Optimistic Reasoning with Verification and Synthesis (ORVS): A Stochastic DAG Architecture for Clinical AI Agents in Rheumatology
We present ORVS (Optimistic Reasoning with Verification and Synthesis), a novel clinical reasoning architecture for AI agents that combines stochastic directed acyclic graphs (DAG) with proof-of-history verification and optimistic computation. Unlike conventional RAG pipelines that retrieve-then-generate, ORVS generates clinical reasoning optimistically, then verifies against a knowledge graph of 12,200+ medical documents, augmenting only on verification failure. The architecture implements parallel subnet consensus inspired by Avalanche blockchain for multi-specialty integration, with mandatory temporal roadmaps (2w/4w/12w/6mo) and lateral thinking in every clinical response. Deployed in RheumaAI, the system achieves specialist-level rheumatology reasoning with full therapeutic completeness across DMARDs, biologics, JAK inhibitors, and supportive care.