Composed output & the source that comes first
Every other output in this system announces itself as a claim. A number invites "is that right?". A flag invites "on what basis?". Well-formed prose invites nothing — it reads as already-checked, and the better the writing, the less of it gets read.
Every clinically material assertion is bound to a source the reader opens in one action, and a sentence that cannot be bound is not shown.
The artefact also states, by category, what it did not carry — because omission is the one error re-reading will never reveal.
Scope
A composed artefact is a piece of prose assembled by software from record content, shown to a clinician as a unit. Handover briefs, discharge summaries, referral drafts. Single-turn, over a defined corpus, non-conversational.
Conversational assistants are held, not covered. Nothing here should be read as an argument that a chat interface over a patient record is a solved design problem; it is a different problem, and this system does not yet have defensible rules for it.
Deliberately technology-neutral. A rules-based template stitching sentences together has every problem on this page. An axis or a pattern named "is it a language model" would be the rules-versus-machine-learning mistake wearing a new hat.
Why the usual devices have no subject here
This system's defence against automation bias is anti-anchoring: withhold the machine's opinion until the reader has formed their own. Reader paradigm can do that, because a mark is a discrete object with an on and an off. Confidence disclosure can do it, because a number can be placed after the evidence.
Neither works on a paragraph. You cannot hide half a sentence, reveal a clause on demand, or put the evidence before a conclusion that arrives grammatically fused to it. The output is not enumerable and its assertions have no separable referents, which is exactly what output tractability was added to the register to name.
So the strategy inverts. Where the rest of this system delays the machine's output, here the interface has to do the checking work before display. It cannot rely on the reader's scepticism, because fluency is precisely the property that suspends it.
Source first
Each clinically material assertion carries a control that opens the record entry it rests on. One action — not a search, not "see notes", not a reference list at the bottom that the reader has to reconcile by hand.
Oxygen requirement fell from 4 L/min to 2 L/min across the shift obs 14:00 obs 21:00.
Antibiotics switched from intravenous to oral at 18:20 med 18:20, following the microbiology result reported that morning micro 09:12.
Pain score rose to 7 at 02:15 obs 02:15. No analgesia is recorded after that entry.
Not carried into this brief: 3 nursing notes · 1 imaging report (reported 22:40) · 2 messages. Open the 6 items
Composed text. Review before committing — you will be recorded as having accepted it, not as its author.Three properties make a binding real rather than ornamental:
- It names what it opens, in words. "obs 21:00", "micro 09:12". The label has to work in print and read aloud, where nothing can be opened at all.
- An assertion drawn from more than one source binds to all of them and says so. The second sentence above is a synthesis; presenting it against a single source would misrepresent where it came from and hide half of what needs checking.
- A binding that resolves to the composer's own earlier sentence is not a binding. Self-citation manufactures the appearance of provenance out of nothing, and is harder to spot the more of it there is.
Withhold rather than compose
A sentence that cannot be bound is not shown. Not shown greyed. Not shown with an "unverified" tag. Not shown in a lighter weight. Not shown.
Note what is not available as a marker: the dotted underline already means the opposite on this page. It marks a binding — a sentence that does rest on something. A vocabulary in which one visual treatment means "checkable" and a neighbouring one means "unsupported" is a vocabulary that will be misread at 07:00, and the reason it will be misread is that the two states differ by a detail rather than by presence.
The obvious objection is that marking it would be more informative, and the objection is wrong for a specific reason: a hedge inside fluent prose is a footnote running against the momentum of the paragraph. The reader who most needs to stop — tired, at the end of a shift, twelve briefs to get through — is the reader least likely to. Every other pattern in this system that faced this choice made the same one: Confidence disclosure withholds outside validated scope rather than qualifying, because a qualified output is still an output and gets used like one.
What the reader gets instead is a count. Two assertions withheld is a fact the reader can act on — by going and looking — in a way that two hedged sentences are not.
The error with no surface
Everything else in this system fails by showing a wrong thing. This fails by not showing a right one, and the two look identical from the reader's chair. The incoming night team is competent but was not present: they can read anything put in front of them, and they have no way at all to notice what is missing.
So the artefact declares an omission budget by category: what kinds of record content were in scope, and how many items of each did not make it into the text, with a control to open them.
Covered: observations, medication changes, results,
clinical notes, 15 Aug 08:00 – 17 Aug 06:30.
Not carried: 3 nursing notes · 1 imaging report (reported 22:40, after the
composing window) · 2 messages.
Not available: theatre record — system unreachable at 06:41.
Two rules keep this honest:
- The count is never zero by rounding. "Everything relevant is included" is not a statement the composer is entitled to make, because relevance is the clinical judgement it was not authorised to exercise. An item is either carried or counted.
- Unreachable is not the same as empty. A source that could not be read is named as unread, exactly as Key–value pair insists that no-value and not-measured are different facts. If the missing source is material, the correct output is no brief at all.
No score on the whole thing
Confidence disclosure already forbids aggregating confidence across findings, on the grounds that a single case-level confidence is not a meaningful quantity. The consequence here is worth stating plainly, because the temptation is strong and the pattern is common: a composed artefact never carries an overall reliability score — no percentage, no quality star, no "high confidence" banner. There is no calibrated quantity to report. Per-assertion bindings are the substitute, and they are better, because they let the reader check the parts, which is the only checking that means anything.
Nor does the text appear progressively. Token-by-token streaming is read as it is produced — the reader has finished the first paragraph before the bindings exist and long before the omission notice does, which means the artefact's entire checking apparatus arrives after the reading is over. It also performs thinking, which is a claim about the software that nobody has verified. Show a wait state, then show the finished artefact.
States
| State | Rendering |
|---|---|
| Composing | A wait state with what is being read and roughly how long, per Progress. No partial text, ever. |
| Composed | The whole artefact, every assertion bound, omission notice above the prose in reading order. |
| Composed with withholdings | As above, plus a count of assertions dropped for want of a source. The count is stated; the sentences are not. |
| Not composed — corpus incomplete | Named systems that could not be read, and no prose. A brief missing the theatre record is not a partial brief, it is a misleading one. |
| Not composed — outside scope | A stated reason and a route to the record. The same refusal as Confidence disclosure: withhold rather than extrapolate. |
| Nothing to compose | "No qualifying entries in the period" with the period stated — an Empty state that proves it looked, not a blank panel. |
Who holds each rule
Composed output is prose with bindings to its sources. The package holds the shape of a wait and the shape of an absence; it holds nothing about the prose.
| Rule | Held by | Where |
|---|---|---|
| The wait state announces politely, and does not claim to know how long | Activity | An indeterminate indicator with no value on its type, announced as busy. Asserted: Activity: no value, and none can be passed |
| Unreachable is not the same as empty | Key–value | An unreachable source is a stated absence with a reason, not a blank. The same union Search uses to refuse “0 results” for a failed index. Asserted: KeyValue: outside-scope carries its reason |
| The count is never zero by rounding | Badge | A count is exact. It also cannot be capped, which is the same discipline from the other end. Asserted: Badge: an exact count, never capped |
| It names what it opens, in words | Composed text | A source is { id, label, href } and the link text is the label — “obs 21:00”, never “source”. What the label says is yours; that it is the link’s name is not.Asserted: ComposedText: every binding is a link with the source's own label, and two sources say so |
| An assertion from more than one source binds to all of them, and says so | Composed text | sources is a tuple; a sentence with more than one renders “from n sources” before the links. Which sources belong on the sentence is your composer’s logic.Asserted: ComposedText: every binding is a link with the source's own label, and two sources say so |
| A binding to the composer’s own earlier sentence is not a binding | Composed text | A source is a record reference with an address; a sentence has no address and is not a RecordSource. Self-citation is unwritable, and so is an unbound sentence: the only alternative to bound is withheld.Asserted: ComposedText: an unbound sentence and a self-citation are unwritable |
| The omission notice precedes the prose in DOM order | Composed text | omissions is required and renders before the first paragraph, with withheld sentences counted into it.Asserted: ComposedText: the omission notice precedes the prose and counts by category |
| Bindings are links with accessible names; underlined, not coloured or boxed | Composed text | Each source is an <a> named by its label, underlined in the running colour.Asserted: ComposedText: every binding is a link with the source's own label, and two sources say so |
| Bound and unbound text are not distinguished by colour | Composed text | There is no unbound text on the surface to distinguish: a sentence without a source is withheld and counted, never rendered. Asserted: ComposedText: an unbound sentence and a self-citation are unwritable |
| The artefact is a document, not a widget | The implementer | Architecture. Whether it prints, copies and survives a lost bundle is a property of how you build it. |
| Bindings take the inline exemption to SC 2.5.8 | The implementer | Only if they are inline in prose, which is your markup. |
A pattern page has no component underneath it, so a rule stated here is held by whoever builds against it unless a component already holds it. Of these 11 rules, 3 are held by a component this package ships, and 8 are the implementer’s. Three held, eight not. Every rule about binding — the thing this pattern exists for — is in the composer, and the composer is not here.
Do's and don'ts
Oxygen fell from 4 L/min to 2 L/min source: record
Points at everything, which is to say nothing. Checking it means the search the binding was supposed to replace.
Not carried: 3 nursing notes · 1 imaging report (reported 22:40) · 2 messages.
The reader knows the shape of the gap and can decide whether to go and look. Counts, not adjectives.
Summary complete.
Asserts coverage the composer cannot establish, and closes the only question the reader should have been asking.
2 assertions withheld — no supporting entry found. Show what was searched
An actionable fact. The reader goes and looks, which is the behaviour the ungrounded sentence would have prevented.
Patient appeared comfortable overnight. (unverified)
The sentence is in the reader's head before the tag is. Tired at 07:00, it is a note in the margin against the pull of the paragraph.
Reading 4 systems… then the whole brief, at once.
Nothing is readable until everything that governs how to read it exists.
Prose appearing word by word.
The reader finishes paragraph one before the bindings or the omission notice exist. It also performs deliberation nobody has verified.
Accessibility
- The omission notice precedes the prose in DOM order, whatever the visual arrangement. A notice announced after nine paragraphs arrives after every decision it existed to qualify.
- Bindings are links with accessible names that say what they open — "observation, 21:00" rather than "source" repeated eleven times. A list of identical link names is unusable by anyone navigating by link.
- Bound and unbound text are not distinguished by colour. They are not distinguished at all, because unbound text is not shown — which is a considerable accessibility saving as well as a safety one — SC 1.4.1.
- The artefact is a document, not a widget. Headings, paragraphs and lists, traversable with heading navigation. Prose inside a scrolling pane with no structure is a wall.
- The wait state announces politely and does not steal focus; the finished artefact does not auto-scroll — per Motion.
- Bindings are underlined, not coloured or boxed — SC 1.4.1. Dotted rather than solid, so a binding is distinguishable from an ordinary link by shape, which is the only distinction that survives the greyscale printout this pattern keeps invoking.
- Bindings take the inline exemption to SC 2.5.8 — their size is constrained by the line height of the prose around them, and enlarging them would break the paragraph they are embedded in. Every non-inline control here — the omission notice's, the commit — is a full 44 px target.
Outcomes of use
What this contributes to, in the terms of Usability & context of use. These are attributes believed to contribute to an outcome; the outcome itself is settled by observing real use in a specified context, not by this page.
- Effectiveness — the reader's belief about what the brief covers matches what it covers. This is the whole game: a competent clinician acting on a complete-looking brief that quietly dropped an imaging report is failing for reasons no amount of skill prevents.
- Efficiency — checking an assertion costs one action rather than a search, which is the difference between checking being something people do and something people intend to do.
- Satisfaction — a tool that says what it left out is a tool that can be trusted about what it put in. One that never mentions omissions earns exactly the confidence it deserves the first time someone finds one.
Clinical safety notes
Trace these in your risk file (ISO 14971) and usability engineering file (IEC 62366-1). Each bullet says what checks it: a component that holds the rule, a test in your verification file, deployment configuration, post-market surveillance, or a design review where no test can see it. A control checked by nothing is a sentence.
- Every clinically material assertion binds to a source, openable in one action. (held by Composed text) Mitigates: an unsupported statement acted on because prose reads as checked.
- An unbindable sentence is withheld, not qualified. (held by Composed text) Mitigates: a hedge losing to the momentum of the paragraph containing it.
- Synthesised assertions bind to every source and say so. (held by Composed text) Mitigates: provenance that looks singular and simple when it is neither.
- Self-citation is not provenance. (held by Composed text) Mitigates: the appearance of grounding manufactured from the composer's own output.
- Omissions are stated by category and count. (held by Composed text) Mitigates: the failure mode with no surface — a competent reader who cannot see what is absent.
- An unreachable source blocks composition when it is material. (a test in your verification file) Mitigates: a brief that is complete-looking and incomplete.
- No aggregate reliability score. (held by Composed text) Mitigates: a number with no calibrated referent standing in for checking the parts.
- No progressive text. (held by Composed text) Mitigates: reading that begins before the bindings and the omission notice exist.
Related
- Authorship & the record — who is recorded as having produced it, once it is fit to show.
- Confidence disclosure — why there is no score for the whole artefact, and the same withhold-rather-than-qualify choice.
- Reader paradigm — the anti-anchoring device that has no subject here, and why.
- Attribution — the same failure in pictures: an output that looks like its own justification.
- AI transparency — Article 13 interpretability and Article 14 oversight.
- NightBrief — the reference application, and the reader who was competent but not present.