agim-cli 1.2.144 → 1.2.148

package/dist/core/skills/builtin/healthcare-cdss-patterns/SKILL.md

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+---
+name: healthcare-cdss-patterns
+description: [ECC] Clinical Decision Support System (CDSS) development patterns. Drug interaction checking, dose validation, clinical scoring (NEWS2, qSOFA), alert severity classification, and integration into EMR workflows.
+origin: Health1 Super Speciality Hospitals — contributed by Dr. Keyur Patel
+version: "1.0.0"
+---
+
+# Healthcare CDSS Development Patterns
+
+Patterns for building Clinical Decision Support Systems that integrate into EMR workflows. CDSS modules are patient safety critical — zero tolerance for false negatives.
+
+## When to Use
+
+- Implementing drug interaction checking
+- Building dose validation engines
+- Implementing clinical scoring systems (NEWS2, qSOFA, APACHE, GCS)
+- Designing alert systems for abnormal clinical values
+- Building medication order entry with safety checks
+- Integrating lab result interpretation with clinical context
+
+## How It Works
+
+The CDSS engine is a **pure function library with zero side effects**. Input clinical data, output alerts. This makes it fully testable.
+
+Three primary modules:
+
+1. **`checkInteractions(newDrug, currentMeds, allergies)`** — Checks a new drug against current medications and known allergies. Returns severity-sorted `InteractionAlert[]`. Uses `DrugInteractionPair` data model.
+2. **`validateDose(drug, dose, route, weight, age, renalFunction)`** — Validates a prescribed dose against weight-based, age-adjusted, and renal-adjusted rules. Returns `DoseValidationResult`.
+3. **`calculateNEWS2(vitals)`** — National Early Warning Score 2 from `NEWS2Input`. Returns `NEWS2Result` with total score, risk level, and escalation guidance.
+
+```
+EMR UI
+  ↓ (user enters data)
+CDSS Engine (pure functions, no side effects)
+  ├── Drug Interaction Checker
+  ├── Dose Validator
+  ├── Clinical Scoring (NEWS2, qSOFA, etc.)
+  └── Alert Classifier
+  ↓ (returns alerts)
+EMR UI (displays alerts inline, blocks if critical)
+```
+
+### Drug Interaction Checking
+
+```typescript
+interface DrugInteractionPair {
+  drugA: string;           // generic name
+  drugB: string;           // generic name
+  severity: 'critical' | 'major' | 'minor';
+  mechanism: string;
+  clinicalEffect: string;
+  recommendation: string;
+}
+
+function checkInteractions(
+  newDrug: string,
+  currentMedications: string[],
+  allergyList: string[]
+): InteractionAlert[] {
+  if (!newDrug) return [];
+  const alerts: InteractionAlert[] = [];
+  for (const current of currentMedications) {
+    const interaction = findInteraction(newDrug, current);
+    if (interaction) {
+      alerts.push({ severity: interaction.severity, pair: [newDrug, current],
+        message: interaction.clinicalEffect, recommendation: interaction.recommendation });
+    }
+  }
+  for (const allergy of allergyList) {
+    if (isCrossReactive(newDrug, allergy)) {
+      alerts.push({ severity: 'critical', pair: [newDrug, allergy],
+        message: `Cross-reactivity with documented allergy: ${allergy}`,
+        recommendation: 'Do not prescribe without allergy consultation' });
+    }
+  }
+  return alerts.sort((a, b) => severityOrder(a.severity) - severityOrder(b.severity));
+}
+```
+
+Interaction pairs must be **bidirectional**: if Drug A interacts with Drug B, then Drug B interacts with Drug A.
+
+### Dose Validation
+
+```typescript
+interface DoseValidationResult {
+  valid: boolean;
+  message: string;
+  suggestedRange: { min: number; max: number; unit: string } | null;
+  factors: string[];
+}
+
+function validateDose(
+  drug: string,
+  dose: number,
+  route: 'oral' | 'iv' | 'im' | 'sc' | 'topical',
+  patientWeight?: number,
+  patientAge?: number,
+  renalFunction?: number
+): DoseValidationResult {
+  const rules = getDoseRules(drug, route);
+  if (!rules) return { valid: true, message: 'No validation rules available', suggestedRange: null, factors: [] };
+  const factors: string[] = [];
+
+  // SAFETY: if rules require weight but weight missing, BLOCK (not pass)
+  if (rules.weightBased) {
+    if (!patientWeight || patientWeight <= 0) {
+      return { valid: false, message: `Weight required for ${drug} (mg/kg drug)`,
+        suggestedRange: null, factors: ['weight_missing'] };
+    }
+    factors.push('weight');
+    const maxDose = rules.maxPerKg * patientWeight;
+    if (dose > maxDose) {
+      return { valid: false, message: `Dose exceeds max for ${patientWeight}kg`,
+        suggestedRange: { min: rules.minPerKg * patientWeight, max: maxDose, unit: rules.unit }, factors };
+    }
+  }
+
+  // Age-based adjustment (when rules define age brackets and age is provided)
+  if (rules.ageAdjusted && patientAge !== undefined) {
+    factors.push('age');
+    const ageMax = rules.getAgeAdjustedMax(patientAge);
+    if (dose > ageMax) {
+      return { valid: false, message: `Exceeds age-adjusted max for ${patientAge}yr`,
+        suggestedRange: { min: rules.typicalMin, max: ageMax, unit: rules.unit }, factors };
+    }
+  }
+
+  // Renal adjustment (when rules define eGFR brackets and eGFR is provided)
+  if (rules.renalAdjusted && renalFunction !== undefined) {
+    factors.push('renal');
+    const renalMax = rules.getRenalAdjustedMax(renalFunction);
+    if (dose > renalMax) {
+      return { valid: false, message: `Exceeds renal-adjusted max for eGFR ${renalFunction}`,
+        suggestedRange: { min: rules.typicalMin, max: renalMax, unit: rules.unit }, factors };
+    }
+  }
+
+  // Absolute max
+  if (dose > rules.absoluteMax) {
+    return { valid: false, message: `Exceeds absolute max ${rules.absoluteMax}${rules.unit}`,
+      suggestedRange: { min: rules.typicalMin, max: rules.absoluteMax, unit: rules.unit },
+      factors: [...factors, 'absolute_max'] };
+  }
+  return { valid: true, message: 'Within range',
+    suggestedRange: { min: rules.typicalMin, max: rules.typicalMax, unit: rules.unit }, factors };
+}
+```
+
+### Clinical Scoring: NEWS2
+
+```typescript
+interface NEWS2Input {
+  respiratoryRate: number; oxygenSaturation: number; supplementalOxygen: boolean;
+  temperature: number; systolicBP: number; heartRate: number;
+  consciousness: 'alert' | 'voice' | 'pain' | 'unresponsive';
+}
+interface NEWS2Result {
+  total: number;           // 0-20
+  risk: 'low' | 'low-medium' | 'medium' | 'high';
+  components: Record<string, number>;
+  escalation: string;
+}
+```
+
+Scoring tables must match the Royal College of Physicians specification exactly.
+
+### Alert Severity and UI Behavior
+
+| Severity | UI Behavior | Clinician Action Required |
+|----------|-------------|--------------------------|
+| Critical | Block action. Non-dismissable modal. Red. | Must document override reason to proceed |
+| Major | Warning banner inline. Orange. | Must acknowledge before proceeding |
+| Minor | Info note inline. Yellow. | Awareness only, no action required |
+
+Critical alerts must NEVER be auto-dismissed or implemented as toast notifications. Override reasons must be stored in the audit trail.
+
+### Testing CDSS (Zero Tolerance for False Negatives)
+
+```typescript
+describe('CDSS — Patient Safety', () => {
+  INTERACTION_PAIRS.forEach(({ drugA, drugB, severity }) => {
+    it(`detects ${drugA} + ${drugB} (${severity})`, () => {
+      const alerts = checkInteractions(drugA, [drugB], []);
+      expect(alerts.length).toBeGreaterThan(0);
+      expect(alerts[0].severity).toBe(severity);
+    });
+    it(`detects ${drugB} + ${drugA} (reverse)`, () => {
+      const alerts = checkInteractions(drugB, [drugA], []);
+      expect(alerts.length).toBeGreaterThan(0);
+    });
+  });
+  it('blocks mg/kg drug when weight is missing', () => {
+    const result = validateDose('gentamicin', 300, 'iv');
+    expect(result.valid).toBe(false);
+    expect(result.factors).toContain('weight_missing');
+  });
+  it('handles malformed drug data gracefully', () => {
+    expect(() => checkInteractions('', [], [])).not.toThrow();
+  });
+});
+```
+
+Pass criteria: 100%. A single missed interaction is a patient safety event.
+
+### Anti-Patterns
+
+- Making CDSS checks optional or skippable without documented reason
+- Implementing interaction checks as toast notifications
+- Using `any` types for drug or clinical data
+- Hardcoding interaction pairs instead of using a maintainable data structure
+- Silently catching errors in CDSS engine (must surface failures loudly)
+- Skipping weight-based validation when weight is not available (must block, not pass)
+
+## Examples
+
+### Example 1: Drug Interaction Check
+
+```typescript
+const alerts = checkInteractions('warfarin', ['aspirin', 'metformin'], ['penicillin']);
+// [{ severity: 'critical', pair: ['warfarin', 'aspirin'],
+//    message: 'Increased bleeding risk', recommendation: 'Avoid combination' }]
+```
+
+### Example 2: Dose Validation
+
+```typescript
+const ok = validateDose('paracetamol', 1000, 'oral', 70, 45);
+// { valid: true, suggestedRange: { min: 500, max: 4000, unit: 'mg' } }
+
+const bad = validateDose('paracetamol', 5000, 'oral', 70, 45);
+// { valid: false, message: 'Exceeds absolute max 4000mg' }
+
+const noWeight = validateDose('gentamicin', 300, 'iv');
+// { valid: false, factors: ['weight_missing'] }
+```
+
+### Example 3: NEWS2 Scoring
+
+```typescript
+const result = calculateNEWS2({
+  respiratoryRate: 24, oxygenSaturation: 93, supplementalOxygen: true,
+  temperature: 38.5, systolicBP: 100, heartRate: 110, consciousness: 'voice'
+});
+// { total: 13, risk: 'high', escalation: 'Urgent clinical review. Consider ICU.' }
+```

package/dist/core/skills/builtin/healthcare-emr-patterns/SKILL.md

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+---
+name: healthcare-emr-patterns
+description: [ECC] EMR/EHR development patterns for healthcare applications. Clinical safety, encounter workflows, prescription generation, clinical decision support integration, and accessibility-first UI for medical data entry.
+origin: Health1 Super Speciality Hospitals — contributed by Dr. Keyur Patel
+version: "1.0.0"
+---
+
+# Healthcare EMR Development Patterns
+
+Patterns for building Electronic Medical Record (EMR) and Electronic Health Record (EHR) systems. Prioritizes patient safety, clinical accuracy, and practitioner efficiency.
+
+## When to Use
+
+- Building patient encounter workflows (complaint, exam, diagnosis, prescription)
+- Implementing clinical note-taking (structured + free text + voice-to-text)
+- Designing prescription/medication modules with drug interaction checking
+- Integrating Clinical Decision Support Systems (CDSS)
+- Building lab result displays with reference range highlighting
+- Implementing audit trails for clinical data
+- Designing healthcare-accessible UIs for clinical data entry
+
+## How It Works
+
+### Patient Safety First
+
+Every design decision must be evaluated against: "Could this harm a patient?"
+
+- Drug interactions MUST alert, not silently pass
+- Abnormal lab values MUST be visually flagged
+- Critical vitals MUST trigger escalation workflows
+- No clinical data modification without audit trail
+
+### Single-Page Encounter Flow
+
+Clinical encounters should flow vertically on a single page — no tab switching:
+
+```
+Patient Header (sticky — always visible)
+├── Demographics, allergies, active medications
+│
+Encounter Flow (vertical scroll)
+├── 1. Chief Complaint (structured templates + free text)
+├── 2. History of Present Illness
+├── 3. Physical Examination (system-wise)
+├── 4. Vitals (auto-trigger clinical scoring)
+├── 5. Diagnosis (ICD-10/SNOMED search)
+├── 6. Medications (drug DB + interaction check)
+├── 7. Investigations (lab/radiology orders)
+├── 8. Plan & Follow-up
+└── 9. Sign / Lock / Print
+```
+
+### Smart Template System
+
+```typescript
+interface ClinicalTemplate {
+  id: string;
+  name: string;             // e.g., "Chest Pain"
+  chips: string[];          // clickable symptom chips
+  requiredFields: string[]; // mandatory data points
+  redFlags: string[];       // triggers non-dismissable alert
+  icdSuggestions: string[]; // pre-mapped diagnosis codes
+}
+```
+
+Red flags in any template must trigger a visible, non-dismissable alert — NOT a toast notification.
+
+### Medication Safety Pattern
+
+```
+User selects drug
+  → Check current medications for interactions
+  → Check encounter medications for interactions
+  → Check patient allergies
+  → Validate dose against weight/age/renal function
+  → If CRITICAL interaction: BLOCK prescribing entirely
+  → Clinician must document override reason to proceed past a block
+  → If MAJOR interaction: display warning, require acknowledgment
+  → Log all alerts and override reasons in audit trail
+```
+
+Critical interactions **block prescribing by default**. The clinician must explicitly override with a documented reason stored in the audit trail. The system never silently allows a critical interaction.
+
+### Locked Encounter Pattern
+
+Once a clinical encounter is signed:
+- No edits allowed — only an addendum (a separate linked record)
+- Both original and addendum appear in the patient timeline
+- Audit trail captures who signed, when, and any addendum records
+
+### UI Patterns for Clinical Data
+
+**Vitals Display:** Current values with normal range highlighting (green/yellow/red), trend arrows vs previous, clinical scoring auto-calculated (NEWS2, qSOFA), escalation guidance inline.
+
+**Lab Results Display:** Normal range highlighting, previous value comparison, critical values with non-dismissable alert, collection/analysis timestamps, pending orders with expected turnaround.
+
+**Prescription PDF:** One-click generation with patient demographics, allergies, diagnosis, drug details (generic + brand, dose, route, frequency, duration), clinician signature block.
+
+### Accessibility for Healthcare
+
+Healthcare UIs have stricter requirements than typical web apps:
+- 4.5:1 minimum contrast (WCAG AA) — clinicians work in varied lighting
+- Large touch targets (44x44px minimum) — for gloved/rushed interaction
+- Keyboard navigation — for power users entering data rapidly
+- No color-only indicators — always pair color with text/icon (colorblind clinicians)
+- Screen reader labels on all form fields
+- No auto-dismissing toasts for clinical alerts — clinician must actively acknowledge
+
+### Anti-Patterns
+
+- Storing clinical data in browser localStorage
+- Silent failures in drug interaction checking
+- Dismissable toasts for critical clinical alerts
+- Tab-based encounter UIs that fragment the clinical workflow
+- Allowing edits to signed/locked encounters
+- Displaying clinical data without audit trail
+- Using `any` type for clinical data structures
+
+## Examples
+
+### Example 1: Patient Encounter Flow
+
+```
+Doctor opens encounter for Patient #4521
+  → Sticky header shows: "Rajesh M, 58M, Allergies: Penicillin, Active Meds: Metformin 500mg"
+  → Chief Complaint: selects "Chest Pain" template
+    → Clicks chips: "substernal", "radiating to left arm", "crushing"
+    → Red flag "crushing substernal chest pain" triggers non-dismissable alert
+  → Examination: CVS system — "S1 S2 normal, no murmur"
+  → Vitals: HR 110, BP 90/60, SpO2 94%
+    → NEWS2 auto-calculates: score 8, risk HIGH, escalation alert shown
+  → Diagnosis: searches "ACS" → selects ICD-10 I21.9
+  → Medications: selects Aspirin 300mg
+    → CDSS checks against Metformin: no interaction
+  → Signs encounter → locked, addendum-only from this point
+```
+
+### Example 2: Medication Safety Workflow
+
+```
+Doctor prescribes Warfarin for Patient #4521
+  → CDSS detects: Warfarin + Aspirin = CRITICAL interaction
+  → UI: red non-dismissable modal blocks prescribing
+  → Doctor clicks "Override with reason"
+  → Types: "Benefits outweigh risks — monitored INR protocol"
+  → Override reason + alert stored in audit trail
+  → Prescription proceeds with documented override
+```
+
+### Example 3: Locked Encounter + Addendum
+
+```
+Encounter #E-2024-0891 signed by Dr. Shah at 14:30
+  → All fields locked — no edit buttons visible
+  → "Add Addendum" button available
+  → Dr. Shah clicks addendum, adds: "Lab results received — Troponin elevated"
+  → New record E-2024-0891-A1 linked to original
+  → Timeline shows both: original encounter + addendum with timestamps
+```

package/dist/core/skills/builtin/healthcare-eval-harness/SKILL.md

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+---
+name: healthcare-eval-harness
+description: [ECC] Patient safety evaluation harness for healthcare application deployments. Automated test suites for CDSS accuracy, PHI exposure, clinical workflow integrity, and integration compliance. Blocks deployments on safety failures.
+origin: Health1 Super Speciality Hospitals — contributed by Dr. Keyur Patel
+version: "1.0.0"
+---
+
+# Healthcare Eval Harness — Patient Safety Verification
+
+Automated verification system for healthcare application deployments. A single CRITICAL failure blocks deployment. Patient safety is non-negotiable.
+
+> **Note:** Examples use Jest as the reference test runner. Adapt commands for your framework (Vitest, pytest, PHPUnit, etc.) — the test categories and pass thresholds are framework-agnostic.
+
+## When to Use
+
+- Before any deployment of EMR/EHR applications
+- After modifying CDSS logic (drug interactions, dose validation, scoring)
+- After changing database schemas that touch patient data
+- After modifying authentication or access control
+- During CI/CD pipeline configuration for healthcare apps
+- After resolving merge conflicts in clinical modules
+
+## How It Works
+
+The eval harness runs five test categories in order. The first three (CDSS Accuracy, PHI Exposure, Data Integrity) are CRITICAL gates requiring 100% pass rate — a single failure blocks deployment. The remaining two (Clinical Workflow, Integration) are HIGH gates requiring 95%+ pass rate.
+
+Each category maps to a Jest test path pattern. The CI pipeline runs CRITICAL gates with `--bail` (stop on first failure) and enforces coverage thresholds with `--coverage --coverageThreshold`.
+
+### Eval Categories
+
+**1. CDSS Accuracy (CRITICAL — 100% required)**
+
+Tests all clinical decision support logic: drug interaction pairs (both directions), dose validation rules, clinical scoring vs published specs, no false negatives, no silent failures.
+
+```bash
+npx jest --testPathPattern='tests/cdss' --bail --ci --coverage
+```
+
+**2. PHI Exposure (CRITICAL — 100% required)**
+
+Tests for protected health information leaks: API error responses, console output, URL parameters, browser storage, cross-facility isolation, unauthenticated access, service role key absence.
+
+```bash
+npx jest --testPathPattern='tests/security/phi' --bail --ci
+```
+
+**3. Data Integrity (CRITICAL — 100% required)**
+
+Tests clinical data safety: locked encounters, audit trail entries, cascade delete protection, concurrent edit handling, no orphaned records.
+
+```bash
+npx jest --testPathPattern='tests/data-integrity' --bail --ci
+```
+
+**4. Clinical Workflow (HIGH — 95%+ required)**
+
+Tests end-to-end flows: encounter lifecycle, template rendering, medication sets, drug/diagnosis search, prescription PDF, red flag alerts.
+
+```bash
+tmp_json=$(mktemp)
+npx jest --testPathPattern='tests/clinical' --ci --json --outputFile="$tmp_json" || true
+total=$(jq '.numTotalTests // 0' "$tmp_json")
+passed=$(jq '.numPassedTests // 0' "$tmp_json")
+if [ "$total" -eq 0 ]; then
+  echo "No clinical tests found" >&2
+  exit 1
+fi
+rate=$(echo "scale=2; $passed * 100 / $total" | bc)
+echo "Clinical pass rate: ${rate}% ($passed/$total)"
+```
+
+**5. Integration Compliance (HIGH — 95%+ required)**
+
+Tests external systems: HL7 message parsing (v2.x), FHIR validation, lab result mapping, malformed message handling.
+
+```bash
+tmp_json=$(mktemp)
+npx jest --testPathPattern='tests/integration' --ci --json --outputFile="$tmp_json" || true
+total=$(jq '.numTotalTests // 0' "$tmp_json")
+passed=$(jq '.numPassedTests // 0' "$tmp_json")
+if [ "$total" -eq 0 ]; then
+  echo "No integration tests found" >&2
+  exit 1
+fi
+rate=$(echo "scale=2; $passed * 100 / $total" | bc)
+echo "Integration pass rate: ${rate}% ($passed/$total)"
+```
+
+### Pass/Fail Matrix
+
+| Category | Threshold | On Failure |
+|----------|-----------|------------|
+| CDSS Accuracy | 100% | **BLOCK deployment** |
+| PHI Exposure | 100% | **BLOCK deployment** |
+| Data Integrity | 100% | **BLOCK deployment** |
+| Clinical Workflow | 95%+ | WARN, allow with review |
+| Integration | 95%+ | WARN, allow with review |
+
+### CI/CD Integration
+
+```yaml
+name: Healthcare Safety Gate
+on: [push, pull_request]
+
+jobs:
+  safety-gate:
+    runs-on: ubuntu-latest
+    steps:
+      - uses: actions/checkout@v4
+      - uses: actions/setup-node@v4
+        with:
+          node-version: '20'
+      - run: npm ci
+
+      # CRITICAL gates — 100% required, bail on first failure
+      - name: CDSS Accuracy
+        run: npx jest --testPathPattern='tests/cdss' --bail --ci --coverage --coverageThreshold='{"global":{"branches":80,"functions":80,"lines":80}}'
+
+      - name: PHI Exposure Check
+        run: npx jest --testPathPattern='tests/security/phi' --bail --ci
+
+      - name: Data Integrity
+        run: npx jest --testPathPattern='tests/data-integrity' --bail --ci
+
+      # HIGH gates — 95%+ required, custom threshold check
+      # HIGH gates — 95%+ required
+      - name: Clinical Workflows
+        run: |
+          TMP_JSON=$(mktemp)
+          npx jest --testPathPattern='tests/clinical' --ci --json --outputFile="$TMP_JSON" || true
+          TOTAL=$(jq '.numTotalTests // 0' "$TMP_JSON")
+          PASSED=$(jq '.numPassedTests // 0' "$TMP_JSON")
+          if [ "$TOTAL" -eq 0 ]; then
+            echo "::error::No clinical tests found"; exit 1
+          fi
+          RATE=$(echo "scale=2; $PASSED * 100 / $TOTAL" | bc)
+          echo "Pass rate: ${RATE}% ($PASSED/$TOTAL)"
+          if (( $(echo "$RATE < 95" | bc -l) )); then
+            echo "::warning::Clinical pass rate ${RATE}% below 95%"
+          fi
+
+      - name: Integration Compliance
+        run: |
+          TMP_JSON=$(mktemp)
+          npx jest --testPathPattern='tests/integration' --ci --json --outputFile="$TMP_JSON" || true
+          TOTAL=$(jq '.numTotalTests // 0' "$TMP_JSON")
+          PASSED=$(jq '.numPassedTests // 0' "$TMP_JSON")
+          if [ "$TOTAL" -eq 0 ]; then
+            echo "::error::No integration tests found"; exit 1
+          fi
+          RATE=$(echo "scale=2; $PASSED * 100 / $TOTAL" | bc)
+          echo "Pass rate: ${RATE}% ($PASSED/$TOTAL)"
+          if (( $(echo "$RATE < 95" | bc -l) )); then
+            echo "::warning::Integration pass rate ${RATE}% below 95%"
+          fi
+```
+
+### Anti-Patterns
+
+- Skipping CDSS tests "because they passed last time"
+- Setting CRITICAL thresholds below 100%
+- Using `--no-bail` on CRITICAL test suites
+- Mocking the CDSS engine in integration tests (must test real logic)
+- Allowing deployments when safety gate is red
+- Running tests without `--coverage` on CDSS suites
+
+## Examples
+
+### Example 1: Run All Critical Gates Locally
+
+```bash
+npx jest --testPathPattern='tests/cdss' --bail --ci --coverage && \
+npx jest --testPathPattern='tests/security/phi' --bail --ci && \
+npx jest --testPathPattern='tests/data-integrity' --bail --ci
+```
+
+### Example 2: Check HIGH Gate Pass Rate
+
+```bash
+tmp_json=$(mktemp)
+npx jest --testPathPattern='tests/clinical' --ci --json --outputFile="$tmp_json" || true
+jq '{
+  passed: (.numPassedTests // 0),
+  total: (.numTotalTests // 0),
+  rate: (if (.numTotalTests // 0) == 0 then 0 else ((.numPassedTests // 0) / (.numTotalTests // 1) * 100) end)
+}' "$tmp_json"
+# Expected: { "passed": 21, "total": 22, "rate": 95.45 }
+```
+
+### Example 3: Eval Report
+
+```
+## Healthcare Eval: 2026-03-27 [commit abc1234]
+
+### Patient Safety: PASS
+
+| Category | Tests | Pass | Fail | Status |
+|----------|-------|------|------|--------|
+| CDSS Accuracy | 39 | 39 | 0 | PASS |
+| PHI Exposure | 8 | 8 | 0 | PASS |
+| Data Integrity | 12 | 12 | 0 | PASS |
+| Clinical Workflow | 22 | 21 | 1 | 95.5% PASS |
+| Integration | 6 | 6 | 0 | PASS |
+
+### Coverage: 84% (target: 80%+)
+### Verdict: SAFE TO DEPLOY
+```