Clinical intelligence

The distinctions that decide whether a note is safe.

“No chest pain” and “chest pain” differ by one word and by an entire clinical decision. Clinoria treats that difference as a first-class field rather than a nuance for a summariser to resolve.

Status vocabulary

Four words, no adjectives.

Every clinical concept in the graph carries exactly one status from a closed set. A closed set is checkable; a paragraph of prose is not.

PRESENT

The finding is there

Stated as current by the patient or clinician, with the supporting span attached.

ABSENT

The finding was explicitly denied

Distinct from never mentioned. A pertinent negative is a clinical fact in its own right.

QUESTIONED

The finding was asked about

“Do you have fever?” is recorded as a question, not as a symptom and not as a denial.

RESOLVED

The finding is historical and settled

A four-day fever that ended last week remains in the record as resolved history rather than vanishing.

Worked example — temporal coexistence

Three truths about fever, all true at once.

A summariser collapses this into one sentence and one tense. Clinoria keeps all three states, because the difference between “had” and “has” is the difference between a resolved illness and an active one.

Synthetic transcript · 12 turns, excerpt

Patient Doctor, I had fever for four days last week. It settled on its own by Saturday.

Doctor Do you have fever now?

Patient No fever now.

Doctor Any chest pain or breathlessness?

Patient I have no chest pain. No breathlessness.

Extracted facts Validator passed

Concept	Status	Source
fever	RESOLVED	turn 1
fever	QUESTIONED	turn 2
fever	ABSENT	turn 3
chest pain	ABSENT	turn 5
breathlessness	ABSENT	turn 5
cough	PRESENT	turn 4
diabetes	RESOLVED	subject: mother

Verified output Rendered as “history of fever for three days, which has since resolved” plus a separate present-tense denial. Nothing is merged.

The six dimensions

How each one is represented.

Negation: A denial produces status: ABSENT with the negated concept attached, rather than removing the concept. Negation is scoped to the clause it appears in: in Malayalam script, an explicit denial and a separate present symptom in the same consultation are recorded independently (verified). The same scoping does not hold for Malayalam typed in Latin characters — see defect R1.
Temporality: Historical and current states are separate facts. A resolved illness keeps its duration and its resolution; a current denial is recorded separately and both survive into the note.
Subject attribution: Family and third-party statements carry a subject other than the patient. This is what prevents “my father had a heart attack” becoming the patient's cardiac history.
Uncertainty: The schema carries an uncertainty field intended to hold hedged statements distinctly from assertions. It is not yet populated reliably — hedged input currently yields null. This is a known defect, listed on the research page.
Contradiction: When a patient denies a symptom and later affirms it, both facts are retained with their own spans. The system does not pick a winner; it surfaces the conflict to the clinician.
Provenance: Every fact carries a source_span pointing into the transcript. A claim without a span is not rendered, and the validator fails closed when a rendered phrase has no supporting fact.

Contradiction, in practice

What happens when the patient changes their story.

Synthetic transcript · same symptom, two answers

Doctor Any chest pain at all?

Patient No, I have no chest pain at all.

Patient Actually yes, when I walk fast I get severe chest pain.

Both are kept

The graph contains chest pain: ABSENT from the first turn and chest pain: PRESENT with a severity and an exertional trigger from the second. Neither overwrites the other.

A clinician reading this needs to see the correction, not a tidied version of it. Silently resolving the contradiction is the failure mode; showing it is the feature.

Verified Both polarities survive extraction and rendering.

Where the representation breaks

Code-switched negation inverts. Malayalam negation typed in Latin characters is not recognised, and a denial can be recorded as a positive finding.
Laterality can be invented. The validator accepted a “right chest” description that the transcript never mentioned.
Compound clauses lose findings. A family-history sentence can lose one relative while keeping another.
Uncertainty is empty. Hedged language is not yet captured as data.

Why publish this

A capability list without a failure list is marketing.

These dimensions are the reason the architecture exists. They are also the reason we can show precisely where it fails: a defect in a closed-vocabulary graph is reproducible, nameable and fixable. A defect inside a fluent paragraph is none of those things.

Read the defect register

Evaluate

Try to break the representation, not the wording.

Bring a denial, a correction and a family history in one sentence. That is where this approach is most likely to fail and most useful to test.

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