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Documentation Index

Fetch the complete documentation index at: https://docs.encoreos.io/llms.txt

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Purpose

Defines integration boundaries for drug-drug interaction (DDI) checking in clinical medication workflows, including external vendor calls and internal consumers.

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Upstream Trigger

  • Medication add/edit in CL-05 reconciliation workflow
  • Pre-transmission validation in CL-06 e-prescribing flow

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External API Contract

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Request

  • Organization and site context
  • Candidate medication code
  • Active medication code set for encounter context

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Response

  • Interaction severity (contraindicated, severe, moderate, minor)
  • Interacting medication references
  • Clinical effect summary
  • Recommended action text
  • Part 2 gating (application layer): When SUD-tagged meds are withheld from the vendor payload, the service returns excludedMedications[] (RxCUI + reason) and sudMedicationsExcludedForConsent for the non-blocking indicator (CL-05-EN-01 FR-4.2).

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Non-Functional Constraints

  • p95 alert resolution target under 500ms for in-workflow rendering
  • Failure mode returns non-blocking warning unless local policy requires hard stop

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Internal Contract

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CL-05 Consumer

  • Renders severity-tagged alerts during medication selection
  • Requires override workflow for severe/contraindicated interactions

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CL-06 Consumer

  • Blocks or gates e-prescribing send action when unresolved high-severity interactions exist

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CL-08 Relationship (CDS Framework)

  • CL-08 owns the CDS rule framework; its drug_interaction rule type delegates to CL-05-EN-01’s DDI query service for vendor-backed interaction data
  • CL-08 EN-29 (Alert Fatigue Analytics) consumes cl_ddi_overrides via direct table query (not event-driven) for override frequency analysis
  • No event contract required: CL-08 reads from cl_ddi_overrides directly within the same core (CL); no cross-core event needed
  • This spec does not modify CL-08 tables (cl_cds_rules, cl_cds_alerts) or rules
  • DDI queries involving SUD-tagged medications invoke cl_has_sud_consent(p_chart_id) (chart-scoped, SECURITY DEFINER) before including those medications in external API payloads
  • If consent is absent, SUD medications are excluded from the DDI query and a non-blocking indicator is shown
  • Trade-off: Without consent, excluded SUD RxCUIs can yield incomplete interaction checks vs. other meds until consent is captured — intentional; surface clearly to clinicians.
  • Override records for SUD medications include a consent reference for Part 2 disclosure logging

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PM-10 Downstream Usage

  • May consume documented override metadata for prior authorization context
  • No PM ownership transfer; this spec remains CL-owned

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Data Persistence Boundary

  • Overrides stored in cl_ddi_overrides
  • Tenant isolation via organization_id and RLS policies
  • Override auditability includes actor, timestamp, and optional cosigner metadata

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Security and Compliance Notes

  • Minimum-necessary data payloads for external calls
  • No PHI in logs or test fixtures
  • Jurisdiction-sensitive policy behavior configured via PF-96 profile, not hardcoded constants
  • Go-live: Clinical + compliance sign-off (CL-05-EN-01 Compliance Review) before production DDI enforcement for SUD populations.
  • specs/cl/specs/CL-05-EN-01-drug-drug-interaction-checking.md
  • specs/cl/specs/CL-05-medication-management-reconciliation.md
  • specs/cl/specs/CL-06-e-prescribing-controlled-substances.md
  • specs/cl/specs/CL-08-clinical-decision-support.md — CDS rule framework; drug_interaction rule type delegates to this spec
  • specs/cl/specs/CL-11-consent-management-42cfr-part2.md — Part 2 consent gating for SUD medications