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Cross-branch clinical safety

JamGuard's power in a hospital chain is that it sees the complete medication history — not just what was prescribed at the current branch. Without JamGuard, a clinician at Branch 01 has no visibility of what was prescribed at Branch 03.

Drug-drug interaction (DDI)​

On every MedicationRequest write, JamGuard:

  1. Queries HAPI FHIR for all active MedicationRequests for Patient/GOLDEN-{id} — across all branches
  2. Sends the RxNorm CUI list to the NLM RxNorm Interaction API
  3. Evaluates severity:
MAJOR → block write + alert prescriber immediately
MODERATE → warning card, write proceeds
MINOR → logged only

Example: Warfarin prescribed at Branch 03, Aspirin active at Branch 07:

NLM RxNorm API: Warfarin (855288) × Aspirin (1191) → MAJOR
Interaction: Increased risk of bleeding
Action: REVIEW_REQUIRED

The MedicationRequest is not written until the prescriber acknowledges and overrides, or changes the prescription.

Drug-allergy​

Checks new MedicationRequest against all AllergyIntolerance resources for the golden patient. Cross-branch allergies are visible because they are stored in HAPI under the same golden ID.

AllergyIntolerance at Branch 07: Penicillin → ALLERGY
New MedicationRequest at Branch 01: Amoxicillin (penicillin-class)
→ JamGuard alert: drug-allergy conflict

Missed follow-up​

Hourly scan for Observations where:

  • OBX-8 = H or L (high/low critical flag)
  • Older than window-hours (default: 72 hours)
  • No follow-up Encounter exists

Fires an alert to the ordering clinician and branch admin.

Polypharmacy​

Flags patients with:

  • 10 active MedicationRequests across all branches

  • Age > 65

The alert goes to the patient's primary clinician for medication review.

Duplicate prescription​

Checks whether a new MedicationRequest is in the same ATC drug class as a medication already active from another branch within 30 days. Prevents two branches independently prescribing the same class of drug.