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用于医疗应用部署的患者安全评估工具。针对CDSS准确性、PHI暴露、临床工作流完整性和集成合规性的自动化测试套件。在安全故障时阻止部署。
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.
Orchestrate building a brand-new feature end to end — research, plan, TDD implementation, review, and gated commit — by delegating each phase to the matching ECC agent. Use when adding a capability that does not exist yet.
Orchestrate bootstrapping a working MVP from a design or spec document — ingest the doc, plan thin vertical slices, scaffold the first end-to-end slice, then TDD-implement, review, and gated commit. Use to turn an SDD/PRD into a running starting point.
Orchestrate altering an existing, working feature to new desired behavior — update its tests to the new spec, change the implementation to match, review, and gated commit. Use when behavior is not broken but should be different.
Orchestrate fixing a bug — reproduce it as a failing regression test, fix to green, review, and gated commit — by delegating each phase to the matching ECC agent. Use when existing behavior is broken or wrong.
Shared orchestration engine for the orch-* skill family. Defines the gated Research-Plan-TDD-Review-Commit pipeline, the size classifier, the agent map, and the two human gates that the orch-* operation skills delegate to. Not usually invoked directly.
| name | healthcare-eval-harness |
| description | 用于医疗应用部署的患者安全评估工具。针对CDSS准确性、PHI暴露、临床工作流完整性和集成合规性的自动化测试套件。在安全故障时阻止部署。 |
| origin | Health1 Super Speciality Hospitals — contributed by Dr. Keyur Patel |
| version | 1.0.0 |
医疗应用部署的自动化验证系统。单个严重故障将阻止部署。患者安全不容妥协。
注意： 示例使用 Jest 作为参考测试运行器。请根据您的框架（Vitest、pytest、PHPUnit 等）调整命令——测试类别和通过阈值与框架无关。
评估框架按顺序运行五个测试类别。前三个（CDSS 准确性、PHI 暴露、数据完整性）是严重关卡，要求 100% 通过率——单个故障即阻止部署。其余两个（临床工作流、集成）是高优先级关卡，要求 95% 以上通过率。
每个类别对应一个 Jest 测试路径模式。CI 流水线使用 --bail（首次失败即停止）运行严重关卡，并使用 --coverage --coverageThreshold 强制执行覆盖率阈值。
1. CDSS 准确性（严重 — 要求 100%）
测试所有临床决策支持逻辑：药物相互作用对（双向）、剂量验证规则、临床评分与发布规范的对比、无假阴性、无静默故障。
npx jest --testPathPattern='tests/cdss' --bail --ci --coverage
2. PHI 暴露（严重 — 要求 100%）
测试受保护健康信息泄露：API 错误响应、控制台输出、URL 参数、浏览器存储、跨机构隔离、未认证访问、服务角色密钥缺失。
npx jest --testPathPattern='tests/security/phi' --bail --ci
3. 数据完整性（严重 — 要求 100%）
测试临床数据安全：锁定就诊记录、审计追踪条目、级联删除保护、并发编辑处理、无孤立记录。
npx jest --testPathPattern='tests/data-integrity' --bail --ci
4. 临床工作流（高优先级 — 要求 95% 以上）
测试端到端流程：就诊生命周期、模板渲染、用药集、药物/诊断搜索、处方 PDF、红色警报。
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/$total)"
5. 集成合规性（高优先级 — 要求 95% 以上）
测试外部系统：HL7 消息解析（v2.x）、FHIR 验证、实验室结果映射、格式错误消息处理。
tmp_json=$(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/$total)"
| 类别 | 阈值 | 失败时操作 |
|---|---|---|
| CDSS 准确性 | 100% | 阻止部署 |
| PHI 暴露 | 100% | 阻止部署 |
| 数据完整性 | 100% | 阻止部署 |
| 临床工作流 | 95% 以上 | 警告，允许经审查后部署 |
| 集成 | 95% 以上 | 警告，允许经审查后部署 |
name: Healthcare Safety Gate
on: [push, pull_request]
jobs:
safety-gate:
runs-on: ubuntu-latest
steps:
- uses: actions/checkout@v4
- uses: actions/setup-node@v4
with:
node-version: '20'
- run: npm ci
# CRITICAL gates — 100% required, bail on first failure
- name: CDSS Accuracy
run: npx jest --testPathPattern='tests/cdss' --bail --ci --coverage --coverageThreshold='{"global":{"branches":80,"functions":80,"lines":80}}'
- name: PHI Exposure Check
run: npx jest --testPathPattern='tests/security/phi' --bail --ci
- name: Data Integrity
run: npx jest --testPathPattern='tests/data-integrity' --bail --ci
# HIGH gates — 95%+ required, custom threshold check
# HIGH gates — 95%+ required
- name: Clinical Workflows
run: |
TMP_JSON=$(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 ${RATE}% below 95%"
fi
--no-bail--coveragenpx jest --testPathPattern='tests/cdss' --bail --ci --coverage && \
npx jest --testPathPattern='tests/security/phi' --bail --ci && \
npx jest --testPathPattern='tests/data-integrity' --bail --ci
tmp_json=$(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 }
## 医疗评估：2026-03-27 [commit abc1234]
### 患者安全：通过
| 类别 | 测试数 | 通过 | 失败 | 状态 |
|----------|-------|------|------|--------|
| CDSS 准确性 | 39 | 39 | 0 | 通过 |
| PHI 暴露 | 8 | 8 | 0 | 通过 |
| 数据完整性 | 12 | 12 | 0 | 通过 |
| 临床工作流 | 22 | 21 | 1 | 95.5% 通过 |
| 集成 | 6 | 6 | 0 | 通过 |
### 覆盖率：84%（目标：80%以上）
### 结论：可安全部署