Clinical Decision Support — Admin Guide

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Overview

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Getting Started

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Accessing CDS Rules

1. Navigate to Clinical → CDS Rules (/cl/cds-rules)
2. You must have the cl.cds_rules.view permission to see the list
3. You must have the cl.cds_rules.manage permission to create, edit, or delete rules

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Who Can Manage Rules?

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Creating a CDS Rule

1. Click “Add Rule” on the CDS Rules page
2. Fill in the required fields:

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General Settings

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Rule Types

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Condition Parameters

• Drug Interaction: Enter two drug class names (e.g., “Opioid” and “Benzodiazepine”). The engine checks if the patient has active medications matching both classes.
• Drug Allergy: Enter one drug class name. The engine checks if the patient has both an active allergy AND an active medication matching that class.
• Medication Monitoring: Enter the LOINC code for the lab test and the number of days after which it’s considered overdue.
• Documentation Gap: Enter the note type and maximum hours before it’s flagged as overdue.

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Action Settings

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Severity Levels

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Hard Stop Rules

1. The clinician sees a blocking modal that cannot be dismissed
2. They must either:
   • Acknowledge the alert (for non-hard-stop alerts)
   • Override with reason — a clinical justification is required
3. The override reason is permanently recorded in the audit trail

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Alert Lifecycle

Rule Triggered → Alert Created → Clinician Sees Alert
                                       ↓
                              ┌─────────┴─────────┐
                              ↓                     ↓
                         Acknowledge            Override
                         (dismiss)          (with reason)
                              ↓                     ↓
                         Alert Closed          Alert Closed
                                            + Audit Record

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Alert Actions

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Audit & Compliance

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What Is Tracked

• Every alert trigger (rule ID, chart ID, severity, timestamp)
• Every acknowledgment (who, when)
• Every override (who, when, reason)
• Domain events published: cds_alert_triggered, cds_rule_overridden

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Reviewing Overrides

1. Viewing the CDS Alerts Panel on any patient chart
2. Filtering alerts to show overridden items
3. Reviewing the override reason and clinician who overrode

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Regulatory Compliance

• Joint Commission medication safety standards
• CMS Conditions of Participation for medication management
• AHCCCS AMPM behavioral health documentation requirements
• 42 CFR Part 2 — alert payloads contain IDs only, no PHI

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Managing Alert Fatigue

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Recommended Practices

1. Start conservative — begin with a small number of critical rules
2. Monitor override rates — high override rates indicate rules may be too aggressive
3. Use appropriate severity — not every alert needs to be “critical”
4. Limit hard stops — reserve for truly dangerous situations
5. Review and adjust — regularly review active rules and deactivate those with low clinical value
6. Site-specific rules — use the optional site_id field to scope rules to specific locations

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Deactivating a Rule

1. Navigate to CDS Rules → find the rule
2. Click Edit
3. Uncheck Active
4. Save — the rule will no longer trigger new alerts

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Permissions Reference

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Troubleshooting

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Technical Notes

• CDS evaluation runs client-side in Phase 1 (simple text matching)
• Future phases will add server-side evaluation via edge functions for external API calls (RxNav, FDB)
• Alert data is stored in cl_cds_alerts with no DELETE policy (audit retention)
• Domain events integrate with the Forms & Workflow (FW) automation engine