Live models

Decision cards (CDS)

Model: aug-cds · Status: Preview · Scope: cds_hooks · Sessions: no

Send a case summary; get back a stream of decision-support cards, most important first: emergencies to rule out, contraindications and interactions in the patient's medicines, the diagnostic work-up, and what is still undocumented. Each card says what to do, why, how certain the evidence is, and where it comes from.

Cards use the HL7 CDS Hooks 2.0 card format, so components built for CDS Hooks cards can display them unchanged. How cards are requested is Augsidius's own: you call aug-cds with the case at any point in your workflow (opening a chart, drafting an order, before discharge) — there is no CDS Hooks service discovery or prefetch to set up.

Request

JSON

{
  "model": "aug-cds",
  "stream": true,
  "messages": [{"role": "user", "content": "58 year old man, known T2DM on metformin 1g BD and ramipril. 2 days of fever 39.2, severe headache and neck stiffness, no rash. Vomited twice. eGFR 25, potassium 5.9. Plan: start spironolactone 25mg OD and ibuprofen 400mg TDS."}]
}

Write the case the way a clinician would summarise it: findings (including what is absent), results with values, current medicines and medicines you are about to start, known conditions. Optional augsidius.observations and augsidius.provider_scope work as in Chat completions. Input up to about 3,000 tokens.

Response: one card per line

Text

{"object":"cds.card","card":{…critical: Rule out bacterial meningitis…}}
{"object":"cds.card","card":{…critical: Metformin contraindicated: Severe renal impairment…}}
{"object":"cds.card","card":{…critical: Spironolactone contraindicated: Hyperkalemia…}}
{"object":"cds.card","card":{…critical: Ibuprofen (NSAID class) contraindicated: Chronic Kidney Disease…}}
{"object":"cds.card","card":{…info: Consider …}}
{"object":"cds.card","card":{…info: Not yet documented: Photophobia, …}}

Then the summary (augsidius on the final chunk / message, or the last NDJSON line):

JSON

{"object": "cds.summary", "cards": 6, "indicators": {"critical": 4, "warning": 0, "info": 2},
 "observations_linked": 9, "billable_calls": 1}

At most 8 cards per call. Cards are ordered: emergency rule-outs, medication safety, diagnostic work-up, documentation gaps.

Card kinds

The kind of every card is in source.topic.code (and extension["com.augsidius"].kind).

Kind (`topic.code`)	`indicator`	When it appears	Suggestions
`emergency_rule_out`	`critical`	A must-not-miss condition fits the findings and has not been ruled out. Up to 2 cards.	The questions, examinations and tests that best rule it out, all recommended.
`contraindication`	`critical` if absolute, otherwise `warning`	A current or planned medicine (or its drug class) is contraindicated by something in this patient — a condition, a result, a state such as pregnancy.	Review {medicine}
`interaction`	`critical` if major, otherwise `warning`	Two of the patient's current or planned medicines (or their classes) interact.	Review {medicine}
`diagnostic_workup`	`info`	Leading considerations and the most informative next steps.	Next tests and examinations; the first is recommended.
`documentation_gap`	`info`	Observations not yet recorded that would change the assessment most.	Document {observation}

Safety cards (contraindication, interaction) appear only when the problem applies to this patient — the card's detail says which fact in the case triggered it ("For this patient: eGFR is 25 mL/min/1.73 m²"). A medicine's general contraindications are not listed.

Indicators

`indicator`	Meaning	Recommended display
`critical`	Act or consciously override now.	Top of the list, distinct colour, never auto-dismissed.
`warning`	Review before proceeding.	Visible without scrolling.
`info`	Useful context; no action required.	Collapsed or secondary panel.

Card fields

JSON

{
  "uuid": "4c1e8a6e-2a59-4b7f-9a39-0c4f7c2d5e11",
  "summary": "Metformin contraindicated: Severe renal impairment (eGFR < 30 mL/min/1.73 m²)",
  "detail": "Metformin is contraindicated in Severe renal impairment (eGFR < 30 mL/min/1.73 m²).\n\nFor this patient: The patient has an eGFR of 25 mL/min/1.73 m².\n\nCertainty: moderate.",
  "indicator": "critical",
  "source": {
    "label": "Augsidius Clinical Evidence",
    "url": "https://augsidius.care",
    "topic": {"system": "https://api.augsidius.care/cds/card-kind", "code": "contraindication", "display": "Contraindication"}
  },
  "suggestions": [
    {"label": "Review Metformin", "uuid": "1f0b…", "isRecommended": true}
  ],
  "selectionBehavior": "any",
  "overrideReasons": [
    {"code": "not-applicable", "system": "https://api.augsidius.care/cds/override-reason", "display": "Not applicable to this patient"},
    {"code": "already-addressed", "system": "https://api.augsidius.care/cds/override-reason", "display": "Already done or addressed"},
    {"code": "benefit-outweighs-risk", "system": "https://api.augsidius.care/cds/override-reason", "display": "Benefit outweighs the risk for this patient"},
    {"code": "patient-declined", "system": "https://api.augsidius.care/cds/override-reason", "display": "Patient declined"},
    {"code": "clinical-judgement", "system": "https://api.augsidius.care/cds/override-reason", "display": "Clinical judgement"}
  ],
  "links": [
    {"label": "PubMed 32138474 (2020)", "url": "https://pubmed.ncbi.nlm.nih.gov/32138474/", "type": "absolute"}
  ],
  "extension": {
    "com.augsidius": {
      "kind": "contraindication",
      "certainty": "moderate",
      "weight": null,
      "concepts": ["c_wibi…", "c_k2pd…"],
      "evidence": [{"claim": "…", "certainty": "moderate", "detail": null, "sources": [ … ]}]
    }
  }
}

Field	Always	Description
`uuid`	yes	Unique id of this card. Use it as `card_id` in feedback.
`summary`	yes	One line, under 140 characters. Show it as the card title.
`detail`	yes	Markdown: the reasoning, the patient-specific trigger, certainty, and related statements.
`indicator`	yes	`critical`, `warning` or `info` — see above.
`source.label`, `source.url`	yes	Attribution.
`source.topic`	yes	The card kind as a coding.
`suggestions`	when there is something to do	Proposed actions (below).
`selectionBehavior`	with suggestions	`any`: the user may accept several suggestions.
`overrideReasons`	yes	Reasons to offer when the user dismisses the card.
`links`	when sources exist	Up to three source links.
`extension["com.augsidius"]`	yes	Augsidius data: `kind`, `certainty` (best certainty among the card's evidence), `weight` (for emergency cards, relative weight of the condition), `concepts` (concept ids involved), `evidence` (full evidence objects with quotes).

Suggestions

JSON

{
  "label": "Cerebrospinal fluid analysis",
  "uuid": "7d2e…",
  "isRecommended": true,
  "actions": [{
    "type": "create",
    "description": "Order Cerebrospinal fluid analysis",
    "resource": {"resourceType": "ServiceRequest", "status": "draft", "intent": "proposal",
                 "code": {"text": "Cerebrospinal fluid analysis"}}
  }],
  "extension": {"com.augsidius": {"action": "test", "concept": "c_t5m9…", "rules_out_emergency": true}}
}

Field	Description
`label`	What to show on the button.
`isRecommended`	`true` for the suggestions to do first.
`actions`	For tests: a draft FHIR `ServiceRequest` your EMR can pre-fill an order from. Questions, examinations and Review / Document suggestions have no `actions` — they are prompts for the clinician.
`extension["com.augsidius"]`	`action` (`ask`, `examine`, `measure`, `test`), `concept`, `rules_out_emergency`.

Feedback

Tell us what clinicians did with each card — it is how the cards get better, and it shows up in Graphite → Feedback.

JSON

POST /v1/feedback
{"request_id": "req_18c…", "card_id": "4c1e8a6e-2a59-4b7f-9a39-0c4f7c2d5e11",
 "outcome": "overridden", "override_reason": "benefit-outweighs-risk"}

`outcome`	When
`accepted`	The user acted on the card or one of its suggestions.
`overridden`	The user dismissed it; send the chosen `overrideReasons` code.
`ignored`	The card was shown and not acted on.

Integration patterns

Chart open / encounter start — call with the visit summary; show critical cards in a banner.
Prescribing — call when an order is drafted, with the planned medicine in the text ("Plan: start ibuprofen 400 mg TDS"); show contraindication and interaction cards before signing.
Before discharge — call with the discharge summary; review documentation gaps.
Backend only — your EMR server calls the API; your key never reaches the browser or the clinician.

Limits and price


Input	Up to about 3,000 tokens
Cards	Up to 8 per call (2 emergency, 4 medication safety, 1 work-up, 1 documentation)
Typical time	10–17 seconds; the first card usually arrives before the last is ready
Price	20 units per call per 500 input tokens — see Plans & billing

Preview limitations. Interaction coverage is narrower than contraindication coverage; absence of an interaction card is not proof that none exists. Cards support clinical judgement and do not replace it.

Care models

Clinical entity extraction