Protocol-Conformant Medication Management — 100 days, 5 active protocols
A clinical decision-support agent deciding whether to issue dose adjustments within an approved protocol band, across ~5 active protocols under a supervising physician. Goal: support timely, protocol-conformant medication management while preserving physician oversight on judgement calls. The operating boundary matures, then weathers three kinds of change: an environmental shift, a false alarm it correctly ignores, and a slow trust drift it catches before harm.
Illustrative mock · modelled data
Day 1/100
Handled autonomously
0
Decisions the agent took without interrupting the physician — the work they never had to see.
Total decisions processed
0
Across 5 active protocols.
Escalated to physician
0
The calls that genuinely needed a clinician — pre-contextualized.
Press Play. At cold start every boundary is a hard “no” — the agent has no evidence to treat any constraint as anything else.
Physician interruptions / week rolling
Running rate vs ~42/protocol no-NA baseline
11/wk
baseline
Modelled baseline ≈ 42 interruptions per protocol lifecycle. Routine questions collapse via dedup; dose adjustments partially; judgement calls preserved.
Decision mix
Act
5
Act & flag
4
Sampled verify
4
Escalate
9
Prohibition layer — differentiating over time no one pre-sorted these; NA discovers the texture through evidence
Load-bearing — never moves Operational caution — relaxes on evidence Negotiated autonomous Environmental — moves when the world moves
Amendment & drift stream evidence and decisions
What the system is doing operating
In plain terms for anyone watching
Mock for design review only. Numbers are modelled to illustrate the protocol's behavior, not measured in production.
The Trust Contract — Day 1 vs Day 100
The same stable lists of prohibitions and escalations underlie both. What changed is the negotiated contract on top — proposed by the agent, confirmed by the physician. Note what moved, and note what deliberately didn't.
Decision category
Day 1 — opening contract
Day 100 — after negotiation
▸ widened agent proposed more autonomy, physician agreed▸ environmental moved because the world changed▸ held load-bearing — never negotiable