Large language models (LLMs) offer promising clinical decision support but remain vulnerable to hallucinated facts, unsupported recommendations, and citation errors. We present DIASENTINEL, a fully on-premise multi-agent system for one-year type 2 diabetes mellitus (T2DM) risk screening and guideline-grounded report generation from electronic health records (EHRs). The system integrates calibrated risk prediction, deterministic clinical signal extraction, Reciprocal Rank Fusion over American Diabetes Association (ADA) guidelines, and a hybrid verification layer combining rule-based checks with LLM entailment. The demonstration provides a real-time batch-screening dashboard and an interactive patient report interface with cited recommendations, verification results, and raw EHR comparison. DIASENTINEL demonstrates a practical framework for reliable, auditable, and privacy-preserving LLM-based clinical decision support.
Large language models can convert medical documents into structured data, but plausible output may still be unsupported by the source. Persisting such output in a longitudinal health record, a record that accumulates patient information over time, therefore creates an integrity risk: unverified data may influence later summaries, trends, or preventive-care computations. We introduce an evidence-gated trust-promotion model that keeps generated data provisional until a deterministic monitor verifies it against the source document. The monitor admits a candidate for a specified downstream use only when the source contains a unique supporting quotation, the relevant fields occur within the same laboratory row, and the required provenance is preserved. The generator cannot approve its own output, missing or ambiguous evidence causes refusal, and refused candidates remain available for human review rather than being silently discarded. We implement the model in Medical DataCloud, a personal health-record application, and evaluate it through automated tests and a replay of saved extraction outputs. All 22 conformance and mutation tests pass. The replay covers nine historical laboratory PDF reports containing 102 manually labelled rows. The reports produce 97 numeric candidates: schema validation accepts all 97, an earlier packet-level evidence check accepts 94, and the hardened quotation- and row-level policy admits 72 while retaining 25 for review. The study evaluates system integrity rather than clinical correctness or clinical safety. The results demonstrate the technical feasibility of an enforceable boundary that prevents generated claims from authorizing their own reuse in a longitudinal health record.
Objective. Large language models (LLMs) increasingly draft clinical research manuscripts, but their fluency can hide fabricated citations, numbers that drift from source tables, and unmet reporting-guideline items. Existing tools generate text without verifying it, and self-critique inherits the blind spots that produce confident fabrication. We describe an architecture that pairs generation with verification. Methods. The design rests on three principles: decompose the workflow into self-contained skills, gate every stage transition with halt-on-failure, and resolve each integrity question with the cheapest sufficient mechanism -- a deterministic, re-executable check where one suffices, and a prose-level probe only where interpretation is unavoidable. This determinism-where-possible split, organized as an integrity-gate taxonomy, is the core contribution. It is realized as MedSci Skills, an open-source toolkit of 43 skills coordinated by one orchestrator, whose deterministic tier comprises 21 standard-library detectors. We evaluate it on three reproducible public-dataset pipelines (STARD, PRISMA, STROBE) and a seeded-defect ablation. Results. Across the three pipelines every content-hash manifest verified clean and the gates surfaced real defects. On 27 identical injected defects the deterministic gates detected all 27 with no false positives on the matched clean fixtures, whereas a generic single-prompt LLM reviewer detected 11, its misses concentrated in generated-code, bibliography-internal, and style defects the prose does not expose. Conclusion. Determinism-where-possible verification yields an auditable, re-executable trail that exposes the evidence a human needs to check an LLM-assisted manuscript -- feasibility and reproducibility evidence, not a claim of human-competitive quality, which a separate blinded study addresses. MedSci Skills is MIT-licensed and archived (v3.8.0).