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.

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.

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.

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.

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.

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

CI/CD Integration

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

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

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