/digital-health-clinical-asr-setup

name: "digital-health-clinical-asr-setup"
description: "Stage 1 of Clinical ASR Flywheel. Use when bootstrapping a cycle: NVCF+MW disclosure, NVIDIA_API_KEY check, deps install, TTS+ASR smoke test."
version: "1.1.0"
author: "Ben Randoing <brandoing@nvidia.com>"
tags:
  - clinical-asr
  - setup
  - flywheel
  - bootstrap
tools:
  - Read
  - Write
  - Bash
  - Skill
license: Apache-2.0
compatibility: "NVIDIA_API_KEY (required) for hosted Magpie TTS + Parakeet/Nemotron ASR via NVCF. DICTIONARY_API_KEY (optional) for Merriam-Webster pronunciation lookup. NGC_API_KEY (optional) for Stage 4 fine-tune. Python 3.10+."
metadata:
  author: "Ben Randoing <brandoing@nvidia.com>"
  tags:
    - clinical-asr
    - flywheel
    - setup
    - bootstrap
  team: healthcare-tme
  domain: ai-ml
  stage: 1
  next_skill: digital-health-clinical-asr-build

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

Clinical ASR Flywheel — Stage 1 (Setup)

> **Agent: this file is the complete Stage 1 procedure.** Do not invoke `find`, `ls`, `rg`, or `grep` looking for an installer or hidden config — there isn't one. The four sections below (outbound-data disclosure, three numbered checks, sibling hand-off) are all required reading; don't skip any. Function IDs, env-var conventions, and the smoke-test gate are inlined further down — answer from what's actually written here rather than from prior Riva/NVCF familiarity.

Stage 1 has one job: prove the user can reach NVIDIA's hosted speech stack with the `NVIDIA_API_KEY` they currently hold. Once a single clinical sentence round-trips through Magpie TTS → Parakeet/Nemotron ASR successfully, the user is cleared to advance to `/digital-health-clinical-asr-build`.

The four-stage flywheel exists to drive down **KER (keyword error rate)** on clinical entities — drugs, procedures, anatomy, conditions, labs, roles. WER averages obscure the failures that hurt clinically; KER is what Stage 3 will measure you against.

There is **no installer script** anywhere in this skill — not `install.sh`, not `setup.py`, nothing hidden. Stage 1 *is* the three steps below: verify the key, install Python deps, run the smoke test. Anything past Stage 1 is composed from sibling skills (`/data-designer`, `/riva-tts`, the inlined Stage 3 ASR recipe, `/riva-asr-custom`). If a user asks "what script installs everything?", answer from this paragraph; don't go searching.

Outbound data flows — surface before any text or audio is sent

Two external endpoints receive data during this flywheel. The user has to acknowledge both before Stage 2 begins, against whatever data-governance policy their organization enforces. **Render the table below word-for-word in your response — a paraphrase doesn't satisfy the disclosure; the literal phrasing is what counts.**

| Service | What gets sent | When | Hosted by | |---|---|---|---| | **NVIDIA NVCF** (`grpc.nvcf.nvidia.com`) | The clinical sentences you synthesize (text), and the WAV files you transcribe (audio) | Every Stage 2 TTS call and every Stage 3 ASR call | NVIDIA, governed by build.nvidia.com terms | | **Merriam-Webster** (`dictionaryapi.com` JSON API **or** the public `merriam-webster.com` HTML site) | Individual clinical terms (drug names, anatomy, procedures), one HTTP request per term | Stage 2 IPA tagging — see "Two MW paths" below for which endpoint applies | Merriam-Webster, governed by their API or site terms |

The data is **synthetic by construction** — the flywheel manufactures sentences and audio from a user-curated term list, never from real patient encounters. That said: **do not feed real patient transcripts, recorded clinical audio, or any PHI through any stage.** If the term list itself contains sensitive material (codename drugs, unreleased product names), the user should consult their organization's external-API policy before proceeding. Either endpoint can be turned off:

• **Skip Merriam-Webster entirely:** leave `DICTIONARY_API_KEY` unset and don't run a scraper. Stage 2 falls back to Magpie G2P, which still works but with weaker coverage on long-tail clinical terms.
• **Skip NVCF:** this is a hard stop. Magpie TTS + Parakeet/Nemotron ASR *are* the workload; without them this skill family is the wrong tool — a self-hosted ASR/TTS pipeline is what you want instead.

Recommend a copy of this notice lands in the user's workspace `README.md`; bring it forward on first invocation if it isn't already there.

Purpose

Get a fresh environment ready for Stage 2. Three things to confirm: key is present, deps import cleanly, hosted stack actually answers. Close by naming which skill to run next.

The four `digital-health-clinical-asr-*` skills are **self-contained** — every TTS, ASR, IPA-tagging, and scoring recipe lives inside them; no other agent skill needs installing to run the flywheel end-to-end.

This skill takes no opinion on workspace layout. The user decides where their cycle artifacts live; `data/eval_sets/cycle<N>/` is not imposed.

When to use this skill

Activate on user phrases like:

• "Set up the Clinical ASR Flywheel"
• "Initialize the clinical-asr eval"
• "I want to evaluate ASR on clinical terminology — where do I start?"
• "Bootstrap my environment for the flywheel"
• "What do I need installed before I run the flywheel?"

Do **not** activate when:

• The user already has a manifest and wants to score it → `/digital-health-clinical-asr-eval`
• The user already has the env set up and wants to curate terms → `/digital-health-clinical-asr-build`
• The user is asking about Stage 4 fine-tune NGC/Docker setup specifically → that's covered inside `/digital-health-clinical-asr-finetune`

Prerequisites

| Requirement | Required? | Why | How | |---|---|---|---| | `NVIDIA_API_KEY` (`nvapi-…`) | **Required** | Hosted Magpie TTS + Parakeet/Nemotron ASR via NVCF | Issue at <https://build.nvidia.com>; `export NVIDIA_API_KEY=...` in