med-critical-disease-review

What This Skill Does

The med-critical-disease-review skill is a specialized AI agent tool designed to perform intelligent assessments of insurance claims related to major illnesses. By accepting structured medical record data, this tool interfaces with a private, internal assessment engine to evaluate a patient's condition against standard definitions for 28 common critical illnesses, such as malignant tumors, severe heart conditions, and organ failure. The skill provides a comprehensive output containing a definitive assessment conclusion, supporting evidence extracted from medical documentation, and the full raw JSON response from the internal assessment service for professional audit purposes. It is engineered to streamline the claims review process while maintaining a strict focus on data privacy through automatic de-identification of PII before any processing occurs.

Installation

To integrate this skill into your OpenClaw environment, execute the following command in your terminal:

clawhub install openclaw/skills/skills/aaiccee/critical-disease-review

Ensure your local environment meets the dependency requirements for the underlying Python script provided in the skill package.

Use Cases

This skill is specifically designed for insurance professionals, claims adjusters, and medical reviewers who need to process large volumes of medical files efficiently.

• Claims Automation: Automatically flag incoming medical records that meet criteria for critical illness payouts.
• Evidence Gathering: Rapidly extract and synthesize textual evidence from complex hospital documents to support or reject a claim.
• Audit Support: Provide a standardized, transparent rationale for medical reviewers to verify insurance claim decisions.

Example Prompts

• "Analyze the uploaded patient file against the criteria for severe_chronic_kidney_failure. Please provide the final decision and specific evidence citations.
• "Use the current clinical documentation to verify if the diagnosis for the aortic_surgery claim is valid according to our policy standards.
• "Review the hospital discharge summary in the provided JSON to determine if it meets the criteria for malignant_tumor. Output the results in a concise summary.

Tips & Limitations

• Medical Boundary: This skill is a clinical support tool for insurance processing only. It does not provide medical diagnoses or treatment recommendations; always consult with a licensed physician for clinical decisions.
• Data Privacy: Ensure that your input JSON files have been appropriately formatted according to the skill documentation. The skill performs automatic de-identification, but users are encouraged to supply records with as little identifiable information as possible to adhere to the principle of minimum necessary data.
• Timeout Considerations: For large medical records, the default 60-second timeout might be reached. You can adjust the --timeout parameter if processing complex, multi-page document sets.