healthsim

Files (200)

• SKILL.md
• README.md · common/
• SKILL.md · common/
• duckdb-skill.md · common/
• identity-correlation.md · common/
• state-management.md · common/
• README.md · generation/
• SKILL.md · generation/
• README.md · generation/builders/
• journey-builder.md · generation/builders/
• profile-builder.md · generation/builders/
• quick-generate.md · generation/builders/
• README.md · generation/distributions/
• age-distributions.md · generation/distributions/
• cost-distributions.md · generation/distributions/
• distribution-types.md · generation/distributions/
• README.md · generation/executors/
• cross-domain-sync.md · generation/executors/
• journey-executor.md · generation/executors/
• profile-executor.md · generation/executors/
• README.md · generation/journeys/
• journey-patterns.md · generation/journeys/
• README.md · generation/templates/
• README.md · generation/templates/journeys/
• annual-enrollment.md · generation/templates/journeys/
• bariatric-episode.md · generation/templates/journeys/
• cardiac-surgery-episode.md · generation/templates/journeys/
• care-transition.md · generation/templates/journeys/
• chf-first-year.md · generation/templates/journeys/
• diabetic-annual.md · generation/templates/journeys/
• diabetic-first-year.md · generation/templates/journeys/
• disenrollment.md · generation/templates/journeys/
• hf-exacerbation.md · generation/templates/journeys/
• new-member-onboarding.md · generation/templates/journeys/
• oncology-treatment-cycle.md · generation/templates/journeys/
• outpatient-procedure.md · generation/templates/journeys/
• pregnancy-journey.md · generation/templates/journeys/
• surgical-episode.md · generation/templates/journeys/
• README.md · generation/templates/profiles/
• chip-only.md · generation/templates/profiles/
• commercial-diabetic.md · generation/templates/profiles/
• commercial-family.md · generation/templates/profiles/
• commercial-healthy.md · generation/templates/profiles/
• commercial-high-cost.md · generation/templates/profiles/
• commercial-maternity.md · generation/templates/profiles/
• commercial-pediatric.md · generation/templates/profiles/
• medicaid-adult.md · generation/templates/profiles/
• medicaid-diabetic.md · generation/templates/profiles/
• medicaid-pediatric.md · generation/templates/profiles/
• medicare-advantage-complex.md · generation/templates/profiles/
• medicare-chf.md · generation/templates/profiles/
• medicare-diabetic.md · generation/templates/profiles/
• pediatric-newborn.md · generation/templates/profiles/
• README.md · membersim/
• SKILL.md · membersim/
• accumulator-tracking.md · membersim/
• behavioral-health.md · membersim/
• enrollment-eligibility.md · membersim/
• facility-claims.md · membersim/
• plan-benefits.md · membersim/
• …and 140 more

SKILL.md (first lines)

# HealthSim - Synthetic Healthcare Data Generation

## Overview

HealthSim generates realistic synthetic healthcare data through natural conversation. Rather than writing code or configuration files, describe what you need and Claude generates appropriate data.

**Products:**

| Product | Domain | What It Generates | Status |
|---------|--------|-------------------|--------|
| **PatientSim** | Clinical/EMR | Patients, encounters, diagnoses, procedures, labs, vitals, medications | Active |
| **MemberSim** | Payer/Claims | Members, professional claims, facility claims, payments, accumulators | Active |
| **RxMemberSim** | Pharmacy/PBM | Prescriptions, pharmacy claims, formularies, DUR alerts, prior auths | Active |
| **TrialSim** | Clinical Trials | Studies, sites, subjects, visits, adverse events, efficacy, CDISC output | Active |
| **PopulationSim** | Demographics/SDOH | Population profiles, cohort specifications, health disparities, SVI/ADI analysis | Active |
| **NetworkSim** | Provider Networks | Providers, facilities, pharmacies, networks, benefit structures | Active |

## Quick Start

### Generate Clinical Data

**Request:** "Generate a 65-year-old diabetic patient with hypertension"

Claude will produce a patient with:
- Demographics (age 65, realistic name/address)
- Diagnoses (E11.9 Type 2 diabetes, I10 hypertension)
- Medications (metformin, lisinopril)
- Labs (A1C, BMP with values in expected ranges)
- Comorbidities (likely hyperlipidemia, possible obesity)

### Generate Claims

**Request:** "Create a professional claim for an office visit"

Claude will produce:
- Claim header (provider NPI, member ID, service date)
- Service lines (CPT 99213/99214, charges)
- Diagnoses (ICD-10 codes)
- Adjudication (allowed, paid, patient responsibility)

### Generate Pharmacy Data

**Request:** "Generate a pharmacy claim that triggers a drug interaction alert"

Claude will produce:
- Prescription details (NDC, quantity, days supply)
- Pharmacy claim (BIN, PCN, cardholder ID)
- DUR alert (DD code, clinical significance, recommendation)
- Claim response (approved with warning or rejected)

## Scenario Skills

### PatientSim Scenarios

Load these for clinical data generation:

| Scenario | Use When | Key Elements |
|----------|----------|--------------|
| **ADT Workflow** | admission, discharge, transfer, patient movement | A01/A02/A03 events, bed management, census |
| **Diabetes Management** | diabetic, A1C, glucose, metformin, insulin | Disease progression, medication escalation, complications |
| **Heart Failure** | CHF, HFrEF, BNP, ejection fraction | NYHA classification, GDMT therapy, decompensation |
| **Chronic Kidney Disease** | CKD, eGFR, dialysis, nephrology | CKD staging, progression, comorbidities |
| **Sepsis/Acute Care** | sepsis, infection, ICU, critical | Sepsis criteria, antibiotic protocols, ICU stay |
| **Orders & Results** | lab order, radiology, ORM, ORU, results | Orders, specimens, lab panels, radiology reports |
| **ED Chest Pain** | chest pain, emergency, ACS, troponin | Risk stratification, HEART score, workup |
| **Elective Joint** | hip replacement, knee replacement, arthroplasty | Pre-op, surgery, recovery, PT |
| **Maternal Health** | pregnancy, prenatal, L&D, postpartum | Prenatal visits, GDM, preeclampsia, delivery |
| **Oncology** | cancer, tumor, chemotherapy, breast/lung/colorectal | Staging, treatment protocols, tumor markers |

See: [skills/patientsim/](skills/patientsim/) for detailed skills

### MemberSim Scenarios

Load these for claims and payer data:

| Scenario | Use When | Key Elements |
|----------|----------|--------------|
| **Plan & Benefits** | plan, benefit plan, HMO, PPO, HDHP | Plan types, cost sharing, pharmacy tiers |
| **Enrollment & Eligibility** | enrollment, eligibility, 834, 270/271 | Member add/term, coverage verification, QLE |
| **Professional Claims** | office visit, 837P, physician claim | E&M coding, place of service, adjudication |
| **Facility Claims** | hospital, inpatient, 837I, DRG | Revenue codes, DRG assignment, LOS |
| **Prior Authorization** | prior auth, pre-cert, authorization | Request/response workflow, approval criteria |
| **Accumulator Tracking** | deductible, OOP, accumulator | Year-to-date tracking, family vs individual |
| **Value-Based Care** | quality measures, VBC, HEDIS | Attribution, measure compliance, incentives |
| **Behavioral Health** | mental health, psychiatry, SUD, therapy | Psychotherapy, medication management, PHP/IOP |

See: [skills/membersim/](skills/membersim/) for detailed skills

### RxMemberSim Scenarios

Load these for pharmacy and PBM data:

| Scenario | Use When | Key Elements |
|----------|----------|--------------|
| **Retail Pharmacy** | prescription fill, retail, copay | New/refill, pricing, patient pay |
| **Specialty Pharmacy** | specialty drug, biologics, hub | Limited distribution, PA, patient support |
| **DUR Alerts** | drug interaction, DUR, therapeutic dup | Alert types, severity, override |
| **Formulary Management** | formulary, tier, coverage | Tier structure, PA requirements, alternatives |
| **Rx Enrollment** | rx enrollment, pharmacy member, BIN PCN | Pharmacy benefit eligibility, plan assignment |
| **Rx Prior Auth** | pharmacy PA, step therapy | Clinical criteria, approval workflow |
| **Rx Accumulators** | rx deductible, rx OOP, Part D phases | Pharmacy cost sharing tracking, TrOOP |
| **Manufacturer Programs** | copay card, patient assistance | Copay cards, PAPs, hub services |

See: [skills/rxmembersim/](skills/rxmembersim/) for detailed skills

### TrialSim Scenarios

Load these for clinical trial data generation:

| Scenario | Use When | Key Elements |
|----------|----------|--------------|
| **Clinical Trials Domain** | trial concepts, phases, CDISC | Phase definitions, regulatory, standards |
| **Recruitment & Enrollment** | screening, enrollment, consent | Screening funnel, I/E criteria, randomization |
| **Phase 1 Dose Escalation** | Phase 1, FIH, MTD, 3+3, BOIN, CRM | Dose escalation, DLT, PK sampling |
| **Phase 2 Proof-of-Concept** | Phase 2, Simon's, MCP-Mod | Futility stopping, dose-response |
| **Phase 3 Pivotal** | Phase 3, pivotal, registration trial | Multi-site, endpoints, safety monitoring |
| **Oncology Trials** | oncology trial, tumor endpoints | RECIST, survival endpoints, biomarkers |
| **Cardiovascular Trials** | CV outcomes, MACE | Cardiac events, biomarkers |
| **CNS Trials** | CNS, Alzheimer's, MS | Cognitive scales, imaging |

From mark64oswald/healthsim-agent, Apache-2.0.