What we still need from Dr. Orecchio
One consolidated list, grouped by workflow step, of the medical input needed to turn this demo logic into a validated Proof of Concept. Everything else — the data structure, the workflow, the synthetic patients — we built ourselves, so his time goes only where his medical authority is actually required.
Step 1–4
Patient data entry
- Final field list — which fields are mandatory vs. optional per pathway, and which identifiers matter (practice ID, insurance number).
- Which fields already exist in the practice / laboratory software today, and in what format, so a realistic import can be scoped.
- Routing questions: is CVD / FH / diabetes / smoking / blood pressure the right set, or are chronic kidney disease, hypertension or family history also needed?
- Lab panel and units: LDL-C, total cholesterol, HDL-C in mmol/L — anything else (lipoprotein(a), triglycerides)?
Step 5
Clinical Decision Engine
- Confirm the pathway category boundaries (age cutoffs, which comorbidities count as “special category”).
- Confirm the precedence order when multiple conditions apply at once.
- Any additional pathways not covered by CVD / FH / diabetes / age.
Step 6
Risk Engine
- Which exact calculator(s) to implement per pathway (SCORE2, SCORE2-OP, diabetes-specific) and how to license / source them.
- The precise coefficients / point tables and category cutoffs.
- Whether Swiss-specific risk charts or adjustments apply.
Step 7
LDL-C Target Engine
- Confirm the exact target thresholds per risk category.
- Confirm whether the “≥50 % reduction from baseline” rule applies, and for which categories.
- Flag any Swiss-specific target deviations from ESC defaults.
Step 8
Treatment Decision Engine
- Confirm the stepped order (statin → ezetimibe → PCSK9i) and any exceptions.
- Define “high-intensity statin” precisely (drugs and doses).
- Define statin intolerance precisely (how many statins, what duration, what counts as a rechallenge).
- Confirm the minimum duration before escalating to a PCSK9 inhibitor.
Step 9
Swiss Reimbursement Engine
- Exact specialty-list criteria per drug beyond Praluent (evolocumab, inclisiran, …).
- Renewal / continuation criteria for therapies already running.
Acceptance testing (for the paid PoC)
- 3–5 representative clinical scenarios with the expected outcome for each (risk category, LDL target, next treatment step, reimbursed yes/no and why) — the medical “ground truth” the PoC is validated against.