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医疗应用中EMR/EHR的开发模式。临床安全、就诊工作流程、处方生成、临床决策支持集成以及以可访问性为先的医疗数据录入用户界面。
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Use after a complex task, failure, or when reviewing what was learned. Teaches how to write growth logs that extract reusable patterns — not diary entries.
Design a goal-oriented agent loop, and review it for the ways loops go wrong — spinning and burning tokens, Goodhart-gaming the verifier, or running a wrong answer to completion. Two actions: (1) WRITE a loop — gate whether to build it, define a machine-decidable goal, pick the loop type, pick a skeleton; (2) REVIEW a loop — run it past five failure modes plus decidability, boundaries, fallback, judge independence, and keep-judgment-with-the-human red lines. Use when designing an autonomous agent loop, or when you already have one and worry it will spin, cheat, or run a wrong answer to the end. Complements the mechanism-layer loop skills (autonomous-loops, continuous-agent-loop) by covering the judgment layer they don't. 中文触发：写 loop、设计 loop、做一个 loop、检查 loop 对不对、loop 体检、loop 会不会跑飞、可判定目标、五个崩法、plan build judge。English triggers: design an agent loop, write a loop, check a loop, loop review, prevent a runaway loop, goal-oriented loop, decidable goal, plan/build/judge.
Stop hook that blocks Claude from finishing until quality checks pass. Detects rationalization patterns (surface text heuristics), stale learning logs (filesystem mtime), and low disk space. Complements self-audit by mechanically enforcing learning capture habits.
React Native and Expo app patterns — Expo Router navigation, state separation (server/client/route/form), TanStack Query data fetching with Zod, performant lists, NativeWind/StyleSheet styling, native APIs, and secure storage. Use when building or editing React Native / Expo screens, components, navigation, or data layers.
Instinct-based learning system that observes sessions via hooks, creates atomic instincts with confidence scoring, and evolves them into skills/commands/agents. v2.1 adds project-scoped instincts to prevent cross-project contamination.
Use this skill when writing new features, fixing bugs, or refactoring code. Enforces test-driven development with 80%+ coverage including unit, integration, and E2E tests.
| name | healthcare-emr-patterns |
| description | 医疗应用中EMR/EHR的开发模式。临床安全、就诊工作流程、处方生成、临床决策支持集成以及以可访问性为先的医疗数据录入用户界面。 |
| origin | Health1 Super Speciality Hospitals — contributed by Dr. Keyur Patel |
| version | 1.0.0 |
构建电子病历（EMR）和电子健康档案（EHR）系统的模式。优先考虑患者安全、临床准确性和医生工作效率。
每个设计决策必须通过以下问题评估："这会对患者造成伤害吗？"
临床就诊应在单页上垂直流动——无需切换标签页：
患者头部信息（固定显示 — 始终可见）
├── 人口学信息、过敏史、当前用药
│
就诊流程（垂直滚动）
├── 1. 主诉（结构化模板 + 自由文本）
├── 2. 现病史
├── 3. 体格检查（按系统分类）
├── 4. 生命体征（自动触发临床评分）
├── 5. 诊断（ICD-10/SNOMED 搜索）
├── 6. 用药（药品数据库 + 相互作用检查）
├── 7. 检查（实验室/影像学医嘱）
├── 8. 计划与随访
└── 9. 签名 / 锁定 / 打印
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
}
任何模板中的危险信号必须触发可见且不可关闭的警报——而非通知提示。
用户选择药物
→ 检查当前用药是否存在相互作用
→ 检查就诊用药是否存在相互作用
→ 检查患者过敏史
→ 根据体重/年龄/肾功能验证剂量
→ 若为严重相互作用：完全阻止开药
→ 临床医生必须记录覆盖理由才能继续操作
→ 若为重大相互作用：显示警告，要求确认
→ 将所有警报和覆盖理由记录在审计追踪中
关键相互作用默认阻止开药。临床医生必须明确覆盖，并在审计追踪中记录原因。系统绝不允许静默通过关键相互作用。
临床就诊一旦签署：
生命体征显示： 当前值带正常范围高亮（绿/黄/红），与上次对比的趋势箭头，自动计算的临床评分（NEWS2、qSOFA），内联升级指导。
检验结果展示： 正常范围高亮，与上次值对比，关键值带不可关闭警报，采集/分析时间戳，待处理医嘱及预期周转时间。
处方PDF： 一键生成，包含患者基本信息、过敏史、诊断、药物详情（通用名+商品名、剂量、给药途径、频率、疗程）、临床医生签名栏。
医疗界面的要求比典型网页应用更严格：
any类型处理临床数据结构医生为患者 #4521 开启接诊
→ 固定头部显示："Rajesh M, 58岁, 男性, 过敏史: 青霉素, 当前用药: 二甲双胍 500mg"
→ 主诉：选择"胸痛"模板
→ 点击标签："胸骨后", "向左臂放射", "压榨性"
→ 红色预警"压榨性胸骨后胸痛"触发不可关闭的警报
→ 检查：心血管系统 — "S1 S2 正常，无杂音"
→ 生命体征：心率 110, 血压 90/60, 血氧饱和度 94%
→ NEWS2 自动计算：评分 8, 风险 高, 显示升级警报
→ 诊断：搜索"ACS" → 选择 ICD-10 I21.9
→ 用药：选择阿司匹林 300mg
→ CDSS 检查与二甲双胍的相互作用：无相互作用
→ 签署接诊 → 锁定，此后仅可添加补充说明
医生为患者 #4521 开具华法林处方
→ CDSS 检测到：华法林 + 阿司匹林 = 严重相互作用
→ 用户界面：红色不可关闭的模态框阻止开药
→ 医生点击“输入理由并覆盖”
→ 输入：“获益大于风险 — 已监测 INR 方案”
→ 覆盖理由及警报记录在审计追踪中
→ 处方在记录覆盖后继续执行
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