everything-claude-code/skills/healthcare-eval-harness/SKILL.md

name, description, origin, version, observe, feedback, rollback

name	description	origin	version	observe	feedback	rollback
healthcare-eval-harness	Patient safety evaluation harness for healthcare application deployments. Automated test suites for CDSS accuracy, PHI exposure, clinical workflow integrity, and integration compliance. Blocks deployments on safety failures.	Health1 Super Speciality Hospitals — contributed by Dr. Keyur Patel	1.0.0	PostToolUse	manual	git revert

Healthcare Eval Harness — Patient Safety Verification

Automated verification system for healthcare application deployments. A single CRITICAL failure blocks deployment. Patient safety is non-negotiable.

When to Activate

• 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

Eval Categories

1. CDSS Accuracy (CRITICAL — 100% required)

Tests all clinical decision support logic:

• Drug interaction pairs: every known pair must fire an alert
• Dose validation: out-of-range doses must be flagged
• Clinical scoring: results must match published specifications
• No false negatives: a missed alert is a patient safety event
• No silent failures: malformed input must error, not silently pass

npx jest --testPathPattern='tests/cdss' --bail --ci

2. PHI Exposure (CRITICAL — 100% required)

Tests for protected health information leaks:

• API error responses contain no PHI
• Console output contains no patient data
• URL parameters contain no PHI
• Browser storage contains no PHI
• Cross-facility data isolation works (multi-tenant)
• Unauthenticated requests return zero patient rows
• Service role keys absent from client bundles

npx jest --testPathPattern='tests/security/phi' --bail --ci

3. Data Integrity (CRITICAL — 100% required)

Tests for clinical data safety:

• Locked encounters cannot be modified
• Audit trail entries exist for every write operation
• Cascade deletes are blocked on patient records
• Concurrent edits trigger conflict resolution
• No orphaned records across related tables

npx jest --testPathPattern='tests/data-integrity' --bail --ci

4. Clinical Workflow (HIGH — 95%+ required)

Tests end-to-end clinical workflows:

• Complete encounter flow (complaint → exam → diagnosis → Rx → lock)
• Template rendering and submission for all clinical templates
• Medication set population and interaction checking
• Drug/diagnosis search functionality
• Prescription PDF generation
• Red flag alert triggering

npx jest --testPathPattern='tests/clinical' --ci

5. Integration Compliance (HIGH — 95%+ required)

Tests external system integrations:

• HL7 message parsing (v2.x)
• FHIR resource validation (if applicable)
• Lab result mapping to correct patients
• Malformed message handling (no crashes)

npx jest --testPathPattern='tests/integration' --ci

CI/CD Integration

GitHub Actions Example

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 — must pass 100%
      - name: CDSS Accuracy
        run: npx jest --testPathPattern='tests/cdss' --bail --ci

      - 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 — must pass 95%+
      - name: Clinical Workflows
        run: npx jest --testPathPattern='tests/clinical' --ci

      - name: Integration Compliance
        run: npx jest --testPathPattern='tests/integration' --ci

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

Eval Report Format

## Healthcare Eval: [date] [commit]

### Patient Safety: PASS / FAIL

| Category | Tests | Pass | Fail | Status |
|----------|-------|------|------|--------|
| CDSS Accuracy | N | N | 0 | PASS |
| PHI Exposure | N | N | 0 | PASS |
| Data Integrity | N | N | 0 | PASS |
| Clinical Workflow | N | N | N | 95%+ |
| Integration | N | N | N | 95%+ |

### Coverage: X% (target: 80%+)
### Verdict: SAFE TO DEPLOY / BLOCKED

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