↔ PM-07: Problem List → Encounter Diagnosis Pre-population — Integration

​

Table of Contents

• Overview
• Quick Reference
• Integration Points
• Event Contract: cl_problem_list_updated
• Cross-Core Read API
• Security and RLS
• Idempotency, Retry, and Ordering
• Failure Modes
• Related Docs

​

Overview

1. CL-08 (Clinical Decision Support) — re-evaluates rules (drug-disease interactions, monitoring, quality-measure gaps) when active problems change.
2. PM-07 (Encounter Diagnosis Capture / Charge Entry) — pre-populates encounter diagnoses from the patient’s active problem list at encounter creation/check-in, so coders/clinicians do not re-enter chronic conditions.

​

Quick Reference

​

Integration Points

​

Event Contract: cl_problem_list_updated

​

Trigger

​

Payload (JSONB)

{
  "event_type": "cl_problem_list_updated",
  "event_version": "1.0.0",
  "occurred_at": "2026-05-12T18:42:11.123Z",
  "organization_id": "uuid",
  "payload": {
    "patient_id": "uuid",
    "problem_id": "uuid",
    "icd10_code": "F33.1",
    "action": "added | status_changed | resolved | reactivated | corrected | removed",
    "previous_status": "active | resolved | inactive | entered_in_error | null",
    "new_status": "active | resolved | inactive | entered_in_error | null",
    "changed_by": "uuid",
    "changed_at": "2026-05-12T18:42:11.000Z"
  }
}

​

Action mapping

​

Subscribers

​

Cross-Core Read API

// src/platform/clinical/index.ts (re-export)
export { usePatientActiveProblems } from '@/platform/clinical/hooks/usePatientActiveProblems';

// Consumer (PM-07 charge capture)
import { usePatientActiveProblems } from '@/platform/clinical';

const { data: problems, isLoading } = usePatientActiveProblems(patientId);
// problems: Array<{ problem_id, icd10_code, icd10_display, onset_date, priority }>

SELECT * FROM cl_get_patient_active_problems(p_organization_id := $1, p_patient_id := $2);

​

Security and RLS

• cl_problems has RLS enabled with FORCE ROW LEVEL SECURITY; all CRUD policies scope by organization_id via cl_user_has_problem_permission(action).
• Cross-core reads from PM-07 execute under the calling user’s auth context — RLS still applies. The SECURITY DEFINER helper does not bypass tenant scoping; it only avoids the need for PM code to know CL table internals.
• Event payload contains no PHI; consumers MUST re-fetch via the read API to obtain ICD-10 display text or clinician description.
• Status state-machine enforcement (e.g., entered_in_error is terminal) is implemented in a BEFORE UPDATE trigger on cl_problems, not in the RLS WITH CHECK clause (which has no access to OLD).

​

Idempotency, Retry, and Ordering

• Idempotency key: problem_id || ':' || action || ':' || changed_at (ISO-8601, millisecond precision). Subscribers MUST de-duplicate using this key for at least 24 h.
• Ordering: Not strictly guaranteed across the domain_events channel. Subscribers MUST treat events as state notifications (re-fetch on receipt) rather than authoritative deltas.
• Retry: PF event dispatcher retries with exponential backoff (per PF-70 event publishing standards). Failed deliveries land in the dead-letter queue after 5 attempts.
• Backfill: On subscriber outage recovery, consumers may call the read API to reconcile state; no replay of historical events is provided.

​

Failure Modes

​

Related Docs

• Spec: CL-46-problem-list-management-icd10.md
• Tasks: CL-46-TASKS.md
• Event registry: EVENT_CONTRACTS.md → cl_problem_list_updated
• Cross-core matrix: CROSS_CORE_INTEGRATIONS.md → CL-46 row
• CL-08 CDS: CL-08-clinical-decision-support-INTEGRATION.md
• Platform integration patterns: PLATFORM_INTEGRATION_LAYERS.md
• ADR-002 (cross-core FK policy): ADR-002-cl-pm-cross-core-foreign-keys.md