A SMART on FHIR Clinical Decision Support engine that intercepts dangerous opioid orders before they reach the patient — designed to embed silently inside Epic and Cerner.
Epic's native drug-safety warnings are dismissed 70–90% of the time (JAMIA). Clinicians have been trained to click past them. The system meant to protect patients has been optimized away.
Exhibit E of the National Opioid Settlement explicitly lists point-of-care decision support as an approved abatement use. Hospitals can apply for funding through state and county abatement programs.
Patient context auto-loads via SMART on FHIR OAuth. Pulls age, weight, creatinine, active meds, allergies, genotype panel. Zero manual entry.
10 deterministic safety rules plus OIRD risk scoring, MME thresholds, pharmacogenomic guidance, and CDC naloxone prompts — all in <100ms.
1-click "Draft Order" injects safe alternative into Epic's CPOE cart. "Export to Chart" writes a billable consult note as a DocumentReference.
OME/MME calculator, OIRD risk tier (PRODIGY-aligned), organ dose gating, naloxone prompt at ≥50 MME, manual data override form.
CDC 2022 taper schedule generator. 10%/2-week protocol. One-click copy to EHR note.
BUPE/methadone/naltrexone protocols. COWS, DSM-5, aberrant behavior screening. Auto-structured consult note.
Transdermal fentanyl/buprenorphine calculators with organ-adjusted dosing. Prevents the most common ICU conversion error.
DAST-10, ASSIST, ORT with sex-adjusted scoring. Reads FHIR nursing flowsheets before prompting manual entry.
PCA 1-hr/4-hr limit calculator. Continuous drip converter with renal-adjusted dosing. Prevents common ICU programming errors.
FDA's January 2026 guidance created a "Non-Device CDS" exemption for deterministic rules a clinician can independently verify. Our Traceability Ledger satisfies Criterion 4 — engineered from day one.
All calculations happen in-memory, discarded after the HTTP response. No database. No PHI at rest. No HIPAA BAA complexity. Every hospital CISO's nightmare — a data breach — is architecturally impossible.
We embed natively via Epic's published APIs. We never ask hospitals to change their workflows. Once a validated clinical system is integrated, hospital IT will never unwind it.
Point-of-care CDS is an Exhibit E eligible use of National Opioid Settlement abatement funds. Qualifying hospitals can pay with settlement money — easing the capital budget conversation.
| Competitor | Approach | Fatal Weakness | Our Wedge |
|---|---|---|---|
| Epic / FDB Alerts Native EHR |
Boolean pop-ups on every order | 70–90% dismiss rate (JAMIA). Alert fatigue is a clinical crisis. | Multi-factor engine. Specific. Override-documented. |
| MDCalc / UpToDate SMART calculators |
Reactive reference the doctor must launch | 5% usage rate. Used in the cafeteria, not the CPOE. | Proactive. Monitors CPOE silently. Fires before the order is signed. |
| Bamboo / NarxCare PDMP database |
Narx Score from retail pharmacy fills | Outpatient only. Useless for ICU. Black-box backlash. | Owns inpatient. Transparent math. Works where NarxCare doesn't. |
| AI/ML CDS Startups Predictive AI |
ML overdose risk models, hundreds of EHR variables | FDA 2026 requires 510(k). $2M+ / 2 years. CISOs refuse. | Deterministic. Non-SaMD. CISO-safe. Pre-cleared. |
| Precision Analgesia ✓ SMART on FHIR CDS |
Proactive CDS Hook engine, FHIR auto-population, deterministic transparent math | — | Inpatient. Proactive. Non-Device CDS. CISO-safe. Settlement-funded. |
Currently free (TestFlight beta). Serves as top-of-funnel — a hospital's CMO downloads the app, uses it at home, champions the enterprise integration. Freemium → institutional subscription path.
medication-prescribe.Where settlement abatement funding applies, hospitals pay for our integration without a capital budget approval. This compresses an 18-month enterprise sales cycle to 4–6 months. Our seed capital funds us to the first 5 settlement-funded contracts.
Every hospital without this tool is writing opioid orders without a safety net. One prevented verdict pays for 50 years of our contract. The clinical engine is built. The regulatory path is clear. The settlement funds are ready.