ClinicalMem — Clinical Safety Memory for Healthcare AI

Live Patient Scenario

SM

Sarah Mitchell

MRN: SM-2026-0847 • DOB: 1959-03-14

2 CRITICAL 2 HIGH

Demographics

Age67

SexFemale

Providers4 Active

Medications7 Active

Active Conditions

Type 2 Diabetes

Hypertension

CKD Stage 3b

Atrial Fibrillation

Active Medications

Warfarin 5mg

Ibuprofen 400mg

Metformin 1000mg

Lisinopril 20mg

Amlodipine 10mg

Amoxicillin 500mg

Atorvastatin 40mg

Allergies: Penicillin (anaphylaxis)

Safety Findings

Warfarin + Ibuprofen

CRITICAL

ER prescribed NSAID without checking anticoagulant. Massively increased bleeding risk.

Layer 1: Deterministic Layer 3: RxNorm

Penicillin Allergy + Amoxicillin

CRITICAL

Amoxicillin is a penicillin-class antibiotic. Cross-reactivity detected via SNOMED CT drug hierarchy.

SNOMED CT Layer 1: Deterministic

Declining GFR + Metformin

HIGH

eGFR declining over 6 months. Approaching metformin contraindication at <30.

Lab Trend Analysis Lab-Med Contraindication

Conflicting BP Targets

HIGH

Cardiologist targets <130/80 vs Nephrologist <140/90. Conflicting treatment plans.

Provider Disagreement Cross-Provider

Bonus: 2 additional findings discovered autonomously

• INR 3.8 — above therapeutic range, correlated with ibuprofen addition
• eGFR declining trajectory — 13-point drop over 6 months

What-If Drug Substitution Simulator

INTERACTIVE

What happens if we swap the dangerous NSAID for a safer alternative?

Ibuprofen 400mg NSAID

Acetaminophen 500mg Non-NSAID

-1

Critical Resolved

Warfarin+NSAID eliminated

Safe

INR Impact

No bleeding risk increase

3

Remaining Findings

1 critical, 2 high

6-Layer Safety Pipeline

Each layer adds confidence. Together they prevent hallucinations about patient safety.

1

Deterministic Table

Rule-based — never hallucinates

<1ms

2

OpenEvidence API

Mayo Clinic / Elsevier ClinicalKey AI

~2s

3

RxNorm API

Drug normalization + NIH interaction DB (Epic/Cerner standard)

~1s

4

Multi-LLM Consensus

6 US-based models must agree

~3s

GPT-5.4 Gemini 3.1 Pro Grok 4.1 Claude Opus 4.6 Perplexity Sonar Gemini Flash

5

LLM Synthesis

Evidence-cited clinical explanations

~3s

6

Abstention Gate

"I don't know" when evidence insufficient — refuses to guess

0ms

Deterministic

Evidence APIs

LLM-Powered

Safety Gate

Clinical Terminology Integration

Three NIH/NLM vocabulary systems power coded clinical reasoning

RxNorm

Drug normalization + interaction detection. Resolves brand names to ingredients, checks NIH interaction DB.

Drug Normalize Interactions

SNOMED CT

Allergy cross-reactivity via drug class hierarchy. 8 drug classes with alias expansion.

8 Drug Classes Cross-Reactivity

UMLS Metathesaurus

Cross-vocabulary mapping: ICD-10 ↔ SNOMED CT ↔ LOINC ↔ RxNorm via CUI equivalence.

Crosswalk 6 Vocabularies

SHA-256 Audit Trail

Tamper-proof Merkle chain — every clinical decision is cryptographically linked

BLOCK #0 — GENESIS 2026-03-07 09:14:22

Patient data ingested: Sarah Mitchell (47 FHIR R4 resources)

a3f8c2e1...d7b94e6f ← prev: 0000000000000000

BLOCK #1 — CRITICAL 2026-03-07 09:14:23

Drug interaction: Warfarin + Ibuprofen (severity=CRITICAL)

7e2b5f91...c4a83d2e ← prev: a3f8c2e1...d7b94e6f

BLOCK #2 — CRITICAL 2026-03-07 09:14:23

Allergy conflict: Penicillin allergy + Amoxicillin (SNOMED CT cross-reactivity)

b1d4e7a3...f82c6d19 ← prev: 7e2b5f91...c4a83d2e

BLOCK #3 — HIGH 2026-03-07 09:14:24

Lab trend: eGFR declining 45→38→32, metformin contraindication approaching

c8f2a196...e3d7b4a5 ← prev: b1d4e7a3...f82c6d19

Every block's SHA-256 hash includes the previous block's hash — HIPAA-grade integrity

MCP Tools & A2A Skills

MCP Server

FastMCP 2.x • 18 Tools • SHARP-on-MCP

store_clinical_observation

recall_patient_context

check_medication_conflicts

check_allergy_conflicts

detect_belief_drift

explain_clinical_conflictGenAI

clinical_care_handoffGenAI

+ 5 more tools (audit trail, dependencies, summary, ingest, health)

A2A Agent

Google ADK • 13 Tools • A2A Protocol

medication-safety-review

clinical-context-recall

contradiction-assessment

care-transition-summary

explain-conflictGenAI

Engine Modules (13)

clinical_memory

clinical_scoring

fhir_client

llm_synthesizer

rxnorm_client

snomed_client

umls_mapper

consensus_engine

fda_client

trials_client

what_if

phi_detector

hallucination_detector

System Architecture

FHIR R4

Patient Data

Medical APIs

RxNorm, SNOMED, UMLS

LLM Consensus

6 US-based models

Shared Engine (13 modules)

Clinical Memory

BM25+Vector+RRF

MIND Kernels

Scoring

Drug Safety

4-Tier Pipeline

LLM Synthesis

Evidence-Cited

RxNorm

SNOMED CT

UMLS

SHA-256 Audit Trail (Merkle Chain)

MCP Server

18 Tools

A2A Agent

13 Tools

Audit Trail

Tamper-proof

Tech Stack

mind-mem

Hybrid Search Engine

MIND Lang

Clinical Scoring

FHIR R4

Patient Data Standard

FastMCP 2.x

MCP Protocol

Google ADK

A2A Protocol

RxNorm + SNOMED

NIH Terminology

UMLS

Cross-Vocabulary

Azure

Container Apps