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healthcare-cdss-patterns Clinical Decision Support System (CDSS) development patterns for drug interaction checking, dose validation, clinical scoring (NEWS2, qSOFA), and alert severity classification. USE WHEN building CDSS safety checks or integrating clinical alerts into EMR workflows.
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name healthcare-cdss-patterns description Clinical Decision Support System (CDSS) development patterns for drug interaction checking, dose validation, clinical scoring (NEWS2, qSOFA), and alert severity classification. USE WHEN building CDSS safety checks or integrating clinical alerts into EMR workflows. origin Health1 Super Speciality Hospitals — contributed by Dr. Keyur Patel version 1.0.0 cluster healthcare
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:
checkInteractions(newDrug, currentMeds, allergies)
InteractionAlert[]
DrugInteractionPair
validateDose(drug, dose, route, weight, age, renalFunction)DoseValidationResult.
calculateNEWS2(vitals)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 interface DrugInteractionPair {
drugA : string ;
drugB : string ;
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 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 [] = [];
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 };
}
}
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 };
}
}
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 };
}
}
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 interface NEWS2Input {
respiratoryRate : number ; oxygenSaturation : number ; supplementalOxygen : boolean ;
temperature : number ; systolicBP : number ; heartRate : number ;
consciousness : 'alert' | 'voice' | 'pain' | 'unresponsive' ;
}
interface NEWS2Result {
total : number ;
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) 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 const alerts = checkInteractions ('warfarin' , ['aspirin' , 'metformin' ], ['penicillin' ]);
Example 2: Dose Validation const ok = validateDose ('paracetamol' , 1000 , 'oral' , 70 , 45 );
const bad = validateDose ('paracetamol' , 5000 , 'oral' , 70 , 45 );
const noWeight = validateDose ('gentamicin' , 300 , 'iv' );
Example 3: NEWS2 Scoring const result = calculateNEWS2 ({
respiratoryRate : 24 , oxygenSaturation : 93 , supplementalOxygen : true ,
temperature : 38.5 , systolicBP : 100 , heartRate : 110 , consciousness : 'voice'
});
