# Langcare Langcare MCP Fhir Critical Value Alert Generator > Critical Value Alert Generator - Skill: `tomevault-io/langcare-langcare-mcp-fhir-critical-value-alert-generator` (Agent Skill, multi-file: 2 files) - Install (CLI): `npx skillmds@latest add tomevault-io/langcare-langcare-mcp-fhir-critical-value-alert-generator` - Raw SKILL.md: https://api.skillmd.com/api/skills/tomevault-io/langcare-langcare-mcp-fhir-critical-value-alert-generator/raw - Safety review: pending (external: skill-scanner PASS, skillspector PASS) - Works with: Claude Code, Claude.ai, OpenAI Codex - Category: AI & ML - Author: tomevault-io (https://skillmd.com/u/tomevault-io) - Updated: 2026-09-17 - Page: https://skillmd.com/skills/tomevault-io/langcare-langcare-mcp-fhir-critical-value-alert-generator --- # Critical Value Alert Generator ## Overview Scan recent laboratory Observation resources for values exceeding critical thresholds defined by CAP (College of American Pathologists) and CLIA guidelines. Generate structured alerts containing: the critical value, threshold exceeded, clinical significance, and recommended immediate action. Support read-back verification workflow for clinical notification compliance. Prioritize alerts by clinical urgency. ## FHIR Resources Used | Resource | Purpose | Key Fields | |----------|---------|------------| | Observation | Lab results to evaluate | code, valueQuantity, interpretation, effectiveDateTime, status | | Patient | Demographics for context | birthDate, gender, name | | MedicationStatement | Drug context for critical values | medicationCodeableConcept, status | | Condition | Clinical context | code, clinicalStatus | ## Instructions ### Step 1: Retrieve Patient Demographics ``` Tool: fhir_read resourceType: "Patient" id: "[patient-id]" ``` Extract name (for alert addressee), age (pediatric thresholds differ), gender. ### Step 2: Pull Recent Laboratory Observations ``` Tool: fhir_search resourceType: "Observation" queryParams: "patient=[patient-id]&category=laboratory&date=ge[24-hours-ago]&_sort=-date&_count=200" ``` Default scan window: 24 hours. Expand to 48 or 72 hours if user requests or if investigating missed alerts. ### Step 3: Screen Against Critical Value Thresholds For each Observation, compare `valueQuantity.value` against critical thresholds. **Priority 1 -- Immediately Life-Threatening:** | Analyte | LOINC | Critical Low | Critical High | Unit | |---------|-------|-------------|---------------|------| | Potassium | 2823-3 | < 2.5 | > 6.5 | mEq/L | | Sodium | 2951-2 | < 120 | > 160 | mEq/L | | Glucose | 2345-7 | < 40 | > 500 | mg/dL | | Calcium (total) | 17861-6 | < 6.0 | > 13.0 | mg/dL | | Ionized Calcium | 1994-3 | < 0.78 | > 1.58 | mmol/L | | pH (arterial) | 2744-1 | < 7.20 | > 7.60 | -- | | pCO2 | 2019-8 | < 20 | > 70 | mmHg | | pO2 | 2703-7 | < 40 | -- | mmHg | | Lactate | 2524-7 | -- | > 4.0 | mmol/L | | Troponin I | 10839-9 | -- | > 0.04 | ng/mL | | Troponin T | 6598-7 | -- | > 0.10 | ng/mL | **Priority 2 -- Urgent (within 1 hour):** | Analyte | LOINC | Critical Low | Critical High | Unit | |---------|-------|-------------|---------------|------| | Hemoglobin | 718-7 | < 7.0 | > 20.0 | g/dL | | WBC | 26464-8 | < 1.5 | > 30.0 | x10^3/uL | | Platelets | 777-3 | < 20 | > 1000 | x10^3/uL | | INR | 6301-6 | -- | > 5.0 | -- | | aPTT | 3173-2 | -- | > 100 | seconds | | Fibrinogen | 3255-7 | < 100 | -- | mg/dL | | Magnesium | 19123-9 | < 1.0 | > 4.0 | mg/dL | | Phosphorus | 2777-1 | < 1.0 | > 8.0 | mg/dL | | Ammonia | 1925-7 | -- | > 100 | umol/L | | Bilirubin (neonatal) | 58941-6 | -- | > 15.0 | mg/dL | **Priority 3 -- Urgent Drug Levels:** | Drug | LOINC | Critical Low | Critical High | Unit | |------|-------|-------------|---------------|------| | Digoxin | 10535-3 | -- | > 2.0 | ng/mL | | Lithium | 14334-7 | -- | > 1.5 | mEq/L | | Phenytoin | 3968-5 | -- | > 30.0 | ug/mL | | Vancomycin (trough) | 4090-7 | -- | > 30.0 | ug/mL | | Theophylline | 4049-3 | -- | > 20.0 | ug/mL | | Carbamazepine | 3432-2 | -- | > 15.0 | ug/mL | | Valproic Acid | 4086-5 | -- | > 120.0 | ug/mL | | Methotrexate (24h) | 14836-1 | -- | > 5.0 | umol/L | See references/critical-value-table.md for complete thresholds with pediatric adjustments. Also check the `interpretation` field: codes `HH` (critical high) or `LL` (critical low) from the FHIR server itself may flag values the threshold table does not cover. ### Step 4: Retrieve Clinical Context for Each Critical Value For each critical value found: ``` Tool: fhir_search resourceType: "MedicationStatement" queryParams: "patient=[patient-id]&status=active" ``` ``` Tool: fhir_search resourceType: "Condition" queryParams: "patient=[patient-id]&clinical-status=active" ``` Correlate: - Critical potassium + ACE inhibitor/ARB/spironolactone = drug-induced hyperkalemia - Critical potassium low + loop diuretic = drug-induced hypokalemia - Critical INR + warfarin = supratherapeutic anticoagulation - Critical glucose low + insulin/sulfonylurea = drug-induced hypoglycemia - Critical lithium + renal impairment = accumulation risk - Critical troponin + known CAD = acute coronary syndrome context ### Step 5: Check for Prior Value (Delta) ``` Tool: fhir_search resourceType: "Observation" queryParams: "patient=[patient-id]&code=[loinc-code]&_sort=-date&_count=2" ``` Compare current critical value to the most recent prior result. Note whether the value is newly critical or has been trending toward critical. ### Step 6: Generate Structured Alert For each critical value, produce an alert block: ``` ===================================================== CRITICAL VALUE ALERT -- PRIORITY [1/2/3] ===================================================== Patient: [Name] (MRN: [id]) Test: [Analyte name] Value: [result] [unit] Threshold: [critical low/high threshold] Collected: [effectiveDateTime] Prior: [prior value] on [prior date] (delta: [change]) CLINICAL SIGNIFICANCE: [1-2 sentence explanation of the clinical risk] RECOMMENDED IMMEDIATE ACTIONS: 1. [First action -- most urgent] 2. [Second action] 3. [Third action] MEDICATION CONTEXT: - [Relevant active medication and its relationship to the critical value] READ-BACK VERIFICATION: "The critical value for [Patient Name] is [analyte] of [value] [unit], collected at [time]. The critical threshold is [threshold]. Please read back the patient name, test name, and value to confirm receipt." ===================================================== ``` ### Step 7: Prioritize and Order Alerts Sort alerts by: 1. Priority level (1 before 2 before 3) 2. Within same priority, by clinical urgency (e.g., potassium 2.0 before potassium 2.4) 3. Timestamp (most recent first within same analyte) If no critical values found, report: "No critical values detected in laboratory results from [date range]. [N] total observations reviewed." ## Examples ### Example 1: Multiple Critical Values Detected **User says:** "Check for critical labs on patient 33201" **Actions:** 1. `fhir_read` Patient/33201 -- returns 58-year-old male, John Martinez 2. `fhir_search` Observation?patient=33201&category=laboratory&date=ge[24-hours-ago]&_sort=-date&_count=200 -- returns 12 results; potassium 6.8 mEq/L (HH), glucose 38 mg/dL (LL), hemoglobin 6.2 g/dL (L) 3. `fhir_search` MedicationStatement?patient=33201&status=active -- returns spironolactone, insulin glargine, aspirin 4. `fhir_search` Condition?patient=33201&clinical-status=active -- returns CKD stage 4, Type 2 DM, CHF 5. `fhir_search` Observation?patient=33201&code=2823-3&_sort=-date&_count=2 -- prior potassium 5.8 two days ago 6. `fhir_search` Observation?patient=33201&code=2345-7&_sort=-date&_count=2 -- prior glucose 95 yesterday 7. `fhir_search` Observation?patient=33201&code=718-7&_sort=-date&_count=2 -- prior hemoglobin 7.1 one week ago **Result:** Three alerts generated: - PRIORITY 1: Potassium 6.8 (threshold > 6.5), trending up from 5.8. Spironolactone + CKD4 causative. Action: ECG stat, calcium gluconate, hold spironolactone, kayexalate. - PRIORITY 1: Glucose 38 (threshold < 40), prior was 95. Insulin glargine causative. Action: D50 IV push, recheck in 15 min, hold insulin pending evaluation. - PRIORITY 2: Hemoglobin 6.2 (threshold < 7.0), dropping from 7.1. Action: Type and screen, transfuse 1 unit pRBC, evaluate for active bleeding. ### Example 2: No Critical Values Found **User says:** "Any critical labs for patient abc-100 in the last 48 hours?" **Actions:** 1. `fhir_read` Patient/abc-100 -- returns 34-year-old female 2. `fhir_search` Observation?patient=abc-100&category=laboratory&date=ge[48-hours-ago]&_sort=-date&_count=200 -- returns 8 results; all within normal limits or mildly abnormal (e.g., LDL 142 mg/dL flagged H) **Result:** "No critical values detected in laboratory results from the past 48 hours. 8 total observations reviewed. Note: 1 non-critical abnormality -- LDL 142 mg/dL (above reference 0-130). No immediate action required." ## Troubleshooting ### FHIR Server Does Not Use interpretation Coding - Some servers omit the `interpretation` field entirely. Rely on threshold comparison against `valueQuantity.value` using the critical value table. - If `valueQuantity` is also absent, check `valueString` -- some results are reported as text (e.g., "> 500" for troponin). Parse the numeric value from the string. ### Observation Uses Different Units Than Expected - Potassium may be reported as mmol/L instead of mEq/L (1:1 conversion for monovalent ions, so thresholds are the same). - Glucose may be mmol/L instead of mg/dL. Convert: mmol/L * 18 = mg/dL. Adjust thresholds: < 2.2 mmol/L (critical low), > 27.8 mmol/L (critical high). - Hemoglobin may be g/L instead of g/dL. Convert: g/L / 10 = g/dL. - Always check `valueQuantity.unit` or `valueQuantity.code` before comparing to thresholds. ### Multiple Specimens for Same Analyte in Scan Window - A repeated critical value may indicate the first was already addressed and this is a follow-up. Compare timestamps. - If the second value is improving (moving toward normal), note "trending toward correction" in the alert. - If the second value is worsening, escalate priority and note "worsening despite intervention." ## Related Skills - `lab-result-interpreter` -- for comprehensive lab interpretation beyond critical values - `renal-function-dashboard` -- for critical electrolytes in the context of renal function staging - `diabetes-panel-review` -- for critical glucose values in the context of diabetes management --- > Converted and distributed by [TomeVault](https://tomevault.io/claim/langcare) — claim your Tome and manage your conversions.