Enhancements User Guide

Documentation Index

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Version: 1.0.0
Last Updated: 2026-02-26
Module: CL (Clinical & EHR)
Status: Active

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.

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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.

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Who Should Use This Guide

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Prerequisites

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Permissions Required

Note: Contact your organization administrator if you don’t have the required permissions.

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EN-27: Server-Side CDS Evaluation

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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:

1. Drug Interaction Checks: When a patient has 2+ active medications with RxCUI codes, the system queries the NLM RxNav API for known interactions.
2. Drug-Allergy Checks: Active medications are cross-referenced against the patient’s allergy list using organization-defined CDS rules.
3. 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.
4. Audit Trail: Every evaluation includes a request_id, timestamp, and latency measurement for compliance auditing.

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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 moderate to critical based 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).

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EN-28: Clinical Pathway Guidance

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Accessing Clinical Pathways

1. Navigate to Clinical in the main sidebar
2. Expand Clinical Pathways
3. Click Pathway Management

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Understanding the Interface

The Pathway Management page displays all defined care pathways as expandable cards:

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Viewing Pathway Steps

1. Click on any pathway card to expand it
2. 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

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Creating a New Pathway

Requires cl.pathways.manage permission.

1. Click New Pathway in the top right
2. 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
3. Add steps:
   • Each step includes a title, description, recommendations, and completion criteria
   • Steps are ordered by step number
4. Click Save

Result: The pathway appears in the list and can be assigned to patient charts.

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EN-29: CDS Alert Fatigue Analytics

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Accessing the Dashboard

1. Navigate to Clinical in the main sidebar
2. Expand CDS Analytics (under Admin section)
3. Click Alert Fatigue Dashboard

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Understanding the Dashboard

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Summary Cards

Four cards at the top provide at-a-glance metrics:

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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

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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.

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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

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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

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Interpreting the Data

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Tips and Best Practices

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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

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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

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Troubleshooting

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Issue: “Access Denied” on Pathways Page

Symptoms: Shield icon with “You don’t have permission to access this page” Cause: Your role doesn’t include cl.pathways.manage permission. Solution: Contact your organization administrator to assign the cl.pathways.manage permission to your role.

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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:

1. Verify CDS rules are configured at Clinical → CDS Rules
2. Try expanding the time window to Last 90 days
3. Confirm rules are set to Active

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Issue: Provider Table Shows UUID Instead of Name

Symptoms: Provider column shows truncated identifiers like “4832659c…” Cause: The provider’s profile doesn’t have a full_name set. Solution: Ask your administrator to update the provider’s profile name in Settings → Users.

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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

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Glossary

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Last Updated: 2026-02-26
Questions? Contact your organization administrator.