Purpose: This guide helps clinicians and staff use Clinical Pathways (EN-28) and CDS Alert Analytics (EN-29). EN-27 (server-side CDS evaluation) operates automatically and requires no direct user interaction.
Overview
The CL-08 Enhancements add three capabilities to Clinical Decision Support:- EN-27 — Server-Side CDS Evaluation: Automatically checks drug interactions via the RxNav API when medications are prescribed or reconciled. Operates behind the scenes with fail-open safety.
- EN-28 — Clinical Pathway Guidance: Structured, step-by-step care pathways that guide clinicians through evidence-based treatment protocols.
- EN-29 — CDS Alert Fatigue Analytics: Dashboard showing alert override rates, acknowledgement times, and per-provider metrics to identify alert fatigue.
Who Should Use This Guide
Prerequisites
Permissions Required
Note: Contact your organization administrator if you don’t have the required permissions.
EN-27: Server-Side CDS Evaluation
How It Works
The server-side CDS engine runs automatically when medications are evaluated. You do not need to take any action — it operates transparently. Key behaviors:- Drug Interaction Checks: When a patient has 2+ active medications with RxCUI codes, the system queries the NLM RxNav API for known interactions.
- Drug-Allergy Checks: Active medications are cross-referenced against the patient’s allergy list using organization-defined CDS rules.
- Fail-Open Safety: If the RxNav API is unavailable (timeout, network error), the system falls back to text-based rule matching. It will never block a workflow due to an API outage — alerts are generated on a best-effort basis.
- Audit Trail: Every evaluation includes a
request_id, timestamp, and latency measurement for compliance auditing.
What You’ll See
- Alerts appear in the patient chart’s CDS alert panel when interactions or allergy conflicts are detected.
- Alert severity ranges from
moderatetocriticalbased on RxNav severity data or rule configuration. - Degraded mode indicator: If the system operated in fallback mode, the evaluation response includes
degraded: true(visible in audit logs, not directly in UI).
EN-28: Clinical Pathway Guidance
Accessing Clinical Pathways
- Navigate to Clinical in the main sidebar
- Expand Clinical Pathways
- Click Pathway Management
Understanding the Interface
The Pathway Management page displays all defined care pathways as expandable cards:Viewing Pathway Steps
- Click on any pathway card to expand it
- Each step shows:
- Step number and title
- Description of what to do at this step
- Recommendations — clinical best practices
- Criteria — what must be true to consider this step complete
Creating a New Pathway
Requires cl.pathways.manage permission.
- Click New Pathway in the top right
- Fill in the required fields:
- Pathway Name: A descriptive name (e.g., “Opioid Use Disorder — MAT Initiation”)
- Condition Type: The clinical condition category
- Description: Optional overview of the pathway’s purpose
- Add steps:
- Each step includes a title, description, recommendations, and completion criteria
- Steps are ordered by step number
- Click Save
EN-29: CDS Alert Fatigue Analytics
Accessing the Dashboard
- Navigate to Clinical in the main sidebar
- Expand CDS Analytics (under Admin section)
- Click Alert Fatigue Dashboard
Understanding the Dashboard
Summary Cards
Four cards at the top provide at-a-glance metrics:Time Window Selector
Use the dropdown in the top right to filter data:- Last 7 days — Recent activity
- Last 30 days — Default view, monthly trends
- Last 90 days — Quarterly analysis
Override Rate by Rule Chart
A bar chart showing the override rate for each CDS rule. Higher bars indicate rules that clinicians frequently override — a potential sign of alert fatigue or overly sensitive rules.Alerts by Rule Table
Detailed breakdown per rule:- Rule name
- Alert count and Override count
- Override Rate (highlighted red if > 50%)
- Avg. Ack Time — How quickly clinicians respond
Alerts by Provider Table
Requires cl.cds_rules.manage permission.
Shows per-provider metrics with display names (resolved from user profiles):
- Provider name
- Alert count, Override count, Override Rate
- Avg. Ack Time
Interpreting the Data
Tips and Best Practices
Do’s
- ✅ Review the Alert Fatigue Dashboard weekly to catch emerging patterns
- ✅ Use pathway steps as a checklist during patient encounters
- ✅ Report false-positive alerts to your admin so rules can be tuned
- ✅ Check the Override Rate by Provider to identify training opportunities
Don’ts
- ❌ Don’t override alerts without reading the alert message
- ❌ Don’t ignore high override rates — they may indicate configuration issues
- ❌ Don’t create duplicate pathways for the same condition type
Troubleshooting
Issue: “Access Denied” on Pathways Page
Symptoms: Shield icon with “You don’t have permission to access this page” Cause: Your role doesn’t includecl.pathways.manage permission.
Solution: Contact your organization administrator to assign the cl.pathways.manage permission to your role.
Issue: CDS Analytics Shows No Data
Symptoms: All summary cards show 0, empty state messages appear. Cause: No CDS alerts have been triggered in the selected time window, or CDS rules are not yet configured. Solution:- Verify CDS rules are configured at Clinical → CDS Rules
- Try expanding the time window to Last 90 days
- Confirm rules are set to Active
Issue: Provider Table Shows UUID Instead of Name
Symptoms: Provider column shows truncated identifiers like “4832659c…” Cause: The provider’s profile doesn’t have afull_name set.
Solution: Ask your administrator to update the provider’s profile name in Settings → Users.
Related Documentation
- Admin Guide:
docs/guides/cl/cl-08-cds-enhancements-admin-guide.md - Specification:
specs/cl/specs/CL-08-ENHANCEMENTS.md - CDS Rule Management: Navigate to Clinical → CDS Rules in the application
Glossary
Last Updated: 2026-02-26
Questions? Contact your organization administrator.