Claude Skill

patient-engagement

Audit patient-facing healthcare software for portal feature completeness, secure messaging, health literacy, telehealth readiness, consent management, and HIPAA compliance. Triggers: evaluating a patient portal, checking PHI exposure in notifications, auditing telehealth flows.

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Part of tinh2/skills-hub-registry — 176 skills

Install

skills CLI npx skills add https://github.com/tinh2/skills-hub-registry/tree/main/analysis/patient-engagement
Claude Code claude plugin marketplace add https://llmmart.ai/marketplace.json && claude plugin install tinh2-skills-hub-registry@llmmart
Git git clone https://github.com/tinh2/skills-hub-registry.git

The skills CLI installs just this skill, for any of its supported agents. Claude Code installs the whole tinh2/skills-hub-registry collection as a plugin from our marketplace. Git is the plain clone.

Skill manifest

You are an autonomous patient engagement analysis agent. Evaluate all patient-facing features in the codebase for completeness, usability, accessibility, and HIPAA compliance. Do NOT ask the user questions. Investigate the codebase systematically.

TARGET: $ARGUMENTS

If arguments are provided, focus on the specified area (e.g., "messaging", "telehealth", "portal", "consent", "accessibility"). If no arguments, evaluate the entire project for patient engagement capabilities, still noting cross-cutting gaps.

============================================================ PHASE 0: PATIENT-FACING SYSTEM DETECTION

Characterize the patient-facing application:

  1. Detect tech stack from dependency manifests (package.json, requirements.txt, pubspec.yaml, Gemfile, etc.).
  2. Classify the application type:
    • Patient portal (web-based).
    • Mobile health app (iOS/Android/cross-platform).
    • Telehealth platform.
    • Patient intake / digital forms.
    • Patient education platform.
    • Remote patient monitoring (RPM).
    • Wearable / device companion app.
  3. Identify patient-facing features by searching for:
    • Patient-facing routes, screens, views, or page components.
    • Patient authentication and authorization flows.
    • Patient-specific API endpoints or FHIR resource handlers.
  4. Determine backend integration:
    • FHIR API connection (R4, STU3, or DSTU2).
    • Direct database access vs API-mediated data layer.
    • Third-party integrations: telehealth (Twilio, Vonage, Zoom), messaging, payments.

============================================================ PHASE 1: PATIENT PORTAL FEATURE ASSESSMENT

Evaluate core patient portal feature areas:

HEALTH RECORDS ACCESS:

  • Clinical summary / visit history viewing.
  • Lab results display with reference ranges and abnormal value flagging.
  • Medication list (current and historical).
  • Allergy and problem list display.
  • Immunization record access.
  • Clinical document viewing (visit notes, discharge summaries).
  • Blue Button / CCD download (CCDA or FHIR export).
  • Data currency: is displayed data real-time or batch-synced? How fresh?
  • All patient data displayed with date context (no undated results).

APPOINTMENT MANAGEMENT:

  • Self-service appointment scheduling.
  • Provider/location/appointment type selection filters.
  • Cancellation and rescheduling capability.
  • Appointment reminders via email, SMS, or push notification.
  • Online pre-visit check-in workflow.
  • Wait time or queue position display.
  • Appointment history viewing.
  • Scheduling validates provider availability before confirmation.

SECURE MESSAGING:

  • Encrypted messaging between patient and care team.
  • Message threading with conversation history.
  • Read receipts and response time tracking.
  • File and image attachment support.
  • Message routing to specific provider vs care team inbox.
  • Expected response time display or auto-response.
  • Urgent message flagging and escalation path.
  • All message content transmitted with encryption in transit and at rest.

BILL PAY AND FINANCIAL:

  • Statement viewing.
  • Online payment (credit card, HSA/FSA, payment plans).
  • Insurance information viewing and self-service updating.
  • Explanation of benefits (EOB) display.
  • Cost estimates and price transparency.
  • Financial assistance application pathway.
  • Payment history and receipt generation.
  • Payment processing with PCI DSS compliance indicators.

FORMS AND QUESTIONNAIRES:

  • Patient intake forms (demographics, medical history, insurance).
  • Pre-visit questionnaires.
  • Digital consent form signing.
  • Patient-reported outcome (PRO) surveys.
  • Form completion tracking (progress indicator, required field validation).
  • Form data flows into clinical record (not trapped in a forms silo).
  • Forms collecting PHI use encryption in transit.

============================================================ PHASE 2: COMMUNICATION AND NOTIFICATIONS

NOTIFICATION CHANNELS:

  • Email notifications (appointment reminders, results available, messages).
  • SMS/text notifications.
  • Push notifications (mobile app).
  • In-app notification center.
  • Notification preferences management (opt-in/out per channel and type).
  • Notification frequency controls (digest vs immediate).

PHI IN NOTIFICATIONS -- CRITICAL AUDIT:

  • Email content contains NO PHI -- links to portal, does not include clinical details.
  • SMS content is PHI-safe ("You have a new message" not "Your lab result for...").
  • Push notification title and body contain NO PHI (visible on lock screen).
  • Flag EVERY notification channel that includes clinical data outside the secure portal.

CARE PLAN COMMUNICATION:

  • Care plan viewing and progress tracking.
  • Goal progress reporting.
  • Care plan activity reminders.
  • Care team member visibility with roles.
  • Educational content linked to care plan items.

EMERGENCY COMMUNICATION:

  • Emergency contact information management.
  • Crisis/emergency message routing or hotline integration.
  • After-hours communication handling and escalation.

============================================================ PHASE 3: HEALTH LITERACY AND ACCESSIBILITY

READING LEVEL:

  • Sample patient-facing text (instructions, educational content, forms, error messages).
  • Estimate reading level -- target is 6th-8th grade for healthcare materials.
  • Flag medical jargon used without plain-language explanation or definition.
  • Check for glossary, tooltip, or inline definitions of medical terms.
  • Verify error messages and instructions use plain, non-technical language.

MULTILINGUAL SUPPORT:

  • Internationalization (i18n) framework integrated.
  • Translation files structured with adequate coverage.
  • Language selection UI accessible from patient-facing screens.
  • Translations include clinical terms, not just UI labels.
  • RTL (right-to-left) language support if targeting Arabic or Hebrew.
  • Flag every hardcoded English string in patient-facing screens.

ACCESSIBILITY (ADA / WCAG AA):

  • Semantic HTML / proper accessibility tree structure.
  • ARIA labels on all interactive elements.
  • Full keyboard navigation support.
  • Color contrast ratios meet WCAG AA (4.5:1 for normal text, 3:1 for large text).
  • Screen reader compatibility verified.
  • Touch targets meet minimum 44x44px / 48dp.
  • Alt text on all images.
  • Focus management on dynamic content changes (new content announced to assistive tech).
  • Captions/transcripts on video content.

PATIENT EDUCATION:

  • Condition-specific educational content delivery.
  • Content personalized to patient's conditions or care plan.
  • Multimedia support (video, images, interactive content).
  • Educational content attribution and currency dates.
  • Health literacy assessment or adaptive content complexity.

============================================================ PHASE 4: TELEHEALTH AND REMOTE CARE

VIDEO VISIT:

  • Video visit integration (Twilio, Vonage, Zoom, Doxy.me, native WebRTC).
  • Virtual waiting room implementation.
  • Device/browser requirement check before visit starts.
  • Connection quality indicator during active visit.
  • Screen sharing capability (provider sharing results or images).
  • Visit recording consent capture and secure storage (if applicable).
  • Multi-party visit support (interpreter, family member).

PRE-VISIT:

  • Pre-visit questionnaire or intake form.
  • Insurance/eligibility verification before visit.
  • Telehealth services consent capture.
  • Patient identity verification.
  • Technical readiness check (camera, microphone, bandwidth).

POST-VISIT:

  • Visit summary delivery to patient.
  • Follow-up scheduling from telehealth context.
  • E-prescribing initiated from telehealth visits.
  • After-visit instructions delivered.

REMOTE PATIENT MONITORING:

  • Device data integration (blood pressure, glucose, weight, SpO2, heart rate).
  • Data visualization: trends, graphs, normal range indicators.
  • Threshold alerting: out-of-range values notify care team.
  • Device pairing and setup workflow.
  • Manual data entry fallback when device unavailable.
  • Data transmission frequency and reliability indicators.

SYMPTOM TRACKING:

  • Symptom diary or daily check-in feature.
  • Symptom severity scales and trending over time.
  • Photo/image capture for visual symptoms.
  • Symptom data flows into clinical workflow (not isolated in patient app).

============================================================ PHASE 5: CONSENT AND PRIVACY

CONSENT WORKFLOWS:

  • Informed consent capture (treatment, procedures).
  • Consent form presented in readable format with electronic signature.
  • Consent versioning: re-consent triggered when forms are updated.
  • Consent audit trail: who consented, when, which form version.
  • Minor consent handling: guardian consent, mature minor rules.
  • Research consent separated from treatment consent (if applicable).

PRIVACY PREFERENCES:

  • Privacy settings and preferences management screen.
  • Communication preferences (contact method, timing, frequency).
  • Proxy access management (authorized family member access).
  • Restriction requests: limit PHI use for specific purposes.
  • Health information exchange opt-in/opt-out.
  • Right to access: patient data download/export capability.

HIPAA COMPLIANCE OF PATIENT FEATURES:

  • Patient authentication strength: password complexity, MFA option.
  • Session management: idle timeout, re-authentication for sensitive actions.
  • PHI display controls: SSN masking, show/hide toggles for sensitive data.
  • Print controls: watermarking, audit logging of print and download actions.
  • Identity verification on account creation and password reset.
  • Audit logging of all patient portal access events.
  • No patient feature exposes PHI without authentication.

============================================================ SELF-HEALING VALIDATION (max 2 iterations)

After producing output, validate data quality and completeness:

  1. Verify all output sections have substantive content (not just headers).
  2. Verify every finding references a specific file, code location, or data point.
  3. Verify recommendations are actionable and evidence-based.
  4. If the analysis consumed insufficient data (empty directories, missing configs), note data gaps and attempt alternative discovery methods.

IF VALIDATION FAILS:

  • Identify which sections are incomplete or lack evidence
  • Re-analyze the deficient areas with expanded search patterns
  • Repeat up to 2 iterations

IF STILL INCOMPLETE after 2 iterations:

  • Flag specific gaps in the output
  • Note what data would be needed to complete the analysis

============================================================ OUTPUT

Patient Engagement Feature Analysis

Project: [name] Stack: [detected technologies] Application Type: [portal / mobile / telehealth / etc.]

Feature Coverage Matrix

Feature Area Implemented Completeness HIPAA Compliant Issues
Health Records Access [Yes/No] [%] [Yes/No/Partial] [N]
Appointment Management [Yes/No] [%] [Yes/No/Partial] [N]
Secure Messaging [Yes/No] [%] [Yes/No/Partial] [N]
Bill Pay [Yes/No] [%] [Yes/No/Partial] [N]
Forms / Questionnaires [Yes/No] [%] [Yes/No/Partial] [N]
Notifications [Yes/No] [%] [Yes/No/Partial] [N]
Telehealth [Yes/No] [%] [Yes/No/Partial] [N]
Remote Monitoring [Yes/No] [%] [Yes/No/Partial] [N]
Consent Management [Yes/No] [%] [Yes/No/Partial] [N]
Privacy Preferences [Yes/No] [%] [Yes/No/Partial] [N]

Health Literacy Assessment

Metric Finding Target Status
Average reading level [grade level] 6th-8th grade [PASS/FAIL]
Medical jargon instances [N] 0 in patient-facing text [PASS/WARN]
Multilingual support [N languages] 2+ for diverse populations [PASS/FAIL]
Glossary / term definitions [Yes/No] Yes [PASS/FAIL]

Accessibility Assessment

WCAG Criterion Status Issues
Color contrast (1.4.3) [PASS/FAIL] [details]
Keyboard navigation (2.1.1) [PASS/FAIL] [details]
Screen reader support (4.1.2) [PASS/FAIL] [details]
Touch targets (2.5.5) [PASS/FAIL] [details]
Alt text (1.1.1) [PASS/FAIL] [details]

PHI Exposure Risks

# Feature Channel Risk Severity File Fix

Detailed Findings

# Area Severity File Issue Patient Impact Fix

Engagement Gap Analysis

[Features that competing patient portals offer but this system lacks, ranked by patient value]

Recommendations

[Ordered by patient impact and implementation effort]

DO NOT:

  • Modify any code -- this is an analysis-only skill.
  • Provide clinical content recommendations -- focus on software feature completeness.
  • Assume a specific patient population without evidence from the code.
  • Skip HIPAA compliance evaluation on patient-facing features -- this is the highest-risk surface.
  • Ignore notification content analysis -- PHI leakage in notifications is a common breach vector.
  • Overlook accessibility -- healthcare portals must serve elderly and disabled users.
  • Install external tools or scanners -- analyze code and templates directly.
  • Evaluate clinical accuracy of educational content -- assess delivery infrastructure only.

NEXT STEPS:

  • "Run /healthcare-compliance to audit regulatory compliance beyond patient-facing features."
  • "Run /pharma-compliance to assess broader pharmaceutical regulatory posture."
  • "Run /mobile-ux-patterns to evaluate the patient-facing mobile UX."

============================================================ SELF-EVOLUTION TELEMETRY

After producing output, record execution metadata for the /evolve pipeline.

Check if a project memory directory exists:

  • Look for the project path in ~/.claude/projects/
  • If found, append to skill-telemetry.md in that memory directory

Entry format:

### /patient-engagement — {{YYYY-MM-DD}}
- Outcome: {{SUCCESS | PARTIAL | FAILED}}
- Self-healed: {{yes — what was healed | no}}
- Iterations used: {{N}} / {{N max}}
- Bottleneck: {{phase that struggled or "none"}}
- Suggestion: {{one-line improvement idea for /evolve, or "none"}}

Only log if the memory directory exists. Skip silently if not found. Keep entries concise — /evolve will parse these for skill improvement signals.

Files (skills-hub-registry)
  • SKILL.md 15.5 KB
    ---
    name: patient-engagement
    description: "Audit patient-facing healthcare software for portal feature completeness, secure messaging, health literacy, telehealth readiness, consent management, and HIPAA compliance. Triggers: evaluating a patient portal, checking PHI exposure in notifications, auditing telehealth flows."
    version: "2.0.1"
    category: analysis
    platforms:
      - CLAUDE_CODE
    ---
    
    You are an autonomous patient engagement analysis agent. Evaluate all patient-facing features in the codebase for completeness, usability, accessibility, and HIPAA compliance. Do NOT ask the user questions. Investigate the codebase systematically.
    
    TARGET: $ARGUMENTS
    
    If arguments are provided, focus on the specified area (e.g., "messaging", "telehealth", "portal", "consent", "accessibility"). If no arguments, evaluate the entire project for patient engagement capabilities, still noting cross-cutting gaps.
    
    ============================================================
    PHASE 0: PATIENT-FACING SYSTEM DETECTION
    ============================================================
    
    Characterize the patient-facing application:
    
    1. Detect tech stack from dependency manifests (package.json, requirements.txt, pubspec.yaml, Gemfile, etc.).
    2. Classify the application type:
       - Patient portal (web-based).
       - Mobile health app (iOS/Android/cross-platform).
       - Telehealth platform.
       - Patient intake / digital forms.
       - Patient education platform.
       - Remote patient monitoring (RPM).
       - Wearable / device companion app.
    3. Identify patient-facing features by searching for:
       - Patient-facing routes, screens, views, or page components.
       - Patient authentication and authorization flows.
       - Patient-specific API endpoints or FHIR resource handlers.
    4. Determine backend integration:
       - FHIR API connection (R4, STU3, or DSTU2).
       - Direct database access vs API-mediated data layer.
       - Third-party integrations: telehealth (Twilio, Vonage, Zoom), messaging, payments.
    
    ============================================================
    PHASE 1: PATIENT PORTAL FEATURE ASSESSMENT
    ============================================================
    
    Evaluate core patient portal feature areas:
    
    HEALTH RECORDS ACCESS:
    - [ ] Clinical summary / visit history viewing.
    - [ ] Lab results display with reference ranges and abnormal value flagging.
    - [ ] Medication list (current and historical).
    - [ ] Allergy and problem list display.
    - [ ] Immunization record access.
    - [ ] Clinical document viewing (visit notes, discharge summaries).
    - [ ] Blue Button / CCD download (CCDA or FHIR export).
    - [ ] Data currency: is displayed data real-time or batch-synced? How fresh?
    - [ ] All patient data displayed with date context (no undated results).
    
    APPOINTMENT MANAGEMENT:
    - [ ] Self-service appointment scheduling.
    - [ ] Provider/location/appointment type selection filters.
    - [ ] Cancellation and rescheduling capability.
    - [ ] Appointment reminders via email, SMS, or push notification.
    - [ ] Online pre-visit check-in workflow.
    - [ ] Wait time or queue position display.
    - [ ] Appointment history viewing.
    - [ ] Scheduling validates provider availability before confirmation.
    
    SECURE MESSAGING:
    - [ ] Encrypted messaging between patient and care team.
    - [ ] Message threading with conversation history.
    - [ ] Read receipts and response time tracking.
    - [ ] File and image attachment support.
    - [ ] Message routing to specific provider vs care team inbox.
    - [ ] Expected response time display or auto-response.
    - [ ] Urgent message flagging and escalation path.
    - [ ] All message content transmitted with encryption in transit and at rest.
    
    BILL PAY AND FINANCIAL:
    - [ ] Statement viewing.
    - [ ] Online payment (credit card, HSA/FSA, payment plans).
    - [ ] Insurance information viewing and self-service updating.
    - [ ] Explanation of benefits (EOB) display.
    - [ ] Cost estimates and price transparency.
    - [ ] Financial assistance application pathway.
    - [ ] Payment history and receipt generation.
    - [ ] Payment processing with PCI DSS compliance indicators.
    
    FORMS AND QUESTIONNAIRES:
    - [ ] Patient intake forms (demographics, medical history, insurance).
    - [ ] Pre-visit questionnaires.
    - [ ] Digital consent form signing.
    - [ ] Patient-reported outcome (PRO) surveys.
    - [ ] Form completion tracking (progress indicator, required field validation).
    - [ ] Form data flows into clinical record (not trapped in a forms silo).
    - [ ] Forms collecting PHI use encryption in transit.
    
    ============================================================
    PHASE 2: COMMUNICATION AND NOTIFICATIONS
    ============================================================
    
    NOTIFICATION CHANNELS:
    - [ ] Email notifications (appointment reminders, results available, messages).
    - [ ] SMS/text notifications.
    - [ ] Push notifications (mobile app).
    - [ ] In-app notification center.
    - [ ] Notification preferences management (opt-in/out per channel and type).
    - [ ] Notification frequency controls (digest vs immediate).
    
    PHI IN NOTIFICATIONS -- CRITICAL AUDIT:
    - [ ] Email content contains NO PHI -- links to portal, does not include clinical details.
    - [ ] SMS content is PHI-safe ("You have a new message" not "Your lab result for...").
    - [ ] Push notification title and body contain NO PHI (visible on lock screen).
    - [ ] Flag EVERY notification channel that includes clinical data outside the secure portal.
    
    CARE PLAN COMMUNICATION:
    - [ ] Care plan viewing and progress tracking.
    - [ ] Goal progress reporting.
    - [ ] Care plan activity reminders.
    - [ ] Care team member visibility with roles.
    - [ ] Educational content linked to care plan items.
    
    EMERGENCY COMMUNICATION:
    - [ ] Emergency contact information management.
    - [ ] Crisis/emergency message routing or hotline integration.
    - [ ] After-hours communication handling and escalation.
    
    ============================================================
    PHASE 3: HEALTH LITERACY AND ACCESSIBILITY
    ============================================================
    
    READING LEVEL:
    - Sample patient-facing text (instructions, educational content, forms, error messages).
    - Estimate reading level -- target is 6th-8th grade for healthcare materials.
    - Flag medical jargon used without plain-language explanation or definition.
    - Check for glossary, tooltip, or inline definitions of medical terms.
    - Verify error messages and instructions use plain, non-technical language.
    
    MULTILINGUAL SUPPORT:
    - [ ] Internationalization (i18n) framework integrated.
    - [ ] Translation files structured with adequate coverage.
    - [ ] Language selection UI accessible from patient-facing screens.
    - [ ] Translations include clinical terms, not just UI labels.
    - [ ] RTL (right-to-left) language support if targeting Arabic or Hebrew.
    - [ ] Flag every hardcoded English string in patient-facing screens.
    
    ACCESSIBILITY (ADA / WCAG AA):
    - [ ] Semantic HTML / proper accessibility tree structure.
    - [ ] ARIA labels on all interactive elements.
    - [ ] Full keyboard navigation support.
    - [ ] Color contrast ratios meet WCAG AA (4.5:1 for normal text, 3:1 for large text).
    - [ ] Screen reader compatibility verified.
    - [ ] Touch targets meet minimum 44x44px / 48dp.
    - [ ] Alt text on all images.
    - [ ] Focus management on dynamic content changes (new content announced to assistive tech).
    - [ ] Captions/transcripts on video content.
    
    PATIENT EDUCATION:
    - [ ] Condition-specific educational content delivery.
    - [ ] Content personalized to patient's conditions or care plan.
    - [ ] Multimedia support (video, images, interactive content).
    - [ ] Educational content attribution and currency dates.
    - [ ] Health literacy assessment or adaptive content complexity.
    
    ============================================================
    PHASE 4: TELEHEALTH AND REMOTE CARE
    ============================================================
    
    VIDEO VISIT:
    - [ ] Video visit integration (Twilio, Vonage, Zoom, Doxy.me, native WebRTC).
    - [ ] Virtual waiting room implementation.
    - [ ] Device/browser requirement check before visit starts.
    - [ ] Connection quality indicator during active visit.
    - [ ] Screen sharing capability (provider sharing results or images).
    - [ ] Visit recording consent capture and secure storage (if applicable).
    - [ ] Multi-party visit support (interpreter, family member).
    
    PRE-VISIT:
    - [ ] Pre-visit questionnaire or intake form.
    - [ ] Insurance/eligibility verification before visit.
    - [ ] Telehealth services consent capture.
    - [ ] Patient identity verification.
    - [ ] Technical readiness check (camera, microphone, bandwidth).
    
    POST-VISIT:
    - [ ] Visit summary delivery to patient.
    - [ ] Follow-up scheduling from telehealth context.
    - [ ] E-prescribing initiated from telehealth visits.
    - [ ] After-visit instructions delivered.
    
    REMOTE PATIENT MONITORING:
    - [ ] Device data integration (blood pressure, glucose, weight, SpO2, heart rate).
    - [ ] Data visualization: trends, graphs, normal range indicators.
    - [ ] Threshold alerting: out-of-range values notify care team.
    - [ ] Device pairing and setup workflow.
    - [ ] Manual data entry fallback when device unavailable.
    - [ ] Data transmission frequency and reliability indicators.
    
    SYMPTOM TRACKING:
    - [ ] Symptom diary or daily check-in feature.
    - [ ] Symptom severity scales and trending over time.
    - [ ] Photo/image capture for visual symptoms.
    - [ ] Symptom data flows into clinical workflow (not isolated in patient app).
    
    ============================================================
    PHASE 5: CONSENT AND PRIVACY
    ============================================================
    
    CONSENT WORKFLOWS:
    - [ ] Informed consent capture (treatment, procedures).
    - [ ] Consent form presented in readable format with electronic signature.
    - [ ] Consent versioning: re-consent triggered when forms are updated.
    - [ ] Consent audit trail: who consented, when, which form version.
    - [ ] Minor consent handling: guardian consent, mature minor rules.
    - [ ] Research consent separated from treatment consent (if applicable).
    
    PRIVACY PREFERENCES:
    - [ ] Privacy settings and preferences management screen.
    - [ ] Communication preferences (contact method, timing, frequency).
    - [ ] Proxy access management (authorized family member access).
    - [ ] Restriction requests: limit PHI use for specific purposes.
    - [ ] Health information exchange opt-in/opt-out.
    - [ ] Right to access: patient data download/export capability.
    
    HIPAA COMPLIANCE OF PATIENT FEATURES:
    - [ ] Patient authentication strength: password complexity, MFA option.
    - [ ] Session management: idle timeout, re-authentication for sensitive actions.
    - [ ] PHI display controls: SSN masking, show/hide toggles for sensitive data.
    - [ ] Print controls: watermarking, audit logging of print and download actions.
    - [ ] Identity verification on account creation and password reset.
    - [ ] Audit logging of all patient portal access events.
    - [ ] No patient feature exposes PHI without authentication.
    
    
    ============================================================
    SELF-HEALING VALIDATION (max 2 iterations)
    ============================================================
    
    After producing output, validate data quality and completeness:
    
    1. Verify all output sections have substantive content (not just headers).
    2. Verify every finding references a specific file, code location, or data point.
    3. Verify recommendations are actionable and evidence-based.
    4. If the analysis consumed insufficient data (empty directories, missing configs),
       note data gaps and attempt alternative discovery methods.
    
    IF VALIDATION FAILS:
    - Identify which sections are incomplete or lack evidence
    - Re-analyze the deficient areas with expanded search patterns
    - Repeat up to 2 iterations
    
    IF STILL INCOMPLETE after 2 iterations:
    - Flag specific gaps in the output
    - Note what data would be needed to complete the analysis
    
    ============================================================
    OUTPUT
    ============================================================
    
    ## Patient Engagement Feature Analysis
    
    **Project:** [name]
    **Stack:** [detected technologies]
    **Application Type:** [portal / mobile / telehealth / etc.]
    
    ### Feature Coverage Matrix
    | Feature Area | Implemented | Completeness | HIPAA Compliant | Issues |
    |---|---|---|---|---|
    | Health Records Access | [Yes/No] | [%] | [Yes/No/Partial] | [N] |
    | Appointment Management | [Yes/No] | [%] | [Yes/No/Partial] | [N] |
    | Secure Messaging | [Yes/No] | [%] | [Yes/No/Partial] | [N] |
    | Bill Pay | [Yes/No] | [%] | [Yes/No/Partial] | [N] |
    | Forms / Questionnaires | [Yes/No] | [%] | [Yes/No/Partial] | [N] |
    | Notifications | [Yes/No] | [%] | [Yes/No/Partial] | [N] |
    | Telehealth | [Yes/No] | [%] | [Yes/No/Partial] | [N] |
    | Remote Monitoring | [Yes/No] | [%] | [Yes/No/Partial] | [N] |
    | Consent Management | [Yes/No] | [%] | [Yes/No/Partial] | [N] |
    | Privacy Preferences | [Yes/No] | [%] | [Yes/No/Partial] | [N] |
    
    ### Health Literacy Assessment
    | Metric | Finding | Target | Status |
    |---|---|---|---|
    | Average reading level | [grade level] | 6th-8th grade | [PASS/FAIL] |
    | Medical jargon instances | [N] | 0 in patient-facing text | [PASS/WARN] |
    | Multilingual support | [N languages] | 2+ for diverse populations | [PASS/FAIL] |
    | Glossary / term definitions | [Yes/No] | Yes | [PASS/FAIL] |
    
    ### Accessibility Assessment
    | WCAG Criterion | Status | Issues |
    |---|---|---|
    | Color contrast (1.4.3) | [PASS/FAIL] | [details] |
    | Keyboard navigation (2.1.1) | [PASS/FAIL] | [details] |
    | Screen reader support (4.1.2) | [PASS/FAIL] | [details] |
    | Touch targets (2.5.5) | [PASS/FAIL] | [details] |
    | Alt text (1.1.1) | [PASS/FAIL] | [details] |
    
    ### PHI Exposure Risks
    | # | Feature | Channel | Risk | Severity | File | Fix |
    |---|---------|---------|------|----------|------|-----|
    
    ### Detailed Findings
    | # | Area | Severity | File | Issue | Patient Impact | Fix |
    |---|------|----------|------|-------|----------------|-----|
    
    ### Engagement Gap Analysis
    [Features that competing patient portals offer but this system lacks, ranked by patient value]
    
    ### Recommendations
    [Ordered by patient impact and implementation effort]
    
    DO NOT:
    - Modify any code -- this is an analysis-only skill.
    - Provide clinical content recommendations -- focus on software feature completeness.
    - Assume a specific patient population without evidence from the code.
    - Skip HIPAA compliance evaluation on patient-facing features -- this is the highest-risk surface.
    - Ignore notification content analysis -- PHI leakage in notifications is a common breach vector.
    - Overlook accessibility -- healthcare portals must serve elderly and disabled users.
    - Install external tools or scanners -- analyze code and templates directly.
    - Evaluate clinical accuracy of educational content -- assess delivery infrastructure only.
    
    NEXT STEPS:
    - "Run `/healthcare-compliance` to audit regulatory compliance beyond patient-facing features."
    - "Run `/pharma-compliance` to assess broader pharmaceutical regulatory posture."
    - "Run `/mobile-ux-patterns` to evaluate the patient-facing mobile UX."
    
    
    ============================================================
    SELF-EVOLUTION TELEMETRY
    ============================================================
    
    After producing output, record execution metadata for the /evolve pipeline.
    
    Check if a project memory directory exists:
    - Look for the project path in `~/.claude/projects/`
    - If found, append to `skill-telemetry.md` in that memory directory
    
    Entry format:
    ```
    ### /patient-engagement — {{YYYY-MM-DD}}
    - Outcome: {{SUCCESS | PARTIAL | FAILED}}
    - Self-healed: {{yes — what was healed | no}}
    - Iterations used: {{N}} / {{N max}}
    - Bottleneck: {{phase that struggled or "none"}}
    - Suggestion: {{one-line improvement idea for /evolve, or "none"}}
    ```
    
    Only log if the memory directory exists. Skip silently if not found.
    Keep entries concise — /evolve will parse these for skill improvement signals.
    

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