{
  "_generated": "GENERATED by lib/governance/evidence-panel/record.ts — DO NOT EDIT BY HAND.",
  "chairId": "rev-chair",
  "charterVersion": "1.0.0",
  "contentHash": "sha256:bbcd860ddbdf00f202db9fcf8df4e4b915caaa8cc3bb1eed716efefb7970275f",
  "decisions": [
    {
      "anchorsAdded": [],
      "anchorsRemoved": [],
      "certaintyDirection": "lowered",
      "modality": "echo",
      "newCertainty": "very_low",
      "orderVolumeRank": 3,
      "priorCertainty": "moderate",
      "rationale": "The live cardiac pre-operative testing family is still anchored only by single-specialty perioperative criteria at arrival. The panel lowers certainty to very_low so the abstention firewall applies until broader corroboration is added.",
      "recusals": [],
      "scenarioId": "pre-op-clearance",
      "variantId": "high-risk-surgery-symptoms",
      "vote": {
        "abstain": 0,
        "against": 0,
        "for": 4
      }
    },
    {
      "anchorsAdded": [],
      "anchorsRemoved": [],
      "certaintyDirection": "lowered",
      "modality": "nm",
      "newCertainty": "very_low",
      "orderVolumeRank": 3,
      "priorCertainty": "moderate",
      "rationale": "Stress-imaging use before elevated-risk surgery is still being represented through single-specialty perioperative guidance rather than independent primary corroboration for this matrix cell. The panel records very_low certainty on arrival.",
      "recusals": [],
      "scenarioId": "pre-op-clearance",
      "variantId": "high-risk-surgery-symptoms",
      "vote": {
        "abstain": 0,
        "against": 0,
        "for": 4
      }
    },
    {
      "anchorsAdded": [],
      "anchorsRemoved": [],
      "certaintyDirection": "lowered",
      "modality": "us",
      "newCertainty": "very_low",
      "orderVolumeRank": 3,
      "priorCertainty": "moderate",
      "rationale": "Cardiac ultrasound in this perioperative pathway inherits the same single-specialty evidence posture as formal echocardiography. The panel lowers certainty to very_low so the published matrix states that unresolved conflict directly.",
      "recusals": [],
      "scenarioId": "pre-op-clearance",
      "variantId": "high-risk-surgery-symptoms",
      "vote": {
        "abstain": 0,
        "against": 0,
        "for": 4
      }
    },
    {
      "anchorsAdded": [],
      "anchorsRemoved": [],
      "certaintyDirection": "lowered",
      "modality": "echo",
      "newCertainty": "very_low",
      "orderVolumeRank": 2,
      "priorCertainty": "moderate",
      "rationale": "Routine pre-operative echocardiography before low-risk surgery is a real low-value pattern, but this cell still arrives through specialty-authored perioperative criteria. The panel lowers certainty to very_low so it abstains rather than pretending broader adjudication has happened.",
      "recusals": [],
      "scenarioId": "pre-op-clearance",
      "variantId": "routine-no-indication",
      "vote": {
        "abstain": 0,
        "against": 0,
        "for": 4
      }
    },
    {
      "anchorsAdded": [],
      "anchorsRemoved": [],
      "certaintyDirection": "lowered",
      "modality": "nm",
      "newCertainty": "very_low",
      "orderVolumeRank": 2,
      "priorCertainty": "moderate",
      "rationale": "Routine pre-operative stress imaging before low-risk surgery is carried into the matrix through a single-specialty perioperative pathway at launch. The panel records very_low certainty to keep the arrival state honest and subject to later review.",
      "recusals": [],
      "scenarioId": "pre-op-clearance",
      "variantId": "routine-no-indication",
      "vote": {
        "abstain": 0,
        "against": 0,
        "for": 4
      }
    },
    {
      "anchorsAdded": [],
      "anchorsRemoved": [],
      "certaintyDirection": "lowered",
      "modality": "us",
      "newCertainty": "very_low",
      "orderVolumeRank": 2,
      "priorCertainty": "moderate",
      "rationale": "The ultrasound rendering of routine pre-operative cardiac testing is not independently corroborated beyond the specialty-authored perioperative guidance. The panel therefore lowers certainty to very_low instead of letting the line inherit a confident-seeming moderate grade.",
      "recusals": [],
      "scenarioId": "pre-op-clearance",
      "variantId": "routine-no-indication",
      "vote": {
        "abstain": 0,
        "against": 0,
        "for": 4
      }
    }
  ],
  "quorumMet": true,
  "recordId": "epr-2026-08-23-cardiac-preop-arrival",
  "reviewers": [
    {
      "affiliation": "Independent GRADE methodologist",
      "coiClass": "none",
      "declaredConflicts": [],
      "reviewerId": "rev-chair",
      "role": "evidence_methodologist"
    },
    {
      "affiliation": "Patient advocate",
      "coiClass": "none",
      "declaredConflicts": [],
      "reviewerId": "rev-patient",
      "role": "patient_representative"
    },
    {
      "affiliation": "Independent primary care",
      "coiClass": "none",
      "declaredConflicts": [],
      "reviewerId": "rev-pcp",
      "role": "primary_care"
    },
    {
      "affiliation": "Community radiology practice",
      "coiClass": "none",
      "declaredConflicts": [],
      "reviewerId": "rev-radiology",
      "role": "radiology"
    }
  ],
  "sessionDateIso": "2026-08-23"
}