A SMART on FHIR Clinical Decision Support engine that surfaces a specific, actionable, guideline-cited recommendation at the moment of prescribing — which the clinician reviews and can accept or override, with every override logged — designed to embed 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.
Point-of-care decision support is a potentially eligible, discretionary remediation-spend category under a hospital's Exhibit E settlement allocation — subject to that hospital's own settlement administrator and state-specific allowable-use rules. Not a designated or guaranteed funding source.
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 describes a "Non-Device CDS" pathway for deterministic rules a clinician can independently verify. Our Traceability Ledger is engineered to support Criterion D — but this is a self-assessment, pending confirmatory review by regulatory counsel, not a guaranteed or settled classification.
All calculations happen in-memory, discarded after the HTTP response. No database. No PHI at rest. A BAA template exists and will require counsel review and execution before any PHI-adjacent pilot. A hospital CISO's biggest fear — a data breach of stored PHI — is architecturally reduced.
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 a potentially eligible, discretionary Exhibit E remediation category of National Opioid Settlement abatement funds — subject to each hospital's own settlement administrator and state rules. Not a guaranteed or designated funding source, but a conversation that can ease the capital budget objection.
| 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 in the background. Surfaces guidance at the moment of prescribing. |
| 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 | Likely needs 510(k) SaMD clearance. $2M+ / 2 years. CISOs wary. | Deterministic. Self-assessed non-SaMD posture. CISO-friendly design. |
| Precision Analgesia SMART on FHIR CDS |
Proactive CDS Hook engine, FHIR auto-population, deterministic transparent math | — | Inpatient. Proactive. Self-assessed Non-Device CDS. CISO-friendly design. Settlement-eligible sales angle. |
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 a hospital's own settlement administrator approves point-of-care CDS as a discretionary Exhibit E remediation use, the integration may not require a separate capital budget approval — not a guaranteed or designated funding source. Where this framing applies, we believe it can compress an 18-month enterprise sales cycle to roughly 4–6 months. Our seed capital funds our first push toward settlement-eligible contracts.
Every hospital without this tool is writing opioid orders without a safety net, against a national $78.5B/yr opioid economic burden (Florence et al., 2016) and a well-documented alert-fatigue problem. The clinical engine is built. Our regulatory posture is self-assessed as favorable, pending confirmatory review by counsel. Settlement funds are a potentially eligible, discretionary funding angle — not a guarantee.