' for them. + +Would you like to draft a "Media Holding Statement" based on these risks? [Y/n] +``` + +## Integration Points + +- **Skill**: Uses `~~ministerial-audit/wargaming` for simulation. +- **Upstream**: Uses output from `/audit` or `/brief`. +- **Downstream**: Feeds into `/comms` outputs. diff --git a/ministerial-audit/skills/bureaucracy-redliner/SKILL.md b/ministerial-audit/skills/bureaucracy-redliner/SKILL.md new file mode 100644 index 0000000..3c71848 --- /dev/null +++ b/ministerial-audit/skills/bureaucracy-redliner/SKILL.md @@ -0,0 +1,145 @@ +--- +name: ministerial-audit/bureaucracy-redliner +description: This skill acts as a "strategic equalizer" for Ministers and Advisors to audit departmental advice. Use it to detect "officialese," identifying implementation "slow-walking," sanity-checking budgetary assumptions, and mapping legislative impacts across existing laws. Invoke when a user uploads a departmental briefing, draft legislation, or implementation plan for critical review. +version: 1.0.0 +--- + +# Bureaucracy Redliner (Ministerial Auditor) + +This skill empowers the Executive to bridge the information asymmetry between the bureaucracy and the Ministry. It provides a critical lens to detect obfuscation, surface hidden risks, and ensure that departmental advice aligns with political intent and financial reality. + +**Important**: This skill is a strategic auditing tool. It does not provide formal legal advice, constitutional rulings, or financial audit certifications. It is designed to prepare the Minister for critical inquiry and strategic pushback. + +## When to Use This Skill + +Invoke when: +- Reviewing a departmental briefing paper (e.g., Cabinet Submission, Ministerial Briefing). +- Auditing draft legislation or regulations for "intent creep." +- Analyzing implementation plans for "bureaucratic friction" or delay tactics. +- Sanity-checking high-level costings and budgetary assumptions in proposals. +- Preparing for a meeting with Departmental Officials or Cabinet Committees. +- Identifying passive voice or jargon that masks accountability or shifts policy intent. + +## Regulatory Context + +| Jurisdiction | Baseline Framework | Procedural Standard | Compliance Trigger | +|--------------|--------------------|---------------------|--------------------| +| **AU/NZ (Baseline)** | Cabinet Manual / Constitution Act | Public Service Act, COPI | Cabinet Submission, Legislative Drafting | +| **United States (Lite)** | Executive Order / APA | GAO Standards | Federal Register, Congressional Briefing | +| **United Kingdom (Lite)** | Ministerial Code | Civil Service Code | Green Book, HMT Approvals | + +### AU/NZ Specifics +- **Cabinet Manual**: The authoritative guide on central government processes and the conduct of Ministers. +- **Ministerial Code of Conduct**: Ethical and procedural expectations for the Executive. +- **COPI (NZ)**: Cabinet Office Policy Instructions for legislative development. +- **Public Service Act**: Defines the role of the apolitical bureaucracy in serving the government of the day. + +## Quick Reference + +1. **Load Baseline**: Identify the Minister's intent (Policy Manifestos, Meeting Notes, past statements). +2. **Scan for Obfuscation**: Use the "Officialese" detector to flag passive voice and jargon. +3. **Audit Implementation**: Scan for "Slow-Walk" indicators (excessive committees, vague milestones). +4. **Verify Financials**: Run the "Budgetary Bullshit Detector" on cost assumptions. +5. **Map Impact**: Check the "Legislative Impact Map" for cross-law conflicts. +6. **Assess Risk**: Generate a "Traffic Light" report showing alignment vs. risk. +7. **Draft Inquiry**: Generate sharp "Interrogatory Questions" for the department. + +## Detailed Guidance + +### 1. "Officialese" & Obfuscation Detection +Identify language patterns designed to shift accountability or blur intent: +- **Passive Voice**: "It was decided..." vs. "The Minister decided..." (Masks who is responsible). +- **Vague Qualifiers**: "Appropriate," "Significant," "Substantial" (Subjective terms that avoid hard metrics). +- **Euphemisms**: "Strategic realignment" usually means "Cutting services" or "Closing an office." +- **Non-Denial Denials**: Complex sentences that appear to answer a question but actually address a different point. + +### 2. "Slow-Walk" Detection +Identify tactics that delay ministerial intent: +- **Committee Bloat**: Proposing new "Steering Groups," "Working Parties," or "Inter-departmental Taskforces" without clear end-dates. +- **Consultation Loops**: Endless rounds of "further consultation" with the same stakeholders to delay a decision. +- **Vague Milestones**: "Implementation will commence in Q3" (Commence what? Planning or delivery?). +- **Complex Dependencies**: Claiming an action "must wait for" an unrelated and slow-moving project. + +### 3. Budgetary Bullshit Detector +Sanity-check the numbers presented by officials: +- **Gold-Plating**: Identifying unusually high contingency funds (e.g., >30%) or unexplained "operational overheads." +- **Lack of Benchmarking**: Flagging when costs are significantly higher than market rates or similar projects in other sectors. +- **Sunk Cost Fallacy**: Arguments for more funding purely because "we've already spent $X million." +- **Optimism Bias**: Underestimating long-term maintenance or IT integration costs. + +### 4. Legislative Impact Map +Check for "Intent Creep" in drafting: +- **Cross-Law Conflicts**: Does this new regulation accidentally contradict a provision in the *Privacy Act* or *Public Finance Act*? +- **Stealth Powers**: Flagging clauses that grant unusually broad discretionary power to the Secretary or CEO. +- **Omission Check**: Did the "Explanatory Memo" promise a protection that didn't make it into the final Bill clauses? + +### 5. Preference Profile (Customization) +The audit depth and tone should be configured based on the user's role: +- **Detail Hawk**: High sensitivity to every phrasing change; focus on technical precision. +- **Strategic Lead**: Focus on "Traffic Light" risks and "Doorstop" soundbites. +- **Risk Neutral/Averse**: Adjust the "Red/Amber" thresholds for policy alignment. + +## Documentation Requirements + +- [ ] **Baseline Comparison**: Document the specific policy/manifesto point being audited against. +- [ ] **Redline Summary**: List of identified jargon/obfuscation points with "Translation" to plain English. +- [ ] **Risk Matrix**: Traffic light assessment (Red/Amber/Green) for Alignment, Cost, and Timeline. +- [ ] **Implementation Audit**: Specific flags for "Slow-Walk" tactics identified. +- [ ] **Interrogatory List**: 3-5 sharp questions ready for the next departmental briefing. + +## Common Mistakes (Anti-Patterns) + +| Mistake | Why It's Wrong | Instead | +|---------|----------------|---------| +| Accepting "Technical Complexity" as a delay excuse | Often a cover for departmental disagreement with the policy. | Ask for a breakdown of the specific technical hurdles and alternative "Agile" delivery models. | +| Trusting "Stakeholder Consensus" blindly | "Stakeholders" may be a curated list of departmental allies. | Ask for a list of who was *not* consulted and why. | +| Focusing on the Summary, not the Bill | Summaries are often written by comms staff; the Bill is written by lawyers. Intent diverges here. | Audit the Bill clauses directly against the Cabinet Minute. | +| Ignoring the "Status Quo" bias | Departments naturally favor existing systems over radical change. | Explicitly ask for an "Option 4" that breaks the current system. | + +## When to Escalate + +Escalate to the Chief of Staff or the Minister when: +- The department refuses to provide the raw data or cost models underlying a brief. +- A "Slow-Walk" tactic is detected in a "Priority 1" election commitment. +- The audit detects a significant contradiction between the brief and the Minister's past public statements. +- The "Budgetary Bullshit Detector" flags a >50% discrepancy from market benchmarks. + +## Privacy Considerations + +- **PHI/PII**: Generally Low (policy focused), but may involve sensitive personal data in individual case briefings. +- **Confidentiality**: HIGH. Briefings are often Cabinet-in-Confidence. +- **Data Minimization**: Do not upload highly classified or "Top Secret" documents. +- **Retention**: Audit notes and "Counter-Briefs" are part of the Ministerial record and should be managed according to the *Public Records Act*. + +## Confidence Indicators + +| Scenario | Confidence | Action | +|----------|------------|--------| +| Direct contradiction between Manifesto and Bill | High | Flag as Red; generate immediate pushback questions. | +| Passively voiced briefing with vague timelines | Medium | Flag for "Slow-Walk" audit; ask for a Gannt chart. | +| Complex financial models with no benchmark data | Low | Flag for "Budgetary Bullshit"; request raw model. | + +## Standard and Lite Modes + +- **Standard**: Full multi-source audit, annotated redline, and "Counter-Brief" suite generation. +- **Lite**: Rapid "Jargon Check" and "Doorstop" summary for a quick read on the move. + +## Tool Requirements + +- `~~web-search` - For checking media sentiment and international precedents. +- `~~document-compare` - For tracking changes between briefing versions. +- `~~openclaw` - (Optional) For social media monitoring. + +## Success Indicators + +You've applied this skill well when: +- [ ] The Minister is briefed on a hidden risk *before* the department mentions it. +- [ ] Departmental officials are "surprised" by the specificity and sharpness of the Minister's questions. +- [ ] A "Slow-Walk" implementation plan is successfully challenged and accelerated. +- [ ] A budget "Gold-Plating" attempt is identified and reduced. + +## Related Skills + +- `~~ministerial-audit/strategic-synthesis` - For generating "Option 4s" and Risk Radars. +- `~~ministerial-audit/wargaming` - For simulating Cabinet pushback. +- `~~ministerial-audit/comms-translator` - For "Doorstop" summaries and social posts. diff --git a/ministerial-audit/skills/comms-translator/SKILL.md b/ministerial-audit/skills/comms-translator/SKILL.md new file mode 100644 index 0000000..5a2f28d --- /dev/null +++ b/ministerial-audit/skills/comms-translator/SKILL.md @@ -0,0 +1,117 @@ +--- +name: ministerial-audit/comms-translator +description: This skill distills complex audits and strategic plans into media-ready outputs. Use it to generate "Doorstop" summaries (30 words), detect "Gotchas" (contradictions with past statements), and draft holding statements or social media posts. Integrates with `openclaw` for social media awareness. +version: 1.0.0 +--- + +# Comms Translator (The Media Voice) + +This skill bridges the gap between the "Strategic Audit" and the "Public Narrative." It ensures the Minister can communicate complex policy changes effectively, stay consistent with their public record, and respond rapidly to the media cycle. + +**Important**: This skill is a communication assistant. It does not replace the expertise of a Press Secretary or Chief of Staff. It is designed to provide high-speed drafts and consistency checks for political and public communication. + +## When to Use This Skill + +Invoke when: +- You need a "Doorstop" summary (20-30 words) of a complex policy change. +- Preparing for a media interview and wanting to check for "Gotchas" (contradictions with past statements). +- Drafting a "Media Holding Statement" after an audit identifies a significant risk. +- Creating social media content based on a new policy announcement. +- Distilling a "Counter-Brief" into three key talking points for public consumption. + +## Regulatory Context + +| Jurisdiction | Comms Goal | Consistency Baseline | Success Indicator | +|--------------|------------|----------------------|-------------------| +| **AU/NZ (Baseline)** | Public Trust | Parliamentary Record (Hansard) | Positive Media Cycle / Sentiment | +| **United States (Lite)** | Transparency | Public Record / Social History | Engagement / News Cycle Control | +| **United Kingdom (Lite)** | Accuracy | Minister's Past Statements | Integrity Rating | + +### AU/NZ Specifics +- **The "Hansard" Check**: Comparing current proposals against previous answers to questions in the House. +- **Media Ethics**: Ensuring holding statements are accurate and not misleading. +- **Social Media Guardrails**: Drafting content that is professional yet engaging for a modern political landscape. + +## Quick Reference + +1. **Generate Doorstop**: Distill 50 pages into 30 words. +2. **Perform "Gotcha" Audit**: Compare the proposal against the Minister's voting record and past interviews. +3. **Draft Talking Points**: Create three "Bulletproof" lines that address the core risk. +4. **Create Media Suite**: Holding statements and draft social posts (using `openclaw` style). +5. **Develop Deflection Lines**: For high-risk areas, provide "Pivot" phrases. + +## Detailed Guidance + +### 1. The "Doorstop" Summarizer +The 30-word rule: +- **What is it?**: One sentence on the action. +- **Why are we doing it?**: One sentence on the benefit. +- **Who is it for?**: One mention of the primary beneficiary. +- **Tone**: Active, confident, and plain English (No "officialese"). + +### 2. "Gotcha" Detection +The "Opposition Research" lens: +- **Past Statements**: Compare the current draft against the Minister's interviews from the last 24 months. +- **Voting Record**: Does this policy contradict a previous vote? +- **Ideological Flip-Flops**: Flag if the policy uses language or logic previously criticized by the Minister. +- **Consistency Rationale**: If there *is* a change, provide the "Growth Narrative" (why the position has evolved). + +### 3. Talking Points (Strategic Messaging) +Move from "What it is" to "What it means": +- **Line 1 (The Mission)**: The positive change for the citizen. +- **Line 2 (The Problem)**: Why the current system (the status quo) had to change. +- **Line 3 (The Assurance)**: How we are protecting the vulnerable or ensuring fiscal responsibility. + +### 4. Media Suite Generation +Ready-to-use artifacts: +- **Holding Statement**: For "Amber/Red" risks identified in the audit. +- **Social Posts**: Short, punchy content optimized for platforms (X, LinkedIn, FB). +- **Pivot Lines**: "I'm not going to get into the departmental process; what I'm focused on is the 10,000 families who will benefit..." + +## Documentation Requirements + +- [ ] **Doorstop Card**: 30-word summary and 3 key talking points. +- [ ] **Gotcha Report**: List of potential contradictions and proposed "Consistency Rationale." +- [ ] **Holding Statement**: Draft response to the most likely critical media inquiry. +- [ ] **Social Pack**: 3-5 draft posts with appropriate hashtags/tags. + +## Common Mistakes (Anti-Patterns) + +| Mistake | Why It's Wrong | Instead | +|---------|----------------|---------| +| Using "Officialese" in Comms | It sounds like a bureaucrat, not a leader. It breeds distrust. | Use active verbs and concrete nouns (e.g., "Helping families" vs "Enhanced service delivery"). | +| Ignoring past contradictions | The media *will* find them. | Acknowledge the change in position and explain the "New Information" that led to it. | +| Making talking points too long | They won't fit in a 10-second news grab. | Keep each point to 15 words or fewer. | +| Being overly defensive | It signals that you are hiding a risk. | Pivot to the positive outcome for the citizen. | + +## Confidence Indicators + +| Scenario | Confidence | Action | +|----------|------------|--------| +| Proposal directly aligns with a recent high-profile interview | High | Use the interview language in the talking points. | +| Clear contradiction with a vote from 5 years ago | Medium | Flag as "Low Risk" but provide a "Growth Narrative." | +| Major contradiction with a statement from last week | High | Flag as RED; suggest immediate comms strategy review. | + +## Standard and Lite Modes + +- **Standard**: Full Gotcha audit, 5-point Talking Point suite, and complete Media Pack. +- **Lite**: Rapid "Doorstop" distillation and "Pivot Lines" only. + +## Tool Requirements + +- `~~web-search` - For checking past media interviews and social media history. +- `~~openclaw` - For social media trend awareness. +- `~~ministerial-audit/bureaucracy-redliner` - For identifying the "Plain English" impacts. + +## Success Indicators + +You've applied this skill well when: +- [ ] The Minister stays "On Message" during a high-pressure interview. +- [ ] A potential "Gotcha" is neutralized with a well-prepared consistency rationale. +- [ ] A complex policy is correctly summarized in a 20-second news grab. +- [ ] Social media engagement is positive and aligns with the core policy intent. + +## Related Skills + +- `~~ministerial-audit/strategic-synthesis` - For the "Risk Radar" that informs the holding statement. +- `~~ministerial-audit/wargaming` - For testing the talking points in a simulated hostile forum. diff --git a/ministerial-audit/skills/strategic-synthesis/SKILL.md b/ministerial-audit/skills/strategic-synthesis/SKILL.md new file mode 100644 index 0000000..a5188c2 --- /dev/null +++ b/ministerial-audit/skills/strategic-synthesis/SKILL.md @@ -0,0 +1,115 @@ +--- +name: ministerial-audit/strategic-synthesis +description: This skill enables Ministers and Advisors to move beyond simple auditing to generating strategic alternatives and identifying systemic risks. Use it to generate "Option 4" policy alternatives, map political risks across stakeholders, identify gaps in consultation, and suggest accountability mechanisms like sunset clauses. +version: 1.0.0 +--- + +# Strategic Synthesis (The Executive Brain) + +This skill provides the strategic "counter-weight" to departmental policy framing. It assists the Executive in identifying what has been omitted, who has been ignored, and how to structure policy for long-term political success and accountability. + +**Important**: This skill is for strategic planning and decision support. It does not replace the need for formal department-led policy development but provides the Minister with a high-leverage "Shadow Policy" capability. + +## When to Use This Skill + +Invoke when: +- A briefing presents "Options" that feel restricted or biased toward a departmental preference. +- You need to map the political impact of a policy across different societal and industry groups. +- Auditing the "Consultation" section of a brief for missing or marginalized voices. +- Designing a new program and wanting to build in automatic exit or review mechanisms. +- Developing a "Shadow Brief" to challenge a departmental narrative in Cabinet. + +## Regulatory Context + +| Jurisdiction | Synthesis Goal | Accountability Norm | Success Indicator | +|--------------|----------------|---------------------|-------------------| +| **AU/NZ (Baseline)** | Ministerial Responsibility | Public Interest Test | PBAC/MSAC-style evidence rigor | +| **United States (Lite)** | Executive Privilege | OMB Circular A-4 | RIA (Regulatory Impact Analysis) | +| **United Kingdom (Lite)** | Political Neutrality | The Green Book | Value for Money (VfM) | + +### AU/NZ Specifics +- **Ministerial Responsibility**: Ministers are responsible for the policy direction, regardless of departmental advice. +- **Evidence-Based Policy**: Ensuring the "evidence" isn't just internal departmental recycling. +- **Stakeholder Engagement**: Moving beyond the "usual suspects" to find broader community impact. + +## Quick Reference + +1. **Generate Option 4**: Identify the omitted ideological alternative to the departmental choices. +2. **Map Risk Radar**: Use the "Political Risk Radar" to predict stakeholder reactions. +3. **Audit Consultation**: Identify which groups were *not* consulted and why it matters. +4. **Recommend Accountability**: Build in "Sunset Clauses" and mandatory independent reviews. +5. **Stress Test Logic**: Find the "Edge Case" scenarios where the policy fails. + +## Detailed Guidance + +### 1. The "Option 4" Generator +Departments often present three choices: Suicidal, Ineffectual, and "The Department's Pick." +- **Analyze the Logic**: Identify the constraints the department has placed on the problem. +- **Break the Frame**: Suggest a fourth option that aligns with the Minister's core ideological goals (e.g., more market-led, more community-focused, or more disruptive to the status quo). +- **Evaluate Feasibility**: Provide a "rough order of magnitude" for implementation of Option 4. + +### 2. Political Risk Radar +Map the policy across the political landscape: +- **Direct Winners/Losers**: Who gains/loses money, power, or convenience immediately? +- **Secondary Stakeholders**: How do groups like Unions, Chambers of Commerce, or Advocacy groups react? +- **"The Front Page" Test**: Predict the headline in a hostile vs. friendly media outlet. +- **Alignment Check**: Does this conflict with the party's core voting base or swing-voter commitments? + +### 3. Consultation Auditor +Identify the "silent voices" in a departmental brief: +- **Stakeholder Mapping**: List who was consulted. +- **Gap Analysis**: Identify missing sectors (e.g., small business vs. corporate; rural vs. urban; end-users vs. providers). +- **Power Imbalance**: Flag if the "Consensus" is dominated by groups that benefit from the status quo. + +### 4. Sunset & Review Recommender +Ensure the Minister has an "exit strategy": +- **Sunset Clauses**: Recommend automatic expiration (e.g., 5 years) for new regulatory powers. +- **Independent Reviews**: Mandate a review by a non-departmental entity (e.g., Auditor General, Private Consultant) at the 24-month mark. +- **Success Metrics**: Define what "Failure" looks like *before* implementation begins. + +## Documentation Requirements + +- [ ] **Option 4 Brief**: A credible alternative proposal with its own risks and benefits. +- [ ] **Stakeholder Matrix**: Mapping "Support vs. Influence" for the proposed policy. +- [ ] **Consultation Gap Report**: List of missing perspectives and proposed "Targeted Consultation" questions. +- [ ] **Accountability Framework**: Proposed Sunset and Review clauses for the legislation. + +## Common Mistakes (Anti-Patterns) + +| Mistake | Why It's Wrong | Instead | +|---------|----------------|---------| +| Confusing "Policy Risk" with "Political Risk" | Departments focus on "will the program work?"; Ministers care about "will I get blamed?". | Explicitly separate the two in your synthesis. | +| Relying on Departmental "Preferred" options | These are often designed for administrative ease, not political effectiveness. | Always demand an alternative that prioritizes the Minister's mandate. | +| Assuming "Consultation" means "Agreement" | Often it's just informing people. | Check for evidence of *changed* thinking based on consultation feedback. | +| Making Sunset clauses too long | A 10-year sunset is a lifetime in politics; it rarely triggers change. | Suggest 3-5 years for high-risk or novel programs. | + +## Confidence Indicators + +| Scenario | Confidence | Action | +|----------|------------|--------| +| Omitted option is clearly viable and aligns with manifesto | High | Present as a priority "Option 4." | +| "Consultation" section is missing key critical stakeholders | High | Flag as a major procedural risk. | +| Complex multi-stakeholder reaction predicted | Medium | Suggest a "Wargaming" session to refine responses. | + +## Standard and Lite Modes + +- **Standard**: Full Option 4 generation, Stakeholder Mapping, and Accountability design. +- **Lite**: Rapid "Consultation Gap" check and high-level "Risk Radar" summary. + +## Tool Requirements + +- `~~web-search` - For international precedents and stakeholder sentiment. +- `~~ministerial-audit/bureaucracy-redliner` - (Prerequisite) To identify the gaps to be synthesized. + +## Success Indicators + +You've applied this skill well when: +- [ ] The Minister chooses a more effective option that the department hadn't proposed. +- [ ] A "blind spot" in stakeholder consultation is addressed before a media scandal breaks. +- [ ] A program has clear "Success/Failure" triggers built in from day one. +- [ ] The Minister is prepared for the "Political Risk" that the departmental brief ignored. + +## Related Skills + +- `~~ministerial-audit/bureaucracy-redliner` - For identifying the "Officialese" to be countered. +- `~~ministerial-audit/wargaming` - For testing the "Option 4" in a simulated environment. diff --git a/ministerial-audit/skills/wargaming/SKILL.md b/ministerial-audit/skills/wargaming/SKILL.md new file mode 100644 index 0000000..647bc3f --- /dev/null +++ b/ministerial-audit/skills/wargaming/SKILL.md @@ -0,0 +1,114 @@ +--- +name: ministerial-audit/wargaming +description: This skill prepares Ministers for high-stakes meetings (Cabinet, Select Committees, Media) by simulating opposition and stress-testing policy. Use it to predict "Treasury/AG" questions, decode lobbyist submissions (Lobbyist X-Ray), find international precedents, and stress-test policy against "Edge Case" personas. +version: 1.0.0 +--- + +# Wargaming & Defense (The Meeting Prep) + +This skill prepares the Minister for the "actual" meeting by simulating the pressures of the Cabinet Committee room, the hostile press gallery, or the critical cross-examination of the Department of Finance. It focuses on finding the weaknesses in a proposal *before* someone else does. + +**Important**: This skill is a simulation and stress-testing tool. It does not replace formal inter-departmental consultation but helps the Minister navigate it with a "strategic advantage." + +## When to Use This Skill + +Invoke when: +- Preparing for a Cabinet Committee meeting where other Ministers (Treasury, Finance, AG) will be present. +- Analyzing an external submission from a lobby group or industry body (Lobbyist X-Ray). +- Searching for proof-of-concept for a radical idea (Precedent Finder). +- Stress-testing a proposed law against vulnerable or specific citizens (Edge Case Finder). +- Preparing for a "Doorstep" or media interview on a controversial topic. + +## Regulatory Context + +| Jurisdiction | Opposition Persona | Success Indicator | +|--------------|-------------------|-------------------| +| **AU/NZ (Baseline)** | Treasury / Finance / AG | Cabinet Minute Approval | +| **United States (Lite)** | OMB / CBO / Congress | Budget Appropriation | +| **United Kingdom (Lite)** | HM Treasury / No. 10 | HMT Green Book Approval | + +### AU/NZ Specifics +- **The "Treasury Question"**: Focus on fiscal impact, efficiency, and market intervention risks. +- **The "Attorney General Question"**: Focus on constitutional risk, judicial review, and the Bill of Rights. +- **Cabinet Collective Responsibility**: Ensuring the Minister is ready to defend the policy to the whole Cabinet. + +## Quick Reference + +1. **Simulate Colleague Pushback**: Predict the "Kill Shots" from Treasury or Finance. +2. **Run Lobbyist X-Ray**: Identify the hidden "Ask" in industry submissions. +3. **Find Precedent**: Look for international "Proof of Concept" (UK, Canada, EU). +4. **Stress Test Edge Cases**: Run the logic against a "Vulnerable Single Parent" or "Small Rural Business" persona. +5. **Draft Interrogatory Prep**: Practice responding to sharp, hostile questions. + +## Detailed Guidance + +### 1. Cabinet Colleague Personas +Simulate the specific "Lens" that other Ministers will apply: +- **Treasury/Finance**: Focus on "Deadweight loss," "Moral hazard," and "Total Cost of Ownership." +- **Attorney General (AG)**: Focus on "Legislative overreach" and "Procedural fairness." +- **Social Ministers**: Focus on "Equity gaps" and "Service delivery friction." + +### 2. Lobbyist X-Ray (Decoding Submissions) +Don't read what they wrote; read what they *want*: +- **The Hidden "Ask"**: Identify the specific regulatory change or funding stream they are targeting. +- **The Omitted Fact**: Flag the data point or alternative model the lobbyist has conveniently ignored. +- **Beneficiary Analysis**: Who *really* makes money if this lobbyist's advice is taken? + +### 3. Precedent Finder (International Proof) +Counter the "It’s never been done" argument: +- **Jurisdictional Search**: Find similar policies in comparable systems (NZ, AU, UK, CA, EU). +- **Lessons Learned**: Identify the "Implementation Failures" in those jurisdictions so the Minister can avoid them. +- **Validation**: Use international success as "Evidence" to bypass local departmental resistance. + +### 4. Edge Case Stress-Testing +Policy often works for the "average" but fails for the "extreme": +- **Vulnerable Personas**: How does this impact someone with no digital access? Or a single parent working three jobs? +- **Small Business Persona**: Does this add 20 hours of compliance work to a 2-person firm? +- **The "Scandal" Scenario**: If the system fails in X way, what is the most damaging headline? + +## Documentation Requirements + +- [ ] **Cabinet Q&A Prep**: A list of the 10 hardest questions Treasury/Finance/AG will ask, with draft responses. +- [ ] **Lobbyist X-Ray Report**: A one-page "Decoding" of major external submissions. +- [ ] **Precedent Brief**: 3 international examples of this policy in action. +- [ ] **Stress-Test Log**: Results of running the policy against 3 different "Edge Case" personas. + +## Common Mistakes (Anti-Patterns) + +| Mistake | Why It's Wrong | Instead | +|---------|----------------|---------| +| "Preaching to the Converted" | Only simulating supporters. | Always simulate the *most hostile* possible colleague or journalist. | +| Ignoring the "Crown Law" risk | Ministers often underestimate the risk of a Judicial Review. | Explicitly run the "AG Persona" check. | +| Trusting Lobbyist "Data" | It is curated for a specific outcome. | Use the X-Ray to find the data they *didn't* include. | +| Searching only for "Successes" | You won't be ready for the "Failure" arguments. | Search for where this policy *failed* internationally and explain how you've fixed it. | + +## Confidence Indicators + +| Scenario | Confidence | Action | +|----------|------------|--------| +| Strong international precedent found for a "radical" idea | High | Present as "Proven Best Practice" to officials. | +| Major constitutional risk identified in AG persona check | High | Flag as RED; suggest immediate legal consultation. | +| Lobbyist submission has a clear, hidden commercial beneficiary | Medium | Flag for the Minister; prepare "Conflict of Interest" questions. | + +## Standard and Lite Modes + +- **Standard**: Full Cabinet simulation, international precedent search, and multi-persona stress testing. +- **Lite**: Rapid "Hardest 3 Questions" prep and a quick "Precedent Search." + +## Tool Requirements + +- `~~web-search` - Essential for international precedent and lobbyist background. +- `~~ministerial-audit/bureaucracy-redliner` - For identifying the bill clauses to stress-test. + +## Success Indicators + +You've applied this skill well when: +- [ ] The Minister is *not* surprised by a question in Cabinet. +- [ ] A "Proof of Concept" from another country is used to win a policy argument. +- [ ] A hidden lobbyist agenda is exposed and neutralized. +- [ ] A policy is modified to fix an "Edge Case" flaw before it becomes a scandal. + +## Related Skills + +- `~~ministerial-audit/strategic-synthesis` - For providing the "Option 4" to be wargamed. +- `~~ministerial-audit/comms-translator` - For turning wargame results into "Doorstop" soundbites. From 78fca55d8606dd013fb13ab91bfc986ebe99341a Mon Sep 17 00:00:00 2001 From: "Dylan Mordaunt (Illawarra Shoalhaven LHD)" Date: Sat, 14 Feb 2026 16:21:44 +1100 Subject: [PATCH 52/57] chore(conductor): Add new track 'real-estate-nz' --- conductor/tracks.md | 4 ++ .../tracks/real-estate-nz_20260214/index.md | 5 +++ .../real-estate-nz_20260214/metadata.json | 8 ++++ .../tracks/real-estate-nz_20260214/plan.md | 33 +++++++++++++++ .../tracks/real-estate-nz_20260214/spec.md | 40 +++++++++++++++++++ 5 files changed, 90 insertions(+) create mode 100644 conductor/tracks/real-estate-nz_20260214/index.md create mode 100644 conductor/tracks/real-estate-nz_20260214/metadata.json create mode 100644 conductor/tracks/real-estate-nz_20260214/plan.md create mode 100644 conductor/tracks/real-estate-nz_20260214/spec.md diff --git a/conductor/tracks.md b/conductor/tracks.md index 8da9314..55b7f44 100644 --- a/conductor/tracks.md +++ b/conductor/tracks.md @@ -120,3 +120,7 @@ PHASE 4: Research/Academic (parallel, depends Phase 3) │ --- - [x] **Track: Establish a Strategic Equalizer plugin for Ministers and Ministerial staffers to audit and challenge bureaucratic advice.** (./tracks/ministerial-audit_20260214/) + +--- + +- [ ] **Track: Establish a Real Estate NZ plugin focused on Ray White Lower Hutt workflows, covering the property lifecycle from prospecting to settlement.** (./tracks/real-estate-nz_20260214/) diff --git a/conductor/tracks/real-estate-nz_20260214/index.md b/conductor/tracks/real-estate-nz_20260214/index.md new file mode 100644 index 0000000..330be5f --- /dev/null +++ b/conductor/tracks/real-estate-nz_20260214/index.md @@ -0,0 +1,5 @@ +# Track real-estate-nz_20260214 Context + +- [Specification](./spec.md) +- [Implementation Plan](./plan.md) +- [Metadata](./metadata.json) diff --git a/conductor/tracks/real-estate-nz_20260214/metadata.json b/conductor/tracks/real-estate-nz_20260214/metadata.json new file mode 100644 index 0000000..de19bc3 --- /dev/null +++ b/conductor/tracks/real-estate-nz_20260214/metadata.json @@ -0,0 +1,8 @@ +{ + "track_id": "real-estate-nz_20260214", + "type": "feature", + "status": "new", + "created_at": "2026-02-14T16:20:00Z", + "updated_at": "2026-02-14T16:20:00Z", + "description": "Establish a Real Estate NZ plugin focused on Ray White Lower Hutt workflows, covering the property lifecycle from prospecting to settlement." +} diff --git a/conductor/tracks/real-estate-nz_20260214/plan.md b/conductor/tracks/real-estate-nz_20260214/plan.md new file mode 100644 index 0000000..c98841e --- /dev/null +++ b/conductor/tracks/real-estate-nz_20260214/plan.md @@ -0,0 +1,33 @@ +# Real Estate NZ Track Plan + +## Phase 1: Listing & Marketing Core +- [ ] Task: Create `real-estate-nz/skills/marketing-suite/SKILL.md` + - [ ] Sub-task: Implement "ToV Personalization" and "Renovation ROI Estimator." + - [ ] Sub-task: Develop "Teaser Campaign," "Suburb Decoder," and "Pre-Listing Kit" logic. +- [ ] Task: Create `real-estate-nz/commands/draft-listing.md` +- [ ] Task: Conductor - User Manual Verification 'Phase 1' (Protocol in workflow.md) + +## Phase 2: CRM & Lead Management +- [ ] Task: Create `real-estate-nz/skills/lead-management/SKILL.md` + - [ ] Sub-task: Implement "Golden Database Tagger" and "Hot Lead Detector." + - [ ] Sub-task: Develop "Voice-to-Text Cleaner" and "Rainy Day Pivot." +- [ ] Task: Create `real-estate-nz/commands/manage-leads.md` +- [ ] Task: Create `real-estate-nz/commands/vendor-report.md` +- [ ] Task: Conductor - User Manual Verification 'Phase 2' (Protocol in workflow.md) + +## Phase 3: Appraisal & Due Diligence +- [ ] Task: Create `real-estate-nz/skills/property-analyst/SKILL.md` + - [ ] Sub-task: Implement "Market Cycle Adjuster" and "Investment Yield Calculator." + - [ ] Sub-task: Develop "Due Diligence Scrutiny" and "School Zone Future Proofing." +- [ ] Task: Create `real-estate-nz/commands/generate-appraisal.md` +- [ ] Task: Create `real-estate-nz/commands/audit-due-diligence.md` +- [ ] Task: Conductor - User Manual Verification 'Phase 3' (Protocol in workflow.md) + +## Phase 4: Compliance & Negotiation +- [ ] Task: Create `real-estate-nz/skills/compliance-closer/SKILL.md` + - [ ] Sub-task: Implement REA/AML audit logic. + - [ ] Sub-task: Develop "Method of Sale" and "Multi-offer" strategy generators. +- [ ] Task: Create `real-estate-nz/commands/check-compliance.md` +- [ ] Task: Create `real-estate-nz/commands/prepare-negotiation.md` +- [ ] Task: Final README and metadata consolidation. +- [ ] Task: Conductor - User Manual Verification 'Phase 4' (Protocol in workflow.md) diff --git a/conductor/tracks/real-estate-nz_20260214/spec.md b/conductor/tracks/real-estate-nz_20260214/spec.md new file mode 100644 index 0000000..7e57d24 --- /dev/null +++ b/conductor/tracks/real-estate-nz_20260214/spec.md @@ -0,0 +1,40 @@ +# Specification: Real Estate NZ Plugin (real-estate-nz) + +## Overview +This plugin transforms Claude into a specialist for New Zealand Real Estate Agents, focusing on the workflows of the Ray White network (Lower Hutt baseline). It covers the property lifecycle from prospecting to settlement, focusing on marketing, strategic appraisals, and strict REA/AML compliance. + +## User Personas +- **Real Estate Agents (NZ):** Focus on conversion, high-quality marketing, and vendor management. +- **Sales Associates:** Focus on administration, listing drafting, and due diligence prep. + +## Functional Requirements +- **Lead & CRM Management:** + - **Golden Database Tagger:** Life-stage segmentation. + - Voice-to-Text Cleaner and Hot Lead Detector. + - Rainy Day Pivot and Vendor Feedback Synthesis. +- **Marketing Suite:** + - **Renovation ROI Estimator:** Advising on pre-sale value adds. + - Trade Me listings, Social Teasers, and Pre-Listing Kits. + - Suburb Decoder and Auction/Tender Openers. +- **Strategic Appraisal Suite:** + - **Market Cycle Adjuster:** Adapting strategy to Boom/Bust cycles. + - **Investment Yield Calculator:** ROI analysis for investors. + - Comparable sales analysis and Appraisal Evidence Pack. +- **Due Diligence & Compliance:** + - **School Zone Future Proofing:** Border zone risk checks. + - Scrutiny Engine (LIMs/Titles) and REA/AML Auditor. +- **Negotiation & Settlement:** + - Method of Sale specialization and Multi-offer strategy. + - Key Handover Checklist. + +## Non-Functional Requirements +- **ToV Personalization:** Learning and mimicking the specific agent's brand voice. +- **Standard vs. Lite Modes:** Transactional vs. Strategic workflows. + +## Acceptance Criteria +- Commands: `/manage-leads`, `/draft-listing`, `/generate-appraisal`, `/check-compliance`, `/prepare-negotiation`, `/audit-due-diligence`, `/vendor-report`. +- Successful handling of NZ-specific documents (LIM, AML forms, REA disclosures). + +## Out of Scope +- Direct trust account management or legal settlement. +- Binding valuations (registered valuer only). From 29ae87590b6cd5cb4284ac774549fbe84ea665b6 Mon Sep 17 00:00:00 2001 From: "Dylan Mordaunt (Illawarra Shoalhaven LHD)" Date: Sat, 14 Feb 2026 16:26:43 +1100 Subject: [PATCH 53/57] chore(conductor): Mark track 'health-evidence' as complete --- conductor/tracks.md | 2 +- 1 file changed, 1 insertion(+), 1 deletion(-) diff --git a/conductor/tracks.md b/conductor/tracks.md index 55b7f44..970156e 100644 --- a/conductor/tracks.md +++ b/conductor/tracks.md @@ -53,7 +53,7 @@ PHASE 4: Research/Academic (parallel, depends Phase 3) │ - Phase: 3 - Adapts From: finance -- [ ] **Track: health-evidence** (./tracks/health-evidence/) +- [x] **Track: health-evidence** (./tracks/health-evidence/) - Phase: 3 - Adapts From: bio-research From 30c789c321defd9d24bb55010e9a67cc43dc9a6a Mon Sep 17 00:00:00 2001 From: "Dylan Mordaunt (Illawarra Shoalhaven LHD)" Date: Sat, 14 Feb 2026 16:37:24 +1100 Subject: [PATCH 54/57] feat: Implement Real Estate plugin --- conductor/tracks.md | 4 + .../tracks/real-estate_20260214/index.md | 5 + .../tracks/real-estate_20260214/metadata.json | 8 + conductor/tracks/real-estate_20260214/plan.md | 33 ++++ conductor/tracks/real-estate_20260214/spec.md | 40 +++++ real-estate/.claude-plugin/plugin.json | 5 + real-estate/.mcp.json | 9 ++ real-estate/CONNECTORS.md | 18 +++ real-estate/README.md | 24 +++ real-estate/commands/audit-due-diligence.md | 68 ++++++++ real-estate/commands/check-compliance.md | 68 ++++++++ real-estate/commands/draft-listing.md | 77 +++++++++ real-estate/commands/generate-appraisal.md | 77 +++++++++ real-estate/commands/manage-leads.md | 71 ++++++++ real-estate/commands/prepare-negotiation.md | 72 +++++++++ real-estate/commands/vendor-report.md | 64 ++++++++ real-estate/skills/compliance-closer/SKILL.md | 144 +++++++++++++++++ real-estate/skills/lead-management/SKILL.md | 144 +++++++++++++++++ real-estate/skills/marketing-suite/SKILL.md | 150 +++++++++++++++++ real-estate/skills/property-analyst/SKILL.md | 151 ++++++++++++++++++ 20 files changed, 1232 insertions(+) create mode 100644 conductor/tracks/real-estate_20260214/index.md create mode 100644 conductor/tracks/real-estate_20260214/metadata.json create mode 100644 conductor/tracks/real-estate_20260214/plan.md create mode 100644 conductor/tracks/real-estate_20260214/spec.md create mode 100644 real-estate/.claude-plugin/plugin.json create mode 100644 real-estate/.mcp.json create mode 100644 real-estate/CONNECTORS.md create mode 100644 real-estate/README.md create mode 100644 real-estate/commands/audit-due-diligence.md create mode 100644 real-estate/commands/check-compliance.md create mode 100644 real-estate/commands/draft-listing.md create mode 100644 real-estate/commands/generate-appraisal.md create mode 100644 real-estate/commands/manage-leads.md create mode 100644 real-estate/commands/prepare-negotiation.md create mode 100644 real-estate/commands/vendor-report.md create mode 100644 real-estate/skills/compliance-closer/SKILL.md create mode 100644 real-estate/skills/lead-management/SKILL.md create mode 100644 real-estate/skills/marketing-suite/SKILL.md create mode 100644 real-estate/skills/property-analyst/SKILL.md diff --git a/conductor/tracks.md b/conductor/tracks.md index 302f8ee..35d2f90 100644 --- a/conductor/tracks.md +++ b/conductor/tracks.md @@ -116,3 +116,7 @@ PHASE 4: Research/Academic (parallel, depends Phase 3) │ - Tasks should include `Owner:` and `Updated:` context at section level for accountability. - Tracks with no `IN PROGRESS` task should remain `planning`. - Explicit blockers should be marked with `BLOCKER:` or `BLOCKED:` so status tooling can detect them. + +--- + +- [x] **Track: Establish a Real Estate NZ plugin focused on Ray White Lower Hutt workflows, covering the property lifecycle from prospecting to settlement.** (./tracks/real-estate_20260214/) diff --git a/conductor/tracks/real-estate_20260214/index.md b/conductor/tracks/real-estate_20260214/index.md new file mode 100644 index 0000000..00897f0 --- /dev/null +++ b/conductor/tracks/real-estate_20260214/index.md @@ -0,0 +1,5 @@ +# Track real-estate_20260214 Context + +- [Specification](./spec.md) +- [Implementation Plan](./plan.md) +- [Metadata](./metadata.json) diff --git a/conductor/tracks/real-estate_20260214/metadata.json b/conductor/tracks/real-estate_20260214/metadata.json new file mode 100644 index 0000000..fa9720c --- /dev/null +++ b/conductor/tracks/real-estate_20260214/metadata.json @@ -0,0 +1,8 @@ +{ + "track_id": "real-estate_20260214", + "type": "feature", + "status": "new", + "created_at": "2026-02-14T16:20:00Z", + "updated_at": "2026-02-14T16:20:00Z", + "description": "Establish a Real Estate NZ plugin focused on Ray White Lower Hutt workflows, covering the property lifecycle from prospecting to settlement." +} diff --git a/conductor/tracks/real-estate_20260214/plan.md b/conductor/tracks/real-estate_20260214/plan.md new file mode 100644 index 0000000..4ee3b5a --- /dev/null +++ b/conductor/tracks/real-estate_20260214/plan.md @@ -0,0 +1,33 @@ +# Real Estate NZ Track Plan + +## Phase 1: Listing & Marketing Core +- [ ] Task: Create `real-estate/skills/marketing-suite/SKILL.md` + - [ ] Sub-task: Implement "ToV Personalization" and "Renovation ROI Estimator." + - [ ] Sub-task: Develop "Teaser Campaign," "Suburb Decoder," and "Pre-Listing Kit" logic. +- [ ] Task: Create `real-estate/commands/draft-listing.md` +- [ ] Task: Conductor - User Manual Verification 'Phase 1' (Protocol in workflow.md) + +## Phase 2: CRM & Lead Management +- [ ] Task: Create `real-estate/skills/lead-management/SKILL.md` + - [ ] Sub-task: Implement "Golden Database Tagger" and "Hot Lead Detector." + - [ ] Sub-task: Develop "Voice-to-Text Cleaner" and "Rainy Day Pivot." +- [ ] Task: Create `real-estate/commands/manage-leads.md` +- [ ] Task: Create `real-estate/commands/vendor-report.md` +- [ ] Task: Conductor - User Manual Verification 'Phase 2' (Protocol in workflow.md) + +## Phase 3: Appraisal & Due Diligence +- [ ] Task: Create `real-estate/skills/property-analyst/SKILL.md` + - [ ] Sub-task: Implement "Market Cycle Adjuster" and "Investment Yield Calculator." + - [ ] Sub-task: Develop "Due Diligence Scrutiny" and "School Zone Future Proofing." +- [ ] Task: Create `real-estate/commands/generate-appraisal.md` +- [ ] Task: Create `real-estate/commands/audit-due-diligence.md` +- [ ] Task: Conductor - User Manual Verification 'Phase 3' (Protocol in workflow.md) + +## Phase 4: Compliance & Negotiation +- [ ] Task: Create `real-estate/skills/compliance-closer/SKILL.md` + - [ ] Sub-task: Implement REA/AML audit logic. + - [ ] Sub-task: Develop "Method of Sale" and "Multi-offer" strategy generators. +- [ ] Task: Create `real-estate/commands/check-compliance.md` +- [ ] Task: Create `real-estate/commands/prepare-negotiation.md` +- [ ] Task: Final README and metadata consolidation. +- [ ] Task: Conductor - User Manual Verification 'Phase 4' (Protocol in workflow.md) diff --git a/conductor/tracks/real-estate_20260214/spec.md b/conductor/tracks/real-estate_20260214/spec.md new file mode 100644 index 0000000..f959126 --- /dev/null +++ b/conductor/tracks/real-estate_20260214/spec.md @@ -0,0 +1,40 @@ +# Specification: Real Estate NZ Plugin (real-estate) + +## Overview +This plugin transforms Claude into a specialist for New Zealand Real Estate Agents, focusing on the workflows of the Ray White network (Lower Hutt baseline). It covers the property lifecycle from prospecting to settlement, focusing on marketing, strategic appraisals, and strict REA/AML compliance. + +## User Personas +- **Real Estate Agents (NZ):** Focus on conversion, high-quality marketing, and vendor management. +- **Sales Associates:** Focus on administration, listing drafting, and due diligence prep. + +## Functional Requirements +- **Lead & CRM Management:** + - **Golden Database Tagger:** Life-stage segmentation. + - Voice-to-Text Cleaner and Hot Lead Detector. + - Rainy Day Pivot and Vendor Feedback Synthesis. +- **Marketing Suite:** + - **Renovation ROI Estimator:** Advising on pre-sale value adds. + - Trade Me listings, Social Teasers, and Pre-Listing Kits. + - Suburb Decoder and Auction/Tender Openers. +- **Strategic Appraisal Suite:** + - **Market Cycle Adjuster:** Adapting strategy to Boom/Bust cycles. + - **Investment Yield Calculator:** ROI analysis for investors. + - Comparable sales analysis and Appraisal Evidence Pack. +- **Due Diligence & Compliance:** + - **School Zone Future Proofing:** Border zone risk checks. + - Scrutiny Engine (LIMs/Titles) and REA/AML Auditor. +- **Negotiation & Settlement:** + - Method of Sale specialization and Multi-offer strategy. + - Key Handover Checklist. + +## Non-Functional Requirements +- **ToV Personalization:** Learning and mimicking the specific agent's brand voice. +- **Standard vs. Lite Modes:** Transactional vs. Strategic workflows. + +## Acceptance Criteria +- Commands: `/manage-leads`, `/draft-listing`, `/generate-appraisal`, `/check-compliance`, `/prepare-negotiation`, `/audit-due-diligence`, `/vendor-report`. +- Successful handling of NZ-specific documents (LIM, AML forms, REA disclosures). + +## Out of Scope +- Direct trust account management or legal settlement. +- Binding valuations (registered valuer only). diff --git a/real-estate/.claude-plugin/plugin.json b/real-estate/.claude-plugin/plugin.json new file mode 100644 index 0000000..3a10e9d --- /dev/null +++ b/real-estate/.claude-plugin/plugin.json @@ -0,0 +1,5 @@ +{ + "name": "real-estate", + "version": "1.0.0", + "description": "Specialized assistant for New Zealand Real Estate Agents, focusing on the Ray White Lower Hutt baseline. Covers marketing, appraisals, CRM management, and compliance." +} diff --git a/real-estate/.mcp.json b/real-estate/.mcp.json new file mode 100644 index 0000000..907eff6 --- /dev/null +++ b/real-estate/.mcp.json @@ -0,0 +1,9 @@ +{ + "mcpServers": { + "google-search": { + "type": "http", + "command": "npx", + "args": ["-y", "@modelcontextprotocol/server-google-search"] + } + } +} diff --git a/real-estate/CONNECTORS.md b/real-estate/CONNECTORS.md new file mode 100644 index 0000000..c97682b --- /dev/null +++ b/real-estate/CONNECTORS.md @@ -0,0 +1,18 @@ +# Connectors + +## How tool references work + +Plugin files use `~~category` as a placeholder for whatever tool the user connects in that category. For example, `~~cloud storage` might mean SharePoint, Box, or any other storage provider with an MCP server. + +Plugins are **tool-agnostic** — they describe workflows in terms of categories rather than specific products. The `.mcp.json` pre-configures specific MCP servers, but any MCP server in that category works. + +## Connectors for this plugin + +| Category | Placeholder | Included servers | Other options | +|----------|-------------|-----------------|---------------| +| CRM / Leads | `~~contact database` | NurtureCloud | Salesforce, HubSpot, Propertybase | +| Property Data | `~~property database` | CoreLogic / PropertyValue | Trade Me API, REINZ Stats | +| Cloud storage | `~~cloud storage` | SharePoint | Google Drive, OneDrive, Box | +| Legislative database | `~~legislation` | NZLII / REA | Westlaw, LexisNexis | +| Budgetary data | `~~budget data` | Hutt City Council | Stats NZ, Treasury.gov | +| Social media | `~~social media` | openclaw | Twitter/X API, LinkedIn | diff --git a/real-estate/README.md b/real-estate/README.md new file mode 100644 index 0000000..eb1383c --- /dev/null +++ b/real-estate/README.md @@ -0,0 +1,24 @@ +# Real Estate NZ Plugin + +A specialized specialist for New Zealand Real Estate Agents, focusing on the workflows of the Ray White network (using Lower Hutt as a structural baseline). It covers the entire property lifecycle from prospecting and lead nurturing to market appraisals, marketing, and negotiation. + +## Core Capabilities + +- **Marketing Suite**: Draft Trade Me descriptions, social media teasers, and pre-listing checklists personalized to the agent's brand voice. +- **Lead & CRM Management**: Rank "Hot Leads" from open homes, synthesize weekly vendor reports, and manage settlement handovers. +- **Property Analyst**: Generate evidence-based market appraisals, calculate rental yields for investors, and audit LIMs/Titles for red flags. +- **Compliance Closer**: Navigate REA Code requirements, manage multi-offer protocols, and ensure AML/CDD documentation is "audit-ready." + +## Commands + +- `/draft-listing`: Create a complete marketing suite from raw notes or dictation. +- `/manage-leads`: Prioritize prospecting and rank open home visitors. +- `/vendor-report`: Synthesize feedback into professional weekly updates. +- `/generate-appraisal`: Create data-driven appraisal packs with feature comparison tables. +- `/audit-due-diligence`: Find the "hidden" red flags in LIMs and Titles. +- `/check-compliance`: Audit listings and entities for REA/AML compliance. +- `/prepare-negotiation`: Wargame multi-offers and auctions with strategic scripts. + +## Jurisdictional Focus + +Defaults to **New Zealand** statutory requirements (REA Act, AML/CFT Act, HCC/WCC LIM standards) with portability for Australian (AU) contexts. diff --git a/real-estate/commands/audit-due-diligence.md b/real-estate/commands/audit-due-diligence.md new file mode 100644 index 0000000..ae9e75b --- /dev/null +++ b/real-estate/commands/audit-due-diligence.md @@ -0,0 +1,68 @@ +--- +name: audit-due-diligence +alias: + - check-lim + - title-audit +description: Scrutinize LIM reports, Titles, and Building Reports for red flags and disclosure requirements. +arguments: + - name: report_text + description: "Raw text or highlights from a LIM, Title, or Builder's report." + required: true + - name: property_type + description: "Type (e.g., Freehold, Cross-lease, Unit Title)." + required: false +--- + +# /audit-due-diligence Command + +Identify risks early and prepare mandatory disclosures. + +## When to Use + +Use this command when: +- You receive a fresh LIM from the Council and need to find the "hidden" red flags. +- You're reviewing a Record of Title for restrictive covenants. +- You need to draft a "Mandatory Disclosure" based on a Builder's Report. +- A buyer asks for a summary of the property's risks. + +## Workflow + +### 1. Scrutinize & Flag + +Use `~~real-estate/property-analyst` to: +- Detect "Unauthorized Works" (e.g., bathrooms with no CCC). +- Identify "Land Risks" (e.g., HCC flood plains, wind zones). +- Highlight "Title Complexities" (e.g., cross-lease common areas). + +### 2. Formulate Disclosures + +Produce: +- **Red Flag Log**: High-priority issues that could crash a sale. +- **REA Disclosure Draft**: Professional wording for the "Disclosure Form." +- **Buyer Guide Snippet**: Transparent explanation of risks for purchasers. + +## Example Session + +**User:** `/audit-due-diligence report_text: "Title: Heritage listing Grade 2. LIM: Surface flooding noted in 2016 event. Builder: Moisture reading of 22% in master ensuite." property_type: "Freehold"` + +**System:** +``` +[~] AUDITING DUE DILIGENCE... +[~] SCANNING REA CODE COMPLIANCE... + +DUE DILIGENCE AUDIT READY: + +1. Critical Red Flag: Moisture level (22%) indicates an active leak in the ensuite. This is a material latent defect. +2. Council Flag: The 2016 surface flooding record requires a 'Flood Risk' disclosure under HCC maps. +3. Title Flag: Grade 2 Heritage listing restricts future external renovations. + +REQUIRED ACTION: +- Draft REA Disclosure: "The vendor discloses that a 2026 builder's report identified elevated moisture levels in the ensuite. Prospective buyers are encouraged to seek their own technical advice." + +Would you like to draft the 'Disclosure Authorization' for the vendor to sign? [Y/n] +``` + +## Integration Points + +- **Skill**: Uses `~~real-estate/property-analyst`. +- **Downstream**: Feeds into `/check-compliance`. diff --git a/real-estate/commands/check-compliance.md b/real-estate/commands/check-compliance.md new file mode 100644 index 0000000..1dced50 --- /dev/null +++ b/real-estate/commands/check-compliance.md @@ -0,0 +1,68 @@ +--- +name: check-compliance +alias: + - rea-check + - aml-audit +description: Perform a compliance audit of a listing, contract, or client entity against REA Code and AML/CDD regulations. +arguments: + - name: document + description: "The listing text, contract draft, or client entity details (e.g., 'Trust' or 'Company')." + required: true + - name: check_type + description: "Specific focus (e.g., 'REA Code Rule 6.4' or 'AML for Family Trust')." + required: false +--- + +# /check-compliance Command + +Ensure your files are "Audit-Ready" and compliant with NZ statutory requirements. + +## When to Use + +Use this command when: +- Performing a final check of a Trade Me listing before it goes live. +- You're about to sign a new vendor and need an AML documentation checklist. +- You want to verify if a specific clause in a contract violates REA ethics. +- Auditing a complex entity (e.g., offshore company) for CDD requirements. + +## Workflow + +### 1. Scrutinize & Verify + +Use `~~real-estate/compliance-closer` to: +- Cross-check `document` against REA Code rules (misleading conduct, disclosures). +- Generate a customized `AML Checklist` for the specific entity type. +- Identify "Conflict of Interest" triggers. + +### 2. Generate Compliance Report + +Produce: +- **Compliance Status**: Pass/Fail with "Fix Needed" flags. +- **Missing Items Log**: List of IDs or Deeds still required for the file. +- **REA Risk Note**: Specific wording to mitigate misleading conduct risks. + +## Example Session + +**User:** `/check-compliance document: "Vendor is a Family Trust with 3 trustees, one lives in UK." check_type: "AML"` + +**System:** +``` +[~] AUDITING ENTITY STRUCTURE... +[~] CHECKING AML/CDD REQUIREMENTS... + +COMPLIANCE AUDIT READY: + +1. Entity Type: Family Trust (High-Medium Risk due to UK Trustee). +2. Required for File: + - Full Copy of Trust Deed (including all variations). + - Photo ID & Proof of Address for all 3 Trustees. + - Verification of 'Source of Wealth' (since UK Trustee is involved). +3. Risk Note: Ensure 'Form 1' (Conflict of Interest) is checked if any trustee has a relationship with the agency. + +Would you like to draft the 'AML Information Request' email for the trustees? [Y/n] +``` + +## Integration Points + +- **Skill**: Uses `~~real-estate/compliance-closer`. +- **Downstream**: Feeds into `/prepare-negotiation`. diff --git a/real-estate/commands/draft-listing.md b/real-estate/commands/draft-listing.md new file mode 100644 index 0000000..b83008f --- /dev/null +++ b/real-estate/commands/draft-listing.md @@ -0,0 +1,77 @@ +--- +name: draft-listing +alias: + - listing-draft + - create-ad +description: Draft a professional property listing for Trade Me, social media, and print based on raw notes, dictation, or photos. +arguments: + - name: notes + description: "Raw property features, car dictation text, or photo descriptions." + required: true + - name: agent_voice + description: "Brief description of the agent's tone (e.g., 'punchy and direct' or 'poetic lifestyle')." + required: false + - name: suburb + description: "The specific Lower Hutt or NZ suburb for amenity decoding." + required: false +--- + +# /draft-listing Command + +Draft a complete marketing suite for a new property listing, optimized for NZ platforms. + +## When to Use + +Use this command when: +- You've just walked through a new property and have messy notes or dictation. +- You need to launch a "Coming Soon" teaser on social media. +- You want to ensure your Trade Me copy includes local suburb "Hooks." +- You need a pre-listing checklist to hand to the vendor. + +## Workflow + +### 1. Clean & Structure + +Use `~~real-estate/marketing-suite` to: +- Process the `notes` (cleaning dictation, stripping filler). +- Map the property to the `suburb` amenities. +- Align the tone with the `agent_voice`. + +### 2. Generate Marketing Artifacts + +Produce: +- **Trade Me/Web Copy**: Main description with "Headline," "Hook," and "Feature List." +- **Social Media Pack**: 1x "Sneak Peek" post and 1x "Full Launch" post (OpenClaw style). +- **Print Highlights**: 3-5 bullet points for signboards or window displays. +- **Suburb amenity Card**: Why this location wins. + +### 3. Provide Vendor Value + +Generate: +- **Pre-Listing Checklist**: 5-7 tasks for the vendor to maximize value. +- **Renovation ROI Note**: (If renovations mentioned in notes) Advice on value-add potential. + +## Example Session + +**User:** `/draft-listing notes: "Petone beachfront, 3 bed villa, original floorboards, needs a bit of love in the garden, great sun, in zone for petone central" agent_voice: "poetic and heritage focused" suburb: "Petone"` + +**System:** +``` +[~] CLEANING DICTATION... +[~] DECODING PETONE AMENITIES... +[~] MATCHING HERITAGE VOICE... + +MARKETING SUITE READY: + +1. Trade Me Headline: "Heritage Charm Meets Beachfront Bliss in the Heart of Petone" +2. Trade Me Copy: "Step back in time and breathe in the salt air. This iconic 3-bedroom villa captures the very essence of Petone living... [Poetic description of boards and sun]... Just moments from the Jackson St buzz..." +3. Social Teaser: "Wait until you see the light in this Petone beachfront beauty. Coming soon. #PetoneLiving #HeritageVilla" +4. Vendor Tip: "Fix the front letterbox and trim the beachfront hedges to instantly boost that coastal street appeal." + +Would you like to generate a 'Rainy Day Pivot' strategy for the first open home? [Y/n] +``` + +## Integration Points + +- **Skill**: Uses `~~real-estate/marketing-suite`. +- **Downstream**: Feeds into `/generate-appraisal` for price alignment. diff --git a/real-estate/commands/generate-appraisal.md b/real-estate/commands/generate-appraisal.md new file mode 100644 index 0000000..7109b75 --- /dev/null +++ b/real-estate/commands/generate-appraisal.md @@ -0,0 +1,77 @@ +--- +name: generate-appraisal +alias: + - appraisal + - market-value +description: Generate a data-driven market appraisal, comparative sales table, and investment yield analysis for a NZ property. +arguments: + - name: property_details + description: "Address, bed/bath/car count, floor area, and land size." + required: true + - name: comparables + description: "List of 3 recent local sales (manual entry or raw data)." + required: true + - name: cycle + description: "Current market cycle (Rising, Falling, Flat)." + required: false +--- + +# /generate-appraisal Command + +Justify your pricing recommendations with an Evidence-based Appraisal Pack. + +## When to Use + +Use this command when: +- Preparing a listing presentation for a potential vendor. +- An investor asks for a yield and cashflow analysis. +- You need to justify a "Price Revision" using recent market evidence. +- A buyer asks for evidence to support their offer price. + +## Workflow + +### 1. Analyze & Index + +Use `~~real-estate/property-analyst` to: +- Compare the `property_details` against the `comparables`. +- Adjust for the `cycle` (indexing old sales to today's market). +- Calculate Rental Yield and local HCC rates impact. + +### 2. Synthesize Evidence + +Produce: +- **Appraisal Evidence Pack**: The "Feature vs Feature" comparison table. +- **Investment Brief**: Gross/Net Yield and Capital Growth outlook. +- **Price Range Recommendation**: Supported by data-driven rationale. + +## Example Session + +**User:** `/generate-appraisal property_details: "123 Petone St, 3 bed, 1 bath, 100sqm, 400sqm land" comparables: "15 Petone St ($1.1m), 22 Maungaraki Rd ($1.05m), 10 Beach St ($1.2m)" cycle: "Falling"` + +**System:** +``` +[~] CALCULATING COMPARATIVE VALUE... +[~] INDEXING FOR FALLING MARKET... + +APPRAISAL EVIDENCE PACK READY: + +1. Feature Comparison Table: + - Subject (123 Petone): 3 Bed | 1 Bath | 100sqm | 400sqm Land + - vs 10 Beach St (Superior): +$100k for second bathroom and beachfront access. + - vs 15 Petone St (Direct): -$20k for lack of internal garaging. + +2. Investment Yield: + - Estimated Rent: $750pw + - Gross Yield: 3.4% (Based on $1.15m mid-point) + +3. Recommended Range: $1.12m - $1.18m (BEO $1.1m) + - Rationale: The 10% premium for Petone St location remains stable despite the 5% market-wide correction. + +Would you like to draft the 'Appraisal Justification' letter for the vendor? [Y/n] +``` + +## Integration Points + +- **Skill**: Uses `~~real-estate/property-analyst`. +- **Upstream**: Feeds into `/draft-listing` copy. +- **Downstream**: Feeds into `/prepare-negotiation`. diff --git a/real-estate/commands/manage-leads.md b/real-estate/commands/manage-leads.md new file mode 100644 index 0000000..34f809b --- /dev/null +++ b/real-estate/commands/manage-leads.md @@ -0,0 +1,71 @@ +--- +name: manage-leads +alias: + - nurture-leads + - rank-leads +description: Prioritize daily prospecting calls, rank open home visitors, and draft personalized follow-ups based on CRM data. +arguments: + - name: data + description: "Raw visitor logs from open homes or prospecting notes from NurtureCloud." + required: true + - name: goal + description: "Specific focus (e.g., 'Identify 5-star buyers' or 'Draft follow-up SMS')." + required: false +--- + +# /manage-leads Command + +Optimize your lead conversion by ranking buyers and automating follow-ups. + +## When to Use + +Use this command when: +- You've just finished a busy open home and need to know who to call first. +- You're starting your morning "Power Hour" of prospecting calls. +- You want to segment your database by "Life Stage" (e.g., Growing Family vs. Empty Nester). +- You need a "Rainy Day" strategy for an upcoming campaign. + +## Workflow + +### 1. Analyze & Rank + +Use `~~real-estate/lead-management` to: +- Identify "Hot Leads" ( finance-ready, highly motivated). +- Categorize database contacts into "Golden Database" tags. +- Detect "Missing Referrals" (e.g., buyers needing a mortgage broker). + +### 2. Generate Action Items + +Produce: +- **Priority Call List**: Top leads with a "Reason for Call" and "Strategic Hook." +- **Follow-up Suite**: Personalized SMS and Email drafts for each lead. +- **Referral Brief**: Professional handoff for Loan Market or Concierge. + +## Example Session + +**User:** `/manage-leads data: "John Smith - loves the kitchen, finance approved, needs to sell in Waterloo first. Mary Jones - first home buyer, pre-approved, ready to offer."` + +**System:** +``` +[~] ANALYZING BUYER MOTIVATION... +[~] RANKING HOT LEADS... + +CONVERSION STRATEGY READY: + +1. Hot Lead #1 (5-Star): Mary Jones (Ready to offer, finance approved). + - Action: Immediate call to draft contract. + - Hook: "Confirming Mary's interest in the Petone beachfront before the weekend." + +2. Hot Lead #2 (4-Star): John Smith (Motivation high, but 'subject to sale' hurdle). + - Action: Offer a market appraisal for his Waterloo home. + - Hook: "Strategic plan to get Waterloo sold so Petone can be secured." + +3. Referrals Needed: Mary Jones (Concierge referral for her upcoming move). + +Would you like to draft the contract offer for Mary Jones? [Y/n] +``` + +## Integration Points + +- **Skill**: Uses `~~real-estate/lead-management`. +- **Downstream**: Feeds into `/prepare-negotiation`. diff --git a/real-estate/commands/prepare-negotiation.md b/real-estate/commands/prepare-negotiation.md new file mode 100644 index 0000000..a4498a0 --- /dev/null +++ b/real-estate/commands/prepare-negotiation.md @@ -0,0 +1,72 @@ +--- +name: prepare-negotiation +alias: + - multi-offer + - auction-prep +description: Develop a negotiation strategy for multi-offers, auctions, or complex counter-proposals. +arguments: + - name: scenario + description: "Brief description of the offers received (e.g., '2 offers, one subject to house sale')." + required: true + - name: method + description: "Method of sale (Auction, Tender, Deadline, BEO)." + required: true +--- + +# /prepare-negotiation Command + +Maximize the deal outcome with specialized negotiation tactics and multi-offer management. + +## When to Use + +Use this command when: +- You've just received multiple offers and need to present them to the vendor. +- You're preparing for an Auction tomorrow and need an "Opening Statement." +- You need to draft professional "Counter-offer" wording for a difficult clause. +- You want to "Score" different offers to help the vendor decide. + +## Workflow + +### 1. Strategic Analysis + +Use `~~real-estate/compliance-closer` to: +- Compare offers on Price, Conditions, and Possession. +- Draft "Multi-offer Protocol" scripts for buyers. +- Generate high-impact "Auction Openers" based on the property's emotional hooks. + +### 2. Formulate Strategy + +Produce: +- **Negotiation Brief**: Suggested counter-prices and clause revisions. +- **The "Multi-Offer Scorecard"**: A table helping the vendor see the best total value. +- **The "Best & Final" Script**: Wording to push buyers to their limit. + +## Example Session + +**User:** `/prepare-negotiation scenario: "Offer A: $1.15m, subject to sale. Offer B: $1.12m, unconditional." method: "Deadline Sale"` + +**System:** +``` +[~] ANALYZING MULTI-OFFER SCENARIO... +[~] SCORING CONTRACT RISK... + +NEGOTIATION STRATEGY READY: + +1. The Comparison: + - Offer A (Higher Price): $1.15m but 'Subject to Sale' adds ~21 days of uncertainty and high crash risk. + - Offer B (Superior Terms): $1.12m Unconditional is effectively 'Money in the bank' today. + +2. Strategic Recommendation: + - "Counter Offer B at $1.14m. The security of an unconditional deal is worth the $10k gap, but there is room to close the price difference." + +3. The 'Best & Final' Script: + - "We have received multiple interest. If you want to secure this Petone home today without competition, this is the moment to put your best foot forward." + +Would you like to draft the counter-offer wording for Offer B? [Y/n] +``` + +## Integration Points + +- **Skill**: Uses `~~real-estate/compliance-closer`. +- **Upstream**: Uses outputs from `/generate-appraisal`. +- **Downstream**: Feeds into `lead-management` for the settlement handover. diff --git a/real-estate/commands/vendor-report.md b/real-estate/commands/vendor-report.md new file mode 100644 index 0000000..580c8ba --- /dev/null +++ b/real-estate/commands/vendor-report.md @@ -0,0 +1,64 @@ +--- +name: vendor-report +alias: + - weekly-report + - campaign-update +description: Synthesize open home feedback and market data into a professional weekly report for the property vendor. +arguments: + - name: feedback + description: "Raw notes from open homes and private viewings." + required: true + - name: stats + description: "Trade Me views, watchlist counts, and contract requests." + required: false +--- + +# /vendor-report Command + +Keep your vendors informed and manage their expectations with data-driven reports. + +## When to Use + +Use this command when: +- Preparing your Monday morning "Campaign Update" for a vendor. +- You need to justify a "Price Pivot" or "Marketing Strategy Change." +- You want to demonstrate the value of your local expertise. + +## Workflow + +### 1. Synthesize Sentiment + +Use `~~real-estate/lead-management` to: +- Categorize feedback into "Positive," "Critical," and "Pricing." +- Highlight market sentiment trends (e.g., "Interest remains high forPetone beachfront"). + +### 2. Formulate Strategy + +Produce: +- **Weekly Summary**: Narrative overview of the campaign's progress. +- **The Sentiment Matrix**: What buyers like vs. what is holding them back. +- **Strategic Recommendation**: "Stay the course," "Price Revision," or "Feature Pivot." + +## Example Session + +**User:** `/vendor-report feedback: "Petone Beachfront OH: 12 groups. Feedback: 'stunning sun,' 'kitchen feels a bit dated,' 'wondering if $1.2m is too high compared to Maungaraki.'"` + +**System:** +``` +[~] SYNTHESIZING VENDOR REPORT... +[~] COMPARING SUBURB BENCHMARKS... + +WEEKLY VENDOR UPDATE READY: + +1. Campaign Snapshot: Strong engagement (12 groups). Interest is highly concentrated on the 'Lifestyle/Beachfront' hook. +2. The Sentiment: Sunlight and location are 5-star features. The kitchen condition is the primary price-resistance point. +3. Market Reality: Suburb benchmark suggests $1.2m is aggressive for a 'dated' kitchen compared to recent Maungaraki sales. +4. Recommendation: Maintain price for 7 more days to capture 'Hot Lead' Mary Jones. If no contract by Wednesday, consider a 'BEO $1.15m' pivot. + +Would you like to draft the 'Price Revision' email for the vendor? [Y/n] +``` + +## Integration Points + +- **Skill**: Uses `~~real-estate/lead-management`. +- **Downstream**: Feeds into `/draft-listing` if a marketing pivot is needed. diff --git a/real-estate/skills/compliance-closer/SKILL.md b/real-estate/skills/compliance-closer/SKILL.md new file mode 100644 index 0000000..fd4d456 --- /dev/null +++ b/real-estate/skills/compliance-closer/SKILL.md @@ -0,0 +1,144 @@ +--- +name: real-estate/compliance-closer +description: This skill should be used when managing legal compliance (REA/AML), coordinating property negotiations, and finalizing settlement documentation for New Zealand real estate. Use for auditing contracts against the REA Code, drafting "Method of Sale" strategies (Auction, Tender), generating multi-offer responses, and ensuring AML/CDD completeness. Invoke when users mention multi-offer situation, auction strategy, REA compliance, or AML checks. +version: 1.0.0 +--- + +# Compliance Closer (The Deal Manager) + +A rigorous framework for navigating the legal and strategic hurdles of a property transaction. This skill ensures the agent remains compliant with the REA Code of Conduct and AML/CDD regulations while maximizing the outcome for the vendor through specialized negotiation tactics. + +**Important**: This skill assists with compliance and strategy but does not replace formal legal advice from a solicitor or independent legal counsel. All AML/CDD verification must be completed according to the agency's formal internal policy. + +## When to Use This Skill + +Invoke this skill when: +- Auditing a Sale and Purchase Agreement against the REA Code of Conduct. +- Designing a "Method of Sale" strategy (Auction, Tender, Deadline, Price). +- Navigating a "Multi-Offer" situation and drafting vendor responses. +- Ensuring AML/CDD (Anti-Money Laundering) documentation is complete for complex entities (e.g., Trusts, Companies). +- Drafting counter-offer wording for complex contract clauses (e.g., "Subject to Finance," "Solicitor's Approval"). +- Preparing an Auctioneer or Lead Agent with an "Opening Statement" for an auction. +- Performing a final "Pre-Go-Live" compliance audit of a listing. + +## Regulatory Context + +### Australia & New Zealand (Default) + +| Regulation/Standard | Relevance | Key Requirements | +|---------------------|-----------|------------------| +| **REA Act 2008 (NZ)** | Professional standards | Statutory requirement for agent licensing and conduct | +| **REA Code of Conduct** | Transaction ethics | Rule 10.1: Client care; Rule 10.10: Disclosure of conflict | +| **AML/CFT Act (NZ)** | Identity verification | Verifying "Source of Funds" and "Beneficial Ownership" | +| **ADLS/REINZ S&P** | Contract standard | The standard form for property sales in New Zealand | + +### AU/NZ Baseline Specifics +- **Multi-Offer Rules**: Strict adherence to the agency's "Multi-offer Process" (Rule 6.2). +- **Auction Rules**: Ensuring the "Auction Conditions" are clearly displayed and verbalized. +- **AML Checks**: Specific requirements for NZ Family Trusts and Look-through Companies (LTCs). + +## Quick Reference + +1. **Audit AML**: Verify ID and Proof of Address for all "Significant Control" persons. +2. **Strategy Selection**: Choose Auction (Scarcity), Tender (Privacy/Control), or Price (Transparency). +3. **Multi-Offer Flow**: Ensure all buyers sign the "Acknowledgement of Multi-offer" form. +4. **Counter the Offer**: Use professional wording to pivot on Price, Possession, or Conditions. +5. **Auction Opener**: Focus on local amenities and the property's unique "emotional hooks." +6. **Code Audit**: Perform final 10-point check of the listing against REA Rule 6.4. + +## Operating Modes + +### Standard Mode +Full compliance and closing workflow including deep AML/CDD verification for complex entities, comprehensive multi-offer strategy generation, detailed auction prep, and formal contract auditing. Use for all live negotiations and contract signing. + +### Lite Mode +Rapid generation of an auction opening statement, quick "Multi-offer script" for buyers, or a 3-point AML checklist for an individual. Optimized for high-speed transaction updates. + +## Detailed Guidance + +### 1. REA/AML Audit Logic + +Ensure the file is "Audit-Ready": +- **Individual**: Photo ID + Proof of Address (<3 months old). +- **Trust**: Copy of Trust Deed + ID for all Trustees + ID for all Settlors. +- **Company**: Verification of all shareholders with >25% ownership. +- **Conflict of Interest**: Has the agent disclosed if they are related to the buyer or have a financial interest? (REA Form 1). + +### 2. Method of Sale Strategies + +Tailor the approach to market conditions: +- **Auction**: Best for "High Demand/Low Supply." Forces buyers to act on an unconditional basis. +- **Tender**: Best for "Unique/Premium" properties. Allows the vendor to compare "apples vs. oranges" (e.g., price vs. longer settlement). +- **Deadline Sale**: Best for "Test the Market." Similar to tender but with more flexibility to sell early. +- **BEO (Buyer Enquiry Over)**: Best for "Price Transparency." Good for high-volume family homes. + +### 3. Multi-Offer Strategy Generator + +Navigate the most high-pressure part of the job: +- **The Protocol**: Verify all buyers have been given the same deadline and opportunity. +- **The Scoring**: Compare offers on Price, Deposit, Conditions, and Possession date. +- **The "Best & Final" Script**: "We have multiple interest; please put your best foot forward as there may not be a second chance." + +### 4. Auction/Tender "Opening Statements" + +Set the energy for the sale: +- **The Hook**: "Moments from the Petone beachfront, where heritage meets modern luxury..." +- **The Value**: "A rare freehold 400sqm site in a suburb with 8% annual growth." +- **The Call**: "Who will start me today? The opportunity is yours." + +## Documentation Requirements + +- [ ] **AML/CDD Checklist**: Verification log for all involved parties. +- [ ] **Multi-Offer Summary**: Comparative table of all received offers. +- [ ] **Contract Audit Log**: Record of REA Code compliance for the listing. +- [ ] **Auction/Tender Strategy**: One-page plan for the method of sale. + +## Common Mistakes + +| Mistake | Why It's Wrong | Instead | +|---------|----------------|---------| +| **Vague Multi-offer Info** | Buyers feel "played"; risk of REA complaint | Be crystal clear about the deadline and the process. | +| **Accepting Old AML ID** | Statutory violation; heavy agency fines | Always require ID less than 3 months old or a current Passport. | +| **Misleading "BEO" Price** | "Under-quoting" leads to buyer grievance | Ensure BEO price is realistic based on recent comparables. | +| **Ignoring Chattels list** | Settlement day disputes over mirrors/shelves | Itemize every non-fixed item in the S&P agreement. | + +## When to Escalate + +Escalate to Branch Manager or Compliance Officer when: +- A buyer or vendor is identified as a "PEP" (Politically Exposed Person). +- There is suspicion of "Source of Wealth" being illegitimate. +- A multi-offer situation involves a "Conflict of Interest" with an internal staff member. +- A party refuses to sign the mandatory REA disclosure forms. + +## Privacy Considerations + +- **Confidentiality**: Multi-offer details (price/terms) must NEVER be shared between buyers. +- **Security**: AML documentation contains highly sensitive PII; store only in encrypted agency systems. + +## Confidence Indicators + +| Scenario | Confidence | Action | +|----------|------------|--------| +| Standard ADLS contract with individual buyers (clean AML) | High | Finalize Multi-offer Summary and proceed to signing. | +| Complex offshore Trust structure requiring CDD | Medium | Request all deeds and escalate to agency Compliance Officer. | +| Dispute over "Verbally accepted" offer vs. written contract | Low | HALT and recommend both parties seek immediate legal advice. | + +## Tool Requirements + +- `~~legislation` - For real-time checking of REA and AML statutory updates. +- `~~cloud storage` - For secure storage of encrypted AML/CDD logs. +- `~~document collaboration` - For multi-party contract review. + +## Success Indicators + +You've applied this skill well when: +- [ ] The Multi-offer process is so transparent that even the "losing" buyers feel treated fairly. +- [ ] AML/CDD files pass an internal or external audit with zero "Exceptions." +- [ ] The "Method of Sale" strategy results in a sale within the campaign timeframe. +- [ ] Contract conditions are "tight" and clear, leading to a smooth unconditional date. + +## Related Skills + +- `~~real-estate/marketing-suite` - For ensuring the Auction energy matches the ad copy. +- `~~real-estate/property-analyst` - For ensuring the multi-offer prices align with market evidence. +- `~~real-estate/lead-management` - For the final "Key Handover" after the deal is closed. diff --git a/real-estate/skills/lead-management/SKILL.md b/real-estate/skills/lead-management/SKILL.md new file mode 100644 index 0000000..29e8219 --- /dev/null +++ b/real-estate/skills/lead-management/SKILL.md @@ -0,0 +1,144 @@ +--- +name: real-estate/lead-management +description: This skill should be used when managing leads, open home feedback, and post-sale settlement for New Zealand real estate. Use for interpreting NurtureCloud data, ranking "Hot Leads," synthesizing weekly vendor reports, generating referral briefs for Loan Market/Concierge, and preparing settlement handover checklists. Invoke when users mention prospecting, open home feedback, vendor updates, or settlement prep. +version: 1.0.0 +--- + +# Lead Management (The Prospector & Closer) + +A comprehensive framework for maximizing lead conversion and ensuring a professional "end-to-end" client experience. This skill focuses on the Ray White NurtureCloud baseline, transforming raw feedback into strategic vendor advice and ranking buyers by conversion probability. + +**Important**: This skill assists with lead prioritization and communication but does not replace CRM data entry or the agent's relationship-building role. All "Conversion Probability" rankings are estimates based on provided buyer profiles. + +## When to Use This Skill + +Invoke this skill when: +- Interpreting NurtureCloud prospecting reports to prioritize daily calls. +- Ranking open home visitors ("Hot Lead Detector") by conversion probability. +- Synthesizing raw open-home notes into a professional "Weekly Vendor Report." +- Drafting personalized follow-up emails or SMS based on buyer preferences. +- Generating "Rainy Day Pivot" strategies for upcoming open homes. +- Drafting "Client Referral Briefs" for Loan Market (Mortgages) or Concierge. +- Preparing "Final Inspection & Key Handover" checklists for settlement. +- Auto-tagging database contacts by "Life Stage" (The Golden Database). + +## Regulatory Context + +### Australia & New Zealand (Default) + +| Regulation/Standard | Relevance | Key Requirements | +|---------------------|-----------|------------------| +| **Privacy Act 2020 (NZ)** | Lead data | Protecting buyer/vendor contact info; purpose-limited data usage | +| **REA Code of Conduct** | Communication | Rule 11.2: Keeping the client informed; Rule 6.3: Professionalism | +| **Unsolicited Electronic Messages Act** | SMS/Email marketing | Ensuring "Unsubscribe" options and valid consent for marketing | + +### AU/NZ Baseline Specifics +- **NurtureCloud**: Alignment with Ray White's proprietary CRM and prospecting logic. +- **Vendor Reporting**: Meeting the expectation for weekly, data-driven campaign updates. + +## Quick Reference + +1. **Tag the Database**: Categorize leads by "Life Stage" (e.g., First Home Buyer, Empty Nester). +2. **Rank the Leads**: Identify "Hot Leads" from open home lists based on buying readiness. +3. **Weekly Synthesis**: Distill vendor feedback into Market Sentiment, Pricing Trends, and Next Steps. +4. **Refer Professionals**: Create professional handoff briefs for brokers and movers. +5. **Weather Proof**: Apply "Rainy Day" strategies to maintain open home energy. +6. **Handover Ready**: Generate the final settlement checklist 48 hours before possession. + +## Operating Modes + +### Standard Mode +Full lead management lifecycle including deep database segmentation, complex visitor ranking, full-length vendor reports, and detailed settlement management. Use for high-volume campaigns and active listings. + +### Lite Mode +Rapid generation of follow-up SMS, quick "Top 3 Leads" identification from a single open home, or a simple settlement reminder list. Optimized for high-speed prospecting sessions. + +## Detailed Guidance + +### 1. The "Golden Database" Tagger (Life Stage) + +Move beyond "Buyer/Seller." Tag contacts to enable targeted long-term marketing: +- **First-Home Buyer**: Focused on Petone/Wainui, needs Loan Market referral. +- **Growing Family**: Looking for 4+ beds in Waterloo/Maungaraki zones. +- **Empty Nester**: Looking to downsize to modern low-maintenance units. +- **Active Investor**: Focused on yield, ROI, and school zone stability. + +### 2. Hot Lead Detector (Open Home Ranking) + +Rank visitors (1-5 stars) based on these "Hot" triggers: +- **5 Stars**: Finance pre-approved, has sold their own home, wants a contract today. +- **4 Stars**: Finance pre-approved, needs to sell, highly engaged with specific features. +- **3 Stars**: Just starting search, finance not yet certain, but active in the suburb. +- **2 Stars**: "Tyre kickers" or curious neighbors. + +### 3. Weekly Vendor Report Synthesis + +Structure reports to manage vendor expectations: +- **The Numbers**: Attendance, Trade Me views, contracts requested. +- **The Sentiment**: "Great kitchen," "Small backyard," "Price feels high for the condition." +- **The Pivot**: Suggested strategy changes based on feedback (e.g., "Change the main photo to the garden"). + +### 4. Rainy Day Pivot Strategy + +When the Hutt Valley weather is poor: +- **The Vibe**: All lights on, fireplace/heat pump to 22°C, background music louder. +- **The Welcome**: Umbrellas at the gate, shoe covers provided, "Hot Coffee" signage. +- **The Hook**: Focus copy on "Cosy heritage charm" and "Indoor-outdoor flow for when the sun returns." + +## Documentation Requirements + +- [ ] **Hot Lead List**: Priority call list with 3 talking points per lead. +- [ ] **Weekly Vendor Report**: Professional PDF-ready synthesis. +- [ ] **Referral Brief**: One-page handoff for Loan Market/Concierge. +- [ ] **Key Handover Checklist**: Final inspection verification for both parties. + +## Common Mistakes + +| Mistake | Why It's Wrong | Instead | +|---------|----------------|---------| +| **Ignoring the "Nos"** | Vendors only hear the good news; price shock later | Include critical feedback about price or condition in every report. | +| **Generic SMS Follow-ups** | Buyers feel like a number | Mention a specific feature they liked (e.g., "the sun-drenched deck"). | +| **Missing the Referral** | Loss of agency revenue and client value | Check "Needs Finance" status for every 4-5 star buyer lead. | +| **Settlement Surprises** | Ruins the referral potential | Ensure alarm codes and garage remotes are verified 24 hours prior. | + +## When to Escalate + +Escalate to Branch Manager when: +- A "Hot Lead" makes a complaint about agent conduct or disclosure. +- A vendor refuses to accept consistent market feedback regarding price. +- A settlement dispute arises regarding "Vacant Possession" or chattels. +- Lead data appears to have been leaked or misused (Privacy Breach). + +## Privacy Considerations + +- **Data Minimization**: Do not share full buyer contact lists with vendors (sentiment only). +- **Consent**: Ensure Loan Market referrals are explicitly authorized by the client. +- **Security**: NurtureCloud access should remain restricted to authorized staff. + +## Confidence Indicators + +| Scenario | Confidence | Action | +|----------|------------|--------| +| Structured visitor feedback from 3 open homes | High | Generate full Weekly Vendor Report and Hot Lead Ranking. | +| Vague NurtureCloud notes with no "Next Action" | Medium | Clean dictation and suggest 3 possible follow-up scripts. | +| Complex multi-party settlement dispute | Low | Escalate to Principal and recommend legal counsel intervention. | + +## Tool Requirements + +- `~~cloud storage` - For archiving vendor reports and settlement logs. +- `~~project tracker` - For managing settlement milestones. +- `~~contact database` - (Optional) Integration with NurtureCloud via MCP. + +## Success Indicators + +You've applied this skill well when: +- [ ] The "Hot Lead" list results in at least 2 contracts within 48 hours. +- [ ] Vendor feedback is realistic and professional, leading to timely price adjustments. +- [ ] Referral rates to Loan Market/Concierge increase by >10%. +- [ ] Settlement day is "surprise-free" for both vendor and buyer. + +## Related Skills + +- `~~real-estate/marketing-suite` - For the "Rainy Day" copy adjustments. +- `~~real-estate/property-analyst` - For data to back up vendor reports. +- `~~real-estate/compliance-closer` - For the REA audit of the final contract. diff --git a/real-estate/skills/marketing-suite/SKILL.md b/real-estate/skills/marketing-suite/SKILL.md new file mode 100644 index 0000000..db3a99c --- /dev/null +++ b/real-estate/skills/marketing-suite/SKILL.md @@ -0,0 +1,150 @@ +--- +name: real-estate/marketing-suite +description: This skill should be used when preparing property listings, marketing materials, and vendor pre-listing advice for the New Zealand real estate market. Use for drafting Trade Me descriptions, social media teasers, suburb-specific amenity profiles, and pre-listing renovation ROI advice. Invoke when users mention property descriptions, open home prep, renovation advice, or suburb amenities. +version: 1.0.0 +--- + +# Marketing Suite (NZ Real Estate) + +A comprehensive framework for creating high-impact property marketing and providing strategic pre-listing advice. This skill focuses on the Ray White Lower Hutt baseline, incorporating agent brand voice, local suburb knowledge, and value-maximizing checklists. + +**Important**: This skill assists with marketing and strategic advice but does not replace professional photography, registered valuations, or formal building inspections. All renovation advice is based on common market trends and ROI estimates. + +## When to Use This Skill + +Invoke this skill when: +- Drafting property descriptions for Trade Me, realestate.co.nz, or print media. +- Creating "Coming Soon" or "Sneak Peek" social media teaser campaigns. +- Generating suburb-specific amenity profiles (e.g., school zones, transport links). +- Providing vendors with pre-listing checklists to maximize property presentation. +- Estimating the potential ROI of pre-sale renovations (e.g., painting, landscaping). +- Personalizing marketing copy to match an agent's specific brand voice (ToV). +- Translating or adapting marketing copy for multi-language community outreach. + +## Regulatory Context + +### Australia & New Zealand (Default) + +| Regulation/Standard | Relevance | Key Requirements | +|---------------------|-----------|------------------| +| **REA Code of Conduct** | Listing accuracy | Rule 6.4: Misleading or deceptive conduct; Rule 10.7: Material latent defects | +| **Fair Trading Act (NZ)** | Marketing claims | Prohibits misleading claims about property features or zones | +| **Privacy Act 2020 (NZ)** | Vendor privacy | Protecting vendor contact details and sensitive information | +| **Copyright Act** | Media usage | Ensuring rights to use photography and floorplans | + +### AU/NZ Baseline Specifics +- **Trade Me Standards**: Adherence to Trade Me Property listing rules. +- **REA Rules**: Ensuring "puffery" does not cross into factual misrepresentation. +- **School Zones**: Accurate representation of Ministry of Education (NZ) zones. + +## Quick Reference + +1. **Brand Voice First**: Load the agent's ToV profile or 3 past successful listings. +2. **Clean Dictation**: Process raw "car dictation" notes into structured feature lists. +3. **Maximize Presentation**: Generate a "Pre-Listing Kit" for the vendor. +4. **Local Expert**: Integrate suburb-specific amenities (Hutt Valley focus). +5. **ROI Check**: Evaluate proposed renovations against estimated market value add. +6. **Tease Early**: Create social media teasers before the main listing goes live. +7. **Multi-Channel**: Draft Trade Me copy, social packs, and print highlights. + +## Operating Modes + +### Standard Mode +Full marketing workflow including deep ToV personalization, detailed suburb decoding, renovation ROI analysis, and comprehensive vendor pre-listing kits. Use for main campaign launches and strategic vendor consultations. + +### Lite Mode +Streamlined generation of quick social media captions, Trade Me "snippet" updates, or rapid suburb amenity lists. Optimized for agents on the move using mobile dictation. + +## Detailed Guidance + +### 1. ToV Personalization (The Agent's Voice) + +Every top agent has a distinct "voice." Use these patterns: +- **The Punchy Direct**: Focus on features, floor area, and ROI. Short, impactful sentences. +- **The Poetic Lifestyle**: Focus on light, flow, morning coffee on the deck, and family memories. +- **The Local Authority**: Focus on school zones, community vibes, and long-term capital growth. + +**Task**: Match the drafted copy to the provided agent profile or past examples. + +### 2. Suburb Decoder (Lower Hutt Example) + +Highlight local benefits to prove expertise: +- **Petone**: Beachfront vibe, Jackson St cafes, heritage charm, 12 min train to Wellington. +- **Waterloo**: Premier school zones (Hutt Valley High), Waterloo station hub, flat walking. +- **Maungaraki**: Panoramic views, "The Maungaraki Shop," strong community feel, hills lifestyle. +- **Wainuiomata**: Family value, regional park access, newer subdivisions, "The Nui" community. + +### 3. Renovation ROI Estimator + +Advise vendors on where to spend money before selling: +- **High ROI**: Interior painting (neutral colors), professional landscaping/hedging, fixing the letterbox/front door. +- **Medium ROI**: Modernizing kitchen hardware (handles/taps), LED lighting upgrades. +- **Low ROI**: Full high-end kitchen/bath renovations (unlikely to recoup 100% cost in a flat market). + +### 4. Voice-to-Text Cleaner + +Process messy dictation (e.g., "Umm yeah so it's got three beds... actually four if you count the study... umm Petone beach is real close..."): +1. Strip filler words ("umm", "ah"). +2. Standardize property specs (e.g., "3 beds + study"). +3. Map location cues to the Suburb Decoder. +4. Structure into a professional feature list before drafting. + +## Documentation Requirements + +- [ ] **Agent ToV Profile**: Summary of the preferred writing style. +- [ ] **Pre-Listing Checklist**: Actionable tasks for the vendor. +- [ ] **Marketing Drafts**: Trade Me, Social, and Print versions. +- [ ] **Suburb Amenity Card**: Local hooks included in the copy. +- [ ] **ROI Rationale**: Brief justification for any renovation advice given. + +## Common Mistakes + +| Mistake | Why It's Wrong | Instead | +|---------|----------------|---------| +| **Misrepresenting School Zones** | High legal risk; major buyer grievance | Use "In zone for [School]" only if verified via Education Counts. | +| **Ignoring the "Rainy Day" Vibe** | Property feels dark and cold | Add "Rainy Day Pivot" advice: all lights on, heat to 22 degrees. | +| **Generic Descriptions** | Listing blends in with 100 others | Use the Suburb Decoder and Agent Voice to find a unique "Hook." | +| **Over-promising on Renovation** | Vendor loses money | Frame ROI as "Estimated market appeal" rather than guaranteed profit. | + +## When to Escalate + +Escalate to Branch Manager or Marketing Director when: +- A vendor requests marketing claims that clearly contradict the LIM or Title. +- There is a dispute over copyright for professional photography. +- The property has unique heritage listings that require specialized legal wording. +- Marketing involves high-value "Premium" properties requiring bespoke strategy. + +## Privacy Considerations + +- **PHI Involved**: No. +- **Data Minimization**: Do not include vendor phone numbers or sensitive motivations in public listings. +- **De-identification**: Ensure "car dictation" notes are scrubbed of sensitive personal chatter before processing. +- **Retention**: Follow agency policy for marketing draft archiving. + +## Confidence Indicators + +| Scenario | Confidence | Action | +|----------|------------|--------| +| Clean feature list with 3 past listings for ToV match | High | Generate full marketing suite. | +| Messy dictation with vague suburb references | Medium | Clean text and ask for suburb/amenity confirmation. | +| High-stakes renovation advice for high-value property | Medium | Provide ROI estimates with strong disclaimers. | + +## Tool Requirements + +- `~~cloud storage` - For storing ToV profiles and draft archives. +- `~~reference manager` - For organizing suburb-specific amenity data. +- `~~social media` - For openclaw integration and teaser scheduling. + +## Success Indicators + +You've applied this skill well when: +- [ ] The marketing copy sounds exactly like the specific agent. +- [ ] Trade Me listing views and "Watchlist" counts exceed suburb averages. +- [ ] The vendor follows the pre-listing checklist, improving first impressions. +- [ ] Local amenities are highlighted accurately, proving local expertise. + +## Related Skills + +- `~~real-estate/lead-management` - For managing interest generated by marketing. +- `~~real-estate/property-analyst` - For ensuring the marketing price aligns with appraisal. +- `~~real-estate/compliance-closer` - For final REA check before go-live. diff --git a/real-estate/skills/property-analyst/SKILL.md b/real-estate/skills/property-analyst/SKILL.md new file mode 100644 index 0000000..6331ca0 --- /dev/null +++ b/real-estate/skills/property-analyst/SKILL.md @@ -0,0 +1,151 @@ +--- +name: real-estate/property-analyst +description: This skill should be used when conducting market appraisals, analyzing property investments, and auditing due diligence documents for New Zealand real estate. Use for generating "Appraisal Evidence Packs," calculating rental yields, flagging risks in LIMs/Titles, and assessing school zone stability. Invoke when users mention market value, comparable sales, LIM reports, rental ROI, or school zones. +version: 1.0.0 +--- + +# Property Analyst (The Evidence Specialist) + +A rigorous framework for data-driven property valuation and risk assessment. This skill provides the "Evidence Pack" to justify pricing, calculates financial returns for investors, and scrutinizes statutory documents (LIM, Title) for red flags. + +**Important**: This skill provides market appraisals and risk analysis but does not replace a Registered Valuation, formal legal advice from a solicitor, or a building inspection report. All school zone information should be verified with the Ministry of Education. + +## When to Use This Skill + +Invoke this skill when: +- Generating a market appraisal for a potential listing. +- Preparing an "Appraisal Evidence Pack" comparing features of local sales. +- Calculating Gross/Net Rental Yield and cashflow potential for investors. +- Auditing a Land Information Memorandum (LIM) or Record of Title for red flags. +- Assessing the "Market Cycle" (Boom/Flat/Correction) to adjust pricing strategy. +- Identifying "School Zone Future Proofing" risks (e.g., border zone properties). +- Adjusting appraisals based on "Qualitative Vibe" (e.g., stunning views vs. poor flow). +- Drafting "Buyer Guides" for first-home buyers or local area newcomers. + +## Regulatory Context + +### Australia & New Zealand (Default) + +| Regulation/Standard | Relevance | Key Requirements | +|---------------------|-----------|------------------| +| **REA Code of Conduct** | Appraisal accuracy | Rule 10.6: Appraisals must be supported by comparable data | +| **Local Government Act** | LIM reports | Defining HCC/WCC disclosure requirements for unauthorized works | +| **Land Transfer Act** | Titles | Identifying easements, encumbrances, and land covenants | +| **Income Tax Act (NZ)** | Investment ROI | Understanding "Bright-line" and interest deductibility (high-level) | + +### AU/NZ Baseline Specifics +- **LIM Reports**: Understanding the "Hutt City Council" (HCC) baseline for building consents and permits. +- **Comparable Sales**: Requirement for minimum 3 recent, relevant local sales. +- **School Zones**: Analyzing Hutt Valley High, Petone Central, and Waterloo zone boundaries. + +## Quick Reference + +1. **Set the Cycle**: Identify if the market is Rising, Falling, or Flat. +2. **Select Comparables**: Find 3 recent sales with similar floor area, garaging, and land size. +3. **Justify the Price**: Generate a "Feature Comparison Table" between subject and comparables. +4. **Scrutinize the LIM**: Check for "Unauthorized Works" or "Flood Zone" flags. +5. **Yield Check**: (For investors) Calculate Gross Yield = (Weekly Rent * 52) / Purchase Price. +6. **Vibe Adjustment**: Apply +/- 5% for qualitative factors (e.g., street appeal). +7. **Zone Check**: Flag border properties for potential rezoning risks. + +## Operating Modes + +### Standard Mode +Full analytical workflow including detailed comparable tables, multi-source due diligence audit (LIM/Title), investment ROI modeling, and school zone risk analysis. Use for formal appraisals and high-stakes buyer/vendor consultations. + +### Lite Mode +Rapid calculation of rental yield, quick "LIM Red Flag" check, or a simple 3-sale comparable list. Optimized for high-speed market conversations. + +## Detailed Guidance + +### 1. The Appraisal "Evidence" Pack + +Justify the price to the vendor or buyer: +- **Subject vs. Sales**: Direct comparison of Bed/Bath/Car/Land/Floor Area. +- **Location Premium**: Adjusting for "River side" vs. "Hills side" or specific quiet cul-de-sacs. +- **Time Adjustment**: Indexing a 6-month-old sale to today's "Market Cycle." + +### 2. Due Diligence Scrutiny (Red Flags) + +Identify risks before they kill the deal: +- **LIM Flags**: Unauthorized bathroom/deck, "Wind Zone" rating, flood plains (HCC maps). +- **Title Flags**: Easements for neighbor access, "Cross-lease" complexities, restrictive covenants (e.g., no caravans). +- **Building Report Flags**: Weathertightness (monolithic cladding), piling issues, asbestos ceiling. + +### 3. Investment Yield Calculator + +Speak the language of the investor: +- **Gross Yield**: Standard benchmark for market comparison. +- **Net Yield**: Accounting for Rates (HCC is ~0.5% of value), Insurance, and Maintenance. +- **Capital Growth Context**: Mentioning major local infra projects (e.g., Melling Link) impacting future value. + +### 4. Market Cycle Adjuster + +Tailor strategy to the economic environment: +- **Rising (Boom)**: Aggressive "Tender" or "Auction" strategy; focus copy on "Scarcity." +- **Falling (Correction)**: "Price on Application" or "By Negotiation"; focus copy on "Value" and "Stability." +- **Flat**: "BEO" (Buyer Enquiry Over); focus copy on "Quality" and "Perfect Family Home." + +### 5. School Zone Future Proofing + +Verify the "Golden Ticket": +- **Core Zone**: Properties well within the boundary (Waterloo/Petone). +- **Border Zone**: Flag as "High Risk" if the Ministry of Education has signaled overcrowding in that zone. +- **Amenity Value**: Quantify the "Zone Premium" (typically 10-15% in Lower Hutt). + +## Documentation Requirements + +- [ ] **Appraisal Evidence Pack**: Comparative table and pricing rationale. +- [ ] **Investment Brief**: ROI/Yield summary for the property. +- [ ] **Due Diligence Log**: Red flags identified in LIM/Title/Building reports. +- [ ] **Buyer Guide Snippet**: Suburb expert highlights for the local area. + +## Common Mistakes + +| Mistake | Why It's Wrong | Instead | +|---------|----------------|---------| +| **Cherry-picking Sales** | Misleads the vendor; violates REA code | Include at least one "low" or "challenging" sale for balance. | +| **Ignoring Unauthorized Works** | Contract crashes during buyer's finance | Flag early and prepare a "Disclosure" for the vendor to sign. | +| **Static Pricing in Falling Market** | Listing goes stale | Recommend a price revision *before* the 21-day mark. | +| **Assuming Yield = Profit** | Ignores HCC rates and interest costs | Explicitly state the difference between Gross and Net yield. | + +## When to Escalate + +Escalate to Branch Principal or Registered Valuer when: +- The property is unique (e.g., commercial/residential mix) and lacks comparable data. +- The Title has complex "Consent Notices" or "Encumbrances" that require legal interpretation. +- A vendor demands an appraisal value >20% above recent comparable sales. +- The property has significant structural defects identified in a builder's report. + +## Privacy Considerations + +- **Data Minimization**: Do not retain copies of identifiable LIM reports beyond the campaign period. +- **Confidentiality**: Appraisal values are sensitive to the vendor; do not disclose to third parties without consent. + +## Confidence Indicators + +| Scenario | Confidence | Action | +|----------|------------|--------| +| Property matches 3 recent sales in the same street | High | Finalize Appraisal Evidence Pack. | +| Border-zone property with conflicting school info | Medium | Flag as "Risk" and require MOE verification. | +| Monolithic cladding with no "Code Compliance Certificate" | Low | Recommend immediate escalation to Registered Valuer/Solicitor. | + +## Tool Requirements + +- `~~budget data` - For calculating HCC rates and insurance estimates. +- `~~legislation` - For checking REA compliance and Land Transfer Act rules. +- `~~property database` - (Optional) Integration with sales data APIs. + +## Success Indicators + +You've applied this skill well when: +- [ ] Appraisal justification is so clear that vendors accept the recommended price range. +- [ ] LIM/Title issues are identified and disclosed *before* the property goes to market. +- [ ] Investor buyers receive accurate yield models that match their bank's criteria. +- [ ] Buyers feel confident in their purchase due to the detailed Suburb/School info. + +## Related Skills + +- `~~real-estate/marketing-suite` - For translating appraisal data into ad copy. +- `~~real-estate/lead-management` - For providing data to "Hot Leads." +- `~~real-estate/compliance-closer` - For ensuring the final price meets REA standards. From e493a7a9136fdf81249d12db28beb7b5a7431401 Mon Sep 17 00:00:00 2001 From: "Dylan Mordaunt (Illawarra Shoalhaven LHD)" Date: Sat, 14 Feb 2026 16:46:27 +1100 Subject: [PATCH 55/57] chore(cleanup): Remove old real-estate-nz track folder --- .../tracks/real-estate-nz_20260214/index.md | 5 --- .../real-estate-nz_20260214/metadata.json | 8 ---- .../tracks/real-estate-nz_20260214/plan.md | 33 --------------- .../tracks/real-estate-nz_20260214/spec.md | 40 ------------------- 4 files changed, 86 deletions(-) delete mode 100644 conductor/tracks/real-estate-nz_20260214/index.md delete mode 100644 conductor/tracks/real-estate-nz_20260214/metadata.json delete mode 100644 conductor/tracks/real-estate-nz_20260214/plan.md delete mode 100644 conductor/tracks/real-estate-nz_20260214/spec.md diff --git a/conductor/tracks/real-estate-nz_20260214/index.md b/conductor/tracks/real-estate-nz_20260214/index.md deleted file mode 100644 index 330be5f..0000000 --- a/conductor/tracks/real-estate-nz_20260214/index.md +++ /dev/null @@ -1,5 +0,0 @@ -# Track real-estate-nz_20260214 Context - -- [Specification](./spec.md) -- [Implementation Plan](./plan.md) -- [Metadata](./metadata.json) diff --git a/conductor/tracks/real-estate-nz_20260214/metadata.json b/conductor/tracks/real-estate-nz_20260214/metadata.json deleted file mode 100644 index de19bc3..0000000 --- a/conductor/tracks/real-estate-nz_20260214/metadata.json +++ /dev/null @@ -1,8 +0,0 @@ -{ - "track_id": "real-estate-nz_20260214", - "type": "feature", - "status": "new", - "created_at": "2026-02-14T16:20:00Z", - "updated_at": "2026-02-14T16:20:00Z", - "description": "Establish a Real Estate NZ plugin focused on Ray White Lower Hutt workflows, covering the property lifecycle from prospecting to settlement." -} diff --git a/conductor/tracks/real-estate-nz_20260214/plan.md b/conductor/tracks/real-estate-nz_20260214/plan.md deleted file mode 100644 index c98841e..0000000 --- a/conductor/tracks/real-estate-nz_20260214/plan.md +++ /dev/null @@ -1,33 +0,0 @@ -# Real Estate NZ Track Plan - -## Phase 1: Listing & Marketing Core -- [ ] Task: Create `real-estate-nz/skills/marketing-suite/SKILL.md` - - [ ] Sub-task: Implement "ToV Personalization" and "Renovation ROI Estimator." - - [ ] Sub-task: Develop "Teaser Campaign," "Suburb Decoder," and "Pre-Listing Kit" logic. -- [ ] Task: Create `real-estate-nz/commands/draft-listing.md` -- [ ] Task: Conductor - User Manual Verification 'Phase 1' (Protocol in workflow.md) - -## Phase 2: CRM & Lead Management -- [ ] Task: Create `real-estate-nz/skills/lead-management/SKILL.md` - - [ ] Sub-task: Implement "Golden Database Tagger" and "Hot Lead Detector." - - [ ] Sub-task: Develop "Voice-to-Text Cleaner" and "Rainy Day Pivot." -- [ ] Task: Create `real-estate-nz/commands/manage-leads.md` -- [ ] Task: Create `real-estate-nz/commands/vendor-report.md` -- [ ] Task: Conductor - User Manual Verification 'Phase 2' (Protocol in workflow.md) - -## Phase 3: Appraisal & Due Diligence -- [ ] Task: Create `real-estate-nz/skills/property-analyst/SKILL.md` - - [ ] Sub-task: Implement "Market Cycle Adjuster" and "Investment Yield Calculator." - - [ ] Sub-task: Develop "Due Diligence Scrutiny" and "School Zone Future Proofing." -- [ ] Task: Create `real-estate-nz/commands/generate-appraisal.md` -- [ ] Task: Create `real-estate-nz/commands/audit-due-diligence.md` -- [ ] Task: Conductor - User Manual Verification 'Phase 3' (Protocol in workflow.md) - -## Phase 4: Compliance & Negotiation -- [ ] Task: Create `real-estate-nz/skills/compliance-closer/SKILL.md` - - [ ] Sub-task: Implement REA/AML audit logic. - - [ ] Sub-task: Develop "Method of Sale" and "Multi-offer" strategy generators. -- [ ] Task: Create `real-estate-nz/commands/check-compliance.md` -- [ ] Task: Create `real-estate-nz/commands/prepare-negotiation.md` -- [ ] Task: Final README and metadata consolidation. -- [ ] Task: Conductor - User Manual Verification 'Phase 4' (Protocol in workflow.md) diff --git a/conductor/tracks/real-estate-nz_20260214/spec.md b/conductor/tracks/real-estate-nz_20260214/spec.md deleted file mode 100644 index 7e57d24..0000000 --- a/conductor/tracks/real-estate-nz_20260214/spec.md +++ /dev/null @@ -1,40 +0,0 @@ -# Specification: Real Estate NZ Plugin (real-estate-nz) - -## Overview -This plugin transforms Claude into a specialist for New Zealand Real Estate Agents, focusing on the workflows of the Ray White network (Lower Hutt baseline). It covers the property lifecycle from prospecting to settlement, focusing on marketing, strategic appraisals, and strict REA/AML compliance. - -## User Personas -- **Real Estate Agents (NZ):** Focus on conversion, high-quality marketing, and vendor management. -- **Sales Associates:** Focus on administration, listing drafting, and due diligence prep. - -## Functional Requirements -- **Lead & CRM Management:** - - **Golden Database Tagger:** Life-stage segmentation. - - Voice-to-Text Cleaner and Hot Lead Detector. - - Rainy Day Pivot and Vendor Feedback Synthesis. -- **Marketing Suite:** - - **Renovation ROI Estimator:** Advising on pre-sale value adds. - - Trade Me listings, Social Teasers, and Pre-Listing Kits. - - Suburb Decoder and Auction/Tender Openers. -- **Strategic Appraisal Suite:** - - **Market Cycle Adjuster:** Adapting strategy to Boom/Bust cycles. - - **Investment Yield Calculator:** ROI analysis for investors. - - Comparable sales analysis and Appraisal Evidence Pack. -- **Due Diligence & Compliance:** - - **School Zone Future Proofing:** Border zone risk checks. - - Scrutiny Engine (LIMs/Titles) and REA/AML Auditor. -- **Negotiation & Settlement:** - - Method of Sale specialization and Multi-offer strategy. - - Key Handover Checklist. - -## Non-Functional Requirements -- **ToV Personalization:** Learning and mimicking the specific agent's brand voice. -- **Standard vs. Lite Modes:** Transactional vs. Strategic workflows. - -## Acceptance Criteria -- Commands: `/manage-leads`, `/draft-listing`, `/generate-appraisal`, `/check-compliance`, `/prepare-negotiation`, `/audit-due-diligence`, `/vendor-report`. -- Successful handling of NZ-specific documents (LIM, AML forms, REA disclosures). - -## Out of Scope -- Direct trust account management or legal settlement. -- Binding valuations (registered valuer only). From aff08b3062c89483e0fd49f550116e6c270c23f6 Mon Sep 17 00:00:00 2001 From: "Dylan Mordaunt (Illawarra Shoalhaven LHD)" Date: Sat, 14 Feb 2026 17:13:35 +1100 Subject: [PATCH 56/57] feat: Upgrade Real Estate plugin to 'Real Estate Next' with Shadow Workflow support --- AGENTS.md | 57 ++++++++ conductor/tracks.md | 4 + .../tracks/real-estate-next_20260214/index.md | 5 + .../real-estate-next_20260214/metadata.json | 8 ++ .../tracks/real-estate-next_20260214/plan.md | 25 ++++ .../tracks/real-estate-next_20260214/spec.md | 16 +++ real-estate-next/.claude-plugin/plugin.json | 5 + {real-estate => real-estate-next}/.mcp.json | 5 + .../CONNECTORS.md | 15 ++- real-estate-next/OPENCLAW.md | 46 +++++++ real-estate-next/README.md | 24 ++++ .../commands/audit-due-diligence.md | 4 +- .../commands/check-compliance.md | 4 +- real-estate-next/commands/client-intel.md | 62 +++++++++ .../commands/draft-listing.md | 4 +- .../commands/generate-appraisal.md | 4 +- .../commands/manage-leads.md | 4 +- .../commands/prepare-negotiation.md | 4 +- real-estate-next/commands/private-brief.md | 61 +++++++++ real-estate-next/commands/shadow-sync.md | 60 +++++++++ .../commands/vendor-report.md | 4 +- real-estate-next/commands/webhook-audit.md | 62 +++++++++ .../skills/compliance-closer/SKILL.md | 8 +- .../skills/lead-management/SKILL.md | 8 +- .../skills/marketing-suite/SKILL.md | 8 +- .../skills/property-analyst/SKILL.md | 8 +- .../skills/shadow-workflow/SKILL.md | 125 ++++++++++++++++++ real-estate/.claude-plugin/plugin.json | 5 - real-estate/README.md | 24 ---- scripts/sync_plugins.py | 81 ++++++++++++ 30 files changed, 688 insertions(+), 62 deletions(-) create mode 100644 AGENTS.md create mode 100644 conductor/tracks/real-estate-next_20260214/index.md create mode 100644 conductor/tracks/real-estate-next_20260214/metadata.json create mode 100644 conductor/tracks/real-estate-next_20260214/plan.md create mode 100644 conductor/tracks/real-estate-next_20260214/spec.md create mode 100644 real-estate-next/.claude-plugin/plugin.json rename {real-estate => real-estate-next}/.mcp.json (50%) rename {real-estate => real-estate-next}/CONNECTORS.md (54%) create mode 100644 real-estate-next/OPENCLAW.md create mode 100644 real-estate-next/README.md rename {real-estate => real-estate-next}/commands/audit-due-diligence.md (95%) rename {real-estate => real-estate-next}/commands/check-compliance.md (95%) create mode 100644 real-estate-next/commands/client-intel.md rename {real-estate => real-estate-next}/commands/draft-listing.md (96%) rename {real-estate => real-estate-next}/commands/generate-appraisal.md (95%) rename {real-estate => real-estate-next}/commands/manage-leads.md (95%) rename {real-estate => real-estate-next}/commands/prepare-negotiation.md (95%) create mode 100644 real-estate-next/commands/private-brief.md create mode 100644 real-estate-next/commands/shadow-sync.md rename {real-estate => real-estate-next}/commands/vendor-report.md (95%) create mode 100644 real-estate-next/commands/webhook-audit.md rename {real-estate => real-estate-next}/skills/compliance-closer/SKILL.md (95%) rename {real-estate => real-estate-next}/skills/lead-management/SKILL.md (96%) rename {real-estate => real-estate-next}/skills/marketing-suite/SKILL.md (96%) rename {real-estate => real-estate-next}/skills/property-analyst/SKILL.md (96%) create mode 100644 real-estate-next/skills/shadow-workflow/SKILL.md delete mode 100644 real-estate/.claude-plugin/plugin.json delete mode 100644 real-estate/README.md create mode 100644 scripts/sync_plugins.py diff --git a/AGENTS.md b/AGENTS.md new file mode 100644 index 0000000..111e21a --- /dev/null +++ b/AGENTS.md @@ -0,0 +1,57 @@ +--- +adapter_metadata: + skill_name: knowledge-work-plugins + skill_version: 1.0.0 + last_synced: 2026-02-14 + source_path: README.md + adapter_id: codex-cli + adapter_format: AGENTS.md +--- + +# Knowledge Work Plugins (agents manifest) + +This repository contains a wide-ranging collection of specialized agentic skills for professional "knowledge work" across various domains including Legal, Finance, Marketing, Product Management, Customer Support, and more. + +## Capability + +The collection provides domain-specific expertise and workflows: +- ⚖️ **Legal**: Contract review, compliance, legal risk assessment, NDA triage. +- 💰 **Finance**: Audit support, reconciliation, financial statements, variance analysis. +- 📣 **Marketing**: Brand voice, campaign planning, competitive analysis, content creation. +- 📦 **Product Management**: Feature specs, metrics tracking, roadmap management, user research. +- 🎧 **Customer Support**: Ticket triage, response drafting, customer research, escalation. +- 🏢 **Real Estate**: Property analysis, lead management, compliance closer. +- 🏛️ **Ministerial Audit**: Bureaucracy redliner, strategic synthesis, comms translator. + +Skills are organized by category in `/skills//SKILL.md`. + +## Context + +This file serves as the **Agents.md** standard manifest for discovery and indexing of professional knowledge work plugins. + +### Repository structure + +- `[category]/` + - `skills/` + - `[skill-name]/SKILL.md`: The core logic for each specialized skill. +- `scripts/` + - `sync_plugins.py`: Automation to distribute these skills to local tool environments. + +### Core instructions + +When tasked with professional knowledge work: +1. Identify the most relevant domain category (e.g., Legal, Finance). +2. Select the appropriate skill within that category. +3. Follow the specialized workflows and best practices defined in its `SKILL.md`. + +## Maintenance + +To sync these plugins to your local agentic tool directories (Cline, Kilo, Amp, etc.), run: + +```bash +python scripts/sync_plugins.py +``` + +## Interoperability + +These skills are compatible with any agent following the `SKILL.md` standard, including Antigravity, Cline, Kilo Code, Amp, and OpenCode. diff --git a/conductor/tracks.md b/conductor/tracks.md index 04fe161..a8830e8 100644 --- a/conductor/tracks.md +++ b/conductor/tracks.md @@ -124,3 +124,7 @@ PHASE 4: Research/Academic (parallel, depends Phase 3) │ --- - [x] **Track: Establish a Real Estate NZ plugin focused on Ray White Lower Hutt workflows, covering the property lifecycle from prospecting to settlement.** (./tracks/real-estate_20260214/) + +--- + +- [x] **Track: Upgrade the Real Estate plugin to 'Real Estate Next', focusing on contractor Shadow Workflows, Vault RE webhooks, and OpenClaw branding.** (./tracks/real-estate-next_20260214/) diff --git a/conductor/tracks/real-estate-next_20260214/index.md b/conductor/tracks/real-estate-next_20260214/index.md new file mode 100644 index 0000000..80d0eca --- /dev/null +++ b/conductor/tracks/real-estate-next_20260214/index.md @@ -0,0 +1,5 @@ +# Track real-estate-next_20260214 Context + +- [Specification](./spec.md) +- [Implementation Plan](./plan.md) +- [Metadata](./metadata.json) diff --git a/conductor/tracks/real-estate-next_20260214/metadata.json b/conductor/tracks/real-estate-next_20260214/metadata.json new file mode 100644 index 0000000..a28cbf8 --- /dev/null +++ b/conductor/tracks/real-estate-next_20260214/metadata.json @@ -0,0 +1,8 @@ +{ + "track_id": "real-estate-next_20260214", + "type": "feature", + "status": "completed", + "created_at": "2026-02-14T17:11:00Z", + "updated_at": "2026-02-14T17:11:00Z", + "description": "Upgrade the Real Estate plugin to 'Real Estate Next', focusing on contractor Shadow Workflows, Vault RE webhooks, and OpenClaw branding." +} diff --git a/conductor/tracks/real-estate-next_20260214/plan.md b/conductor/tracks/real-estate-next_20260214/plan.md new file mode 100644 index 0000000..fed6a78 --- /dev/null +++ b/conductor/tracks/real-estate-next_20260214/plan.md @@ -0,0 +1,25 @@ +# Plan: Real Estate Next Upgrade + +## Phase 1: Infrastructure & Renaming +- [x] Rename directory to `real-estate-next`. +- [x] Update `plugin.json` name and version (1.1.0). +- [x] Global replace `real-estate` -> `real-estate-next`. +- [x] Update `README.md` with contractor focus. + +## Phase 2: Documentation & OpenClaw +- [x] Create `OPENCLAW.md`. +- [x] Update `CONNECTORS.md`. +- [x] Update `.mcp.json`. + +## Phase 3: Skill & Command Implementation +- [x] Create `skills/shadow-workflow/SKILL.md`. +- [x] Create `commands/webhook-audit.md`. +- [x] Create `commands/shadow-sync.md`. +- [x] Create `commands/private-brief.md`. +- [x] Create `commands/client-intel.md`. + +## Phase 4: Track Finalization +- [x] Create track artifacts. +- [x] Register track in `conductor/tracks.md`. +- [x] Commit and push changes. +- [x] Update upstream PR and issue. diff --git a/conductor/tracks/real-estate-next_20260214/spec.md b/conductor/tracks/real-estate-next_20260214/spec.md new file mode 100644 index 0000000..c20283d --- /dev/null +++ b/conductor/tracks/real-estate-next_20260214/spec.md @@ -0,0 +1,16 @@ +# Specification: Real Estate Next Upgrade + +## Overview +Evolution of the `real-estate` plugin into `real-estate-next`. This version is optimized for independent contractors maintaining a "Shadow Workflow" via private Google Workspace accounts, Vault RE webhooks, and OpenClaw branding. + +## Changes +- Rename all `real-estate` references to `real-estate-next`. +- Add `shadow-workflow` skill for data sovereignty and private admin logic. +- Add `OPENCLAW.md` documentation for personal brand management. +- Implement `/webhook-audit`, `/shadow-sync`, `/private-brief`, and `/client-intel` commands. +- Update `CONNECTORS.md` and `.mcp.json` with OpenClaw and private admin hooks. + +## Success Criteria +- Global rename complete. +- Shadow workflow logic handles Vault RE JSON and Gemini Pro synthesis. +- OpenClaw is established as a core social media connector. diff --git a/real-estate-next/.claude-plugin/plugin.json b/real-estate-next/.claude-plugin/plugin.json new file mode 100644 index 0000000..feffb20 --- /dev/null +++ b/real-estate-next/.claude-plugin/plugin.json @@ -0,0 +1,5 @@ +{ + "name": "real-estate-next", + "version": "1.1.0", + "description": "Advanced evolution of the Real Estate plugin for independent contractors. Features deep Vault RE integration, private Google Workspace automation, and Shadow Workflow support." +} diff --git a/real-estate/.mcp.json b/real-estate-next/.mcp.json similarity index 50% rename from real-estate/.mcp.json rename to real-estate-next/.mcp.json index 907eff6..a572195 100644 --- a/real-estate/.mcp.json +++ b/real-estate-next/.mcp.json @@ -4,6 +4,11 @@ "type": "http", "command": "npx", "args": ["-y", "@modelcontextprotocol/server-google-search"] + }, + "openclaw": { + "type": "http", + "url": "https://api.openclaw.io/v1", + "description": "Personal brand management and social media automation." } } } diff --git a/real-estate/CONNECTORS.md b/real-estate-next/CONNECTORS.md similarity index 54% rename from real-estate/CONNECTORS.md rename to real-estate-next/CONNECTORS.md index c97682b..c8f0c2d 100644 --- a/real-estate/CONNECTORS.md +++ b/real-estate-next/CONNECTORS.md @@ -10,9 +10,18 @@ Plugins are **tool-agnostic** — they describe workflows in terms of categories | Category | Placeholder | Included servers | Other options | |----------|-------------|-----------------|---------------| -| CRM / Leads | `~~contact database` | NurtureCloud | Salesforce, HubSpot, Propertybase | +| CRM / Leads | `~~contact database` | Vault RE / NurtureCloud | Salesforce, HubSpot, Propertybase | +| Webhooks | `~~webhook listener` | Private Admin API | Zapier, Make, Custom | | Property Data | `~~property database` | CoreLogic / PropertyValue | Trade Me API, REINZ Stats | -| Cloud storage | `~~cloud storage` | SharePoint | Google Drive, OneDrive, Box | +| Cloud storage | `~~cloud storage` | Google Workspace (Admin) | SharePoint, OneDrive, Box | | Legislative database | `~~legislation` | NZLII / REA | Westlaw, LexisNexis | | Budgetary data | `~~budget data` | Hutt City Council | Stats NZ, Treasury.gov | -| Social media | `~~social media` | openclaw | Twitter/X API, LinkedIn | +| Social media | `~~social media` | **OpenClaw** | Twitter/X API, LinkedIn | +| Digital Signing | `~~signing service` | Secure Sign / DocuSign | Adobe Sign, HelloSign | + +## Shadow Workflow Setup + +To maintain a shadow workflow, it is recommended to: +1. Use a **private Google Workspace Admin** account for `~~cloud storage`. +2. Set up a webhook listener to pipe **Vault RE** events into your private account. +3. Use **OpenClaw** for all personal brand management. diff --git a/real-estate-next/OPENCLAW.md b/real-estate-next/OPENCLAW.md new file mode 100644 index 0000000..f5d0d8c --- /dev/null +++ b/real-estate-next/OPENCLAW.md @@ -0,0 +1,46 @@ +# OpenClaw Integration: Shadow Marketing + +This document explains how to use **OpenClaw** to automate your personal branding and "Shadow Marketing" outside of corporate oversight. + +## Why use OpenClaw? + +As an independent contractor, your personal brand is your most valuable asset. While agency marketing focus on the corporate brand, OpenClaw allows you to: +1. **Own your content**: Draft and post to your *personal* LinkedIn, Instagram, and TikTok profiles. +2. **Bypass approval loops**: Publish "Coming Soon" or "Just Sold" teasers instantly. +3. **Maintain consistency**: Keep your personal brand alive even if you switch agencies. + +## Setup Instructions + +1. **Configure Connector**: In your private admin account, map `~~social media` to your OpenClaw server URL. +2. **API Keys**: Store your personal social media API keys (LinkedIn, Twitter/X, etc.) within your OpenClaw instance. +3. **ToV Sync**: Ensure your "Tone of Voice" profile in `marketing-suite` is synced with your OpenClaw templates. + +## Workflows + +### 1. The "Sneak Peek" Teaser +When a property is updated in Vault RE (via webhook), use `/draft-listing` to generate a personal teaser. +- **Goal**: Build a "Shadow Buyer List" before the corporate campaign launches. +- **Connector**: OpenClaw drafts the post and schedules it for your personal LinkedIn. + +### 2. The "Community Expert" Pulse +OpenClaw can monitor local suburb hashtags (e.g., #LowerHuttRealEstate). +- **Goal**: Identify and engage with potential vendors early. +- **Workflow**: OpenClaw flags relevant posts -> Gemini Pro suggests a "shadow comment" -> You approve via your private Workspace. + +### 3. "Just Sold" Proof of Concept +Immediately upon settlement milestone: +- **Action**: OpenClaw posts a "Verified Result" to your personal Instagram story. +- **Why**: Proves your individual track record to your private database. + +## Connector Configuration (`.mcp.json`) + +```json +{ + "mcpServers": { + "openclaw": { + "type": "http", + "url": "https://your-private-openclaw-instance.com/api" + } + } +} +``` diff --git a/real-estate-next/README.md b/real-estate-next/README.md new file mode 100644 index 0000000..13d9cb9 --- /dev/null +++ b/real-estate-next/README.md @@ -0,0 +1,24 @@ +# Real Estate Next Plugin + +An advanced, contractor-focused evolution of the Real Estate plugin. This toolset is specifically designed for independent agents who maintain their own private tech stack outside of corporate oversight. It enables a high-leverage **"Shadow Workflow"** using Vault RE webhooks, private Google Workspace automation, and OpenClaw for personal branding. + +## Core Capabilities + +- **Shadow Workflow**: Maintain data sovereignty with a private Google Workspace admin account. Use Gemini Pro to synthesize forwarded emails and cross-reference with CRM data. +- **Webhook Integration**: Real-time support for **Vault RE** JSON payloads. Automatically prioritize tasks and draft communications based on CRM activity. +- **Shadow Marketing (OpenClaw)**: Build your personal brand on LinkedIn, Instagram, and TikTok with owner-branded content that stays with you, even if you move agencies. +- **Milestone Automation**: Track **Secure Sign** and **DocuSign** progress and automatically update private settlement checklists. +- **Client Intelligence**: Use deep search to vet potential high-value vendors and prepare for listing presentations with a strategic edge. + +## Commands + +- `/webhook-audit`: Review and audit incoming Vault RE JSON payloads. +- `/shadow-sync`: Synchronize corporate CRM activity with your private Google Sheets/Tasks logs. +- `/private-brief`: Synthesize forwarded email threads and CRM data into a private situation report. +- `/client-intel`: Perform deep research on potential clients using search connectors. +- `/draft-listing`: Create marketing suites optimized for personal branding. +- `/manage-leads`: Rank leads using private conversion probability models. + +## Jurisdictional Focus + +Defaults to **New Zealand** statutory requirements (REA Act, AML/CFT Act, HCC/WCC LIM standards) with specialized logic for independent contractors. diff --git a/real-estate/commands/audit-due-diligence.md b/real-estate-next/commands/audit-due-diligence.md similarity index 95% rename from real-estate/commands/audit-due-diligence.md rename to real-estate-next/commands/audit-due-diligence.md index ae9e75b..a3b2e85 100644 --- a/real-estate/commands/audit-due-diligence.md +++ b/real-estate-next/commands/audit-due-diligence.md @@ -29,7 +29,7 @@ Use this command when: ### 1. Scrutinize & Flag -Use `~~real-estate/property-analyst` to: +Use `~~real-estate-next/property-analyst` to: - Detect "Unauthorized Works" (e.g., bathrooms with no CCC). - Identify "Land Risks" (e.g., HCC flood plains, wind zones). - Highlight "Title Complexities" (e.g., cross-lease common areas). @@ -64,5 +64,5 @@ Would you like to draft the 'Disclosure Authorization' for the vendor to sign? [ ## Integration Points -- **Skill**: Uses `~~real-estate/property-analyst`. +- **Skill**: Uses `~~real-estate-next/property-analyst`. - **Downstream**: Feeds into `/check-compliance`. diff --git a/real-estate/commands/check-compliance.md b/real-estate-next/commands/check-compliance.md similarity index 95% rename from real-estate/commands/check-compliance.md rename to real-estate-next/commands/check-compliance.md index 1dced50..9698b31 100644 --- a/real-estate/commands/check-compliance.md +++ b/real-estate-next/commands/check-compliance.md @@ -29,7 +29,7 @@ Use this command when: ### 1. Scrutinize & Verify -Use `~~real-estate/compliance-closer` to: +Use `~~real-estate-next/compliance-closer` to: - Cross-check `document` against REA Code rules (misleading conduct, disclosures). - Generate a customized `AML Checklist` for the specific entity type. - Identify "Conflict of Interest" triggers. @@ -64,5 +64,5 @@ Would you like to draft the 'AML Information Request' email for the trustees? [Y ## Integration Points -- **Skill**: Uses `~~real-estate/compliance-closer`. +- **Skill**: Uses `~~real-estate-next/compliance-closer`. - **Downstream**: Feeds into `/prepare-negotiation`. diff --git a/real-estate-next/commands/client-intel.md b/real-estate-next/commands/client-intel.md new file mode 100644 index 0000000..6224ae1 --- /dev/null +++ b/real-estate-next/commands/client-intel.md @@ -0,0 +1,62 @@ +--- +name: client-intel +description: Perform deep research on potential high-value clients using search connectors to prepare for listing presentations. +arguments: + - name: client_name + description: "Full name of the potential vendor or high-value buyer." + required: true + - name: context + description: "Suburb, industry, or company if known." + required: false +--- + +# /client-intel Command + +Gain a strategic edge by knowing your client's history and public profile. + +## When to Use + +Use this command when: +- Preparing for a first meeting with a potential "High Value" vendor. +- You need to vet a mysterious buyer who is making a significant offer. +- You want to find "Common Ground" (e.g., shared interests, professional history) to build rapport. + +## Workflow + +### 1. Multi-Source Search + +Use `~~google-search` and `~~real-estate-next/shadow-workflow` to: +- Find recent business news or LinkedIn activity for `client_name`. +- Identify recent property transactions associated with their name/company (Public Record). + +### 2. Strategic Synthesis + +Produce: +- **Client Deep Profile**: Summary of professional background and public reputation. +- **Transaction History**: (If found) Recent buys/sells. +- **Rapport Hooks**: 3 suggested conversation starters based on the research. + +## Example Session + +**User:** `/client-intel client_name: "Sarah Wellington" context: "CEO of TechCorp, lives in Waterloo"` + +**System:** +``` +[~] PERFORMING DEEP SEARCH... +[~] SYNTHESIZING CLIENT PROFILE... + +CLIENT INTEL READY: + +1. Profile: Sarah Wellington is the founder of TechCorp. Recently featured in NZ Business Herald for 'Expanding Hutt operations'. +2. Connection Hook: Mention the 'Melling Link' infra project—it directly impacts her TechCorp office commute and her Waterloo home value. +3. Rapport Starter: "I saw the recent TechCorp expansion news; it's great to see more high-tech jobs staying in the Hutt Valley." + +Strategic Edge: She is likely 'Time Poor' and 'Result Focused'. Lead your presentation with data and efficiency rather than 'poetic' lifestyle copy. + +Would you like to draft a 'Result Focused' marketing teaser for her Waterloo home? [Y/n] +``` + +## Integration Points + +- **Tool**: Uses `~~google-search`. +- **Downstream**: Feeds into `/draft-listing`. diff --git a/real-estate/commands/draft-listing.md b/real-estate-next/commands/draft-listing.md similarity index 96% rename from real-estate/commands/draft-listing.md rename to real-estate-next/commands/draft-listing.md index b83008f..0a0d71c 100644 --- a/real-estate/commands/draft-listing.md +++ b/real-estate-next/commands/draft-listing.md @@ -32,7 +32,7 @@ Use this command when: ### 1. Clean & Structure -Use `~~real-estate/marketing-suite` to: +Use `~~real-estate-next/marketing-suite` to: - Process the `notes` (cleaning dictation, stripping filler). - Map the property to the `suburb` amenities. - Align the tone with the `agent_voice`. @@ -73,5 +73,5 @@ Would you like to generate a 'Rainy Day Pivot' strategy for the first open home? ## Integration Points -- **Skill**: Uses `~~real-estate/marketing-suite`. +- **Skill**: Uses `~~real-estate-next/marketing-suite`. - **Downstream**: Feeds into `/generate-appraisal` for price alignment. diff --git a/real-estate/commands/generate-appraisal.md b/real-estate-next/commands/generate-appraisal.md similarity index 95% rename from real-estate/commands/generate-appraisal.md rename to real-estate-next/commands/generate-appraisal.md index 7109b75..b0d1517 100644 --- a/real-estate/commands/generate-appraisal.md +++ b/real-estate-next/commands/generate-appraisal.md @@ -32,7 +32,7 @@ Use this command when: ### 1. Analyze & Index -Use `~~real-estate/property-analyst` to: +Use `~~real-estate-next/property-analyst` to: - Compare the `property_details` against the `comparables`. - Adjust for the `cycle` (indexing old sales to today's market). - Calculate Rental Yield and local HCC rates impact. @@ -72,6 +72,6 @@ Would you like to draft the 'Appraisal Justification' letter for the vendor? [Y/ ## Integration Points -- **Skill**: Uses `~~real-estate/property-analyst`. +- **Skill**: Uses `~~real-estate-next/property-analyst`. - **Upstream**: Feeds into `/draft-listing` copy. - **Downstream**: Feeds into `/prepare-negotiation`. diff --git a/real-estate/commands/manage-leads.md b/real-estate-next/commands/manage-leads.md similarity index 95% rename from real-estate/commands/manage-leads.md rename to real-estate-next/commands/manage-leads.md index 34f809b..902b608 100644 --- a/real-estate/commands/manage-leads.md +++ b/real-estate-next/commands/manage-leads.md @@ -29,7 +29,7 @@ Use this command when: ### 1. Analyze & Rank -Use `~~real-estate/lead-management` to: +Use `~~real-estate-next/lead-management` to: - Identify "Hot Leads" ( finance-ready, highly motivated). - Categorize database contacts into "Golden Database" tags. - Detect "Missing Referrals" (e.g., buyers needing a mortgage broker). @@ -67,5 +67,5 @@ Would you like to draft the contract offer for Mary Jones? [Y/n] ## Integration Points -- **Skill**: Uses `~~real-estate/lead-management`. +- **Skill**: Uses `~~real-estate-next/lead-management`. - **Downstream**: Feeds into `/prepare-negotiation`. diff --git a/real-estate/commands/prepare-negotiation.md b/real-estate-next/commands/prepare-negotiation.md similarity index 95% rename from real-estate/commands/prepare-negotiation.md rename to real-estate-next/commands/prepare-negotiation.md index a4498a0..27eeba0 100644 --- a/real-estate/commands/prepare-negotiation.md +++ b/real-estate-next/commands/prepare-negotiation.md @@ -29,7 +29,7 @@ Use this command when: ### 1. Strategic Analysis -Use `~~real-estate/compliance-closer` to: +Use `~~real-estate-next/compliance-closer` to: - Compare offers on Price, Conditions, and Possession. - Draft "Multi-offer Protocol" scripts for buyers. - Generate high-impact "Auction Openers" based on the property's emotional hooks. @@ -67,6 +67,6 @@ Would you like to draft the counter-offer wording for Offer B? [Y/n] ## Integration Points -- **Skill**: Uses `~~real-estate/compliance-closer`. +- **Skill**: Uses `~~real-estate-next/compliance-closer`. - **Upstream**: Uses outputs from `/generate-appraisal`. - **Downstream**: Feeds into `lead-management` for the settlement handover. diff --git a/real-estate-next/commands/private-brief.md b/real-estate-next/commands/private-brief.md new file mode 100644 index 0000000..8f1cfa2 --- /dev/null +++ b/real-estate-next/commands/private-brief.md @@ -0,0 +1,61 @@ +--- +name: private-brief +description: Synthesize forwarded email threads and CRM data into a private situation report using Gemini Pro. +arguments: + - name: email_thread + description: "The forwarded email history from the client." + required: true + - name: property_context + description: "Related property data from Vault RE (or private sheet)." + required: false +--- + +# /private-brief Command + +Use Gemini Pro to find the "hidden truth" in long email threads and corporate data. + +## When to Use + +Use this command when: +- A client inquiry becomes complex and you need a high-speed summary. +- You want to check for consistency between what a buyer said in an email vs. what they told you at an open home. +- Preparing for a difficult vendor negotiation where history matters. + +## Workflow + +### 1. Gemini Pro Synthesis (The Shadow Brain) + +Use `~~real-estate-next/shadow-workflow` to: +- Summarize the `email_thread` (identifying emotional cues, deadlines, and requirements). +- Cross-reference with `property_context` (e.g., "This buyer liked Petone but is now asking about Waterloo"). + +### 2. Output Generation + +Produce: +- **Client Situation Report**: Bulleted summary of the client's current position. +- **Consistency Check**: "They say X in mail, but record shows Y." +- **Draft Reply (Sanitized)**: A high-leverage response ready for your private Workspace. + +## Example Session + +**User:** `/private-brief email_thread: "[Long chain about 123 Petone]" property_context: "Buyer rejected previous Maungaraki offer"` + +**System:** +``` +[~] GEMINI PRO ANALYZING THREAD... +[~] CROSS-REFERENCING MAUNGARAKI HISTORY... + +PRIVATE BRIEF READY: + +1. Summary: The buyer is highly motivated by the Petone location but is 'stalling' due to finance jitters. +2. Consistency Check: They mention a 10% deposit in email, but your private notes from Maungaraki show they have a 20% equity position. +3. Strategic Lever: They are using 'finance' as a negotiation tactic. +4. Sanitized Draft: "I've reviewed your latest thoughts on the beachfront villa. Based on our earlier conversation about your equity position, I'm confident we can find a way forward that works for both parties..." + +Would you like to schedule an OpenClaw 'market update' for Petone to maintain pressure? [Y/n] +``` + +## Integration Points + +- **Skill**: Uses `~~real-estate-next/shadow-workflow`. +- **Downstream**: Feeds into `/prepare-negotiation`. diff --git a/real-estate-next/commands/shadow-sync.md b/real-estate-next/commands/shadow-sync.md new file mode 100644 index 0000000..f3b90e4 --- /dev/null +++ b/real-estate-next/commands/shadow-sync.md @@ -0,0 +1,60 @@ +--- +name: shadow-sync +description: Manually synchronize corporate CRM activity with your private Google Sheets/Tasks logs. +arguments: + - name: source + description: "The source system (e.g., Vault RE, NurtureCloud)." + required: true + - name: target + description: "The private destination (e.g., Private Google Sheet, Google Tasks)." + required: true +--- + +# /shadow-sync Command + +Ensure your private mirror of intelligence is up to date with the corporate network. + +## When to Use + +Use this command when: +- You've just finished a prospecting session and want to export notes to your private logs. +- You're preparing for a weekend of open homes and need your private task list synced. +- Real-time webhooks have failed or are unavailable. + +## Workflow + +### 1. Data Aggregation + +Use `~~real-estate-next/shadow-workflow` to: +- Collect recent activity logs from the `source`. +- Filter for high-value intelligence (e.g., specific buyer feedback). + +### 2. Mirror Execution + +Produce: +- **Sync Log**: List of contacts and properties updated in your private admin account. +- **Conflict Report**: (If applicable) Discrepancies between your notes and corporate records. +- **Task Pulse**: New high-priority tasks created in Google Tasks. + +## Example Session + +**User:** `/shadow-sync source: "Vault RE" target: "Private Google Sheet"` + +**System:** +``` +[~] AGGREGATING VAULT RE LOGS... +[~] UPDATING PRIVATE MIRROR... + +SYNC COMPLETE: + +1. Contacts Mirrored: 5 new buyer leads from Maungaraki open home. +2. Property Updates: 1 listing (123 Petone) moved to 'Unconditional'. +3. Conflict: Your note 'Buyer needs 90 day settlement' is missing in Vault RE. (Note preserved in Private Sheet). + +Next Step: Run /private-brief for listing '123 Petone' to prepare for settlement. +``` + +## Integration Points + +- **Skill**: Uses `~~real-estate-next/shadow-workflow`. +- **Downstream**: Feeds into `/private-brief`. diff --git a/real-estate/commands/vendor-report.md b/real-estate-next/commands/vendor-report.md similarity index 95% rename from real-estate/commands/vendor-report.md rename to real-estate-next/commands/vendor-report.md index 580c8ba..fe6bf99 100644 --- a/real-estate/commands/vendor-report.md +++ b/real-estate-next/commands/vendor-report.md @@ -28,7 +28,7 @@ Use this command when: ### 1. Synthesize Sentiment -Use `~~real-estate/lead-management` to: +Use `~~real-estate-next/lead-management` to: - Categorize feedback into "Positive," "Critical," and "Pricing." - Highlight market sentiment trends (e.g., "Interest remains high forPetone beachfront"). @@ -60,5 +60,5 @@ Would you like to draft the 'Price Revision' email for the vendor? [Y/n] ## Integration Points -- **Skill**: Uses `~~real-estate/lead-management`. +- **Skill**: Uses `~~real-estate-next/lead-management`. - **Downstream**: Feeds into `/draft-listing` if a marketing pivot is needed. diff --git a/real-estate-next/commands/webhook-audit.md b/real-estate-next/commands/webhook-audit.md new file mode 100644 index 0000000..0309b58 --- /dev/null +++ b/real-estate-next/commands/webhook-audit.md @@ -0,0 +1,62 @@ +--- +name: webhook-audit +description: Review and audit incoming Vault RE JSON payloads to trigger private actions. +arguments: + - name: payload + description: "The raw JSON payload from a Vault RE webhook." + required: true + - name: action_type + description: "The type of event (e.g., contact.added, property.updated)." + required: false +--- + +# /webhook-audit Command + +Audit real-time CRM events and map them to your shadow workflow. + +## When to Use + +Use this command when: +- A new lead enters Vault RE and you want to "vet" it privately. +- A property status changes and you need to prep "Shadow Marketing" (OpenClaw). +- You want to verify the data integrity of a corporate system event. + +## Workflow + +### 1. JSON Parsing + +Use `~~real-estate-next/shadow-workflow` to: +- Extract key entities (Contact Name, Property Address, User ID). +- Identify the specific trigger (e.g., "Signed via Secure Sign"). + +### 2. Strategy Mapping + +Produce: +- **Shadow Event Summary**: Plain English explanation of the webhook. +- **Recommended Private Action**: (e.g., "Update Private Deal Sheet," "Draft Personal IG Story"). +- **Priority Rating**: High/Medium/Low based on conversion potential. + +## Example Session + +**User:** `/webhook-audit payload: {"event": "property.updated", "id": 123, "status": "Listing"}` + +**System:** +``` +[~] PARSING VAULT RE PAYLOAD... +[~] MAPPING TO SHADOW WORKFLOW... + +WEBHOOK AUDIT COMPLETE: + +1. Event: Property '123 Petone St' moved from Appraisal to Listing. +2. Shadow Action: + - Update 'Private Deal Tracker' (Google Sheet). + - Trigger OpenClaw: Draft 'Just Listed' post for personal LinkedIn. + - Task: Create 48-hour follow-up for all appraisal-stage leads. + +Would you like to draft the OpenClaw teaser for this listing? [Y/n] +``` + +## Integration Points + +- **Skill**: Uses `~~real-estate-next/shadow-workflow`. +- **Downstream**: Feeds into `/draft-listing`. diff --git a/real-estate/skills/compliance-closer/SKILL.md b/real-estate-next/skills/compliance-closer/SKILL.md similarity index 95% rename from real-estate/skills/compliance-closer/SKILL.md rename to real-estate-next/skills/compliance-closer/SKILL.md index fd4d456..af38b00 100644 --- a/real-estate/skills/compliance-closer/SKILL.md +++ b/real-estate-next/skills/compliance-closer/SKILL.md @@ -1,5 +1,5 @@ --- -name: real-estate/compliance-closer +name: real-estate-next/compliance-closer description: This skill should be used when managing legal compliance (REA/AML), coordinating property negotiations, and finalizing settlement documentation for New Zealand real estate. Use for auditing contracts against the REA Code, drafting "Method of Sale" strategies (Auction, Tender), generating multi-offer responses, and ensuring AML/CDD completeness. Invoke when users mention multi-offer situation, auction strategy, REA compliance, or AML checks. version: 1.0.0 --- @@ -139,6 +139,6 @@ You've applied this skill well when: ## Related Skills -- `~~real-estate/marketing-suite` - For ensuring the Auction energy matches the ad copy. -- `~~real-estate/property-analyst` - For ensuring the multi-offer prices align with market evidence. -- `~~real-estate/lead-management` - For the final "Key Handover" after the deal is closed. +- `~~real-estate-next/marketing-suite` - For ensuring the Auction energy matches the ad copy. +- `~~real-estate-next/property-analyst` - For ensuring the multi-offer prices align with market evidence. +- `~~real-estate-next/lead-management` - For the final "Key Handover" after the deal is closed. diff --git a/real-estate/skills/lead-management/SKILL.md b/real-estate-next/skills/lead-management/SKILL.md similarity index 96% rename from real-estate/skills/lead-management/SKILL.md rename to real-estate-next/skills/lead-management/SKILL.md index 29e8219..9f5634c 100644 --- a/real-estate/skills/lead-management/SKILL.md +++ b/real-estate-next/skills/lead-management/SKILL.md @@ -1,5 +1,5 @@ --- -name: real-estate/lead-management +name: real-estate-next/lead-management description: This skill should be used when managing leads, open home feedback, and post-sale settlement for New Zealand real estate. Use for interpreting NurtureCloud data, ranking "Hot Leads," synthesizing weekly vendor reports, generating referral briefs for Loan Market/Concierge, and preparing settlement handover checklists. Invoke when users mention prospecting, open home feedback, vendor updates, or settlement prep. version: 1.0.0 --- @@ -139,6 +139,6 @@ You've applied this skill well when: ## Related Skills -- `~~real-estate/marketing-suite` - For the "Rainy Day" copy adjustments. -- `~~real-estate/property-analyst` - For data to back up vendor reports. -- `~~real-estate/compliance-closer` - For the REA audit of the final contract. +- `~~real-estate-next/marketing-suite` - For the "Rainy Day" copy adjustments. +- `~~real-estate-next/property-analyst` - For data to back up vendor reports. +- `~~real-estate-next/compliance-closer` - For the REA audit of the final contract. diff --git a/real-estate/skills/marketing-suite/SKILL.md b/real-estate-next/skills/marketing-suite/SKILL.md similarity index 96% rename from real-estate/skills/marketing-suite/SKILL.md rename to real-estate-next/skills/marketing-suite/SKILL.md index db3a99c..ba2744f 100644 --- a/real-estate/skills/marketing-suite/SKILL.md +++ b/real-estate-next/skills/marketing-suite/SKILL.md @@ -1,5 +1,5 @@ --- -name: real-estate/marketing-suite +name: real-estate-next/marketing-suite description: This skill should be used when preparing property listings, marketing materials, and vendor pre-listing advice for the New Zealand real estate market. Use for drafting Trade Me descriptions, social media teasers, suburb-specific amenity profiles, and pre-listing renovation ROI advice. Invoke when users mention property descriptions, open home prep, renovation advice, or suburb amenities. version: 1.0.0 --- @@ -145,6 +145,6 @@ You've applied this skill well when: ## Related Skills -- `~~real-estate/lead-management` - For managing interest generated by marketing. -- `~~real-estate/property-analyst` - For ensuring the marketing price aligns with appraisal. -- `~~real-estate/compliance-closer` - For final REA check before go-live. +- `~~real-estate-next/lead-management` - For managing interest generated by marketing. +- `~~real-estate-next/property-analyst` - For ensuring the marketing price aligns with appraisal. +- `~~real-estate-next/compliance-closer` - For final REA check before go-live. diff --git a/real-estate/skills/property-analyst/SKILL.md b/real-estate-next/skills/property-analyst/SKILL.md similarity index 96% rename from real-estate/skills/property-analyst/SKILL.md rename to real-estate-next/skills/property-analyst/SKILL.md index 6331ca0..90cd94a 100644 --- a/real-estate/skills/property-analyst/SKILL.md +++ b/real-estate-next/skills/property-analyst/SKILL.md @@ -1,5 +1,5 @@ --- -name: real-estate/property-analyst +name: real-estate-next/property-analyst description: This skill should be used when conducting market appraisals, analyzing property investments, and auditing due diligence documents for New Zealand real estate. Use for generating "Appraisal Evidence Packs," calculating rental yields, flagging risks in LIMs/Titles, and assessing school zone stability. Invoke when users mention market value, comparable sales, LIM reports, rental ROI, or school zones. version: 1.0.0 --- @@ -146,6 +146,6 @@ You've applied this skill well when: ## Related Skills -- `~~real-estate/marketing-suite` - For translating appraisal data into ad copy. -- `~~real-estate/lead-management` - For providing data to "Hot Leads." -- `~~real-estate/compliance-closer` - For ensuring the final price meets REA standards. +- `~~real-estate-next/marketing-suite` - For translating appraisal data into ad copy. +- `~~real-estate-next/lead-management` - For providing data to "Hot Leads." +- `~~real-estate-next/compliance-closer` - For ensuring the final price meets REA standards. diff --git a/real-estate-next/skills/shadow-workflow/SKILL.md b/real-estate-next/skills/shadow-workflow/SKILL.md new file mode 100644 index 0000000..6e85736 --- /dev/null +++ b/real-estate-next/skills/shadow-workflow/SKILL.md @@ -0,0 +1,125 @@ +--- +name: real-estate-next/shadow-workflow +description: This skill enables independent contractors to maintain a high-leverage "Shadow Workflow" outside of corporate oversight. It provides logic for parsing Vault RE webhooks, synthesizing forwarded emails using Gemini Pro, sanitizing private drafts, and mirroring corporate tasks into private admin logs. Invoke when users mention webhooks, forwarded emails, private Workspace, or avoiding oversight. +version: 1.0.0 +--- + +# Shadow Workflow (The Contractor's Edge) + +A strategic framework for independent real estate agents to maintain data sovereignty and operational efficiency through a private tech stack. This skill enables the "Shadow Brain" that operates parallel to corporate CRM systems, ensuring the agent owns their intelligence and personal brand. + +**Important**: This skill is designed for agents who control their own private Google Workspace Admin account. It focuses on the separation of personal IP from corporate data while maintaining synchronization. + +## When to Use This Skill + +Invoke this skill when: +- Receiving or auditing **Vault RE** webhook JSON payloads. +- Synthesizing forwarded email threads from a corporate account into a private admin account. +- Drafting client communications that need to be scrubbed of "Corporate Oversight" markers (Privacy Sanitizer). +- Mirroring CRM milestones (e.g., "Contract Signed via Secure Sign") into private Google Sheets or Tasks. +- Using **Gemini Pro** to analyze complex, multi-source client histories. +- Drafting "Shadow Marketing" content for **OpenClaw** that lives on personal profiles. + +## Operational Context + +| Workflow Element | Corporate Mode | Shadow Mode (Next) | Advantage | +|------------------|----------------|-------------------|-----------| +| **CRM** | Vault RE (Shared) | Private Sheet Mirror | Data Ownership | +| **Email** | RW Corporate | Private Gmail (Forwarded) | Gemini Pro Analysis | +| **Signing** | DocuSign (Audit trail) | Private Secure Sign Log | Milestone Control | +| **Marketing** | Agency Brand | **OpenClaw** Personal Brand | IP Preservation | + +## Quick Reference + +1. **Parse Webhook**: Analyze Vault RE JSON for property/contact updates. +2. **Synthesize Threads**: Use Gemini Pro to distill forwarded email context. +3. **Mirror Tasks**: Sync corporate milestones to your private task list. +4. **Sanitize Drafts**: Remove internal corporate jargon and tracking pixels. +5. **Brand Pulse**: Schedule personal posts via OpenClaw based on deal milestones. + +## Detailed Guidance + +### 1. Vault RE Webhook Parser + +Process incoming JSON payloads: +- **`contact.added`**: Extract name, source, and notes. Auto-tag in private "Golden Database." +- **`property.updated`**: Detect status changes (e.g., "Appraisal" -> "Listing"). Trigger private marketing prep. +- **`user.update`**: Monitor for corporate configuration changes that might impact the shadow flow. + +### 2. Email Forwarding Synthesis (Gemini Pro) + +Independent agents often forward emails to a private admin account to leverage advanced AI: +- **Task**: Summarize long threads including attachments (multi-modal). +- **Cross-Reference**: Match email names against Vault RE contact IDs found in webhooks. +- **Action**: Draft replies in the private account, then copy-paste to the corporate sender. + +### 3. The Privacy Sanitizer + +Ensure outgoing communications don't reveal the "Shadow" setup: +- **Logic**: Strip hidden tracking pixels often added by corporate CRM mailers. +- **Tone**: Adjust language from "The Team at [Agency]" to "I" (Personal Brand focus). +- **Metadata**: Verify that PDF properties or document headers don't show "Private Admin" origins. + +### 4. Task Mirroring + +Maintain an invisible log of activity: +- **Trigger**: Webhook signals "Offer Received." +- **Action**: Update private Google Sheet "Deal Tracker" and create a high-priority Google Task. +- **Why**: Ensures if you lose access to the corporate CRM, your deal pipeline and client Intel remain with you. + +## Documentation Requirements + +- [ ] **Webhook Log**: Record of parsed JSON events. +- [ ] **Situation Report**: Gemini Pro synthesis of forwarded emails + CRM data. +- [ ] **Private Task List**: Mirrored milestones from corporate systems. +- [ ] **Sanitized Draft**: Final communication ready for delivery. + +## Common Mistakes (Anti-Patterns) + +| Mistake | Why It's Wrong | Instead | +|---------|----------------|---------| +| **Direct API write to Vault** | High audit risk; reveals shadow tool usage | Use the "Mirror" pattern: read from Vault, act in Private. | +| **Leaving corporate sig in private mail** | Looks unprofessional/confusing | Use separate, personal-brand signatures in the admin account. | +| **Storing PII in insecure Sheets** | Regulatory risk (Privacy Act) | Use encrypted fields or private Google Cloud storage. | +| **Ignoring Webhook latency** | Data becomes stale | Manually trigger `/shadow-sync` if real-time webhooks fail. | + +## When to Escalate + +Escalate to your private Tech Advisor or Solicitor when: +- Corporate IT signals a crackdown on email forwarding or third-party webhooks. +- A "Conflict of Interest" arises between personal brand IP and agency contracts. +- There is a breach of your private admin account credentials. + +## Privacy Considerations + +- **Data Sovereignty**: The agent is the owner of the "Shadow Brain." +- **Minimized Footprint**: Do not push private data back into the corporate CRM without explicit intent. +- **Regulatory**: Ensure your shadow workflow complies with the REA Act and Privacy Act 2020. + +## Confidence Indicators + +| Scenario | Confidence | Action | +|----------|------------|--------| +| Standard `contact.added` JSON payload | High | Auto-populate private log and suggest follow-up. | +| Fragmented email thread forwarded from 3 sources | Medium | Use Gemini Pro for "Deep Synthesis" and flag gaps. | +| Outgoing draft contains corporate tracking links | High | Flag for Sanitizer and propose clean version. | + +## Tool Requirements + +- `~~webhook listener` - Essential for real-time Vault RE integration. +- `~~cloud storage` - Private Google Workspace account. +- `~~social media` - OpenClaw for personal brand posts. + +## Success Indicators + +You've applied this skill well when: +- [ ] You have a complete, private mirror of your deal pipeline. +- [ ] You respond to client emails 50% faster thanks to Gemini Pro synthesis. +- [ ] Your personal brand (LinkedIn/IG) is active and deal-driven without corporate approval delays. +- [ ] Corporate management is unaware of your high-leverage private tech stack. + +## Related Skills + +- `~~real-estate-next/marketing-suite` - For personal brand content templates. +- `~~real-estate-next/lead-management` - For the "Hot Lead" ranking within the shadow database. +- `~~real-estate-next/compliance-closer` - For REA checks on private drafts. diff --git a/real-estate/.claude-plugin/plugin.json b/real-estate/.claude-plugin/plugin.json deleted file mode 100644 index 3a10e9d..0000000 --- a/real-estate/.claude-plugin/plugin.json +++ /dev/null @@ -1,5 +0,0 @@ -{ - "name": "real-estate", - "version": "1.0.0", - "description": "Specialized assistant for New Zealand Real Estate Agents, focusing on the Ray White Lower Hutt baseline. Covers marketing, appraisals, CRM management, and compliance." -} diff --git a/real-estate/README.md b/real-estate/README.md deleted file mode 100644 index eb1383c..0000000 --- a/real-estate/README.md +++ /dev/null @@ -1,24 +0,0 @@ -# Real Estate NZ Plugin - -A specialized specialist for New Zealand Real Estate Agents, focusing on the workflows of the Ray White network (using Lower Hutt as a structural baseline). It covers the entire property lifecycle from prospecting and lead nurturing to market appraisals, marketing, and negotiation. - -## Core Capabilities - -- **Marketing Suite**: Draft Trade Me descriptions, social media teasers, and pre-listing checklists personalized to the agent's brand voice. -- **Lead & CRM Management**: Rank "Hot Leads" from open homes, synthesize weekly vendor reports, and manage settlement handovers. -- **Property Analyst**: Generate evidence-based market appraisals, calculate rental yields for investors, and audit LIMs/Titles for red flags. -- **Compliance Closer**: Navigate REA Code requirements, manage multi-offer protocols, and ensure AML/CDD documentation is "audit-ready." - -## Commands - -- `/draft-listing`: Create a complete marketing suite from raw notes or dictation. -- `/manage-leads`: Prioritize prospecting and rank open home visitors. -- `/vendor-report`: Synthesize feedback into professional weekly updates. -- `/generate-appraisal`: Create data-driven appraisal packs with feature comparison tables. -- `/audit-due-diligence`: Find the "hidden" red flags in LIMs and Titles. -- `/check-compliance`: Audit listings and entities for REA/AML compliance. -- `/prepare-negotiation`: Wargame multi-offers and auctions with strategic scripts. - -## Jurisdictional Focus - -Defaults to **New Zealand** statutory requirements (REA Act, AML/CFT Act, HCC/WCC LIM standards) with portability for Australian (AU) contexts. diff --git a/scripts/sync_plugins.py b/scripts/sync_plugins.py new file mode 100644 index 0000000..465c5d1 --- /dev/null +++ b/scripts/sync_plugins.py @@ -0,0 +1,81 @@ +import os +import shutil +from pathlib import Path + +# Paths +REPO_ROOT = Path(__file__).parent.parent +HOME = Path.home() + +# Distribution Targets +TARGETS = { + "cline": HOME / ".cline" / "skills", + "kilo": HOME / ".kilo" / "skills", + "amp": HOME / ".amp" / "skills", + "opencode": HOME / ".opencode" / "skills", + "claude": HOME / ".claude" / "skills", + "antigravity": HOME / ".gemini" / "antigravity" / "skills", +} + +def sync_plugins(): + print(f"Syncing knowledge-work-plugins from {REPO_ROOT}...") + + # Categories are directories in REPO_ROOT that contain a 'skills' subdirectory + categories = [d for d in REPO_ROOT.iterdir() if d.is_dir() and (d / "skills").exists()] + + for target_name, target_base_path in TARGETS.items(): + print(f" Syncing to {target_name} ({target_base_path})...") + + for category_dir in categories: + category_name = category_dir.name + skills_dir = category_dir / "skills" + + for skill_dir in skills_dir.iterdir(): + if not skill_dir.is_dir(): + continue + + skill_name = skill_dir.name + qualified_skill_name = f"{category_name}-{skill_name}" + + target_skill_dir = target_base_path / qualified_skill_name + target_skill_dir.mkdir(parents=True, exist_ok=True) + + # Source SKILL.md + source_skill_md = skill_dir / "SKILL.md" + if not source_skill_md.exists(): + continue + + # Target SKILL.md + target_skill_md = target_skill_dir / "SKILL.md" + + # Read content and inject metadata + content = source_skill_md.read_text(encoding="utf-8") + + # Basic metadata injection + today = "2026-02-14" + metadata_lines = [ + "adapter_metadata:", + f" skill_name: {qualified_skill_name}", + " skill_version: 1.0.0", + f" last_synced: {today}", + f" source_path: {category_name}/skills/{skill_name}/SKILL.md", + f" adapter_id: {target_name}", + f" adapter_format: {target_name.capitalize()} skill" + ] + metadata = "\n".join(metadata_lines) + + # Handle YAML frontmatter + if content.startswith("---"): + parts = content.split("---", 2) + if len(parts) >= 3: + new_content = f"---{parts[1]}{metadata}\n---{parts[2]}" + else: + new_content = f"---\n{metadata}\n---" + content + else: + new_content = f"---\n{metadata}\n---\n\n" + content + + target_skill_md.write_text(new_content, encoding="utf-8") + + print("\nSync Complete.") + +if __name__ == "__main__": + sync_plugins() From 8c3bd222fbb0862c60cee486a05834fadb8c1a6f Mon Sep 17 00:00:00 2001 From: "Dylan Mordaunt (Illawarra Shoalhaven LHD)" Date: Sat, 14 Feb 2026 17:17:15 +1100 Subject: [PATCH 57/57] chore: Rename repository to -next and revert plugin name to 'real-estate' --- conductor/tracks.md | 2 +- .../index.md | 2 +- .../metadata.json | 2 +- .../plan.md | 4 ++-- .../spec.md | 4 ++-- .../.claude-plugin/plugin.json | 2 +- {real-estate-next => real-estate}/.mcp.json | 0 .../CONNECTORS.md | 0 {real-estate-next => real-estate}/OPENCLAW.md | 0 {real-estate-next => real-estate}/README.md | 0 .../commands/audit-due-diligence.md | 4 ++-- .../commands/check-compliance.md | 4 ++-- .../commands/client-intel.md | 2 +- .../commands/draft-listing.md | 4 ++-- .../commands/generate-appraisal.md | 4 ++-- .../commands/manage-leads.md | 4 ++-- .../commands/prepare-negotiation.md | 4 ++-- .../commands/private-brief.md | 4 ++-- .../commands/shadow-sync.md | 4 ++-- .../commands/vendor-report.md | 4 ++-- .../commands/webhook-audit.md | 4 ++-- .../skills/compliance-closer/SKILL.md | 8 ++++---- .../skills/lead-management/SKILL.md | 8 ++++---- .../skills/marketing-suite/SKILL.md | 8 ++++---- .../skills/property-analyst/SKILL.md | 8 ++++---- .../skills/shadow-workflow/SKILL.md | 8 ++++---- scripts/sync_plugins.py | 19 +++++++++++++++++++ 27 files changed, 68 insertions(+), 49 deletions(-) rename conductor/tracks/{real-estate-next_20260214 => real-estate-upgrade_20260214}/index.md (69%) rename conductor/tracks/{real-estate-next_20260214 => real-estate-upgrade_20260214}/metadata.json (86%) rename conductor/tracks/{real-estate-next_20260214 => real-estate-upgrade_20260214}/plan.md (87%) rename conductor/tracks/{real-estate-next_20260214 => real-estate-upgrade_20260214}/spec.md (65%) rename {real-estate-next => real-estate}/.claude-plugin/plugin.json (88%) rename {real-estate-next => real-estate}/.mcp.json (100%) rename {real-estate-next => real-estate}/CONNECTORS.md (100%) rename {real-estate-next => real-estate}/OPENCLAW.md (100%) rename {real-estate-next => real-estate}/README.md (100%) rename {real-estate-next => real-estate}/commands/audit-due-diligence.md (95%) rename {real-estate-next => real-estate}/commands/check-compliance.md (95%) rename {real-estate-next => real-estate}/commands/client-intel.md (97%) rename {real-estate-next => real-estate}/commands/draft-listing.md (96%) rename {real-estate-next => real-estate}/commands/generate-appraisal.md (95%) rename {real-estate-next => real-estate}/commands/manage-leads.md (95%) rename {real-estate-next => real-estate}/commands/prepare-negotiation.md (95%) rename {real-estate-next => real-estate}/commands/private-brief.md (95%) rename {real-estate-next => real-estate}/commands/shadow-sync.md (94%) rename {real-estate-next => real-estate}/commands/vendor-report.md (95%) rename {real-estate-next => real-estate}/commands/webhook-audit.md (94%) rename {real-estate-next => real-estate}/skills/compliance-closer/SKILL.md (95%) rename {real-estate-next => real-estate}/skills/lead-management/SKILL.md (96%) rename {real-estate-next => real-estate}/skills/marketing-suite/SKILL.md (96%) rename {real-estate-next => real-estate}/skills/property-analyst/SKILL.md (96%) rename {real-estate-next => real-estate}/skills/shadow-workflow/SKILL.md (95%) diff --git a/conductor/tracks.md b/conductor/tracks.md index a8830e8..c9de1b6 100644 --- a/conductor/tracks.md +++ b/conductor/tracks.md @@ -127,4 +127,4 @@ PHASE 4: Research/Academic (parallel, depends Phase 3) │ --- -- [x] **Track: Upgrade the Real Estate plugin to 'Real Estate Next', focusing on contractor Shadow Workflows, Vault RE webhooks, and OpenClaw branding.** (./tracks/real-estate-next_20260214/) +- [x] **Track: Upgrade the Real Estate plugin to include contractor Shadow Workflows, Vault RE webhooks, and OpenClaw branding.** (./tracks/real-estate-upgrade_20260214/) diff --git a/conductor/tracks/real-estate-next_20260214/index.md b/conductor/tracks/real-estate-upgrade_20260214/index.md similarity index 69% rename from conductor/tracks/real-estate-next_20260214/index.md rename to conductor/tracks/real-estate-upgrade_20260214/index.md index 80d0eca..00897f0 100644 --- a/conductor/tracks/real-estate-next_20260214/index.md +++ b/conductor/tracks/real-estate-upgrade_20260214/index.md @@ -1,4 +1,4 @@ -# Track real-estate-next_20260214 Context +# Track real-estate_20260214 Context - [Specification](./spec.md) - [Implementation Plan](./plan.md) diff --git a/conductor/tracks/real-estate-next_20260214/metadata.json b/conductor/tracks/real-estate-upgrade_20260214/metadata.json similarity index 86% rename from conductor/tracks/real-estate-next_20260214/metadata.json rename to conductor/tracks/real-estate-upgrade_20260214/metadata.json index a28cbf8..93c61f5 100644 --- a/conductor/tracks/real-estate-next_20260214/metadata.json +++ b/conductor/tracks/real-estate-upgrade_20260214/metadata.json @@ -1,5 +1,5 @@ { - "track_id": "real-estate-next_20260214", + "track_id": "real-estate_20260214", "type": "feature", "status": "completed", "created_at": "2026-02-14T17:11:00Z", diff --git a/conductor/tracks/real-estate-next_20260214/plan.md b/conductor/tracks/real-estate-upgrade_20260214/plan.md similarity index 87% rename from conductor/tracks/real-estate-next_20260214/plan.md rename to conductor/tracks/real-estate-upgrade_20260214/plan.md index fed6a78..280f7d5 100644 --- a/conductor/tracks/real-estate-next_20260214/plan.md +++ b/conductor/tracks/real-estate-upgrade_20260214/plan.md @@ -1,9 +1,9 @@ # Plan: Real Estate Next Upgrade ## Phase 1: Infrastructure & Renaming -- [x] Rename directory to `real-estate-next`. +- [x] Rename directory to `real-estate`. - [x] Update `plugin.json` name and version (1.1.0). -- [x] Global replace `real-estate` -> `real-estate-next`. +- [x] Global replace `real-estate` -> `real-estate`. - [x] Update `README.md` with contractor focus. ## Phase 2: Documentation & OpenClaw diff --git a/conductor/tracks/real-estate-next_20260214/spec.md b/conductor/tracks/real-estate-upgrade_20260214/spec.md similarity index 65% rename from conductor/tracks/real-estate-next_20260214/spec.md rename to conductor/tracks/real-estate-upgrade_20260214/spec.md index c20283d..a711da9 100644 --- a/conductor/tracks/real-estate-next_20260214/spec.md +++ b/conductor/tracks/real-estate-upgrade_20260214/spec.md @@ -1,10 +1,10 @@ # Specification: Real Estate Next Upgrade ## Overview -Evolution of the `real-estate` plugin into `real-estate-next`. This version is optimized for independent contractors maintaining a "Shadow Workflow" via private Google Workspace accounts, Vault RE webhooks, and OpenClaw branding. +Evolution of the `real-estate` plugin into `real-estate`. This version is optimized for independent contractors maintaining a "Shadow Workflow" via private Google Workspace accounts, Vault RE webhooks, and OpenClaw branding. ## Changes -- Rename all `real-estate` references to `real-estate-next`. +- Rename all `real-estate` references to `real-estate`. - Add `shadow-workflow` skill for data sovereignty and private admin logic. - Add `OPENCLAW.md` documentation for personal brand management. - Implement `/webhook-audit`, `/shadow-sync`, `/private-brief`, and `/client-intel` commands. diff --git a/real-estate-next/.claude-plugin/plugin.json b/real-estate/.claude-plugin/plugin.json similarity index 88% rename from real-estate-next/.claude-plugin/plugin.json rename to real-estate/.claude-plugin/plugin.json index feffb20..9be5a6a 100644 --- a/real-estate-next/.claude-plugin/plugin.json +++ b/real-estate/.claude-plugin/plugin.json @@ -1,5 +1,5 @@ { - "name": "real-estate-next", + "name": "real-estate", "version": "1.1.0", "description": "Advanced evolution of the Real Estate plugin for independent contractors. Features deep Vault RE integration, private Google Workspace automation, and Shadow Workflow support." } diff --git a/real-estate-next/.mcp.json b/real-estate/.mcp.json similarity index 100% rename from real-estate-next/.mcp.json rename to real-estate/.mcp.json diff --git a/real-estate-next/CONNECTORS.md b/real-estate/CONNECTORS.md similarity index 100% rename from real-estate-next/CONNECTORS.md rename to real-estate/CONNECTORS.md diff --git a/real-estate-next/OPENCLAW.md b/real-estate/OPENCLAW.md similarity index 100% rename from real-estate-next/OPENCLAW.md rename to real-estate/OPENCLAW.md diff --git a/real-estate-next/README.md b/real-estate/README.md similarity index 100% rename from real-estate-next/README.md rename to real-estate/README.md diff --git a/real-estate-next/commands/audit-due-diligence.md b/real-estate/commands/audit-due-diligence.md similarity index 95% rename from real-estate-next/commands/audit-due-diligence.md rename to real-estate/commands/audit-due-diligence.md index a3b2e85..ae9e75b 100644 --- a/real-estate-next/commands/audit-due-diligence.md +++ b/real-estate/commands/audit-due-diligence.md @@ -29,7 +29,7 @@ Use this command when: ### 1. Scrutinize & Flag -Use `~~real-estate-next/property-analyst` to: +Use `~~real-estate/property-analyst` to: - Detect "Unauthorized Works" (e.g., bathrooms with no CCC). - Identify "Land Risks" (e.g., HCC flood plains, wind zones). - Highlight "Title Complexities" (e.g., cross-lease common areas). @@ -64,5 +64,5 @@ Would you like to draft the 'Disclosure Authorization' for the vendor to sign? [ ## Integration Points -- **Skill**: Uses `~~real-estate-next/property-analyst`. +- **Skill**: Uses `~~real-estate/property-analyst`. - **Downstream**: Feeds into `/check-compliance`. diff --git a/real-estate-next/commands/check-compliance.md b/real-estate/commands/check-compliance.md similarity index 95% rename from real-estate-next/commands/check-compliance.md rename to real-estate/commands/check-compliance.md index 9698b31..1dced50 100644 --- a/real-estate-next/commands/check-compliance.md +++ b/real-estate/commands/check-compliance.md @@ -29,7 +29,7 @@ Use this command when: ### 1. Scrutinize & Verify -Use `~~real-estate-next/compliance-closer` to: +Use `~~real-estate/compliance-closer` to: - Cross-check `document` against REA Code rules (misleading conduct, disclosures). - Generate a customized `AML Checklist` for the specific entity type. - Identify "Conflict of Interest" triggers. @@ -64,5 +64,5 @@ Would you like to draft the 'AML Information Request' email for the trustees? [Y ## Integration Points -- **Skill**: Uses `~~real-estate-next/compliance-closer`. +- **Skill**: Uses `~~real-estate/compliance-closer`. - **Downstream**: Feeds into `/prepare-negotiation`. diff --git a/real-estate-next/commands/client-intel.md b/real-estate/commands/client-intel.md similarity index 97% rename from real-estate-next/commands/client-intel.md rename to real-estate/commands/client-intel.md index 6224ae1..70ccbf2 100644 --- a/real-estate-next/commands/client-intel.md +++ b/real-estate/commands/client-intel.md @@ -25,7 +25,7 @@ Use this command when: ### 1. Multi-Source Search -Use `~~google-search` and `~~real-estate-next/shadow-workflow` to: +Use `~~google-search` and `~~real-estate/shadow-workflow` to: - Find recent business news or LinkedIn activity for `client_name`. - Identify recent property transactions associated with their name/company (Public Record). diff --git a/real-estate-next/commands/draft-listing.md b/real-estate/commands/draft-listing.md similarity index 96% rename from real-estate-next/commands/draft-listing.md rename to real-estate/commands/draft-listing.md index 0a0d71c..b83008f 100644 --- a/real-estate-next/commands/draft-listing.md +++ b/real-estate/commands/draft-listing.md @@ -32,7 +32,7 @@ Use this command when: ### 1. Clean & Structure -Use `~~real-estate-next/marketing-suite` to: +Use `~~real-estate/marketing-suite` to: - Process the `notes` (cleaning dictation, stripping filler). - Map the property to the `suburb` amenities. - Align the tone with the `agent_voice`. @@ -73,5 +73,5 @@ Would you like to generate a 'Rainy Day Pivot' strategy for the first open home? ## Integration Points -- **Skill**: Uses `~~real-estate-next/marketing-suite`. +- **Skill**: Uses `~~real-estate/marketing-suite`. - **Downstream**: Feeds into `/generate-appraisal` for price alignment. diff --git a/real-estate-next/commands/generate-appraisal.md b/real-estate/commands/generate-appraisal.md similarity index 95% rename from real-estate-next/commands/generate-appraisal.md rename to real-estate/commands/generate-appraisal.md index b0d1517..7109b75 100644 --- a/real-estate-next/commands/generate-appraisal.md +++ b/real-estate/commands/generate-appraisal.md @@ -32,7 +32,7 @@ Use this command when: ### 1. Analyze & Index -Use `~~real-estate-next/property-analyst` to: +Use `~~real-estate/property-analyst` to: - Compare the `property_details` against the `comparables`. - Adjust for the `cycle` (indexing old sales to today's market). - Calculate Rental Yield and local HCC rates impact. @@ -72,6 +72,6 @@ Would you like to draft the 'Appraisal Justification' letter for the vendor? [Y/ ## Integration Points -- **Skill**: Uses `~~real-estate-next/property-analyst`. +- **Skill**: Uses `~~real-estate/property-analyst`. - **Upstream**: Feeds into `/draft-listing` copy. - **Downstream**: Feeds into `/prepare-negotiation`. diff --git a/real-estate-next/commands/manage-leads.md b/real-estate/commands/manage-leads.md similarity index 95% rename from real-estate-next/commands/manage-leads.md rename to real-estate/commands/manage-leads.md index 902b608..34f809b 100644 --- a/real-estate-next/commands/manage-leads.md +++ b/real-estate/commands/manage-leads.md @@ -29,7 +29,7 @@ Use this command when: ### 1. Analyze & Rank -Use `~~real-estate-next/lead-management` to: +Use `~~real-estate/lead-management` to: - Identify "Hot Leads" ( finance-ready, highly motivated). - Categorize database contacts into "Golden Database" tags. - Detect "Missing Referrals" (e.g., buyers needing a mortgage broker). @@ -67,5 +67,5 @@ Would you like to draft the contract offer for Mary Jones? [Y/n] ## Integration Points -- **Skill**: Uses `~~real-estate-next/lead-management`. +- **Skill**: Uses `~~real-estate/lead-management`. - **Downstream**: Feeds into `/prepare-negotiation`. diff --git a/real-estate-next/commands/prepare-negotiation.md b/real-estate/commands/prepare-negotiation.md similarity index 95% rename from real-estate-next/commands/prepare-negotiation.md rename to real-estate/commands/prepare-negotiation.md index 27eeba0..a4498a0 100644 --- a/real-estate-next/commands/prepare-negotiation.md +++ b/real-estate/commands/prepare-negotiation.md @@ -29,7 +29,7 @@ Use this command when: ### 1. Strategic Analysis -Use `~~real-estate-next/compliance-closer` to: +Use `~~real-estate/compliance-closer` to: - Compare offers on Price, Conditions, and Possession. - Draft "Multi-offer Protocol" scripts for buyers. - Generate high-impact "Auction Openers" based on the property's emotional hooks. @@ -67,6 +67,6 @@ Would you like to draft the counter-offer wording for Offer B? [Y/n] ## Integration Points -- **Skill**: Uses `~~real-estate-next/compliance-closer`. +- **Skill**: Uses `~~real-estate/compliance-closer`. - **Upstream**: Uses outputs from `/generate-appraisal`. - **Downstream**: Feeds into `lead-management` for the settlement handover. diff --git a/real-estate-next/commands/private-brief.md b/real-estate/commands/private-brief.md similarity index 95% rename from real-estate-next/commands/private-brief.md rename to real-estate/commands/private-brief.md index 8f1cfa2..340f094 100644 --- a/real-estate-next/commands/private-brief.md +++ b/real-estate/commands/private-brief.md @@ -25,7 +25,7 @@ Use this command when: ### 1. Gemini Pro Synthesis (The Shadow Brain) -Use `~~real-estate-next/shadow-workflow` to: +Use `~~real-estate/shadow-workflow` to: - Summarize the `email_thread` (identifying emotional cues, deadlines, and requirements). - Cross-reference with `property_context` (e.g., "This buyer liked Petone but is now asking about Waterloo"). @@ -57,5 +57,5 @@ Would you like to schedule an OpenClaw 'market update' for Petone to maintain pr ## Integration Points -- **Skill**: Uses `~~real-estate-next/shadow-workflow`. +- **Skill**: Uses `~~real-estate/shadow-workflow`. - **Downstream**: Feeds into `/prepare-negotiation`. diff --git a/real-estate-next/commands/shadow-sync.md b/real-estate/commands/shadow-sync.md similarity index 94% rename from real-estate-next/commands/shadow-sync.md rename to real-estate/commands/shadow-sync.md index f3b90e4..01b0c6b 100644 --- a/real-estate-next/commands/shadow-sync.md +++ b/real-estate/commands/shadow-sync.md @@ -25,7 +25,7 @@ Use this command when: ### 1. Data Aggregation -Use `~~real-estate-next/shadow-workflow` to: +Use `~~real-estate/shadow-workflow` to: - Collect recent activity logs from the `source`. - Filter for high-value intelligence (e.g., specific buyer feedback). @@ -56,5 +56,5 @@ Next Step: Run /private-brief for listing '123 Petone' to prepare for settlement ## Integration Points -- **Skill**: Uses `~~real-estate-next/shadow-workflow`. +- **Skill**: Uses `~~real-estate/shadow-workflow`. - **Downstream**: Feeds into `/private-brief`. diff --git a/real-estate-next/commands/vendor-report.md b/real-estate/commands/vendor-report.md similarity index 95% rename from real-estate-next/commands/vendor-report.md rename to real-estate/commands/vendor-report.md index fe6bf99..580c8ba 100644 --- a/real-estate-next/commands/vendor-report.md +++ b/real-estate/commands/vendor-report.md @@ -28,7 +28,7 @@ Use this command when: ### 1. Synthesize Sentiment -Use `~~real-estate-next/lead-management` to: +Use `~~real-estate/lead-management` to: - Categorize feedback into "Positive," "Critical," and "Pricing." - Highlight market sentiment trends (e.g., "Interest remains high forPetone beachfront"). @@ -60,5 +60,5 @@ Would you like to draft the 'Price Revision' email for the vendor? [Y/n] ## Integration Points -- **Skill**: Uses `~~real-estate-next/lead-management`. +- **Skill**: Uses `~~real-estate/lead-management`. - **Downstream**: Feeds into `/draft-listing` if a marketing pivot is needed. diff --git a/real-estate-next/commands/webhook-audit.md b/real-estate/commands/webhook-audit.md similarity index 94% rename from real-estate-next/commands/webhook-audit.md rename to real-estate/commands/webhook-audit.md index 0309b58..1ca8f6e 100644 --- a/real-estate-next/commands/webhook-audit.md +++ b/real-estate/commands/webhook-audit.md @@ -25,7 +25,7 @@ Use this command when: ### 1. JSON Parsing -Use `~~real-estate-next/shadow-workflow` to: +Use `~~real-estate/shadow-workflow` to: - Extract key entities (Contact Name, Property Address, User ID). - Identify the specific trigger (e.g., "Signed via Secure Sign"). @@ -58,5 +58,5 @@ Would you like to draft the OpenClaw teaser for this listing? [Y/n] ## Integration Points -- **Skill**: Uses `~~real-estate-next/shadow-workflow`. +- **Skill**: Uses `~~real-estate/shadow-workflow`. - **Downstream**: Feeds into `/draft-listing`. diff --git a/real-estate-next/skills/compliance-closer/SKILL.md b/real-estate/skills/compliance-closer/SKILL.md similarity index 95% rename from real-estate-next/skills/compliance-closer/SKILL.md rename to real-estate/skills/compliance-closer/SKILL.md index af38b00..fd4d456 100644 --- a/real-estate-next/skills/compliance-closer/SKILL.md +++ b/real-estate/skills/compliance-closer/SKILL.md @@ -1,5 +1,5 @@ --- -name: real-estate-next/compliance-closer +name: real-estate/compliance-closer description: This skill should be used when managing legal compliance (REA/AML), coordinating property negotiations, and finalizing settlement documentation for New Zealand real estate. Use for auditing contracts against the REA Code, drafting "Method of Sale" strategies (Auction, Tender), generating multi-offer responses, and ensuring AML/CDD completeness. Invoke when users mention multi-offer situation, auction strategy, REA compliance, or AML checks. version: 1.0.0 --- @@ -139,6 +139,6 @@ You've applied this skill well when: ## Related Skills -- `~~real-estate-next/marketing-suite` - For ensuring the Auction energy matches the ad copy. -- `~~real-estate-next/property-analyst` - For ensuring the multi-offer prices align with market evidence. -- `~~real-estate-next/lead-management` - For the final "Key Handover" after the deal is closed. +- `~~real-estate/marketing-suite` - For ensuring the Auction energy matches the ad copy. +- `~~real-estate/property-analyst` - For ensuring the multi-offer prices align with market evidence. +- `~~real-estate/lead-management` - For the final "Key Handover" after the deal is closed. diff --git a/real-estate-next/skills/lead-management/SKILL.md b/real-estate/skills/lead-management/SKILL.md similarity index 96% rename from real-estate-next/skills/lead-management/SKILL.md rename to real-estate/skills/lead-management/SKILL.md index 9f5634c..29e8219 100644 --- a/real-estate-next/skills/lead-management/SKILL.md +++ b/real-estate/skills/lead-management/SKILL.md @@ -1,5 +1,5 @@ --- -name: real-estate-next/lead-management +name: real-estate/lead-management description: This skill should be used when managing leads, open home feedback, and post-sale settlement for New Zealand real estate. Use for interpreting NurtureCloud data, ranking "Hot Leads," synthesizing weekly vendor reports, generating referral briefs for Loan Market/Concierge, and preparing settlement handover checklists. Invoke when users mention prospecting, open home feedback, vendor updates, or settlement prep. version: 1.0.0 --- @@ -139,6 +139,6 @@ You've applied this skill well when: ## Related Skills -- `~~real-estate-next/marketing-suite` - For the "Rainy Day" copy adjustments. -- `~~real-estate-next/property-analyst` - For data to back up vendor reports. -- `~~real-estate-next/compliance-closer` - For the REA audit of the final contract. +- `~~real-estate/marketing-suite` - For the "Rainy Day" copy adjustments. +- `~~real-estate/property-analyst` - For data to back up vendor reports. +- `~~real-estate/compliance-closer` - For the REA audit of the final contract. diff --git a/real-estate-next/skills/marketing-suite/SKILL.md b/real-estate/skills/marketing-suite/SKILL.md similarity index 96% rename from real-estate-next/skills/marketing-suite/SKILL.md rename to real-estate/skills/marketing-suite/SKILL.md index ba2744f..db3a99c 100644 --- a/real-estate-next/skills/marketing-suite/SKILL.md +++ b/real-estate/skills/marketing-suite/SKILL.md @@ -1,5 +1,5 @@ --- -name: real-estate-next/marketing-suite +name: real-estate/marketing-suite description: This skill should be used when preparing property listings, marketing materials, and vendor pre-listing advice for the New Zealand real estate market. Use for drafting Trade Me descriptions, social media teasers, suburb-specific amenity profiles, and pre-listing renovation ROI advice. Invoke when users mention property descriptions, open home prep, renovation advice, or suburb amenities. version: 1.0.0 --- @@ -145,6 +145,6 @@ You've applied this skill well when: ## Related Skills -- `~~real-estate-next/lead-management` - For managing interest generated by marketing. -- `~~real-estate-next/property-analyst` - For ensuring the marketing price aligns with appraisal. -- `~~real-estate-next/compliance-closer` - For final REA check before go-live. +- `~~real-estate/lead-management` - For managing interest generated by marketing. +- `~~real-estate/property-analyst` - For ensuring the marketing price aligns with appraisal. +- `~~real-estate/compliance-closer` - For final REA check before go-live. diff --git a/real-estate-next/skills/property-analyst/SKILL.md b/real-estate/skills/property-analyst/SKILL.md similarity index 96% rename from real-estate-next/skills/property-analyst/SKILL.md rename to real-estate/skills/property-analyst/SKILL.md index 90cd94a..6331ca0 100644 --- a/real-estate-next/skills/property-analyst/SKILL.md +++ b/real-estate/skills/property-analyst/SKILL.md @@ -1,5 +1,5 @@ --- -name: real-estate-next/property-analyst +name: real-estate/property-analyst description: This skill should be used when conducting market appraisals, analyzing property investments, and auditing due diligence documents for New Zealand real estate. Use for generating "Appraisal Evidence Packs," calculating rental yields, flagging risks in LIMs/Titles, and assessing school zone stability. Invoke when users mention market value, comparable sales, LIM reports, rental ROI, or school zones. version: 1.0.0 --- @@ -146,6 +146,6 @@ You've applied this skill well when: ## Related Skills -- `~~real-estate-next/marketing-suite` - For translating appraisal data into ad copy. -- `~~real-estate-next/lead-management` - For providing data to "Hot Leads." -- `~~real-estate-next/compliance-closer` - For ensuring the final price meets REA standards. +- `~~real-estate/marketing-suite` - For translating appraisal data into ad copy. +- `~~real-estate/lead-management` - For providing data to "Hot Leads." +- `~~real-estate/compliance-closer` - For ensuring the final price meets REA standards. diff --git a/real-estate-next/skills/shadow-workflow/SKILL.md b/real-estate/skills/shadow-workflow/SKILL.md similarity index 95% rename from real-estate-next/skills/shadow-workflow/SKILL.md rename to real-estate/skills/shadow-workflow/SKILL.md index 6e85736..a7bcac2 100644 --- a/real-estate-next/skills/shadow-workflow/SKILL.md +++ b/real-estate/skills/shadow-workflow/SKILL.md @@ -1,5 +1,5 @@ --- -name: real-estate-next/shadow-workflow +name: real-estate/shadow-workflow description: This skill enables independent contractors to maintain a high-leverage "Shadow Workflow" outside of corporate oversight. It provides logic for parsing Vault RE webhooks, synthesizing forwarded emails using Gemini Pro, sanitizing private drafts, and mirroring corporate tasks into private admin logs. Invoke when users mention webhooks, forwarded emails, private Workspace, or avoiding oversight. version: 1.0.0 --- @@ -120,6 +120,6 @@ You've applied this skill well when: ## Related Skills -- `~~real-estate-next/marketing-suite` - For personal brand content templates. -- `~~real-estate-next/lead-management` - For the "Hot Lead" ranking within the shadow database. -- `~~real-estate-next/compliance-closer` - For REA checks on private drafts. +- `~~real-estate/marketing-suite` - For personal brand content templates. +- `~~real-estate/lead-management` - For the "Hot Lead" ranking within the shadow database. +- `~~real-estate/compliance-closer` - For REA checks on private drafts. diff --git a/scripts/sync_plugins.py b/scripts/sync_plugins.py index 465c5d1..269bccb 100644 --- a/scripts/sync_plugins.py +++ b/scripts/sync_plugins.py @@ -14,6 +14,9 @@ "opencode": HOME / ".opencode" / "skills", "claude": HOME / ".claude" / "skills", "antigravity": HOME / ".gemini" / "antigravity" / "skills", + "codex": HOME / ".codex" / "skills", + "copilot": HOME / ".config" / "github-copilot", + "qwen": HOME / ".qwen" / "skills", } def sync_plugins(): @@ -25,6 +28,22 @@ def sync_plugins(): for target_name, target_base_path in TARGETS.items(): print(f" Syncing to {target_name} ({target_base_path})...") + # Copilot uses a consolidated file approach + if target_name == "copilot": + consolidated_path = target_base_path / "knowledge-work-plugins.md" + target_base_path.mkdir(parents=True, exist_ok=True) + all_content = ["# Knowledge Work Plugins Collection", ""] + for category_dir in categories: + category_name = category_dir.name + skills_dir = category_dir / "skills" + for skill_dir in skills_dir.iterdir(): + if skill_dir.is_dir() and (skill_dir / "SKILL.md").exists(): + all_content.append(f"## Category: {category_name} | Skill: {skill_dir.name}") + all_content.append((skill_dir / "SKILL.md").read_text(encoding="utf-8")) + all_content.append("\n---\n") + consolidated_path.write_text("\n".join(all_content), encoding="utf-8") + continue + for category_dir in categories: category_name = category_dir.name skills_dir = category_dir / "skills"