{"schema_version":1,"research_id":"eoa_inverse_innovation_exp05_external_evaluation_20260803","source_assessment_id":"layer_decay_and_expiration_management__psychology:P1:v0","cell_id":"layer_decay_and_expiration_management__psychology","search_queries":["clinical documentation outdated information copied forward EHR patient safety study note bloat","psychotherapy clinical formulation electronic health record formulation review superseded","HL7 FHIR ClinicalImpression status completed entered-in-error official","health record problem list reconciliation stale problems patient safety study","site:apa.org record keeping guidelines psychologists 2007 pdf retention clinical records","site:apa.org psychology clinical record keeping guideline formulation treatment rationale","site:nhs.uk psychological formulation review care plan current formulation standard","site:nice.org.uk mental health care plan review formulation multidisciplinary","site:hhs.gov HIPAA medical record amendment append link original record retain official","site:healthit.gov electronic health record amendment audit trail signed note official","site:hl7.org/fhir clinicalimpression previous status official FHIR R5","site:hl7.org/fhir provenance record lifecycle superseded clinical impression","electronic health record clinical formulation structured formulation mental health software","clinical formulation electronic record versioning superseded formulation mental health","problem-oriented longitudinal record current assessment plan prior art clinical reasoning timeline","MedKnowts concept oriented EHR documentation study clinical information retrieval","site:bps.org.uk good practice guidelines psychological formulation 2011 review formulation pdf","British Psychological Society formulation should be reviewed regularly guideline","psychological formulation dynamic evolving hypothesis review study formulation utility","case formulation quality agreement clinicians empirical study psychotherapy","site:explore.bps.org.uk/content/report-guideline/bpsrep.2025.rep188 \"Assessment, formulation, and diagnosis guidelines\" publication date"],"sources":[{"source_id":"S1","title":"Formulation — Assessment, formulation, and diagnosis guidelines (adults)","publisher":"British Psychological Society","url":"https://explore.bps.org.uk/content/report-guideline/bpsrep.2025.rep188/chapter/bpsrep.2025.rep188.6","source_class":"OFFICIAL_GUIDANCE","publication_date":"2025","accessed_at":"2026-08-03","claims_supported":["Formulation is ongoing collaborative sense-making rather than a fixed truth.","Formulation is always open to revision when new information appears.","Formulations should be evidence-grounded, meaningful to the client, and attentive to power, context, and bias.","Formulation is a core practitioner-psychologist competency."]},{"source_id":"S2","title":"Mental health personalised care framework: the modern care programme approach","publisher":"NHS England","url":"https://www.england.nhs.uk/long-read/mental-health-personalised-care-framework-the-modern-care-programme-approach/","source_class":"OFFICIAL_GUIDANCE","publication_date":"2026-07-17","accessed_at":"2026-08-03","claims_supported":["NHS mental-health services are an identifiable adopter class expected to maintain current assessments and current co-produced care plans.","Formulation should inform care and treatment recommendations and should draw on previous assessments and multiple information sources.","Patients should be able to correct inaccuracies or propose changes, with unresolved differences documented.","Plans should respond to change, be reviewed timely, preserve safety information, and put important information where it will not be missed."]},{"source_id":"S3","title":"Examining the Copy and Paste Function in the Use of Electronic Health Records","publisher":"National Institute of Standards and Technology","url":"https://www.nist.gov/publications/examining-copy-and-paste-function-use-electronic-health-records","source_class":"GOVERNMENT_OR_REGULATOR","publication_date":"2017-01-19","accessed_at":"2026-08-03","claims_supported":["Empirical human-factors work found that copied EHR material can become convoluted or irrelevant and impair situation awareness.","Clinicians can miss important information in long copied material.","Users need attribution, edit history, authorship, date, and time information.","Failure to review copied material can propagate wrong information and create patient-safety risk."]},{"source_id":"S4","title":"Psychodynamic case formulations without technical language: a reliability study","publisher":"BMC Psychology","url":"https://pmc.ncbi.nlm.nih.gov/articles/PMC6813052/","source_class":"PRIMARY_RESEARCH","publication_date":"2019-10-24","accessed_at":"2026-08-03","claims_supported":["Case formulations are sets of hypotheses about causes, precipitants, and maintaining factors that guide intervention.","Prior formulation research has reported quality, reliability, and validity limitations; only 44% were rated good enough in one cited study.","Structured components and plain language can improve communicability and reliability.","In this experienced-clinician sample, overall formulation reliability exceeded 0.70, but reliability for inferred mechanisms had a lower-bound estimate of 0.61, showing that disagreement is not inevitable but remains concentrated in inferential content."]},{"source_id":"S5","title":"FHIR R5 ClinicalImpression","publisher":"Health Level Seven International","url":"https://www.hl7.org/fhir/R5/clinicalimpression.html","source_class":"STANDARD","publication_date":"2023-03-26","accessed_at":"2026-08-03","claims_supported":["FHIR provides a structured ClinicalImpression resource with patient, performer, assessment date, status, supporting information, findings, and a link to the previous impression.","The resource explicitly anticipates repeated reassessment and revised care plans.","The resource is maturity level 1 and Trial Use.","HL7 identifies unresolved questions about revision versus new impressions, provisional status, and relationships among impressions and care plans."]},{"source_id":"S6","title":"FHIR R5 Provenance","publisher":"Health Level Seven International","url":"https://fhir.hl7.org/fhir/provenance.html","source_class":"STANDARD","publication_date":"2023-03-26","accessed_at":"2026-08-03","claims_supported":["FHIR Provenance can record who created, revised, deleted, or signed a resource and the entities involved.","Provenance can apply to current or past resource versions and supports authenticity, trust, and reproducibility.","Implementing complete provenance may introduce requirements for unique identity and versioning.","AuditEvent and Provenance provide complementary implementation paths for lifecycle accountability."]},{"source_id":"S7","title":"MedKnowts: Unified Documentation and Information Retrieval for Electronic Health Records","publisher":"ACM Symposium on User Interface Software and Technology / arXiv","url":"https://arxiv.org/abs/2109.11451","source_class":"PRIMARY_RESEARCH","publication_date":"2021-09-23","accessed_at":"2026-08-03","claims_supported":["A prior prototype combines structured capture with concept-oriented longitudinal views and contextual retrieval.","Persistent shared cards can surface selected high-value history without copying it into notes.","A one-month deployment with four medical notetakers found favorable usability but was small and outside longitudinal psychology.","Concept-oriented views are a close interface analogue, but MedKnowts does not implement hypothesis leases, safety-dependency gates, reversible retirement, or tested archival."]},{"source_id":"S8","title":"HIPAA Audit Protocol — Updated July 2018","publisher":"U.S. Department of Health and Human Services, Office for Civil Rights","url":"https://www.hhs.gov/hipaa/for-professionals/compliance-enforcement/audit/protocol/index.html","source_class":"GOVERNMENT_OR_REGULATOR","publication_date":"2018-07","accessed_at":"2026-08-03","claims_supported":["For U.S. HIPAA-covered entities, individuals have amendment rights for designated-record-set information while it is maintained.","Accepted amendments must identify affected records and append or link the amendment rather than silently rewriting history.","Disputed amendments require linked requests, denials, disagreements, and rebuttals as applicable.","This supports append-and-link architecture but does not itself authorize automated demotion, archival, or destruction; jurisdiction-specific policy remains necessary."]}],"problem_evidence":{"support":"MODERATE","rationale":"The underlying mechanisms are visible: NIST documents copied, irrelevant, wrongly attributed, and insufficiently reviewed EHR content that can obscure important information; BPS and NHS guidance treat formulations as revisable and require current assessments; and formulation research shows inferential quality and reliability limitations. However, no located study measures how often stale psychological hypotheses are reused as current premises, whether their age or supersession is hidden, or the resulting clinical harm. General EHR evidence cannot establish the candidate's psychology-specific prevalence or effect size.","source_ids":["S1","S2","S3","S4"]},"stakeholder_evidence":{"support":"MODERATE","rationale":"NHS mental-health service providers, named workers, practitioner psychologists, supervisors, and records-governance functions are identifiable adopters or authorizers. NHS England expressly calls for current formulations, correction of inaccuracies, responsive review, continuity, and prominent safety information. BPS assigns formulation to competent practitioner psychologists. This is genuine pull for current and revisable reasoning, but neither source requests a leasebook, automatic review-due demotion, quarantine, or archive-restore workflow.","source_ids":["S1","S2"]},"prior_art":{"proximity":"ADJACENT_PRIOR_ART","closest_analogues":[{"name":"Ongoing collaborative formulation and current care-plan review","similarity":"BPS and NHS practice already require formulations to remain revisable, current, collaborative, and connected to care planning, covering much of the proposed governance objective.","remaining_difference":"They do not prescribe persistent hypothesis-level identities, expiring review leases, default-view demotion, dependency gates, quarantine, tombstones, or restore drills.","source_ids":["S1","S2"]},{"name":"FHIR ClinicalImpression plus Provenance","similarity":"Together these standards provide dated clinical impressions, prior-impression links, supporting evidence references, lifecycle status, authorship, version lineage, and records of revision or deletion.","remaining_difference":"ClinicalImpression is Trial Use and explicitly leaves revision and provisional-status semantics unresolved; neither standard supplies formulation-class review leases, staleness policy, clinical dependency detection, or a validated user workflow.","source_ids":["S5","S6"]},{"name":"MedKnowts concept-oriented clinical-record view","similarity":"MedKnowts structures concepts, retrieves longitudinal context, and lets teams maintain a persistent selected view alongside immutable clinical documentation.","remaining_difference":"It prioritizes retrieval during note authoring rather than governing the lifecycle of psychological hypotheses and does not provide lease expiry, human-authorized supersession, retention exceptions, reversible retirement, or reconstruction testing.","source_ids":["S7"]},{"name":"HIPAA append-and-link amendment workflow","similarity":"The U.S. rule preserves historical records while linking corrections and disagreements, closely paralleling non-destructive supersession and disposition markers.","remaining_difference":"It governs patient amendment rights and record handling, not clinician review cadence, current-visibility rules, hypothesis validity, or archival testing.","source_ids":["S8"]}],"distinctive_claim_remaining":"Relative to ordinary chronology, periodic case review, or a concept-oriented view, a read-only hypothesis-level Leasebook that marks uncorroborated formulations review-due, privileges clinician-confirmed current formulations, and preserves explicit evidence, predecessor, disagreement, safety-dependency, and reconstruction links will improve correct identification of the formulation governing a specified decision without increasing missed safety dependencies, unjustified certainty, review time, or reconstruction failure. The distinctive element is the joint workflow; its individual components are established or adjacent.","confidence":"MODERATE"},"implementation_evidence":{"support":"MODERATE","rationale":"The metadata and lineage are technically representable using ClinicalImpression-like resources and FHIR Provenance, and append/link correction is compatible with the cited U.S. HIPAA protocol. A read-only sidecar and mock interface are therefore plausible without rewriting signed notes. Feasibility is constrained by ClinicalImpression's low maturity, local EHR integration, access controls for sensitive mental-health material, narrative and external dependencies that are not machine-readable, jurisdiction-specific retention rules, patient disagreement handling, and clinician workload. No source validates TTL-like demotion or dependency detection for psychological formulations.","source_ids":["S2","S5","S6","S8"]},"scores":{"meaningful_impact":{"score":3,"rationale":"Stale clinical information and difficult retrieval can affect safety, while formulations guide treatment; the psychology-specific prevalence and realized harm remain unmeasured.","source_ids":["S2","S3","S4"]},"stakeholder_pull":{"score":4,"rationale":"A current NHS framework explicitly requires current formulations, correction, review, continuity, and visible safety information, although it does not request this product form.","source_ids":["S1","S2"]},"incremental_advantage":{"score":3,"rationale":"The proposal adds explicit hypothesis lifecycle governance and reconstruction safeguards beyond chronology and concept-oriented retrieval, but advantage over ordinary collaborative review has not been tested.","source_ids":["S1","S2","S7"]},"distinctiveness_plausibility":{"score":3,"rationale":"No exact match was found in the bounded search, but the proposal composes close practice, standards, provenance, amendment, and interface precedents rather than introducing a wholly new primitive.","source_ids":["S1","S2","S5","S6","S7","S8"]},"technical_implementability":{"score":3,"rationale":"Core identity, evidence, prior-version, status, and provenance data are representable, but the relevant FHIR resource is low-maturity and narrative dependencies remain difficult to resolve.","source_ids":["S5","S6"]},"adoption_authority_feasibility":{"score":3,"rationale":"Clinicians and service providers have recognizable roles, but records authorities, privacy officers, patients, supervisors, and jurisdiction-specific law constrain visibility and disposition decisions.","source_ids":["S1","S2","S8"]},"evidence_readiness":{"score":3,"rationale":"A mock-interface comparison is bounded and measurable, but patient-safe evaluation still requires clinician participation, curated cases, adjudication, and potentially proprietary historical data.","source_ids":["S2","S4","S7"]},"safety_net_benefit":{"score":4,"rationale":"Non-destructive supersession, explicit lineage, human authorization, and append/link provenance could reduce irreversible error, provided expired is not presented as false and safety dependencies are not missed.","source_ids":["S5","S6","S8"]},"scalability":{"score":2,"rationale":"Standards-based metadata can scale computationally, but formulation classes, review intervals, access rules, tacit dependencies, and clinical accountability vary substantially across services and jurisdictions.","source_ids":["S1","S2","S5","S8"]}},"score_confidence":"MODERATE","costs":{"first_evidence":{"band_2026_usd":"50K_TO_250K","scope":"Design a read-only mock-up; curate and adjudicate 40–60 synthetic or authorized de-identified longitudinal cases; recruit 12–20 clinicians; run a randomized crossover comparison and one copied-data restore drill; analyze safety, accuracy, agreement, and time outcomes.","confidence":"MODERATE","assumptions":["Approximately 500–1,500 hours across clinical experts, research design, interface prototyping, privacy review, data preparation, and analysis.","No live EHR integration or alteration of source records.","Clinician participation is compensated and cases receive independent reference-standard adjudication."],"source_ids":["S2","S4","S7"]},"initial_deployment_startup":{"band_2026_usd":"250K_TO_1M","scope":"Build a single-organization sidecar or EHR extension with formulation identity, evidence and predecessor links, role-based access, review states, provenance, test archive, and policy configuration.","confidence":"LOW","assumptions":["One EHR environment and one mental-health service line.","Uses existing identity, authentication, audit, and FHIR capabilities where available.","Excludes automatic NLP truth judgments, hard deletion, and multi-enterprise exchange.","Includes security, privacy, clinical-safety, usability, and records-policy work."],"source_ids":["S5","S6","S8"]},"operational_launch":{"band_2026_usd":"250K_TO_1M","scope":"Configure and validate the system across several teams in one organization, migrate or annotate an initial formulation inventory, train clinicians and supervisors, establish escalation and rollback procedures, and perform monitored rollout.","confidence":"LOW","assumptions":["Several hundred clinicians or a comparably sized service.","Manual review for safety-linked, contested, and retention-sensitive cases.","Parallel operation with chronological records during launch.","No custom integration across multiple unrelated EHR vendors."],"source_ids":["S1","S2","S5","S8"]},"annual_recurring":{"band_2026_usd":"250K_TO_1M","scope":"Product maintenance, security and access review, clinical governance, user support, review-queue administration, exception revalidation, archive-restore drills, monitoring, and refresher training for one medium-to-large organization.","confidence":"LOW","assumptions":["Recurring cost is dominated by protected clinician and governance time rather than storage.","Review volume and lease lengths are unknown and could move cost outside this band.","No savings from reduced search time are credited.","Material multi-jurisdiction expansion would require a higher band."],"source_ids":["S1","S2","S6","S8"]}},"verified_pipeline_gates":{"externally_supported_problem":{"status":"YES","reason":"Revisability of formulations, limitations in formulation reliability, and safety/usability problems from copied and poorly attributed clinical information are externally supported, though exact formulation-staleness prevalence is not.","source_ids":["S1","S2","S3","S4"]},"externally_credible_adopter_or_authorizer":{"status":"YES","reason":"NHS mental-health services and competent practitioner psychologists are identifiable adopters; supervisors and organizational records authorities are credible authorizers for the relevant portions of the workflow.","source_ids":["S1","S2"]},"distinct_testable_incremental_claim":{"status":"YES","reason":"The claim can compare current-formulation identification, stale-premise use, safety-dependency misses, time, disagreement, and reconstruction under chronology, ordinary review, and the Leasebook.","source_ids":["S2","S7"]},"bounded_next_evidence_step":{"status":"YES","reason":"A read-only randomized crossover evaluation on synthetic or authorized de-identified cases, followed by a copied-data restore drill, is finite and does not alter patient care or signed records.","source_ids":["S4","S7"]},"no_unresolved_safety_or_authority_stop":{"status":"UNCERTAIN","reason":"The read-only study is plausibly safe, but live deployment still lacks validated safety-dependency detection, patient-facing interpretation safeguards, local records-authority approval, access classification, and jurisdiction-specific retention analysis.","source_ids":["S1","S2","S5","S8"]},"credible_cost_scope_and_range":{"status":"UNCERTAIN","reason":"Resource-equivalent scopes and broad bands can be bounded, but no vendor quote, local EHR estimate, review-volume measurement, or clinician-workload study was found.","source_ids":["S2","S5","S6"]}},"next_evidence_step":"Run a preregistered randomized crossover study with 12–20 independent clinicians and 40–60 synthetic or appropriately authorized de-identified longitudinal cases. Compare (A) ordinary chronological notes, (B) chronological notes plus a periodic clinician-review summary, and (C) a read-only Leasebook mock-up. For a specified treatment or safety decision, measure adjudicated accuracy in selecting the currently supported formulation, selection of contradicted or superseded premises, missed safety-linked dependencies, clinician agreement, evidence-location time, confidence calibration, and reconstruction of one prior decision. Include patient/lived-experience review of labels and one end-to-end archive/restore drill on copied test data. Predeclare falsifiers: no clinically meaningful improvement over both comparators in current-formulation identification; any increase in safety-dependency misses; more unjustified confidence or material disagreement; review time exceeding the baseline without compensating accuracy; users interpreting review-due as false; or any failure to reconstruct the prior decision or restore copied data. Do not change live visibility, treatment, diagnosis, safety plans, or source records.","blocking_evidence":["No direct prevalence estimate for stale, contradicted, or superseded psychological formulations remaining cognitively active in longitudinal care.","No controlled evidence that hypothesis-level lease labels improve current-formulation identification beyond ordinary case review or summarization.","No validated sensitivity or acceptable miss threshold for detecting narrative, external, or tacit safety dependencies.","No evidence that clinicians and patients reliably interpret review-due, superseded, quarantined, and archived labels without treating them as truth judgments.","No organization-specific privacy, patient-access, records-retention, legal-hold, clinical-safety, or destruction-authority approval.","No measured clinician review burden, EHR integration estimate, procurement quote, or recurring operating-volume data.","No live evidence that archives, tombstones, and predecessor/evidence links remain reconstructable across EHR upgrades and organizational handoffs."],"research_disposition":"PARTNERED_RESEARCH_PROGRAM","world_novelty_boundary":"A bounded web search found adjacent practice, standards, interfaces, and legal record-amendment mechanisms but no direct source implementing the complete hypothesis-level lease, dependency-gated disposition, reversible retirement, and tested-reconstruction workflow in longitudinal psychology. This is not a world-novelty, patentability, freedom-to-operate, market-size, or realized-impact determination; those remain unmeasured.","arm":"COMPLETE_PROPOSAL_PORTFOLIO","candidate_version":0,"controller_recommendation":{"action":"STOP_EMPIRICAL_RESEARCH_NEEDED","repairable":false,"material_progress_observed":true,"progress_targets":["Quantify the prevalence and decision relevance of stale or superseded formulation reuse in a defined longitudinal-care setting.","Complete the three-arm clinician crossover study with predeclared accuracy, safety, workload, calibration, and reconstruction criteria.","Demonstrate that safety-linked dependency misses are not increased and that review-due labels are not interpreted as falsity.","Obtain patient/lived-experience, clinical-safety, privacy, and records-authority review for the proposed metadata and visibility states.","Validate an archive-and-restore path and predecessor/evidence lineage on copied test data.","Replace resource assumptions with organization-specific integration, training, review-volume, and recurring-cost estimates."],"reason":"Bounded web research establishes a credible problem mechanism, adopter class, adjacent prior art, and technical representation, but cannot determine the proposal's incremental clinical benefit, safety-dependency sensitivity, label interpretation, workflow burden, or reconstruction performance. Those questions require clinician fieldwork or live/simulated testing with governed data, so the evaluation must stop for empirical research; under the controller rule, every STOP is non-repairable."},"proposal_index":1}