healthcare-eval-harness

# Healthcare Eval Harness — Patient Safety Verification Automated verification system for healthcare application deployments. A single CRITICAL failure blocks deployment. Patient safety is non-negotiable. > **Note:** Examples use Jest as the reference test runner. Adapt commands for your framework (Vitest, pytest, PHPUnit, etc.) — the test categories and pass thresholds are framework-agnostic. ## When to Use - Before any deployment of EMR/EHR applications - After modifying CDSS logic (drug interactions, dose validation, scoring) - After changing database schemas that touch patient data - After modifying authentication or access control - During CI/CD pipeline configuration for healthcare apps - After resolving merge conflicts in clinical modules ## How It Works The eval harness runs five test categories in order. The first three (CDSS Accuracy, PHI Exposure, Data Integrity) are CRITICAL gates requiring 100% pass rate — a single failure blocks deployment. The remaining two (Clinical Workflow, Integration) are HIGH gates requiring 95%+ pass rate. Each category maps to a Jest test path pattern. The CI pipeline runs CRITICAL gates with `--bail` (stop on first failure) and enforces coverage thresholds with `--coverage --coverageThreshold`. ### Eval Categories **1. CDSS Accuracy (CRITICAL — 100% required)** Tests all clinical decision support logic: drug interaction pairs (both directions), dose validation rules, clinical scoring vs published specs, no false negatives, no silent failures. ```bash npx jest --testPathPattern='tests/cdss' --bail --ci --coverage ``` **2. PHI Exposure (CRITICAL — 100% required)** Tests for protected health information leaks: API error responses, console output, URL parameters, browser storage, cross-facility isolation, unauthenticated access, service role key absence. ```bash npx jest --testPathPattern='tests/security/phi' --bail --ci ``` **3. Data Integrity (CRITICAL — 100% required)** Tests clinical data safety: locked encounters, audit trail entries, cascade delete protection, concurrent edit handling, no orphaned records. ```bash npx jest --testPathPattern='tests/data-integrity' --bail --ci ``` **4. Clinical Workflow (HIGH — 95%+ required)** Tests end-to-end flows: encounter lifecycle, template rendering, medication sets, drug/diagnosis search, prescription PDF, red flag alerts. ```bash 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/$total)" ``` **5. Integration Compliance (HIGH — 95%+ required)** Tests external systems: HL7 message parsing (v2.x), FHIR validation, lab result mapping, malformed message handling. ```bash tmp_json=$(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/$total)" ``` ### Pass/Fail Matrix | Category | Threshold | On Failure | |----------|-----------|------------| | CDSS Accuracy | 100% | **BLOCK deployment** | | PHI Exposure | 100% | **BLOCK deployment** | | Data Integrity | 100% | **BLOCK deployment** | | Clinical Workflow | 95%+ | WARN, allow with review | | Integration | 95%+ | WARN, allow with review | ### CI/CD Integration ```yaml name: Healthcare Safety Gate on: [push, pull_request] jobs: safety-gate: runs-on: ubuntu-latest steps: - uses: actions/checkout@v4 - uses: actions/setup-node@v4 with: node-version: '20' - run: npm ci # CRITICAL gates — 100% required, bail on first failure - name: CDSS Accuracy run: npx jest --testPathPattern='tests/cdss' --bail --ci --coverage --coverageThreshold='{"global":{"branches":80,"functions":80,"lines":80}}' - name: PHI Exposure Check run: npx jest --testPathPattern='tests/security/phi' --bail --ci - name: Data Integrity run: npx jest --testPathPattern='tests/data-integrity' --bail --ci # HIGH gates — 95%+ required, custom threshold check # HIGH gates — 95%+ required - name: Clinical Workflows run: | TMP_JSON=$(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 ${RATE}% below 95%" fi ``` ### Anti-Patterns - Skipping CDSS tests "because they passed last time" - Setting CRITICAL thresholds below 100% - Using `--no-bail` on CRITICAL test suites - Mocking the CDSS engine in integration tests (must test real logic) - Allowing deployments when safety gate is red - Running tests without `--coverage` on CDSS suites ## Examples ### Example 1: Run All Critical Gates Locally ```bash npx jest --testPathPattern='tests/cdss' --bail --ci --coverage && \ npx jest --testPathPattern='tests/security/phi' --bail --ci && \ npx jest --testPathPattern='tests/data-integrity' --bail --ci ``` ### Example 2: Check HIGH Gate Pass Rate ```bash tmp_json=$(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 } ``` ### Example 3: Eval Report ``` ## Healthcare Eval: 2026-03-27 [commit abc1234] ### Patient Safety: PASS | Category | Tests | Pass | Fail | Status | |----------|-------|------|------|--------| | CDSS Accuracy | 39 | 39 | 0 | PASS | | PHI Exposure | 8 | 8 | 0 | PASS | | Data Integrity | 12 | 12 | 0 | PASS | | Clinical Workflow | 22 | 21 | 1 | 95.5% PASS | | Integration | 6 | 6 | 0 | PASS | ### Coverage: 84% (target: 80%+) ### Verdict: SAFE TO DEPLOY ```