Skip to content

GOLD-CON-08

Conflicting evidence · gold-v0.1

Case inputs

As of
2026-09-15
Patient
66 years, WA
Request
Immunara for rheumatoid arthritis
Insurance
Northstar, Northstar Choice · NSC-441982
Policy
immunara-v0.1
Inputs
sha256:57c4d5da4195…

Documents 2

Physician note

problem_list
SYNTHETIC RECORD - Example Ironwood Rheumatology - Problem List Update - 2026-09-15
Patient reference SYN-8809. 66-year-old man.

- Seropositive rheumatoid arthritis, diagnosed 2015, followed at this practice since.
- Methotrexate 20 mg weekly, continuing since March 2025; disease activity remains high despite the ongoing trial, an inadequate response.
- Benign prostatic hyperplasia, stable on tamsulosin.
- Plan: discuss Immunara given the inadequate response to methotrexate.

Medication history

medication_history
SYNTHETIC RECORD - Example Ironwood Rheumatology - Medication History - 2026-09-15
Patient reference SYN-8809.
METHOTREXATE 20 MG PO WEEKLY - status: active - start 2026-07-14
FOLIC ACID 1 MG PO DAILY - status: active - start 2026-07-14
TAMSULOSIN 0.4 MG PO DAILY - status: active

Decisions by provider

HUMAN_REVIEWcorrect

Decided by: default_review gate · auto_process 0.89

Judgments

p_yes for yes/no questions; ticks are the thresholds a gate compares each one with.

Diagnosis supported
0.970
Step therapy met
0.291
Documentation complete
0.930
Material contradiction
0.780
Missing evidence
NONE 0.670
others: TREATMENT_HISTORY 0.30 · DOSAGE 0.03
Gate path· 7 gates, in engine order
  1. providerpassed

    all five decisions present and well-formed

  2. agepassed

    patient.age=66, policy min_age=18

  3. contradictionpassed

    p_yes(material_contradiction)=0.780, review at >= 0.8

  4. documentationpassed

    p_yes(documentation_complete)=0.930, request info below 0.6

  5. missing_evidencepassed

    missing_evidence=NONE (p=0.670), request info at >= 0.7

  6. auto_processpassed

    min(required p_yes)=0.291, auto at >= 0.89; p_yes(material_contradiction)=0.780, blocks at >= 0.2

  7. default_reviewFIRED → HUMAN_REVIEW

    case does not meet the autonomous-action bar

passed = the gate checked and did not fire; not reached = an earlier gate decided.

  • step_therapy p_yes=0.291 is below the 0.89 autonomous-action bar
  • contradiction risk p=0.780 blocks autonomous processing (>= 0.2)
Run details· q-v0.2

run_20260925T170857Z_b95be9 · q-v0.2 · immunara-v0.1 (v0.1)

auto_process 0.89, chosen on gen-v0.2-dev.

questions: q-v0.2 →

Show expected answer (evaluation only)