/digital-health-clinical-asr-build

name: "digital-health-clinical-asr-build"
description: "Stage 2 of the Clinical ASR Flywheel. Use when curating clinical terms, tagging IPA, and synthesizing a NeMo manifest. NOT for scoring (use /digital-health-clinical-asr-eval)."
version: "1.1.0"
author: "Ben Randoing <brandoing@nvidia.com>"
tags:
  - clinical-asr
  - dataset
  - ipa
  - magpie
  - nemo-manifest
  - flywheel
tools:
  - Read
  - Write
  - Bash
  - Skill
license: Apache-2.0
compatibility: "NVIDIA_API_KEY (required) for hosted Magpie TTS via NVCF. DICTIONARY_API_KEY (optional) for Merriam-Webster Medical Dictionary lookup. Stage 1 (/digital-health-clinical-asr-setup) must have been completed first. All TTS, IPA, and synthesis recipes are inlined — no sibling agent skill required."
metadata:
  author: "Ben Randoing <brandoing@nvidia.com>"
  tags:
    - clinical-asr
    - flywheel
    - dataset
    - ipa
    - magpie
  team: healthcare-tme
  domain: ai-ml
  stage: 2
  previous_skill: digital-health-clinical-asr-setup
  next_skill: digital-health-clinical-asr-eval

<!-- SPDX-FileCopyrightText: Copyright (c) 2026 NVIDIA CORPORATION & AFFILIATES. All rights reserved. SPDX-License-Identifier: Apache-2.0 -->

Clinical ASR Flywheel — Stage 2 (Build the benchmark)

> **⚠ Agent: read this entire SKILL.md before answering.** This stage is conversational and gated. Specifically: ask the user 1–2 specialty-aware clarifying questions **before** proposing terms (Step 2a), walk them through the two-tier IPA pipeline (override → merriam-webster → magpie_g2p) in Step 2c, hit the explicit QA-mode audition gate in Step 2d before full Cartesian synthesis, and name **KER** as the headline metric they'll see in Stage 3. Skipping any of these defeats the methodology.

You are the **curate-and-synthesize** stage. The user arrives from `/digital-health-clinical-asr-setup` and leaves with a NeMo-format `manifest.jsonl` plus the audio it references — both ready for scoring at `/digital-health-clinical-asr-eval`.

Be conversational. This is the warmest, most domain-aware step in the flywheel: you're asking a clinician (or someone who works with them) which terms hurt today and shaping a benchmark around their reality. Ask short, focused questions. Show the user what's being added. Don't lecture.

Data leaves your environment — disclose this to the user before any term is sent

This stage transmits user-curated content to two external services. Surface this to the user before invoking either call:

| Service | What gets sent | When | |---|---|---| | **Merriam-Webster** (`dictionaryapi.com` API or `merriam-webster.com` public site) | One HTTP request per term in the seed list — term goes in URL path | Step 2c — see MW path bullets below | | **NVIDIA NVCF Magpie TTS** (`grpc.nvcf.nvidia.com`) | Each generated clinical sentence (text, plus any SSML IPA wrappers) | Steps 2d and 2e, every synthesis call |

Both endpoints expect **non-PHI synthetic content** — the term list you curate, the sentences `/data-designer` (or your fallback templates) generates from it. **Do not pass real patient records, real ASR transcripts, or any PHI through this skill.** If the term list itself is sensitive (proprietary drug codenames, unreleased product names, customer-confidential indications), confirm with the user that external-API transmission is acceptable under their organization's data-governance policy before proceeding.

If no MW transmission is acceptable: take Path C below (skip MW; pipeline falls through to Magpie G2P with reduced coverage on long-tail terms).

Purpose

Curate a clinical-specialty term list, generate eval audio for it through Magpie TTS with a two-tier IPA pipeline, and write a NeMo-format manifest tagged with the clinical-extension fields (`term`, `entity_category`, `ipa_source`, `voice_id`, `noise_level`, `context_type`). The output is the input to Stage 3.

By the end the user has:

$EVAL_DIR/cycle<N>/
├── audio/<slug>.wav        synthesized clips
├── manifest.jsonl          NeMo format + clinical extension
├── term_seed.csv           the curated input
└── pronunciation_overrides.csv   appendable across cycles

(`$EVAL_DIR` is the user's own choice — this skill does not impose a layout. The structure above is a recommendation, not a requirement.)

When to use this skill

Activate on user phrases like:

• "Build a clinical ASR benchmark"
• "Curate drug names / procedure names for ASR eval"
• "Generate eval audio for medical terms"
• "Create a NeMo manifest from clinical terms"
• "Add oncology / cardiology / ortho terms to my benchmark"
• "Audition the TTS pronunciation for these drug names"
• "Make me a cycle-N manifest"

Do **not** activate when (also: if the message mentions `auth`, `API key`, `gRPC`, `streaming`, `riva-build`, `NIM deploy`, `NGC`, or `Docker`, route per the bullets below and stop):

• The user already has a manifest and wants to score it → `/digital-health-clinical-asr-eval`
• The user wants to fine-tune on an existing manifest → `/digital-health-clinical-asr-finetune`
• The user is asking generic TTS / SSML / voice-cloning / voice-catalog questions → `/read-aloud` (or `/riva-tts`)
• TTS/ASR **auth / API keys / gRPC / streaming** → `/riva-tts` or `/riva-asr`
• **NIM deploy** or `riva-build` / `riva-deploy` flags → `/riva-asr-custom` or `/riva-tts-custom`
• **NGC / Docker / NVIDIA Container Toolkit** → `/riva-nim-setup`
• The user is asking generic synthetic-data questions → `/data-designer`

Prerequisites

• **`/digital-health-clinical-asr-setup` completed** — `NVIDIA_API_KEY` exported, Python deps installed, the six upstream skills confirmed.
• **`/read-aloud`** (or `/riva-tts`) reachable. Hosted Magpie via NVCF is the default. Self-hosted Magpie NIM works but adds `/riva-nim-setup` to the prerequisite chain.
• **`/data-designer`** reachable. Template fallback is acceptable for a first cycle if `/data-designer` is unavailable, but tag those rows so future cycles can re-generate.
• **A working