healthcare-emr-patterns

name healthcare-emr-patterns description 電子医療記録（EMR）パターン、相互運用性、およびHL7/FHIR統合。 origin Health1 Super Speciality Hospitals — contributed by Dr. Keyur Patel version 1.0.0 Healthcare EMR Development Patterns Patterns for building Electronic Medical Record (EMR) and Electronic Health Record (EHR) systems. Prioritizes patient safety, clinical accuracy, and practitioner efficiency. When to Use Building patient encounter workflows (complaint, exam, diagnosis, prescription) Implementing clinical note-taking (structured + free text + voice-to-text) Designing prescription/medication modules with drug interaction checking Integrating Clinical Decision Support Systems (CDSS) Building lab result displays with reference range highlighting Implementing audit trails for clinical data Designing healthcare-accessible UIs for clinical data entry How It Works Patient Safety First Every design decision must be evaluated against: "Could this harm a patient?" Drug interactions MUST alert, not silently pass Abnormal lab values MUST be visually flagged Critical vitals MUST trigger escalation workflows No clinical data modification without audit trail Single-Page Encounter Flow Clinical encounters should flow vertically on a single page — no tab switching: Patient Header (sticky — always visible) ├── Demographics, allergies, active medications │ Encounter Flow (vertical scroll) ├── 1. Chief Complaint (structured templates + free text) ├── 2. History of Present Illness ├── 3. Physical Examination (system-wise) ├── 4. Vitals (auto-trigger clinical scoring) ├── 5. Diagnosis (ICD-10/SNOMED search) ├── 6. Medications (drug DB + interaction check) ├── 7. Investigations (lab/radiology orders) ├── 8. Plan & Follow-up └── 9. Sign / Lock / Print Smart Template System interface ClinicalTemplate { id : string ; name : string ; // e.g., "Chest Pain" chips : string []; // clickable symptom chips requiredFields : string []; // mandatory data points redFlags : string []; // triggers non-dismissable alert icdSuggestions : string []; // pre-mapped diagnosis codes } Red flags in any template must trigger a visible, non-dismissable alert — NOT a toast notification. Medication Safety Pattern User selects drug → Check current medications for interactions → Check encounter medications for interactions → Check patient allergies → Validate dose against weight/age/renal function → If CRITICAL interaction: BLOCK prescribing entirely → Clinician must document override reason to proceed past a block → If MAJOR interaction: display warning, require acknowledgment → Log all alerts and override reasons in audit trail Critical interactions block prescribing by default . The clinician must explicitly override with a documented reason stored in the audit trail. The system never silently allows a critical interaction. Locked Encounter Pattern Once a clinical encounter is signed: No edits allowed — only an addendum (a separate linked record) Both original and addendum appear in the patient timeline Audit trail captures who signed, when, and any addendum records UI Patterns for Clinical Data Vitals Display: Current values with normal range highlighting (green/yellow/red), trend arrows vs previous, clinical scoring auto-calculated (NEWS2, qSOFA), escalation guidance inline. Lab Results Display: Normal range highlighting, previous value comparison, critical values with non-dismissable alert, collection/analysis timestamps, pending orders with expected turnaround. Prescription PDF: One-click generation with patient demographics, allergies, diagnosis, drug details (generic + brand, dose, route, frequency, duration), clinician signature block. Accessibility for Healthcare Healthcare UIs have stricter requirements than typical web apps: 4.5:1 minimum contrast (WCAG AA) — clinicians work in varied lighting Large touch targets (44x44px minimum) — for gloved/rushed interaction Keyboard navigation — for power users entering data rapidly No color-only indicators — always pair color with text/icon (colorblind clinicians) Screen reader labels on all form fields No auto-dismissing toasts for clinical alerts — clinician must actively acknowledge Anti-Patterns Storing clinical data in browser localStorage Silent failures in drug interaction checking Dismissable toasts for critical clinical alerts Tab-based encounter UIs that fragment the clinical workflow Allowing edits to signed/locked encounters Displaying clinical data without audit trail Using any type for clinical data structures Examples Example 1: Patient Encounter Flow Doctor opens encounter for Patient #4521 → Sticky header shows: "Rajesh M, 58M, Allergies: Penicillin, Active Meds: Metformin 500mg" → Chief Complaint: selects "Chest Pain" template → Clicks chips: "substernal", "radiating to left arm", "crushing" → Red flag "crushing substernal chest pain" triggers non-dismissable alert → Examination: CVS system — "S1 S2 normal, no murmur" → Vitals: HR 110, BP 90/60, SpO2 94% → NEWS2 auto-calculates: score 8, risk HIGH, escalation alert shown → Diagnosis: searches "ACS" → selects ICD-10 I21.9 → Medications: selects Aspirin 300mg → CDSS checks against Metformin: no interaction → Signs encounter → locked, addendum-only from this point Example 2: Medication Safety Workflow Doctor prescribes Warfarin for Patient #4521 → CDSS detects: Warfarin + Aspirin = CRITICAL interaction → UI: red non-dismissable modal blocks prescribing → Doctor clicks "Override with reason" → Types: "Benefits outweigh risks — monitored INR protocol" → Override reason + alert stored in audit trail → Prescription proceeds with documented override Example 3: Locked Encounter + Addendum Encounter #E-2024-0891 signed by Dr. Shah at 14:30 → All fields locked — no edit buttons visible → "Add Addendum" button available → Dr. Shah clicks addendum, adds: "Lab results received — Troponin elevated" → New record E-2024-0891-A1 linked to original → Timeline shows both: original encounter + addendum with timestamps