PRISM-Consult: A Panel-of-Experts Architecture for Clinician-Aligned Diagnosis

Abstract

We present PRISM-Consult, a clinician-aligned panel-of-experts architecture that extends the compact PRISM sequence model into a routed family of domain specialists. Episodes are tokenized as structured clinical events; a light-weight router reads the first few tokens and dispatches to specialist models (Cardiac-Vascular, Pulmonary, Gastro-Oesophageal, Musculoskeletal, Psychogenic). Each specialist inherits PRISM's small transformer backbone and token template, enabling parameter efficiency and interpretability. This initial study evaluates a scoped panel of five specialist families defined by high-impact ED diagnostic groups. On real-world Emergency Department cohorts, specialists exhibit smooth convergence with low development perplexities across domains, while the router achieves high routing quality and large compute savings versus consult-all under a safety-first policy. We detail the data methodology (initial vs.\ conclusive ICD-9 families), routing thresholds and calibration, and report per-domain results to avoid dominance by common events. The framework provides a practical path to safe, auditable, and low-latency consult at scale, and we outline validation steps-external/temporal replication, asymmetric life-threat thresholds, and multi-label arbitration-to meet prospective clinical deployment standards.