> ## 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.

# Outcomes Tracking & Measurement — Integration

> Feature ID: CL-10 Status: 📋 Spec approved; implementation pending Spec Reference: CL-10-outcomes-tracking-measurement.md Last Updated: 2026-02-19

**Feature ID:** CL-10\
**Status:** 📋 Spec approved; implementation pending\
**Spec Reference:** [CL-10-outcomes-tracking-measurement.md](../../../specs/cl/specs/CL-10-outcomes-tracking-measurement.md)\
**Last Updated:** 2026-02-19

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## Overview

CL-10 defines outcomes tracking and measurement: patient-reported outcome measures (PROMs), HEDIS measure calculation (FUH, FUM, IET, AMM), program-level outcomes dashboards, and CARF/reporting compliance. It depends on PF (organizations, RBAC, reports), CL-01/02/03 (chart, assessments, treatment plan), and CL-15 (quality reporting). Data flows to PF-12 (report engine) and CL-15.

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## Integration Points (from Spec)

| Dependency                    | Pattern    | Purpose                                                                    |
| ----------------------------- | ---------- | -------------------------------------------------------------------------- |
| PF-01 (Organizations & Sites) | Direct     | Multi-tenant isolation                                                     |
| PF-02 (RBAC)                  | Direct     | Permission keys; role-based access to outcome entry and program dashboards |
| PF-12 (Reports)               | Platform   | Report generation; HEDIS/outcome data for ad-hoc and scheduled reports     |
| CL-01 (Patient Chart)         | Internal   | Outcome scores and trends on chart                                         |
| CL-02 / CL-03                 | Internal   | Assessment and treatment plan data feed measure calculation                |
| CL-15                         | Internal   | Outcome data used in quality reporting                                     |
| RH (rh\_programs)             | Cross-core | `cl_program_outcomes.program_id` references `rh_programs(id)` via FK       |

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## Cross-Core Data Reference

`cl_program_outcomes.program_id` references `rh_programs(id)` by design for program-scoped outcomes (HEDIS aggregates, program dashboards).

* **Rationale:** Program context is required for CARF/reporting and program-level dashboards; the FK ensures referential integrity and aligns with RH-03, RH-04, PM-04.
* **Failure/coupling implications:** RH program deletion or schema changes to `rh_programs(id)` can affect CL (e.g. FK constraint violations, orphaned program\_id). Compatibility and migration expectations are documented in the integration contracts below; RH owns `rh_programs` and must not break the contract for `id` without a coordinated migration.
* **Integration contracts:** See [CL-10–RH program\_id data contract](rh-program-id-data-contract.md) (publisher: RH; consumer: CL). That document specifies the data contract, ownership, and migration/compatibility rules for `cl_program_outcomes.program_id` and `rh_programs(id)`.

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## API / Data Contracts

* **Outcome measures:** Stored in `cl_outcome_measures`; consumed by chart UI (CL-01), PF-12, and CL-15.
* **Program outcomes:** Stored in `cl_program_outcomes`; aggregated from measures and HEDIS logic; consumed by dashboards and CL-15.
* **HEDIS calculation:** Batch (cron) and on-demand; reads from `cl_transitions`, `cl_problems`, `cl_medications`, PM encounters; writes to `cl_program_outcomes`.

*(Add request/response or event schemas here when APIs or events are defined.)*

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## Event Contracts

*(None specified for CL-10. Outcome data is consumed via direct queries and PF-12/CL-15 reporting; add events here if outcome-recorded or measure-calculated events are added.)*

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## Security and RLS

* RLS on `cl_outcome_measures` and `cl_program_outcomes` via SECURITY DEFINER helpers (e.g. `cl_has_org_access`); no direct queries to RLS-protected tables in policies (§5.7).
* UPDATE policies include WITH CHECK on `organization_id` (§5.2.4).
* Permission keys: `cl.outcome_measures.view/create/update`, `cl.program_outcomes.view/manage` (seed in migration per PF-30).

***

## Related Docs

* [Spec](../../../specs/cl/specs/CL-10-outcomes-tracking-measurement.md)
* [PLATFORM\_INTEGRATION\_LAYERS.md](PLATFORM_INTEGRATION_LAYERS.md) (PF-12 Reports)
* [CROSS\_CORE\_INTEGRATIONS.md](CROSS_CORE_INTEGRATIONS.md)