kodelyth-ecc 2.18.0 → 2.19.0

package/.roo/skills/google-workspace-ops/SKILL.md

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+---
+name: google-workspace-ops
+description: Operate across Google Drive, Docs, Sheets, and Slides as one workflow surface for plans, trackers, decks, and shared documents. Use when the user needs to find, summarize, edit, migrate, or clean up Google Workspace assets without dropping to raw tool calls.
+origin: ECC
+---
+
+# Google Workspace Ops
+
+This skill is for operating shared docs, spreadsheets, and decks as working systems, not just editing one file in isolation.
+
+## When to Use
+
+- User needs to find a doc, sheet, or deck and update it in place
+- Consolidating plans, trackers, notes, or customer lists stored in Google Drive
+- Cleaning or restructuring a shared spreadsheet
+- Importing, repairing, or reformatting a Google Slides deck
+- Producing summaries from Docs, Sheets, or Slides for decision-making
+
+## Preferred Tool Surface
+
+Use Google Drive as the entry point, then switch to the right specialist:
+
+- Google Docs for text-heavy docs
+- Google Sheets for tabular work, formulas, and charts
+- Google Slides for decks, imports, template migration, and cleanup
+
+Do not guess structure from filenames alone. Inspect first.
+
+## Workflow
+
+### 1. Find the asset
+
+Start with the Drive search surface to locate:
+
+- the exact file
+- sibling assets
+- likely duplicates
+- recently modified versions
+
+If several documents look similar, confirm by title, owner, modified time, or folder.
+
+### 2. Inspect before editing
+
+Before making changes:
+
+- summarize current structure
+- identify tabs, headings, or slide count
+- detect whether the task is local cleanup or structural surgery
+
+Pick the smallest tool that can safely perform the work.
+
+### 3. Edit with precision
+
+- For Docs: use index-aware edits, not vague rewrites
+- For Sheets: operate on explicit tabs and ranges
+- For Slides: distinguish content edits from visual cleanup or template migration
+
+If the requested work is visual or layout-sensitive, iterate with inspection and verification instead of one giant blind update.
+
+### 4. Keep the working system clean
+
+When the file is part of a larger workflow, also surface:
+
+- duplicate trackers
+- outdated decks
+- stale docs vs canonical docs
+- whether the asset should be archived, merged, or renamed
+
+## Output Format
+
+Use:
+
+```text
+ASSET
+- file name
+- type
+- why this is the right file
+
+CURRENT STATE
+- structure summary
+- key problems or blockers
+
+ACTION
+- edits made or recommended
+
+FOLLOW-UPS
+- archive / merge / duplicate cleanup / next file to update
+```
+
+## Good Use Cases
+
+- "Find the active planning doc and condense it"
+- "Clean up this customer spreadsheet and show me the churn-risk rows"
+- "Import this deck into Slides and make it presentable"
+- "Find the current tracker, not the stale duplicate"

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

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+---
+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.
+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/.roo/skills/healthcare-emr-patterns/SKILL.md

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+---
+name: healthcare-emr-patterns
+description: 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
+```