avaidyam / projectehr Goto Github PK

View Code? Open in Web Editor NEW

0.0 0.0 0.0 40.48 MB

Home Page: https://ehr.aditya.vaidyam.me/

HTML 0.69% JavaScript 96.94% CSS 2.37%

clinical-data ehr fhir medical-imaging medicine

projectehr's People

Contributors

Watchers

projectehr's Issues

Build local FHIR store for testing

See required resources here.

Also see FHIR documentation here.

Of note, FHIR stores clinical notes in a non-standard way, using DocumentReference with an attached Binary that actually contains the note contents (HTML, etc.). Here is an example.

Do note the format of the reference element:

If it refers to an external reference on the same server, then it can be a relative reference like medication/@12345

If it refers to an external reference on a different server, then you need the full url – eg http://fhir.myserver/medication/@12345

In either of the above examples you can have the full history – eg medication/@12345/history/@3 – to refer to a specific version of the resource

If it is a reference to a contained resource, then use the # symbol – eg #12345 – where the id is the id on the contained element, and doesn’t include the resource type

Personal records usage and external records integration

See Fasten

Currently, every case has to be fully manually defined by the user, which can be time consuming. Instead, we may want to simulate patient data (i.e. individual lab results such as for a CMP, given mean/std to use for randomization), the whole patient profile (i.e. given a patient ‘archetype’), or multiple patients all at once. See SimHospital for an example. Also see Synthea.

Example using Gout:

Imaging Viewer Tab

We’ll need to build a very minimal imaging viewer interface. For now we’d like to be able to see static files only (no 3D model manipulation) such as X-rays and CT slices. A comprehensive user manual for the IBM iConnect Access system can be found here.

"Break the glass" when trying to open the incorrect patient chart

For example, if a student opens a patient chart not on schedule for PBL or OSCE, it should show this dialog. https://epicsupport.sites.uiowa.edu/epic-resources/break-glass

Initial Project Backlog

Goals:

wants to throw everything into this tool and centralize things
sim purposes: pt chart in the background while running a sim
enter in admission orders, document visit/encounter, etc as part of phase 2 OSCEs
"living breathing EMR with different data accessibility"
for simulation, avoid PPT and be able to handle minute-by-minute
UI like EPIC
view lab/imaging results
active orders list (order rx/procedure OR use order sets)
write a basic note, EPIC sidebar activities
insurance info + Rx cost
reusing cases (idea: profiles with STAGES (i.e. Hanson_1, Hanson_2, etc) with automated progression between stages which are deltas)

major UI components:

patient schedule page
patient chart page layout (sidebar, tabs on top, different sub-pages)
patient sidebar (pt info, personal notes, hover popups with detail, etc)
chart review (filter by note/lab/enc/etc)
note viewer (essentially sandboxed HTML content)
note composer (essentially a WYSIWYG editor → HTML)
flowsheets/results review (grid of all lab results chronologically)
add orders (popup list with an HTML form for each type of order; labs, referrals, Rx, etc)
rooming page (vitals entry, etc)
wrap-up page (follow-up, patient edu, etc)
history page (PMHx, PSHx, FHx, SHx, etc)
visit page (visit diagnoses, etc)
NoteWriter (interactive smartblocks for HPI, ROS, PE - try .physicalexam in your clinic notes if you haven't already!)

review the following standards:

ICD-10 codes for diagnoses (specifically sub-coding and specifiers, etc)
LOINC codes for lab orders (imaging or pathology, etc)
RxNorm codes for all possible FDA approved Rx (incl every dosage and dosage form, etc)
FHIR documents and an [example bundle of what we're working with] (https://healthintellect.github.io/fhir-ui/examples/fhir-examples/patient-bundle)

Sid: patient chart page + patient sidebar + rooming page
Tony: integrating LOINC codes + RxNorm codes for the order builder
Anthony: base app + page navigation (i.e. schedule -> patient tab, inner pages knowing which MRN is loaded currently, etc)
JD: note viewer + note composer + notewriter
Kristy: patient schedule table
@avaidyam: flowsheets/results review

Seeded sample data

We need to incorporate sample data for testing and development of the EHR. See R4 generated sample data. The dates of certain encounters will need to be shifted dynamically at runtime to preserve the patient’s storyboard/timeline (i.e. age 60 for encounter A, age 70 for encounter B).

Build CodeSystem index

See FHIR standard CodeSystems here. We will need to integrate RxNorm, SNOMED-CT, ICD-10, LOINC, and others into a central index (database, API, or JSON file).

Patient Home → Orders Composer

Add Order Button (Left)
Pending Orders List (Right)
Individual Order Composer (Dialog)

Order Composer

Order Type

Order Type	Used when…
House Icon	Lab tests are ordered in the ambulatory setting
Bed Icon	Lab tests are ordered in the inpatient setting

Status Field

Status	Used when…
Normal	Do not use because this will cause the orders to automatically be released to the lab as if the patient has arrived at the lab and had their tests drawn. Providers and staff should only use standing or future.
Standing	For repeat labs such as AMS INR’s. You want multiple orders to be done in the future. When setting up a Standing Order, it is important that you include in the Interval field how often the test should be drawn as well as indicate in the Count field the number of times the lab should be drawn.
Future	Should be used for all lab orders that are not Standing (repeat orders). Patient will show up later for this lab order. (Example Fasting Glucose or Lipid Panel)

Date Fields

Date Fields	Used when…
Expected Date	Provider indicates the date patient can have the lab drawn. Note: labs can be drawn up to 7 days before the expected date. For example – you would like to order a TSH to be drawn in 3 months after you have made changes to a patient’s thyroid medicine. You should indicate that the Expected Date should be 3 months from today’s date. If you left the default Expected Date to today, the patient could have the TSH drawn any time from today forward. The Lab Department will draw the test based on the Expected Date.
Expires	Date Provider indicates the last date a patient can have a lab drawn. Note: labs can draw up to 7 days past the expiration date.

Priority Field

Priority	Used when…
Routine	Routine is the most common priority and should not be used for urgent or emergent situations.
STAT	Results will be available within an hour in the ambulatory setting once the specimen arrives in the laboratory.
Timed	Not used in the out-patient setting.
Urgent	Results will be available within 2 hours once the specimen arrives in the laboratory.

Class Field

Class	Used when…
Lab Collect	Test will be resulted by Organization’s Laboratory. Example: CMP and CBC lab will be collected, tested, and resulted at Organization. Example: Pro-time will be collected by Home Care. The specimen will be delivered to the Carle laboratory where it will be tested and resulted.
Clinic Collect	Patient specimen is collected in the provider office during patient visit. Example: Throat swab collected in the doctor’s office.
External Collect	Patient will have an ordered test collected, tested, and resulted outside of the organization. Example: Patient needs CBC and CMP drawn at Hospital.

Pending Order List

TBD

Order Search

TBD

Name	Description
Bar	Color displays patient rooming status.
Circle	Color displayed depends on organization/department needs.
Status	Current rooming status and exam room number.
Bar	Color displays patient rooming status.
Patient	Patient name and age.
Provider	Provider name.
Type	Visit type (office visit, well child visit, physical exam, etc.).
Notes	Appointment notes/details incl. chief complaint.

Clicking on the row should bring up the preview on the right side.
Double-clicking on the row should open a new patient tab.
Toolbar on top should have several options (currently undefined for our needs).
Table toolbar should have a schedule name button and editable date button.
Clicking the schedule name should bring a dropdown menu to select a schedule across departments AND filter by provider name.

Patient Home → Rooming/Plan/WrapUp Tabs

The Rooming Tab contains:

Reason for Visit → edits the chief complaint for the current encounter (office visit or admission)
Vital Signs → simple UI to edit the underlying VS flowsheet
History, Birth Control Hx, Immunizations → with links to separate Tab
Medications → with link to separate Tab
Episodes, Flu Vaccine Screen, BestPractice, Questionnaires, Outside Meds, Verify Benefits, Pt ClinRev, Additional Vitals → Unrelated to our scope of work

The Plan Tab contains:

Problem List → with link to separate Tab
Medication Management → with link to separate Tab
Pt Clin Review, Chronic Care Mgmt, Goals, BestPractice → Unrelated to our scope of work

The Wrap-Up Tab contains: