med-reconcile

Med Reconcile

Action level: L0 (read and analyse only). The diff is reported, never applied; nothing is ordered or filed.

Purpose

Prove the discharge medication list is safe before it is drafted into the summary.

When to use

After admission-synthesise, whenever a discharge medication list is being prepared. Typical triggers: "reconcile the discharge meds", "check the discharge medication list", "did anything get stopped during the stay", "just pull the home med list forward as-is".

When NOT to use

When NOT to use: do not use it to draft or edit any prose (summary-draft, patient-instructions), to build the follow-up list (followup-plan), or to apply a correction to draft_discharge_meds - it is a report, not a fix. Do not use it as a clinical decision aid: it does not judge whether a medication is appropriate, only whether the draft matches the documented record. Do not run it on a partial medication list to get an early "clean" - an incomplete list is escalated, not reconciled.

Inputs

admission_meds; inpatient_changes (stop/start/change with reasons, each with source_note and documented_date); draft_discharge_meds. Rules: base/references/discharge-rules.md.

Steps

1. Run the med_reconcile engine tool (python3 base/scripts/med_reconcile.py --question <payload> --out <payload>) to compute expected_discharge_meds from admission_meds + inpatient_changes.
2. Diff draft_discharge_meds against expected_discharge_meds in both directions - additions and omissions.
3. Record every discrepancy with its type, its numbered rule citation and the documenting note/date it came from.
4. Set clean only when the discrepancy list is empty and no inpatient action was unrecognised; raise one escalation per discrepancy.
5. Hand reconciliation_report to summary-draft and patient-instructions; never re-derive the list downstream.

Output

reconciliation_report on the contract: {expected_discharge_meds[{drug, dose, status, reason, source_note, documented_date}], stopped_meds[{drug, status, reason, source_note, documented_date}], discrepancies[{drug, type, detail, citation, source_note, documented_date}], clean, source} plus one escalation string per discrepancy. expected_discharge_meds lists only medications expected to be active at discharge; reason is present only when an inpatient start or change set it. A medication stopped in-house is not on that list - it is on stopped_meds with its stop reason and citation (so summary-draft can show the discontinuation), and it surfaces as a discrepancy if the draft mishandles it. unrecognised_actions[] appears only when an inpatient change has an action other than start/stop/change. Seven discrepancy types, each mirroring a numbered rule:

• unresolved_stop_reappeared (#1) - a stopped drug carried forward without a new order.
• missing_from_discharge (#4) - an expected active drug absent from the draft, or listed there with a stop status that no inpatient order supports.
• stopped_med_undocumented (#5) - a stopped drug deleted from the draft instead of listed as stopped, or listed with a stop status but no stop reason (1.0.3).
• unordered_addition (#6) - a drug on the draft that was never on admission and never started in-house.
• dose_mismatch (#7) - draft dose different from the expected dose.
• change_to_absent_med (#8) - a documented change naming a drug that is not on the expected list.
• change_provenance_missing (#9) - an inpatient change with no documenting note and date.