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In LUKE Health, this is implemented with dual-layer PostgreSQL triggers: Layer 1: A database trigger on the orders table checks for an active, non-expired prescription matching the compound being ordered Layer 2: A constraint trigger verifies the prescribing provider's license is valid for the patient's state This isn't application logic that a developer might accidentally bypass during a feature update

For anyone dealing with GLP-1 medication side effects , that difference is significant

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References Beer, C., & Keiler, A

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10.1016/j.vph.2018.02.010 76 VukojevicJ.VrdoljakB.MalekinusicD.SiroglavicM.MilavicM.KolencD.et al (2020)