> ## Documentation Index > Fetch the complete documentation index at: https://docs.encoreos.io/llms.txt > Use this file to discover all available pages before exploring further. # Clinical Decision Support โ€” Integration > Feature ID: CL-08 Status: ๐Ÿ“ Planned Spec Reference: CL-08-clinical-decision-support.md Last Updated: 2026-02-18 **Feature ID:** CL-08\ **Status:** ๐Ÿ“ Planned\ **Spec Reference:** [CL-08-clinical-decision-support.md](../../../specs/cl/specs/CL-08-clinical-decision-support.md)\ **Last Updated:** 2026-02-18 *** ## Table of Contents * [Overview](#overview) * [Quick Reference](#quick-reference) * [Integration Points (from Spec)](#integration-points-from-spec) * [API / Data Contracts](#api--data-contracts) * [Event Contracts](#event-contracts) * [Security and RLS](#security-and-rls) * [Related Docs](#related-docs) *** ## Overview CL-08 provides clinical decision support (CDS): drug-drug and drug-allergy alerts, medication monitoring reminders (e.g. lithium, clozapine), documentation completeness and overdue alerts, and quality measure gap detection (HEDIS: FUH, FUM, IET, AMM). Alerts are configurable per organization (severity, hard stop vs soft), with override tracking for alert fatigue management. Delivery uses PF-10 (notifications). *** ## Quick Reference | Category | Value | | ------------------------ | ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- | | **Tables** | `cl_cds_rules`, `cl_cds_alerts` | | **Rule types** | drug\_interaction, drug\_allergy, monitoring, documentation, quality\_measure, custom | | **Trigger events** | medication\_add, prescription\_submit, document\_save, chart\_open, assessment\_due, quality\_measure\_eval | | **Condition/action** | JSONB structure per spec Errata E-3 (CdsRuleCondition, CdsRuleAction) | | **RLS helpers** | `cl_has_org_access(organization_id)`; rule CRUD via `cl_can_manage_cds_rules(organization_id, auth.uid())` โ€” delegates to `pf_is_org_admin(user, org)` at SQL level; finer-grained access (compliance role) via PF-30 permissions at app layer | | **SECURITY DEFINER** | `create_cl_cds_rule()`, `acknowledge_cl_cds_alert()`, `override_cl_cds_alert()` โ€” `SET search_path = public` | | **Notification pattern** | Direct insert into `pf_notifications` (client-side with org\_id filter) or via `createNotificationIfNew()` from `supabase/functions/_shared/` in edge functions | *** ## Integration Points (from Spec) | Dependency | Pattern | Purpose | | ----------------------------- | ----------- | ----------------------------------------------------------------------------------------------------------------------------------------------------- | | CL-01 (Patient Chart) | Data | Alerts scoped to chart; `cl_cds_alerts.chart_id` โ†’ `cl_patient_charts.id` | | CL-05 (Medication Management) | API | Drug interaction checking from medication list; CDS evaluates at medication add/reconciliation | | CL-06 (E-Prescribing) | API | Prescribing alerts during e-prescribing workflow (e.g. at prescription\_submit) | | CL-10 (Outcomes Tracking) | API / Data | Quality measure gap data; CL-08 rules consume or react to HEDIS gap data from CL-10 or platform measure logic. Exact contract (events/APIs) TBD here. | | PF-10 (Notifications) | Event / API | Alert delivery via notifications system (in-app; email/push per PF-10) | | PF-70 (Code Libraries) | API | ICD-10-CM, CPT, HCPCS, LOINC for rule conditions and display (e.g. lab LOINC in monitoring rules) | **Drug interaction data source:** CL-05/CL-06/CL-08 do not specify the interaction database (First Databank, Medi-Span, RxNav/NLM, etc.). Per CL-PM-SPEC-REVIEW: define data source and update process in a PF-level or CL-08 integration contract. CL-05 integration doc currently references RxNav/NLM for MVP with interface abstracted for future FDB swap; CL-08 should use the same abstraction. *** ## API / Data Contracts ### `cl_cds_rules` * **Scope:** `organization_id`; rule types and trigger\_event per spec Data Model. * **Condition/action:** JSONB schemas per spec Errata E-3. * **Audit:** `created_at`, `updated_at`; add `created_by`, `updated_by` per Errata E-1. * **Custom fields:** `custom_fields JSONB NOT NULL DEFAULT '{}'`. ### `cl_cds_alerts` * **Scope:** `organization_id`, `chart_id`; optional `rule_id` linking to rule that fired. * **Lifecycle:** triggered\_at โ†’ acknowledged\_by/acknowledged\_at; overridden + override\_reason when user proceeds despite alert. * **Audit:** `created_at`, `updated_at`; add `created_by`, `updated_by` per Errata E-1. ### CDS invocation (inbound) * **Callers:** CL-05 (medication list + allergies โ†’ interaction check), CL-06 (prescription submit โ†’ interaction/allergy check), documentation/chart flows (documentation\_gap, quality\_measure\_eval). * **Response:** List of alerts with severity and is\_hard\_stop; caller blocks or shows modal per config. ### Outbound to PF-10 * **Payload:** Alert title, message, severity, chart\_id, user context; optional deep link to chart/medication. * **When:** On insert of `cl_cds_alerts` (or via application logic that creates alert then notifies). *** ## Event Contracts | Event | Channel | Direction | Purpose | | --------------------- | ----------- | -------------------- | ------------------------------------------------------------------------------------------------------------------- | | `cds_alert_triggered` | `cl_events` | CL-08 โ†’ PF-10, PF-04 | Alert created; triggers in-app notification via direct `pf_notifications` insert and audit log | | `cds_rule_overridden` | `cl_events` | CL-08 โ†’ PF-10, PF-04 | Alert overridden with reason; audit event for compliance review | | (TBD) | `cl_events` | CL-10 โ†’ CL-08 | Quality measure gap data available for CDS rules (optional; may be pull/API). Blocked until CL-10 Phase 1 complete. | **Registration:** Both `cds_alert_triggered` and `cds_rule_overridden` must be inserted into `fw_workflow_events` with `category = 'operational'` during Phase 1 migration. *** ## Security and RLS * **RLS:** Enabled on `cl_cds_rules` and `cl_cds_alerts`; org isolation via `cl_has_org_access(organization_id)` (per Errata E-2). Do not use `current_setting('app.current_org')`. * **Rule CRUD:** Restrict INSERT/UPDATE/DELETE on `cl_cds_rules` to users with org access and permitted role (e.g. admin, compliance) via SECURITY DEFINER helper `cl_can_manage_cds_rules(organization_id, auth.uid())`. * **Alerts:** SELECT/UPDATE for clinicians in same org; UPDATE for acknowledgement/override only (clinician or prescriber roles). Compliance may manage rules; may have read-only access to alert history for audit. * **SECURITY DEFINER:** All helpers use `SET search_path = public`. UPDATE policies include WITH CHECK (ยง5.2.4). *** ## Related Docs * [CL-08 Spec](../../../specs/cl/specs/CL-08-clinical-decision-support.md) * [CL-05 Medication Management Integration](./medication-management-integration.md) โ€” drug interaction request/response * [CL-06 E-Prescribing Integration](./e-prescribing-epcs-integration.md) โ€” prescribing-time CDS * [CROSS\_CORE\_INTEGRATIONS](./CROSS_CORE_INTEGRATIONS.md) โ€” matrix entry for CL-08