codeply-cli 0.3.1 → 0.4.0

package/skills/healthcare-cdss-patterns/SKILL.md

@@ -1,246 +1,246 @@
----
-name: healthcare-cdss-patterns
-description: Clinical Decision Support System (CDSS) development patterns. Drug interaction checking, dose validation, clinical scoring (NEWS2, qSOFA), alert severity classification, and integration into EMR workflows.
-metadata:
-  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.' }
-```
+---
+name: healthcare-cdss-patterns
+description: Clinical Decision Support System (CDSS) development patterns. Drug interaction checking, dose validation, clinical scoring (NEWS2, qSOFA), alert severity classification, and integration into EMR workflows.
+metadata:
+  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.' }
+```