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Skills

Skills are markdown instruction overlays that change how the agent approaches a task. They are not the same thing as agent modes, and they are not a mechanism for registering new native medical backends.

OpenMed currently ships 13 built-in skills. You can also add your own local skills.

What skills do

Skills can:

  • add domain-specific instructions
  • bias the workflow shape the model follows
  • provide reusable task framing for common jobs
  • optionally carry metadata such as allowed_tools

Important boundary:

  • skills are mainly prompt/instruction overlays
  • hard tool restriction is primarily enforced by agent mode, not by the skill layer alone

How to use skills

Use any of these entry points:

  • type $ in the TUI to browse skills
  • run /skill in the TUI
  • launch with openmed agent --skill <skill-id>
  • ask the agent to load a specific skill

Example:

openmed agent --skill reviewing-prior-auth

Built-in skills

Skill ID Purpose
analyzing-clinical-text Clinical entity extraction, note comparison, medication review, and related text analysis
analyzing-health-data Multi-source consumer record import, trend analysis, reconciliation, visit prep, narratives, and optional FHIR-oriented output
auditing-medical-codes ICD-10 specificity review, terminology cross-checks, coding compliance, and HCC / RAF-oriented audits
care-coordination Inbox triage, discharge handoff, adapter-prepared input packs, follow-up tasks, and reviewer-safe patient drafts
developing-fhir FHIR R4 implementation, validation, and debugging
documenting-clinical-visits SOAP-note generation from visit transcripts with coding hints
drafting-trial-protocols Structured trial protocol drafting from provided inputs
explaining-eob-claims Plain-language explanation of EOB and claim data
processing-pii PII detection, extraction, and de-identification workflows
researching-literature PubMed search, abstract retrieval, and evidence synthesis
reviewing-appeals Appeal review against denial requirements and evidence gaps
reviewing-prior-auth Prior-auth review against codes and LCD/NCD criteria
running-clinical-workflows Guidance for the built-in deterministic workflow set

Two practical rules:

  • pair analyzing-health-data with --agent consumer when you want the restricted personal-health lane
  • pair care-coordination with --agent coordination when you want inbox/discharge work plus reviewer-safe finalize flows

Add your own skills

Custom skills load from:

  • ~/.config/openmed/skills/
  • or OPENMED_SKILLS_DIR if you override the directory

Supported formats:

  • a flat markdown file named <skill-id>.md
  • a package directory named <skill-id>/SKILL.md

The filename or folder name becomes the skill ID used by $, /skill, load_skill, and openmed agent --skill.

Example: flat markdown skill

~/.config/openmed/skills/payer-policy-review.md

---
description: Review payer policy context before prior auth analysis.
allowed_tools:
  - search_pubmed
  - mcp__guidelines__*
---

Always check the payer policy toolset before drafting the recommendation.
Prefer policy citations over generic summaries when both are available.

Example: package skill

~/.config/openmed/skills/payer-policy-review/SKILL.md

Review payer policy context before prior auth analysis.

Always check the payer policy toolset before drafting the recommendation.
Prefer policy citations over generic summaries when both are available.

Skill loading behavior

  • New or edited skills are picked up on restart
  • User skills can override built-in skills by reusing the same skill ID
  • The TUI skill picker shows built-in and user skills together
  • User-added skills and user-added MCP servers are supported today
  • Brand-new native medical tool integrations are not a public extension surface yet

Skill vs agent mode vs MCP

Use the right surface for the right job:

Surface Use it when...
Skill You want reusable instructions for how the agent should approach a task
Agent mode You want a different tool-access boundary such as clinical, consumer, coordination, or plan
MCP You need external tools or data sources that are not already part of OpenMed's native tool inventory

Example prompts

Load the reviewing-prior-auth skill and review this request against LCD criteria.

Load the documenting-clinical-visits skill and turn this transcript into a structured SOAP note.

Load the running-clinical-workflows skill and run a chart summary on tests/fixtures/demo_inputs/case_001/intake_note.txt

Load the analyzing-health-data skill, import this FHIR export, and run a draft consumer_summary with timeline, trends, reconciliation notes, and visit-prep questions.

Load the care-coordination skill, normalize this portal export into a thread pack, and run a draft clinical_inbox_triage workflow.