@zanii/health 0.1.0

package/LICENSE

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package/README.md

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+# @zanii/health
+
+**Medical audit trails without leaking the pattern.**
+
+For medicine, **the metadata *is* the sensitive data.** Zanii's usual privacy story ("we store
+only hashes; payloads never leave your systems") is what makes it safe everywhere else — and it
+is exactly what fails here. A stable public subject slice leaks *that* a record was opened, by
+how many parties, how often, and when. **Access frequency to an oncology or psychiatric record
+is itself PHI.**
+
+So this package deliberately breaks the one property Zanii otherwise relies on — a single,
+stable, linkable identifier per subject.
+
+> **Design target: an episode is verifiable; a life is not linkable except by the patient.**
+
+**Threat model** (it decides everything): we do **not** need to hide the encounter from the
+treating provider — they hold the chart. We must stop *everyone else* — a second provider, an
+insurer, **the log operator** — from **linking encounters into a history**.
+
+## 🔴 The rule that makes or breaks this
+
+> **The patient supplies the TAG. The patient never supplies the SEED.**
+
+If a provider held the seed it could enumerate `n = 1, 2, 3…` and reconstruct the patient's
+**entire cross-institution history** — the privacy gain would be zero, and *illusory*. The
+patient's app derives the tag for **this** encounter and hands over one opaque string.
+
+There is a **red test** (`the seed must never reach a provider`) in both languages, existing
+purely so nobody "optimises" the seed into the provider's hands later.
+
+```sh
+npm install @zanii/health @zanii/core
+```
+
+```ts
+import { episodeSeed, episodeTag, buildAccessReceipt, buildRecommendation,
+         buildClinicianConfirmation, buildBreakGlass, fetchEpisodes } from '@zanii/health';
+
+// patient app (device keystore) — the seed never leaves here
+const seed = episodeSeed();
+const tag  = episodeTag(seed, 12);   // hand THIS to the provider, and nothing else
+
+// provider side — learns one encounter, nothing about any other
+await zanii.record({ ...buildAccessReceipt({ episodeTag: tag, actor: clinician.did,
+  purpose: 'treatment', consentRef, ts }), subjectTag: tag });
+
+// patient side — the only party who can link the chain
+const history = await fetchEpisodes(seed);
+history.pendingBreakGlass;   // emergency access on my record that nobody reviewed
+```
+
+## The four-party question (what a malpractice case actually turns on)
+
+| Question | Receipt |
+|---|---|
+| **Who accessed the record?** | `health.access` — actor `did:key`, **purpose** (limitation is not optional), consent ref |
+| **Which model recommended what?** | `health.recommendation` — `model_id` + `runtime_hash` |
+| **Under which clinical protocol?** | same receipt — **`manifest_hash` is required**; a recommendation with no protocol on record is rejected |
+| **Which *named human* took responsibility?** | `health.confirmation` — the **clinician signs personally**. The model did not decide; a person did. |
+
+## `protocolTrail` is **not** `ruleConsistency` — and that distinction is clinical
+
+In `@zanii/gov`, *"the same rulebook decided everyone"* is the fairness property and
+**interleaved rulebooks are a red flag**. **That does not transfer to medicine.**
+
+**Individualised care is correct.** Protocols legitimately coexist — comorbidities, cohorts,
+trial arms. Flagging interleaved protocols would false-alarm on *good medicine* and train
+clinicians to ignore the tool. So `protocolTrail` reports **disclosure and change**, and passes
+**no verdict on uniformity** (there is no `consistent` field to fail):
+
+- **which** protocol governed each recommendation,
+- **when** protocols changed,
+- **deviation** — recorded, *never* prevented, and **never treated as a defect** (departing from
+  a protocol is legitimate and common),
+- **`unprotocolled`** — a recommendation with **no** protocol. *That* is the defect.
+
+## Break-glass: **loud, not impossible**
+
+An unconscious patient supplies no tag — yet care must proceed **and be recorded**. Break-glass
+is the classic PHI-snooping vector (the celebrity-record case), so:
+
+- **every break-glass emits a receipt** — a `reason` is mandatory;
+- the **acting clinician signs it personally** — a named human puts their name on it, and *that
+  signature is the deterrent*;
+- **`pendingBreakGlass()`** counts events with no review on record — visible in the
+  institution's own audit **and to the patient**.
+
+**We ship the metric, not the mandate.** We do not enforce a review policy we have no power to
+enforce — we make **ignoring it undeniable**. A regulator can *require* review; the institution
+**cannot hide that it didn't do it.**
+
+> **This is a hole we deliberately keep open — a closed one kills patients.**
+
+## Honest limits (read these)
+
+- **We hide linkage, not existence.** An episode is verifiable; a life is not linkable except by
+  the patient. Anyone who obtains **one** tag still learns **that encounter's provider** — and
+  for a single-specialty clinic, that lone inference is itself sensitive. **Cannot be
+  eliminated; must be disclosed.**
+- **Seed loss ≠ record loss.** Lose the seed and you lose *linkability of past episodes* — the
+  chart persists, care is unaffected. The system degrades to *unlinkable*, never *lost*. This is
+  precisely why we can refuse dangerous recovery schemes.
+- **No social/Shamir recovery — deliberately.** In health, **the guardians are frequently the
+  adversary** (coercion, abuse, an employer who is also a relative). Social recovery is right for
+  a wallet and wrong for a medical history. Use a device keystore + an offline recovery code.
+- **Institution-held seed escrow is a labelled downgrade, never a default.** If your provider can
+  decrypt the seed, they can link your history. Say it in those words.
+- **A permissioned slice reintroduces server trust for confidentiality.** It stops opportunistic
+  pattern-mining, **not the operator**. Deploy sovereign where that matters.
+- **This proves the process, not the medicine.** Which model, which protocol, which clinician
+  signed — never that the treatment was *right*.
+
+## Changelog
+- **0.1.0** — initial release: `episodeSeed`/`episodeTag`/`episodeTags` (unlinkable per-episode identity), `buildAccessReceipt`, `buildRecommendation` (protocol required), `buildClinicianConfirmation`, `buildBreakGlass` + `pendingBreakGlass`/`markReviewed`, `protocolTrail` (**not** `ruleConsistency`), `fetchEpisodes`.
+
+## License
+Apache-2.0.

package/dist/index.d.ts

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+/**
+ * @zanii/health — medical audit trails **without leaking the pattern**.
+ *
+ * For medicine, the metadata IS the sensitive data. Zanii's usual privacy story ("we store
+ * only hashes") is what makes it safe everywhere else — and it is exactly what fails here:
+ * a stable public `subject_tag` slice leaks *that* a record was opened, by how many parties,
+ * how often, and when. **Access frequency to an oncology or psychiatric record is itself
+ * PHI.** So this package breaks the one property Zanii otherwise relies on: a single, stable,
+ * linkable identifier per subject.
+ *
+ * **Design target: an episode is verifiable; a life is not linkable except by the patient.**
+ *
+ * Threat model (it decides everything): we do NOT need to hide the encounter from the
+ * treating provider — they hold the chart. We must stop *anyone else* — a second provider,
+ * an insurer, the log operator — from **linking encounters into a history**.
+ *
+ * ## The rule that makes or breaks this
+ *
+ * **The patient supplies the TAG. The patient never supplies the SEED.**
+ *
+ * If a provider held the seed it could enumerate `n = 1, 2, 3…` and reconstruct the patient's
+ * entire cross-institution history — the privacy gain would be zero, and *illusory*. The
+ * patient's app derives the tag for THIS encounter and hands over one opaque string. There is
+ * a red test guarding this (`a provider holding the seed can link everything`) so nobody
+ * "optimises" the seed into the provider's hands later.
+ *
+ * Answers the four-party question that actually decides a malpractice case:
+ * **who accessed the record, which model recommended what, under which protocol version, and
+ * which named human took responsibility.**
+ */
+import { type ActionConfirmation } from '@zanii/core';
+export type FetchLike = (input: string, init?: RequestInit) => Promise<Response>;
+/**
+ * The patient's episode seed. **Never leaves the patient.** Held in a device keystore with
+ * an offline recovery code — deliberately NOT social/Shamir recovery: in health the
+ * guardians are frequently the adversary (coercion, abuse, an employer who is also a
+ * relative). We can refuse it because **seed loss ≠ record loss**: you lose linkability of
+ * past episodes, never the chart.
+ */
+export interface EpisodeSeed {
+    v: 1;
+    /** 32 bytes of entropy, hex. The secret. */
+    secret: string;
+}
+/** Generate a patient seed. Store in a device keystore; back up with an offline code. */
+export declare function episodeSeed(secretHex?: string): EpisodeSeed;
+/**
+ * The tag for encounter `n`. Derived by the PATIENT and handed to the provider as one opaque
+ * string. Unlinkable: two tags from the same patient are not relatable without the seed.
+ */
+export declare function episodeTag(seed: EpisodeSeed, n: number): string;
+/** The patient's own chain — only they can enumerate it. */
+export declare function episodeTags(seed: EpisodeSeed, from: number, to: number): string[];
+export interface HealthReceipt {
+    target: string;
+    payload: Record<string, unknown>;
+    /** Stamp this as the receipt's `subjectTag` — it is the episode tag, not a patient id. */
+    subjectTag: string;
+    /** Keep to disclose committed details later (dispute/audit). */
+    nonce: string;
+}
+export interface AccessInput {
+    episodeTag: string;
+    /** The clinician or system that opened the record (`did:key`). */
+    actor: string;
+    /** Why — `treatment`, `billing`, `research`. Purpose limitation is a PDPL/HIPAA hinge. */
+    purpose: string;
+    /** Reference to the consent receipt in force at access time (`@zanii/consent`). */
+    consentRef?: string;
+    /** Details that must not sit in the clear (department, record section). Salt-committed. */
+    details?: Record<string, unknown>;
+    ts: string;
+}
+/** Who accessed the record. `health.access` */
+export declare function buildAccessReceipt(input: AccessInput): HealthReceipt;
+export interface RecommendationInput {
+    episodeTag: string;
+    /** The model that produced the recommendation. */
+    modelId: string;
+    /** The deployed runtime that ran it. */
+    runtimeHash?: string;
+    /** REQUIRED — the clinical protocol/guideline version that governed this. */
+    manifestHash: string;
+    /** The recommendation itself, e.g. `{ code: 'CHEMO-A', line: 2 }`. */
+    outcome: Record<string, unknown>;
+    /**
+     * Departing from the governing protocol is **legitimate and common** in medicine. It is
+     * recorded, never prevented — and never treated as a defect.
+     */
+    deviation?: {
+        from: string;
+        rationale: string;
+    };
+    ts: string;
+}
+/** Which model recommended what, under which protocol. `health.recommendation` */
+export declare function buildRecommendation(input: RecommendationInput): HealthReceipt;
+/**
+ * Which **named human** took responsibility. `health.confirmation`
+ *
+ * The clinician signs the recommendation with their own key — the model did not decide, a
+ * person did. This is the artifact a malpractice case turns on.
+ */
+export declare function buildClinicianConfirmation(input: {
+    episodeTag: string;
+    clinicianDid: string;
+    recommendationHash: string;
+    confirmedAt: string;
+}, clinicianPrivateKey: Uint8Array): HealthReceipt & {
+    confirmation: ActionConfirmation;
+};
+/** A clinician's confirmation is valid only if signed by that clinician. */
+export declare function verifyClinicianConfirmation(payload: Record<string, unknown> | undefined): boolean;
+export interface BreakGlassInput {
+    /** Provider-derived, because an unconscious patient supplies no tag. Claimable later. */
+    episodeTag: string;
+    /** The clinician who is personally accountable. NOT merely the system. */
+    clinicianDid: string;
+    reason: string;
+    ts: string;
+}
+/**
+ * Emergency access. `health.break_glass`
+ *
+ * **A hole we deliberately keep open — a closed one kills patients. We make it LOUD, not
+ * impossible.** Break-glass is the classic PHI-snooping vector (the celebrity-record case),
+ * so: the acting clinician signs it **personally** — a named human puts their name on it, and
+ * that signature is the deterrent. Un-reviewed break-glass is a countable defect
+ * (`pendingBreakGlass`), visible in the institution's own audit and to the patient on claim.
+ *
+ * We ship the **metric, not the mandate**: we do not enforce a review policy we have no power
+ * to enforce — we make **ignoring it undeniable**.
+ */
+export declare function buildBreakGlass(input: BreakGlassInput, clinicianPrivateKey: Uint8Array): HealthReceipt & {
+    confirmation: ActionConfirmation;
+};
+/** Mark a break-glass reviewed — the institution's own audit artifact. */
+export declare function markReviewed(payload: Record<string, unknown>, reviewer: string, ts: string): Record<string, unknown>;
+/**
+ * **The metric, not the mandate.** Break-glass events with no review on record.
+ * A regulator can *require* review; the institution cannot hide that it didn't.
+ */
+export declare function pendingBreakGlass(payloads: Array<Record<string, unknown>>): Array<Record<string, unknown>>;
+export interface ProtocolWindow {
+    manifest_hash: string;
+    count: number;
+    first_ts: string;
+    last_ts: string;
+}
+export interface ProtocolTrail {
+    protocols: ProtocolWindow[];
+    /** Recommendations that departed from their governing protocol — legitimate, recorded, NOT a defect. */
+    deviations: number;
+    /** Recommendations with NO protocol on record. THIS is the defect. */
+    unprotocolled: number;
+}
+/**
+ * Which protocol governed what, and when protocols changed.
+ *
+ * **Deliberately NOT `ruleConsistency`.** In government, "the same rulebook decided everyone"
+ * is the fairness property and interleaving is a red flag. **In medicine, individualised care
+ * is CORRECT** — protocols legitimately coexist (comorbidities, cohorts, trial arms). Flagging
+ * interleaved protocols would false-alarm on *good medicine* and train clinicians to ignore
+ * the tool. So we report **disclosure and change**, and pass **no verdict on uniformity**.
+ */
+export declare function protocolTrail(payloads: Array<Record<string, unknown>>): ProtocolTrail;
+export interface EpisodeHistory {
+    episodes: Array<{
+        n: number;
+        tag: string;
+        receipts: Array<Record<string, unknown>>;
+    }>;
+    /** Total receipts across the chain. */
+    total: number;
+    /** Break-glass events on this patient with no review recorded. */
+    pendingBreakGlass: number;
+    protocols: ProtocolTrail;
+}
+/**
+ * Fetch and merge the patient's episode chain. **Only the seed-holder can do this** — which
+ * is the entire point. `@zanii/subject`'s `fetchSubjectHistory` is one-tag-at-a-time; this is
+ * the multi-tag fetch it lacks.
+ */
+export declare function fetchEpisodes(seed: EpisodeSeed, opts?: {
+    server?: string;
+    fetchImpl?: FetchLike;
+    from?: number;
+    to?: number;
+}): Promise<EpisodeHistory>;
+//# sourceMappingURL=index.d.ts.map

package/dist/index.d.ts.map

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package/dist/index.js

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+/**
+ * @zanii/health — medical audit trails **without leaking the pattern**.
+ *
+ * For medicine, the metadata IS the sensitive data. Zanii's usual privacy story ("we store
+ * only hashes") is what makes it safe everywhere else — and it is exactly what fails here:
+ * a stable public `subject_tag` slice leaks *that* a record was opened, by how many parties,
+ * how often, and when. **Access frequency to an oncology or psychiatric record is itself
+ * PHI.** So this package breaks the one property Zanii otherwise relies on: a single, stable,
+ * linkable identifier per subject.
+ *
+ * **Design target: an episode is verifiable; a life is not linkable except by the patient.**
+ *
+ * Threat model (it decides everything): we do NOT need to hide the encounter from the
+ * treating provider — they hold the chart. We must stop *anyone else* — a second provider,
+ * an insurer, the log operator — from **linking encounters into a history**.
+ *
+ * ## The rule that makes or breaks this
+ *
+ * **The patient supplies the TAG. The patient never supplies the SEED.**
+ *
+ * If a provider held the seed it could enumerate `n = 1, 2, 3…` and reconstruct the patient's
+ * entire cross-institution history — the privacy gain would be zero, and *illusory*. The
+ * patient's app derives the tag for THIS encounter and hands over one opaque string. There is
+ * a red test guarding this (`a provider holding the seed can link everything`) so nobody
+ * "optimises" the seed into the provider's hands later.
+ *
+ * Answers the four-party question that actually decides a malpractice case:
+ * **who accessed the record, which model recommended what, under which protocol version, and
+ * which named human took responsibility.**
+ */
+import { createConfirmation, jcsHash, saltedPayloadHash, verifyConfirmation } from '@zanii/core';
+/** Generate a patient seed. Store in a device keystore; back up with an offline code. */
+export function episodeSeed(secretHex) {
+    const secret = secretHex ?? bytesToHexLocal(cryptoRandom(32));
+    if (!/^[0-9a-f]{64}$/.test(secret))
+        throw new Error('seed secret must be 32 bytes of hex');
+    return { v: 1, secret };
+}
+function cryptoRandom(n) {
+    const out = new Uint8Array(n);
+    globalThis.crypto.getRandomValues(out);
+    return out;
+}
+function bytesToHexLocal(b) {
+    return [...b].map((x) => x.toString(16).padStart(2, '0')).join('');
+}
+/**
+ * The tag for encounter `n`. Derived by the PATIENT and handed to the provider as one opaque
+ * string. Unlinkable: two tags from the same patient are not relatable without the seed.
+ */
+export function episodeTag(seed, n) {
+    if (!Number.isInteger(n) || n < 0)
+        throw new Error('n must be a non-negative integer');
+    return jcsHash({ v: 1, type: 'episode_tag', secret: seed.secret, n });
+}
+/** The patient's own chain — only they can enumerate it. */
+export function episodeTags(seed, from, to) {
+    const out = [];
+    for (let n = from; n <= to; n++)
+        out.push(episodeTag(seed, n));
+    return out;
+}
+/** Who accessed the record. `health.access` */
+export function buildAccessReceipt(input) {
+    if (!input.episodeTag)
+        throw new Error('episodeTag is required');
+    if (!input.actor)
+        throw new Error('actor is required');
+    if (!input.purpose)
+        throw new Error('purpose is required — purpose limitation is not optional');
+    const { payload_hash, nonce } = saltedPayloadHash(JSON.stringify(input.details ?? {}));
+    return {
+        target: 'health.access',
+        subjectTag: input.episodeTag,
+        nonce,
+        payload: {
+            _zr_kind: 'health', _zr_domain: 'health', v: 1, kind: 'access',
+            actor: input.actor, purpose: input.purpose,
+            consent_ref: input.consentRef, details_commitment: payload_hash, ts: input.ts,
+        },
+    };
+}
+/** Which model recommended what, under which protocol. `health.recommendation` */
+export function buildRecommendation(input) {
+    if (!input.episodeTag)
+        throw new Error('episodeTag is required');
+    if (!input.modelId)
+        throw new Error('modelId is required');
+    if (!input.manifestHash) {
+        throw new Error('manifestHash is required — a clinical recommendation with no governing protocol on record is not auditable');
+    }
+    const { payload_hash, nonce } = saltedPayloadHash(JSON.stringify(input.outcome));
+    return {
+        target: 'health.recommendation',
+        subjectTag: input.episodeTag,
+        nonce,
+        payload: {
+            _zr_kind: 'health', _zr_domain: 'health', v: 1, kind: 'recommendation',
+            model_id: input.modelId, runtime_hash: input.runtimeHash,
+            manifest_hash: input.manifestHash,
+            outcome_commitment: payload_hash,
+            deviation: input.deviation,
+            ts: input.ts,
+        },
+    };
+}
+/**
+ * Which **named human** took responsibility. `health.confirmation`
+ *
+ * The clinician signs the recommendation with their own key — the model did not decide, a
+ * person did. This is the artifact a malpractice case turns on.
+ */
+export function buildClinicianConfirmation(input, clinicianPrivateKey) {
+    const confirmation = createConfirmation({ ownerId: input.clinicianDid, actionHash: input.recommendationHash, confirmedAt: input.confirmedAt }, clinicianPrivateKey);
+    return {
+        target: 'health.confirmation',
+        subjectTag: input.episodeTag,
+        nonce: '',
+        confirmation,
+        payload: {
+            _zr_kind: 'health', _zr_domain: 'health', v: 1, kind: 'confirmation',
+            clinician: input.clinicianDid,
+            recommendation_hash: input.recommendationHash,
+            confirmation,
+            ts: input.confirmedAt,
+        },
+    };
+}
+/** A clinician's confirmation is valid only if signed by that clinician. */
+export function verifyClinicianConfirmation(payload) {
+    const c = (payload ?? {}).confirmation;
+    if (!c || payload.clinician !== c.owner_id)
+        return false;
+    return verifyConfirmation(c);
+}
+/**
+ * Emergency access. `health.break_glass`
+ *
+ * **A hole we deliberately keep open — a closed one kills patients. We make it LOUD, not
+ * impossible.** Break-glass is the classic PHI-snooping vector (the celebrity-record case),
+ * so: the acting clinician signs it **personally** — a named human puts their name on it, and
+ * that signature is the deterrent. Un-reviewed break-glass is a countable defect
+ * (`pendingBreakGlass`), visible in the institution's own audit and to the patient on claim.
+ *
+ * We ship the **metric, not the mandate**: we do not enforce a review policy we have no power
+ * to enforce — we make **ignoring it undeniable**.
+ */
+export function buildBreakGlass(input, clinicianPrivateKey) {
+    if (!input.reason)
+        throw new Error('reason is required — an unexplained break-glass is exactly the abuse this exists to catch');
+    const actionHash = jcsHash({ v: 1, type: 'break_glass', tag: input.episodeTag, ts: input.ts });
+    const confirmation = createConfirmation({ ownerId: input.clinicianDid, actionHash, confirmedAt: input.ts }, clinicianPrivateKey);
+    return {
+        target: 'health.break_glass',
+        subjectTag: input.episodeTag,
+        nonce: '',
+        confirmation,
+        payload: {
+            _zr_kind: 'health', _zr_domain: 'health', v: 1, kind: 'break_glass',
+            clinician: input.clinicianDid, reason: input.reason,
+            confirmation, reviewed: false, ts: input.ts,
+        },
+    };
+}
+/** Mark a break-glass reviewed — the institution's own audit artifact. */
+export function markReviewed(payload, reviewer, ts) {
+    return { ...payload, reviewed: true, reviewed_by: reviewer, reviewed_at: ts };
+}
+/**
+ * **The metric, not the mandate.** Break-glass events with no review on record.
+ * A regulator can *require* review; the institution cannot hide that it didn't.
+ */
+export function pendingBreakGlass(payloads) {
+    return payloads.filter((p) => p._zr_kind === 'health' && p.kind === 'break_glass' && p.reviewed !== true);
+}
+/**
+ * Which protocol governed what, and when protocols changed.
+ *
+ * **Deliberately NOT `ruleConsistency`.** In government, "the same rulebook decided everyone"
+ * is the fairness property and interleaving is a red flag. **In medicine, individualised care
+ * is CORRECT** — protocols legitimately coexist (comorbidities, cohorts, trial arms). Flagging
+ * interleaved protocols would false-alarm on *good medicine* and train clinicians to ignore
+ * the tool. So we report **disclosure and change**, and pass **no verdict on uniformity**.
+ */
+export function protocolTrail(payloads) {
+    const recs = payloads.filter((p) => p._zr_kind === 'health' && p.kind === 'recommendation');
+    const windows = new Map();
+    let deviations = 0;
+    let unprotocolled = 0;
+    for (const p of [...recs].sort((a, b) => String(a.ts).localeCompare(String(b.ts)))) {
+        if (p.deviation)
+            deviations += 1;
+        const h = p.manifest_hash;
+        if (!h) {
+            unprotocolled += 1;
+            continue;
+        }
+        const ts = p.ts;
+        const w = windows.get(h);
+        if (w) {
+            w.count += 1;
+            w.last_ts = ts;
+        }
+        else {
+            windows.set(h, { manifest_hash: h, count: 1, first_ts: ts, last_ts: ts });
+        }
+    }
+    return {
+        protocols: [...windows.values()].sort((a, b) => a.first_ts.localeCompare(b.first_ts)),
+        deviations,
+        unprotocolled,
+    };
+}
+/**
+ * Fetch and merge the patient's episode chain. **Only the seed-holder can do this** — which
+ * is the entire point. `@zanii/subject`'s `fetchSubjectHistory` is one-tag-at-a-time; this is
+ * the multi-tag fetch it lacks.
+ */
+export async function fetchEpisodes(seed, opts = {}) {
+    const server = (opts.server ?? 'https://ledger.zanii.agency').replace(/\/$/, '');
+    const fetchImpl = opts.fetchImpl ?? ((u, i) => fetch(u, i));
+    const from = opts.from ?? 0;
+    const to = opts.to ?? 50;
+    const episodes = [];
+    const all = [];
+    for (let n = from; n <= to; n++) {
+        const tag = episodeTag(seed, n);
+        const res = await fetchImpl(`${server}/v1/subjects/${encodeURIComponent(tag)}`);
+        if (res.status === 404)
+            continue; // no encounter at this index
+        if (!res.ok)
+            throw new Error(`episode lookup failed: HTTP ${res.status}`);
+        const body = (await res.json());
+        const payloads = (body.receipts ?? [])
+            .map((r) => r.receipt.payload)
+            .filter((p) => !!p);
+        episodes.push({ n, tag, receipts: payloads });
+        all.push(...payloads);
+    }
+    return {
+        episodes,
+        total: all.length,
+        pendingBreakGlass: pendingBreakGlass(all).length,
+        protocols: protocolTrail(all),
+    };
+}
+//# sourceMappingURL=index.js.map

package/dist/index.js.map

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package/package.json

@@ -0,0 +1,42 @@
+{
+  "name": "@zanii/health",
+  "version": "0.1.0",
+  "description": "Medical audit trails without leaking the pattern: per-episode unlinkable tags (the patient supplies the tag, never the seed), plus who accessed the record, which model recommended what under which protocol, and which named clinician took responsibility. Break-glass is loud, not impossible.",
+  "license": "Apache-2.0",
+  "homepage": "https://ledger.zanii.agency",
+  "type": "module",
+  "main": "./dist/index.js",
+  "types": "./dist/index.d.ts",
+  "exports": {
+    ".": {
+      "types": "./dist/index.d.ts",
+      "import": "./dist/index.js"
+    }
+  },
+  "files": [
+    "dist",
+    "src",
+    "README.md",
+    "LICENSE"
+  ],
+  "publishConfig": {
+    "access": "public"
+  },
+  "engines": {
+    "node": ">=18"
+  },
+  "devDependencies": {
+    "@types/node": "^26.1.0",
+    "typescript": "^5.8.2",
+    "vitest": "^3.0.9"
+  },
+  "dependencies": {
+    "@zanii/core": "0.4.0",
+    "@zanii/subject": "0.1.0"
+  },
+  "scripts": {
+    "build": "tsc -p tsconfig.build.json",
+    "test": "vitest run",
+    "typecheck": "tsc --noEmit"
+  }
+}

package/src/index.ts

@@ -0,0 +1,366 @@
+/**
+ * @zanii/health — medical audit trails **without leaking the pattern**.
+ *
+ * For medicine, the metadata IS the sensitive data. Zanii's usual privacy story ("we store
+ * only hashes") is what makes it safe everywhere else — and it is exactly what fails here:
+ * a stable public `subject_tag` slice leaks *that* a record was opened, by how many parties,
+ * how often, and when. **Access frequency to an oncology or psychiatric record is itself
+ * PHI.** So this package breaks the one property Zanii otherwise relies on: a single, stable,
+ * linkable identifier per subject.
+ *
+ * **Design target: an episode is verifiable; a life is not linkable except by the patient.**
+ *
+ * Threat model (it decides everything): we do NOT need to hide the encounter from the
+ * treating provider — they hold the chart. We must stop *anyone else* — a second provider,
+ * an insurer, the log operator — from **linking encounters into a history**.
+ *
+ * ## The rule that makes or breaks this
+ *
+ * **The patient supplies the TAG. The patient never supplies the SEED.**
+ *
+ * If a provider held the seed it could enumerate `n = 1, 2, 3…` and reconstruct the patient's
+ * entire cross-institution history — the privacy gain would be zero, and *illusory*. The
+ * patient's app derives the tag for THIS encounter and hands over one opaque string. There is
+ * a red test guarding this (`a provider holding the seed can link everything`) so nobody
+ * "optimises" the seed into the provider's hands later.
+ *
+ * Answers the four-party question that actually decides a malpractice case:
+ * **who accessed the record, which model recommended what, under which protocol version, and
+ * which named human took responsibility.**
+ */
+import { createConfirmation, jcsHash, saltedPayloadHash, verifyConfirmation, type ActionConfirmation } from '@zanii/core';
+
+export type FetchLike = (input: string, init?: RequestInit) => Promise<Response>;
+
+// ---------------------------------------------------------------------------
+// Episode identity — unlinkable by construction
+// ---------------------------------------------------------------------------
+
+/**
+ * The patient's episode seed. **Never leaves the patient.** Held in a device keystore with
+ * an offline recovery code — deliberately NOT social/Shamir recovery: in health the
+ * guardians are frequently the adversary (coercion, abuse, an employer who is also a
+ * relative). We can refuse it because **seed loss ≠ record loss**: you lose linkability of
+ * past episodes, never the chart.
+ */
+export interface EpisodeSeed {
+  v: 1;
+  /** 32 bytes of entropy, hex. The secret. */
+  secret: string;
+}
+
+/** Generate a patient seed. Store in a device keystore; back up with an offline code. */
+export function episodeSeed(secretHex?: string): EpisodeSeed {
+  const secret = secretHex ?? bytesToHexLocal(cryptoRandom(32));
+  if (!/^[0-9a-f]{64}$/.test(secret)) throw new Error('seed secret must be 32 bytes of hex');
+  return { v: 1, secret };
+}
+
+function cryptoRandom(n: number): Uint8Array {
+  const out = new Uint8Array(n);
+  globalThis.crypto.getRandomValues(out);
+  return out;
+}
+function bytesToHexLocal(b: Uint8Array): string {
+  return [...b].map((x) => x.toString(16).padStart(2, '0')).join('');
+}
+
+/**
+ * The tag for encounter `n`. Derived by the PATIENT and handed to the provider as one opaque
+ * string. Unlinkable: two tags from the same patient are not relatable without the seed.
+ */
+export function episodeTag(seed: EpisodeSeed, n: number): string {
+  if (!Number.isInteger(n) || n < 0) throw new Error('n must be a non-negative integer');
+  return jcsHash({ v: 1, type: 'episode_tag', secret: seed.secret, n });
+}
+
+/** The patient's own chain — only they can enumerate it. */
+export function episodeTags(seed: EpisodeSeed, from: number, to: number): string[] {
+  const out: string[] = [];
+  for (let n = from; n <= to; n++) out.push(episodeTag(seed, n));
+  return out;
+}
+
+// ---------------------------------------------------------------------------
+// The four receipts
+// ---------------------------------------------------------------------------
+
+export interface HealthReceipt {
+  target: string;
+  payload: Record<string, unknown>;
+  /** Stamp this as the receipt's `subjectTag` — it is the episode tag, not a patient id. */
+  subjectTag: string;
+  /** Keep to disclose committed details later (dispute/audit). */
+  nonce: string;
+}
+
+export interface AccessInput {
+  episodeTag: string;
+  /** The clinician or system that opened the record (`did:key`). */
+  actor: string;
+  /** Why — `treatment`, `billing`, `research`. Purpose limitation is a PDPL/HIPAA hinge. */
+  purpose: string;
+  /** Reference to the consent receipt in force at access time (`@zanii/consent`). */
+  consentRef?: string;
+  /** Details that must not sit in the clear (department, record section). Salt-committed. */
+  details?: Record<string, unknown>;
+  ts: string;
+}
+
+/** Who accessed the record. `health.access` */
+export function buildAccessReceipt(input: AccessInput): HealthReceipt {
+  if (!input.episodeTag) throw new Error('episodeTag is required');
+  if (!input.actor) throw new Error('actor is required');
+  if (!input.purpose) throw new Error('purpose is required — purpose limitation is not optional');
+  const { payload_hash, nonce } = saltedPayloadHash(JSON.stringify(input.details ?? {}));
+  return {
+    target: 'health.access',
+    subjectTag: input.episodeTag,
+    nonce,
+    payload: {
+      _zr_kind: 'health', _zr_domain: 'health', v: 1, kind: 'access',
+      actor: input.actor, purpose: input.purpose,
+      consent_ref: input.consentRef, details_commitment: payload_hash, ts: input.ts,
+    },
+  };
+}
+
+export interface RecommendationInput {
+  episodeTag: string;
+  /** The model that produced the recommendation. */
+  modelId: string;
+  /** The deployed runtime that ran it. */
+  runtimeHash?: string;
+  /** REQUIRED — the clinical protocol/guideline version that governed this. */
+  manifestHash: string;
+  /** The recommendation itself, e.g. `{ code: 'CHEMO-A', line: 2 }`. */
+  outcome: Record<string, unknown>;
+  /**
+   * Departing from the governing protocol is **legitimate and common** in medicine. It is
+   * recorded, never prevented — and never treated as a defect.
+   */
+  deviation?: { from: string; rationale: string };
+  ts: string;
+}
+
+/** Which model recommended what, under which protocol. `health.recommendation` */
+export function buildRecommendation(input: RecommendationInput): HealthReceipt {
+  if (!input.episodeTag) throw new Error('episodeTag is required');
+  if (!input.modelId) throw new Error('modelId is required');
+  if (!input.manifestHash) {
+    throw new Error('manifestHash is required — a clinical recommendation with no governing protocol on record is not auditable');
+  }
+  const { payload_hash, nonce } = saltedPayloadHash(JSON.stringify(input.outcome));
+  return {
+    target: 'health.recommendation',
+    subjectTag: input.episodeTag,
+    nonce,
+    payload: {
+      _zr_kind: 'health', _zr_domain: 'health', v: 1, kind: 'recommendation',
+      model_id: input.modelId, runtime_hash: input.runtimeHash,
+      manifest_hash: input.manifestHash,
+      outcome_commitment: payload_hash,
+      deviation: input.deviation,
+      ts: input.ts,
+    },
+  };
+}
+
+/**
+ * Which **named human** took responsibility. `health.confirmation`
+ *
+ * The clinician signs the recommendation with their own key — the model did not decide, a
+ * person did. This is the artifact a malpractice case turns on.
+ */
+export function buildClinicianConfirmation(
+  input: { episodeTag: string; clinicianDid: string; recommendationHash: string; confirmedAt: string },
+  clinicianPrivateKey: Uint8Array,
+): HealthReceipt & { confirmation: ActionConfirmation } {
+  const confirmation = createConfirmation(
+    { ownerId: input.clinicianDid, actionHash: input.recommendationHash, confirmedAt: input.confirmedAt },
+    clinicianPrivateKey,
+  );
+  return {
+    target: 'health.confirmation',
+    subjectTag: input.episodeTag,
+    nonce: '',
+    confirmation,
+    payload: {
+      _zr_kind: 'health', _zr_domain: 'health', v: 1, kind: 'confirmation',
+      clinician: input.clinicianDid,
+      recommendation_hash: input.recommendationHash,
+      confirmation,
+      ts: input.confirmedAt,
+    },
+  };
+}
+
+/** A clinician's confirmation is valid only if signed by that clinician. */
+export function verifyClinicianConfirmation(payload: Record<string, unknown> | undefined): boolean {
+  const c = (payload ?? {}).confirmation as ActionConfirmation | undefined;
+  if (!c || (payload as { clinician?: string }).clinician !== c.owner_id) return false;
+  return verifyConfirmation(c);
+}
+
+export interface BreakGlassInput {
+  /** Provider-derived, because an unconscious patient supplies no tag. Claimable later. */
+  episodeTag: string;
+  /** The clinician who is personally accountable. NOT merely the system. */
+  clinicianDid: string;
+  reason: string;
+  ts: string;
+}
+
+/**
+ * Emergency access. `health.break_glass`
+ *
+ * **A hole we deliberately keep open — a closed one kills patients. We make it LOUD, not
+ * impossible.** Break-glass is the classic PHI-snooping vector (the celebrity-record case),
+ * so: the acting clinician signs it **personally** — a named human puts their name on it, and
+ * that signature is the deterrent. Un-reviewed break-glass is a countable defect
+ * (`pendingBreakGlass`), visible in the institution's own audit and to the patient on claim.
+ *
+ * We ship the **metric, not the mandate**: we do not enforce a review policy we have no power
+ * to enforce — we make **ignoring it undeniable**.
+ */
+export function buildBreakGlass(
+  input: BreakGlassInput,
+  clinicianPrivateKey: Uint8Array,
+): HealthReceipt & { confirmation: ActionConfirmation } {
+  if (!input.reason) throw new Error('reason is required — an unexplained break-glass is exactly the abuse this exists to catch');
+  const actionHash = jcsHash({ v: 1, type: 'break_glass', tag: input.episodeTag, ts: input.ts });
+  const confirmation = createConfirmation(
+    { ownerId: input.clinicianDid, actionHash, confirmedAt: input.ts },
+    clinicianPrivateKey,
+  );
+  return {
+    target: 'health.break_glass',
+    subjectTag: input.episodeTag,
+    nonce: '',
+    confirmation,
+    payload: {
+      _zr_kind: 'health', _zr_domain: 'health', v: 1, kind: 'break_glass',
+      clinician: input.clinicianDid, reason: input.reason,
+      confirmation, reviewed: false, ts: input.ts,
+    },
+  };
+}
+
+/** Mark a break-glass reviewed — the institution's own audit artifact. */
+export function markReviewed(payload: Record<string, unknown>, reviewer: string, ts: string): Record<string, unknown> {
+  return { ...payload, reviewed: true, reviewed_by: reviewer, reviewed_at: ts };
+}
+
+/**
+ * **The metric, not the mandate.** Break-glass events with no review on record.
+ * A regulator can *require* review; the institution cannot hide that it didn't.
+ */
+export function pendingBreakGlass(payloads: Array<Record<string, unknown>>): Array<Record<string, unknown>> {
+  return payloads.filter((p) => p._zr_kind === 'health' && p.kind === 'break_glass' && p.reviewed !== true);
+}
+
+// ---------------------------------------------------------------------------
+// Protocol trail — NOT ruleConsistency
+// ---------------------------------------------------------------------------
+
+export interface ProtocolWindow {
+  manifest_hash: string;
+  count: number;
+  first_ts: string;
+  last_ts: string;
+}
+
+export interface ProtocolTrail {
+  protocols: ProtocolWindow[];
+  /** Recommendations that departed from their governing protocol — legitimate, recorded, NOT a defect. */
+  deviations: number;
+  /** Recommendations with NO protocol on record. THIS is the defect. */
+  unprotocolled: number;
+}
+
+/**
+ * Which protocol governed what, and when protocols changed.
+ *
+ * **Deliberately NOT `ruleConsistency`.** In government, "the same rulebook decided everyone"
+ * is the fairness property and interleaving is a red flag. **In medicine, individualised care
+ * is CORRECT** — protocols legitimately coexist (comorbidities, cohorts, trial arms). Flagging
+ * interleaved protocols would false-alarm on *good medicine* and train clinicians to ignore
+ * the tool. So we report **disclosure and change**, and pass **no verdict on uniformity**.
+ */
+export function protocolTrail(payloads: Array<Record<string, unknown>>): ProtocolTrail {
+  const recs = payloads.filter((p) => p._zr_kind === 'health' && p.kind === 'recommendation');
+  const windows = new Map<string, ProtocolWindow>();
+  let deviations = 0;
+  let unprotocolled = 0;
+  for (const p of [...recs].sort((a, b) => String(a.ts).localeCompare(String(b.ts)))) {
+    if (p.deviation) deviations += 1;
+    const h = p.manifest_hash as string | undefined;
+    if (!h) {
+      unprotocolled += 1;
+      continue;
+    }
+    const ts = p.ts as string;
+    const w = windows.get(h);
+    if (w) {
+      w.count += 1;
+      w.last_ts = ts;
+    } else {
+      windows.set(h, { manifest_hash: h, count: 1, first_ts: ts, last_ts: ts });
+    }
+  }
+  return {
+    protocols: [...windows.values()].sort((a, b) => a.first_ts.localeCompare(b.first_ts)),
+    deviations,
+    unprotocolled,
+  };
+}
+
+// ---------------------------------------------------------------------------
+// The patient's view — the only party who can link the chain
+// ---------------------------------------------------------------------------
+
+export interface EpisodeHistory {
+  episodes: Array<{ n: number; tag: string; receipts: Array<Record<string, unknown>> }>;
+  /** Total receipts across the chain. */
+  total: number;
+  /** Break-glass events on this patient with no review recorded. */
+  pendingBreakGlass: number;
+  protocols: ProtocolTrail;
+}
+
+/**
+ * Fetch and merge the patient's episode chain. **Only the seed-holder can do this** — which
+ * is the entire point. `@zanii/subject`'s `fetchSubjectHistory` is one-tag-at-a-time; this is
+ * the multi-tag fetch it lacks.
+ */
+export async function fetchEpisodes(
+  seed: EpisodeSeed,
+  opts: { server?: string; fetchImpl?: FetchLike; from?: number; to?: number } = {},
+): Promise<EpisodeHistory> {
+  const server = (opts.server ?? 'https://ledger.zanii.agency').replace(/\/$/, '');
+  const fetchImpl = opts.fetchImpl ?? ((u: string, i?: RequestInit) => fetch(u, i));
+  const from = opts.from ?? 0;
+  const to = opts.to ?? 50;
+  const episodes: EpisodeHistory['episodes'] = [];
+  const all: Array<Record<string, unknown>> = [];
+
+  for (let n = from; n <= to; n++) {
+    const tag = episodeTag(seed, n);
+    const res = await fetchImpl(`${server}/v1/subjects/${encodeURIComponent(tag)}`);
+    if (res.status === 404) continue; // no encounter at this index
+    if (!res.ok) throw new Error(`episode lookup failed: HTTP ${res.status}`);
+    const body = (await res.json()) as { receipts?: Array<{ receipt: { payload?: Record<string, unknown> } }> };
+    const payloads = (body.receipts ?? [])
+      .map((r) => r.receipt.payload)
+      .filter((p): p is Record<string, unknown> => !!p);
+    episodes.push({ n, tag, receipts: payloads });
+    all.push(...payloads);
+  }
+
+  return {
+    episodes,
+    total: all.length,
+    pendingBreakGlass: pendingBreakGlass(all).length,
+    protocols: protocolTrail(all),
+  };
+}